摘要:

Objective: Prenatal ultrasonography can localize the level of the spinal cord malformation, allowing prediction of the potential postnatal neurological deficit and functional prognosis. Methods: This study has two evaluations: (a) a retrospective prenatal review of 26 fetuses with spinal dysraphism (1987–1991), and (b) a follow-up descriptive study of patients (1971–1981) who underwent closure of the spinal lesion and ventricular shunting in the neonatal period. Results: Prenatal ultrasound evaluation enabled the accurate definition of the last intact vertebral level which allows separation of fetuses into three functional groups (last intact level L2, L3–4, L5–sacral). Patterns of ambulation, urinary and bowel continence, and school performance vary according to level of spinal lesion and the neurological deficit. The need for ventricular shunts, the incidence of other spinal malformations and surgical interventions did not vary with the level of the spinal lesion. Conclusions: The functional outcome for patients with myelomeningocele is variable; however, distinct patterns emerge based on the level of spinal dysraphism and the resultant neurological deficit. By relating the level of the fetal spinal lesion to outcome data, more precise functional prognoses can be given to f

ISSN:1015-3837    

DOI:10.1159/000264297

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Background: The applications of cordocentesis are limited by its safety. Cordocentesis is performed either freehand or with the aid of a fixed needle guide. Recent reports suggest a loss rate of 1–7% using the freehand technique. The potential influence of technique on the perinatal loss rate has not been examined. Study Design: The procedure-related loss rates of two fetal diagnosis and treatment units, one in the United States (10 operators) and one in Japan (15 operators), who perform diagnostic cordocentesis with the aid of a fixed needle guide is calculated from a prospectively maintained database and compared to the published experience of large centers who use a freehand technique. Results: A total of 1,260 diagnostic cordocenteses were performed. The mean gestation at sampling was 29.1 ± 5 weeks. The umbilical vein was punctured in 90%. There were 12 procedure-related losses yielding an overall perinatal loss rate of 0.9%. There was no relationship between the risk of a loss and the number of prior procedures the operator had performed. Losses were more often associated with puncture of the umbilical artery (41.7 vs. 9.2%, p = 0.002). Eleven of 12 losses were associated with a postprocedure bradycardia. Eight fetuses who died had either a trisomy or triploidy, 1 had renal agenesis, 2 had severe early-onset growth restriction and 1 had rhesus disease. For all diagnoses other than a chromosome abnormality and severe fetal growth restriction, the procedure-related loss rate from diagnostic cordocentesis was 0.2% (2/1,021). Conclusion: This study suggests that technique is a variable in the loss rate for cordocentes

ISSN:1015-3837    

DOI:10.1159/000264298

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Severe twin-to-twin transfusion syndrome presenting before 28 weeks’ gestation is associated with a high neonatal mortality and morbidity due to polyhydramnios-related very premature delivery or intrauterine death of one or both twins. Management options include serial amniodrainages or laser coagulation of the intertwin placental anastomoses; however, early antenatal prognostic factors are lacking. Serial amniocenteses were performed in 9 pregnancies with twin-to-twin transfusion syndrome presenting with second-trimester polyhydramnios, and serial measurements of amniotic fluid pressure were made. Although in 8 cases the pre-drainage pressure was above the 95th centile of the normal range for singleton pregnancies, the pressures were lower in the pregnancies resulting in two livebirths than in the cases where one or both babies died. This study suggests that patients presenting with intra-amniotic pressure > 17 mm Hg cannot be safely managed by serial amniodrainage

ISSN:1015-3837    

DOI:10.1159/000264299

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

In order to evaluate the efficiency of antenatal diagnosis and postnatal management of urinary malformations, we reviewed 142 cases from October 1988 to December 1992 with abnormalities detected by routine ultrasound. A routine karyotype analysis showed 7 fetuses with chromosomal defects. Nine cases with isolated bilateral urinary tract dilatation underwent pelvic fetal urine sampling in order to assess antenatal renal function. The 142 cases comprised 107 children born alive (group I) and 35 intrauterine fetal deaths (group II). In group I, 79 kidneys had a transient pyelectasis, and 11 kidneys had a hydronephrosis which disappeared at postnatal examination. Among 103 pyelectasis cases detected during the second trimester of pregnancy, 22 kidneys were pathological after birth (positive predictive value (PPV) = 21.4%) with 17 ureteropelvic junction obstructions. The PPV was 66% when ultrasound showed hydronephrosis at the end of pregnancy. In that group, 15 cases had vesicoureteric reflux, with 5 cases where the homolateral upper urinary tract was morphologically normal in utero. Group II comprised 27 fetuses with multiple defects in other systems, and 8 cases with urological defects only 7 of which had urethral anomalies. This study confirmed the benefit of antenatal diagnosis for uropathies, and the advantage of prenatal consultation between pediatric surgeon and parents in order to explain what anomalies are involved and to program postnatal follow-up.

ISSN:1015-3837    

DOI:10.1159/000264300

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The criteria for the detection of fetal pyelectasis are still controversial. Prenatal and postnatal data from 2,170 consecutive pregnant women who underwent at least one antenatal ultrasound scan were prospectively studied. Fetal pyelectasis was defined on the basis of a mean renal pelvis dimension > 5 or 10 mm before or after 28 weeks of gestation, respectively. Pyelectasis was detected in 95 (4.4%) fetuses. Eighty-nine among them were explored after birth. In 13 (13.7%) cases, an obstructive urinary tract abnormality, a severe vesicoureteral reflux, or a megaureter were diagnosed postnatally. In 29 (30.5%) cases, pyelectasis was confirmed postnatally, while complementary investigations ruled out an obstruction of the urinary tract. The incidence of urinary tract malformations was thus 0.60%, while the positive predictive value was 13.7%. We recommend to use a value not < 10 mm of the renal pelvis mean dimension beyond 28 weeks of gestation as a threshold for detection of fetal upper urinary tract obstruction, in the absence of ureteric and/or bladder dilation. Any value between 5 and 10 mm measured during the 2nd trimester of gestation should be confirmed by a second ultrasound examination performed during the 3rd trimester, before being considered pathological.

ISSN:1015-3837    

DOI:10.1159/000264301

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The positive predictive value of 1st-trimester nuchal translucency for the diagnosis of fetal aneuploidy is reported to range from 19 to 72% in retrospective series and from 2.8 to 4.8% in prospective studies. In order to analyze the biases accounting for such discrepancies, we retrospectively analyzed a consecutive series of 66 cases of translucency and studied the rate of aneuploidy as a function of sonographic findings and maternal age. The aneuploidy rate was significantly higher in the 23 cases in whom translucency involved the fetal trunk (65%) than in the 43 cases in whom translucency was confined to the nuchal area (16%). This rate was not significantly higher in septated translucencies. These trends persisted after adjustment for maternal age, but the rate of chromosomal anomalies was twice lower in younger mothers. Among the 46 cases in whom the maternal age was < 35 years, 10% of the 30 fetuses with localized nuchal translucency had an abnormal karyotype. In contrast, the rate of aneuploidy was 85% among the 7 cases with diffuse translucency for whom the maternal age was 35 years or above. These findings confirm that both maternal age and size of the translucency should be taken into account to evaluate the risks of aneuploidy.

ISSN:1015-3837    

DOI:10.1159/000264302

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Congenital megaureter in a solitary kidney (CMSK) is a life-threatening disease. From January 1988 to December 1993, we treated 9 patients for CMSK (2 cases with unilateral renal dysplasia and 7 with unilateral renal agenesis). In 7 cases, the malformation was detected by prenatal ultrasonography and urological counseling. The ages at first postnatal observation ranged from 24 h to 5 years (mean = 8 months). The postnatal urological workup included: serum renal function screening, urinary system ultrasonography, a micturition cystogram, intravenous pyelography and a nuclear renal scan. The therapy of choice was decided on the basis of renal function. One emergency divertive procedure was performed after birth, in 3 cases of renal failure in the first 2 weeks of life. The remaining cases were operated electively at an average age of 20 months. In 2 cases that underwent delayed surgical elective correction and in 1 of the 3 cases that underwent an emergency diversion, some degree of renal failure still persists. In our opinion, prenatal diagnosis, accurate postnatal urological workup and strict postoperative follow-up are fundamental to avoid the devastating consequences of CMSK on the affected child.

ISSN:1015-3837    

DOI:10.1159/000264303

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The outcome analysis of 10 pregnancies at risk for neonatal alloimmune thrombocytopenia (NAIT) is presented. An experimental protocol of cordocentesis and maternal administration of intravenous immunoglobulin (IVIG) is compared to a control group of older untreated affected siblings. The outcome in pregnancies treated with IVIG shows improved fetal platelet count in 70% and no intraventricular hemorrhage. We conclude that maternal administration of IVIG appears to improve clinical outcome in fetuses at risk for NAIT.

ISSN:1015-3837    

DOI:10.1159/000264304

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Background: Lymphangiomas are commonly diagnosed by prenatal ultrasound. These anomalies are most often cervical, but occasionally present in the axilla, thorax and abdomen. We present a case in which intrauterine drainage was followed by an uneventful vaginal delivery. Case: A 30-year-old G4P3 female was referred to our ultrasound unit at 36 weeks of gestation for evaluation of a large cystic chest wall mass. Ultrasound demonstrated a large septated mass along the left chest wall up to the apex of the axilla of the fetus. The left arm was held in 90° abduction due to the mass. Because of concern about shoulder dystocia at delivery the cystic mass was aspirated under ultrasound guidance and the patient underwent an uneventful induction of labor. Conclusion: Intrauterine decompression of large axillary lymphangiomas may obviate concern about a shoulder dystocia and avoid the need for cesarean sections

ISSN:1015-3837    

DOI:10.1159/000264305

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Umbilical cord cysts diagnosed antenatally present a challenge to the clinician as they may be associated with adverse perinatal outcomes including abnormal karyotypes and stillbirths. We present a case of an umbilical cord cyst diagnosed by routine ultrasound at 30 weeks of gestation. Findings on sonography included unidirectional movement of echogenic particles suggesting a large varix of the umbilical vein. The patient delivered vaginally at 39 weeks and histopathology confirmed the diagnosis.

ISSN:1015-3837    

DOI:10.1159/000264306

出版商:S. Karger AG    

年代:1996

数据来源: Karger