SEARCH

SEARCH BY CITATION

C.L., a 33-year-old healthy, gravida 1, para 1000, presents for her first gynecologic examination following an unexplained stillbirth at 38 weeks' gestation 2 years ago. During the encounter, C.L. questions whether or not it is “safe” to become pregnant again. She is very apprehensive about pregnancy because of her last pregnancy outcome. A thorough history is gathered during the visit. Her obstetric history was unremarkable before presentation in labor at 38 weeks' gestation. She was dilated to 4 to 5 cm when she arrived at the hospital with intact membranes. Once admitted, the stillbirth diagnosis was confirmed. Her membranes were artificially ruptured and meconium was noted. She delivered vaginally and an autopsy performed following delivery was normal. During the pregnancy, two ultrasounds were performed, both of which were normal. All routine laboratory values obtained during the pregnancy were normal, except for a diagnosis of iron-deficiency anemia. She also had normal genetic screening results. The patient's gynecologic history included a diagnosis of polycystic ovarian syndrome managed with metformin that she continued during her pregnancy. She had a normal 1-hour glucose tolerance screen during the second trimester of her pregnancy. Her medical, surgical, family, and social histories were unremarkable. She reported no drug or alcohol use during her pregnancy. However, she was a 1 pack per day smoker during that pregnancy. Since then, she has discontinued smoking. During pregnancy, her medication exposures included metformin, prenatal vitamins, and ferrous sulfate. C.L believes that she last felt fetal movement 2 to 3 days before presenting to the hospital in labor. C.L. confided that she desperately wanted to become pregnant but she “couldn't bear to go through the same thing again.” She states that she is finally feeling “okay” and not paralyzed by her grief. She asks if anything can be done to ensure that her next pregnancy is “healthy.”