Investigations and treatment
The patient underwent various studies described below.
A blood test showed mild anaemia with haemodilution (haemoglobin 11.8 g/dl and haematocrit 33.8%), significant proteinuria (urine protein/creatinine index of 0.47 mg/mg) and transaminasemia (ALT 54 U/L. AST 37 U/L) as the most remarkable data. The cardiotocographic record showed a normal preterm foetal pattern and regular uterine dynamics. The abdominal ultrasound examination revealed foetal hydrops with ascites and pericardial effusion, as well as suspicion of placentomegaly. The patient was admitted to the hospital for maternal and foetal hydrops and monitoring of uterine dynamics.
The next day, a foetal morphological ultrasound was performed that confirmed the presence of ascites with displacement of the intestinal loops to the pelvis and placentomegaly, with a thickness of 80 mm. In addition, pericardial effusion marked by mild cardiomegaly and significant generalized foetal subcutaneous oedema was visualized. No other morphological alterations were found, and the complete Doppler study did not demonstrate other haemodynamic alterations. The maximum velocity of the middle cerebral artery was normal in several repeated measurements (36 cm/s, MoM 1.1), and foetal anaemia could not be diagnosed at the time of the examination.
The serological study was negative for the presence of maternal-foetal infections associated with foetal hydrops (parvovirus B19, toxoplasma, rubella, syphilis, EBV, VH6, VZV and HIV). An indirect Coombs study with the usual panel was negative.
The most relevant ultrasound images and clinical examination results for the patient are presented in Figures 1, 2, 3 and 4.