Incidence Of Hydrops Research Articles

Prenatally Diagnosed Large Lung Lesions: Timing of Resection and Perinatal Outcomes

IntroductionFetuses with large lung lesions including congenital cystic adenomatoid malformations (CCAMs) are at risk for cardiopulmonary compromise. Prenatal maternal betamethasone and cyst drainage for micro- and macrocystic lesions respectively have improved outcomes yet some lesions remain large and require resection before birth (open fetal surgery, OFS), at delivery via an Ex Utero Intrapartum Treatment (EXIT), or immediately post cesarean section (section-to-resection, STR). We sought to compare prenatal characteristics and outcomes in fetuses undergoing OFS, EXIT, or STR to inform decision-making and prenatal counseling. MethodsA single institution retrospective review was conducted evaluating patients undergoing OFS, EXIT, or STR for prenatally diagnosed lung lesions from 2000 to 2021. Specimens were reviewed by an anatomic pathologist. Lesions were divided into “CCAMs” (the largest pathology group) and “all lung lesions” since pathologic diagnosis is not possible during prenatal evaluation when care decisions are made. Prenatal variables included initial, greatest, and final CCAM volume-ratio (CVR), betamethasone use/frequency, cyst drainage, and the presence of hydrops. Outcomes included survival, ECMO utilization, NICU length of stay (LOS), postnatal nitric oxide use, and ventilator days. ResultsSixty-nine percent (59 of 85 patients) of lung lesions undergoing resection were CCAMs. Among patients with pathologic diagnosis of CCAM, the initial, largest, and final CVRs were greatest in OFS followed by EXIT and STR patients. Similarly, the incidence of hydrops was significantly greater and the rate of hydrops resolution was lower in the OFS group. Although the rate of cyst drainage did not differ between groups, maternal betamethasone use varied significantly (OFS 60.0%, EXIT 100.0%, STR 74.3%; p = 0.0378). Notably, all OFS took place prior to 2014. There was no difference in survival, ventilator days, nitric oxide, NICU LOS, or ECMO between groups. In multiple variable logistic modeling, determinants of survival to NICU discharge among patients undergoing resection with a pathologic diagnosis of CCAM included initial CVR <3.5 and need for <3 maternal betamethasone doses. ConclusionFor CCAMs that remain large despite maternal betamethasone or cyst drainage, surgical resection via OFS, EXIT, or STR are viable options with favorable and comparable survival between groups. In the modern era there has been a shift from OFS and EXIT procedures to STR for fetuses with persistently large lung lesions. This shift has been fueled by the increased use of maternal betamethasone and introduction of a Special Delivery Unit during the study period and the appreciation of similar fetal and neonatal outcomes for STR vs. EXIT and OFS with reduced maternal morbidity associated with a STR. Accordingly, efforts to optimize multidisciplinary perinatal care for fetuses with large lung lesions are important to inform patient selection criteria and promote STR as the preferred surgical approach in the modern era. Level of EvidenceLevel IV.

OP36.01: Feedback as an educational tool in gynecological ultrasound

first trim scan, including DV Doppler assessment, has been performed by certified specialists. All cases of ADV underwent serial echocardiography looking for signs of cardiac insufficiency until birth and middle-term postnatal follow-up. Results: A total of 58 cases of ADV were detected (54 singleton and 4 twin pregnancies), 38 (48%) of them were diagnosed in first trim scan. 38 (66%) of these cases had intrahepatic (IH) umbilical venous drainage, 10% of them developed severe hydrops. Another one with associated anomalies underwent TOP, the rest were born uneventfully and are alive and well (1 Aortic Coartation operated at six months and 1 renal policystosis). The remaining 20 (34%) cases had extrahepatic (EH) drainage, either directly into right atrium (4), Inferior Vena Cava (4) or the Iliac Vein (2). 20% of them developed severe hydrops (4 died postnataly, 3 asked for TOP and 1 is alive). In the EH drainage group 11 (55%) of fetuses had associated malformations (5 cardiac and 6 extracardiac). Increased NT was present in both types of ADV, but was more related to poor prognosis in the EH group. The IH drainage group, when compared to EH group, had less incidence of hydrops (16% versus 60% (P < 0.05)) and less anomalies (16% vs. 50% (P < 0.05)) with a significantly better postnatal outcome (normality of 79% vs. 50% (P < 0.05)). Conclusions: Fetuses with IH umbilical venous drainage have better prognosis, especially in the absence of associated malformations or increased NT.

A Neonate with Non-immune Hydrops Foetalis in Rh Non-immunized Mother

DOI: http://dx.doi.org/10.3329/bjch.v34i2.10221BJCH2010; 34(2): 70-72

Prognostic Role of Tumor-Head Volume Ratio in Fetal Sacrococcygeal Teratoma

Objective: To evaluate the ability of a tumor-head volume ratio to predict outcome and incidence of hydrops in fetuses with sacrococcygeal teratoma. Methods: Seventy-one sonograms were reviewed retrospectively from 28 fetuses with sacrococcygeal teratoma managed in our institution. Head volume (HV) and total tumor volume were calculated from sonograms. Amount of cystic tumor was estimated to determine solid tumor volume (STV) for the STV/HV ratio. Results: Twenty percent of sonograms with STV/HV <1 and 97.3% with STV/HV >1 were associated with 1 or more abnormal sonographic signs (p = 0.000). Overall mortality was 11/27 (41%). There was no mortality in fetuses with a ratio of <1, while 11/18 (61%) of fetuses with ratio >1 died (p = 0.003). Conclusion: The STV/HV ratio may be used to identify fetuses with a high risk of a poor outcome due to high-output cardiac failure and hydrops, and may help guide management.

22 VASCULAR ENDOTHELIAL GROWTH FACTOR mRNA EXPRESSION IN FETAL MEMBRANES DURING EARLY PREGNANCY AS A BIOMARKER FOR DEVELOPMENT OF HYDROPS PLACENTA LATER IN PREGNANCY IN BOVINE EMBRYOS CREATED THROUGH SOMATIC CELL NUCLEAR TRANSFER (SCNT)

Pregnancies obtained via somatic cell nuclear transfer (SCNT) show an increased incidence of pregnancy complications, including poor placental vascularization, hydrops placenta, and abnormal placental morphology. In a preliminary study of hydrops placentas from SCNT clones v. control cow placentas close to term, we observed a thickening of the endometrial epithelium, which appeared pseudostratified; in addition, the subepithelial endometrial vascular bed consisted of large, rare arterioles with thick basement membranes compared with the normal capillary bed observed in control animals. The fetal membranes of hydrops placenta from bovine SCNT clones also exhibited macroscopic morphological differences, which included edema, increased membrane thickness, and a gelatinous appearance. All of these morphological differences were similar to those we have reported for sheep SCNT clones (Palmieri et al. 2007 Placenta 28, 577–584). In the search for biomarkers that may indicate abnormal placental development early in pregnancy, placental tissues were collected on day 40 from pregnancies established after transfer of embryos created through SCNT (n = 17) or IVF (n = 6). Nuclear donor cells used to obtain SCNT embryos were those we have previously found to be highly susceptible to hydrops (from 5 to 19%), whereas the incidence of hydrops in IVF and controls in our laboratories did not exceed 0.5%. A sample of fetal membranes was fixed in 10% buffered formalin for histological analysis; another sample was snap-frozen in liquid nitrogen for analysis of mRNA levels for vascular endothelial growth factor (VEGF) and its receptors (KDR and FLT) by quantitative, real-time RT-PCR. Histological analysis of cell proliferation rate was performed using immunohistochemical localization of proliferating cell nuclear antigen and image analysis software (Image-Pro Plus). There were no differences (P = 0.39) in the rate of cell proliferation of the trophoblast in SCNT v. IVF (29.4 ± 4.9% v. 22.1 ± 3%). However, VEGF mRNA expression was less (P &lt; 0.04) in the fetal membranes of SCNT than IVF on day 40 of pregnancy (0.30 ± 0.04 v. 0.53 ± 0.12, normalized to α-actin mRNA levels). The mRNA expression for KDR and FLT were similar in SCNT and IVF. These data suggest that the lower expression of VEGF, a major placental angiogenic factor, in fetal membranes of early pregnant SCNT fetuses may be an early biomarker for the development of hydrops placenta later in pregnancy. NDAES Proj. ND01727.

Fetal Risk Factors for Intra‐Uterine Demise (IUFD) in the Bronx, NY from 1997–2006

Background: IUFD greatly impacts low‐income, minority women in the Bronx. We reported that IUFD cases with chorioamnionitis (CA) increased at Montefiore Medical Center (MMC) over the last 12 years (EB 2007). To date, no study has compared fetal risks in cases to those of live deliveries.Objective: To determine which factors are tied to IUFD in the Bronx.Design: IUFD autopsies (n=150) from 1997–2006 at MMC were compared to randomly selected live‐birth controls (n=300).Results: IUFDs were 49.7% Hispanic, 35.2% Black; controls were 41.4% Hispanic, 38.0% Black. IUFDs had a greater incidence of small fetal weight for gestational age (7.4% v. 0.67%, Fisher's Exact, p=0.00016). The odds (OR) were strong that IUFD was tied to small fetal weight (OR=11.88, 95% CI=2.60−54.31). The incidence of oligohydramnios was greater in cases (10.2% v. 0.67%, p=0.0065), &amp; the odds showed this was linked to IUFD (OR=2.99, 95%CI=1.34−6.68). The incidence of polyhydramnios was greater in IUFDs (4.1% v. 0%, p=0.0012), &amp; the incidence of hydrops was greater too (6% v. 0%, p=0.000043).Conclusion: The associations of fetal risks &amp; IUFD are evident in the Bronx. Small fetal weight indicates vascular compromise to fetal tissues. Oligohydramnios signifies abnormal fetal genitourinary function, &amp; polyhydramnios suggests gastrointestinal obstruction. These findings can guide prenatal care &amp; monitoring for low‐income women.

Meniere's disease: the incidence of hydrops in the contralateral asymptomatic ear.

This study analyzes the incidence of endolymphatic hydrops in the asymptomatic contralateral ear of patients with classic Meniere's disease. A retrospective study of 3000 subjects who underwent electrocochleography (ECOG) from 1988 to 1998. The presence of endolymphatic hydrops was determined by use of ECOG recordings, which were made through a transtympanic recording needle situated in the round window niche. Analysis was made of the 1-kHz toneburst summation potential (SP), and comparison was made between asymptomatic contralateral "Meniere's ears" (n = 144) and asymptomatic normal "control ears" (n = 114). Results demonstrated that more than 10% of the contralateral asymptomatic Meniere's ears have an ECOG recording that is highly suggestive of the presence of endolymphatic hydrops. In contrast, less than 2% of the control population demonstrate abnormal ECOG recordings. Furthermore, 15% of the population of contralateral Meniere's ears lie above the 95th percentile of the control population for 1-kHz tone-burst (100 dB) SP negativity. This study suggests that a high percentage of patients who have what appears to be unilateral Meniere's disease have evidence of endolymphatic hydrops in the contralateral asymptomatic ear. This finding has important clinical relevance for the management of patients in whom destructive surgery is planned and further highlights the importance of electrocochleography in the diagnosis and management of this disease process.

Importance of Docosahexaenoic Acid in Marine Larval Fish

AbstractMarine finfish require n‐3 HUFA such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) as essential fatty acids (EFA) for their normal growth. But it remained unclear as to which of the n‐3 HUFA, either EPA or DHA, was important. Unlike the freshwater species, the EFA efficiency of EPA and DHA may vary in marine fish. The developing eggs rapidly utilize DHA either for energy or for production of physiologically important substances like prostaglandin.This report reveals that in marine larval fish DHA is superior to EPA as EFA. In the case of red seabream, feeding rotifers incorporating EPA and DHA or an n‐3 HUFA mixture prevented many of the ill‐effects observed when the rotifers were low in n‐3 HUFA. Apart from the best growth and survival in an activity test for the larvae fed on DHA‐rotifer, the incidence of hydrops seemed to be totally prevented dietetically by DHA. Similar results were obtained in larval yellowtail, striped jack, striped knifejaw and flounder. There seems to exist a functional difference between EPA and DHA.

Comparison between eicosapentaenoic and docosahexaenoic acids in terms of essential fatty acid efficacy in larval red seabream.

Efficacy of EPA and DHA as the EFA for larval red seabream was evaluated by feeding them rotifers enriched with respectively methyl oleate, EPA, DHA and n-3 HUFA mixture for 8 days in 100l tanks.The larvae fed on rotifers containing a low percentage of n-3 HUFA showed low growth and survival rates together with a high incidence of the so-called hydrops. These larvae also showed poor vitality and all of them died in the both vitality tests. The growth and survival rates were effectively improved by the incorporation of EPA and DHA or n-3 HUFA mixture into the rotifers. However, the incidence of hydrops was not completely prevented by EPA and the n-3 HUFA mixture, but was almost totally prevented by DHA. The growth and the survival rate after vitality test were also highest in the larvae fed the DHA-rotifer.The fatty acid analysis on the total lipids of larvae has shown that the level of assimilation of DHA was much higher than EPA, although EPA may partly be converted to 22:5n-3 and that no retroconversion of DHA may be available. Thus DHA is found to be superior to EPA as EFA for larval red seabream.

Osmic Acid in Rheumatoid Synovitis: A Controlled Study

Ninety-nine adult RA patients with knee joint synovitis were randomized into two groups. The knee joints of the first group (52 patients) were treated with osmic acid and those of the second group (47 patients) with a placebo. After 6 months, the incidence of hydrops and pain was statistically less significant in joints treated with osmic acid. the result was better in joints without advanced radiological destruction. It is concluded that osmic acid is still of benefit in the local treatment of rheumatoid knee joint synovitis at an early stage.