Antenatal Management of Second Trimester Oligohydramnios and Evolving Abnormal Ultrasound Findings: Case Report

Roshan Daniel,Timor Ilan,Plonka Shira,Kolman Ellen

doi:10.23937/2377-9004/1410183

Abstract

Appropriate patient selection for prenatal intervention in the setting of abnormal antenatal ultrasound findings remains challenging. This case illustrates the course of a complicated pregnancy in a 35-year-old gravida 1 para 0 who presented to our Maternal-Fetal-Medicine clinic at 24.2 weeks gestation with fetal ascites, scalp edema, and oligohydramnios.

Highlights

Throughout this case, intrauterine fluid was manipulated through multiple procedures due to evolving ominous ultrasound findings
Throughout the course of her pregnancy, multiple therapeutic interventions were performed in order to maintain a stable fetal environment, including intrauterine paracentesis, transabdominal amnioinfusion, vesicocentesis, and placement of a peritoneal amniotic shunt
The purpose of this case report is to investigate the role of fetal intervention in second trimester abnormal ultrasound findings and improve the quality of future prenatal consultation and therapy

Summary

Introduction

Throughout this case, intrauterine fluid was manipulated through multiple procedures due to evolving ominous ultrasound findings. An intrauterine paracentesis of ascites fluid was initially performed to decompress the fetal abdomen, alongside an amnioinfusion to correct oligohydramnios. At 28.2 weeks, AFI began to decline, and a distended bladder with a distinct keyhole appearance was seen on ultrasound, consistent with a fetal lower urinary tract obstruction (LUTO). Close monitoring revealed gradually worsening hydronephrosis but stable low-normal AFI over the upcoming weeks. At 25.6 weeks gestation, an intrauterine paracentesis of ascites fluid was performed as both a diagnostic and therapeutic procedure. At 28.2 weeks, the fetal urinary bladder appeared grossly over distended, and revealed a distinct “Keyhole” sign (Figure 3). At 34.5 weeks, a sonogram revealed a sudden drop in AFI (2%), in conjunction with resolving fetal ascites and smaller appearing bladder; all signs pointed to decreased amniotic fluid production and pending renal failure. She is a home maker, and denied any tobacco, alcohol, and drug use

Discussion

Findings

Conclusion