Differential Diagnosis for Pregnancy-Related Complications The patient's presentation suggests a potential issue with fetal growth. The differential diagnosis can be organized into the following categories:
Single Most Likely Diagnosis
- Intrauterine Growth Restriction (IUGR): The patient's fetus is measuring in the 25th percentile for gestational age, and the patient has gained less than the recommended weight, which is a risk factor for IUGR. IUGR is a condition where the fetus does not grow at a normal rate inside the womb.
Other Likely Diagnoses
- Placental Insufficiency: The patient's fetus is not growing at a normal rate, which could be due to placental insufficiency, where the placenta is not functioning properly to provide the necessary nutrients and oxygen to the fetus.
- Maternal Malnutrition: The patient's prepregnancy BMI was 18 kg/m2, which is underweight, and she has gained less than the recommended weight, which could indicate malnutrition and contribute to the fetus's growth restriction.
- Preeclampsia: Although the patient's vital signs are normal, preeclampsia can cause fetal growth restriction, and it's essential to monitor the patient's blood pressure and urine protein levels.
Do Not Miss Diagnoses
- Chromosomal Abnormalities: Although the patient's fetus is measuring small, it's essential to consider chromosomal abnormalities, such as Down syndrome, which can cause growth restriction.
- Uterine Anomalies: Uterine anomalies, such as a septate uterus, can increase the risk of fetal growth restriction and other pregnancy complications.
- Inherited Thrombophilias: Inherited thrombophilias, such as factor V Leiden, can increase the risk of placental insufficiency and fetal growth restriction.
Rare Diagnoses
- Fetal Infections: Fetal infections, such as cytomegalovirus or toxoplasmosis, can cause growth restriction, although they are less common.
- Maternal Exposure to Toxins: Exposure to toxins, such as heavy metals or pesticides, can cause fetal growth restriction, although this is relatively rare.