Case History/examination
A 23-year-old Afghan woman (gravida 3 para 2) at 31 weeks of gestation presented to our clinic following a routine ultrasound examination that had raised concerns regarding placental abnormalities. The patient had previously undergone two cesarean sections (CS) and had an unremarkable medical or familial history. Her first pregnancy, four years prior, concluded with a preterm CS at 36 weeks due to ruptured membranes. During her second pregnancy, she developed gestational diabetes, which was successfully managed with metformin, ultimately resulting in a term delivery. The current pregnancy progressed uneventfully. However, due to her poor socioeconomic status, the patient did not receive appropriate prenatal care and did not undergo the first or second-trimester screening tests or the fetal anomaly scan. The initial ultrasound at 19 weeks revealed an intrauterine gestation consistent with dates, with the placenta forming anteriorly. The follow-up scan at 28 weeks showed multiple masses within the placenta, along with increased placental thickness (77mm), suggesting chorioangiomas or placental cysts as likely diagnoses. Despite these findings, fetal growth remained satisfactory, with no evidence of cardiovascular compromise and a normal amniotic fluid index (AFI=20). Additionally, the patient’s glucose tolerance test results were as follows: fasting glucose was 72, one-hour post-test was 166, and two hours post-test was 127. These results indicated negative findings, suggesting the absence of gestational diabetes. Considering the complexity of the case, the patient was referred for further evaluation.