Case Of ………. Case 1 . A.Y 19 year- old gravida 2 para 1 was referred to Razan Center – Nablus on 24/03/2012 at GA 29 + as a case of hydrops fetalis . US revealed moderate amount of feta ascites and mild skin edema . There was no other structural abnormality identified .
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Fetal M – mode echocardiography revealed Supraventricular tachycardia at a rate of 240 beats per minute with no evidence of atrio ventricular block .
Treatment intiated with Digoxin ( Transplacentally ) 250 mcg 4 times a day for 3 days .
After 3 days , ( 28/03/2012 ) cardioversion noted with heart rate 139 bpm .
31/3 /2012; 3 days later , there was intermittent SVT again with moderate ascites .
Over 96 hours , cardioversion noted with heart rate was 160 bpm , with no evidence of heart block .
Ultrasound findings revealed a viable fetus structurally normal, biometries consistent with 20 + weeks’ with normal thin placenta and an adjacent thickened, nonhomogeneous placenta with a diffuse multicysticappearance ocuppying the lower segment .
the patient was counseled on the risks of continuing the pregnancy. Especially that coexisting molar pregnancy was confirmed to be covering the internal cervical os as a complete placenta previa.
An amniocentesis was performed which returned as a normal 46, XY karyotype
During the following 9 weeks , she developed several episodes of APH which settled spontaneously.
At 29 weeks, the patient presented to the hospital with a marked increase in vaginal bleeding and passage of large clots. Her labs remained stable with a hemoglobin of 11.0 g/dL.
The decision was made to hospitalize the patient for the remainder of her pregnancy due to the persistent vaginal bleeding in a complete previa molar pregnancy.
2 days later , delivery was done by CS in the presence of excessive vaginal bleeding .
Uterus was well contracted after evacuation of the molar placenta with no bleeding by using aggressive medical management .
In summary, pregnancies complicated by CHMF may result in a viable liveborn infant approximately 25 % of the time.
Thus, anticipation for increased surgical blood loss and possible cesarean hysterectomy may assist in decreasing maternal morbidity and mortality.
Review of literature suggest that absence of the ductusvenosus is associated with a high incidence of fetal anomalies and adverse outcomes, including
At 31 weeks , growth velocity start to be declined but with normal doppler and amniotic fluid .
US revealed triplet pregnancy , one of them was miscarried confirmed by colordoppler .
At 22 weeks , on 11/08/2012 , she was referred as acardiacfetus.
Triplet , MonochorionicTriamnioticcmplicated by TRAP sequense and TTTS ( moderate ) between twin 1 and 2 .