Fetal Biometry: A Case Study

Breasts: no masses, no nipple retraction, no discharge. Heart: S1 and S2, no gallops, rubs, or murmurs appreciated. Abdomen is scaphoid, soft and non-tender with positive bubble sounds. Pelvic/ Rectal: deferred as patient has recently visited her GYN for a routine Pap smear. Neurologic exam reveals normal motor strength in all muscle

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.

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

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.

Joanne and Steve wanted a C-section as they had difficultly delivery with their first child; however Joanne went into labour early. The baby was delivered 3 days before the C-section was scheduled. With her first child she was given an epidural that did not work, this is why she had requested the C-section for the birth of this child. Their first child died at 21 days old, he was an IVF baby and it had taken them 5-6 years to get him. After a couple of years they started trying for another baby, they had been saving up for more IVF but they managed to conceive naturally. They had more scans during this pregnancy to ensure the health of the baby was okay.

Erin is a 33yo, G3 P1101, who was seen for an ultrasound evaluation and consultation. The patient has a longstanding past history of substance abuse as well as alcohol abuse and she is HIV positive with a positive viral load. She is followed by infectious disease and is on numerous medications including Genvoya and Prezista. She also is reportedly hepatitis C positive. She has a history of alcohol abuse in the past but states that she has not had any alcohol since early June. Her LMP was 08/06/17. She also has a history of cocaine usage but again denies any usage in the past year. She does have a longstanding history of physical abuse and has had issues with anxiety. She has 2 previous deliveries. The 1st of which was in 2004 that occurred

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.

On today’s assessment, she is 34 weeks. The amniotic fluid volume is again somewhat increased even beyond last week with an AFI of 32 cm. BPP is 8/8 and the Doppler study is very reassuring and again, the patient has good fetal movement.

Marisna is a 39yo, G3 P2002, who is currently 21 weeks 0 days as dated by LMP using a due date of 04/25/17. This was consistent with her 1st ultrasound in your office that measured just slightly ahead with a due date of 04/18/17. She is AMA. She had a quad screen in your office that returned screen positive with an increased risk of Down syndrome of 1:100. This is close to what her age based risk would be. Open neural tube defect was screen negative. In reviewing her analytes, AFP was slightly elevated at 2.15 MoM and inhibin was borderline at 1.87 MoM. She was diagnosed with chronic HTN fairly early in her last pregnancy. She did not have preeclampsia with that pregnancy to her knowledge. The baby was quite small, as it weighed just over 4 lb at term. She was not on BP medication chronically, but coming into this pregnancy at 19 weeks her BP was elevated at 162/90 and she was started on labetalol. I cannot tell in the records if she had protein in her urine but she did have 2+ on her dip in our office today. She reports that she has collected a 24-hr urine last week, although we do not have those results. Because she entered care late, she is not on baby aspirin for the prevention of preeclampsia.

Her original due date had been estimated as April 6, 2015 then re-evaluated and moved to April 2, 2015. Apparently the new date was not noted in the charts. Carnett felt a 4 day difference would make no difference, deferring the ultra-sound to the next visit. Ms. Meister says she told Carnett and staff she expected and wanted the ultra-sound but no one really commented beyond noting it would be done at her next visit.

G4 P3003 (4 Gestations, 3 Full Term, 0 Preterm, 0 Miscarriages, 3 Currently Living); 3 Spontaneous Vaginal Deliveries; Last birth was 7 years ago by SVD, weighed 4000 grams; No previous obstetrical complications or morbidity; No past medical history; No past surgical history; No prior antenatal care

A pregnant woman may have special tests during pregnancy to make sure that her developing baby (fetus) is healthy. These tests are called fetal monitoring. A contraction stress test, also called an oxytocin challenge test, is one type of fetal monitoring. This test is used to check the baby's heart rate when the womb (uterus) contracts. A health care provider may do this test to see how well the baby will tolerate labor and delivery. A woman may also have a contraction stress test if other fetal monitoring tests suggest that the baby may be at risk during labor and delivery.