To assess the longitudinal intrathoracic changes after pleuroamniotic shunting in fetuses with massive unilateral or bilateral hydrothorax. The presence of intrafetal fluid effusions, and the observed/expected lung-to-head ratio (O/E-LHR) of both lungs were weekly evaluated in a cohort of fetuses with severe hydrothorax treated pleuro-amniotic shunting (PAS) in a single reference center in Mexico. Severe fetal hydrothorax was diagnosed as an accumulation of fluid within the fetal pleural space accompanied with severe bilateral lung compression, mediastinal shift, polyhydramnios, and/or hydrops. The longitudinal changes in intrafetal fluid effusions, and pulmonary growth were analyzed by survival and multilevel analysis against weeks after fetal intervention. Fifty-six pregnancies with severe fetal hydrothorax were treated with PAS at a median gestational age of 30.1 (range, 20.8-36.1) weeks. After shunting, all cases were longitudinally analyzed and in whom a total of 332 scans were performed (median 6, range 2-16). A complete disappearance of hydrops and hydrothorax was observed at a median interval of 1.6 and 5.9 weeks after PAS, respectively. A progressive increase in lung growth were observed, becoming normal O/E-LHR at on average 7.0 weeks after PAS. Fetal pleuro-amniotic shunting promotes disappearance of all fetal fluid effusions, and a normalization of the pulmonary growth after fetal intervention.

BackgroundMitochondrial DNA depletion syndrome 13 (MTDPS13) is an autosomal recessive disorder presenting in early infancy with encephalopathy, hypotonia, lactic acidosis, and severe global developmental delay. Patient‐derived cells typically exhibit impaired mitochondrial oxidative phosphorylation and a marked reduction in mitochondrial DNA (mtDNA) copy number.Case ReportWe report the case of a male preterm neonate born at 31 + 3 weeks of gestation following a pregnancy marked by severe polyhydramnios. At birth, his weight was 1400 g. Physical examination revealed dysmorphic features, redundant and lax skin, and generalized muscular hypotonia. Laboratory investigations showed marked lactic acidosis associated with lactic aciduria, ketonuria, and urinary biomarkers indicating activation of preoxidative phosphorylation biochemical pathways to sustain ATP production. Echocardiography demonstrated mild, early‐onset hypertrophic cardiomyopathy.The Exome Analysis Clinical and Biochemical Markers: The exome analysis, performed within the first week of life, highlighted a pathogenic variant in homozygous state of FBXL4 gene (c.1648_1649delGA), which led to the diagnosis of MTDPS13. In this clinical contest, a ketogenic diet (KD) was started with a daily caloric intake of 120 kcal/kg and an initial ketogenic ratio of 1:1. These intakes were administered both with a parenteral nutrition and continuous nasogastric tube feeding and were gradually increased and adapted on a day‐by‐day basis according to lactic acidosis, growth increase, and common metabolic parameters such as glucose, electrolytes, creatinine, and blood urea nitrogen. After 3 days of this treatment approach, a significant reduction in lactate levels and improvement in acid–base balance and growth trend were observed along with clinical and cardiovascular parameters. At discharge from neonatal intensive care unit, the KD was continued at home and during follow‐up. The infant showed stability in the clinical and biochemical markers.ConclusionsThis is the first documented report of the use of a KD in a preterm neonate with this mitochondrial disorder during the early days of life. Prompt genetic confirmation and early initiation of KD may enable a more targeted and effective management of MTDPS within the neonatal intensive care setting.

Introduction: Fetal oropharyngeal teratoma, or epignathus, is an extremely rare congenital malformation that represents less than 2% of congenital teratomas. Its main clinical relevance lies in the risk of complete obstruction of the fetal airway and perinatal death. Reported cases are typically diagnosed in the third trimester or at birth; however, ultrasound detection in the second trimester remains exceptional. This case provides evidence of early prenatal diagnosis of an epignathus with intrauterine demise in a resource-limited setting. Case presentation: A 20-year-old primigravida with prenatal care beginning at nine weeks presented at 27.2 weeks with rapid abdominal enlargement and a sensation of abdominal tension. Structural ultrasound revealed a heterogeneous oropharyngeal mass measuring 7.5 × 5.7 cm, associated with severe polyhydramnios, pleural effusion, ascites, and nonimmune fetal hydrops. No fetal heart rate was detected. Differential diagnoses included lymphangioma, branchial cleft cyst, rhabdomyosarcoma, and anterior encephalocele, with a presumptive diagnosis of oropharyngeal teratoma (epignathus). Labor induction was performed using 25 µg of vaginal misoprostol every 4 hours, resulting in the delivery of a female fetus weighing 700 g with a 6 × 6 cm oropharyngeal mass causing complete airway obstruction. The mother had a favorable postoperative course without complications. Conclusion: Early prenatal diagnosis of oropharyngeal teratoma is essential for planning care in specialized centers capable of advanced perinatal management. This case is unique due to its second-trimester diagnosis and comprehensive ultrasonographic correlation, contributing valuable information to the existing medical literature. The key takeaway is that timely sonographic suspicion, even in resource-limited settings, allows for diagnostic orientation, genetic counseling, and the provision of comprehensive and compassionate care in the setting of adverse fetal outcomes.

Objective: To determine the frequency of fetal malformations among pregnant women with polyhydramnios. To determine the association between the severity of polyhydramnios and fetal congenital malformations. Method: A descriptive cross-sectional study was conducted at Lady Reading Hospital, Peshawar over a period of six months (April-Oct, 2022). A sample size of 380 pregnant women was selected through non-probability consecutive sampling technique including pregnant women undergoing medical history, physical examination and detailed ultrasound screening. Data was collected using a proforma. IBM SPSS 24 was used to analyze the data descriptive statistics were applied and chi- square test was used to determine the association between the severity of polyhydramnios and fetal congenital malformations. Result: Regarding parity, 42.1% were nulliparous, 25.5% primiparous, and 32.4% multiparous. Ultrasound revealed mild polyhydramnios in 19.7%, moderate in 47.6%, and severe in 32.6%. Fetal anomalies were present in 50.8% of cases of polyhydramnios, including gastrointestinal (12.1%), cardiovascular (11.1%), central nervous system (16.6%), musculoskeletal (7.6%), and multi-organ system malformations (3.4%) while 49.2% had no anomalies. A significant association was observed between fetal anomalies and the severity of polyhydramnios (p < 0.001). Fetal anomalies were more commonly noted with severe polyhydramnios. Conclusion: A significant association was found between the severity of polyhydramnios and the presence of fetal anomalies with approximately half of the cases exhibited fetal malformations i.e., GIT, CVS and CNS abnormalities being the most common. The likelihood of fetal malformations increased notably with severity of polyhydramnios.

The VACTERL association refers to a collection of congenital anomalies that typically affect the vertebral column (V), anus (A), cardiovascular system (C), tracheoesophageal structures (TE), renal and urinary tract (R), and limbs (L). The diagnosis is considered when a patient has defects in at least three of these systems. This multisystem disorder can be life-threatening if not identified and managed early. Prompt and thorough evaluation is crucial to reduce long-term complications and morbidity. Here, we describe the case of a neonate born from a twin pregnancy at 38 weeks’ gestation, with antenatal findings of severe polyhydramnios and a single umbilical artery and vein. This report focuses on the imaging characteristics of congenital cardiac, skeletal, and tracheoesophageal abnormalities in this infant.

MAGED2 -related Bartter syndrome is a rare X-linked disorder characterized by severe fetal polyuria, polyhydramnios, preterm birth, and increased perinatal morbidity. This study evaluates the efficacy of amnioreduction in prolonging gestation and improving outcomes in affected pregnancies. We analyzed three cases of severe polyhydramnios detected via prenatal ultrasound. Whole-exome sequencing (WES) was performed to identify causative mutations. Two cases underwent therapeutic amnioreduction, while the third received expectant management. Clinical outcomes, including gestational age at delivery and neonatal complications, were compared. WES confirmed hemizygous MAGED2 mutations in all fetuses. The two cases treated with amnioreduction were delivered at 35 weeks 2 days and 37 weeks 1 day, respectively, with no severe neonatal complications. In contrast, the untreated case was delivered prematurely at 32 weeks and 6 days, resulting in transient brain damage requiring postnatal rehabilitation. Amnioreduction mitigates polyhydramnios-driven preterm birth in MAGED2 -related Bartter syndrome, enabling safer gestational prolongation. Integration of WES for rapid genetic diagnosis and multidisciplinary care optimizes prenatal management. These findings support amnioreduction as a critical intervention for this high-risk population, emphasizing early genetic testing, and proactive fetal therapy.

Summary. Despite recent advances in medicine, polyhydramnios occurs in 1–2% of pregnancies worldwide and is associated with a high risk of perinatal complications, accounting for 13–17% of perinatal mortality. In recent years, the rate of cesarean section among pregnant women with acute polyhydramnios has increased to 60–75%. Furthermore, *“...perinatal mortality in pregnancies complicated by polyhydramnios is reported to be 2.3 times higher” [1].The purpose of the study. To assess the effectiveness of amnioreduction using a universal intrauterine port compared to the standard method in pregnant women with acute polyhydramnios.Materials and Methods. An analysis was conducted on obstetric and perinatal outcomes in 55 patients divided into a main group (N=21) and a comparison group (N=34). The main group underwent prolonged amnioreduction using a universal port, while the comparison group received repeated standard amnioreductions.Results. The study revealed significantly better outcomes in terms of pregnancy prolongation and perinatal results in the main group. Perinatal outcomes analysis showed the advantage of using a universal port for amnioreduction. In the main group, 61.9% of newborns had a birth weight ≥2500 g, and 57.1% had an Apgar score of 8–10; no perinatal losses were recorded. In the comparison group, only two newborns had a birth weight ≥2500 g or an Apgar score of 8–10; there were 2 antenatal and 3 early neonatal deaths. Based on the analysis, it was established that the group undergoing amnioreduction with a universal intrauterine port showed higher birth weight, normal fetal growth, higher Apgar scores, and no perinatal losses.Conclusion. In the main group, the use of a universal intrauterine port for amniodrainage in severe polyhydramnios was associated with a reduction in perinatal morbidity and mortality compared to the standard amnioreduction method. The comparison group demonstrated lower birth weight, lower Apgar scores, and higher mortality rates. This confirms that amnioreduction using a universal port plays an important role in improving perinatal outcomes and is an effective method for treating polyhydramnios.

INTRODUCTIONHypercalcaemia with nephrocalcinosis in infants is commonly caused by excessive calcium or vitamin D supplementation, neonatal primary hyperparathyroidism, subcutaneous fat necrosis or various genetic disorders. CASEWe present a 6-month-old Indian male infant who was born preterm at 33 weeks, via elective LSCS for polyhydramnios with weight of 1.33 kg, length of 46 cm and head circumference of 27 cm. His mother had severe polyhydramnios, requiring amnioreduction thrice. Both parents were consanguineous. During his 3-month-stay at NICU, he had persistent hypercalcaemia with intermittent polyuria. Serum calcium ranged: 2.5–2.9 mmol/L, phosphate: 1.85–3.05 mmol/L, alkaline phosphatase (ALP): 500–800 IU/L and 25(OH)D₃: 200 nmol/L. He also had hypochloraemic hypokalemic metabolic alkalosis, hyperreninemia (>550 mU/L) and hyperaldosteronemia (>3656 pmol/L). Ultrasound at 2-month-old demonstrated bilateral renal medullary nephrocalcinosis and cholelithiasis. Skeletal survey revealed no significant bony abnormalities. There were episodes of hyponatremia and hypokalemia, which improved spontaneously. Clinically, he had prominent forehead, triangular face, right hand pre-axial polydactyly and bilateral short distal phalanx of the 4th and 5th fingers with nail hypoplasia. His weight gain was poor with delayed motor development and hypotonia. At 6-month-old, his care was shared by paediatric nephrologist and endocrinologist. He was 3.57 kg with a length of 57.8 cm. His iPTH later resulted in relatively inappropriately raised level, (Ca: 2.81 mmol/L, PO₄: 1.87 mmol/L, ALP: 770 IU/L, iPTH: 68.3 pg/mL). Urinalysis showed profound natriuresis and hypercalciuria (24-hour urine Ca: 5.3 mg/kg/day). Ultrasound of the thyroid exhibited no abnormality. The parents’ calcium profiles were normal. Pamidronic acid (1 mg/kg/dose) was given (when serum calcium >3.0 mmol/L) but the hypercalcemia only transiently improved. Eventually, he was treated with indomethacin and free water supplement. The whole exome sequencing revealed a heterozygous pathogenic variant in ROR2 gene and a homozygous variant of uncertain significance in KCNJ1 gene. CONCLUSIONAntenatal Bartter syndrome presents insidiously during neonatal period, typically with polyhydramnios, IUGR, prematurity, polyuria and failure to thrive. It can present with nephrocalcinosis accompanied by features resembling primary hyperparathyroidism. Genetic testing enhances the diagnostic precision of various Bartter syndrome subtypes.

Objective: To determine the presentation and outcome of polyhydramnios in pregnancy at a tertiary care hospital. Study Design: Descriptive Cross-sectional study. Setting: Department of Obstetrics and Gynaecology, Independent University Hospital Faisalabad. Period: 1-Jan-2020 to 31-Dec-2022. Methods: All the cases diagnosed as polyhydramnios after confirmation on ultrasonography by measuring single deepest vertical pool were included. Results: The total number of patients included in the study were 80. The patients having age <35 years were 62 (77.5%) while the patients having age > 35 years were 18 (22.5%). 16 patients (20%) were primigravida while 64 patients (80%) were multigravida. The patients with Mild polyhydramnios were52 (65%), moderate polyhydramnios 21 (26.5%) and with severe polyhydramnios 7 (8.7%). The various maternal complications were as preterm labour in 11 patients (13.7%), gestational diabetes mellitus 8 patients (10%), Pre-PROM 7 patients (8.75%), PIH and its complications 3 patient (3.75%) and Placental abruption 2 patients (2.5%). while 49 patients (61.25%) had no complications. Regarding mode of delivery 13 patients (16.3%) were delivered vaginally while 67 patients (83.7%) underwent caesarean section. Fetal outcome was quite good. There were normal alive babies 67 (83.75%), anomalous 9 (11.25%) and 4 babies (5%) were diagnosed as IUD. Conclusion: In the present study, polyhydramnios had diversity in its presentation and maternal versus fetal outcome was associated with degree of polyhydramnios.

Polyhydramnios is associated with both maternal and fetal adverse outcomes. Idiopathic polyhydramnios, regardless of its severity category, was considered not to be associated with an increase in adverse outcomes. In contrast, when conditions such as congenital and chromosomal abnormalities or diabetes mellitus are detected, neonatal and maternal adverse outcomes can be up to five times higher. We thus aimed to document the outcomes of patients with mild, moderate and severe polyhydramnios according to whether an underlying cause was found and which management protocol was followed. We conducted a retrospective cohort study of all patients with polyhydramnios on ultrasound examination at our secondary hospital between January 1, 2018 and December 31, 2020. Hospital folders were reviewed. We recorded demographic data, information on underlying causes, management and outcomes. We summarised categorical variables using count (percentage). We tested the association between categorical variables using the chi-square test. Statistical significance was set at p < 0.05. A total of 136 patients with polyhydramnios (80 mild, 42 moderate, and 14 severe) were included. Most cases of polyhydramnios were idiopathic regardless of category [81.2% (65/80), 78% (32/42) and 78% (11/14) in the mild, moderate and severe groups, respectively]. The likelihood of occurrence of the composite adverse outcome, was higher with increasing severity of polyhydramnios, with 6.75%. 19.05%, and 35.71% in the mild, moderate and severe groups, respectively, having the composite adverse outcome (p = 0.01). Elective delivery before 40 weeks' gestation for polyhydramnios in patients with idiopathic polyhydramnios was associated with a significant reduction in the occurrence of the composite adverse outcome compared to awaiting spontaneous labor (3.77% versus 15.79%, p = 0.036),. Adverse outcomes were related to severity of the polyhydramnios and were significantly lower in the mild compared to the moderate and severe groups, with the rate of adverse outcome in the mild group comparable to that of the general population. Early delivery before 40 weeks gestation may be associated with benefit in moderate and severe groups of polyhydramnios.

Objective: To report and discuss the management and delivery of a patient with a placental chorioangioma and associated severe polyhydramnios in the third trimester of pregnancy. Background: Chorioangiomas are the most common benign tumors of the placenta, with an incidence of 0.2-0.6%. They are made up of fetal vessels which results in a hyperdynamic circulatory state in the fetus. Large chorioangiomas, those measuring more than 4 cm in diameter, are associated with complications. Fetal thrombocytopenia and microangiopathic hemolytic anemia can occur resulting in cardiac failure and hydrops. Other complications include preterm delivery and intrauterine death. Chorioangiomas are associated with severe polyhydramnios due to transudate from the tumor vessels and increased fetal urinary output due to the hyperdynamic state. Polyhydramnios is defined as a single deepest vertical pocket (DVP) ≥ 8 cm or an amniotic fluid index (AFI) ≥ 24 cm, while severe polyhydramnios is a DVP of ≥ 16 cm or an AFI of ≥ 35 cm. Severe polyhydramnios can cause maternal respiratory compromise, preterm labor, and postpartum hemorrhage. Treatment is typically with amnioreductions with the options of intrauterine blood transfusions, alcohol injection, endoscopic laser coagulation, and interstitial laser therapy. Case Description: A 32-year-old G5P2022 presented at 27 weeks and 1 day gestation with contractions. An ultrasound showed an exophytic hypoechoic vascular placental mass measuring 4.5 x 5.7 x 4.6 cm, likely a placental chorioangioma, AFI of 18 cm. Her obstetrical history included two cesarean sections and two spontaneous miscarriages. At 29 weeks and 3 days gestation, she was admitted for contractions and severe polyhydramnios, AFI was 54.9 cm. An amnioreduction was performed which yielded 2500 mL of amniotic fluid. She was given twelve hours of magnesium for neuroprotection and a betamethasone course for fetal lung maturity. She had a normal level II anatomy ultrasound, low-risk NIPT, and normal amniotic fluid chromosomal microarray. Weekly biophysical profiles and middle cerebral artery dopplers were ordered. She was then readmitted at 30 weeks and 4 days gestation for contractions and severe polyhydramnios with an AFI of 39 cm. She was given indomethacin and magnesium for tocolysis and was discharged. At 31 weeks and 6 days gestation, she was admitted for contractions and shortness of breath in the setting of severe polyhydramnios, AFI was 65 cm. An amnioreduction was performed which yielded 3000 mL of amniotic fluid, repeat AFI was 27 cm. She was given nifedipine for tocolysis and discharged. She was readmitted at 33 weeks and 1 day gestation for contractions and worsening shortness of breath, AFI was 58 cm. An amnioreduction was performed which drained 2325 mL of fluid, repeat AFI was 28. She was given nifedipine for tocolysis and discharged. She then presented again at 33 weeks and 6 days gestation for worsening contractions and shortness of breath. Maternal Fetal Medicine was consulted who recommended pain control and rescue betamethasone course followed by delivery. A repeat cesarean section was performed at 34 weeks and 0 days without complications. A viable female infant with APGAR scores of 8 and 9 was delivered. The 7.0 x 6.5 x 5.2 cm chorioangioma was well-circumscribed and homogenous. Pathology showed multiple benign well-defined proliferations of vascular spaces. She did well in the postpartum period and was discharged on postoperative day three. The patient did not follow-up postpartum. Discussion: Chorioangiomas are the most common benign placental tumors and are associated with severe polyhydramnios. If severe polyhydramnios is diagnosed, an ultrasound to assess for a chorioangioma should be performed. Once diagnosed, we performed a level II anatomy ultrasound, weekly middle cerebral artery dopplers for fetal anemia surveillance and biophysical profiles. An amnioreduction may be performed if there is maternal discomfort. This patient’s polyhydramnios was refractory to three amnioreductions. Overall, there is no consensus on the volume that should be removed and the use of tocolytics for an amnioreduction. In our practice, we performed continuous electronic fetal monitoring for at least one hour (longer if patient was on magnesium), used tocolytics (magnesium, indomethacin, or nifedipine) for 12 hours, optimized pain control (hydroxyzine, morphine, oxycodone, and or robaxin as needed), and gave intravenous fluids (bolus and maintenance) after an amnioreduction. Maternal Fetal Medicine recommended delivery for this patient at 34 weeks and 0 days in the setting of refractory severe polyhydramnios and maternal discomfort. Currently, there are no accepted standards to guide delivery of these patients.

Otocephaly (OC) is a rare malformation characterized by the association of agnathia (agenesis of mandible) or mandibular hypoplasia, melotia (anteromedial malposition of ears), microstomia (small mouth), aglossia or microglossia (absent or rudimentary tongue). We present an extremely preterm/very low birth weight/female baby born to a G2P1IUD1 mother. The baby did not cry at birth. APGAR was 3 at 1 min and 1 at 5 min. On examination, the baby had multiple craniofacial abnormalities including an absent mandible, small mouth, rudimentary tongue, ventromedian malposition of ears, and bilateral choanal atresia. Mother had gestational diabetes mellitus and severe polyhydramnios. No similar history in the family. Within 30 s of life, the baby became cyanotic. Bagging with mask and intubation was tried but resuscitation was not successful due to upper airway malformation. The baby had bradycardia and expired at 20 min of life.

Background Idiopathic polyhydramnios is associated with adverse neonatal outcome. The aim of this study was to examine the value of the middle cerebral artery pulsatility index (MCA-PI) in predicting adverse perinatal outcome in pregnancies affected by idiopathic polyhydramnios. Methods A retrospective study was performed during 2013–2022 at a tertiary-care university affiliated hospital. The study included singleton pregnancies with idiopathic polyhydramnios. Obstetrical and perinatal outcomes were compared between women with MCA-PI <10th percentile and women with MCA-P ≥ 10th percentile. A composite adverse perinatal outcome was defined as an Apgar score <7 at 5 minutes, umbilical artery pH <7.15, emergent caesarean delivery (CD) or operative delivery due to foetal distress, neonatal intensive care admission or foetal death. Results Among 45,459 pregnancies, 128 (0.3%) had idiopathic polyhydramnios; 27 exhibited MCA-PI <10th percentile. Among the latter, compared to pregnancies with MCA-PI ≥10th percentile group, the rates were higher of emergent CD (25.9% vs. 7.9%, p = 0.017) and adverse perinatal outcomes (37.0% vs. 15.8%, p = 0.020). These differences persisted in a subgroup analysis of women with moderate or severe polyhydramnios. In the MCA-PI <10th percentile group, the median MCA-PI and cerebroplacental ratio were lower: 0.9 vs. 1.7, p < 0.001 and 0.7 vs. 2.1, p < 0.001, respectively. Receiver operating characteristic curve analysis indicated a significant association of MCA-PI with emergent CD/operative delivery for foetal distress (area under curve = 0.672, p = 0.031); the sensitivity was 46.7% and specificity 82.3%. Cerebroplacental ratio values were not associated with adverse perinatal outcomes. Conclusions Idiopathic polyhydramnios might be associated with foetal cerebral blood flow redistribution, potentially contributing to an increased risk of adverse neonatal outcomes. Prospective studies are required to establish the role of foetal Doppler studies in the antenatal surveillance of idiopathic polyhydramnios, and to determine whether evidence of abnormal MCA-PI serves as a reliable predictor of perinatal outcomes, potentially necessitating labour induction.

To recalculate the estimated fetal weight (EFW) based on ultrasound measurements in patients complicated with isolated polyhydramnios, using 14 current formulas to observe which formula better predicts the EFW. This study examined pregnant women who gave birth in the hospital between January 2015 and January 2020. Maximum vertical pocket (MVP) was classified as, mild, moderate, and severe polyhydramnios, and the patients' measurements were reanalyzed using 14 formulas. The estimation of birth weight (EBW) alongside observed birth weight (OBW) facilitated the computation of statistical indices, namely the mean absolute percentage error (MAPE) expressed as [(EBW - OBW)/OBW × 100], the mean percentage error (MPE) denoted as (EBW - OBW)/(OBW × 100), and their corresponding 95% confidence intervals. A total of 564 polyhydramnios patients were included in the study. When looking at the MAPE, the lowest rate (7.65) was found in the Hadlock 2 formula. Hadlock 1, Hadlock 3, and Shinozuka formulas demonstrated MAPE values most closely aligned with Hadlock 2. Weiner I and Thurnau were the formulas with the highest MAPE values. When the cut-off values for MAPE were taken as 10%, 4/14 of the formulas (Weiner I-II, Vintzleos and Thurnau) gave results above 10%. Among 14 formulas, 3 (21.4%) had positive (sonographic overestimation) (Hadlock 3, Shinozuka, and Vintzleos) and the other 11 (78.6%) had negative MPE (sonographic underestimation). The Hadlock 2 formula had the lowest MAPE in predicting birth weight in patients with polyhydramnios, closely followed by the Hadlock 1, Hadlock 3, and Shinozuka formulas.

Introduction: Fetal sacrococcygeal teratomas (SCGT), the most common fetal neoplasm diagnosed in fetuses, are a rare condition with an estimated incidence of 1 in 40,0000 live births. Fetal SCGT is usually suspected when characteristic findings are seen on ultrasound such as a mass that is cystic and/or solid and is located in the sacral region. MRI may also be used to more accurately characterize the tumor and to help distinguish between SCGTs and distal neural tube defects like sacral meningomyelocele. Despite advances in ultrasound and MRI, only approximately 50% are diagnosed prenatally. The detection of fetal SCGT is important because it changes pregnancy monitoring and management as it is associated with fetal hydrops, intrauterine death, polyhydramnios, mirror syndrome, and mortality rates as high as 43%. Once an SCGT has been identified, serial ultrasound evaluation of the fetus, placenta, and SCGT is important to identify early signs of fetal hydrops, fetal anemia, or cardiac failure and to intervene as appropriate. Case Report: A 40-year-old G5P4004 was referred to Maternal Fetal Medicine (MFM) due to findings of a 1 cm mass near the fetal bladder on first trimester ultrasound. She had a level II ultrasound performed by MFM at 16.2 weeks where a 3.6 x 2.3 x 2.6 cm mass was identified. This mass was adjacent to the sacrococcygeal region. Due to its location and characteristic appearance, with both cystic and solid components with high vascularity, a fetal sacrococcygeal teratoma was suspected. There were no signs of hydrops or fetal anemia. At this time, the recommendation for management was: ultrasounds every 2 weeks to assess for hydrops and fetal anemia, growth ultrasound every 4 weeks, an echocardiogram by pediatric cardiology at 22-24 weeks, a fetal MRI at 28 weeks, and delivery between 37-39 weeks or earlier pending clinical course. At 24.2 weeks, she developed polyhydramnios with a maximum vertical pocket (MVP) of 10.5 cm. She had also failed her 1-hour glucose tolerance test with a value of 287 mg/dL. Due to the new finding of polyhydramnios and diagnosis of gestational diabetes, her monitoring was increased to weekly, with biophysical profile (BPP) starting at 28 weeks and weekly nonstress tests (NST) at 32 weeks. A fetal MRI was performed at 26.4 weeks and showed a large lesion extending off the sacrococcygeal region measuring 9.6 x 6.3 x 7.7 cm that was composed of both solid and cystic components. By 32.2 weeks, she developed severe polyhydramnios with an AFI of 36.0 cm and accelerated fetal growth due to an AC &gt; 99th percentile. The last ultrasound she had at 34.2 weeks the SCGT measured 17.7 x 13.3 x 13.6 cm and severe polyhydramnios persisted. The patient went into preterm labor at 35.2 weeks and had a cesarean section due to known SCGT measuring greater than 5 cm. Immediately after delivery, the neonate was evaluated by the neonatal team and transferred to the Neonatal Intensive Care Unit. The infant had surgical resection of the mass and will have tumor markers, AFP and LDH, monitored for development of recurrent immature or mature teratoma. The pathology report confirmed the diagnosis for benign sacrococcygeal teratoma. Discussion: Failure to diagnose a fetal sacrococcygeal teratoma has potentially catastrophic consequences for the fetus and mother. Maternal complications include hyperemesis, preeclampsia, mirror syndrome, preterm labor, and HELLP syndrome. Significant obstetric complications can be as high as 81%. Intrauterine fetal complications include fetal hydrops from high-output failure, fetal anemia, intratumoral hemorrhage, polyhydramnios, genitourinary obstruction leaking to hydronephrosis and or hydroureter. SCGT size &gt;10 cm or tumor with rapid growth has &gt; 50% perinatal mortality. Tumor characteristics associated with higher mortality rates are early diagnosis, solid components, high vascularity, tumor size &gt; 10 cm, and rapid growth &gt; 150 cm3/week. Another way to risk stratify these patients is by calculating a tumor volume to fetal weight ratio (TFR), which if &gt; 0.12 at &lt; 24 weeks is predictive of an overall poor prognosis. When comparing this case to literature review of sacrococcygeal teratomas, the patient’s fetal SCGT would be classified as high risk of mortality due to the tumor characteristics of early diagnosis, TFR at 20 weeks being 0.16, large size, rapid growth, and pronounced vascularity. Overall, in this high risk case of SCGT, the close follow up and evidence-based management with utilization and collaboration of a multidisciplinary team including Maternal Fetal Medicine, NICU, and Pediatric Surgery in a tertiary center resulted in a successful outcome.

Introduction: Fetal sacrococcygeal teratomas (SCGT), the most common fetal neoplasm diagnosed in fetuses, are a rare condition with an estimated incidence of 1 in 40,0000 live births. Fetal SCGT is usually suspected when characteristic findings are seen on ultrasound such as a mass that is cystic and/or solid and is located in the sacral region. MRI may also be used to more accurately characterize the tumor and to help distinguish between SCGTs and distal neural tube defects like sacral meningomyelocele. Despite advances in ultrasound and MRI, only approximately 50% are diagnosed prenatally. The detection of fetal SCGT is important because it changes pregnancy monitoring and management as it is associated with fetal hydrops, intrauterine death, polyhydramnios, mirror syndrome, and mortality rates as high as 43%. Once an SCGT has been identified, serial ultrasound evaluation of the fetus, placenta, and SCGT is important to identify early signs of fetal hydrops, fetal anemia, or cardiac failure and to intervene as appropriate. Case Report: A 40-year-old G5P4004 was referred to Maternal Fetal Medicine (MFM) due to findings of a 1 cm mass near the fetal bladder on first trimester ultrasound. She had a level II ultrasound performed by MFM at 16.2 weeks where a 3.6 x 2.3 x 2.6 cm mass was identified. This mass was adjacent to the sacrococcygeal region. Due to its location and characteristic appearance, with both cystic and solid components with high vascularity, a fetal sacrococcygeal teratoma was suspected. There were no signs of hydrops or fetal anemia. At this time, the recommendation for management was: ultrasounds every 2 weeks to assess for hydrops and fetal anemia, growth ultrasound every 4 weeks, an echocardiogram by pediatric cardiology at 22-24 weeks, a fetal MRI at 28 weeks, and delivery between 37-39 weeks or earlier pending clinical course. At 24.2 weeks, she developed polyhydramnios with a maximum vertical pocket (MVP) of 10.5 cm. She had also failed her 1-hour glucose tolerance test with a value of 287 mg/dL. Due to the new finding of polyhydramnios and diagnosis of gestational diabetes, her monitoring was increased to weekly, with biophysical profile (BPP) starting at 28 weeks and weekly nonstress tests (NST) at 32 weeks. A fetal MRI was performed at 26.4 weeks and showed a large lesion extending off the sacrococcygeal region measuring 9.6 x 6.3 x 7.7 cm that was composed of both solid and cystic components. By 32.2 weeks, she developed severe polyhydramnios with an AFI of 36.0 cm and accelerated fetal growth due to an AC &gt; 99th percentile. The last ultrasound she had at 34.2 weeks the SCGT measured 17.7 x 13.3 x 13.6 cm and severe polyhydramnios persisted. The patient went into preterm labor at 35.2 weeks and had a cesarean section due to known SCGT measuring greater than 5 cm. Immediately after delivery, the neonate was evaluated by the neonatal team and transferred to the Neonatal Intensive Care Unit. The infant had surgical resection of the mass and will have tumor markers, AFP and LDH, monitored for development of recurrent immature or mature teratoma. The pathology report confirmed the diagnosis for benign sacrococcygeal teratoma. Discussion: Failure to diagnose a fetal sacrococcygeal teratoma has potentially catastrophic consequences for the fetus and mother. Maternal complications include hyperemesis, preeclampsia, mirror syndrome, preterm labor, and HELLP syndrome. Significant obstetric complications can be as high as 81%. Intrauterine fetal complications include fetal hydrops from high-output failure, fetal anemia, intratumoral hemorrhage, polyhydramnios, genitourinary obstruction leaking to hydronephrosis and or hydroureter. SCGT size &gt;10 cm or tumor with rapid growth has &gt; 50% perinatal mortality. Tumor characteristics associated with higher mortality rates are early diagnosis, solid components, high vascularity, tumor size &gt; 10 cm, and rapid growth &gt; 150 cm3/week. Another way to risk stratify these patients is by calculating a tumor volume to fetal weight ratio (TFR), which if &gt; 0.12 at &lt; 24 weeks is predictive of an overall poor prognosis. When comparing this case to literature review of sacrococcygeal teratomas, the patient’s fetal SCGT would be classified as high risk of mortality due to the tumor characteristics of early diagnosis, TFR at 20 weeks being 0.16, large size, rapid growth, and pronounced vascularity. Overall, in this high risk case of SCGT, the close follow up and evidence-based management with utilization and collaboration of a multidisciplinary team including Maternal Fetal Medicine, NICU, and Pediatric Surgery in a tertiary center resulted in a successful outcome.

Pregnancies complicated by severe polyhydramnios are associated with a high rate of underlying fetal anomaly. Amnioreduction may be offered to alleviate maternal symptoms. This is a retrospective study of amnioreductions performed on singleton and twin gestations complicated by symptomatic polyhydramnios between 2010 and 2023 at our tertiary referral center. The indications, procedural techniques and pregnancy and neonatal outcomes were retrieved from an archive database and reviewed with the use of the maternal and child medical record chart, the hospital electronic clinical discharge report and telephone recalls. Our study comprised 86 pregnancies, 65 singletons and 21 twin pregnancies. Fetal anomalies were identified in 79% of cases, mainly gastrointestinal obstructive anomalies; 9.3% of cases were idiopathic. The median gestational age at first amnioreduction was 32.5 weeks, and peri-procedural complications were rare (1 case of placental abruption and 2 cases of preterm delivery). The median gestational age at delivery was 36.5 weeks, with a median prolongation of the pregnancy from the time of first drain until birth of 30 days. Preterm labor < 37 weeks occurred in 48.8% of procedures, with 26.7% of patients delivering before 34 weeks and pPROM < 36 weeks recorded in 23.2% of cases. In conclusion, amnioreduction offered to alleviate maternal symptoms is a reasonably safe procedure with a low complication rate. These pregnancies necessitate management in a tertiary referral center because of their need for a multidisciplinary approach both prenatally and postnatally.

IntroductionThe perinatal period poses heightened vulnerability to bipolar affective episodes. Lithium serves as first line in the management of bipolar disorder, demonstrating efficacy in stabilizing mood episodes and preventing relapses. Therefore, it also a recommended treatment during the pregnancy period. However, its use presents potential risks for both the mother and the developing fetus. Given the prevalence of bipolar disorder in reproductive-age women, it is crucial to investigate the risks associated with lithium use during pregnancy, along with its subsequent obstetric and neonatal complications.ObjectivesThis report outlines a case of severe polyhydramnios in a 42-year-old primigravida patient, under long-term lithium and antipsychotic treatment. Additionally, a systematic search for similar case reports was conducted to provide an overview of the existing literature.MethodsThe patient’s medical history and perinatal medical care are documented in this case report. A systematic literature search on MEDLINE (PubMed) was conducted using Boolean operators.ResultsThe patient was diagnosed with bipolar disorder type I and had a history of lithium treatment for over 20 years, supplemented later with antipsychotics. During her pregnancy, she experienced a polyuria-polydipsia syndrome and a severe polyhydramnios. She also suffered renal impairment. Together, it is indicative of a nephrogenic diabetes insipidus (NDI), likely induced by prolonged lithium treatment. As the pregnancy progressed, she experienced premature rupture of membranes at 34 weeks and 5 days. The newborn needed medical support and was admitted to the neonatal unit, without further complications.Systematic research showed three published case reports describing nephrogenic diabetes insipidus (NDI) and polyhydramnios associated to lithium treatment.ConclusionsChronic administration of lithium may contribute to the development of resistance to antidiuretic hormone (ADH), leading to polyuria-polydipsia syndrome and potentially severe obstetric complications. The co-administration of lithium and antipsychotics may exacerbate these effects. Further research is needed to elucidate their combined clinical impacts.Disclosure of InterestNone Declared

Abstract Rhabdoid tumors of the kidney are highly lethal malignancies of infancy. We report the prenatal detection of this renal tumor in a fetus in the third trimester of pregnancy. Ultrasonologically, the tumor appeared as a large mass in the left renal area associated with severe polyhydramnios. Though the sonographic features alone did not allow distinction from a benign lesion, tumor extension into the subcutaneous plane favored the possibility of a malignant renal tumor and this was confirmed postnatally on histopathology.

Mosaic trisomy 14 or partial trisomy 14 is a rare genetic abnormality that occurs when only a portion of cells have an additional copy of chromosome 14. It has a female prevalence of 3:1 and is associated with a wide range of related disorders. In this case, severe polyhydramnios because of borderline micrognathia was correlated to the diagnosis of mosaic trisomy 14. Early sonographic detection of associated findings can prompt the genetic testing required for diagnosis. Combining sonography and genetic testing leads to an accurate diagnosis, proper management, and postnatal planning for the patient.