Test your clinical knowledge with the daily Case in Point program, which gives you the opportunity each weekday to work through a subspecialty case.

CASE OF THE DAY

A 21-year-old woman (gravida 4 para 2012) at 21.4 weeks with no prenatal care presents with a 2-week history of intermittent aching left lower quadrant abdominal pain. She had loss of clear vaginal fluid and fetal movement, denying fever and vaginal bleeding. She had two prior normal vaginal deliveries to two healthy children and one prior elective termination. Physical examination was remarkable for a gravid abdomen and minimal tenderness to palpation of the left lower quadrant. Vaginal and speculum examination showed no pooling of fluid with the cervix closed, long and high. She reports no alcohol, tobacco, drug, or medication use during or prior to the current pregnancy. Her urine human chorionic gonadotropin was 4,346 mIU/mL, the rupture of membranes plus test was negative, and complete blood count, chemistry, and urinalysis were within normal limits. Transabdominal and transvaginal ultrasound was performed with color Doppler, shown below.