A 36-year-old Rhesus (Rh)-positive, gravida 2, para 1 woman was referred at 36 weeks of gestation in view of hepatomegaly noted in the fetus during third-trimester scan. High-resolution ultrasound examination (Voluson E 10, Wipro GE Healthcare Private Limited, Austria) showed single intrauterine fetus with normal growth parameters, hepatosplenomegaly (liver span 75 mm [95 centile = 62 mm], spleen transverse diameter 63 mm [95 centile = 55 mm]), placentomegaly, and a uniformly echogenic bowel. There was polyhydramnios; however, there were no signs of hydrops. Detailed echocardiographic examination showed structurally normal heart with cardiomegaly (cardiac circumference to thoracic circumference ratio: 0.66), normal ventricular function, and pericardial effusion. Doppler examination of umbilical artery showed high-resistance flow; middle cerebral artery (MCA) showed increase in diastolic flow with increased peak systolic velocity [ ]; ductus venosus showed normal flow. The picture was suggestive of a hyperdynamic circulation. We noted an intrahepatic arterial connection between portal vein and descending aorta showing high-velocity flow in the connecting vessel [ ]. Mesentery was echogenic depicting mesenteric steal phenomenon. There were no other associated gross anomalies. The patient had spontaneous onset of labor at 36 weeks 4 days and had a vaginal delivery. The baby expired 3 h after delivery, due to high output cardiac failure.
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机译：鉴于妊娠晚期胎儿肝肿大，一名36岁的恒河猴（Rh）阳性孕妇gravida 2，第1段妇女在妊娠36周时被转诊。高分辨率超声检查（Voluson E 10，奥地利Wipro GE Healthcare Private Limited）显示具有正常生长参数，肝脾肿大（肝跨距75毫米[95百分= 62毫米]，脾横径63毫米[95百分比= 55毫米]），胎盘肿大和回声均匀的肠子。有羊水过多。但是，没有出现积液的迹象。详细的超声心动图检查显示心脏结构正常，心脏肥大（心围与胸围之比：0.66），心室功能正常和心包积液。脐动脉多普勒检查显示高阻力血流。脑中动脉（MCA）的舒张血流增加，同时收缩期峰值速度增加[]；静脉导管显示正常血流。图片暗示有高动力循环。我们注意到门静脉和降主动脉之间的肝内动脉连接显示了连接血管中的高速流动[]。肠系膜是回声的，描述了肠系膜盗窃现象。没有其他相关的总体异常。该患者在第36周第4天自然分娩，并经阴道分娩。由于高输出心力衰竭，婴儿在分娩后3 h过期。
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