LaRae Brown, MD


March 09, 2011

Case Presentation

A 35-year-old woman who was gravida 3 para 1 with 0 preterm pregnancies, 1 abortion, and 1 living child presented to labor and delivery in active preterm labor at 35 weeks. Her prenatal course was remarkable for limited care, having only 3 total prenatal visits. Her prenatal laboratory studies were unremarkable, but as a result of the patient's noncompliance, she did not receive serum aneuploidy screening or a detailed anatomy ultrasound. Her pregnancy was dated by a 6-week crown rump length measurement.


The patient's medical and surgical histories were unremarkable. Her obstetrical history was significant for 1 full-term uncomplicated spontaneous vaginal delivery and 1 first trimester elective abortion. Her family history was significant for cleft palate in the patient's brother, but no other birth defects were noted. The patient was intermittently incarcerated during this pregnancy and had a history significant for frequent drug use, including crack cocaine, marijuana, and alcohol. At the time of admission, the patient admitted cocaine use immediately preceding her presentation to the labor and delivery unit.

After admission to the hospital, the patient experienced rapid cervical change and subsequently delivered a malformed fetus (Figures 1 and 2). The obstetrical team was surprised by the appearance of the infant, as the craniofacial findings were unexpected. Of note, the infant appeared grossly normal from the neck down. The pediatric team was immediately called to the room to evaluate the newborn. At birth, the newborn's heart rate was < 60 beats per minute, the infant was pale with absent tone and exhibited minimal gasping. The infant was given supplemental blow-by oxygen without noticeable improvement in heart rate or respiratory effort. Apgar scores were 1 and 1 at 1 and 5 minutes, respectively.

Figure 1. Newborn with craniofacial malformation, side view. Used with permission. Figure 2. Newborn with craniofacial malformation, front view. Used with permission.


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