Prenatal Sonography in Suspected Proximal Gastrointestinal Obstructions: Diagnostic Accuracy and Neonatal Outcomes

BackgroundThe purpose of this study was to assess diagnostic accuracy and neonatal outcomes in fetuses with a suspected proximal gastrointestinal obstruction (GIO).MethodsAfter IRB approval, a retrospective chart review was conducted on prenatally suspected and/or postnatally confirmed cases of proximal GIO at a tertiary care facility (2012–2022). Maternal-fetal records were queried for presence of a double bubble ± polyhydramnios, and neonatal outcomes were assessed to calculate the diagnostic accuracy of fetal sonography.ResultsAmong 56 confirmed cases, the median birthweight and gestational age at birth were 2550 g [interquartile range (IQR) 2028–3012] and 37 weeks (IQR 34–38), respectively. There was one (2%) false-positive and three (6%) false-negatives by ultrasound. Double bubble had a sensitivity, specificity, positive predictive value, and negative predictive value for proximal GIO of 85%, 98%, 98%, and 83%, respectively. Pathologies included 49 (88%) with duodenal obstruction/annular pancreas, three (5%) with malrotation, and three (5%) with jejunal atresia. The median postoperative length of stay was 27 days (IQR 19–42). Cardiac anomalies were associated with significantly higher complications (45% vs 17%, p = 0.030).ConclusionsIn this contemporary series, fetal sonography has high diagnostic accuracy for detecting proximal gastrointestinal obstruction. These data are informative for pediatric surgeons in prenatal counseling and preoperative discussions with families.Level of EvidenceDiagnostic Study, Level III.     

Neonatal airway obstruction caused by rapidly growing nasopharyngeal teratoma

A case report is presented of a rapidly growing congenital nasopharyngeal teratoma (epignathus) in a preterm infant, leading to severe upper airway obstruction. Prenatal diagnosis by ultrasonography did not reveal the condition because the tumour masses were initially small and there was no polyhydramnios. Epignathus is a rare cause of upper airway obstruction of the newborn that can grow rapidly in the neonatal period and should be treated surgically.
Conclusion:  Epignathus is a rare cause of upper airway obstruction of the newborn that can grow rapidly in the neonatal period.     

Congenital duodenal obstruction: does prenatal diagnosis improve the outcome?

Prenatal diagnosis of congenital duodenal obstruction (CDO) provides information about associated anomalies; helps plan the delivery, resuscitation, and neonatal surgery; and allows for appropriate family counseling. This report compares the outcomes of two groups of newborns: one with prenatal diagnosis of CDO (group I) and the other without (group II). Charts of the 23 newborns with CDO admitted to the Hospital of UNICAMP between 1993 and 2001 were retrospectively reviewed. Ten (44%) newborns had prenatal diagnosis of CDO. Among group I patients, the postnatal diagnosis was confirmed on the 1st day of life, whereas patients without prenatal diagnosis (group II) had the diagnosis of CDO confirmed at a mean age of 5.7 days (p=0.004). The mean ages at surgery, at total oral feeding, and at hospital discharge were also statistically lower among infants with prenatal diagnosis, and more complications occurred in group II patients. The earlier care could explain the statistically lower morbidity for patients with prenatal diagnosis, since they were able to undergo further investigation and surgical repair before any impairment to their clinical status could take place. We believe that prenatal diagnosis of CDO, associated with earlier surgery and adequate postoperative support, can provide lower morbidity, decrease the hospitalization period, and, therefore, decrease its costs to the state and to society.     

Antenatal prediction of hypertrophic pyloric stenosis

This is the first reported case where the diagnosis of hypertrophic pyloric stenosis (HPS) was entertained in the antenatal period and the neonate was followed up in the postnatal period on a prospective basis until the HPS became manifest. Accepted: 16 August 2000     

Prenatal ultrasonic diagnosis of epignathus.

This case demonstrated a mass seen on an ultrasound scan performed prior to amniocentesis to determine fetal maturity. It emphasizes the importance of scanning the entire contents of the amniotic sac rather than simply looking at the portion for which the examination was ordered. It is important to recognize such lesions to prepare for adequate management of the airway in the neonate, to prepare for surgical excision as soon as feasible, and to prepare the family for the birth of a baby with a congenital abnormality.     

Clinical features of pregnancies with fatal fetal abnormality

Obstetrical features and antenatal findings in 68 pregnancies with fatal fetal abnormalities are evaluated. The course of the pregnancy was complicated in 81% of these cases, the most common complication being intrauterine fetal growth retardation (IUGR) which was typical for 18-trisomies and multimalformed fetuses. The retardation in symphyseal-fundal growth was manifested on the average on the 25th gestational week. Low-profile type biparietal growth retardation was associated with 43% of the IUGR cases, and the brain-sparing effect in growth was found in 29%. Polyhydramnios was a complication in 30% of the series. Premature labor was associated with 60% of the spontaneously initiated deliveries in the series, and was not due to the polyhydramniotic tendency only. Antenatal evaluation of the fetoplacental unit function revealed a normal capacity in 62% of the cases. The fatality of the fetal abnormality was not manifested in any special feature in the complications of the pregnancy. Antenatal etiological evaluation and search for fetal anomalies in all pregnancies complicated by early IUGR, polyhydramnios and imminent premature labor is stressed for the adequate assessment of perinatal care.     

Quand faut-il évoquer en anténatal une disomie uniparentale paternelle 14 ?

The paternal uniparental disomy 14 is a rare malformation syndrome whose postnatal pathognomonic sign is the deformation of the rib as coat hanger. In prenatal, ultrasonographic signs are major recurrent polyhydramnios, a narrow thorax and deformed long bones short and sometimes other anomalies including ends. The authors report one rare case of prenatal paternal uniparental disomy 14 with the deformation of the rib as coat hanger. Prenatally, the narrow deformed thorax can be searched by ultrasound three-dimensional (3D) and/or helical CT and thus represent an aid to prenatal diagnosis.     

Perinatal Outcome with Sonographically Thin Placentas

In order to determine the incidence and significance of sonographically thin placentas, we reviewed the computerized records of 18,937 viable, singleton pregnancies. Of these, 0.6% had thin placentas diagnosed by ultrasound examination with a mean thickness of 16 ± 4 mm in the second and 20 ± 3 mm in the third trimester. At the time of the first ultrasound diagnosis of a thin placenta, 22.2% had polyhydramnios, and 1.8% had oligohydramnios. When the thin placenta cohort without polyhydramnios was compared to controls, there was a significantly increased incidence of perinatal mortality, odds ratio = 2.9, 95% confidence limits (CL) = 1.2 to 7.3; neonatal intensive care unit admissions, odds ratio = 2.2, CL = 1.3 to 3.7; and birth weight below the 10th percentile, odds ratio = 2.8, CL = 1.7 to 4.7. The finding of a thin placenta by ultrasound should alert the clinician to the possibility of compromised perinatal outcome.     

妊娠晚期羊水过多57例临床分析

目的 探讨妊娠晚期羊水过多的妊娠结局及无激惹试验的临床应用价值。方法 对妊娠晚期羊水过多孕妇５７例进行回顾性分析和总结,以比较羊水过多的发生时间、性质、程度与胎儿畸形的相关性,及无激惹试验正常和异常与围生儿预后的关系。结果 羊水过多发生在妊娠中晚期（２９～３６＾＋６周）胎儿畸形发生率明显高于妊娠足月（３７～４２周,Ｐ〈０．０５）;急性或重度羊水过多和无激惹试验异常的胎儿窘迫、新生儿窒息及胎儿畸形发