![]() In recent years NIPT is becoming increasingly popular. The placenta weighed 170 g with signs of acute vasculitis, funisitis, and chorioamnionitis. The umbilical cord was trivascular with central insertion. ![]() On the pathology report the amniotic membranes were described as dull, thin, delicate, and green tinged. Apgar scores were 5, 7, and 9 at 1, 5, and 10 min and neonatal weight was 720 g. Two days after admission the patient went into spontaneous labor and due to a nonreassuring fetal heart rate tracing, delivery by a cesarean section was performed. ![]() The nonstress test was subsequently reactive with a reassuring BPP of 8/8 and UA S/D ratio of 3.0.Īt 29 + 2 weeks GA the patient was admitted with preterm premature rupture of membranes and the betamethasone course was repeated. Due to a biophysical profile (BPP) of 6/10 with nonrepetitive variable decelerations the patient was observed on labor and delivery and a course of betamethasone was administered for fetal lung maturation. Intense fetal monitoring was initiated to assess fetal well‐being in view of the interval fetal growth and fetal weight. At 27 + 6 weeks GA UA Doppler flow studies continued to be normal with S/D ratios of 2.49 and 3.08 and an EFW of 504 g. Surprisingly, at 25 + 5 weeks GA normal end diastolic flow was documented in the umbilical arteries with S/D ratios of 3.0 and 3.5. The patient was counseled regarding the increased risk of fetal demise. Oligohydramnios was documented with an AFI of 5.9 cm. Prophylactic doses of enoxaparin 40 mg daily and aspirin 81 mg daily were restarted at 19 + 5 weeks GA.Ī repeat ultrasound examination at 23 + 5 weeks GA revealed worsening fetal growth restriction with an EFW of 272 g and UA Doppler studies revealed absent end diastolic flow (AEDF). ![]() Free fetal DNA was obtained which was negative.ĭue to the results of the serum analytes and lagging fetal growth, placental dysfunction was suspected and close maternal and fetal surveillance was initiated with weekly visits. As anticipated, the Down Syndrome risk based on the QUAD screen was 1 in 3. The results of the QUAD Screen at 17 + 5 weeks GA revealed a MSAFP of 2.61 MOM, THCG of 3.52 MOM, Inhibin‐A of 3.73 MOM and uE3 of 0.40 MOM. However, due to early onset fetal growth restriction, the patient was recommended the 2nd trimester serum screen for assessment of placental function. Doppler flow studies in both umbilical arteries revealed elevated resistance with S/D ratios of 8.7 and 9.3.įirst trimester screen was normal with a Down Syndrome risk of 1/490 (PAPP‐A: 0.45 MOM, THCG: 1.68 MOM, and Nuchal Translucency: 0.60 MOM). Fetal anatomical examination was limited due to intrauterine growth restriction, but no obvious structural anomalies were seen and amniotic fluid volume and placental echotexture both appeared normal. At 19 + 5 weeks GA the discrepancy between GA and fetal growth was 3 weeks. Due to the ultrasound findings, enoxaparin and aspirin were discontinued.Ī repeat ultrasound exam at 17 + 5 weeks GA was significant for a 2‐week lag in fetal growth. Ultrasound examination revealed a small subchorionic bleed. Due to her past obstetrical history and FVL heterozygosity, a decision was made to start prophylactic enoxaparin 40 mg subcutaneously daily and aspirin 81 mg oral daily at 7 weeks GA.Īt 14 + 2 weeks GA the patient experienced an episode of vaginal bleeding. She denied smoking, alcohol, or drug abuse. The reason to test for FVL was for reasons of a positive family history. Our patient's antiphospholipid antibody workup was negative, but did demonstrate Factor V Leiden (FVL) heterozygosity. Preconception workup included parental karyotypes and hysterosalpingogram, both of which were normal. Her fourth pregnancy was an ectopic pregnancy. A 30‐year‐old Gravida 5 Para 0040 at 11 + 0 weeks gestational age (GA) presented with a history of recurrent spontaneous abortions at 7, 9, and 12 weeks GA.
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