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Women with a previous pregnancy complicated by any trisomy, in which the fetus survived at least to the second trimester, are at risk for having a recurrence of the same or different trisomy. The risk of trisomy recur rence is 1 . 2 times the maternal age risk. This risk depends on several fac tors, including the maternal age during the index pregnancy, type of trisomy, and pregnancy outcome. Certain sex-chromosome abnormalities may also carry an increased risk of recurrence. Turner syndrome (XO) and XYY karyotypes carry a nominal recurrence risk; fetal XXX or XXY has an increased recurrence risk.
Physical examination shows a gravid uterus with a fundal height of 36 em. The baby is found to be ver tex by Leopold maneuvers. Speculum examination shows an anterior, soft, thinning cervix with some serous discharge. Microscopic examination of the vaginal discharge shows few bacteria, 0 to 5 white blood cells (WBCs)/hpf (high power field), 0 to 5 RBCs/hp£ No ferning was noted. Manual cervical examination indicates that she is dilated 3 em, 75% effaced, and at 0 station. What is the next step in the management of this patient?
17 - ----1 • I '-': F 1--16 19 -- --4 20 G . -21 22 X y Fig u re 3-4 (A) (B) (C) (D) (E) a-fetoprotein (AFP) , intact hCG, estradiol, inhibin A Intact hCG, estradiol, inhibin A AFP, estradiol, inhibin A AFP, intact hCG, inhibin A AFP, intact hCG, estradiol The answer is E : AFP, i ntact hCG, estrad i o l . Inhibin A is not used in the calculation of risk for trisomy 1 8 . Typically, the values of AFP, intact hCG, and estradiol are all reduced when the fetus is at increased risk for trisomy 1 8 (see Figure 3 -4) .