Per-vaginal Management of a Fetal Ascites Intended Dystocia in a Cross Breed Cow: A Case Study

This article discussed about a case of per-vaginal management of dystocia in a cross breed cow due to fetal ascites cause. A 3.5 years old cross breed cow was presented at Mobile Veterinary Clinic, Gosaba Block, South 24 Paragans, West Bengal with a history of prolonged labor. The water bag was ruptured but there was no progression of parturition. Per-vaginal examination revealed that the cervix was completely dilated and the fetus was in anterior longitudinal presentation with an extremely distended abdomen. The case was diagnosed as dystocia due to fetal ascites. After epidural anesthesia, the abdominal wall of fetus was punctured with a fetotomy knife and about 5-7 liters of clear straw colored ascitic fluid was evacuated. Finally fetus was removed by gentle traction. Post operative therapy with antibiotics, analgesic, intravenous fluid and multivitamin successfully cured the animal.

Ascitis fetal: a propósito de un caso y revisión de la literatura / Fetal ascites: Apropos of a case and literature review

Fetal ascites is defined as the presence of intraperitoneal fluid that may be part of a generalized or isolated hydrops. The mortality of non-immune ascites, both fetal and neonatal, is approximately 60%. We present a case of fetal ascites not associated with hydrops and we review the pathogenesis, clinical features, diagnostic approach and treatment of this fetal and neonatal condition.

La ascitis fetal se define como la presencia de líquido intraperitoneal que puede ser parte de un hidrops generalizado o aislado. La mortalidad de la ascitis no inmune, tanto fetal como neonatal, es aproximadamente 60%. Se presenta un caso de ascitis fetal no asociada a hidrops y se revisa la patogenia, clínica y el enfoque diagnóstico y tratamiento de esta condición fetal y neonatal.

Ascitis fetal como forma de presentación de agenesia de la vena cava inferior / Fetal ascites as clinical presentation of inferior vena cava agenesis

La vena cava inferior (VCI) está constituida por tres segmentos de diferente origen embriológico. De su mala fusión, surge un amplio espectro de anomalías. La prevalencia de anomalías de la VCI es de 0,07-8,7% de la población. Generalmente, se diagnostica como hallazgo incidental en la vida adulta. Representa el 5-9,5% de las trombosis venosas profundas idiopáticas en menores de 30 años sin factores de riesgo asociados. Se presenta a una recién nacida a término con diagnóstico prenatal de ascitis en la semana 20 de gestación. Se diagnosticó, mediante angiotomografía abdominal, la agenesia de VCI. El tratamiento de pacientes con agenesia de la VCI se basa en el manejo de las complicaciones. Debido al mayor riesgo que presentan de sufrir un evento trombótico, se debe considerar la profilaxis antitrombótica a largo plazo. Se recomienda iniciar profilaxis anticoagulante en la pubertad.

Inferior Vena Cava (IVC) is composed of three segments from different embryological origin. Its lack of fusion originates a wide spectrum of anomalies of the IVC. These malformations are present in 0.07-8.7% of the population. It is generally diagnosed as an incidental finding in adult life. It represents between 5 and 9.5% of idiopathic deep vein thrombosis in patients younger than 30 years old without associated risk factors. We present a case of a term newborn with prenatal diagnosis of ascites during the 20th week of gestation. IVC Agenesis was diagnosed with the use of abdominal angiotomography. The treatment of patients with IVC Agenesis is based on the management of its complications. Due to the increased thrombotic risk of these patients, we should consider lifelong anticoagulation. We suggest initiating it during puberty.

Intraperitoneal rectal perforation presenting as fetal ascites – a rare occurrence.

Spontaneous perforation of the rectum presenting as fetal ascites is an extremely rare occurrence. We report the case of an infant where antenatally detected fetal ascites was attributable to intraperitoneal rectal perforation. Investigations directed to identify common causes of this condition did not reveal any aetiology. Patient underwent surgical colostomy formation on day two of life, which was reversed at six weeks of age. We suggest that meconium ascites and peritonitis should be considered as differential diagnoses in fetuses with ascites and, if the neonate requires a laparotomy, the rectal area should be thoroughly inspected to exclude this entity.

Síndrome de Ballantyne (síndrome del espejo - mirror syndrome) / Ballantyne syndrome

Presentamos el caso de una gestante de 29 semanas que acude a urgencias por edemas en extremidades inferiores, un incremento ponderal en la última semana de 7 kg, oliguria y disnea. El feto presentaba un cuadro de ascitis y edema subcutáneo. Se realizó el diagnóstico de hidrops fetal no inmune, en el contexto de un síndrome de Ballantyne de causa desconocida. Inició trabajo de parto a los 7 días del ingreso y el puerperio cursó sin incidencias siendo dada de alta a las 48 horas post parto. El neonato precisó soporte respiratorio con ventilación no invasiva durante dos semanas y actualmente sigue controles periódicos en neonatología, con muy buena evolución.

We report a case of a 29 weeks pregnant who came to the emergency department because she presented oedema in lower extremity, weight increased in the last week of 7 kg, oliguria and dyspnoea. The fetus showed ascites and subcutaneous oedema. It was diagnosed a non-immune hydrops, in the context of Ballantyne syndrome of unknown cause. Childbirth was 7 days after admission and puerperium envolved normally, the patient was discharged at 48 hours postpartum. The neonate required respiratory support with non-invasive ventilation for two weeks and nowadays the baby is currently regular checks in neonatology, with a positive evolution.

Ascitis fetal aislada idiopática: caso clínico / Isolated idiophatic fetal ascites: a case report

La ascitis fetal aislada es una entidad comúnmente relacionada a distintas patologías, el diagnóstico final se realiza cuando se han descartado sus múltiples causas. Presentamos el caso de una ascitis fetal de causa idiopática, que no tuvo repercusión en el desarrollo fetal y neonatal. El diagnóstico oportuno y manejo adecuado permite buenos resultados perinatales.

Isolated fetal ascites is an entity commonly related to various diseases, the final diagnosis is made when multiple causes have been ruled out. We report an idiopathic fetal ascites, which had no effect on fetal and neonatal development. Early diagnosis and proper management allows good perinatal outcome.

Un caso raro de malformación del tubo neural: síndrome de hendidura notocordal / A rare case of neural tube defect: split notochord syndrome

Se trata de una embarazada de 33 años de edad, II gesta, I para, con 27 semanas de gestación, referida con el diagnóstico de ascitis fetal. Al estudio ecosonográfico se encuentra polihidramnios, abdomen fetal distendido ocupado por una gran masa líquida que inicialmente impresiona como ascitis fetal, además se encuentra intestino ecogénico compatible con peritonitis meconial y polimicrogiria. En una posterior evaluación ultrasonográfico se observa defecto en columna vertebral a nivel del sacro de donde emerge una imagen anecogénica equivalente a la conocida "espina bífida anterior" corroborándose restos de hallazgos ecográficos anteriores. A las 33 semanas de gestación se realiza cesárea extrayéndose recién nacido vivo, masculino, 2820 g y 45 cm de talla, con puntuación de Apgar de 6 y 7 al 1 y 5 minuto de vida respectivamente. Presentó síndrome de distrés respiratorio transitorio y sintomatología de obstrucción intestinal, la cual fue resuelta quirúrgicamente. Atresia intestinal y se confirma el síndrome de hendidura notocordal. El recién nacido falleció por sepsis. No se realizó autopsia. Los hallazgos ultrasonográficos dependen del tipo de lesión, pero frecuentemente se reportan como quistes abdomino-torácicos, mielo-meningocele y espina bífida. El pronóstico generalmente es ominoso, pero dependerá de la extensión de las lesiones y anomalías asociadas

A 33 years old woman, gravida II, para I, was referred at 27 weeks gestation with the diagnosis of fetal ascites. Ultrasound report showed, polyhydramnios, fetal abdomen distended occupied by a large liquid mass initially impressed as fetal ascites, echogenic bowel is also consistent with meconium peritonitis and polymicrogiria. In a subsequent ultrasonography was observed column defect on the sacrum where emerges a cystic mass equivalent to the known "anterior spina bifida", others previous ultrasound findings were confirmed. Cesarean section was performed at 33 weeks gestation, obtaining male live newborn, 2820 g and 45 cm in length, with Apgar score of 6 y 7 at 1 and 5 minutes, respectively. The newborn presented transient distress respiratory syndrome and symptoms of intestinal obstruction which was resolved surgically. Intestinal atresia, and confirming the split notochord syndrome. The newborn died of sepsis. No autopsy was performed. The ultrasound findings depend on the form of the lesion, but often are abdomino-thoracic cysts, myelomeningocele and spina bifida. The prognosis is usually ominous, but depends on the extent of the lesions and associated anomalies

Ascite fetal isolada / Isolated fetal ascites

A ascite fetal é uma entidade associada a múltiplas doenças, podendo ser uma manifestação primária da hidropisia ou um achado isolado. Os autores relatam o caso de uma paciente em acompanhamento pré-natal, com diagnóstico de ascite fetal com 25 semanas de idade gestacional. A gestação evoluiu sem intercorrências. Próximo ao termo foram encontradas calcificações intraabdominais. Após o parto, o recém-nascido apresentou flacidez da parede abdominal, porém sem ascite.

Fetal ascites is an entity associated to multiple pathologies. It can represent either an initial sign of hydrops or it can be an isolated manifestation. The authors describe a case of a patient in prenatal followup, presenting fetal ascites at 25 weeks gestation. There were no other abnormalities during pregnancy. Next to term the ultrasound examination showed intra-abdominal calcifications. The infant was born in good conditions, presenting flacid abdominal wall but no ascites.

Peritoneo-Amniotic Shunting in Isolated Fetal Ascites of Unknown Origin / 대한산부인과학회잡지

Although sporadic cases of transient fetal ascites have been described, pulmonary hypoplasia or hydrops fetalis may occur as potentially lethal complications of isolated fetal ascites. Antenatal fetal paracentesis may be useful in improving neonatal pulmonary function, however rapid accumulation of fluid after paracentesis usually required repetitive invasive procedures. We successfully treated an isolated fetal ascites with peritoneo- amniotic shunt. Under the ultrasonographic guidence, we inserted a Double-Basket Catheter into the left lower quadrant of fetal abdominal wall at the end of second trimester. Shunt remained in place until the fetus was delivered at term. The peritoneo-amniotic shunt can improve fetal outcome and avoid repeated paracentesis before delivery.

Prenatal Sonographic Finding of A Case of Hydrometrocolpos / 대한산부인과학회잡지

Cloacal anomalies are very rare congenital malformations with the incidence of 1/50,000-250,000 births. Hydrocolpos involves the dilatation of the vagina due to obstruction of the genital tract, leading to accumulation of secretions. Because of wide spectrum of abnormal anatomy involving urogenital and gastrointestinal systems, prenatal diagnosis is difficult. As ultrasound becomes more and more reliable, prenatal diagnosis is possible as early as in the second trimester. The presence of prenatally detected hydro (metro) colpos warrants a systematic evaluation of fetal and neonatal anatomy to rule out a large variety of possibly associated malformations or syndromes. We present a case of urogenital sinus maldevelopment which was initially presented as a fetal ascites.

Ultrasound-directed paracentesis of idiopathic massive fetal ascites / 대한산부인과학회잡지

Isolated fetal ascites may be different from general category of nonimmune hydrops in both prenatal course and prognosis. We experienced one case of isolated fetal ascites of unknown origin treated by in utero ultrasound-directed paracentesis and so present it with brief review of literature.

Prenatal Cytogenetic Diagnosis with Fetal Ascitic Fluid as a Rapid Chromosome Analysis / 대한산부인과학회잡지

OBJECTIVE: The goal of this study is to determine the efficacy of rapid karyotyping from fetal ascitic fluid. METHODS: In three cases of isolated fetal ascites diagnosed by prenatal ultrasonography, ultrasound guided fetal paracentesis and amniocentesis were performed and successfully obtained. Fetal karyotyping in each case at 29, 30 and 32 weeks gestation using modified lymphocyte culture method was conducted. RESULTS: The chromosomal analysis was successful within 72 hours and abnormalities were detected in two cases and revealed trisomy 21 in each case. Our study demonstrated that the majority distribution of white blood cells was lymphocytes which ranged from 2.1 * 10(6) cells/ml to 3.7 * 10(6) cells/ml and the cell density for culture was at least than 0.35 * 10(6) cells/ml. CONCLUSION: The use of ascitic fluid as a cell source to achieve rapid fetal karyotyping can be valuable when cordocenteis or amniocentesis would be technically more difficult, or when rapid result is required for planning of perinatal management at late second or third trimester gestational age.