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2011-04-22-12 Arthrogryposis © Iacovache www.TheFetus.net


Arthrogryposis

Tudor Iacovache, MD.

 Obstetrics and Gynecology Hospital, Brasov, Romania.


Case report

This is a case of a 37 year old G4 P1 who delivered 1 healthy child and underwent 2 terminations of the pregnancy. Her personal and family history were otherwise non-contributive.

The ultrasound exam at 8 weeks showed a viable singleton pregnancy and uterine synechiae.
During the first trimester ultrasound scan at 12 weeks, we saw the fetal head trapped behind this uterine synechiae and the fetus released itself at the end of the exam and moved freely afterwards. Both upper and lower extremities were of normal appearance and showed a normal range of motion. There were no fetal anomalies detected during this exam, nuchal translucency was normal.
We have decided to closely follow-up this pregnancy.

The ultrasound scan at 15 weeks showed an abnormal position of the limbs, fixed position of the feet and fingers. Extremities and fingers showed a minimal movement. These findings were consistent with arthrogryposis.
The subsequent ultrasound at 17 weeks confirmed our diagnosis of arthrogryposis.

The patient opted for a pregnancy termination. The pathologist confirmed our diagnosis of arthrogryposis.
We are not sure if the head entrapment by the synechiae and restricted space in the uterine cavity could have potentially lead to arthrogryposis or if the uterine synechiae was just an accidental finding and did not have any effect on the fetus.

Deering et al. described the fetal head entrapment by the uterine synechiae at a twin pregnancy. The affected twin was severely growth restricted and they suggested that this maybe a consequence of the head entrapment. [1]
We have not found any article describing arthrogryposis as a result of the uterine synechiae.

Images 1,2: 12 weeks, images show head entrapment by the uterine synechiae (arrow).


Images 3,4
: Image 3 shows the abdomen and extremities. Image 4 shows a release of the head which was previously entrapped by the synechiae.


Videos 1,2
: 12 weeks, Video 1 shows the fetus whose head is trapped behind the intrauterine synechiae. Video 2 shows the trapped fetal head which is released on it's own at the end of the video. Both upper and lower extremities were of normal appearance.


Image 5: 17 weeks hand affected by arthrogryposis.



Videos 3,4: Video 3, 15 weeks, shows the arthrogryposis of the lower and upper extremities which was not present on the ultrasound at 12 weeks. Video 4, 17 weeks, shows the arthrogryposis.

 

Videos 5,6
: 17 weeks, video 5 shows the progressive arthrogryposis of the lower extremities. Video 6 shows both lower and upper extremities with arthrogryposis.



Images 6-10: Images of the fetus after pregnancy termination. Note abnormal position of all the extremitites and hands and feet.







References:

1. Deering SH, Heller J, Winkel C, Landy HJ. Intrauterine head entrapment of a second twin by a uterine synechia. Obstet Gynecol. 2003 Oct;102(4):693-5.




 


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