Cretia Case Study

Cretia is a 30yo, G3 P0111, who is currently 36 weeks 4 days. She is relatively healthy. She has no medical complications. She has one prior delivery at 36 weeks that was spontaneous labor. She has declined 17-OHP. She did have preterm contractions this pregnancy that ultimately were able to be arrested. The pregnancy has also been complicated by an adrenal mass which is suspected to be an adrenal hemorrhage given the fact that it decreased in size. She is here today for a final growth scan and evaluation of the adrenal.

On ultrasound, there is a live fetus in cephalic presentation. Fetal biometry is slightly ahead of dates but measurements are fairly symmetric between the head and abdominal circumference. A limited survey was unremarkable.
Amniotic fluid is normal at 17 cm. Umbilical artery Doppler was within normal limits. BPP is 8/8. A limited evaluation did again note a small mass above the right fetal kidney that is expected to be an adrenal hemorrhage and was stable in measurements at 1.6 x 1.8 x 1.7 cm.

At today’s office visit we discussed several issues.
In regards to the fetal adrenal, I do suspect that this is hemorrhage but I would recommend a neonatal ultrasound after delivery to rule-out mass. We also discussed her BP’s. She was seen in triage on Friday and had a couple of elevated BP’s that returned to normal. Labs at that time were negative and she was told to follow-up today for labs as well. BP in the office today was 118/73 and she had only a trace of protein. I did obtain STAT labs and a p/c ratio for completeness. She did not have any symptoms of preeclampsia but has some mild edema. Deep tendon reflexes were 1+. There was no evidence of
clonus.

I reviewed BP criteria to classify her as gestational HTN which would then necessitate induction of labor after 37 weeks.
Because we have only had documented elevated BP’s on one occasion, I do not think she currently has gestational HTN but should she have elevated BP’s anytime moving forward we may consider induction at that time. In the meantime, she will continue with preeclampsia precautions and I will contact if her labs return abnormal. For now, she is not scheduled to follow-up here. I assume she will either go into spontaneous labor and deliver at the Birth Center or that she will have elevated BP’s that will necessitate induction here through the hospital. If this occurs, please contact our office and we will get her scheduled for induction or send her to
triage.

Thank you for referring this patient to our office. Please do not hesitate to call us if you have any questions.

THIS REPORT HAS BEEN DICTATED BUT NOT EDITED
Lynlee Wolfe, M.D.
Maternal-Fetal Medicine