Cystic hygroma in one gemel: diagnosis and outcome of pregnancy. Perinatal Journal 2014;22(3):SE40
- Department of Obstetrics and Gynecology, Clinical Center of Vojvodina, University of Novi Sad Medical Faculty- Novi Sad SR
- Institute of Railway- Belgrad SR
- University of Novi Sad Medical Faculty- Novi Sad SR
Mirjana Bogavac, Department of Obstetrics and Gynecology, Clinical Center of Vojvodina, University of Novi Sad Medical Faculty- Novi Sad SR,
Conflicts of Interest
No conflicts declared.
Cystic hygroma is seen as abnormally enlarged nuchal thickness mostly with septa inside and filled with liquid-lymph usually seen during late first or second trimester of pregnancy. This finding, especially seen during the first trimester of pregnancy is highly associated with chromosomal abnormalities, most commonly with Turner’s syndrome, but however trisomies 21, 18 and 13 are also prevalent.
The aim was the presentation of successfully completed pregnancy by C-section, in a patient with prenatally diagnosed cystic hygroma in diamnotic-dichorionic twin pregnancy (DCDA) after selective embrioreduction in 15 week of gestation (WG).
It is a presented case of successfully completed pregnancy by C-section complicated with gestational diabetes, hypertension and embrioreduction in 15 WG due to confirmed anomaly in DCDA twins.
Case: Patient 33 years old and 12WG with confirmed pregnancy of DCDA twins was admitted into the Clinical Center of Vojvodina, Department of Obstetrics and Gynecology Novi Sad due to a suspected anomaly of one fetus. During ultrasouund examination twin pregnancy DCDA in 12 GW was noted wherein CRL of one fetus was 44mm with regular heart action and septated cystic hygroma in transversal cross-section to 13 mm. The other fetus: CRL 60mm with normal morphology and regular heart action. After two weeks the patient was admitted into the clinic in 15 WG for a scheduled intervention–selective embrioreduction. The intervention was successful. The patient was disharged home with advise to report in two weeks for early amniocentesis of other vital fetus. The patient did not want amniocentesis to be performed. During ultrasound control in 30 WG polyhydramnion was diagnosed and because of positive family history of diabetes glucose stress test was performed. Diabetes diet was introduced of 2200 kCal. Due to hypertension a therapy with methyldopa was administered in 36 WG to which the patient reacted well.The patient was admitted into the clinic due to regular contractions, and considering the ultrasoundly estimated weight of fetus of 3800 g, gestational diabetes, occurrence of variable decelerations on CTG recordings it was decided on the operative completion of pregnancy. A female baby was born, weight 3760 g and 21 cm lenght, Apgar score 9/10. Postoperative course was well, the patient was discharged home four days after the operation together with her child.
Case study points out to the importance of chorionicity being diagnosed as early as possible in twin pregnancies. Case study indicates the importance of prenatally diagnosed anomaly in one twin, and also success of ultrasound invasive procedures in treatment of twin pregnancy with anomaly of one fetus and healthy other fetus. The pregnancy was completed successfully in term with expulsion of a healthy newborn, and after a series of ultrasound examinations and diagnostic procedures.
Twins, cystic hygroma, selective embrioreduction.