Case 182 Patient, 32 years old, fourth pregnancy with three previous abortions, without comorbidities or complaints. Seeks obstetric evaluation due to history of multiple miscarriages, in which genetic studies have shown fetuses with normal karyotypes. Gestational age of 36 weeks, blood group A, Rh negative, BMI = 22, normoglycemic, susceptible to toxoplasmosis and unmarkable serology. On examination: blood pressure = 120x70mmHg, uterus fundus of 24cm, uterus' cervix was posterior, long and closed. Results from previous obstetrical ultrasound (Table 1). Doppler velocimetry of the middle cerebral artery at gestational age of 36 weeks.Results of obstetric ultrasound performed by the patient.Results of obstetric ultrasound performed by the patient. Question:Based on clinical history, laboratory tests, ultrasound and Doppler velocimetric evolution, which is the most likely diagnosis and the best therapeutic management? A) Fetus small-for-gestational-age; ultrasound monitoring is indicated until the end of term. B) Fetus with intrauterine growth restriction (IUGR), type I - Symmetrical; absolute rest and follow up to the end of term are indicated. C) Fetus with intrauterine growth restriction (IUGR), type II - Asymetrical; immediate cesarean section is indicated. D) Fetus with intrauterine growth restriction (IUGR), intermediate type; administration of dexamethasone (2 doses of 12 mg, IM, at 24 intervals) is indicated. Time is Up! Time's up
