A transient finding of fetal head entrapment caught in a uterine synechium or amniotic band

Background Uterine synechia are bands of fibrous tissue that when seen on prenatal ultrasound are not felt to pose significant risk to a fetus outside of early pregnancy loss. On the contrary, amniotic bands are diagnosed when bands of amniotic tissue are found to entrap and possible amputate involved fetal parts. Case presentation Ultrasound imaging demonstrated a twin pregnancy affected by entrapment of twin B’s head in a uterine synechium versus an amniotic band at 11 weeks + 0 days. The entrapment persisted until the second trimester. After a review of still images and video clips with a fetal surgeon, the patient was scheduled for possible fetal surgery. Upon arrival at 16 weeks + 0 days, the entrapment was observed to have spontaneously resolved. The patient experienced preterm premature rupture of membranes at 17 weeks + 6 days, and developed chorioamnionitis at 18 weeks + 5 days. Shortly after diagnosis with chorioamnionitis, she delivered spontaneously at 18 weeks + 5 days. Postnatal hysteroscopy demonstrated uterine synechium at the uterine fundus, which was resected. Conclusions This is the first case of fetal head entrapment by a uterine synechium.

Avaliação ultrassonográfica no espessamento endometrial: revisão de literatura

Introdução: A avaliação ecográfica do endométrio permite a análise minuciosa da mucosa uterina na prática clínica ginecológica, com o intuito de auxiliar no manejo das patologias endometriais. Neste artigo, fazemos uma revisão narrativa para avaliar o real papel da ecografia pélvica na visualização das doenças endometriais. As alterações uterinas, como pólipos, miomas, sinéquias uterinas, hiperplasia e câncer endometrial são morbidades frequentes na população feminina, tanto nas pacientes em idade reprodutiva como nas que estão na pós-menopausa. Os métodos de avaliação endometrial têm obtido diversos avanços nos tempos atuais, sendo o ultrassom transvaginal o método de escolha para investigação inicial das doenças endometriais, tanto nas pacientes com sangramento genital, quanto nas mulheres assintomáticas principalmente na pós-menopausa. Conclusão: A ecografia é o exame primordial e elementar na investigação de pacientes com sangramento uterino anormal ou sob suspeita de outras doenças que alteram o padrão endometrial, conduzindo o prognóstico do quadro investigado. Palavras-chave: Ultrassonografia, Doenças Uterinas, Endométrio. ABSTRACT Introduction: The ultrasound evaluation of the endometrium allows a detailed analysis of the uterine mucosa in gynecological clinical practice, in order to assist in the management of endometrial pathologies. In this article, we make a narrative review to evaluate the real role of pelvic ultrasound in the visualization of endometrial diseases. Uterine changes such as polyps, fibroids, uterine synechia, hyperplasia, and endometrial cancer are frequent morbidities in the female population, both in postmenopausal and post-reproductive age patients. Methods of endometrial evaluation have achieved several advances in the present times, with transvaginal ultrasound being the method of choice for the initial investigation of endometrial diseases, both in patients with genital bleeding and in asymptomatic women, especially postmenopausal women. Conclusion: Ultrasonography is the primary and elemental examination in the investigation of patients with abnormal uterine bleeding or under suspicion of other diseases that alter the endometrial pattern, leading to the prognosis of the investigated condition. Keywords: Ultrasonography, Uterine Diseases, Endometrium.