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Dolichocephaly and ventriculomegaly (10 mm).

Fetal sagittal views where we observed hydrops fetalis with ascites and hydropericardium. Thorax was compressed by the distended abdomen.

Fetal abdomen with ascites.

Fetal kidney with a cystic renal dysplasia appearance.

Fetal leg and foot which looked like talipes because we could clearly see tibia and fibula un the same plane as the foot bones.

We performed a fetal echocardiography which suggested the presence of a small VSD.

Umbilical artery Doppler was normal.

Because of the placental width we thought that this could be the expression of a TORCH infection. Also, the fact that the patient had an extremely early preeclampsia, and the anechoic images we observed in the placenta made us think in a partial molar pregnancy case, even thought the frequency of this pathology, specially in at this gestational age is really rare.

Blood b-hCG was over 100.000 U/ml.

A cordocentesis was performed a couple of days later.

The TORCH lab confirmed the diagnosis of fetal rubella. Fetal karyotype was 69XXY.

The final diagnosis of this case is Partial molar pregnancy + Fetal Rubella.

Figure 18: fetal karyotype.

At 24 she delivered a stillborn which is showed in the following images:

Image of the fetus along with the placenta.

Images of the fetal and maternal face of the molar placenta. In the detailed views we observe a few molar cysts.

Image to show the placental thickness.

Detail of the placental cysts.

Fetal back.

Fetal profile (note the small, low set malformed ears, micro retrognathia).

Detail of the fetal hand with syndactyly of third and fourth digits (bilateral) and the simian crease.

In the necropsy, we confirmed the prenatal diagnosis of  VSD and multicystic renal dysplasia.

Detail of VSD which is showed in these three images.

Detail of fetal kidneys.