Section 2 - Answer Case description A 31-year-old pregnant woman, multigravida (G3P2), was referred to our outpatient department at 30 weeks of gestation for abnormal growth pattern at the mid-trimester ultrasound scan (3 centile) performed at 20 weeks and 5 days of gestation despite normal morphology of the fetus for this stage. Previous pregnancies were uneventful. Early antenatal care was managed at primary care. Routine first-trimester scan and combined screening demonstrated a reduced risk for aneuploidies. Serologic screening for HIV, hepatitis B, and syphilis was negative, and she lacked immunity for the Rubella virus and Toxoplasmosis. At 31 weeks and 5 days, an ultrasound at our department revealed ventriculomegaly affecting the 3rd, 4th, and lateral ventricles [Figure 1] with hyperechogenic ventricular walls [Figure 2]. At the posterior fossa, a hyperechogenic cerebellum with an apparent loss of substance was observed [Figure 3]. A review of the remaining fetal anatomy also evidenced the presence of Grade 2 echogenic bowel [Figure 4].
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