Insights into Congenital Body Stalk Anomaly Coupled with Placenta Accreta Conditions: A Case Report.

Abstract

BACKGROUND Body stalk anomaly is a rare abdominal wall defect thought to be a consequence of abnormalities in the development of cephalic, caudal, and lateral embryonic folding and defect in closure of the body wall during embryogenesis. Placenta accreta spectrum (PAS) is a general term frequently used to encompass accreta, increta, and percreta conditions. This report describes a distinct pregnancy with a body stalk abnormality and PAS. CASE REPORT A 34-year-old woman, gravida 2 para 1, with no previous abortions, was referred to the Maternal-Fetal Medicine Unit for further investigation of omphalocele at 29 weeks of gestation. Although the defect was not suspected during the first trimester scan, subsequent obstetric ultrasounds revealed a severe abdominal wall defect, kyphoscoliosis, a very rudimentary umbilical cord, and limb defects. Ultrasound examination of the placenta showed increased vascularity at the placental bed and loss of the retroplacental-myometrial radiolucent interface, leading to diagnosis of suspected body stalk anomaly, with PAS. Cesarean delivery was performed at 30 weeks, with plan for conservative treatment for PAS, including uterine-sparing surgery. Baby was born weighing 800 g and measuring 25 cm in length, with an APGAR score of 1-1. Clinical examination confirmed a very short umbilical cord and severe abdominal wall and limb defects. However, due to significant hemorrhage during surgical procedure, cesarean hysterectomy was done. CONCLUSIONS The management of body stalk anomaly with PAS is challenging. Preconception counseling is important to detect abnormalities earlier, and a multidisciplinary care team is needed to create patients' treatment plans. This congenital defect is invariably fatal.