PMC3299365_01
Week 20. Transvaginal colour Doppler ultrasound. The aberrant cotyledon is clearly seen covering the internal os and seems to include the cord insertion. The cervix is very short (9.9 mm) (a) and the Dopper impedances of both the VA and MCA are very low (RI 0.55/PI 0,86) (b, c).
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fig1
Moreover, the umbilical cord seemed to be inserted into this anomalous cotyledon (Figure 1(a)). Interestingly, despite the fetus maintained an adequate growth and the umbilical artery Doppler was normal, the cerebral vessels showed an early and marked decrease of the vascular impedance in both the vertebral (VA) and the middle cerebral arteries (MCAs) (RI 0.55/PI 0.86, both) Figures 1(b) and 1(c).
Week 27. Magnetic resonance. One of the three placental portions seen in the image (c) is clearly situated below the fetal head (white arrow) covering the internal os, inside the funnel of a very short and incompetent cervix (black arrow).
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fig2
At 27 weeks, a magnetic resonance confirmed the sonographic findings (Figure 2) and the colour Doppler ultrasound showed a very shortened cervix (6,9 mm) with an umbilical cord clearly inserted into this cervical anomalous cotyledon (Figure 3).
Week 27. Transvaginal colour Doppler ultrasound. The aberrant cotyledon is seen covering the internal os including the umbilical cord insertion. The cervix has become slightly shorter (6,9 mm).
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fig3
At 27 weeks, a magnetic resonance confirmed the sonographic findings (Figure 2) and the colour Doppler ultrasound showed a very shortened cervix (6,9 mm) with an umbilical cord clearly inserted into this cervical anomalous cotyledon (Figure 3).
Week 28. Transvaginal colour Doppler ultrasound. The aberrant cotyledon is clearly seen covering the internal os but the cervix has become longer (13 mm) (a). There is a normalization of the VA and MCA impedance (RI 0.82/PI 1.97, RI 0.90/PI 2.64) (b, c).
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fig4
Surprisingly, one week afterwards, the cervix became slightly longer (13 mm) (Figure 4(a)). This improvement, perhaps a consequence of the progesterone action, brought along an increase and normalization of the VA and MCA impedance (RI 0.82/PI 1.97 and RI 0.90/PI 2.64) see, Figures 4(b) and 4(c).
The placenta succenturiata after delivery. An inferior cotyledon may be seen with the insertion of the umbilical cord. Three main lobes, anterior and posteriorly situated, are seen in a superior position. The membranous pars was thick and fibrous. UC: umbilical cord, C plus white arrow: cervical aberrant cotyledon, L1-3 plus black arrows: main lobes, M: membranous pars.
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fig5
The placental findings were confirmed after birth (Figure 5).