A 27-year-old gravida 3, para 0-1-1-1 pregnant woman with diabetes mellitus type 1 presented at 37 0/7 weeks’ gestation for scheduled induction of labor for preeclampsia without severe features. Her pregnancy was otherwise complicated by fetal truncus arteriosus, marginal cord insertion, and a single umbilical artery with plans for multidisciplinary neonatal support and stabilization at the time of delivery. Growth ultrasonography at 34 1/7 weeks’ gestation demonstrated an estimated fetal weight of 2,734 g (70th percentile), and biweekly biophysical profile was normal with no evidence of amniotic fluid volume disturbances, hydrops, or pericardial effusions.

Her history was notable for prior preterm birth at 33 3/7 weeks’ gestation due to preeclampsia with severe features and treatment-resistant central nervous system dysfunction. During her prior pregnancy, she was hospitalized for diabetic ketoacidosis. Delivery was complicated by a 1-minute shoulder dystocia. Her first neonate weighed 3,020 g and was subsequently diagnosed with a clavicular...

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