Department of Gynecology Department of Neonatology, Hôpital Félix Guyon - Ile de la Réunion, France
This is a 35-year-old pregnant, G4P3. Since 2000, she has a renal insufficiency. Kidney transplantation was done in 2003. After the surgery, she has been taken several medications to prevent immunologic rejections and anti-hypertensives (Progreff, Immurel, and Brisopopol). She got pregnant on May 2005.
At 13 weeks, the nuchal translucency was 0,5 mm and the triple test was normal. At 24 weeks, the fetal scan was normal and particularly the echocardiogram at 32 weeks. At 34 weeks, the patient was seen routinely. She said that the baby was not moving in the last 24 hours. Her blood pressure was 165/100 with albumin. The non-stress test was normal, without micro-oscillation. A fetal scan was performed with the following findings:
low amniotic fluid
the baby weight was 1610 g
The Pourcelot index was 1, without reverse flow (with notch uterine artery).
cardiomegaly (Figure 1-2) with index cardiothoracic > 0,5
mitral and tricuspid regurgitation during systole (Figure 3)
There was no aortic or pulmonary regurgitation (Figure 4-5-6-7).
The patient was immediately hospitalized and a cesarean section was performed (1620 g; Apgar 0,2 and 6). A tracheal intubation was performed and neonatal reanimation (cardiac massage and adrenalin). A triple antibiotherapy was instituted. The screening for infectious was negative.
An early fetal echocardiography diagnosed a myocardial dysfunction with diastolic and systolic bi-ventricular dysfunction without hydro or hemopericardium. There was either a pulmonary or an aorta insufficiency. At day 6, the echocardiography revealed a normal hemodynamic evolution. The ductus arterius canal was closed. At day three, an extubation was performed. The MRI did not find any neurological anomaly and the electroencephalogram was normal.
The patient was hospitalized from January 11th to February 15th. In conclusion, this baby developed cardiac insufficiency, due to maternal cardiac toxemia with placenta insufficiency.
Four chamber view. Note the cardiomegaly.