Acute polyhydramnios in term pregnancy may be caused by multiple nuchal cord loops
Ultrasound Obstet Gynecol 2010; 35: 253–254Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.7543Picture of the MonthAcute polyhydramnios in term pregnancy may be caused by multiple nuchal cord loopsY. PERLITZ*†, I. BEN-SHLOMO* and M. BEN-AMI*†*Department of Obstetrics and Gynecology, The Baruch Padeh Medical Center, Poriya, Tiberias and †Rappaport Faculty of Medicine,Technion, Israeli Institute of Technology, Haifa, IsraelAcute severe polyhydramnios developing in the thirdtrimester or at term is a rare condition. Although thereare many possible fetal or maternal causes for thisphenomenon, in the majority of cases a speciﬁc etiology Multiple nuchal cord loopscannot be found. We describe our imaging ﬁndings andmanagement of a case of severe acute polyhydramnios Fetal headdeveloping at the 40th gestational week. A 24-year-old healthy mother of two children wasreferred to our obstetrics department at 41+2 gestational Fetal bodyweeks of her third pregnancy owing to very recentdistention of her uterus. Her pregnancy had beenuneventful, including a 22-week sonographic anomalyscan. No other screening tests were performed duringpregnancy. During a visit for a routine check-up1 week earlier, a sonogram revealed normal amnioticﬂuid volume and adequate gross body and breathing Figure 1 Doppler ultrasound image showing the fetus in themovements. Current sonography at admission revealed longitudinal position, face down; multiple nuchal cord loops aresevere polyhydramnios, reaching an amniotic ﬂuid index wrapped around its neck.of 40 cm. A Doppler examination of the umbilical corddiscovered multiple cord loops wrapped around the in-utero ability to swallow amniotic ﬂuid. This in turnfetal neck (Figure 1). A healthy baby was delivered by could have led to accelerated, late-onset polyhydramnios.Cesarean section. The estimated amniotic ﬂuid volume We propose that in any case of such sudden and late devel-was approximately 2.5 L. The umbilical cord was tightly opment of polyhydramnios, the fetal neck area should bewrapped three times around the fetal neck, forming a scanned by ultrasonography, and the presence of nuchalbulk which limited the free movement of the neck, but no cord loops should be considered as a possible cause of thestrangulation marks were evident around the baby’s neck. polyhydramnios. Third-trimester or term pregnancy acute onset polyhy-dramnios is rare, usually mild, and not associated withstructural defects1 . However, in the severe polyhydram- Referencesnios state, in 75% of cases signiﬁcant fetal abnormalities 1. Hill LM, Breckle R, Thomas ML, Fries JK. Polyhydramnios:are found that predominantly involve the central nervous Ultrasonically detected prevalence and neonatal outcome. Obstetsystem, gastrointestinal tract, heart and genitourinary Gynecol 1987; 69: 21–25. 2. Barkin SZ, Pretorius DH, Beckett MK, Manchester DK, Nel-tract2 . Esophageal atresia often leads to polyhydram- son TR, Manco-Johnson ML. Severe polyhydramnios: incidencenios, usually early in the third trimester3 . We found some of anomalies. AJR Am J Roentgenol 1987; 148: 155–159.circumstantial evidence in the literature that impediment 3. Brantberg A, Blaas HG, Haugen SE, Eik-Nes SH. Esophagealto swallowing by goiters4 , cervical teratomas5 – 7 or skin obstruction – prenatal detection rate and outcome. Ultrasoundabnormalities8 is associated with polyhydramnios. In our Obstet Gynecol 2007; 30: 180–187. 4. Perelman AH, Johnson RL, Clemons RD, Finberg HJ, Clewellcase, the lack of any of these abnormalities in the newborn WH, Trujillo L. Intrauterine diagnosis and treatment of fetalmakes it tempting to postulate that the bulky accumula- goitrous hypothyroidism. J Clin Endocrinol Metab 1990; 71:tion of cord loops around its neck may have limited the 618–621.Correspondence to: Dr Y. Perlitz, Department of Obstetrics & Gynecology, The Baruch Padeh Medical Center, Poriya, MPO Lower Galillee15208, Tiberias, Israel (e-mail: email@example.com)Copyright 2010 ISUOG. Published by John Wiley & Sons, Ltd. PICTURE OF THE MONTH
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