Implantation of the zygote outside the uterine cavity occurs in 2% of all pregnancies. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The prevalence of ectopic pregnancy in all women presenting to an emergency department with first-trimester bleeding, lower abdominal pain or a combination of the two is between 6 and 16%. When diagnosis is made early, the product of conception can be removed safely by laparoscopic surgery and be submitted for histological examination. Tubal rupture is a complication of late diagnosed tubal pregnancy which is more difficult to treat conservatively and often indicates tubectomy or segmental resection. In 5 to 15% of treated ectopic pregnancy cases, remnant conception product parts are diagnosed and may require a final methotrexate (MTX) injection. Rare sites of ectopic pregnancy include interstitial, cervical, abdominal and cesarean scar pregnancies. Our manuscript reviews and illustrates the use of novel sonographic methods such as three-dimensional ultrasound, multiplanar view, in combination with color and power Doppler ultrasound, for early detection of ectopic tubal pregnancy and of other, rare locations of ectopic pregnancy.
We are reporting the case of a 40 years old 2nd gravida, 1 para. At 26 weeks of the reported pregnancy, fetal movements stopped suddenly and almost completely within 24 hours. At 30w2d she was referred for Doppler scan and fetal biometry. In ultrasonography (US) normal morphology was seen. Biometry corresponded to 28w1d. Outstanding observation was the permanent immobility of the entire fetus in four-dimensional ultrasound (4D-US). We found during two US examinations an abnormal KANET test, the first at 30w2d with a score of 3 points, and the second at 31w4d, with a score of 4 points. Cardiotocography (CTG) demonstrated complete loss of variability and accelerations. The patient developed severe polyhydramnios at 33 weeks. After lower segment cesarean section (LSCS) because of breech position, the newborn required ventilation, and passed away after 5 days.Keywords: Fetal brain death syndrome, KANET, Fixed fetal heart rate, Fetal akinesia, Pena-Shokeir, Arthrogryposis. Source of support: Nil Conflict of interest: None declared CASE REPORTWe are reporting the case of a 40 years old 2nd gravida, 1 para, with spontaneous pregnancy. This lady had an uneventful previous medical and obstetrical history of an uncomplicated first pregnancy, with normal vaginal delivery at term. In this pregnancy she had normal pregnancy surveys with normal ultrasound (US) scans at 6 and 8 weeks. She had a low risk evaluation of her 1st trimester nuchal translucency screening, and a normal morphology scan at 20 weeks. Though she changed her obstetrician thrice until 26 weeks, she adhered to regular checkups with her obstetricians every 4 weeks. She felt fetal movements first at 18 weeks and emphasized that they were more frequent and vigorous than in her first pregnancy where she started to notice fetal movements only at 21 weeks. At 26 weeks of the reported pregnancy, fetal movements stopped suddenly and almost completely within 24 hours. She went to an emergency unit where she was reassured. At 30w2d she was referred for Doppler scan and fetal biometry. In US normal morphology was detected. Biometry corresponded to 28w1d. Abdominal circumference minus 2.4 SD, cerebellum diameter minus 2.2 SD indicated moderate intrauterine growth restriction (IUGR). Apparently normal neurosonoanatomy with normal ventricular width was noticed. Normal Doppler flow parameters of fetal (umbilical artery, middle cerebral artery) and maternal side (uterine arteries) and moderate polyhydramnios were observed. Outstanding observation was the permanent immobility of the entire fetus in 4D-US. The fetus was in breech position with extended legs, the tongue was protruding from a slightly gaping mouth with moderate retrognathia, and the fists were clenched. We found during our two US examinations an abnormal KANET test, the first at 30w2d with a score of 3 points, and the second at 31w4d, with a score of 4 points. Cardiotocography (CTG) demonstrated complete loss of variability and accelerations, in repeated CTG samples with registration over more than 30 ...
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