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Impaired renal function in the mother may result in a high false positive rate in Down Syndrome screening

A 38-year-old woman presented in her third pregnancy with dichorionic diamniotic twins following in vitro fertilisation (IVF). Both previous pregnancies had followed IVF with the first ending in miscarriage at 9 weeks and the second in a ventouse delivery at term. The antenatal period had been uneventful in the last pregnancy. In her present pregnancy she had an uncomplicated antenatal period and ultrasound scans at 12, 20, 28, 32 and 36 weeks showed normally growing fetuses and placentae to be high anterior. However, at 38 weeks, a repeat scan showed a change in placental position which was low posterior and lying across the internal os. Following this scan, she was admitted to the antenatal ward for elective caesarean section at 39 weeks. The day after her admission she spontaneously ruptured the membranes and an emergency caesarean section was performed under general anaesthesia. Intraoperative findings showed the uterus to be completely dextrorotated through 1808 with engorged veins of the broad ligament stretched over the lower segment. The left ovary and tube were stretched across the anterior surface of the uterus. The uterus was successfully de-rotated and a lower segment caesarean section was performed. Both the babies were delivered in good condition. The placentae were noted to be posterior extending to just above the internal os. The mother recovered uneventfully and both mother and babies were discharged on the fifth postoperative day.