Early Antenatal Diagnosis Research Articles

LAPAROSCHISIS: ABOUT A CASE REPORT AND LITERATURE REVIEW

Laparoschisis is a congenital anomaly characterized by the protrusion of abdominal organs, predominantly the intestines, through a defect in the abdominal wall, typically observed on the right side. It is categorized into simple and complex types based on the extent of the defect and involvement of other organs. The estimated prevalence of laparoschisis is approximately 1 in 10,000 births, with variations noted in different regions. Interestingly, certain areas, like New York and Georgia exhibit an increasing trend, particularly among younger mothers. In Morocco, a study carried out at the Les Orangers hospital in Rabat in 2020 showing that the laparoschisis represent 5.1% of musculoskeletal malformations in newborns (equivalent to 1.7per 10,000 total births). Prenatal ultrasound is the primary diagnostic tool, enabling early detection of the abdominal wall defect and protruding organs. Magnetic resonance imaging (MRI) can provide additional information for diagnosis. Treatment options for laparoschisis include primary repair, performed shortly after birth, and delayed closure, which is postponed for a certain period after birth, depending on case-specific factors such as defect size, condition of protruding organs, and the presence of complications such as stenosis and atresia. Prognosis is influenced by the gravity of the malformation and associated conditions, necessitating close obstetrical and neonatal monitoring with tailored interventions for optimal outcomes. To illustrate the practical aspects of laparoschisis management, we present a case study involving a live-born infant diagnosed with laparoschisis at 34 weeks gestation using prenatal ultrasound. A comprehensive one-stage surgical repair was performed on the newborn. This case highlights the importance of early antenatal diagnosis through ultrasound, potential complications, and immediate and secondary management strategies for optimal outcomes in affected infants.

Acalvaria: the first case report from Nepal

Introduction and importance: Acalvaria is a rare congenital malformation in which the flat bones of the cranial vault, dura mater, and associated muscles are absent while the central nervous system usually remains unaffected. It is an extremely rare congenital anomaly with only a handful of cases being reported in literature. Case presentation: The authors report a case of a 2-month-old male infant with acalvaria who was delivered at home and brought to our centre with the complaint of an abnormally soft skull. He was evaluated in a primary centre in rural Nepal. Parietal bones were missing bilaterally but no other abnormalities were found during the physical examination and investigations. Major differential diagnoses like anencephaly, cephalocele, osteogenesis imperfecta type II, and hypophosphatasia were ruled out with the help of history, physical examination, and available investigations and the case was diagnosed as acalvaria. Clinical discussion: Acalvaria is a post-neurulation defect which is associated with anomalies of various organ systems. Radiological diagnosis, with supportive laboratory investigations, is the most reliable method of antenatal diagnosis. Conclusion: Acalvaria is known to have a dismal prognosis and all the living cases with long-term follow-up are mentally retarded and physically disabled. Early and reliable antenatal diagnosis can reduce the economic, physical, and psychological burden associated with this fatal disease, especially in low-income countries.

Evaluation of Fetomaternal Outcome in Expectant and Active Management of Term Prelabour Rupture of Membranes

Background: PROM is a complex condition with multifactorial etiology, including factors like multigravida, low socioeconomic status, concomitant infections, late symptom presentation, and a history of preterm PROM. Conventional management strategies include expectant management, waiting for spontaneous labor, and active management, involving induction with oxytocin or prostaglandins. Objectives: This prospective cross- sectional observational study aimed to evaluate fetomaternal outcomes in both expectant and active management of term PROM. Methods: Conducted at the Obstetrics and Gynecology Department of Rangpur Medical College Hospital, the study included 50 pregnant women with a history of PROM, gestational age ≥37 weeks, and spontaneous membrane rupture. Data were collected from March to September 2019 using purposive sampling. Demographic information was recorded, and clinical examinations were performed. Data were processed, analyzed, and compared between active management (Group-A) and expectant management (Group-B). Results: The study population's age ranged from 17 to 35 years, with a majority aged 20-25 years (42.0%). Most patients were from urban areas (52.0%), with 52% belonging to a socioeconomically disadvantaged class. Group-A, which underwent active management, showed a significantly higher rate of delivery within 12 hours (80.0%) compared to Group-B (48%). Both groups had similar induction-to-delivery intervals. Vaginal deliveries were more frequent in Group-A (84% vs. 64%), while Group-B had a higher rate of C-sections due to fetal distress. Group-B experienced more maternal complications, including puerperal sepsis, wound infections, and postpartum hemorrhage. Neonatal outcomes were better in Group-A, with higher Apgar scores at both 1 and 5 minutes. Conclusion: Active management was associated with better outcomes in term PROM cases compared to expectant management. Early antenatal diagnosis and risk factor identification are essential tools.....

Prenatal diagnosis of non-janiceps type of cephalopagus conjoined twins: a case report

BackgroundConjoined twin pregnancy is a very rare variety of twin pregnancy which results from the failure of complete separation of a zygote after 13 days, ‘cephalopagus’ being the rarest variety of such twin pregnancies. Two forms of cephalopagus conjoined twins have been described in the literature: Janiceps (two faces are on the either side of the head) and non-janiceps (with one head and a single face); non-janiceps type being even rarer. The features that may hint towards the diagnosis on ultrasound include inseparable fetal bodies, unvarying relative positioning of the two fetuses, both heads persistently at the same level to each other, bi-breech or bicephalic presentations and a single umbilical cord with more than three vessels. 3-D ultrasound and Fetal MRI may help in confirmation of this rare entity.Case presentationA 19-year-old primigravida, presented at 12 weeks of gestation for antenatal ultrasound. Ultrasonography showed evidence of a conjoined twin with a single head and single face, fused thoracic cavities with single heart, two lungs, fused upper abdomen with shared stomach and liver, separate pelvic cavities with two different urinary bladders and two pairs of upper and lower limbs. Fetal MRI corroborated these findings. The pregnancy was terminated vaginally, and cephalopagus fetus was delivered. The parents were appropriately counselled for future pregnancies.ConclusionsA very rare case of non-Janiceps variety of cephalopagus conjoined twin gestation which was detected at 12 weeks of gestation by antenatal ultrasound and confirmed on fetal MRI. Early antenatal diagnosis is extremely important for appropriate and timely management as the prognosis is very poor in such twins. Antenatal ultrasound and fetal MRI prove very beneficial in this aspect as well as for diagnosis of other associated fetal abnormalities.

A Study of Fetomaternal Outcome in Relation to Major Degree Placenta Previa: An Experience at a Tertiary Care Hospital

Background: Placenta previa is one of the major causes of antepartum hemorrhage. Although placenta previa accounts for approximately 0.4 – 0. % of all pregnancies, still it remains a major cause of fetomaternal morbidity and mortality. Aim: To determine the incidence of major degree placenta previa and its relation to fetomaternal outcome in a tertiary care hospital. Methods: This is a prospective observational study which was carried out in the department of Obstetrics and Gynecology Hayatabad medical complex, a tertiary care hospital in Peshawar Khyber Pakhtunkhwa from January 2022 to December 2022. Study was started after ethical approval was taken from institutional ethical committee. Total 35 pregnant women with ultrasonographic diagnosis of major degree placenta previa were enrolled in the study after fulfilling inclusion and exclusion criteria. Detailed history was taken, relevant Obstetrical examination was performed and relevant baseline labs and pre-op workup was done. All the relevant data was entered in a predesigned proforma and fetomaternal outcome was studied in addition to the incidence of major degree placenta previa. Results: Total no. of deliveries were 5712 in the study period. Total number no. of major degree placenta previa were 35 making its incidence as 0.6%. In present study majority of the patients presented between age 21-35 years. All the patients with a diagnosis of major degree placenta previa were multigravida and there was no single case of primigravida in the present study. Majority patients were unbooked. Majority of the patients ended up in emergency C/Section due to massive bleeding episode. Previous C/Section was the most important risk factor found in present study. 29 women required blood transfusion, 5 women had accidental diagnosis of the morbidly adherent placenta and cesarean hysterectomy was done in 4 cases. Uterine packing was done in 16 cases. There was no maternal mortality in the present study. Majority of the patient delivered between 33-36 weeks of gestation and majority of the babies had a birth rate of > 2.5Kg. Practical implication Patients with or without previous history of cesarean section and with major degree placenta previa diagnosed on ultrasonography should be booked and admitted earlier in Tertiary Care Hospital with all pre-op preparation to prevent maternal morbidity and mortality and better neonatal outcome. Conclusion: The higher fetomaternal morbidity and mortality, associated with placenta previa can definitely be curtailed by early antenatal diagnosis of placenta previa, advance planning, timely referral, delivery at a tertiary care hospital with availability of round the clock blood bank facility, NICU facility and obstetric ICU / HDU facility. Keywords: Major degree Placenta previa, maternal mortality, perinatal mortality, fetomaternal morbidity.

Limb Body Wall Complex: A Case Report

Limb-body wall complex (LBWC) is a rare, congenital defect defined by lateral body-wall defects, limb reduction abnormalities and/or craniofacial defects. The developmental pathogenesis as well as the etiology of LBW complex is controversial and has no sex or familial predilection. The poor prognosis of LBWC necessitates an early antenatal diagnosis. Serum alpha-fetoprotein measurement and ultrasonographic examination is the key to prenatal diagnosis. Prenatally, the abnormal fetoplacental attachment can be detected ultrasonographically by the end of the first gestational trimester. Postnatal, the examination of placenta, umbilical cord and membranes is crucial in confirming the diagnosis of LBWC. The present case is associated with amniotic adhesive bands, thoraco-abdominoschisis, minor encephalocele, and belongs to the category of LBWC with craniofacial defects.

Epidemiological profile of congenital anomalies detected during antenatal ultrasound in three imaging centers in the city of Ouagadougou

Objectives: To study congenital anomalies discovered during antenatal care in three medical imaging centers in the city of Ouagadougou. Specifically, the aim was to determine the prevalence of antenatal malformations on ultrasound, to identify the different types of malformations detected and to determine the average gestational age (GA) of discovery of CAMs in our context. Materials and Methods: This was a retrospective and prospective multicenter cross-sectional study conducted in the imaging departments of the following three health facilities: the University Hospital of Bogodogo (CHUB), the Nina Polyclinic, and the Yati Medical Clinic. The study was carried out from January 1, 2016, to October 31, 2019. It included all women who had a fetal malformation during obstetrical ultrasound performed during the study period. Results: Fetal malformations represented 1.10% of all obstetric ultrasounds performed in the three medical imaging centers in the city of Ouagadougou. The mean GA of discovery of CAMs was 27 weeks 2 days. The most common malformations were (in decreasing order) the central nervous system (67.10%), the urogenital system (18.62%), the abdomen (14.72%), the digestive system (13.85%), the skeleton (13.42%), the cardiovascular system (8.23%), and the respiratory system (5.19%). An abnormality of the amniotic fluid was associated with 35.50% of the malformations detected. Conclusion: The prevalence of congenital anomaly in our study is similar to that of other studies and obstetric ultrasound plays a key role in its early antenatal diagnosis”.

Fetal growth retardation in multiple pregnancy: anthropometrical and haemodynamic criteria of early antenatal diagnosis

Ultrasound investigation o f feta l biometry and haemodynamic indices in fetoplacental system during pregnancy since 14 weeks was carried out in 53 women havingtwins as a result o f spontaneous pregnancy or using o f assisted reproductive technology methods. The frequency and possible reasons oflU G R development in multiple pregnancy were analyzed. To predict the possibility o f IUG R in II and III trimester o f multiple pregnancy the mathematic model was worked out based on the standard fetometric indices measuring at 14-16 weeks o f pregnancy.

Conservative versus Radical Management of Morbidly Adherent Placenta: An Audit

Abstract Background: Maternal and neonatal morbidity and mor-tality are associated with abnormal placentation and obstetric hemorrhage. To reduce morbidity and mortality in morbidly adherent placentas, a high index of suspicion, early antenatal diagnosis, adequate patient counselling, scheduled surgery at a well-equipped institution, and anticipation of high volume blood transfusion are the essential steps. Aim of Study: The aim of this study was to reach the best way of management of abnormal adherent placentathrough evaluation of conservative and radical management of cases ofplacenta accreta over last three years in Mansoura University Hospital. Patients and Methods: A retrospective observational study conducted in Obstetrics and Gynecology Dept. of Mansoura University Hospital. We reviewed the medical records of 250 women who diagnosed as invasive placenta from the beginning of (2017) to the end of (2019). The main aim to reach the best way of management of abnormal adherent placenta through evaluation of conservative and radical management of cases of placenta accreta over last three years in Mansoura University. Results: There was statistically significant higher median volume blood loss, packed RBCs units, fresh frozen plasma and platelet units with radical management than with conserv-ative management. Regarding maternal complications, bladder injury, ureteric injury, major vessel injury, wound infection, coagulopathy, re-admission and ICU admission were higher incidence among cases in radical group than cases with conservative management. Grade 3 was present among cases with radical management only (30.5%) while grade 1 was higher among cases with conservative management 96.9%. Conclusion: According to our study, conservative man-agement in G1 (placenta accreta) is the recommended man-agement option, well-planned cesarean hysterectomy in G3 (placenta percreta) is the only management option. While G2 (placenta increta) can be managed either radically or conserv-atively according to bleeding degree and bleeding control.

Placenta Accreta Overlying a Caesarean Section Scar: A 10-Year Experience in a Tertiary-Care Centre in Portugal.

Placenta accreta spectrum disorders are among the leading causes of maternal morbidity and mortality and their prevalence is likely to increase in the future. The risk of placenta accreta spectrum disorders is highest in cases of placenta previa overlying a previous cesarean section scar. Few studies have evaluated placenta accreta spectrum disorders in Portugal. The aim of this study was to review the cases of placenta accreta spectrum overlying a cesarean section scar managed in a Portuguese tertiary center over the last decade. Retrospective, cross-sectional study, with data collected from hospital databases. Only cases with histopathological confirmation of placenta accreta spectrum were included. During the study period, 15 cases of placenta accreta spectrum overlying a cesarean section scar were diagnosed (prevalence 0.6/1000). All cases were diagnosed antenatally. A transverse cesarean section was present in all cases; 13 were managed by a scheduled multidisciplinary approach, while two required emergent management. Total or subtotal hysterectomy was performed in 12 cases. There were no cases of maternal or neonatal death. Histopathological evaluation confirmed nine cases of placenta accreta, three cases of placenta increta and three cases of placenta percreta. Early antenatal diagnosis is important for a programmed multidisciplinary management of these cases, which may reduce potential morbidity and mortality and ensure better obstetric outcomes. This case series of placenta accreta spectrum overlying a cesarean section scar reports the reality of a tertiary-care perinatal center in Portugal, in which no maternal or neonatal mortality due to placenta accreta spectrum was registered over the last decade; this may be attributed to prenatal diagnosis and a coordinated multidisciplinary team approach.

Maternal and neonatal outcomes of morbidly adherent placenta in Ain Shams University Maternity Hospital from 2012 to 2017

ABSTRACTBackground: Morbidly adherent placenta (MAP) is now a significant obstetric challenge results in significant maternal morbidity and mortality (it is responsible for 7-10% of maternal mortality). The incidence of MAP have increased over the past few decades, this is mainly because of the increasing caesarean delivery rate. Risk factors for MAP include placenta previa, cesarean delivery, high maternal age and high parity.Objective: To investigate patient characteristics and neonatal and maternal outcomes of placenta accreta in Ain Shams from 2012 to 2017.Methods: This is a retrospective study which was carried out in Ain Shams University Maternity Hospital (a major tertiary referral hospital in Egypt) during the period from January 2012 to December 2017 (6 years), the archives of the hospital were examined for hospital records fulfilling the criteria of the study population during the study period. Results: The results revealed that morbidly adherent placenta was recorded during the studied period in 467 cases with an incidence of 6.6/1000 deliveries (0.66%). Conclusion: Early antenatal diagnosis of morbidly adherent placenta through imaging (ultrasound colour doppler and MRI) allows for multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality. Also, proper counselling of patients regarding associated risks reduce maternal morbidity and mortality.

Sacrococcygeal teratoma in one twin: a case report and literature review

BackgroundSacrococcygeal teratoma is one of the most common congenital tumors in newborns and infancy. The incidence is 1 per 20,000–40,000 live births. Ultrasonography is an optimal method for prenatal screening and diagnosis of fetal sacrococcygeal teratoma. MRI can be used to assist in the diagnosis. However, sacrococcygeal teratoma in the twin pregnancy is rare.Case presentationWe reported a case of one twin with sacrococcygeal teratoma in dichorionic-diamniotic twin pregnancy.One twin with sacrococcygeal teratoma was diagnosed at the second trimester by ultrasonic examination and another twin was normal. A regular and careful antenatal care was conducted by the multidisciplinary team. The parents refused to perform the fetal MRI and examine the chromosome of both twin.At 37 + 1 of gestation, planned cesarean section was performed. The healthy male co-twin (twin A) weighed 2880 g.The male twin with SCT (twin B) weighed 2900 g, complying with 6 × 3 × 3 cm cystic and solid mass in sacrococcygeal region. At four days of age twin B underwent excisional surgery of the sacrococcygeal teratoma and coccyx and discharged 7 days after surgery. The mother and both babies were followed up and are all in good health until now.Conclusion(s)Sacrococcygeal teratoma in twin pregnancy is rare. Early antenatal diagnosis is important. Once the sacrococcygeal teratoma is diagnosed, clinicians should be aware of the associated maternal and fetal complications. Expecting parents should be counseled by the multidisciplinary team about the management and prognosis of the STC twin and co-twin. Prompt surgical excision of the sacrococcygeal teratoma after birth should be suggested.

Prenatal Diagnosis of Gastroschisis on Ultrasonography

Gastroschisis is an abdominal wall defect resulting from ischemia to blood vessels that supply the abdominal wall during the first trimester of pregnancy. The injury results in an opening in the abdominal wall that allows the abdominal contents, most often intestines and stomach, to develop outside the abdominal cavity. Early antenatal diagnosis of gastroschisis allows parental counseling regarding prognosis and optimizes management through a multidisciplinary approach.

Prevalence of anemia in antenatal women at first point-of-care visit to district combined hospital, Chakia, Uttar Pradesh, India

Background: The WHO global database on anemia for 1993–2005, covering almost half of the world's population, estimated the prevalence of anemia worldwide at 25%. India is one of the countries with anemia as a serious public health concern. Nearly 50% of the pregnant women in India and 51% in Uttar Pradesh were shown to be anemic as per the National Family Health Survey-4 (2015/16). Objectives: This study was undertaken to determine (1) the prevalence of anemia in women attending the Antenatal Outpatient Department of District Combined Hospital, Chakia, Uttar Pradesh and (2) the association of sociodemographic variables with anemia. Materials and Methods: This was a retrospective cross-sectional study, wherein information regarding hemoglobin (Hb) levels and other variables of 631 antenatal women were taken from the records. Anemia was classified as per the WHO and Centers for Disease Control and Prevention (CDC) criteria for Hb levels. Results: The prevalence of anemia was 92% using the WHO criteria and 87.6% with CDC criteria. About 63.2% of women had moderate anemia (WHO), of which 59.3% were between age group of 22 and 30 years, 61.4% were second gravidas, 60.7% came in the second trimester, and 59.8% had ≥1 live birth. There was association with blood types as well. Conclusion: Early antenatal registration, diagnosis, and management of anemia are important due to high prevalence of moderate anemia in the study area.

PERSISTENT UROGENITAL SINUS PRESENTING AS HYDROMETROCOLPOS AND URINARY ASCITES

Persistent urogenital sinus (UGS) is a rare congenital cloacal anomaly whereby the urinary and genital tracts fail to separate during embryonic development. It can present as hydrometrocolpos (HMC) with severe vaginal stenosis/atresia, ambiguous genitalia, and/or urinary ascites. A term neonate born to a primigravida showed on antenatal ultrasound scan features suggestive of gross fetal ascites with severe oligohydramnios and hydronephrosis. Postnatally, the neonate presented with respiratory distress, urinary ascites, and abdominal mass and unilateral buphthalmos. An ascitic tap was done and HMC was drained. The cystogenitoscopy revealed vaginal stenosis for which vaginoplasty was done. The child was discharged and on follow-up is gaining weight. Our report shows an unusual presentation of a persistent UGS and also emphasizes the importance of early antenatal diagnosis andprompt post-natal management to reduce morbidity.

Prenatal sonographic diagnosis of limb body wall complex: A rare lethal fetal anomaly

Limb-body wall complex (LBWC) is a rare fatal congenital malformation syndrome. We report a case of sonographically diagnosed LBWC at the gestational age of 28 weeks which was confirmed after delivery. The parents opted for termination of pregnancy. Physical examination postdelivery revealed a large abdominal and thoracic wall defect with the contents protruding outside the body without any covering membrane. The umbilical cord and the eviscerated urinary bladder arose from the midline. In addition, there was the absence of the right upper limb. The baby died few minutes after the delivery. Early antenatal sonological diagnosis is necessary so that the parents can make an informed decision on the options of continuation or termination of pregnancy. Therefore, expertise in prenatal detection of congenital anomalies is invaluable in antenatal care.

Management of Congenital Diaphragmatic Hernia in Newborn - Paradigm Shift and Ethical Issues.

Management of congenital diaphragmatic hernia (CDH) begins soon after it is detected, whether antenatally or postnatally. Assessment of the severity of the condition, associated congenital anomalies, maternal health and related issues, weight of the fetus/baby, mode of delivery, timing of delivery, immediate appropriate management of the baby with CDH at birth, appropriate utilization of available treatment modalities as well as infrastructure of the treating institute have an impact on the outcome of the neonate. Survival without significant long-term/permanent morbidity is considered as good outcome. With advances in antenatal diagnosis, several legal and ethical considerations have cropped up. While on one hand there are proponents of early antenatal diagnosis and medical termination of pregnancy (MTP), on the other hand there are several socio-cultural groups who look upon human life as precious and argue against MTP. There is an ongoing ethical battle between maternal vs. fetal rights; there is no way to put a lid on the controversy whether the mother be allowed to choose in favor of MTP after being aware of the anomalous fetus or, we must attempt to save every fetus irrespective of the antenatal diagnosis of life-threatening anomalies. Notwithstanding, appropriate assessment of the condition, thorough counseling and sound evidence-based decisions could avert ethical dilemma in most cases. This review article provides information about the various choices available in the diagnostic and treatment armamentarium, though it should be kept in mind that the entire spectrum of management strategies may not be universally available.

Aids-related kaposi’s sarcoma in a four year old child: the challenge of a missed opportunity

Background : AIDSrelated Kaposi’s sarcoma (KS) is an AIDS-defining illness and is now increasingly recognized in children infected with HIV. Many of these cases are missed due to low index of suspicion. Vertical transmission of HIV is the commonest route of transmission in children and this is preventable by early maternal antenatal diagnosis, early commencement of HAART by the mother and adoption of the safest possible mode of delivery. The index case did not benefit from these services, making her acquire HIV and then develop AIDS-defining illness (KS) at a tender age of 4 years. Aim and objective: The study is aimed at emphasizing the need for all pregnant women to have antenatal screening as soon as pregnancy is confirmed so as to prevent vertical transmission of HIV to the unborn child. It is also aimed at creating awareness in clinical practice so as to increase index of suspicion among clinicians when evaluating chronically ill children. Case Description: GG was a 4year old girl who presented at 108 Nigerian Air force Hospital, Abuja with non-itchy skin rashes of two weeks duration, generalized body swelling, cough and haematochezia of one week duration, and fever of four days duration. She was a paternal orphan having lost her father a year prior to presentation to Acquired immunodeficiency syndrome (AIDS)-related illness. Her mother also tested positive to Human Immunodeficiency virus (HIV) and has been on highly active anti-retroviral therapy (HAART) for a year. Physical examination revealed moderate pallor, bilateral pitting pedal oedema, and matted non-tender peripheral lymphadenopathy. There were papular and nodular skin lesions with a reddish solid lesion on the hard palate. She tested positive to HIV. Abdominal ultrasound scan revealed moderate hepatomegaly with ascites, while chest x-ray showed bilateral interstitial pneumonitis, right hilar lymphadenopathy, right pulmonary nodule and ipsilateral pleural effusion. Excisional biopsy of one of the skin nodules confirmed the diagnosis of Kaposi’s sarcoma. She was commenced on HAART and antibiotics, with a unit of blood transfused. Her condition deteriorated, which necessitated referral to university of Abuja Teaching Hospital where she eventually died after a day of admission. Conclusion : Paediatric AIDSrelated KS is becoming increasingly common in Nigeria and as such, high index of suspicion is required while evaluating pediatric patients. This, coupled with early commencement of HAART is required to avert the pitfalls observed in this case; bearing in mind that childhood AIDSrelated KS is lethal. Keywords : Generalized lymphadenopathy; Kaposi’s sarcoma; Missed opportunity; Paediatric AIDS; Skin rashes

Iniencephalic Fetus Detected on Fetal Magnetic Resonance Imaging

Fetal iniencephaly is an uncommon neural tube anomaly characterized by fixed retroflexion of the head, an occipital defect, and cervicothoracic rachischisis. Polyhydramnios and elevated levels of α-fetoprotein are present in most cases. Fetal iniencephaly can be detected on antenatal ultrasonography. If undiagnosed prenatally, it may result in a difficult delivery as well a multitude of postnatal problems for both the patient and the family. Early antenatal diagnosis is therefore important. We present a case of iniencephaly detected on ultrasonography and fetal magnetic resonance imaging.

Meconium Peritonitis: Correlation of Antenatal Diagnosis and Postnatal Outcome - An Institutional Experience over 10 Years

Objective: To identify the fetal and neonatal imaging characteristics of meconium peritonitis (MP) and their clinical outcome. We also studied the role of prenatal ultrasound (US) in antenatal diagnosis and its use in predicting the need for surgical intervention postnatally. Material and Methods: We conducted a retrospective analysis of a cohort of 18 infants with MP from April 2004 to March 2014. Results: Prenatal US detected MP-related abnormalities in 15/18 (83.3%) fetuses. The median gestational age at initial diagnosis of MP was 24 weeks (range 19-31). Fetal ascites (93.3%) was the most common prenatal US finding. Of the 18 infants, 12 (66.7%) required surgical intervention. The overall survival rate was 94.4%. All infants with a prenatal US scan showing meconium pseudocyst or bowel dilatation required surgical intervention postnatally. Discussion: A combination of ascites, intraperitoneal calcification, and echogenic bowel on fetal US raises a high suspicion of MP. Surgical intervention is indicated in the presence of meconium pseudocyst on fetal or postnatal US scan. Antenatal US has high specificity (100%) but low sensitivity (22.2%) in detecting meconium pseudocyst. A favorable outcome can be expected with early antenatal diagnosis and timely surgical intervention in a tertiary hospital.