Meconium per vaginam secondary to ileal atresia and meconium peritonitis

A neonate was referred for an abdominal mass and passing meconium per vaginam. The anorectum was normal. Roentgenograms revealed a small-bowel obstruction and hypogastric peritoneal calcifications. Findings at celiotomy were: ileal atresia, meconium peritonitis, and two meconium-filled pseudocysts draining through the female genital tract. Excision of the inflammatory masses, resection of the atretic segment, and primary ileoileostomy were followed by an uneventful recovery. Only two similar cases, both fatal, are reported in the English literature. Meconium peritonitis should be considered in the neonate passing meconium per vaginam.     

In utero intussusception producing ileal atresia and meconium peritonitis with and without free air

Two cases of intestinal atresia due to in utero intussusception are reported. Meconium peritonitis occurred in both cases and in one free air in the peritoneal cavity was also found. Both were managed successfully by resection and end-to-end anastomosis. The intussusceptions were discovered on gross and microscopic examination of the distal ileal segment. These two cases and 33 from the literature are reviewed to determine major features of this seemingly unusual occurrence. The atresia was limited to the ileum and jejunum in all cases and involved the ileum in 77%. The atresia was limited to the gap and fibrous-connecting-cord types in all cases, with the gap type slightly more frequent (57%). In all but 1 of the 35 cases (97%), the intussusceptum was found in the small-bowel segment distal to the atresia; in only 2 were free air and calcium deposits identified at birth on X-ray studies of the abdomen. Prematurity was encountered in only 14% of the 35 cases, suggesting that intussusceptum-induced midgut atresia occurs late in pregnancy. The occurrence of two cases in 2 years in Torrance, California, and three cases in 3 years in Helsinki, Finland, suggest that this occurrence must be more frequent than the sparse incidence reported in the literature would indicate. It is suggested that careful gross and microscopic examination of the small-bowel segment just distal to the atresia be carried out in all cases of jejunoileal atresia of gap or cord types to determine the true incidence and clinical nature of this type of in utero intussusception-induced jejunoileal atresia.     

Neonatal ovarian cysts

Twelve cases of ovarian cysts are reported. The diagnosis was made antenatally by ultrasound scan. The authors consider the ultrasonic images of these cysts and signs of in-utero torsion, the antenatal and postnatal evolution, the pathological findings at surgery, and the histological results for six children that were operated. A review of the literature enables us to describe the possible complications in the evolution of this tumor and to discuss the perinatal management of the ovarian cyst, which depends on the appearance and diameter of the cyst and on its evolution. Offprint requests to: J. Gaudin     

Obstetrics services - womens' perspectives

To obtain women's views of obstetric care 400 randomly selected mothers were interviewed postnatally. Since family planning is a constitutional right and all related services free of charge and virtually 100% of pregnant women attend the antenatal clinic, the questions asked were mainly oriented to evaluation of existing obstetric practice. Women were generally satisfied with labor and delivery care (71.2%), but as many as 88.2% of them expressed their dissatisfaction with postnatal care practice. Our women opted for optimal hospital perinatal care — a home-like postnatal care, possibilities for better bonding between mothers and newborn infants and more open, individually oriented communication with medical staff.     

Is postpartum contraceptive advice given antenatally of value?

In response to the concept that a good postpartum program should begin prenatally, this study was designed to determine whether the provision of expert contraceptive counseling during the antenatal period would have an impact on contraceptive uptake, patterns of contraceptive usage, and pregnancy rates during the first year after childbirth. Over 500 women attending antenatal clinics in each of three centers (Edinburgh, Scotland; Shanghai, People's Republic of China; Cape Town, South Africa) were randomized to receive expert contraceptive advice (participants, n = 771) or the standard advice routinely given in that setting (controls, n = 866). Follow-up was by postal or interviewer-administered questionnaires at 16 and 52 weeks after childbirth. There were no significant differences in the prevalence of contraceptive use at one year (over 79% in all centers) between participants and controls. In Edinburgh, participants were more likely to undergo sterilization (p < 0.01) than controls, otherwise there were no differences among Edinburgh, Shanghai, or Cape Town in either the methods of contraception chosen or in the methods used over time. Contraceptive counseling delivered antenatally appeared to have no impact on the pregnancy rate during the first year after childbirth. In Shanghai, over 11% of women in both groups underwent termination of pregnancy in the year of follow-up. In conclusion, although women in all centers said they found the opportunity to discuss contraception antenatally was useful, it had very little effect on contraceptive use or on subsequent pregnancy rates.     

四腔心切面在产前超声诊断先天性心脏畸形中的作用

目的:分析四腔心切面所见异常在产前超声诊断先天性心脏畸形中的作用和临床意义。方法:据四腔心切面所见异常对产前超声诊断先天性心脏畸形所提供的心脏信息及对诊断意义的不同,将产前超声诊断的先天性心脏畸形胎儿病例71例分为3组。结果:第1组为根据四腔心切面所见异常即可明确诊断的胎儿先天性心脏畸形,共52例,占73.24%,但该组伴发的大动脉畸形25例,占48.08%,如果单用四腔心切面将全部漏诊;第2组为根据四腔心切面所见异常可以提供存在先天性心脏畸形重要线索,共12例,占16.90%;第3组为四腔心切面所见基本正常,但存在先天性心脏畸形,共7例,占9.86%。71例中合并心外畸形的病例39例,占54.93%。结论:四腔心切面在产前超声筛选新生儿先天性心脏畸形方面具有非常重要的作用和临床意义,90%以上的先天性心脏畸形在四腔心切面上或多或少有异常特征,但有局限性,大动脉畸形漏诊相当常见,如果能加上左、右心室流出道等切面则明显减少漏诊。     

Prenatal thoracoabdominal tumor mimicking pulmonary sequestration: a diagnosis dilemma

Thoracoabdominal masses are among the many congenital anomalies being detected in fetus. The differential diagnosis of such anomalies include cystic adenomatoid malformation, pulmonary sequestration, neuroblastoma, lymphangioma, congenital diaphragmatic hernia, and bronchial atresia. We report a fetal thoracoabdominal mass that proved to be an angioma that was treated by partial embolization. Complete regression was observed. Received: 2 November 1999 Revised: 3 April 2000 Accepted: 4 April 2000     

Perinatal indomethacin treatment and neonatal complications in preterm infants

To evaluate the incidence of neonatal complications among infants exposed to indomethacin antenatally, postnatally or both ante-and postnatally (combined), the records of 240 infants of gestational ages between 23 to 32 weeks were analysed retrospectively. Antenatal indomethacin treatment for longer than 2 days with a daily or cumulative dosage ≥150 mg correlated with a significantly higher incidence of grade I-II intraventricular haemorrhage. Combined exposure, cumulative antenatal exposure ≥150 mg and duration of antenatal exposure of more than 2 days was associated with necrotising enterocolitis and a cumulative exposure with sepsis. There was no independent association between indomethacin exposure and pneumothorax, bronchopulmonary dysplasia or respiratory distress syndrome. Conclusion Preterm infants with exposure to antenatal indomethacin might be at increased risk of grade I and II intraventricular haemorrhage and those with both ante- and postnatal exposure at an increased risk of necrotising enterocolitis and sepsis. Received: 18 January 1999 / Accepted: 8 July 1999     

Quality of child–parent attachment moderates the impact of antenatal stress on child fearfulness

Background: Animal studies have shown that prenatal stress has persisting effects on several aspects of offspring development; more recent studies show that this effect may be eliminated by positive postnatal rearing. Human studies of prenatal anxiety/stress are now also beginning to document links between antenatal stress/anxiety and behavioural and cognitive development of the child; however, there is no human evidence as to whether the early caregiving environment moderates the effect of antenatal anxiety/stress on child outcomes. Methods: Antenatal and postnatal measures of stress were collected on 123 women who were recruited from an antenatal clinic. Laboratory‐based assessment of the children’s cognitive development and fearfulness were assessed when the children were aged 17 months. In addition, child–parent attachment quality was assessed using the Strange Situation. Results: Attachment classification moderated the link between antenatal stress and observed fearfulness. The effect of antenatal stress on fearfulness was most accentuated in children with an Insecure/Resistant attachment classification; the significant antenatal stress × attachment classification interaction held after controlling for postnatal stress and obstetric, social and demographic factors. Attachment did not moderate the effects of antenatal anxiety on cognitive development. Discussion: These findings provide the first human evidence that postnatal parenting may moderate the adverse effects of antenatal stress. These results raise developmental questions about the timing and effect of interventions to reduce the adverse effects of antenatal stress exposure.     

Antenatal diagnosis of sacrococcygeal teratomas: prognostic features

During a 6-year span the prenatal ultrasound diagnosis of a sacrococcygeal mass was made eight times at the High-Risk Perinatal Centers of Case Western Reserve University. The gestational age at the time of diagnosis ranged from 21 to 35 weeks. In one of the pregnancies, the affected fetus was one of a set of fraternal twins. Two patients were delivered vaginally and five were delivered by cesarean section. One fetus died in utero. In seven the diagnosis of sacrococcygeal teratoma (SCT) was confirmed histologically. In the eighth the lesion was a fungating malignant melanoma of the lower sacral region. The decision as to mode of delivery was made based on the size of the tumor relative to the biparietal diameter and fetal presentation. Four of the six remaining patients with SCT survived. In the three with fatal outcome, the ratio of infant weight to tumor weight was below 1.7. This measurement is a clear indication of the very large size of these lesions. The increased blood flow through these tumors can lead to fetal cardiac failure, hydrops, and death. With the almost routine use of ultrasound, more SCT may be identified antenatally. Included in this group and referred to tertiary care centers will be nonviable fetuses as well as very small fetuses with exceptionally large tumors; this will raise the overall mortality in this group of patients traditionally regarded by pediatric surgeons as having a good outlook.