What is the most likely cause of fetal growth restriction, characterized by an estimated fetal weight at the 4th percentile, in a 36-year-old woman at 26 weeks gestation with a history of depression, treated with a selective serotonin reuptake inhibitor (SSRI), and an atrial septal defect detected on anatomy ultrasound?

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Differential Diagnosis for Fetal Findings

The patient's fetal findings, including an estimated fetal weight at the 4th percentile and an atrial septal defect, suggest a potential underlying condition affecting fetal growth and development. The following differential diagnosis is organized into categories:

  • Single Most Likely Diagnosis
    • Placental Insufficiency: This condition is the most likely cause of the fetal findings, given the estimated fetal weight at the 4th percentile and the presence of an atrial septal defect. Placental insufficiency can lead to intrauterine growth restriction (IUGR), which is consistent with the patient's fetal ultrasound results.
  • Other Likely Diagnoses
    • Chromosomal Abnormalities: Although the patient declined genetic testing, chromosomal abnormalities such as Turner syndrome or trisomy 18 can cause fetal growth restriction and congenital heart defects, including atrial septal defects.
    • Intrauterine Infection: Infections such as cytomegalovirus (CMV) or toxoplasmosis can cause fetal growth restriction and congenital anomalies, including heart defects.
    • Maternal Hypertension: The patient's blood pressure is elevated (138/89 mm Hg), which may indicate maternal hypertension. This condition can lead to placental insufficiency and fetal growth restriction.
  • Do Not Miss Diagnoses
    • Pregnancy-Induced Hypertension with Severe Features: This condition can cause placental insufficiency, fetal growth restriction, and congenital anomalies. It is essential to monitor the patient's blood pressure and fetal well-being closely.
    • Autoimmune Disorders: Conditions such as systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS) can increase the risk of fetal growth restriction, congenital heart defects, and other complications.
  • Rare Diagnoses
    • Fetal Metabolic Disorders: Rare metabolic disorders, such as fetal growth restriction due to mitochondrial disease, can cause fetal growth restriction and congenital anomalies.
    • Congenital Heart Disease due to Teratogenic Exposure: Exposure to certain teratogens, such as lithium or other medications, can increase the risk of congenital heart defects, including atrial septal defects. However, the patient's history of selective serotonin reuptake inhibitor use is not typically associated with an increased risk of congenital heart defects.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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