Mirror syndrome, also called Ballantyne syndrome, is a rare condition in pregnancy, defined by the presence of the clinical triad of fetal hydrops, placentomegaly and maternal oedema. Any aetiology of fetal hydrops, including rhesus iso-immunization, congenital infection, twin-to-twin transfusion, structural anomalies and fetal malignancies, can lead to the syndrome. The pathogenesis, although not well established, mimics trophoblastic damage and maternal vascular endothelial dysfunction, as is also seen in pre-eclampsia, and, hence, the two conditions may have a similar clinical presentation. They may even co-exist, where a patient with maternal mirror syndrome develops features of pre-eclampsia. A timely, accurate diagnosis and prompt interventions are needed to prevent fetal mortality and maternal morbidity.
Cytomegalovirus is the most common congenital viral infection. Infection can cause developmental delay, sensorineural deafness and fetal death. Fetal damage is more severe when infection occurs in the first trimester of pregnancy. Prenatal ultrasound findings may be cerebral, such as ventriculomegaly, microcephaly and periventricular leukomalacia, as well as non-cerebral, such as echogenic bowel, ascites and pericardial effusion. We present a case of congenital cytomegalovirus infection in which the only ultrasound sign noted at routine second-trimester scan was low-grade echogenic bowel, a soft marker, which progressed to severe disease in the third trimester, when further investigation was prompted, leading to the diagnosis. Patients need to be counselled regarding the possible perinatal prognosis. Ultrasound markers can often but not always predict severity and, hence, counselling can be a challenge.
Conclusion: A meticulous anatomy survey in mid-trimester remains the norm and ultrasound soft markers should prompt comprehensive testing for viral infections in pregnancy.
Objective: To find out the association of ultrasound estimated fetal weight (UEFW) between 10th and 50th centile, in early third trimester and the risk of spontaneous preterm delivery.
Materials and methods:Fetal weight of 965 women with singleton pregnancy was estimated between 28 and 34 weeks. Women with multiple gestation, medical disorders, fetal anomalies and induced labor were excluded. Values of UEFW were converted into centile values and multiples of median (MoM) for each gestational age. The risk of spontaneous preterm delivery was correlated with the UEFW.
Results:Out of 965 subjects 62 were either excluded as per exclusion criteria or lost for follow-up. Out of 91 subjects with fetal weights ≤ 10th centile 17 (18.7%, OR 1.82, p-value 0.003) and out of 180 with that ≤ 20th centile 29 (16.1% OR 1.51, p-value 0.040) had preterm delivery. When the deviation was below 0.85 MoM, 15 out of 73 (20.5% OR 2.08, p-value 0.024) subjects had preterm delivery.
Conclusion:When UEFW in early third trimester is below 20th centile or below 0.80 MoM the risk for spontaneous preterm delivery increases, hence, it may be prudent to be vigilant when the fetal weight is between 10th and 20th centile to avoid preterm delivery.
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