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Case of the Week # 100

Raul Martinez, MD

July 25-August 15, 2003

Unidad Regiomontana de Diagnostico, Monterrey, N.L., Mexico.

Case Report: A 22-year-old woman with no family history of malformations or genetic disorders, due to polyhydramnios was referred to our ultrasound unit at 29 weeks. The following images were obtained:

Three weeks later the patient underwent another examination. This time scalp and upper torso edema was noticed and fetal stomach was no longer visible. Fetal echocardiography was normal. Posturing of the extremities was the same than it was three weeks before. Fetal position in uterine cavity was also the same. The mother was never aware of fetal movements. These images were obtained:

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29-7
29-6

Three weeks later the patient underwent another examination. This time scalp and upper torso edema was noticed and fetal stomach was no longer visible. Fetal echocardiography was normal. Posturing of the extremities was the same than it was three weeks before. Fetal position in uterine cavity was also the same. The mother was never aware of fetal movements. These images were obtained:

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32-15
32-16
32-2
32-9
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32-8
32-4
32-20
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The last examination was performed at 34 weeks. Polyhydramnios had increased, fetal position was the same seen in previous scans, and ulnar deviation of the hands was documented in 3D reconstructions. Doppler analysis of umbilical cord showed absent diastolic flow of umbilical artery, and umbilical vein pulsations were present. Facial diplegia was more evident.

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Considering these findings, delivery was decided. The infant died immediately after delivery.

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Answer

2003-05-19-15 Answer to case of the week # 100 © Martinez www.TheFetus.net

Case Report: A 22-year-old woman with no family history of malformations or genetic disorders, due to polyhydramnios was referred to our ultrasound unit at 29 weeks. Ultrasonography revealed polyhydramnios with an amniotic fluid index of 35, absence of fetal movements, bilateral talipes equinovarus, facial diplegia, and a high resistance index of umbilical artery of 0.81. The following images were obtained:

29-1
29-7
29-6

Three weeks later the patient underwent another examination, showing persistence of the findings mentioned before. This time scalp and upper torso edema was noticed and fetal stomach was no longer visible. Fetal echocardiography was normal. Posturing of the extremities was the same than it was three weeks before. Fetal position in uterine cavity was also the same. The mother was never aware of fetal movements. These images were obtained:

32-12
32-11
32-13
32-14
32-15
32-16
32-2
32-9
32-10
32-8
32-4
32-20
32-17
32-18


Last examination was performed at 34 weeks. Polyhydramnios had increased, fetal position was the same seen in previous scans, and lunar deviation of the hands was documented in 3D reconstructions. Doppler analysis of umbilical cord showed absent diastolic flow of umbilical artery, and umbilical vein pulsations were present. Facial diplegia was more evident.

34-1
34-10
34-13
34-2
34-8
34-6
34-7
34-9
34-14
34-15
34-16
34-17
34-18
34-3
34-4
34-5


Considering these findings, interruption of pregnancy was decided. The infant was severely affected with absence of swallowing and respiratory movement, and died immediately after delivery.

Differential diagnosis:
 

  • Idiopathic polyhydramnios.
  • Fetal hypomobility caused by a central nervous system anomaly.
  • Non-immune hydrops fetalis.

Myotonic dystrophy

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