CLINICAL CASES 299 When discussing the diagnosis of stillbirth with this patient it is important to convey sensitivity and offer support. ➤ HELLP syndrome may be confused with other medical, surgical conditions or obstetric complications (Level II-3). There is no single NT measurement that serves as the cut off between normal and abnormal. Case Files Obstetrics And Gynaecology 5th Edition presents 60 real-life cases that illustrate essential concepts in this area of medicine. . Fetal-maternal hemorrhage (FMH) is reported in 3% to 14% of cases of stillbirths5 (Level II-2). ➤ HbA1c levels greater than 11.2% prior to conception are associated with neonatal morbidity rates as high as 25% (Level II-3). Michelfelder E, Gottliebson W, Border W, et al. Hu CL, Li YB, Zou YG, et al. Her values are as follows: AFP uE3 hCG Inhibin A 3.1 MoM 1.4 MoM 0.9 MoM 0.8 MoM Based on these results, she is referred for genetic counseling and targeted sonography. Case 26 A 28-year-old G4P3 at 40 weeks’ gestation presents to labor and delivery in active labor and ruptured membranes. Pressure support ventilation (PSV) Ventilator provides preset level of pressure to patient-initiated inspiration. Prevention of neural tube defects: results of the Medical Research Council Vitamin study. When VE is selected for an appropriate case, the operator is advised to pay particular attention to cup position, which should be symmetric and centered approximately 3 cm anterior (toward the fetal face) to the posterior fontanel. She reminds you that when she was 18 years of age, she was involved in a serious auto accident in which she suffered a splenic laceration. Obstetrics, Gynaecology and Reproductive Medicine. The woman in our case scenario, for example, requires aggressive fluid resuscitation and transfer to an intensive care unit. Finally, a review of prior inpatient records may also be informative. Van Pampus MG, Wolf H, Mayruhu G, et al. . Some patients may present with preterm contractions/labor or with decreased fetal movement (secondary to maternal acidosis). The exact mechanism(s) that leads to fetal loss are uncertain but it is hypothesized that thrombosis and inflammation may lead to infarction in the placenta resulting in second or third-trimester fetal deaths. Clin Perinatol. 2. Perinatal mortality in type 2 diabetes mellitus. The 3-hour OGTT is reserved for women with positive screening results. 2007;109(1):229-237. . Ghossain MA, Buy JN, Ruiz A, et al. The reasons for these expansions remain unknown. Philadelphia, PA: WB Saunders; 2000. Of these, the historical examination is the most important and useful. It was also thought to potentially decrease the risk of preterm delivery as a result of the uterine overdistension. 12.4 D. Group B Streptococcus resides in the vagina and rectum, and is rarely eradicated with antibiotics. As another example, urinary tract infections may be subdivided into lower tract infections (cystitis) that are treated by oral antibiotics on an outpatient basis, versus upper tract infections (pyelonephritis) that generally require hospitalization and intravenous antibiotics. Describe other clinical conditions that are part of the differential diagnosis of a seizure in pregnancy. This patient has an increased risk for developing GDM due to her ethnic background, obese status, age greater than 25 years, and history of giving birth to a macrosomic infant. Understand which patients are candidates for treatment during pregnancy. Desensitization In patients with IgE-mediated penicillin allergy who require penicillin therapy, immune tolerance can be produced by administering successively increasing doses of penicillin. Figure 2–1 depicts proper alignment of fetus and location of calipers when measuring NT. 2. 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