Presentation
Patient on management for pre-eclampsia, para 3+0 gravida four. Gestation by dates (GBD) 26 weeks 5 days, with complaints of reduced fetal movements for two days.
Patient Data
A single non-viable intrauterine pregnancy in cephalic presentation demonstrating overlapping of the calvarium/skull bones along the bilateral coronal suture lines (positive Spalding sign), plus fetal subcutaneous tissue edema changes are noted. The fetal liver organ appears enlarged spanning a length of 39.2 mm longitudinally with diffusely thickened and accentuated echoes from the walls of the intra-hepatic biliary radicles reminiscing the usual night starry sky appearance. Relative crowding at the fetal chest region with interspersed miniature gaseous foci noted is likely attributed to Robert's sign.
The liquor is reduced in amount and distribution with the maximal pocket volume measuring 2.73 cm. The placenta is anterior, not low lying and shows no detachment from the uterine wall. The composite fetal maturity by femoral length corresponds to 23 weeks 0 days gestation. The cervix is closed and measures 3.01 cm in length.
Bilateral maternal uterine arteries show persistent dicrotic flow notching within the uterine arterial waveforms with resultant elevated pulsatility indices (right uterine artery PI = 1.65; RI = 0.73. left uterine artery PI = 1.77; RI = 0.74) accompanied by arterialized collateral formations on the right and visible kinking plus relative coiling of the uterine arteries.
Case Discussion
Kinking, and coiling of the maternal uterine arteries characterized by dicrotic flow notching at the bilateral prediastolic take-offs in their waveforms with resultant elevated pulsatility, and resistive indices in the current pre-eclamptic patient status. Multiple arterialized collateral formations are noted coursing at the maternal right uterine artery inferior-medially. Features consistent with intrauterine fetal death and oligohydramnios at 23 weeks gestation are present with superimposed features of fetal hepatomegaly and hepatitis, Roberts sign, Spalding sign, subcutaneous tissue edema, and oligohydramnios.
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