Analysis of frequency of congenital fetal anomalies diagnosed on antenatal ultrasound in a tertiary care hospital of Balochistan

Background: The objective of our study is to check the incidence of various congenital fetal anomalies in antenatal period by ultrasonography in a subset of population.Methods: This cross sectional study was conducted in the department of Radiology, Bolan Medical Complex Hospital Quetta from November 2017 to October 2018. Total of 1323 second and third trimester pregnancies were analyzed for a period of one year. 34 fetal anomalies were detected making the prevalence of 2.5%. Information obtained from history, clinical examination and Ultrasound examination were recorded. The data was analyzed in SPSS 20.These patients were also interviewed for folic acid supplementation and consanguineous marriage.Results: 1323 patients were examined with congenital abnormalities detected in 34 fetuses. Among 34 fetuses, 20 were male and 14 were female fetuses. Out of 34, mother of 24 fetuses verified that they did not take folic acid supplementation. Consanguineous marriage recognized as the important risk factor as found in 22 congenital abnormal fetus.  CNS anomalies were the most commonly occurring anomalies with prevalence of (0.9%) followed by gastrointestinal tract anomalies (0.3%) and Urinary tract anomalies (0.3%).Conclusions: The fetus prognosis largely depends on early detection of its any congenital anomaly on antenatal ultrasound as they can result in abortions, still births and other fetal defects. So antenatal ultrasound is very important and safe method for early detection and management of fetal anomalies.

Antenatal diagnosis of alobar holoprosencephaly: a case report

'Holoprosencephaly (HPE) is a structural malformation of the brain that results from the complete or incomplete noncleavage of the forebrain/ prosencephalon of the embryo into 2 hemispheres1. We present a case of twenty-five year-old primigravida presented to the Outpatient department of Obstetrics for routine checkup and diagnosed with Alobar holoprosencephaly on 2nd level USG. Fetal MRI was performed and the findings were confirmed. Even though ultrasonography is diagnostic in the detection of fetal anomalies, MRI plays a vital role due to its multiplanar capability and excellent soft tissue resolution. The purpose of publishing this case is to sensitize the clinicians to the classical features of holoprosencephaly on various imaging modalities and to stress the importance of its detection before 20 weeks of gestation so as to allow for legal medical termination and alleviate maternal psychological trauma of bearing a deformed fetus.

Congenital cystic adenomatoid malformation, antenatal diagnosis: about one case

Antenatal ultrasound screening of fetal malformations requires for management, the immediate nature of which at certain birth, conditions the survival of the newborn. The Objectives Describe a case of pulmonary cystic adenomatoid malformation discover during antenatal ultrasonography. It was a 36 years old primary patient, referred to the maternity of Lafontaine hospital (France) for the presence, on obstetrical ultrasound screening, of suspected lesions on the foetal right lung’s field in a 21 weeks gestation pregnancy. After successive obstetric ultrasound scan, it was discovered that the left lungs were big with some parenchymal cysts of different sizes more than 3 mm in diameter. We made a diagnosis of type I left pulmonary cyst adenoma with excess amniotic fluid, without associated anomalies. The pregnancy progressed to 40 weeks gestation and a caesarean section was done with extraction of a live female new born weighing 2730 gr. The new born had 40 days later a successful surgical lobectomy for a cystic adenomatoid dysplasia. Histological examination revealed type I Stocker congenital pulmonary cystic adenomatoid malformation. During obstetrical ultrasound screening, we paid more attention to the brain, the heart, the face. Through this study we realised that during routine antenatal ultrasound for morphology, we should also pay more attention to the lungs.

Thoraco-Lumbar Hemangiolymphangioma diagnosed antenatally by ultrasonography / Philippine Journal of Obstetrics and Gynecology

@#This is a case of a fetus with a complex cystic structure on the mid-thorax to the lumbar area detected by ultrasonography at 23 weeks age of gestation. There were no other structural abnormalities noted. The fetal Doppler of the middle cerebral and umbilical arteries were normal. The increase in size of the cystic mass, diagnosed as lymphangioma, and the appearance of pleural effusion at 27 weeks age of gestation prompted further surveillance with magnetic resonance imaging. It showed an extensive subcutaneous mass involving the right thoraco- lumbar region, to consider hemangioma. Expectant management, bringing the pregnancy close to term as possible, was planned. However, the progression of the effusion to the bilateral hemithorax and presence of fetal ascites led to the cesarean delivery of a live preterm male with a birthweight of 1,885 grams (4 lbs 1 oz), maturity index of 29 weeks and an Apgar score of 4, 7, 8 at the first, fifth and tenth minute of life. There was a 15 x 13 cm hemangiolymphangioma on the right thoraco-lumbar area. An ultrasound-guided thoracentesis was done to help alleviate fetal distress. The infant was observed in the neonatal intensive care unit and was sent home stable. Presently, the hemangiolymphangioma is gradually resolving.

Clinical characteristics and outcomes of antenatal fetal intra-abdominal umbilical vein varix detection

OBJECTIVE: This study reviewed clinical characteristics of fetal intra-abdominal umbilical vein (FIUV) varices that were detected during antenatal ultrasound examinations. METHODS: Between January 2006 and January 2012, 121 cases of FIUV varices were detected and 7 cases were lost to follow-up. We retrospectively reviewed the medical records of 114 patients and neonates. RESULTS: From a total 96,553 ultrasound examinations in 43,995 pregnancies, 121 cases of FIUV varices were identified (2.8 per 1,000 pregnancies). Gestational age at diagnosis was 32.0 +/- 2.9 weeks (range, 20.1-36.3 weeks), the mean diameter of the FIUV varix was 12.6 +/- 2.1 mm (range, 8.0-21.0 mm) at initial diagnosis and the mean maximal diameter was 13.1 +/- 2.3 mm (range, 8.0-21.0 mm) during follow-up. The most severe pregnancy complications included one case of intrauterine fetal death and another case of fetal hydrops. Associated fetal anomalies (n = 11, 9.6%) detected by ultrasonography included bilateral renal pelvis dilatation, ventriculomegaly, cryptorchidism, incomplete renal duplication and pulmonary sequestration. A total of 104 cases (91.2%) were delivered at term and 10 cases (8.8%) were preterm deliveries before 37 weeks of gestation. CONCLUSION: FIUV varices that are not associated with fetal anomalies based on ultrasound examination during prenatal care have favorable pregnancy outcomes. Nevertheless, close fetal monitoring is recommended to decrease perinatal complications.

Even a single third trimester antenatal fetal screening for congenital anomalies can be life saving.

We report two cases of malrotation with extremely different outcomes based on the availability and non-availability of antenatal scanning. The first one had a single third trimester ultrasound which detected malrotation and helped in saving baby’s life whereas the second baby without antenatal screening succumbed to midgut volvulus and its sequelae because of delayed presentation. In developing countries where most of the pregnancies may go unsupervised, a single third trimester scan for fetal anomalies by an experienced sonologist, in areas where routine antenatal screening program has failed or not feasible can help save the baby’s life at least in surgically correctable anomalies. This may be an important strategy to reduce the infant mortality rate in the country.