Article Text

Download PDFPDF
An abnormal finding in the third trimester
  1. Hannah Marshall,
  2. Kyle Petrie
  1. Department of Paediatrics, North Middlesex University Hospital NHS Trust, London, UK
  1. Correspondence to Dr Hannah Marshall, Department of Paediatrics, North Middlesex University Hospital NHS Trust, London N18 1QX, UK; hannah.marshall1{at}


A healthy woman presented with an antepartum haemorrhage at 35/40 during a low-risk pregnancy with normal antenatal bloods and anomaly scan at 20/40 gestation. Following an abnormal ultrasound (USS), the baby was delivered by emergency C-section.

A male infant was born in good condition but admitted to the neonatal unit for monitoring. Examination revealed global hypotonia, a weak uncoordinated suck and absent Moro reflex. He had widened sagittal sutures and a large posterior fontanelle. The remainder of the examination was unremarkable. Abnormal bloods are shown in table 1 .

Table 1

Initial newborn blood results

He was treated for suspected sepsis due to jaundice and temperature instability.

Cranial USS was performed immediately ( figure 1 ). Urgent MRI of the brain further characterised these abnormalities ( figures 2–3 ).

Figure 1

Coronal section of cranial ultrasound obtained on day 1 of life.

Figure 2

Coronal section from MRI performed on day 1 of life.

Figure 3

Sagittal section from MRI performed on day 1 of life.


  1. What are the causes for the abnormalities seen in figures 1–3 ?

  2. What investigations should be considered?

  3. What is the diagnosis?

  4. How do we manage this condition?

  5. What are the likely outcomes?

Questions Answers can be found on page 2

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors HM and KP drafted the manuscript jointly.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.