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2013-06-23-10 Case of the week #351 © Al-Asali

Case of the week #351

August 15, 2013 - August 29, 2013 

Othman A. R. M. Al-Asali
, MD; Fayez Yassen, MD.

Department of Obstetrics and Gynecology, Al-Hammadi Hospital, Riyadh, Saudi Arabia.

Case report

This is a 29-year-old woman (G3P2) from a non-consanguineous marriage, with non-contributive history. She had attacks of hypoglycemia over the last year, associated with low fasting glucose and high insulin levels, managed by diet. 

The patient underwent amniocentesis at 18 weeks revealing normal karyotype - 46XY.

At 23 weeks the patient was hospitalized due to diarrhea related to Entamoeba histolytica
 infection and was placed on Flagyl (metronidazole).

Her ultrasound examinations performed at 24 and 28 weeks of gestation did not show any fetal anomaly. 

At 34 and 37 weeks ultrasound examination revealed following findings:
Images 1, 2, 3, and 4: 34-37 weeks.



Images 5, 6, and 7: 37 weeks.

Cesarean section was performed at 37 weeks due to fetopelvic disproportion (fetal biometry corresponded to 39 weeks) and a male newborn weighing 3230 grams (Apgar score 9, 10) was delivered. Amniotic fluid was stained by old and fresh meconium.

Postnatal abdominal ultrasound and X-ray were done, but revealed no anomaly. No vomiting or abdominal distension were present and normal meconium discharge was noticed. 

The newborn was placed at neonatal unit with usual care and feeding. At 6th day after delivery the neonate was discharged home.

At 9th day the neonate had to be admitted at NICU (Neonatal Intensive Care Unit) because of vomiting, abdominal distension, and poor feeding. Abdominal X-ray and contrast X-ray were done.

At 11th day
 the neonate underwent an operation.
Images 8, 9: Contrast X-ray with Gastrografin applied via nasogastric tube at 10th day after delivery.

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