Electromagnetic Case Studies

Angela is a 31yo, G2 P0010, who was seen for an ultrasound evaluation and consultation due to an abnormal quad screen with an elevated risk for trisomy 21 of 1:27. Her inhibin A is also elevated at 3.75 MoM. She does have a longstanding history of opiate use disorder. She was on Subutex 12 mg daily (4 mg t.i.d.). She pays out of pocket for this. She has been taking intermittent ibuprofen and was told to discontinue this based on her gestational age. She reportedly is hepatitis C positive but I am uncertain of the viral load. She also states that she has a history of endocarditis in 2013. She does smoke cigarettes at ½ pack per day. She was further counseled on cessation. On today’s assessment, she has positive fetal movement. She was seen

We discussed further genetic testing options in the form of amniocentesis with its risks and complications and pros and cons as well as noninvasive prenatal testing (NIPT) with its benefits and limitations. She was not interested in the amniocentesis and therefore it was declined. She was interested in the NIPT and this labwork was drawn today and we will forward the results to your office upon return.

With her history of endocarditis, we would recommend that you obtain a cardiac evaluation with an echocardiogram to make sure there are no issues at the time of delivery. In addition, with the elevated inhibin A we would recommend serial scans with weekly antenatal testing starting at around 32 weeks gestation.

The patient states that she might be interested in weaning but has had some intermittent PNC and therefore at this point in time plans on staying on her regimen of 12 mg Subutex daily. She was aware of the potential risks for neonatal abstinence syndrome (NAS) and that DCS will be involved following delivery to monitor her family situation. In the meantime, we told her to follow daily fetal movement counts and to follow-up with us in 4 weeks for interval growth for us to reassess the fetal anatomy including completion of the cardiac