Applicability of Magnetic Resonance Imaging in the Assessment of Fetal Urinary Tract Malformations

ObjectiveTo assess the applicability of magnetic resonance imaging (MRI) to complement ultrasound in the diagnosis of fetal urinary tract anomalies.MethodsThis was a retrospective cohort study that included 41 women between 19 weeks and 37 weeks and 6 days of gestation carrying fetuses with malformations of the urinary tract which were initially diagnosed by ultrasound and then referred for MRI. In all cases, the diagnosis was confirmed after birth either through imaging or autopsy. A surface coil was positioned over the abdomen and T2-weighted sequences were obtained in the axial, coronal, and sagittal planes; T1 in at least one plane; and three-dimensional (3-D) TRUFI in fetuses with dilatation of the urinary tract.ResultsMean gestational age at the time of MRI examination was 28.21 weeks. The rapid T2 sequences allowed all the anomalies of the fetal urinary tract to be assessed, whereas 3-D TRUFI sequencing proved very useful in evaluating anomalies involving dilatation of the urinary tract. The signs of pulmonary hypoplasia characterized by hypointense signal in the T2-weighted sequences were identified in 13 of the 41 fetuses.ConclusionMRI confirmed and added information to the ultrasound regarding fetal urinary tract anomalies, as well as information related to the other associated malformations, their progress in the prenatal period, and possible postnatal prognosis.     

Review of the environmental prenatal exposome and its relationship to maternal and fetal health

Environmental chemicals comprise a major portion of the human exposome, with some shown to impact the health of susceptible populations, including pregnant women and developing fetuses. The placenta and cord blood serve as important biological windows into the maternal and fetal environments. In this article we review how environmental chemicals (defined here to include man-made chemicals [e.g., flame retardants, pesticides/herbicides, per- and polyfluoroalkyl substances], toxins, metals, and other xenobiotic compounds) contribute to the prenatal exposome and highlight future directions to advance this research field. Our findings from a survey of recent literature indicate the need to better understand the breadth of environmental chemicals that reach the placenta and cord blood, as well as the linkages between prenatal exposures, mechanisms of toxicity, and subsequent health outcomes. Research efforts tailored towards addressing these needs will provide a more comprehensive understanding of how environmental chemicals impact maternal and fetal health.     

D or anti-D!!! Unblocking the dilemma of blocking-D phenomenon using acid elution

Maternal IgG antibodies directed against fetal red cells can cause hemolytic disease in fetus and newborn manifesting as anemia and jaundice. Sometimes, these antibodies are so strong that they encapsulate the antigens on neonatal red blood cells and result in erroneous laboratory findings when tested. A requisition for double volume exchange transfusion was received for a term,3.1 kg female baby with neonatal jaundice at day 2 of life, born to a multiparous woman. The neonate was typed as AB RhD negative and the mother as A Rh D negative. The maternal sample tested positive for Indirect antiglobulin testing showing presence of Anti-D with IgG titer of 128. The direct antiglobulin testing for baby was strongly (4 +) positive. The strong DAT result with negative RhD typing for the neonate indicated towards the Blocking-D phenomenon. We attempted to resolve the Blocked-D case using acid elution, which revealed the presence of D antigen on the eluted neonate's red cells. The report emphasizes the importance of appropriate blood typing for neonates to provide prompt adequate care as a team by the departments of Neonatology and Transfusion Medicine.     

Papel complementario de la resonancia magnética en el estudio del sistema urinario fetal

Urinary system birth defects represent the abnormality most often detected in prenatal studies, accounting for 30% to 50% of all structural anomalies present at birth. The most common disorders are urinary tract dilation, developmental variants, cystic kidney diseases, kidney tumors, and bladder defects. These anomalies can present in isolation or in association with various syndromes. They are normally evaluated with sonography, and the use of magnetic resonance imaging (MRI) is considered only in inconclusive cases. In this article, we show the potential of fetal MRI as a technique to complement sonography in the study of fetal urinary system anomalies. We show the additional information that MRI can provide in each entity, especially in the evaluation of kidney function through diffusion-weighted sequences.     

胎儿肾积水的超声诊断及预后评价

目的探讨胎儿肾积水的产前超声诊断及其预后。方法对56例胎儿肾积水按肾盂扩张的前后径(<10mm,10~15mm,>15mm)为准,分为轻,中,重度3组,并于首次检查后l个月,两周、产前及出生后l个月,3个月,6个月,12个月,18个月,24个月进行随访复查。结果29例轻度肾积水胎儿,随访过程中有26例肾积水消失,2例肾积水减轻,1例肾积水加重;16例中度肾积水胎儿,随访过程有7例肾积水消失,1例肾积水减轻,8例肾积水加重;11例重度肾积水胎儿随访过程中均见病情加重。结论胎儿肾积水应于出生后复查以明确诊断。超声检查安全无创,能在一定程度上判断胎儿预后,具有较高的临床及社会价值。     

Histogenesis of uterus in human fetuses

Introduction

The histological changes during the development of the human uterus throughout the fetal period exhibit varying cellular patterns in the lining epithelium. The present study documents these progressive changes during fetal uterine maturation.

超声筛查孕11~13+6周胎儿颅脑畸形的现状及意义

随着影像技术的发展,超声医师技能的提升、经验的积累及产前超声对胎儿中枢神经系统(CNS)的正常发育特征及异常表现的深入研究,超声检出胎儿CNS畸形的时间越来越早。目前在孕11~13⁺⁶周,超声可以诊断的颅脑畸形有无脑畸形/露脑畸形、脑膜膨出/脑膜脑膨出、全前脑、脉络丛囊肿;同时还可提供CNS异常发育的线索。本文对超声在孕11~13⁺⁶周胎儿颅脑畸形筛查中的现状及意义进行综述。     

胎儿颜面部的产前超声研究

目的 探讨宫内胎儿颜面部的超声表现与显示手法，提高产前超声对胎儿颜面部正常结构及畸形的认识。方法 选择2000年8月至2002年6月在我院行彩超产前检查的连续病例4200例，确定胎位后，对每一胎儿颜面部均进行冠状、矢状及横切面扫查。结果 99．62％(4184例)的胎儿颜面部各个结构均能够通过常规胎儿颜面部冠状切面、矢状切面、横切面正确显示，其深部骨性结构大部分亦能清楚显示，但硬腭与软腭不能显示。检出各种颜面部畸形29例78个，总检出率89．66％，漏诊7例9个(10．34％)，均经产后或引产证实。产前超声诊断胎儿颜面部畸形的敏感性、特异性、准确性、阳性预告值和阴性预告值分别为85．29％，99．95％，99．83％，93．55％和99．88％。结论 常规二维超声产前对胎儿颜面部大部分表面结构与深部骨性结构均能清楚显示，是显示胎儿颜面部结构与诊断胎儿颜面部畸形的可靠影像诊断方法。     

超声对胎儿心脏横纹肌瘤的诊断价值

目的提高对胎儿心脏横纹肌瘤的认识,评价超声心动图在胎儿心脏横纹肌瘤诊断中的应用价值。方法男性胎儿3例,女性胎儿2例。检查仪器HP1500、2000、5500、7500型彩色多普勒超声心动仪,探头频率2.5～8MHz。以四腔心为主要切面,多切面探查肿块形态,位置,数量及与周边关系,结合彩色多普勒进行评价。结果5例胎儿超声心动图均发现心室腔内不同部位多个等回声或强回声光团。直径1.9mm×2.3mm～11.5mm×6.3mm,回声均匀,境界清晰,侵犯室间隔及室壁,部分侵及房室瓣口及左室流出道。病理诊断心脏横纹肌瘤。结论胎儿超声心动图技术可对胎儿心脏横纹肌瘤准确定位,反复多切面扫查可提高诊断率。