Is it possible to detect large transmural infarction and extensively necrotic decidua basalis on ultrasound?
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I had a stillbirth at 32 weeks due to intrauterine growth restriction associated with extensive infarction. My last ultrasound at 29 weeks showed my baby was growing well and in the 75th percentile. A doppler was requested at this appointment but was not completed. I had an APH at 30 weeks and was admitted to the hospital. No ultrasound was completed and again no doppler. The cause of her death was a large transmural infarct that involved 50% of the placental volume. The decidua basalis was also extensively necrotic in association with the infraction. How long does it take these infarctions to form and could these infarctions (or the thickened area of placenta/necrosis of decidua) have been seen on an ultrasound (or doppler) at any point? Thank you.
Posted Sat, 4 Jan 2014 in Abortion and Stillbirth
Answered by Dr. Mahesh Koregol 56 minutes later
Brief Answer: more information Detailed Answer: Hi I would like to answer in detail. Can you provide information on following 1. Do you have hypertension 2. Please upload all important investigations done 3. Please scan and attach ultrasound copy Regards
Follow-up: Is it possible to detect large transmural infarction and extensively necrotic decidua basalis on ultrasound? 1 hour later
My blood pressure was slightly elevated throughout this pregnancy. In my previous pregnancy I developed severe pre-eclampsia and had an emergency c-section at 37 weeks. I have attached a copy of my readings at my midwife appointments. I have also attached a copy of the hospital notes from my APH at 30 weeks. During this admission my blood pressure was 136/92. Please also find my last scan before my stillbirth- 29 weeks. No scan was done between this time and the birth at 32 weeks, only CTG monitoring while in hospital (for two days at the time of my APH at 30 weeks) which were normal. Thank you.
Answered by Dr. Mahesh Koregol 3 hours later
Brief Answer: hypertension Detailed Answer: Hi, I am sorry for your loss. Though it is complicated, i will try explaining in easier non medical language for you to understand: 1) Normally when placenta develops, the blood vessels supplying baby through placenta join with maternal prepregnancy blood vesels. This process is called invagination in medical language. 2) When there is hypertension, possible preeclampsia ( especially you had in previous pregnancy), this process is affected and blood vessels connection gets affected which becomes narrow and not able to carry enough amount of oxygenated blood to placenta. 3) In such circumstaces lack of enough blood circulation leads to infarction and hence sudden stoppage of blood supply to baby from placenta which is prime reason for fetal death. 4) Your question was you wanted to know how long this process takes? Answer is it starts around 20 weeks and slowly progresses. If blood pressure is well controlled, this can be postponed. If not depending upon severity of blood pressure, it goes on worsening and can be detected by regular doppler ultrasound at least once in 15 days. 5) If the doppler shows decreased blood flow, immediate termination of pregnancy to be performed. When you had APH, it probably had infearction started and pogressed slowly which ended in fetal demise. I hope your question is answered. Let me know if you have any followup queries. Regards, Dr. Mahesh Koregol
Follow-up: Is it possible to detect large transmural infarction and extensively necrotic decidua basalis on ultrasound? 31 minutes later
Thank you for explaining that to me. Just to clarify when I had my APH at 30 weeks the infarction most likely started. If an ultrasound/doppler was performed at the time of my APH would it have shown any signs of this reduced blood flow? Could it have shown, if not at this time, perhaps in the two week period before her death? Thanks again.
Answered by Dr. Mahesh Koregol 3 minutes later
Brief Answer: Yes Detailed Answer: Hi, Thats possible. Looking back now, i feel doppler ultrasound could have showed decreased blood flow. Regards