A 36-year-old woman, gravida 3 para 2, at 15 weeks gestation comes to the office for routine prenatal care. The patient has no
vaginal bleeding, leakage of fluid, or cramping She has chronic hypertension controlled by 1 medication. She is taking a daily
prenatal vitamin and does not use tobacco, alcohol, or illicit drugs. Her 2 prior pregnancies were uncomplicated. Blood pressure is
146/90 mm Hg and pulse is 88/min. BMI is 28 kg/m2
• Fetal heart rate is normal. Urinalysis is negative for protein. The first-trimester
combined test results are reviewed with the patient and include an abnormally elevated 13-hCG level as well as a 13-week ultrasound
that shows an increased nuchal thickness but no other abnormalities. Which of the following is the most appropriate next step in
management of this patient?
- QA Amniocentesis
- 0 B. Chorionic villus sampling
- 0 C. Dilation and suction curettage
- 0 D. Maternal karyotype
- 0 E. Maternal serum quadruple screen
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