A female infant was born vaginally to a gravida 4, para 1, 24-year-old woman at term. The child's birth weight was 2,800 g; her length was 51 cm. The mother had a history of three spontaneous abortions. The present pregnancy was complicated by threatened abortion at 15 weeks. The mother was given hydroxyprogesterone hexanoate, 500 mg IM weekly for 6 weeks.
A female infant was born vaginally to a gravida 4, para 1, 24-year-old woman at term. The child's birth weight was 2,800 g; her length was 51 cm. The mother had a history of three spontaneous abortions. The present pregnancy was complicated by threatened abortion at 15 weeks. The mother was given hydroxyprogesterone hexanoate, 500 mg IM weekly for 6 weeks.
Physical examination showed an infant in no apparent distress. The clitoris was enlarged, and the labia majora and labia minora were hyperpigmented. The child's blood pressure and pulse were normal, as were abdominal ultrasound and chromosomal analysis. Levels of serum electrolytes and serum 17a-hydroxyprogesterone were also normal.
Clitoral hypertrophy suggests fetal exposure to excessive androgens, most commonly from congenital adrenal hyperplasia or other disorders of sexual differentiation, maternal use of progesterone, or maternal arrhenoblastoma.
Exposure to excessive androgen before 13 weeks of gestational age usually results in labioscrotal fusion with clitoral hypertrophy, whereas exposure to excessive androgens after this age usually results in isolated clitoral hypertrophy. In premature infants, the clitoris may appear inappropriately large, but it tends to regress with time. Other causes of clitoral hypertrophy include chronic severe vulvovaginitis, neurofibromatosis, and hemangiopericytoma.
The infant had clitoral hypertrophy secondary to maternal use of hydroxyprogesterone hexanoate. Although progesterone therapy has been used for the treatment of recurrent and threatened abortion, there is no evidence that its use improves fetal salvage.
3 Reasons Urology Practices Should Add Onsite UTI PCR Labs Under New LCD Rules
March 11th 20251. ONSITE PCR TESTING BRINGS SIGNIFICANT CLINICAL BENEFITS TO A PRACTICE. - ACCURACY Traditional urine cultures can give false-negative results. - SPECIFICITY Accurate microbial identification leads to targeted treatment. - SPEED Same day results vs. 3-5 days for traditional urine cultures - - - ANTIBIOTIC RESISTANCE MARKERS Improves antimicrobial stewardship 2. MAINTAIN INDEPENDENCE BY INCREASING REVENUE SIGNIFICANTLY THROUGH REVENUE SHIFTING FROM THE REFERENCE LAB TO THE PRACTICE. - Turnkey: Consultation on COLA and CLIA certification, all necessary equipment, standard operating procedures, personnel sourcing and interview, billing and coding training, 3-4 days of onsite training. - Stark Law Compliant: Complies with anti-kickback statutes. - Medicare part B pays at 100%, Med Advantage Plans at 80% - No lab build-out, only 8 linear feet of counter space needed - Z-code procurement for required states 3. BETTER PATIENT CARE LEADS TO BETTER OUTCOMES. - CONVENIENCE Point of care, no third-party referral lab. - TIMELY Results early in the care process. - CORRECT MEDICATION Avoids two trips to the pharmacy. - BETTER OUTCOMES Reduction of recurrent UTI and hospitalizations