Antenatal renal vein thrombosis after accidental electric shock in a pregnant woman.

Abstract

In utero RVT is not commonly suspected in the differential diagnosis of a renal mass in the fetus. To date, only six antenatal cases have been published. While the causes are diverse and the pathophysiologic mechanisms unclear, antenatal RVT is frequently associated with fetal distress. We report a new case of antenatal RVT, revealed by ultrasonography performed at 36 weeks' gestation for fetal distress, after an accidental electric shock 2 weeks earlier. CASE REPORTA 32 year old gravida 8 para 5 woman consulted the emergency department at 34 weeks' gestation after having received an electric shock. While mowing her lawn in bare feet, she accidentally grasped a partially unprotected area of her lawn mower's electric cable sheath. According to witnesses, her right hand firmly grasped the cable, after which she fell on her knees without losing consciousness. Her history suggested vertical flow of electric current from her right hand (entry point) to her bare feet (exit point), in that electric current travels to the area of lower resistance.She reported decreased fetal movements. The results of the obstetric examination were normal. Fetal well-being appeared normal, assessed by five cardiotocograms over a 24 h period and by fetal ultrasonography, which showed no pathologic conditions as compared to her 22 weeks' ultrasonography. No burn marks were observed. Her electrocardiogram showed a sinus tachycardia. She left the department after 24 h of observation, the fetal condition and hers considered normal.Two weeks later (36 weeks' of pregnancy), the patient returned to the emergency department, reporting an absence of fetal activity for the last 48 h. She also complained of pain in the fifth digit of her right hand, which was found to be the site of a punctiform third degree burn lesion. The patient was experiencing spontaneous uterine contractions, and a cardiotocogram revealed fetal tachycardia (170 beats/min), markedly reduced beat to beat variability, absence of accelerations, and sporadic late decelerations. The placenta, amniotic fluid index, and Doppler umbilical flow were all normal on sonographic

Prenatal Diagnosis of Renal Vein Thrombosis: A Case Report and Literature Review

“…There are no reports of prenatal intervention, and all therapeutic options have focused on supportive care in the neonatal period and on postnatal thrombolytic/anticoagulant drugs. Tissue plasminogen activator, unfractionated heparin, low-molecular-weight heparin and warfarin have all been used during the neonatal period in the reported cases of fetal RVT [6,19,21,24]. We could not find any report of maternal anticoagulation in the management of fetal RVT, and given the fact that heparin does not cross the placenta, the role of maternal anticoagulation may only have significance if the mother has an identified thrombophilia requiring anticoagulation.…”

“…Bleeding of the adrenal cortex occurred in 1 neonate who received a combination of tissue plasminogen activator and unfractionated heparin [6]. All of these cases survived; however, in 1 case, a nonfunctional kidney was found during follow-up evaluations [19]. The other cases did not receive any specific antithrombotic/anticoagulation therapy and underwent observational and supportive treatment such as hydration.…”

“…Five cases, including our case, received thrombolytic/anticoagulation treatment after birth [6,19,21,24]. Bleeding of the adrenal cortex occurred in 1 neonate who received a combination of tissue plasminogen activator and unfractionated heparin [6].…”

“…Fetal RVT is associated with long-term adverse outcomes including an increased risk of renal failure [19,22]. Even in cases with normalization of the renal size and no signs of reduced perfusion, long-term follow-up revealed compromised renal function [32].…”

“…We excluded 46 papers in which the RVT was diagnosed postnatally. Thus, 21 articles describing 22 cases of prenatally diagnosed RVT were included in the present study [2,3,6,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]. Of these pregnancies, 19 were singleton and 3 were twin pregnancies.…”