Normal Amount Of Amniotic Fluid Research Articles

Labor Induction in Women with Isolated Polyhydramnios at Term: A Multicenter Retrospective Cohort Analysis.

Background: With the increasing popularity of elective induction after 39 + 0 weeks, the question of whether induction of labor (IOL) is safe in women with isolated polyhydramnios has become more relevant. We aimed to evaluate the pregnancy outcomes associated with IOL among women with and without isolated polyhydramnios. Methods: This was a multicenter retrospective cohort that included women who underwent induction of labor at term. The study compared women who underwent IOL due to isolated polyhydramnios to low-risk women who underwent elective IOL due to gestational age only. The main outcome measure was a composite adverse maternal outcome, while the secondary outcomes included maternal and neonatal adverse pregnancy outcomes. Results: During the study period, 1004 women underwent IOL at term and met inclusion and exclusion criteria; 162 had isolated polyhydramnios, and 842 had a normal amount of amniotic fluid. Women who had isolated polyhydramnios had higher rates of the composite adverse maternal outcome (28.7% vs. 20.4%, p = 0.02), prolonged hospital stay, perineal tear grade 3/4, postpartum hemorrhage, and neonatal hypoglycemia. Multivariate analyses revealed that among women with IOL, polyhydramnios was significantly associated with adverse composite maternal outcome [aOR 1.98 (1.27-3.10), p < 0.01]. Conclusions: IOL in women with isolated polyhydramnios at term was associated with worse perinatal outcomes compared to low-risk women who underwent elective IOL. Our findings suggest that the management of women with polyhydramnios cannot be extrapolated from studies of low-risk populations and that clinical decision-making should take into account the individual patient's risk factors and preferences.

A Study to Determine the Perinatal Outcome in Isolated Oligohydramnios at Term Pregnancy

Objective: A Study to Determine the Perinatal Outcome in Isolated Oligohydramnios at Term Pregnancy Study Design: A cross-sectional study Place and Duration: Department of Gynecology and Obstetrics, Hayatabad Medical Complex from October 2022 to March 2023 Methodology: Our sample size was 250 which were divided into 1:1 including 125 cases with isolated oligohydramnios and 125 control cases. Patients with chronic medical disorders and having fetal anomalies or IUGR were excluded. The mode of delivery was noted. Neonatal outcomes in the form of Apgar score, baby weight and need for NICU were noted. Results: The cases with isolated oligohydramnios were associated with an increased incidence of CTG changes, meconium-stained amniotic fluid and the cesarean section as compared to women with normal amount of amniotic fluid. There was no difference between the cases and controls as regards duration of labor, need for oxytocin augmentation, need for neonatal resuscitation, APGAR score at 5 minutes, NICU admission birth weight of neonates or incidence of LSCS for fetal distress. A significant association (OR=1.85, P&lt;0.001) was found between caesarean section in mothers with oligohydramnios compared to controls. Conclusion: Our study found increase cesarean section rate due to CTG changes and meconium stained liquor in isolated oligohydramnios. However neonatal outcome in the form of birth weight, Apgar score and NICU admission was same for both cases and control. Keywords: Oligohydramnios, Perinatal, Term Pregnancy

Vesicoamniotic Shunting before 17 + 0 Weeks in Fetuses with Lower Urinary Tract Obstruction (LUTO): Comparison of Somatex vs. Harrison Shunt Systems.

(1) Background: The aim of this study was to compare perinatal outcomes and complication rates of vesicoamniotic shunting (VAS) before 17 + 0 weeks in isolated LUTO (lower urinary tract obstruction) with the Somatex® intrauterine shunt vs. the Harrison fetal bladder shunt. (2) Methods: This is a retrospective cohort study in two tertiary fetal medicine centers. From 2004–2014, the Harrison fetal bladder shunt was used, and from late 2014–2017, the Somatex shunt. Obstetrics and pediatric charts were reviewed for complications, course of pregnancy, perinatal outcome, and postnatal renal function. (3) Results: Twenty-four fetuses underwent VAS with a Harrison (H) shunt and 33 fetuses with a Somatex (S) shunt. Live birth rates and survival to last follow-up were significantly higher in the Somatex group, at 84.8% and 81.8%, respectively, vs. 50% and 33.3% in the Harrison group (p = 0.007 and p < 0.001). The dislocation rate in the Somatex group (36.4%) was significantly lower than in the Harrison group (87.5%) (p < 0.001). The median time to dislocation was significantly different, at 20.6 days (H) vs. 73.9 days (S) (p = 0.002), as was gestational age at dislocation (17 (H) vs. 25 (S) weeks, p < 0.001). Renal function was normal in early childhood in 51% (S) vs. 29% (H) (p = 0.11). (4) Conclusions: VAS before 17 + 0 weeks gestational age with a Somatex shunt improves perinatal survival significantly and might even have a positive effect on renal function, probably due to the lower dislocation rates. A normal amount of amniotic fluid in the third trimester was the best predictor of normal renal function in early childhood.

Oligohydramnion in the First Half of Pregnancy in the Fetuses with Congenital Abnormalities: Ultrasound Diagnostics and Obstetric Outcomes

Background.Oligohydramnion in the first half of pregnancy, combined with congenital abnormalities in the fetus has objective difficulties in diagnosis. The morphology features and type of defects associated with oligohydramnion, which manifests in the first half of pregnancy, are not sufficiently studied at the present stage.&#x0D; Aims to evaluate the clinical significance of diagnosing oligohydramnion in the first half of pregnancy in women with congenital fetal malformations.&#x0D; Materials and methods.The analysis of the course of pregnancy and perinatal outcomes in 77 women with low water content in combination with congenital malformations of the fetus and 72 patients with a normal amount of amniotic fluid and no congenital malformations of the fetus was performed. The patients of the main group were divided into two subgroups depending on the severity of oligohydramnion: the 1st subgroup (n = 54) patients with severe oligohydramnion and the 2nd subgroup (n = 23) patients with moderate oligohydramnion. The amount of amniotic fluid was determined by 3D/4D ultrasound (1321 weeks of gestation) and the structure of fetal abnormalities associated with oligohydramnion was analyzed. We evaluated perinatal outcomes in women with congenital malformations of the fetus in combination with oligohydramnion and the effect of its severity on the outcome of pregnancy.&#x0D; Results.In the main group (n = 77), fetal abnormalities were detected in patients: urinary system 39 (50.6%), respiratory system 4 (5.2%), heart 1 (1.3%), chromosomal and genetic abnormalities 14 (18.2%), central nervous system 3 (3.9%), osseous system 3 (3.9%), multiple 13 (16.9%). In the main group (n = 77), pregnancy was terminated for medical indications in 47 (61%) cases, in 6 (7.8%) spontaneous miscarriage occurred, in 5 (6.5%) antenatal fetal death. 19 (24.7%) children were born alive, and surgical treatment in the neonatal period was required in 8 (10.4%) cases. In the 1st subgroup (n = 54) in 53 (98.1%) cases, there was a loss of the fetus, in 1 (1.9%) the newborn died on the 9th day. In the 2nd subgroup (n = 23), fetal death occurred in 5 (21.7%) cases, 18 (78.3%) children were born alive, and 8 (44.4%) newborns were operated on in the neonatal period. In the control group, all pregnancies ended with the birth of healthy children. A decrease in ultrasound imaging of internal organs in the fetus was observed when a pregnant woman was obese (BMI more than 35).&#x0D; Conclusions.Oligohydramnion in the first half of pregnancy in combination with fetal malformation should be considered an extremely unfavorable clinical sign for the prognosis of pregnancy and the health of the fetus and newborn. 3D/4D ultrasound scanning allows you to reliably determine oligohydramnion in the first half of pregnancy, and the degree of its severity to assume the nature of complications.

Prenatal diagnostic and management of megacystis microcolon intestinal hypoperistalsis syndrome: A report on a rare case in Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) is a rare and the most severe form of functional intestinal obstruction in the newborn. The characteristic features of this congenital and fatal disease are abdominal distension, absent or decreased bowel peristalsis. Abdominal distension is a consequence of the distended, unobstructed urinary bladder with or without hydro nephrosis. Some previous reports have revealed that the typical antenatal sonographic findings are as follows: a greatly distended bladder, bilateral hydro nephrosis, and a normal amount of amniotic fluid; however, the antenatal diagnosis of this syndrome is occasionally difficult.

Prenatal hyperechogenic kidneys in three cases of infantile hypercalcemia associated with SLC34A1 mutations

Prenatal diagnosis of hyperechogenic kidneys is associated with a wide range of etiologies and prognoses. The recent advances in fetal ultrasound associated with the development of next-generation sequencing for molecular analysis have enlarged the spectrum of etiologies, making antenatal diagnosis a very challenging discipline. Of the various known causes of hyperechogenic fetal kidneys, calcium and phosphate metabolism disorders represent a rare cause. An accurate diagnosis is crucial for providing appropriate genetic counseling and medical follow-up after birth. We report on three cases of fetal hyperechogenic kidneys corresponding to postnatal diagnosis of nephrocalcinosis. In all cases, antenatal ultrasound showed hyperechogenic kidneys of normal to large size from 22 gestational weeks, with a normal amount of amniotic fluid. Postnatal ultrasound follow-up showed nephrocalcinosis associated with hypercalcemia, hypercalciuria, elevated 1,25(OH)2-vitamin D, and suppressed parathyroid hormone levels. Molecular genetic analysis by next-generation sequencing performed after birth in the three newborns revealed biallelic pathogenic variants in the SLC34A1 gene, encoding the sodium/phosphate cotransporter type 2 (Npt2a), confirming the diagnosis of infantile hypercalcemia. Nephrocalcinosis due to infantile hypercalcemia can be a cause of fetal hyperechogenic kidneys, which suggests early antenatal anomaly of calcium and phosphate metabolism. This entity should be considered in differential diagnosis. Postnatal follow-up of infants with hyperechogenic kidneys should include evaluation of calcium and phosphate metabolism.

Induction of labor in cases of late preterm isolated oligohydramnios: is it justified?

Objectives: To analyze in a retrospective cohort study the outcomes of pregnancies with isolated oligohydramnios at the late preterm period (34–36.6 weeks of gestation).Study design: This retrospective cohort study included three groups of women: (1) Women with isolated oligohydramnios whose pregnancy was managed conservatively (n = 33 births); (2) women with isolated oligohydramnios who were managed actively (i.e. induction of labor) (n = 111 births); and (3) a control group including women with normal amount of amniotic fluid who had a spontaneous late preterm delivery (n = 10,445 births). Maternal and fetal characteristics and obstetrics outcomes were collected from a computerized database of all deliveries at Soroka University Medical Center during the study period.Results: Our cohort included 10,589 births. The rate of inducing labor was higher in the oligohydramnios groups compared to the controls (p < .001). There was an increase in the rate of cesarean section (CS) in the conservative treatment group (p < .001), compared with the other groups. Conservative management was associated with higher rates of maternal infection (p = .026), chorioamnionitis (p = .01), and transitory tachypnea of the newborn (p = .02). After controlling for confounding factors, mal presentation (OR = 19.9), and a prior CS (OR = 2.4) were independently associated with an increased risk for CS, while induction of labor was associated with a reduced risk for CS (OR = 0.28).Conclusions: Women with late preterm isolated oligohydramnios had a higher rate of induction of labor than women with a normal amount of amniotic fluid. Induction of labor seems to be beneficial to both the neonate and the mother as seen by a lower rate of CS conducted in this group, as well as lower maternal and neonatal morbidity in comparison to the conservative group. Therefore, women with oligohydramnios at late preterm may benefit from induction of labor.

Evaluation of the relation between placental weight and placental weight to foetal weight ratio and the causes of stillbirth: a retrospective comparative study

The aim of the present study was to evaluate the clinical importance of placental weight (PW) and placental weight to foetal weight (PW/FW) ratio according to maternal characteristics, pathological conditions in obstetrics and the causes of foetal death by category in stillbirths. The results of autopsies and placental histopathological examinations for 145 singleton stillbirths were reviewed retrospectively. Pathological features of the placenta were significantly associated with lower PW compared to the group with no pathological placental parameters (230 grams versus 295 grams, p = .045). Foetal growth restriction (FGR) with pre-eclampsia (PE) was accompanied by significantly lower FW, PW and PW/FW compared to FGR cases without PE (1045 grams versus 1405 grams, p = .026, 200 grams versus 390 grams, p = .006 and .19 versus .24, p = .037, respectively), whereas a similar trend was not observed in the non-FGR pregnancies complicated by PE. Oligohydramnios was accompanied by lower foetal weight compared to those who had normal amount of amniotic fluid (650 grams versus 1400 grams, p = .006). Among the clinical factors, only PE and oligohydramnios contributed to disproportionate fetoplacental growth in stillbirth, while none of the categories of stillbirth was related to unequal fetoplacental growth.Impact statementWhat is already known on this subject: In 27% of stillbirths, pathological features of the placenta or placental vascular bed are recorded. Underlying placental pathology contributes to foetal growth restriction (FGR) in approximately 50%. Although placental weight relative to foetal weight (PW/FW ratio) is an indicator of foetal as well as placental growth, data on PW/FW in stillbirth has not yet been published.What the results of this study add: Causes of death do not show any correlation with PW/FW ratio. Placentas derived from pregnancies complicated by pre-eclampsia (PE) and concomitant FGR are smaller and PW/FW is also diminished. Oligohydramnios is associated with an enhanced risk of restricted placental growth. FGR is not correlated with any categories of causes of death.What the implications are of these findings for clinical practice and/or further research: Sonographic follow-up of placental volume and FW can predict the stillbirth in PE complicated by FGR and oligohydramnios.

A rare fetal umbilical cord complication: 37 week antenatal loss

Introduction: Investigation of antenatal fetal loss case due to the umbilical cord wrapping 3 times around the neck of a 37-week fetus and being truly knotted in 2 places in light of the literature. Case: A 35-year old G:4 P:3 patient applied with the complaint of no movement of the baby for 3 days. Ultrasonography observed fetal biometric measurements in accordance with 37 weeks gestation, 3210 gr weight with normal amount of amniotic fluid. Doppler USG observed an in utero mort fetus with 3 loops of nuchal cord. The placenta was observed on the anterior wall. Examination one week previously did not identify cord around the fetal neck, and biophysical profile was evaluated as 10 points. During cesarean section the cord was found to be fully wrapped around the neck of the fetus 3 times and true knots were found at 2 places in the cord. The total length of the umbilical cord was 125 cm and a wide and deep mark was left on the fetus’ neck. Discussion: Observed in 1 of 3 pregnancies and generally benign, nuchal cord is a complication that rarely causes antenatal loss. 1 Clinics of Gynecology and Obstetrics, Uskudar

Detection of altered methylation status at 11p15.5 and 7q32 in placental mesenchymal dysplasia

ObjectiveThis paper aims to present molecular cytogenetic and epigenetic evaluation of placental mesenchymal dysplasia (PMD). Materials and methodsA 33-year-old woman was referred to the hospital at 18 weeks of gestation because of a multicystic mass in the placenta. Ultrasound showed a normal amount of amniotic fluid and a normal singleton fetus. Amniocentesis revealed a karyotype of 46,XX. Array comparative genomic hybridization analysis of amniocytes revealed no genomic imbalance. Preterm labor and premature rupture of the membranes occurred, and a female fetus was delivered with no structural abnormality. The placenta was enlarged and filled with many grape-like vesicles. In the placental cystic mass, interphase fluorescence in situ hybridization revealed diploidy and array comparative genomic hybridization revealed no genomic imbalance. Quantitative fluorescent polymerase chain reaction (QF-PCR), methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA), and methylation-specific PCR were performed in the placental cystic mass. ResultsMS-MLPA analysis showed hypermethylation (methylation index = 0.8) at H19 differentially methylated region (DMR) [imprinting center 1 (IC1)] at 11p15.5 and hypomethylation (methylation index = 0.2) at KvDMR1(IC2) at 11p15.5. Methylation-specific PCR assay identified hypomethylation of PEG1/MEST at 7q32, and hypermethylation at H19DMR and hypomethylation at KvDMR1 at 11p15.5. QF-PCR analysis identified androgenetic/biparental mosaicism in the placenta. The placental cystic mass was consistent with the diagnosis of PMD. ConclusionMS-MLPA and methylation-specific PCR are useful methods for rapid detection of epigenetic alternations in PMD, and QF-PCR is useful in the diagnosis of androgenetic/biparental mosaicism.

Detection of a de novo Y278C mutation in FGFR3 in a pregnancy with severe fetal hypochondroplasia: Prenatal diagnosis and literature review

ObjectiveWe describe a prenatal molecular diagnosis of hypochondroplasia (HCH) in a pregnancy not at risk of HCH and review the literature on prenatal diagnosis of HCH. Case reportA 28-year-old primigravid woman was referred for genetic counseling at 30 weeks of gestation because of short-limbed dwarfism in the fetus. The woman had a body height of 152 cm. Her husband had a body height of 180 cm. Level II ultrasound showed a normal amount of amniotic fluid and a singleton fetus with fetal biometry equivalent to 30 weeks except for short limbs. Fetal biometry measurements were as follows: biparietal diameter = 7.38 cm (30 weeks); head circumference = 28.14 cm (30 weeks); abdominal circumference (AC) = 24.64 cm (30 weeks); femur length (FL) = 3.97 cm (<5th centile); FL/AC ratio = 0.161 (normal > 0.18); humerus = 3.64 cm (<5th centile); radius = 3.49 cm (30 weeks); ulna = 3.76 cm (<5th centile); tibia = 3.67 cm (<5th centile); and fibula = 3.72 cm (<5th centile). The digits and craniofacial appearance were normal. A tentative diagnosis of achondroplasia (ACH) was made. DNA testing for the FGFR3 gene and whole-genome array comparative genomic hybridization (aCGH) analysis were performed using cord blood DNA obtained by cordocentesis. FGFR3 mutation analysis revealed a de novo heterozygous c.833A > G, TAC > TGC transversion in exon 7 leading to a p.Tyr278Cys (Y278C) mutation in the FGFR3 protein. aCGH analysis revealed no genomic imbalance in cord blood. After delivery, the fetus had short limbs, a narrow thorax, brachydactyly, and relative macrocephaly. Cytogenetic analysis of cultured placental cells revealed a karyotype of 46,XX. ConclusionPrenatal diagnosis of abnormal ultrasound findings suspicious of ACH should include a differential diagnosis of HCH by molecular analysis of FGFR3.

Monochorionic twin fetus with VACTERL association after intracytoplasmic sperm injection

We report a rare case of a monochorionic twin gestation after intracytoplasmic sperm injection (ICSI) in which one of the fetuses had VACTERL association. A 27-year-old woman became pregnant by ICSI and was found to have monochorionic twin fetuses. One fetus was noted to have the following anomalies: a multicystic, dysplastic left kidney with a hydroureter, and a dilated colon. A normal-sized stomach and normal amount of amniotic fluid were observed during the prenatal period with no other anomalies. The postnatal examination revealed hypospadias, and anal, esophageal, and duodenal atresia; thus, a diagnosis of VACTERL association was established. Although the prenatal diagnosis of this disorder is a challenge, even in a singleton, some of the characteristic features observed during antepartum ultrasonography may be a clue to the diagnosis, especially in a twin pregnancy after ICSI.

Megacystis-Microcolon intestinales Hypoperistaltik-Syndrom (MMIHS) als seltene Differenzialdiagnose bei fetaler Megacystis im Ultraschall

Foetal megacystis (incidence 1:1 500) occurring in the first trimester may already be a sign of congenital malformation. Often, urethral valves are causally responsible in male foetuses far more frequently than urethral atresia. As a further differential diagnosis, the "prune-belly syndrome" needs to be distinguished. Far more difficult to classify prenatally is the rare MMIHS which, in contrast to the diagnosis of urethral valves, is associated with an unfavourable prognosis. This is a report on a 28-year-old IG/0P, whose foetus of 26+4 gestational weeks was found on ultrasonography for the first time to have a megacystis of 48 mm diameter and bilateral hydronephrosis. The female foetus was surrounded by a normal amount of amniotic fluid which, during the further course of the pregnancy, developed into polyhydramnios. The serial puncture of the urinary bladder showed a normal karyotype and no impairment of the renal concentrating capacity or of protein loss. By reason of an immense enlargement of the abdomen due to the 100 mm large urinary bladder, a Caesarean section was conducted at 36+0 gestational weeks. A catheter could be inserted into the urinary bladder postpartum easily. However, nourishment was not possible and after radiological examination, MMIHS was diagnosed. In the case of a foetal megacystis detected by ultrasonography, especially associated with polyhydramnios and female gender, the rare MMIHS, which is infaust, should be taken into consideration.

699: Perinatal outcome in pregnancies complicated by isolated oligohydramnios prior to 37 weeks of gestation

Optimal management in cases of isolated oligohydramnios is a matter of controversy, moreover, data is limited regarding isolated oligohydramnios< 37 weeks of gestation. Thus, we aimed to compare pregnancy outcome in cases of isolated oligohydramnios at preterm with that of low-risk pregnancies with normal amount of amniotic fluid.

Endoloop ligation of the umbilical cord of an aborted fetus in a twin gestation

A 28-year-old primigravida who had conceived bichorionic twins after undergoing assisted reproductive treatment presented to the emergency department in the 18th week of pregnancy. She was experiencing contractions and mild vaginal bleeding, and the cervix was found to be dilated to 5 cm. The contractions stopped after the spontaneous expulsion of one of the fetuses, approximately 3 hours following admission. The vaginal bleeding stopped, there were no clinical or laboratory signs of chorioamnionitis, and the results of the clotting tests were normal. On ultrasound the other fetus was of appropriate size for gestational age, was surrounded by a normal amount of amniotic fluid, and seemed viable. The prolapsed umbilical cord of the aborted fetus wasexposedusing an aseptic speculum and ligated high in the cervical canal using the Endoloop automated device fitted with a size-0 Endoloop ligature (Endoloop Ligature Type-0 Coated Vicryl; Ethicon, Summerville, NJ, USA). The cervix was then sutured according to the McDonald procedure. Prophylactic antibiotics were administered perioperatively. The patient had no clinical signs of infection or impending placental abruption and was soon discharged.

Limb–Body Wall Complex with Craniofacial Defects After Ovarian Stimulation

474 A primigravid woman aged 34 years was referred for genetic counseling at 23 weeks’ gestation because of fetal abdominal wall defects, cranioplacental attachment, craniofacial (CF) abnormalities, and an upper limb abnormality. The father was aged 36 years. The mother reported no illnesses or recent infections. She had no history of prenatal exposure to teratogenic agents, nor any family history of congenital malformations. The woman had a 4-year history of primary infertility. She conceived after ovarian stimulation with clomiphene citrate and human menopausal gonadotropin. Level II ultrasound examinations demonstrated a live fetus with cranioplacental attachment, an occipital encephalocele, facial cleft, hypoplasia of the right humerus, absence of the right forearm and right hand, absence of the right hemithorax, extracorporeal right lungs, abdominal wall defects with eviscerated liver, stomach and bowel, a normal amount of amniotic fluid, a fetal biometry equivalent to 20 weeks’ gestation, and scoliosis. The pregnancy was subsequently terminated. A female fetus was delivered with a body weight of 394 g. Cytogenetic analysis of fetal tissues revealed a 46,XX karyotype. Postnatal examinations confirmed limb–body wall complex (LBWC) with CF defects (Figure). The female external genitalia, anus, lower extremities and umbilical cord were normal. LBWC describes a heterogenic group of fetal malformations, including lateral body-wall defects and limb reduction anomalies [1–8]. Cases of LBWC with CF defects frequently show severe anomalies of the upper limbs, CF defects, constrictive amniotic bands, and cranioplacental attachment, whereas cases of LBWC without CF defects usually present with major anomalies of the lower limbs, abnormal genitalia, anal atresia, renal defects, abdominoplacental attachment, and umbilical cord abnormalities [6,9]. The difference in the incidence of births between these two groups may be in part because of their different pathogenesis, or due to lethality resulting in early pregnancy loss in cases of LBWC with CF defects [6]. The possible pathogenetic mechanisms for LBWC include early amnion rupture [10], vascular disruption [7,8], and early embryonic maldevelopment [11,12]. Russo et al [9] suggested that LBWC with CF defects is caused by an early vascular disruption, whereas LBWC without CF defects is related to defective lateral and caudal folding of the embryonic disk. Recent reports have suggested that infants conceived by assisted reproductive technology have an increased risk of congenital malformations, compared LIMB–BODY WALL COMPLEX WITH CRANIOFACIAL DEFECTS AFTER OVARIAN STIMULATION

COURSE OF PREGNANCY, DELIVERY AND PUERPERAL PERIOD IN PATIENTS FROM GROUP OF HIGH PERYNATAL RISK

Objective: to analyze course of pregnancy, delivery and puerperal period in patients from group of high perynatal risk. Design and subjects: a prospective study 176 pregnant women with polyhydramnion and 73 pregnant with normal amount of amniotic fluid. Results: there are an increase frequency of chronic placental insufficiency in 2,2 times, gestosis and powerless labor in 2,5 times, colpitis in 2,9 times, violations of detachment of placenta in 2,6 times and involution of uterus in 7,7 times.

Concordant partial urorectal septum malformation sequence in monozygotic twins

The urorectal septum malformation (URSM) sequence is defined as the absence of the perineal and anal opening in association with ambiguous genitalia and urogenital, colonic, and lumbosacral anomalies. The URSM sequence is usually lethal in the newborn period due to pulmonary hypoplasia resulting fromsevere oligohydramnios. The abnormalities of this condition are though to arise early in development due to incomplete subdivision of the primitive cloaca and lackof breakdownof the cloacal membrane [Escobar et al., 1987; Wheeler et al., 1997]. A less severe form of URSM sequence is referred to by Wheeler and Weaver [2001] as the partial URSM sequence. Individuals with a partial URSM sequence typically have a single perineal/anal opening that serves as an outlet for a common cloaca and conduit for urine and feces to the outside. It is important to differentiate the partial from the full URSM sequence because the prognosis in the partial URSM sequence is generally good, with long-term survival a common feature. In this article we report a case of monozygotic twins concordant for the milder and generally nonlethal form of the URSM sequence. Monozygotic twinning with this condition has not been previously reported. The mother, a 19-year-old Caucasian woman, gravida 1, para 0, was presented to the ultrasound unit of the department of medical genetics and fetal medicine at 18 weeks of spontaneous pregnancy for routine screening. There was no family history of congenital malformations. The mother denied teratogenic exposure. On sonographic examination, a monochorionic, diamniotic twin pregnancy was diagnosed. Twin A had dilated distal bowel loops with enterolithiasis (an ultrasonographic examination revealed an echogenic bowel with multiple foci of calcified meconium intraluminally). Twin B had dilated distal bowel loops. A possible diagnosis of anal atresia was made. The genitalia could not be clearly determined. In view of the abnormal sonographic findings, amniocentesis was performed. Both fetuses had a normal 46,XY karyotype. The patient was referred to the high-risk clinic. Fetal biometry was appropriate for gestational age and a normal amount of amniotic fluid was observed. To further exclude anorectal malformation, magnetic resonance imaging (MRI) was performed which demonstrated dilated distal bowel loops (with enterolithiasis in twin A). The parenchyma of the kidneys and urinary bladder appeared normal. The twins were delivered by cesarean at 35 weeks of gestation after premature membrane rupture. TwinA weighed 1,950 g, twin B weighed 2,350 g. Postpartum examination revealed close placental insertions of both umbilical cords, each containing three vessels. Over a length of 25 cm the umbilical cords, separated by amniotic membranes, ran in such close proximity that they appeared to have a common course. The monochorionic, diamniotic twin pregnancy was confirmed and concordant fetal abnormalities were diagnosed. Both neonates had a single

Megacystis‐Microcolon‐Intestinal Hypoperistalsis Syndrome

The purpose of this report is to describe the in utero sonographic appearance of megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) and examine the role of vesicocentesis. Two cases of the sonographic appearance of MMIHS were reviewed. We performed vesicocentesis in 2 fetuses with MMIHS and performed vesicoamniotic shunting in 1 of them. The sonographic findings after these procedures were compared with those before puncture. In both cases, ultrasound examination showed a massively enlarged fetal bladder and bilateral hydroureteronephrosis with a normal amount of amniotic fluid. Fetal urinary sodium and chloride concentrations were within normal limits in both cases; this suggested normal fetal renal function. Generally, it is difficult to detect the dilated fetal bowel in MMIHS, probably because of the disturbance caused by a large bladder. In our cases, however, the ultrasound examination clearly showed fetal bowel dilatation after these procedures; this made the antenatal diagnosis of MMIHS more definite. The sonographic features after vesicocentesis may be helpful in confirming the antenatal diagnosis of MMIHS.

Darstellung und Quantifizierung der fetalen Lungendurchblutung mittels Power-Doppler-Ultraschall

Purpose: Can information be obtained about the effectiveness of a medication for foetal lung maturation in cases of premature labour or the development of lung hypoplasia in cases of severe oligohydramnios using power-Doppler quantification of central and peripheral foetal lung perfusion? Methods: We examined the perfusion of the right lung at the level of the four-chamber view of 23 foetuses undergoing lung maturation therapy (day 0 and 3; 12 mg betamethasone day 1 and 2), 12 foetuses with severe oligohydramnios (largest pocket <2cm) and 12 foetuses with normal amounts of amniotic fluid using power-Doppler. Picture sequences were stored during foetal immobility for at least 20 seconds (frame rate 6 Hz). Data analysis was performed using a 8 bit procedure. Colour pixels were counted for every frame and separated for the central and peripheral parts of the foetal lung perfusion. The frequencies of colour pixels were arranged into 16 groups depending on a given scale of different colours ranging from dark red representing small amounts of blood to light yellow representing large amounts of blood. We calculated 3D-diagrams, colour range (colour pixels/grey pixels) and a weighted mean (colour pixel x hue/16 hues). Results: Foetal lung perfusion is significantly increased in the central part of the lung compared to the peripheral part. There was no change of lung perfusion after a medication for foetal lung maturation. Cases complicated by severe oligohydramnios showed an over-all decrease of blood flow peripherally and the appearance of larger amounts of blood (shunts) as compared to foetuses with normal amounts of amniotic fluid. Conclusions: The development of foetal lung hypoplasia is associated with a decrease of lung perfusion as well as the appearance of larger amounts of blood in the peripheral parts of the lung. This phenomenon can be detected early in pregnancy by a quantification of colour pixels using power-Doppler ultrasound.