Thursday, July 18, 2013

The Apple and the Tree

A 25 year old G4P0 woman who has not had any prenatal care comes to the hospital with sudden vaginal bleeding, abdominal and back pain, and uterine contractions. Her obstetric history is notable for stillbirths and a fetal demise in the past. She appears to be at term. Because of nonreassuring fetal heart tones, she goes to a stat C-section. She is hypertensive in the operating room prior to anesthesia. After delivery, there is significant blood loss, and baby is delivered to the pediatric team.

When the baby is two to three days old, he is noted to have tremors, a high pitched cry, irritability, excess suck, hyperalertness, and episodes of apnea.

Challenge: What's going on?

Image is in the public domain.


sibogox said...

cocaine withdrawal from prenatal exposure?

Craig Chen said...

The Apple and the Tree

This is cocaine use in pregnancy. Risks include spontaneous abortion, fetal demise, placental abruption (described here), prematurity, and intrauterine growth restriction. Newborns show acute CNS and autonomic nervous system perturbations.

Source: UpToDate.