prenatal care/intrauterine fetal demise

See Explanation

[]

Question 1 / 2

683d0c22c1b3f4bd827da664

Obstetrics

prenatal care

intrauterine fetal demise

Case History

A 35-year-old G3P2002 woman arrives at the labor and delivery unit at 32 weeks and 3 days gestation, reporting profound absence of fetal movement for the past 24 hours. She has not felt any kicks or significant movement since yesterday morning. Her prior pregnancies resulted in two full-term uncomplicated vaginal deliveries. This pregnancy has been complicated by poorly controlled gestational diabetes, requiring insulin, but she admits to inconsistent adherence. She also has a history of mild hypertension managed with lifestyle modifications. On admission, her temperature is 37.1°C, blood pressure is 152/88 mmHg, pulse is 80/min, and respirations are 16/min. Physical examination reveals an obese woman appearing distressed, with a fundal height measuring 34 centimeters. An initial handheld Doppler assessment by the admitting nurse fails to detect fetal heart tones. Given the clinical presentation, what is the most appropriate diagnostic confirmation and the subsequent initial management strategy?

Lab Parameter	Value	Reference Range
Random Plasma Glucose	12.8 mmol/L	< 7.8 mmol/L
HbA1c	8.5%	< 6.5%
White Blood Cell Count	9.8 x 10^9/L	4.0 - 10.0 x 10^9/L
Hemoglobin	128 g/L	120 - 150 g/L
Platelets	250 x 10^9/L	150 - 450 x 10^9/L
Prothrombin Time (PT)	11.5 seconds	10.0 - 13.0 seconds
Activated Partial Thromboplastin Time (aPTT)	28 seconds	25 - 35 seconds
Fibrinogen	3.5 g/L	2.0 - 4.0 g/L (non-pregnant), 3.0-6.0 g/L (pregnant)

A ) Perform a non-stress test and consider admission for close monitoring.

B ) Initiate intravenous labetalol for blood pressure control and schedule a biophysical profile.

C ) Conduct a comprehensive ultrasound for definitive diagnosis of fetal demise and plan for induction of labor.

D ) Recommend an urgent amniocentesis for genetic testing and immediate cesarean delivery.

E ) Confirm with handheld Doppler and arrange for outpatient follow-up in 24 hours.

Edit question

See Explanation

[]

Question 2 / 2

683d0c22c1b3f4bd827da663

Obstetrics

prenatal care

intrauterine fetal demise

Case History

A 32-year-old G4P0 woman, now at 29 weeks gestation, presents to the outpatient clinic reporting a marked decrease in fetal movement over the past 48 hours. She denies any vaginal bleeding, leakage of fluid, or uterine contractions. Her obstetric history is notable for three prior spontaneous abortions, occurring at 10, 14, and 18 weeks of gestation, respectively. She also has a documented history of deep vein thrombosis following a minor ankle sprain five years ago, requiring anticoagulation for three months. She is otherwise healthy and takes only prenatal vitamins. On physical examination, her fundal height measures 24 cm, significantly lagging for gestational age. Fetal heart tones are inaudible using Doppler. An abdominal ultrasound performed urgently reveals an absence of fetal cardiac activity and biometric measurements consistent with a 26-week gestational age, indicating intrauterine fetal demise. The patient, though distressed, expresses a strong desire to understand the cause of this recurrent loss and requests a thorough investigation, including a fetal autopsy. Given her complex history and the current findings, what is the most appropriate immediate management and crucial diagnostic step for identifying the underlying etiology?

Lab Parameter	Value	Reference Range
Complete Blood Count (CBC)	Within normal limits	WBC 4.5-11.0 x 10^9/L, Hb 120-160 g/L, Platelets 150-450 x 10^9/L
Prothrombin Time (PT)	11.5 seconds	10.0-13.0 seconds
Activated Partial Thromboplastin Time (aPTT)	32 seconds	25-35 seconds
Fibrinogen	3.8 g/L	2.0-4.0 g/L
Lupus Anticoagulant	Positive	Negative
Anti-cardiolipin antibodies (IgG/IgM)	Elevated	Negative
Beta-2 glycoprotein I antibodies (IgG/IgM)	Elevated	Negative

A ) Scheduled Cesarean delivery to expedite delivery and immediate initiation of prophylactic anticoagulation.

B ) Expectant management, allowing for spontaneous labor, with concurrent genetic counseling and parental karyotyping as the primary diagnostic approach.

C ) Dilation and evacuation (D&E) for uterine evacuation, followed by a general thrombophilia screening panel.

D ) Prompt induction of labor, comprehensive post-mortem fetal evaluation including autopsy and karyotyping, and a complete maternal thrombophilia workup.

E ) Induction of labor at 37 weeks gestation to allow for full fetal development, combined with extensive counseling on lifestyle modifications.

Edit question