Jeannie: A Case Study

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.

On today’s evaluation, she is 13 6/7 weeks and the crown-rump length measurement is concordant. The nuchal translucency measurement fell within the normal range. The nasal bone was identified, and there was normal ductus flow.

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.

Views today demonstrate a viable singleton fetus at 31 weeks 0 days in vertex presentation with an anterior placenta. Fetal biometry appears symmetric and corresponds with stated EDD falling at the 56%ile. Interval growth is noted; however, the growth percentage did trend down from the 80%ile to the 56%ile. Follow-up fetal anatomy visualized as normal or was previously documented as normal. Ductal velocity today measured at 69.2 cm/se, which falls within normal limits. AFI remains reassuring at 12.6 cm. BPP 8/8. Doppler studies are normal in value and wave form.

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.

Kecia is a 25yo, G3 P2002, who was seen for an ultrasound evaluation to evaluate the fetal abdomen. She overall denies any major medical disorders. She reportedly had a seizure related to an anesthesia event in a prior surgery but denies any history of epilepsy and therefore is not on an anticonvulsant. She has 2 previous term uncomplicated vaginal deliveries in 2012 and 2016. On today’s evaluation, overall, she has no obstetrical complaints and has positive fetal movement.

This particular case study involves a 29 year old obstetric patient who presented to the labor and delivery unit at 33 weeks gestation with complaints of abdominal pain for the past three days that had become more severe and absence of fetal movement noted since the previous evening. Her obstetric history revealed she has one living child and has had one previous miscarriage at ten weeks

On ultrasound, there is a live fetus in breech presentation. Fetal biometry is symmetric and consistent with dates. A detailed anatomic survey was overall unremarkable but we were unable to adequately obtain fetal cardiac views in order to complete the echocardiogram. Both myself and the sonographer scanned and unfortunately the fetus remained in the spine up position after an extended amount of

Thank you for the opportunity to participate in the care of Ms. Stansberry, who as you know is a 15yo female, G1 P0, currently at 26 weeks 0 days EGA with a pregnancy complicated by late establishment of PNC and maternal obesity.

The patient is an 18 year old Spanish female who came to the unit on 11/31/2016 at 23:10 complaining of cramping and she had thought that her water had broken. Her pain was a 4 on a scale of 0-10 in her abdomen described as cramping. Upon examination she was dilated to 3cm, 80% effaced and the position of the baby was -2 and vertex. Her membranes remained intact. Her estimated due date was 10/28/2016. This is her first pregnancy. She has no history of abortion or miscarriage. She has had her flu vaccine and tdap vaccine in October, 2016. She has never smoked or done illegal drugs. She is negative for group b strep, hepatitis, HIV, and syphilis, gonorrhea, and chlamydia. She is rubella immune. There is a language barrier between the patient and the staff. The patient and her family only speak Spanish and only knew very little

One of the most important determinant of fetal viability is the pulmonary system development and maturity. The prenatal awareness of any abnormalities or anomalies going to ensure better management of the pregnancy, also giving the opportunity for the medical team and parents to prepare for the delivery and postnatal treatment. Congenital malformations of the fetal thorax are common which can involve many organs. Early detection and accurate diagnosis of fetal pathology are possible by using ultrasound and MRI imaging.

There are many different options for pregnant women regarding screening for trisomy 21. There are two more common types of tests available, nuchal translucency ultrasound with biochemistry testing in the first trimester, and cell-free DNA testing starting at 10 weeks until delivery. With these options come many questions about which one is more accurate in

R/s Jeanette (mom) is bipolar and she isn’t taking her medication, so it affects her parenting. R/s there was an inappropriate incident between Aiyana (4) and Roehbe (3) and Jeanette is failing to discover what the source is.

A woman goes to the pediatric Eemergency Ddepartment with her four-month old daughter following her pediatrician’s phone recommendation. The infant has been extremely irritable and has not been breastfeeding as usual for the past 24 hours. The mother’s last three attempts to feed the baby were followed by vomiting of whitish, serous fluid. The perinatal history is unremarkable and she received antenatal care. The patient was born by spontaneous vaginal delivery with no complications. Apgar scores were 8, and 9 at 1 and 5 minutes of life. The patient is up to date with her vaccines. Prior to this event, she could raise her chest while lying on her stomach, follow moving objects and smile at the sound of her mother’s voice; she could babble and imitate facial expressions. Physical examination is significant for an ill-looking and irritable

Madaisa is20yo, G2 P0100, who is currently 34 weeks 4 days. She is followed in the High-Risk Upstairs Clinic secondary to a history of an abruption of an IUFD around 32 weeks. She actually presented to the hospital with fetal heart tones and had an emergency cesarean delivery but the baby was not alive. She is now being followed in weekly testing. Her growth scan 2 weeks ago was appropriate. She is here today for antenatal testing.