Krystal Case Studies

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Krystal is a 36yo, G5 P4004, who is currently 20 weeks 6 days. She was seen 2 days ago in our office as a work-in for suspected brain abnormality. At that time, there was questionable dilation of the third-ventricle and fourth-ventricle and possible absent cavum septum pellucidum with dilated ventricles. Also of note, the head measurements were slightly behind dates as well.

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
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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
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