A Perinatal Pathology View of Preterm Labor

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Case Study 2

This woman's first pregnancy in 1997, at age 28, was complicated by spontaneous membrane rupture at 28 weeks. Ultrasonography showed a fetus with biparietal diameter consistent with 27 weeks 3 days and abdominal circumference and femur length consistent with 23 weeks and 24 weeks 1 day, respectively. The fetus was diagnosed with asymmetric growth retardation. Expectant management was planned, and the patient was moved to the antepartum floor for surveillance. Mild uterine contractions were noted, but no cervical change could be documented. Two days after admission, no fetal heart tones could be obtained. A stillborn growth-restricted fetus was delivered. The placenta was diagnosed as "mature placenta with trivascular umbilical cord." Fetal karyotype was 46,XX (normal female). After this initial loss, the woman's case was reviewed by the local perinatologist. On the basis of clinical course, medical history, and postpartum evaluation, she was counseled that her recurrence risk was low and she would not be considered high risk in the next pregnancy.

In 1998, the patient conceived again, and at 13 weeks, had spontaneous onset of uterine contractions, with abdominal pain and intermittent bright red vaginal bleeding. She was evaluated and placed on bed rest. At 13 weeks and 3 days, her membranes ruptured, and she presented to the emergency room, where she delivered a male fetus with growth appropriate for 13 weeks gestation. Fetal karyotype was also normal, 46,XY.

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