*23-year-old pregnant female
What is the most likely diagnosis?
Answer
Answer: Fetal death
Case Discussion:
US and Doppler US images showing Spalding sign, maceration, oligohidramnios, no cardiac and intracranial blood flow.
The loss of a fetus at any stage is a fetal death. Fetal death must be confirmed by ultrasonographic examination. Fetal death is diagnosed by visualization of the fetal heart and the absence of cardiac activity on ultrasonographic examination (1).
Ultrasound features of fetal death are absent fetal heart beat, absent fetal movements, occasional findings [overlapping of skull bones (Spalding sign), gross distortion of fetal anatomy (maceration), soft tissue oedema: skin >5 mm], and uncommon findings [thrombus in fetal heart, gas shadow in fetal heart (Robert’s sign)] (2).
References:
1. MacDorman MF, Kirmeyer S, Wilson EC. Fetal and perinatal mortality, United States, 2006. Natl Vital Stat Rep. 2012 Aug 28. 60(8):1-22.
2. Merz E. Ultrasound in Obstetrics and Gynecology, Volume 1 Obstetrics. Thieme. (2011) ISBN:3131614722.