Protocols for the treatment of supraventricular tachycardias in the fetus]

The protocols mentioned are used by Utrecht University Hospital for the treatment of foetal supraventricular tachycardias. In the case of atrial flutters the pregnant woman is treated with sotalol administered orally and, if no sinus rhythm is obtained nor a reduced ventricular rhythm occurs, subsequently with digoxin. If there is no hydrops foetalis then this is also the treatment regimen for other forms of foetal supraventricular tachycardia. In the case of hydrops foetalis the treatment is more aggressive: digoxin intravenously or flecanide orally; if the rhythm does not convert into a sinus rhythm nor a reduced ventricular rhythm occurs then both of these medications are administered; if that also proves to be insufficient then direct foetal therapy can be considered.     

颅内血肿微创清除术治疗36例高血压脑出血临床分析

目的探讨高血压脑出血颅内血肿微创清除术后病人意识恢复时间、血肿吸收时间及再出血情况.方法对行微创清除术的36例高血压脑出血(治疗组)和保守治疗的32例高血压脑出血(对照组)患者进行比较.结果治疗组病人意识恢复时间较对照组短,差异有非常显著性(P＜0.01).治疗组血肿吸收较对照组提前2～3周,再出血两组无差异.结论血肿微刨清除术治疗高血压脑出血疗效确切.     

Fetal DNA in maternal blood

There is a certain degree of foetal-maternal transfusion in every pregnancy. The possibilities for using intact foetal cells extracted from maternal blood for prenatal diagnosis are limited. Recently real-time polymerase chain reaction (PCR) techniques have allowed the identification and quantification of foetal DNA in the maternal blood. Foetal sex determination with Y-chromosome-PCR has been found to have a specificity of 100%. The sensitivity is 96% but increases with gestational age, so that from 10 weeks onwards the sensitivity approaches 100%. In the case of X-linked diseases, this technique can reduce invasive prenatal diagnosis by 50%. In the case of a foetus with an elevated risk for congenital adrenal hyperplasia, early non-invasive foetal sexing can also shorten the period of maternal dexamethasone use so as to prevent virilisation in the female foetus. Early second trimester non-invasive foetal RhD genotyping with an RhD-PCR has a sensitivity and specificity of 100% each. Therefore in the future, anti-D immunoprophylaxis will be superfluous in RhD-negative women with an RhD-negative foetus. Theoretically all new and paternal inherited disorders with a known gene defect can be detected in maternal plasma. Some examples have already been described. Recently published small scale studies describe elevated concentrations of free foetal DNA in maternal plasma in (threatening) preterm labour, pre-eclampsia and aneuploidy. Large-scale studies are necessary to demonstrate the value of these findings.     

Intradiploic hematoma: report of two cases and review of literature

Diploic hematoma is an uncommon lesion which develops generally after minor head trauma. Only seven cases have been published so far and we are reporting two new cases of diploic hematoma in infancy. The diagnosis was made by computerized tomography and confirmed by histology. Diploic hematoma should be considered as part of the differential diagnosis in case of with a diploic lesion.     

重度子痫前期剖宫产术后并发腹壁血肿7例分析

目的 探讨重度子痫前期(severe preeclampsia,sPE)剖宫产术后并发腹壁血肿的病因及防治.方法 回顾性分析成都市第三人民医院2016年1月至2020年12月sPE剖宫产术后并发腹壁血肿7例患者的临床资料.结果 sPE剖宫产术后并发腹壁血肿发生率为0.56％(7/1 235).3例行加压包扎保守治疗,4...     

Discordant fetal growth in multiple pregnancy: intervention should be based on chorionicity]

In three women, aged 28, 35, and 38 years, with multiple pregnancies and discordant foetal growth, the question arose what to do in case of (threatening) intrauterine death of one twin. In one monochorionic pregnancy with single foetal death the survivor suffered irreversible neurological damage and died at the age of five months, in one monochorionic pregnancy the survivor was born healthy and in one dichorionic pregnancy both twins were born healthy although one twin showed severe intrauterine growth retardation. The problem concerning single foetal death in a monochorionic pregnancy is whether to terminate the pregnancy and accept the risk of premature birth to the surviving twin, or to continue the pregnancy and accept the risk of damage to the survivor. In a dichorionic pregnancy foetal death of one twin does not entail any great risk of damage to the survivor; in such a pregnancy single foetal death in a premature phase may be accepted and the pregnancy may be continued. Sonographic determination of the chorionicity in multiple pregnancy at an early stage is essential because it also determines the policy if foetal problems occur.     

Subdural hematomas and isolated transient aphasia

Chronic subdural hematoma (CSDH) is particularly common in the older patient. Chronic subdural hematoma can present with atypical, and sometimes unusual, manifestations. It has an insidious onset and can, at times, be very difficult to diagnose. The most frequent presenting symptoms are headache, changes in mental status, and hemiparesis. Chronic subdural hematoma might also present as a transient ischemic attack. Here we report a case of CSDH that presented with intermittent aphasia and no other neurological deficit. Chronic subdural hematoma usually begins with a hemorrhage into the subdural space, which then becomes encapsulated by a membrane with abundant abnormal vessels in the outer portion of the membrane. Chronic subdural hematoma is a distinct and interesting clinical entity with diverse and insidious onset. A high index of suspicions is needed to make the early diagnosis and to start appropriate treatment to avoid morbidity and mortality.     

外伤性后颅窝血肿25例临床诊断和治疗

目的探讨外伤性后颅窝血肿的诊断、治疗及预后。方法对25例外伤性后颅窝血肿患者临床资料进行回顾性分析。结果首次头颅CT示后颅窝硬膜外血肿16例,硬膜下血肿4例,小脑挫裂伤并颅内血肿1例,复查发现进展性后颅窝硬膜外血肿4例。血肿位于单侧后颅窝22例,位于双侧后颅窝3例,血肿骑跨横窦2例,合并颅骨骨折10例,人字缝分离3例,合并幕上血肿4例。血肿致梗阻性脑积水形成5例,第四脑室、环池受压变形4例。12例行保守治疗,13例行手术治疗,术后死亡1例。伤后6个月,24例患者预后按GOS分级：2分1例;3分4例;4分10例;5分9例。保守治疗患者与手术患者平均预后分级评分无统计学差异。结论外伤性后颅窝血肿病情危重,早期诊断和治疗是改善患者预后的关键。     

肾上腺外伤性血肿的螺旋CT诊断

目的:探讨螺旋CT在肾上腺外伤性血肿的诊断价值。方法:回顾性分析5例肾上腺外伤性血肿的CT表现。结果:5例肾上腺血肿,3例位于右侧肾上腺,2例位于左侧肾上腺,1例伴脾脏破裂及胰腺假性囊肿,1例伴有后腹膜血肿、胃结肠韧带挫伤,4例并发骨折。结论:螺旋CT对肾上腺外伤性血肿能做出正确诊断。     

Dutch Institute for Health Care Improvement's standard code of practice entitled, "Donation of fetal tissue"

The Dutch Law on Foetal Tissue (Wet Foetaal Weefsel) sets out conditions and regulations concerning the donation, storage and permissibility of use of foetal tissue. Each institution where foetal tissue becomes available has to formulate an in-house code of conduct describing how the law will be applied within that institution. A committee, including abortion physicians and gynaecologists, has formulated a number of rules of conduct within the standard code of conduct under the auspices of the Kwaliteitsinstituut voor de Gezondheidszorg CBO [Dutch Institute for Healthcare Improvement]. Complying with this standard code ensures that the law is upheld. In clinical practice, one may deviate from this standard code in case of solid reasons only. Generally, all women can be asked to donate foetal tissue. A basic prerequisite for the inclusion of non-Dutch women is that oral and written communication is possible. The committee considers the age of 16 as a minimum threshold and mental incompetence as an exclusion criterion. Much attention should be paid to providing the women with information and to requesting permission. The basic principle is that the decision to terminate a pregnancy should be strictly separated from the decision to donate foetal tissue. As a general rule, foetal tissue should be stored anonymously. Adjustment of the abortion method in view of the intended scientific research is not permitted.     

Parvovirus B19 infection in pregnancy: a cause of non-immune hydrops fetalis

Four pregnancies, in two women aged 39 and two women aged 34 years respectively, were complicated by foetal parvovirus B19 infection. First-trimester intrauterine death resulting from multiple congenital anomalies was diagnosed in one patient with proven foetal parvovirus B19 infection. In three patients foetal hydrops was found in the second trimester with variable clinical course. In one of them, foetal hydrops resulted in second-trimester foetal death; in another, foetal hydrops resolved following intrauterine blood transfusion and in a third foetal hydrops resolved spontaneously. Foetal parvovirus B19 infection was diagnosed by polymerase chain reaction (PCR) using foetal cells obtained by amnioscentesis. It is concluded that maternal parvovirus B19 infection is mostly asymptomatic. However, the clinical impact of maternal infection on the foetus is diverse, i.e. infection may result in foetal death or--transient--foetal morbidity, in particular foetal anaemia. In mothers with proven foetal parvovirus B19 infection close monitoring of the foetus by ultrasound is warranted. Occasionally intrauterine transfusion is required. From the literature to date, the estimated incidence of maternal parvovirus B19 infection in pregnancy is 3-7%. The vertical transmission rate approximates 30%. When pregnancy is complicated by foetal hydrops foetal parvovirus B19 infection should be kept in mind.     

外伤性颅内血肿清除术后继发迟发性血肿临床分析

目的：探讨急性外伤性颅内血肿清除术后，如何及时发现颅内迟发性血肿并及时处理、提高疗效。方法：对25例颅内血肿清除术后有瞳孔和意识改变的患者及时行CT检查。结果：CT检查后均发现迟发性颅内血肿，再次手术清除颅内血肿18例，保守治疗7例，治愈11例，轻残3例，重残3例。植物生存4例，死亡4例。结论：对首次CT提示颅内血肿伴脑挫裂伤或小出血灶、术后病情有变化者应考虑有迟发性颅内血肿形成，宜动态复查CT，早诊早治以改善预后。     

Value of fetal MRI in the prenatal diagnosis of renal polycystic disease: a case report

We present a case of foetal polycystic kidney disease diagnosed at 34 weeks of gesttion thanks to resonance imaging (MRI). MRI demonstrated enlarged foetal kidneys that were low signal intensity on T1 weighted images and high signal intensity on T2 weighted images. These MRI findings suggested a high water containing of the renal parenchyma.     

THE EFFECTS OF CHRONIC ALCOHOL CONSUMPTION ON PREGNANT RATS AND THEIR OFFSPRING

The effect of chronic ethanol intake during gestation was studiedin rats fed a liquid diet in which ethanol provided 36% of thetotal calories. The animals were chronically alcoholised beforemating, and the body weight gain and nutritional status duringpregnancy were noted. Blood ethanol levels were measured duringpregnancy and parturition. Specifically, we have shown thatchronic ethanol intake during pregnancy lengthens the gestationperiod, decreases foetal viability, increases the placentalweight and diminishes foetus, liver and brain weights, as wellas the protein and DNA content of foetal brain. The reducedbody weight of rats prenatally exposed to alcohol continuedfor the first two months of the postnatal period and was mostapparent during lactation.     

Parvovirus B19 infection in hydrops fetalis

In a retrospective study from 210 foetal autopsies carried out in a period between 1992 and 1999 fifteen hydropic foetuses were found. The cause of the hydrops was shown to be Rh incompatibility in one case only. The cause of hydrops was not discernible in one case. In the others pathological examination clarified the cause and pathomechanism of non-immune hydrops. One isolated cystic hygroma, one monochorionic twin pregnancy with twin to twin transfusion, one case of sacrococcygeal teratoma and 4 cases of congenital heart diseases were reported. Postmortem interphase cytogenetic examination showed X0 monosomy in 2 cases. In further 4 foetuses pathognomic viral inclusions in the proerythroblasts raised the probability of parvovirus B19 infection what was confirmed by immunohistochemistry and electronmicroscopic examination. The occurrence of the parvovirus B19 associated cases of foetal hydrops was shown to be higher (4/15) in this series than in the literature. The accumulation of cases in 1998 is suggestive of an outbreak. The prenatal diagnostic implications and the attempts on further management are also discussed.     

Acute fatty liver of pregnancy. Three case reports

The acute fatty liver of pregnancy is a specific disease of pregnancy. Its incidence is rare but prognosis is poor in complicated entities, and can compromise the foetal and maternal life. An early diagnosis of the illness and a multidisciplinary management based on uterine evacuation and an intensive medical care can improve the prognosis of the acute fatty liver of pregnancy (A.F.L.P). In hope to contribute at a better approach of this affection, the authors report their experience about 3 cases of A.F.L.P., collected in 1997.     

Infection with human parvovirus B19 ('fifth disease') during pregnancy: potential life-threatening implications for the foetus

Four pregnant women, aged 29, 32, 36 and 36 years, respectively, were diagnosed with Human parvovirus B19 (B19V) infection. Only the first woman had exanthema and fever. In the first three cases, the source of infection appeared to be another child; two of these children were infected during a school outbreak. All four foetuses were infected, but the first foetus was asymptomatic and healthy at birth. The second foetus had anaemia and increased blood flow in the middle cerebral artery; it received an intrauterine transfusion and was healthy at birth. The third foetus was almost immobile and had cardiomegaly and hydrops fetalis; it was dead upon induced birth. In the fourth case, pregnancy was uneventful until two days before parturition, when the mother reported a decrease in foetal movement. The infant was born and developed respiratory insufficiency after 8 hours. Imaging revealed multiple bilateral lesions in frontal, occipital and parietal white matter consistent with infarction. The infant died after 5 days. Infection with B19V is associated with a wide range of clinical presentations and outcomes. Effects may range from an uncomplicated pregnancy to severe hydrops fetalis or intrauterine foetal death. Maternal symptoms may be aspecific, which complicates early diagnosis. When maternal B19V infection is suspected, immediate investigation for recent B19V infection should be performed. Quantitative B19 viral load measurements may provide insight into the stage of infection and may guide foetal monitoring. Referral to a foetal therapy unit is essential for hydrops fetalis or severe foetal anaemia. Intrauterine transfusion with erythrocytes significantly improves foetal outcome. Despite a successful transfusion procedure, long-term neurodevelopment may be affected, and developmental follow up is advised.     

Chromosomal mosaicism in the placenta

Chromosomal mosaicism is when two (or more) cell lines with different chromosomal complements are found within one individual. Mosaicism can be found in all tissues but may also be confined to a specific tissue. During pregnancy the aberrant cell line, often with a trisomy, may be confined to the placenta. In prenatal diagnosis, more specifically in chorionic villus sampling, this can interfere with the results and may necessitate follow-up investigation with amniotic fluid cell culture. Confined placental mosaicism can have no visible effect whatsoever on foetal development, but can also lead to serious foetal problems, depending on the chromosome involved. Uniparental disomy in the diploid cell line of the mosaicism may also have a negative effect on the foetal phenotype. In the case of the reverse situation, where the normal diploid cell line is confined to the placenta and the foetus has trisomy 13 or 18, it has been suggested that the diploid cell line might play a role in intrauterine survival; a recent study by the present authors could not confirm this view.     

Echographic diagnosis and perinatal management in fetal abdominal wall defects]

Twenty-seven cases of foetal abdominal wall defects are described, diagnosed prenatally by means of real-time ultrasonography in the period 1 January 1980-31 December 1989, in the hospital of the Free University of Amsterdam. In 17 out of 20 (85%) cases with omphalocele there were additional abnormalities, mainly chromosomal defects (41%), cardiac (25%) and genitourinary (25%) malformations. In gastroschisis, associated structural anomalies occurred in 57% (4/7). No chromosomal defects were found in the group with gastroschisis. Intrauterine foetal death occurred in 10 cases. Seven pregnancies were electively aborted because of association with an anomaly incompatible with postnatal life. One child died at two months. Six children (4 with omphalocele, 2 with gastroschisis) were successfully treated surgically. When ultrasonography demonstrates a foetal abdominal wall defect detailed sonographic examination is recommended to exclude additional malformations. In case of omphalocele prenatal chromosome analysis is indicated. Delivery in a tertiary care center is recommended. Elective caesarean section does not appear justified.     

Battered child syndrome mimicking acute appendicitis

The paper presents the case of a 15-year-old child suffering from battered child syndrome, who was operated on with the presumed diagnosis of acute appendicitis. On the course of the operation the injury and hematoma of the mesentery of the small bowel was discovered, along with retroperitoneal hematoma and blood in the abdominal cavity. Consecutive investigation revealed a child abuse lasting for at least 3 years. Lessons of the case were the misleading symptoms of the serious intraabdominal injuries, caused by life-threatening maltreatment of the child, which eventually led to the false diagnosis of appendicitis. The case has a moral message towards society as well: we need to pay attention on the surrounding world and act against aggression.