Diagnosis and outcome of pregnancies with prenatally diagnosed fetal dextrocardia

Objective: To evaluate the incidence, associated cardiac and extracardiac malformations and clinical outcome of fetuses with dextrocardia.

Method: A retrospective review of 3556 fetal echocardiograms between 2000 and 2011 revealed 39 cases of dextrocardia. Dextrocardia was defined as right-sided positioning of the fetal heart. Prenatal and postnatal records of the fetuses were reviewed.

Results: The incidence was 1.1%. Of the 39 fetuses, 22 were primary dextrocardia and 17 were dextroposition. Diaphragmatic hernia was the most common cause of dextroposition with the incidence of 76%. Of the fetuses with dextroposition 35.5% had a cardiac anomaly. The survival rate of dextroposition was 31.2% and none of the survivors had an associated cardiac anomaly. Primary fetal dextrocardia was most common with situs solitus (45.4%), followed by situs ambiguous (36.3%) and then situs inversus totalis (18.1%). Structural cardiac malformations were found in 100%, 80% and 25% of fetuses with situs ambiguous, solitus and inversus, respectively. Of the dextroposition, 47.6% terminated pregnancy, 14.2% resulted in intrauterine death, 9.5% died after birth, and 28.5% survived.

Conclusion: A wide spectrum of complex cardiac malformations are associated with fetal dextrocardia. Fetal echocardiography enables detection of complex cardiac anomalies so that parents can be appropriately counselled.     

Impact of a prenatally diagnosed nuchal cord on obstetrical outcome in an unselected population

Objective: Evaluate the outcome of prenatally diagnosed nuchal cord.

Methods: A retrospective study on all cases of prenatally diagnosed nuchal cord. Study end points were gestational age at delivery, intrapartum fetal heart rate (FHR) abnormalities, mode of delivery, intrauterine fetal growth retardation (IUGR), intrauterine fetal demise (IUFD), and the rate of labor induction.

Results: This study included 44 cases; 86% were diagnosed at second trimester scan, confirmed by Color Doppler and 3D ultrasound. Mean gestational age at delivery was 39 weeks.18/44 cases (41%) underwent labor induction mostly as a result of parental anxiety. Primary cesarean rate was 34% (15/44), and 16% (7/44) had intrapartum FHR abnormalities with no impact for induction of labor. Instrumental vaginal delivery was used in 5 cases. IUGR was present in 7% (3/44), and none had IUFD. Nuchal cord was confirmed at birth in all cases. Correct prenatal diagnosis was in only one case of the 5/44 (11%) with multiple loops.

Conclusion: Prenatal diagnosis of nuchal cord is feasible with difficulty in determining multiple loops. Outcome is favorable, but parental anxiety is common and may increase induction rates, without leading to difference in cesarean rates or FHR abnormalities.     

Correlation between fetal mild ventriculomegaly and biometric parameters

Introduction: The aim of this study was to assess the correlation between fetal lateral ventricle width and biometric measurements.

Material and methods: A prospective study on 335 fetuses, 101 fetuses with isolated mild ventriculomegaly and a control group of 234 fetuses with a normal US examination. All fetuses underwent a detailed brain ultrasound scan and a full biometric evaluation. To further compare biometric parameters, we matched, according to gestational week and gender, 91 fetuses from the study group to 91 fetuses from the control group.

Results: The mean gestational week during the exam was significantly different between the groups (29.6 weeks in the study group versus 28.3 in the control group, p?=?.001). The mean maternal age, obstetrical history, mode of conception, or fetal gender did not differ between the groups. After matching according to gestational age and fetal gender, the mean gestational week between the matched groups did not differ and was 29?+?5 weeks in both groups. The study group had significantly larger head circumference (p = .009), biparietal diameter (p?p?=?.023), and estimated fetal weight (p = .024) compared with the control group.

Conclusions: Isolated mild ventriculomegaly could be related to other larger fetal biometric measurements and does not necessarily mean a pathological condition.     

Outcome of prenatally diagnosed fetal hydronephrosis

OBJECTIVE: To demonstrate the postnatal investigation, treatment and outcome of infants with hydronephrosis prenatally diagnosed by ultrasound between 1994 and 1996. STUDY DESIGN: In a two-year period we studied 20 infants who presented with hydronephrosis diagnosed by prenatal ultrasound and confirmed by postnatal ultrasound. Unilateral hydronephrosis was diagnosed in 17 infants and bilateral hydronephrosis in 3. An anteroposterior renal pelvic diameter > 7 mm after 33 weeks of pregnancy was used to predict abnormal outcomes. In the postnatal follow-up period, the infants were followed with sequential ultrasound and urinalysis. 99mTc-diethylene triamine pentaacetic acid scan, intravenous pyelography and voiding cystourethrography were performed in selected cases. Pyeloplasty was performed only if there was evidence of renal compromise. RESULTS: A male predilection was found. The left kidney was more commonly involved. Ultrasonic follow-up of the 20 infants showed that hydronephrosis resolved in 9, who were all in the unilateral hydronephrosis group. The range of fetal renal pelves on prenatal ultrasound was 7-15 mm in the resolution group. Pyeloplasty was performed in three unilateral hydronephrosis infants. Follow-up ranged from 36 to 72 months. CONCLUSION: When the fetal renal pelvis was < 15 mm on prenatal ultrasound, it never progressed. Prenatally diagnosed hydronephrosis may be safely observed, and surgical correction should be performed only if renal compromise occurs.     

A dilated fetal stomach predicts a complicated postnatal course in cases of prenatally diagnosed gastroschisis

OBJECTIVE: The purpose of this study was to determine whether dilation of the fetal stomach is associated with increased perinatal complications in infants with prenatally diagnosed gastroschisis. STUDY DESIGN: From 34 newborn infants with gastroschisis who were delivered at our institution over a 10-year period, 2 groups were analyzed on the basis of the presence or absence of a dilated fetal stomach. Reactive versus nonreactive nonstress test results were recorded, when performed. Neonatal outcomes were compared. RESULTS: Twenty-one fetuses had no evidence of gastric dilation. Thirteen fetuses had a dilated fetal stomach that was identified by ultrasound scanning. Within this group there was a higher incidence of nonreactive nonstress tests (P=.01). Infants with a prenatally dilated stomach had a higher incidence of volvulus and neonatal death, a significantly delayed time to full oral feeds, and a longer hospitalization than those infants who did not have a prenatally dilated stomach (P 相似文献   

Three-Level view of fetal brain imaging in the prenatal diagnosis of congenital anomalies

Objective: To determine whether a systematic stream-lined approach could be routinely used in the evaluation of fetal intracranial anatomy.

Methods: Nine thousand six hundred uncomplicated pregnancies were evaluated using a three-level view of fetal brain imaging. An axial scan, which passed through the level of the lateral ventricles, was first obtained. This was followed by a second view passing through the cavum septum pellucidum anteriorly, the thalami medially, and the 3rd ventricle centrally. Finally, a third view was made passing through the posterior fossa.

Results: Although the fetus had different presentations, we were able to fully image the fetal brain in all three levels in most cases. The intracranial anatomy could be scrutinized in most cases. Ninety-six percent of abnormal cases (126/133) were diagnosed using Levels I, II, or III independently or in combination.

Conclusions: The three-level view provides a comprehensive and systematic sonographic approach to the evaluation of the fetal intracranial anatomy, and for the diagnosis of anomalous fetal brain development.     

Proximity of term labor deepens the fall of Doppler impedance in the fetal cerebral arteries

ABSTRACT

Objective: To determine the existence of Doppler changes in the fetal vertebral, middle cerebral and umbilical arteries prior to term labor.

Methods: Five hundred and twenty eight Doppler examinations of the vertebral (VA), middle cerebral (MCA) and umbilical (UA) arteries resistance indices (RI) were performed between 37 and 41 weeks gestation. For each artery, values were converted into multiples of the median (MoM) and were divided into four groups according to the interval to labor and compared using Kruskal–Wallis tests. Subsequently, values were plotted in scattergrams and linear regressions and 95% confidence intervals were calculated. Finally, using multivariate analysis and model averaging, the importance and interrelationship of Doppler measurements in the explanation of the interval to labor was evaluated.

Results: Univariate and multivariate analysis confirmed that, independently of gestational age, fetuses examined close to labor presented more intense Doppler changes in the cerebral arteries with a significant reduction of the VA RI and MCA RI. This reduction was larger in the MCA. No significant changes were detected in the UA.

Conclusion: Before the onset of term labor, the fetal cerebral flow presents an additional reduction of impedance, which is more intense in the MCA system.     

The comparison of fetal behavior in high risk and normal pregnancies assessed by four dimensional ultrasound

Objective.?We compared fetal behavior (FB) in high risk and normal pregnancies using four dimensional ultrasound (4DUS).

Methods.?For assessment of FB in high risk and normal pregnancies, we used a scoring system of Kurjak's antenatal neurological test (KANET). The newborns were assessed by a postnatal neurological test, Amiel-Tison neurological assessment at term (ATNAT). The scores of KANET in high risk (N?=?116) and in normal pregnancies (N?=?110) were compared. After delivery, the results of KANET from both groups were compared with ATNAT test.

Results.?There was a statistically significant difference between group of high risk and normal pregnancies, for 8 out of 10 parameters in KANET: isolated anteflection of the head, eye blinking, facial expressions, mouth movements, isolated hand movement, hand to face movement, fist and finger movements, general movements. There was no difference for cranial sutures and isolated leg movements. Comparison of KANET and ATNAT showed statistically significant, moderate correlation between the two tests, which means that the neuropediatric exam (ATNAT) confirmed the prenatal 4DUS finding (KANET).

Conclusion.?The difference of FB between the high risk and normal pregnancies was evident. These preliminary results are promising but further studies have to be done before the test could be recommended for wider clinical practice.     

Postnatal management and outcome of prenatally diagnosed lung lesions

Advancements in fetal diagnostic imaging have increased prenatal diagnosis of many fetal anomalies. The purpose of this chapter is to review the etiology and natural history of prenatally diagnosed cystic lung lesions, including congenital cystic adenomatoid malformations (CCAM), pulmonary sequestrations (PSs), hybrid lesions, and bronchogenic cysts, and then discuss current concepts in the management and outcome of these lesions.     

Natural history and outcome of prenatally diagnosed cystic hygroma

OBJECTIVE: To define the outcome in cases of cystic hygroma diagnosed from a routine obstetric population. METHOD: This was a retrospective study of 42 cases of fetal cystic hygroma detected at 11 to 23 weeks' gestation in a routine obstetric population of 25 352 pregnancies. Fetal cystic hygroma was categorized according to position, severity, presence of cardiac defects and Hydrops fetalis. RESULTS: There were 20 (47.6%) cases with aneuploidy (9 trisomies and 11 Turner's syndrome). Major congenital cardiac defects were identified in 12 (28.6%) cases. Regression of the hygroma was noted in 2/20 (10%) of the aneuploid pregnancies and 3/17 (17.6%) of the euploid pregnancies. The majority (90.0%) of the aneuploid fetuses were female. In contrast, 70.58% of the fetuses in the euploid group were male and all the surviving normal babies were also male (n = 3). CONCLUSION: The findings of this study would support invasive prenatal diagnosis for an ultrasound finding of fetal cystic hygroma. Even in euploid pregnancies with cystic hygroma, there is a high mortality with associated abnormalities. The data also suggest a guarded pregnancy prognosis for the finding of fetal cystic hygroma, and that it is improved with spontaneous resolution, especially in male fetuses of normal karyotype.     

胎儿先天性膈疝及其相关异常的产前诊断

目的 分析胎儿先天性膈疝与合并其他畸形及染色体异常的相关性,探讨可能影响膈疝预后的因素. 方法 总结2002年1月至2008年11月在我院产前超声诊断的胎儿膈疝病例,分析其类型、合并畸形种类、与染色体异常的关系及临床结局.采用Fisher精确概率法进行统计学分析. 结果 产前超声诊断胎儿膈疝71例,左侧62例(87.3%),右侧9例(12.7%).单纯型膈疝38例(53.5%),复合型膈疝33例(46.5%).复合型膈疝中合并的其他异常中常见的有心血管系统畸形18例(54.5%),神经系统畸形10例(30.3%),泌尿系统畸形9例(27.2%).71例膈疝病例中19例行胎儿染色体核型检查,其中12例单纯型膈疝胎儿的染色体均正常,7例复合型膈疝中4例(4/7)染色体核型异常:18-=体综合征2例,13、21-三体综合征各1例.复合型膈疝病例染色体异常的发生率高于单纯型膈疝(P=0.009).复合型膈疝病例均引产;单纯型膈疝病例中32例引产,6例继续妊娠,其中5例足月出生后接受膈疝修补术,均存活;1例出生后死亡. 结论 胎儿先天性膈疝以左侧多见,近半数合并其他异常且以心血管系统畸形为主.单纯型膈疝发生染色体异常的风险低,复合型膈疝发生染色体异常的风险高.膈疝手术对预后的影响尚不能确定.     

Predisposing factors and effects of fetal bradycardia following cordocentesis at mid-pregnancy

Objectives: To identify predisposing factors of fetal bradycardia following cordocentesis at mid-pregnancy and to compare the pregnancy outcomes to those without bradycardia. Methods: All cordocenteses performed at 18–22 weeks of gestation were prospectively enrolled. The inclusion criteria consisted of: (i) singleton pregnancies; (ii) no fetal structural or chromosomal abnormalities; (iii) the procedures done by experienced operators. They were divided into two groups; procedures with fetal bradycardia (Group 1) and those without bradycardia (Group 2). Factors related to bradycardia were identified and pregnancy outcomes between the two groups were also compared. Results: Of 6147 cordocenteses recruited, 2829 met the inclusion criteria. Of these,152 had fetal bradycardia whereas the remaining 2677 did not. The procedures involving placenta penetration, and umbilical cord bleeding were significantly related to a higher rate of fetal bradycardia. On the other hand, cordocenteses with fetal bradycardia had a significantly higher rate of fetal loss (11.8 vs. 1.9%, respectively, p = 0.001) as well as a higher rate of low birth weight and preterm birth. Conclusions: Cordocentesis with placenta penetration and umbilical cord bleeding carries a higher risk for fetal bradycardia and fetal bradycardia was an independent factor for a higher rate of fetal loss, preterm birth and low birth weight.     

Three- and four-dimensional ultrasonography for the structural and functional evaluation of the fetal face

Ultrasonographic examination of the fetal face can provide information that may lead to the diagnosis of anomalies in other organs or systems. Thus, the fetal face represents a "diagnostic window" for fetal diseases and syndromes. Three-dimensional ultrasonography (3DUS) improves the evaluation of anatomic fetal facial anomalies over what is possible by 2-dimensional ultrasonography (2DUS). Four-dimensional ultrasonography (4DUS), by adding the temporal component to the examination, allows visualization of facial expressions that might be useful in the study of fetal behavior and maternal-fetal bonding. In this article, we evaluate the potential of 3D/4DUS for the study of structural and functional development of the fetal face.