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.