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.