Fetal Anatomical Case Study Examples

She had an 8-week ultrasound that confirmed her dates. She now is 11 ½ weeks and is interested in a FTS. The nuchal translucency measurement fell within the normal range. The nasal bone was identified, and there was normal ductus flow. She therefore underwent laboratory testing and the complete result of this screen should be available in the next 4-7 days. If the result of this screen returns with decreased risks, we would recommend a good fetal anatomical survey between 18-22 weeks gestation.

Keia is a 31yo, G2 P0100, who is currently 9 weeks 6 days as dated by a 6-week scan that was off from her LMP. She has a history of an IUFD at 29 weeks. She reports that she had decreased fetal movement prior to coming in and there being no fetal heart tones on examination, but other than that there were no other significant precipitating events. She did have an increased risk for Down syndrome at 1:140 but per the old reports all of her analytes were within normal limits. At the time of delivery, the baby did appear to be appropriate weight and there were no obvious causes at the time of delivery. She reports that she had chromosomes performed after and the chromosomes were negative. She also thinks she had a full autopsy that was unremarkable. She did have a work-up for clotting disorders due to the history of loss and according to the chart everything is relatively within normal limits except for MTHFR which was heterozygous for C677T and A1298C. I did not see beta-2 glycoprotein or antithrombin III. Because of the relatively normal work-up she is on a baby aspirin and Metanx. She is here today to discuss her history and plans for this pregnancy.

Serrita is a 26yo, G3 P1011, who was seen for an ultrasound evaluation and fetal anatomy assessment. As you know, she has chronic HTN and is on methyldopa 500 mg b.i.d. Her BP is normal on today’s assessment at 130/78. Her urine evaluation was negative. She is also hypothyroid status-post a diagnosis of Hashimoto’s thyroiditis. She is on replacement therapy. She did undergo noninvasive prenatal testing (NIPT) that returned low-risk, female and her maternal serum AFP was normal at 0.58 MoM. Based on her height and weight at the start of the pregnancy, her BMI was about 38. Lastly, she is on metformin 500 mg b.i.d. She states that she believes that she was on this due to abnormal insulin levels but she was not completely certain as to why

Views today demonstrate a viable singleton fetus at 12 weeks 2 days. Fetal crown-rump length measures 59.2 mm. The best nuchal translucency measurement obtained was 1.8 mm, and the nasal bone was visualized as present. Fetal cardiac activity is visualized. Due to early gestational age, fetal anatomy was not assessed, but 4 extremities are noted. Amniotic fluid and placental location are visualized as normal within limitations of early gestational age. Adnexa are suboptimally seen. No notching is seen on the uterine artery Doppler’s.

By dates, the patient is 35 5/7 weeks and the measurements are concordant. The amniotic fluid volume is normal. The fetus is in cephalic presentation. The BPP and Doppler studies are reassuring. A complete fetal anatomical survey was performed and no major malformations were noted at this time within the resolution of the ultrasound equipment other than the fetal abdomen. There is a cystic structure seen in the fetal abdomen that is about 3 cm in diameter with some echolucency surrounding this. It is below the kidney but above the fetal bladder as identified in your office.

Rachel is a 32yo, G7 P3033, who is currently 18 weeks 1 day. She is dated by LMP. She was seen previously for a dating scan and declined aneuploidy screening. She has 3 prior full-term deliveries. She had preterm labor with her last pregnancy but ultimately delivered at term. While she has miscarriages, she does not have 3 in a row. She is here today for an anatomic survey.

A.G.’s mother states that she was born at Sunrise Hospital in Las Vegas. She was birthed through cesarean at 36 weeks. Her heart rate continued to drop so they were forced todeliver earlier than planned. There were no complications during or after birth. She weighed 7.6 pounds. A.G.’s mother denies any surgeries, hospitalizations, or mental health problems. She was diagnosed with Chicken pox at the age of 9 years old but no other major childhood illness. The Apgar score is unknown. Last eye exam was 06/2016. She wears glasses but not consistently as recommended by the Optometrists. Last dental exam was 01/2016. There were no cavities or gum disease noted. Teeth were in good condition with all 4 wisdom teeth present. Last hearing test is unknown

She is a full term baby who was born with weight of 2.977 kg (6 lbs 9 oz) with normal spontaneous vaginal delivery. She was healthy with no respiratory, congenital or cardiac issues. She didn’t require special care or hospitalization in the NICU. She was discharged after three days with her mother.

Angela is a 36yo, G5 P3013, who was seen for an ultrasound evaluation and consultation for AMA. The patient is currently 36 but would be 37 at the time of her EDD. She does have a history of chronic HTN and reportedly is on labetalol 100 mg b.i.d. but in talking to her she has actually not filled the prescription yet and therefore has not started the medication. Her BP was 141/98 on her initial check and on repeat 140/92. Her urine evaluation is negative for protein. She does have asthma but is currently asymptomatic. Based on her height and weight at the start of the pregnancy, her BMI was 44. She also does smoke cigarettes at ½ pack per day. She was counseled on cessation.

By dates, she is 20 5/7 weeks and the measurements are concordant. 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 malformations were noted at this time within the resolution of the ultrasound equipment.

We discussed the findings of today’s scan and the potential implications. I explained to them that neurologic abnormalities are a very difficult counseling sessions because it is impossible to determine outcomes. Even mildly dilated ventricles with no other associated findings can have significant delay. We discussed longterm consequences of both agenesis as well as Dandy-Walker given the findings on the ultrasound. We discussed their wishes in terms of continuation of pregnancy and to give us more information I opted to order a fetal MRI. This would likely be able to help us to determine the findings in the third and fourth ventricles and possibly even agenesis of the corpus callosum. We discussed the possibility of invasive testing with amniocentesis but they had previously done preimplantation genetic diagnosis and did not desire any further testing at this time. Finally, I spoke with Krystal about the implications of non-continuation of pregnancy and how the procedure is typically performed using laminaria in a 2-day process. For now, we will proceed with ordering the MRI and we will see her back in 4 weeks if she continues the pregnancy; otherwise, we will give her information for

DIAGNOSTIC CRITERIA: Prenatal onset of marked growth deficiency, microcephaly with secondary premature synostosis. Receding forehead, prominent nose micrognathia low set ears malformed ears with the lack of lobule down slanting palpebral fissures. Clinodactyly of fifth finger

Jessica is a 29yo, G4 P1021, who was seen for an ultrasound evaluation and possible FTS. She overall denies any major medical disorders other than she does have some issues with depression but is currently not on treatment and states that she is doing okay currently. Obstetrically, she has one previous 36-week delivery in 2012. She was induced for what sounds like preeclampsia. She does not recall whether or not her BP was elevated but she had some liver dysfunction and some kidney dysfunction and the fetus was growth restricted at 3 lb 9 oz. It did stay in the NICU for about 30 days. However, again this was an induced preterm delivery and therefore she would not be a candidate for 17-OHP. Currently at this time she has no complaints.

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.

She is attending Dr. Tabb's office on Monday. She will have an ultrasound. The last anatomy scan Dr. Tabb could not see the baby's spine. She mentioned how everything looked okay.