Giancotti Antonella, Spagnuolo Antonella, D'Ambrosio Valentina, Pasquali Gaia, Muto Brunella, Bisogni Francescantonio, La Torre Renato, Anceschi Maurizio Marco, De Gado Fabrizio
Department of Obstetrics and Gynecology, "Sapienza" University Umberto I Hospital, Viale del Policlinico, 155, 00161 Rome, Italy.
J Med Case Rep. 2011 Jan 27;5:37. doi: 10.1186/1752-1947-5-37.
We describe a case of early and persistent reverse end-diastolic flow in the middle cerebral artery in a fetus with severe ascites. These features are associated with a rare liver malformation known as ductal plate malformation.
A 28-year-old Caucasian woman was referred to our high-risk obstetric unit at 24 weeks' gestation for fetal ascites detected during a routine ultrasound examination. During her hospitalization we performed medical investigations, including a fetal paracentesis, to detect the etiology of fetal ascites. The cause of fetal ascites (then considered non-immune or idiopathic) was not evident, but a subsequent ultrasound examination at 27 weeks' gestation showed a reverse end-diastolic flow in the middle cerebral artery without any other Doppler abnormalities. A cesarean section was performed at 28 weeks' gestation because of the compromised fetal condition. An autopsy revealed a rare malformation of intrahepatic bile ducts known as ductal plate malformation.
Persistent reverse flow in the middle cerebral artery should be considered a marker of adverse pregnancy outcome. We recommend careful ultrasound monitoring in the presence of this ultrasonographic sign to exclude any other cause of increased intracranial pressure. To better understand the nature of these ultrasonographic signs, additional reports are deemed necessary. In fact in our case, as confirmed by histopathological examination, the fetal condition was extremely compromised due to failure of the fetal liver. Ductal plate malformation altered the liver structures causing hypoproteinemia and probably portal hypertension. These two conditions therefore explain the severe hydrops that compromised the fetal situation.
我们描述了一例患有严重腹水的胎儿大脑中动脉舒张末期血流早期且持续反向的病例。这些特征与一种罕见的肝脏畸形——导管板畸形有关。
一名28岁的白种女性在妊娠24周时因常规超声检查发现胎儿腹水而被转诊至我们的高危产科病房。在她住院期间，我们进行了医学检查，包括胎儿腹腔穿刺术，以查明胎儿腹水的病因。胎儿腹水的原因（当时认为是非免疫性或特发性的）并不明显，但随后在妊娠27周时的超声检查显示大脑中动脉舒张末期血流反向，且无其他多普勒异常。由于胎儿状况不佳，在妊娠28周时进行了剖宫产。尸检发现一种罕见的肝内胆管畸形，即导管板畸形。
大脑中动脉持续反向血流应被视为不良妊娠结局的一个标志。我们建议在出现这种超声征象时进行仔细的超声监测，以排除任何其他颅内压升高的原因。为了更好地理解这些超声征象的本质，认为有必要增加报告。事实上，在我们的病例中，经组织病理学检查证实，由于胎儿肝脏功能衰竭，胎儿状况极差。导管板畸形改变了肝脏结构，导致低蛋白血症并可能引发门静脉高压。因此，这两种情况解释了严重水肿危及胎儿状况的原因。
