Heather is a 37yo, G4 P2103, who was seen for an ultrasound evaluation and consultation for AMA. The patient currently is 37 and will be 37 at the time of her EDD. She does have 3 previous deliveries; one that occurred 20 years ago in 1996 and was delivered at 35 weeks gestation but in that one she states that she had minimal PNC and was hiding the pregnancy from her family and several other stress factors were in play and that was the cause of her preterm labor and delivery. That delivery was then followed by 2 other deliveries that went to 42 weeks gestation and 39 ½ weeks gestation resulting in infants that weighed 9 ½ lb and 8 lb, both of which were vaginal. She also had a positive UDS for THC early on in the pregnancy but denies any current usage. On today’s assessment, she has no complaints and has positive fetal movement.
By dates, she is 20 weeks and the measurements are concordant. The amniotic fluid volume is normal, and the cervix is long and closed with no evidence of membrane funneling. A complete fetal
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We did have a full discussion with her regarding AMA issues and her risk for trisomy 21 as well as aneuploidy at term based on age alone. The fact that the ultrasound was completely negative decreases this risk somewhat. We did discuss various genetic testing options including amniocentesis with its risks and complications and pros and cons versus noninvasive prenatal testing (NIPT) with its benefits and limitations versus a quad screen. The patient was not interested in any further genetic testing or screening and therefore this was declined. She was told that if she changed her mind the quad screen should be performed this week based on her gestational age and that we would prefer to perform the amniocentesis in the next 2 weeks if possible again be cause of her gestational age. The NIPT can be performed at