Fetal Abdomen Case Summary

During our initial assessment of Ms. K.R., the following vital signs were noted: blood pressure was 147/67, temp 36.6 degrees Celsius, pulse 80 beats per min., respiratory rate of 20, pulse ox 99% on room air, a pain score of 8 during contractions, and fetal heart tones had a baseline of 130 over the last two hours. Her labs showed 2+ protein in her urine but she denied any headaches, vision changes, right upper quadrant pain, and no DTRs or colonus were observed. Ms.K.R. seemed to be handling her labor well, with the exception of being in a lot of pain and unable to find a comfortable position.

On ultrasound there is a live fetus in cephalic presentation. Fetal biometry is consistent with dates. Measurements are around the mid-percentiles. A limited survey was unremarkable. AFI today is 23.5 cm. Umbilical

On ultrasound today, there is a live fetus in cephalic presentation. We did not full biometry but we did remeasure the head circumference and confirmed that it lagged by 2 weeks. In other intracranial imaging, we did not see overtly dilated ventricles, although they did appear to be somewhat prominent frontal horns. We could not completely visualize the cavum septum

A 24 year old female at 27 weeks gestation presented to our institution with abdominal pain and concern for preterm labor. The patient had undergone a laparoscopic cholecystectomy for chronic cholecystitis ten days prior at another institution, which is where she presented for a prenatal visit. In the transfer record, patient had multiple recent admissions due to emesis, attributed to hyperemesis gravidum and cholecystitis. On admission to our institution, she complained of uncomfortable cramping abdominal pain with concern for preterm labor. She was febrile, with a leukocytosis of 26.3. The obstetric service performed a negative amniocentesis for what they suspected to be chorioamnionitis. Ten hours after admission, her pain failed to improve, she was placed on piperacillin/tazobactam. MRI was obtained and demonstrated a

On ultrasound there is a live fetus in cephalic presentation. Fetal biometry is consistent with dates. A limited survey was unremarkable. Fluid and Doppler’s are overall reassuring and BPP is 8/8.

On ultrasound there is a live fetus in cephalic presentation. Amniotic fluid is normal at 10 cm. Umbilical artery Doppler was within normal limits. BPP is 8/8. Transvaginal cervical length is 1.6 cm and decreases to 1.3 cm with pressure and there is a wide funnel noted. The placenta was anterior and again no clear evidence of abruption.

On ultrasound evaluation today a single living fetus is identified currently in cephalic presentation with a 3-vessel cord and an anterior placenta. Fetal biometry today is consistent with an EFW of 1386 g, which equates to the 20%ile for gestational age and a symmetric appearing growth pattern. The amniotic fluid volume is within

On ultrasound there is a live fetus whose biometry is consistent with 20 weeks 5 days. A detailed anatomic survey was unremarkable but spine and RVOT were suboptimal. The placenta is posterior. Abdominal cervical length is reassuring.

On today’s evaluation the measurements are concordant with an EFW at the 50%ile. The amniotic fluid volume is normal, and the cervix is long and closed with no evidence of membrane funneling. A complete fetal anatomical survey was performed, and no major or minor malformations were noted at this time within the resolution of

The sonographer then started the transabdominal scan. When the transducer made contact with the patient, and obvious fundal intra-uterine pregnancy was present, and the IUD could not be identified right away. She then switched the protocol from pelvic to an OB 1st trimester setting. After scanning for a few minutes, the artifact of the IUD could be seen directly posterior to the gestational sac. The TV scanned revealed normal appearing ovaries and adnexa with a properly placed IUD and a trace amount of posterior Cul-de-Sac fluid. However, there was no identifiable string for the IUD. The fetus was dated to be 9w1d by the patient’s LMP, and 8w3d by the ultrasound CRL measurements.

The fetus is in breech presentation. The amniotic fluid volume is normal. The placenta appears to be posterior and a thorough evaluation under high resolution ultrasound does not identify any distinct placental abruption but these can be missed since clot can have the same appearance as placental tissue. The fetal size was too small for any highly-detailed assessment but on evaluation of the heart there was a question of a slightly abnormal axis at 80-degrees and there is a question of a potential atrial ventricular septal defect due to the position of the valves and their appearance upon motion. The bowel appears to be somewhat echogenic. A stomach bubble was identified with a normal appearing bladder and again the amniotic fluid volume is normal. The fetal brain also appeared normal and the cerebellum had a normal shape and the spine the best we could tell was not abnormal. By report, she has an elevated AFP. The abdominal wall cord insertion also appears

Abdomen Assessment – The patient’s abdomen does not display any striae, scars, prominent veins, or spider nevi. It is flat with no bulging, and the umbilicus is midline and inverted. There is no pulsating above the umbilicus. Bowel sounds are active x4. No heard bruits over the abdominal areas. There is no complaints of pain upon percussion of the abdomen. Tympany is heard over the abdomen, and dullness is heard over the liver. Patient feels pain with fist percussion on the right flank. She also expresses discomfort in the lower abdominal quadrants upon palpations.

On ultrasound there is a live fetus in cephalic presentation. Fetal biometry is about 1 ½ weeks behind dates but measurements are fairly symmetric. Growth is at the 8%ile. Amniotic fluid is normal. Umbilical artery Doppler’s continue to be mildly resistive. The MCA is without evidence of shunting. BPP is 8/8.

Abdominal exploration through midline infraumbilical incision under general anesthesia was performed and the parietal peritoneum was opened, the fetus was delivered cephalic (figure 1) and it was a living female. Apgar score was 6/10 at one minute and 5 minutes and the birth weight was 1800g. Immediate resuscitation was performed and the baby was then transferred to the neonatal intensive care unit (NICU). The placenta was found to be attached to the right upper part of the uterus at the site of corn (figure 2). However, there was no morbid adhesions to the bowel, omentum, or great vessels. The

Her abdomen was distended with a symphysio fundal height of 35 cm. The foetus assumed a longitudinal lie with its back on the maternal left. The foetal head was ballotable and the presenting part was soft with irregular margins, confirming that the foetus was in breech position. The presenting part was not engaged. An ultrasound scan done on admission showed that the foetus was in flexed (complete) breech with normal growth parameters. The cardiotocograph (CTG) done was reactive. Before ECV was performed, a full blood count, a blood sugar profile, ECG, and urea and electrolytes were done. Once all the results were back and within normal range, then an ECV was done for Madam Siti.