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Puzzling case - longishFrom: RModugno@aol.comFri Feb 14 06:24:23 2003
28 year old P0G1 presents for routine screening ultrasound at -22 weeks - cervical funnelling seen. Treated conservatively - funnelling worsens - "rescue" cerclage performed(M'Donalds) A few days later diagnosed with cystitis -placed on Macrobid. About 10 days after cerclage placement, follow-up sonogram shows worsening of funneling and dilation, baby in breech presentaion - now 25 weeks.Membranes intact.Patient admitted for bedrest, steroids, indocin and trendelenberg.Develops a cough, steadily worsens, dyspnoea, and within 3 days of hospital admission develops what seems to be ARDS. Is intubated and on ventilator.WBC 20,000. Highest temp 99.4. Urine cultures,blood, amniotic fluid(amniocentesis) sputum cultures negative for usual pathogens including fungi, negative, bronchoscopy negative.HIV negative. HBV positive, normal liver functions. No ruptured membranes. Pregnancy terminated by cesarean section at pulmonologists request as ARDS is worsening - live male infant weighing 900 grams delivered, no evidence of chorio-amnionitis.One week post cesarean section, now on jet ventilator, no real improvement, open lung biopsy probably consistent with ARDS - specimen sent to Mayo Clinic to be reviewed by expert pulmonary pathologist. No one has a clue as to what is going on. Any thoughts? Robert Modugno MD MBA FACOG Marietta, GA http://www.novaobgyn.yourmd.com
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