I'd like to present a case of a patient with a previous uneventful pregnancy at term and a healthy boy, a second twin pregnancy with two girls born at term, who died with 8 months of age. Despite extensive research no death cause could be found.
In the current third pregnancy at the screening ultrasound at 20 weeks a series (at least 5) of cysts inserted on the chorionic plate of the placenta and protruding into the amniotic cavity was observed.
The cysts were not only in close proximity of the umbilical (three vessel) cord inseertion on the placenta but two cord vessels were circumscribing the cysts as on fig.1.
Therefore an exact attribution of the cysts to the chorionic plate or the umbilical cord was not possible. The fetal karyotype by amniocentesis was 46,XX.
As the pregnancy progressed the cysts increased in volume with the two major cysts growing up to a diameter of ca. 7-8 cm. at 30 weeks. At 30 weeks fetal growth was restricted at the 5th percentile for gestational age, although the Doppler flow of the unmbilical artery was normal. A substantial reduction of amniotic fluid with a negative PROM test was ascertained . The pregnancy is ongoing and the patient still feels strong fetal movements despite the Redman-Daws criteria are not satisfied on the computerized CTG due to absence of high movements. The short term variability on the CTG is 5.6.
My questions are:
- This is the first time in 27 years I have seen such cysts, anybody out there with some similar experience?
- Are the reduction of amniotic fluid, the reduction of high variability and the growth restriction in connection to some genetic problem of the fetus rather than a placental or cord (insertion) insufficiency?
- I don't expect an answer, when should I deliver this baby?
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