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Objective To evaluate the pregnancy outcomes and prognosis of fetuses with different levels of ventriculomegaly.Methods Fetuses with ventriculomegaly subjected to the multidisciplinary consultation in the Obstetrics and Gynecology Hospital of Fudan University between January 2004 and December 2013 were included in this study.The fetuses were divided into three groups according to the width of the lateral ventricles on ultrasound examination as follows:mild ventriculomegaly (Mild Group,≥ 10 -＜12 mm,151 cases),moderate ventriculomegaly (Moderate Group,≥ 12-＜15 mm,56 cases) and severe ventriculomegaly (Severe Group,≥ 15 mm,34 cases).All cases were followed up with additional ultrasound scans during pregnancy and follow up was continued until the children were almost nine years old.Chi square test,Fisher's exact test and Bonferroni method were used to analyze the data.Results Two hundred and forty one fetuses were followed up.Ninety-one cases were terminated,and 150 were born (105 cases in Mild Group,30 cases in Moderate Group,and 15 cases in Severe Group).During ultrasound follow up of the 150 cases,the lateral ventricle width regressed in 42 cases (28.0％) and remained stable in 108 cases (72.0％).In the regressed group,the ventricle width in 31 cases in the Mild Group regressed to normal and a hearing abnormality was noted in one case after birth.In the Moderate Group,the lateral ventricle width in nine cases regressed to normal,one case had mild ventriculomegaly,and none of these cases showed abnormalities after birth.One case in the Severe Group showed no abnormalities,while the width of the lateral ventricles decreased to 14.0 and 16.0 mm.With regard to the outcomes of lateral ventricle width with or without regression,one of 42 cases in the regressed group had a significant abnormality,while 19 of 108 cases in the stable group [eleven cases (14.9％,11/74) in Mild Group,two (10.9％,2/20) in Moderate Group,and six (6/14) in Severe Group] showed significant abnormalities.Statistically significant differences were found between the two groups [2.4％(1/42) vs 17.6％(19/108),x2=4.940,P=0.026].When the outcomes of the three groups were compared,12 of 105 cases in the Mild Group (11.4％),two of 30 cases in the Moderate Group (6.7％),and 6 of 15 cases in the Severe Group (6/15) had significant abnormalities.Statistically significant differences were found between the three groups (x2=6.908,P=0.032).Statistical significance was observed in the Moderate Group and Severe Group (x2=4.929,P=0.026),while the Mild Group had a more favorable prognosis than the Severe Group (x2=5.266,P=0.022).Chromosomal examinations were carried out in 57 cases and the incidence of chromosomal abnormalities was 8.8％(5/57) [7.0％ (3/43),1/8 and 1/6 in the three groups,respectively].Infection screening was performed in 29 cases and one case was found to be positive for rubella virus-IgM,two cases were positive for cytomegalovirus-IgM,and one case was positive for toxoplasma gondii-IgM.Conclusions Pregnancy outcomes and the prognosis of fetal ventriculomegaly are associated with the degree and progression of ventricular dilatation.
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Objective To assess the clinical significance of fetal pyelectasis and its changing in utero. Methods One hundred and ninty-seven isolated pyelectasis cases were retrospective reviewed from Jan 2012 to Jul 2014.Isolated pyelectasis was defined as a renal pelvis anteroposterior diameter (RPAPD)of ≥5 mm without other fetal anomaly in second trimester.Persistent or progressive pyelectasis was defined as a RPAPD of ≥10 mm before delivery.They were divided into two groups according to the size of renal pelvis in second trimester:group A (RPAPD 5 - 10 mm)and group B (RPAPD ≥ 10 mm).As the same,there were two groups after 32 weeks of gestation:group C (RPAPD < 10 mm)and group D (RPAPD ≥ 10 mm).Results Totally 1 54 cases were followed up.There were 1 88 cases (95.4%)in group A,with 41 cases lost,141 cases (95.9%)RPAPD <10 mm,6 cases (4.1 %)RPAPD ≥10 mm before delivery.There were 9 cases (4.6%)in group B,with 2 cases lost,remained 7 cases RPAPD ≥ 10 mm before delivery. Conclusions Although most of the fetuses with RPAPD 5 - 10 mm in second trimester will remain the same or resolved before delivery,those with RPAPD ≥ 10 mm may persistent or progress.Prenatal assessment of fetal renal pelvis may provide properly consultation.
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ObjectiveTo summarize and review the clinical characteristics of congenital pulmonary lymphangiectasia with fetal bilateral pleural effusions.MethodsThe clinical data of a newborn diagnosed as congenital pulmonary lymphangiec-tasia with bilateral pleural effusions in Obstetrics and Gynecology Hospital, was summarized. The clinical, radiographic features, treatment and prognosis of this case are discussed in the context of the literature review.ResultsThe premature infants present-ed with rapid progression bilateral pleural effusions, respiratory distress, chylothorax, hypoalbuminemia and persistent pulmo-nary hypertension at birth. The pulmonary surfactant was given and mechanical ventilation was used for respiratory support. NO was inhaled, high-frequency mechanical ventilation was applied and albumin was repeatedly administered. After treatment for 3 months in the NICU, the patient was discharged. After 10 days, the patient was administered to the PICU with severe pneumo-nia, chronic lung disease, mechanical ventilation and anti-infection treatments were applied for 2 months. After living for six months, the baby died.ConclusionsCongenital pulmonary lymphangiectasia is extremely rare and prenatal diagnosis was dif-ifcult. The disease should be considered in patients presented with progressive dyspnea, interstitial emphysema after birth. Lung tissue biopsy and radioisotope scanning should be performed in time to get diagnosis.
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Objective To summarize the clinical characteristics of neonates with non-immune hydrops fetalis.Methods The clinical data of ten neonates with non-immune hydrops fetalis, who were admitted to the Department of Neonatology, Gynecology and Obstetrics Hospital of Fudan University between January 2012 and June 2014, were retrospectively studied.Prenatal characteristics, causes, clinical features and prognosis were explored and analyzed with descriptive statistical methods.Results (1) One of the ten neonates was diagnosed after birth presented with hydroderma and abdominal distension, and the rest ones were diagnosed antenatally.There were six males and four females, and eight premature and two term neonates with the average gestational age of (33.6±2.4) weeks and birth weight of(2 680±478) g.(2) The mean maternal age was (30.3 ±4.6) years.Two of the mothers had gestational diabetes mellitus and one had gestational diabetes mellitus complicating with hyperthyroidism.The blood types of all mothers were O and Rh(+).None of the mothers were tested for parvovirus B19 and no fetus was reported with abnormal chromosome karyotype in the five cases received fetal karyotype analysis.(3) The average gestational age at initial identification of hydrops fetalis by fetal ultrasound was (31.3 ± 2.4) weeks (25.1～37.0 weeks) among nine cases diagnosed prenatally.By ultrasound screening, there were seven cases with hydrothorax, six with seroperitoneum, five with polyhydramnios and four with hydroderm.(4) Two neonates had normal non-stress test results during labor, and eight were abnormal and suffered from severe neonatal asphyxia at birth and resuscitated by endotracheal intubation.Ten neonates had hydroderm, seven had hydrothorax, six had seroperitoneum and one had hydropericardium.One complicated with multiple malformations and one had chromosome abnormality.Four cases received thoracentesis and three had abdominal paracentesis after parturition.(5) Prognosis: One neonate survived and nine died among which six due to resuscitation failure in delivery room, two died one day after giving up treatment after one day, and one died due to treatment failure six months after birth.(6) The causes of hydrops fetalis were anemia (two cases) and congenital diaphragmatic hemangioma, recurrent atrial premature beat, Down's syndrome, congenital pulmonary lymphangiectasia, paroxysmal supraventricular tachycardia, placental chorioangioma, suspicious genetic syndrome and idiopathic (one for each).Conclusions The prognosis varies because of different etiology of non-immune hydrops fetalis.Neonates with hydrops fetalis might have a higher rate of asphyxia and mortality rate, and difficulties in resuscitation at birth.
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Objective To establish the reference ranges for fetal cardiac axis in the mid-second trimester and to evaluate the use of fetal cardiac axis in prenatal diagnosis.Methods 6744 unselected singleton pregnancies were enrolled from September 2008 to October 2010.Routine screening scan of second trimester and fetal echocardiography were performed at 18- 23+6 weeks gestation.Fetal cardiac axis was measured on the four-chamber view of the heart.Results The 6744 fetuses had a mean cardiac axis of (37.03 ± 6.10)°,ranging from 9.80° to 102.41°. Using above or below 95％ range of population (26.63° -49.40°) as a cut-off,there were significant difference of cardiac axis between normal group [(36.96 ± 5.91)°,P ＜0.01] and the group with heart defects [(43.12 ± 15.67)°,P ＜0.01],the group with intrathoricic anomalies or abdominal wall defect [(51.74 ± 15.97)°].ConclusionsThe reference ranges of fetal cardiac axis for local population in mid-second trimester may helpful for detecting congenital defects.Presence of an abnormal cardiac axis in the fetuses is associated with a substantial risk of congenital heart disease and/or other extra cardiac defects.
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Objective To review the clinical treatment and outcome of ultrasonographic soft markers in prenatal diagnostics. Methods This study recruited 268 pregnant women who underwent prenatal diagnostics in our hospital between Jun 2005 to Mar 2009. Fetuses were followed up postnatally. The outcome and chromosomal abnormalities of ultrasonographic soft markers were assessed. Results Of 268 cases consulted, 29 cases were missed (10.8%), 34 cases (12.7%) chose abortion, and 205 cases (76.5%) delivered. The top four most common delivered isolated markers were thickened nuchal fold, mild pyelectasis, echogenic bowel and rhizomelic limb shortening. Mild ventriculomegals had the highest aborted rate (17.2%). Six chromosomal structural abnormalities and one 21-trisome were detected in 59 fetuses who received chromosomal examination. Conclusions Ultrasonographic soft markers are risks to both fetal trisome and chromosomal structural abnormalities. Owing to extinction in most cases, consultant should be strengthed to avoid unnecessary invasive examination and abortion.
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Objective To assess prenatal heart disease screening program by ultrasound. Methods A total of 11 544 second-trimester screening scans were performed before 24 weeks′ gestation on 11 410 women between February 2004 and May 2007 in Obstetrics and Gynecology Hospital of Fudan University. Fetal heart screening was based on four-chamber and outflow tract views( left ventricular outflow + three vessel view). The sensitivity and specificity of different views were evaluated. Follow-up data of newborns was obstained. Results (1) Among 11 544 cases, 48 cases of congenital heart disease (CHD) were diagnosed in utero. Six cases were false negative, and 2 cases were false positive. The incidence of CHD was 0.47% (54/11 544). (2) Thirty-three CHDs were detected based on the four-chamber view, including 18 ventricular septal defect (9 with conotroncal anomalies),6 anomalous atrioventricle valve, 9 disproportion of left/right ventricle. The sensitivity of the four-chamber view alone was 61.11% (33/54), and the specificity was 99. 98% ( 11 488/11 490). Fifteen CHDs were detected based on the left ventricular outflow and three vessel views, including 1 pulmonary atresia, 3 pulmonary valve stenosis, 2 transposition of the great arteries ( TGA ), 1 pulmonary stanosis with TGA, 6 tetralogy of Fallot, and 2 pulmonary stenosis. The sensitivity of the combination of the four-chamber and outflow tract views was 88. 89% (48/54), and the specificity was 99. 98% (11 488/11 490). (3)Of 48 CHDs,11 cases were eceompanied by other malformations. Eleven cases were performed amniocentesis, amony whom 5 cases were trisemy 21. Conclusion The screening program based on four-chamber and outflow tract views shows good sensitivity and excellent specificity. Our prenatal heart screening program is clinically feasible.