CHIEF COMPLAINT: -labor at term
-arrest of descent
-respiratory arrest/loss of consciousness presumably due to high
spinal anesthesia

PRESENT ILLNESS: 33yo P0 @ 40w3d gestational age with regular contractions now
2-3mins apart. Cervical exam in the office [**1-/2170**]/-1. +AFM. GBS
neg. No SROM.

MEDICAL HISTORY: PMH: L3-4-5 compression fracture from fall
PSH: tonsillectomy, wrist surgery

MEDICATION ON ADMISSION: PNV

ALLERGIES: Biaxin / Yellow Fever Vaccine

PHYSICAL EXAM: T 97 HR 91 RR 16 BP 127/79
healthy-appearing
SVE 4-5/90/-1
Ext NT

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: married, no tob/drug use, occasional ETOH
Post term pregnancy, delivered, with or without mention of antepartum condition,Acute posthemorrhagic anemia,Other injury to pelvic organs, delivered, with or without mention of antepartum condition,Obstruction caused by malposition of fetus at onset of labor, delivered, with or without mention of antepartum condition,High head at term, delivered, with or without mention of antepartum condition,Outcome of delivery, single liveborn,Secondary uterine inertia, delivered, with or without mention of antepartum condition,Abnormality in fetal heart rate or rhythm, delivered, with or without mention of antepartum condition,Central nervous system complications of anesthesia or other sedation in labor and delivery, delivered, with mention of postpartum complication,Anemia of mother, delivered, with mention of postpartum complication
Post term preg-del,Ac posthemorrhag anemia,Ob inj pelv org NEC-del,Obstruc/fet malpos-deliv,High head at term-deliv,Deliver-single liveborn,Sec uterine inert-deliv,Abn ftl hrt rate/rhy-del,Cns complic-del w p/p,Anemia-delivered w p/p
Admission Date:  [**2200-11-26**]              Discharge Date:   [**2200-11-30**]

Date of Birth:  [**2167-12-2**]             Sex:   F

Service: OBSTETRICS/GYNECOLOGY

Allergies:
Biaxin / Yellow Fever Vaccine

Attending:[**First Name3 (LF) 8252**]
Chief Complaint:
-labor at term
-arrest of descent
-respiratory arrest/loss of consciousness presumably due to high
spinal anesthesia


Major Surgical or Invasive Procedure:
-primary c.section low seg transverse.
-extension of hysterotomy into broad ligament.
-small cystotomy


History of Present Illness:
33yo P0 @ 40w3d gestational age with regular contractions now
2-3mins apart. Cervical exam in the office [**1-/2170**]/-1. +AFM. GBS
neg. No SROM.

Past Medical History:
PMH: L3-4-5 compression fracture from fall
PSH: tonsillectomy, wrist surgery

Social History:
married, no tob/drug use, occasional ETOH

Family History:
non-contributory

Physical Exam:
T 97 HR 91 RR 16 BP 127/79
healthy-appearing
SVE 4-5/90/-1
Ext NT

Pertinent Results:
[**11-26**] CTA Head/Neck:
IMPRESSION:
Normal study. No evidence of intracranial hemorrhage or vascular
abnormality.

CT Spine [**11-26**]:
1. Tip of catheter at the superior endplate of L3. However,
intrathecal
versus extrathecal location is difficult to evaluate. If
warranted, an MRI,
or myelogram could be performed.

[**2200-11-26**] 03:30AM BLOOD WBC-15.6* RBC-4.33 Hgb-13.0 Hct-36.0
MCV-83# MCH-29.9 MCHC-36.1* RDW-13.1 Plt Ct-343
[**2200-11-26**] 05:08PM BLOOD WBC-20.0* RBC-3.25* Hgb-9.8*# Hct-27.4*
MCV-84 MCH-30.0 MCHC-35.6* RDW-13.2 Plt Ct-322
[**2200-11-26**] 07:16PM BLOOD WBC-22.1* RBC-3.14* Hgb-9.5* Hct-26.7*
MCV-85 MCH-30.3 MCHC-35.6* RDW-13.3 Plt Ct-248
[**2200-11-26**] 10:25PM BLOOD WBC-37.6*# RBC-3.82* Hgb-11.3* Hct-32.9*
MCV-86 MCH-29.5 MCHC-34.3 RDW-13.6 Plt Ct-375#
[**2200-11-27**] 03:16AM BLOOD WBC-24.9* RBC-3.00* Hgb-9.0* Hct-25.5*
MCV-85 MCH-29.9 MCHC-35.2* RDW-13.7 Plt Ct-302
[**2200-11-27**] 07:10AM BLOOD WBC-21.6* RBC-2.82* Hgb-8.5* Hct-24.5*
MCV-87 MCH-30.2 MCHC-34.8 RDW-13.6 Plt Ct-310
[**2200-11-27**] 05:10PM BLOOD WBC-22.2* RBC-2.65* Hgb-8.1* Hct-22.6*
MCV-85 MCH-30.5 MCHC-35.8* RDW-13.5 Plt Ct-287
[**2200-11-26**] 07:16PM BLOOD Neuts-91* Bands-1 Lymphs-3* Monos-5 Eos-0
Baso-0 Atyps-0 Metas-0 Myelos-0
[**2200-11-27**] 05:10PM BLOOD Neuts-86.4* Lymphs-8.3* Monos-4.6 Eos-0.3
Baso-0.3
[**2200-11-26**] 05:08PM BLOOD PT-14.0* PTT-23.5 INR(PT)-1.2*
[**2200-11-26**] 10:25PM BLOOD PT-13.3 PTT-24.4 INR(PT)-1.1
[**2200-11-27**] 03:16AM BLOOD PT-14.1* PTT-24.9 INR(PT)-1.2*
[**2200-11-26**] 05:08PM BLOOD Fibrino-342
[**2200-11-26**] 10:25PM BLOOD Fibrino-437*
[**2200-11-26**] 07:16PM BLOOD Glucose-114* UreaN-10 Creat-0.5 Na-141
K-3.3 Cl-115* HCO3-17* AnGap-12
[**2200-11-26**] 10:25PM BLOOD Glucose-168* UreaN-11 Creat-0.7 Na-139
K-4.4 Cl-111* HCO3-14* AnGap-18
[**2200-11-27**] 03:16AM BLOOD Glucose-120* UreaN-10 Creat-0.7 Na-141
K-3.4 Cl-113* HCO3-19* AnGap-12
[**2200-11-26**] 07:16PM BLOOD ALT-8 AST-21 LD(LDH)-189 AlkPhos-106*
TotBili-0.4
[**2200-11-27**] 03:16AM BLOOD ALT-10 AST-25 LD(LDH)-264* CK(CPK)-424*
AlkPhos-105 TotBili-0.4
[**2200-11-26**] 07:16PM BLOOD CK-MB-14* cTropnT-<0.01
[**2200-11-26**] 10:25PM BLOOD CK-MB-20* MB Indx-2.9 cTropnT-<0.01
[**2200-11-27**] 03:16AM BLOOD CK-MB-15* MB Indx-3.5
[**2200-11-26**] 07:16PM BLOOD Albumin-2.1* Calcium-6.9* Phos-3.9
Mg-1.2*
[**2200-11-26**] 10:25PM BLOOD Calcium-7.5* Phos-4.4 Mg-1.3*
[**2200-11-27**] 03:16AM BLOOD Albumin-2.4* Calcium-7.6* Phos-3.1 Mg-2.2
[**2200-11-27**] 03:16AM BLOOD Cortsol-25.2*
[**2200-11-26**] 10:25PM BLOOD TSH-4.6*
[**2200-11-27**] 05:45PM URINE Blood-LG Nitrite-NEG Protein-TR
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-SM
[**2200-11-27**] 05:45PM URINE RBC-1 WBC-4 Bacteri-FEW Yeast-NONE Epi-<1
TransE-<1
[**2200-11-27**] 05:45PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.006

Brief Hospital Course:
Ms. [**Known lastname **] was admitted to the labor and delivery floor in labor.
She underwent a stat low transverse cesarean section with
vertical skin incision on [**11-26**] for arrest of descent and
non-reassuring fetal heart tracing. Her intraoperative course
was complicated by a large hysterotomy extension into the
posterior uterus and right broad ligament and cystotomy.  The
patient's EBL was 2L  and she received 1 unit of packed red
blood cells. For full details please see the operative report.
Her immediate postoperative course was significant for sudden
respiratory arrest and loss of brainstem function likely due to
total spinal anesthesia.
The patient underwent head/neck and spine CT that showed no
hemorrhage or extracranial vascular abnormality and the tip of
the epidural catheter at the superior endplate of L3.
The patient was observed in the SICU overnight. She regained all
neurological function, the epidural catheter was removed and she
was transferred to the post-partum floor in stable condition.

From a respiratory standpoint, the patient was intubated after
her c-section due to respiratory arrest. She was extubated the
same day when respiratory function returned and had no further
respiratory issues.

From a cardiovascular standpoint she remained hemodynamically
stable preoperatively, intraoperatively and postoperatively. She
received a total of 1 unit PRBCs and her Hct was monitored until
stable. Her coags were monitored and found to be within normal
range.

The patient's cystotomy was repaired in 2 layers and an
intraoperative [**Doctor Last Name 1356**] flush was negative. Her creatinine was
stable between 0.5 - 0.7 and her urine output was adequate and
clear. She was discharged home with her foley to remain in place
for a total of 7 days.

On post-operative day #1 the patient had a temperature of 100.7.
She receieved gentamicin and clindamycin IV  for 24 hrs
afebrile. Urine culture and blood cultures were negative.

The question of pituitary pathology was raised by CT, however,
follow up MRI was not indicated clinically. Of note, the
patient's TSH was found to be 4.6. The patient's thyroid
function will be reassessed outside of the acute postoperative
period.

The patient was discharged home on post-operative day #4 in
stable condition.

Medications on Admission:
PNV

Discharge Medications:
1. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
2. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. breast pump
difficulty latching on.
5. leg bag catheter
patient to go home with foley in place and come to office around
pod#10 for removal
6. ferrous sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
c/section for failure to descend, pushed for 3 hours.
small cystotomy.
neuro event with respiratory arrest and loss of consciousness
presumably due to high spinal anesthesia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
per instruction sheet.
foley to stay in for 10 days. will come to office to have it
removed.


Followup Instructions:
10 days from surgery to foley removal
{'Post term pregnancy, delivered, with or without mention of antepartum condition,Acute posthemorrhagic anemia,Other injury to pelvic organs, delivered, with or without mention of antepartum condition,Obstruction caused by malposition of fetus at onset of labor, delivered, with or without mention of antepartum condition,High head at term, delivered, with or without mention of antepartum condition,Outcome of delivery, single liveborn,Secondary uterine inertia, delivered, with or without mention of antepartum condition,Abnormality in fetal heart rate or rhythm, delivered, with or without mention of antepartum condition,Central nervous system complications of anesthesia or other sedation in labor and delivery, delivered, with mention of postpartum complication,Anemia of mother, delivered, with mention of postpartum complication'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: -labor at term
-arrest of descent
-respiratory arrest/loss of consciousness presumably due to high
spinal anesthesia

PRESENT ILLNESS: 33yo P0 @ 40w3d gestational age with regular contractions now
2-3mins apart. Cervical exam in the office [**1-/2170**]/-1. +AFM. GBS
neg. No SROM.

MEDICAL HISTORY: PMH: L3-4-5 compression fracture from fall
PSH: tonsillectomy, wrist surgery

MEDICATION ON ADMISSION: PNV

ALLERGIES: Biaxin / Yellow Fever Vaccine

PHYSICAL EXAM: T 97 HR 91 RR 16 BP 127/79
healthy-appearing
SVE 4-5/90/-1
Ext NT

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: married, no tob/drug use, occasional ETOH 

### Response:
{'Post term pregnancy, delivered, with or without mention of antepartum condition,Acute posthemorrhagic anemia,Other injury to pelvic organs, delivered, with or without mention of antepartum condition,Obstruction caused by malposition of fetus at onset of labor, delivered, with or without mention of antepartum condition,High head at term, delivered, with or without mention of antepartum condition,Outcome of delivery, single liveborn,Secondary uterine inertia, delivered, with or without mention of antepartum condition,Abnormality in fetal heart rate or rhythm, delivered, with or without mention of antepartum condition,Central nervous system complications of anesthesia or other sedation in labor and delivery, delivered, with mention of postpartum complication,Anemia of mother, delivered, with mention of postpartum complication'}
