PMC3699162_01
(Upper panel) Biventricular inflow Dopplers were abnormal with greater flow in early diastole (E) compared with late diastole atrial systole (A), potentially in keeping with abnormal myocardial diastolic function. (Lower panel) Four-chamber view of the heart demonstrating mild cardiomegaly associated with increased biventricular wall thickness or hypertrophy and no chamber dilation. The calculated combined cardiac output was normal for gestational age. LV, left ventricle; RA, right atrium; RV, right ventricle.
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Fetal echocardiography showed moderate cardiomegaly and biventricular hypertrophy with normal end diastolic ventricular dimensions and normal systolic function (Fig. 1). Pulsed Doppler findings were consistent with mild diastolic dysfunction with increased ventricular inflow velocities during early diastole (Fig. 1), abnormal tissue velocities, and increased a-wave reversal in the hepatic veins.
(Upper panel) Peritoneal aspiration and transfusion. The white arrow delineates the needle inserted into fetal abdomen for drainage of ascites and intraperitoneal transfusion. (Lower panel) Posttransfusion middle cerebral artery Dopplers. The peak systolic velocity is within normal range for this gestation; however, very high diastolic flow is seen. A, hemorrhagic ascites; L, fetal liver; P, hydropic placenta.
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Upon entry into the peritoneal cavity, the aspirated fluid was noted to be bloody rather than serous as expected in fetal hydrops (Fig. 2). An unusual MCA finding was the presence of very high diastolic flow velocities suggesting cerebral redistribution (Fig. 2).
The stillborn fetus shows hydrops and extensive petechial hemorrhages on skin.
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Pathological examination of the fetus showed extensive petechial hemorrhages into the skin (Fig. 3), with bloody fluid in the pleural and peritoneal cavities.