Ultrasound-guided manipulation of fetal entrapment by a large uterine fibroid







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Case notes


A 34-year-old G2P0010 presents for nuchal translucency at 12 weeks’ gestation. Ultrasound revealed a dolichocephalic fetus (cephalic index of 49) ( Figure 1 ). This was attributed to fetal “entrapment” secondary to compartmentalization of the fetus superiorly due to an anterior, submucosal myoma (8.8 × 9.4 × 8.0 cm) separating it inferiorly from the placenta and amniotic fluid ( Figure 2 ). Nuchal translucency could not be measured and there was concern for long-term compression morbidity. Thus, external manipulation via ultrasound was used to decompartmentalize the fetus.




Figure 1


Fetal entrapment preprocedure

Entrapped fetus with oligohydramnios in superior compartment and normal amniotic fluid in inferior compartment.

Dinglas. Ultrasound-guided manipulation of fetal entrapment. Am J Obstet Gynecol 2015 .



Figure 2


Dolichocephalic fetus preprocedure

Fetal head is compressed by fibroid with cephalic index of 49.

Dinglas. Ultrasound-guided manipulation of fetal entrapment. Am J Obstet Gynecol 2015 .


Gentle, steady pressure with the transabdominal ultrasound probe was applied to the uterine fundus in a maternal caudad vector ( Figure 3 ) ( Video ). The fetus was freed into the inferior compartment containing the amniotic fluid. The nuchal translucency measured 1.7 mm ( Figure 4 ) and the fetus was normocephalic (cephalic index of 74) ( Figure 5 ) with good movement. Anatomical survey at 16 weeks was normal and without previously noted compartmentalization. Cervical length was 3.5 cm. The patient was incidentally found at 21 weeks to have no measurable cervix and subsequently developed premature rupture of membranes, delivering a nonviable infant.


May 5, 2017 | Posted by in GYNECOLOGY | Comments Off on Ultrasound-guided manipulation of fetal entrapment by a large uterine fibroid
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