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AJP Rep 2014; 04(02): e97-e100
DOI: 10.1055/s-0034-1395990
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prenatal Diagnosis of Fetal Encephalomalacia after Maternal Diabetic Ketoacidosis

Rozalyn Love
1   Department of Obstetrics and Gynecology, Naval Medical Center, Portsmouth, Virginia
,
Amy Lee
2   Department of Obstetrics and Gynecology, Langley Air Force Base, Virginia
,
April Matiasek
3   Department of Radiology, Naval Medical Center. Portsmouth, Virginia
,
William Carter
3   Department of Radiology, Naval Medical Center. Portsmouth, Virginia
,
Marissa Ylagan
1   Department of Obstetrics and Gynecology, Naval Medical Center, Portsmouth, Virginia
› Author Affiliations
Further Information

Publication History

28 June 2014

18 September 2014

Publication Date:
18 November 2014 (online)

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Abstract

Introduction Encephalomalacia in a developing fetus is a rare and devastating neurological finding on radiologic imaging. Maternal diabetic ketoacidosis (DKA) can lead to metabolic and vascular derangements which can cause fetal encephalomalacia.

Case We report the case of a 27-year-old pregnant woman with White's Class C diabetes mellitus who presented in the 25th week of gestation with DKA. Four weeks after her discharge, marked fetal cerebral ventriculomegaly was noted on ultrasound. A subsequent fetal magnetic resonance imaging (MRI) demonstrated extensive, symmetric cystic encephalomalacia, primarily involving both cerebral hemispheres. The pregnancy was continued with close fetal and maternal surveillance. The patient underwent a repeat cesarean delivery in her 37th week. The infant had a 1 month neonatal intensive care unit stay with care rendered by a multiple disciplinary team of pediatric subspecialists. The postnatal course was complicated by global hypotonia, poor feeding, delayed development and ultimately required anticonvulsants for recurrent seizures. He died at the age of 9 months from aspiration during a seizure.

Discussion Although the maternal mortality from DKA has declined, DKA still confers significant neurological fetal morbidity to its survivors.

Keywords

diabetic pregnancy - diabetic ketoacidosis - encephalomalacia

Note

This article was presented at the American College of Obstetricians and Gynecologists Armed Forces District Annual Meeting, Baltimore, MD, October 2013.


 

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