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LegalEase: How Small Is Too Small?
Burkman RT
TheFemalePatient.2012;37(9):43-46.

You have been caring for a patient who, after three attempts, has had a successful in vitro fertilization pregnancy. She is 42 years of age, has a body mass index of 39, but is otherwise healthy. Her antenatal course has been relatively unremarkable until tonight, at 23 weeks of gestation: she gives a history suggestive of premature rupture of membranes. At the hospital you document that indeed her membranes have ruptured and that her cervix is closed. An ultrasound documents the presence of minimal amounts of amniotic fluid and a male fetus, at an estimated weight of 450 grams, in a breech presentation. She has occasional contractions but does not appear to be in active labor. The fetal heart tracing demonstrates minimal variability with occasional variable decelerations of short duration. You discuss starting betmethasone and antibiotics; however, the parents request counseling about the likely outcome should she deliver and their options for management given the circumstances.


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