IUGR OR SKELETAL DYSPLASIA OR RENAL DYSPLASIA


At times we get a few patients , whom we are reluctant to give a definitive label , as we are not very sure of what is happening. This is one such case . This was a 24 year old primi gravida  . She had no history of consanguinity. She had no history of Diabetes, systemic hypertension or thyroid disorder. Her 1st trimester scan had confirmed her dates and gestational age was assigned as per LMP ( at a different centre ).

As it can be seen , the GA was around 20 weeks , but the AUA was around 17 weeks. All parameters – BPD, HC, AC, FL are < 2.3 %tile and all other long bones are  < 5.0 %tile.

 

 

 

iugr

 

IMG_20140520_2_5

 

IMG_20140520_2_10

The kidneys and the urinary bladder appear to be normal.

IMG_20140520_2_16

 

Amniotic fluid appears to be adequate.

 

IMG_20140520_2_18

 

 

IMG_20140520_2_22 IMG_20140520_2_21

The following report is of the same patient after 5 weeks  3 days.

image

 

The GA was around 25 weeks , but the AUA was around 19 to 20 weeks. All parameters – BPD, HC, AC, FL are < 2.3 %tile and all other long bones are  < 5.0 %tile.

Prominent placentomegaly seen .

PLACENTOMEGALY DD SKE DYS IUGR _1

 

Oligohydramnios seen.

 

 

PLACENTOMEGALY DD SKE DYS IUGR _6

 

PLACENTOMEGALY DD SKE DYS IUGR _2

 

PLACENTOMEGALY DD SKE DYS IUGR _7

 

PLACENTOMEGALY DD SKE DYS IUGR _17 PLACENTOMEGALY DD SKE DYS IUGR _16

Fetal kidneys are hyperechoic and enlarged.

PLACENTOMEGALY DD SKE DYS IUGR _15

 

PLACENTOMEGALY DD SKE DYS IUGR _13 PLACENTOMEGALY DD SKE DYS IUGR _12

Umbilical arterial P.I. and R.I. are higher for the GA.

PLACENTOMEGALY DD SKE DYS IUGR _4

 

 

At this point a diagnosis of  Placentomegaly , Symmetrical Intra Uterine Growth Restriction , Probable renal dysplasia with oligohydramnios was suggested . The patient  was referred by her consultant to a higher centre . The patient opted for termination of pregnancy as the 2nd opinion was also not favourable. But she had a spontaneous abortion few hours before the planned procedure. The fetus and the placenta underwent autopsy . The findings are summarised below :

Placenta showed focal areas of infarct and calcification 

Cord with only two vessels seen  and umbilical cord measured 20 cms in length.

Lungs and spleen show congestion.

Kidneys with adrenal were normal .

The cause of death was Placental Insufficiency due to Placental Infarct and abnormal umbilical cord vessel anatomy .

Please look at the placenta again . The infarcts are made out clearly.

 

 

 

 

 

5 thoughts on “IUGR OR SKELETAL DYSPLASIA OR RENAL DYSPLASIA

  1. I’ve been working in ultrasound for about 18years and I have never seen a patient with infarcted uterus this was very; interesting and I learned
    a lot thank you for this article

    Like

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