Differential Diagnosis for a 30-year-old Woman at 26 Weeks Gestation
- Single most likely diagnosis:
- Intrauterine Growth Restriction (IUGR) - The patient's fundal height is less than expected for her gestational age, and the ultrasound reveals a fetus measuring in the 25th percentile, indicating that the fetus is not growing at a normal rate. The patient's low prepregnancy BMI and inadequate weight gain during pregnancy also support this diagnosis.
- Other Likely diagnoses:
- Placental insufficiency - This condition can cause the fetus to not receive enough oxygen and nutrients, leading to growth restriction.
- Maternal malnutrition - The patient's low prepregnancy BMI and inadequate weight gain during pregnancy may indicate that she is not consuming enough calories and nutrients to support fetal growth.
- Chronic hypertension - Although the patient's vital signs are normal, chronic hypertension can cause placental insufficiency and IUGR.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Preeclampsia - This condition can cause severe hypertension and damage to organs such as the liver and kidneys. Although the patient's vital signs are normal, preeclampsia can develop rapidly and without warning.
- Uterine anomaly or Müllerian duct anomaly - These conditions can cause abnormal fetal growth and development.
- Fetal chromosomal abnormality - Certain chromosomal abnormalities, such as trisomy 18, can cause growth restriction and other fetal anomalies.
- Rare diagnoses:
- Fetal infection - Certain infections, such as cytomegalovirus, can cause growth restriction and other fetal anomalies.
- Autoimmune disorders - Conditions such as lupus or antiphospholipid syndrome can cause placental insufficiency and IUGR.
- Fetal tumors or cysts - Rarely, fetal tumors or cysts can cause growth restriction and other fetal anomalies.