ABSTRACT
Objective To explore the clinical significance of prenatal ultrasound examination in diagnosing twin reversed arterial perfusion sequence (TRAP). Methods This was a retrospective study on 5 cases of TRAP sequence conifrmed by prenatal ultrasound and clinical method. The clinical data and ultrasound images were analyzed. Cases were collected at Hubei Maternal and Child Health Hospital from 2001 January to 2013 February. Results Four-iffths of TRAP were not corrected diagnosed and another one was misdiagnosised as asymmetrical conjoined twins in early pregnancy. Five cases of TRAP were correctly diagnosed during the second trimester. Sonographic ifndings of ifve acardia without blood lfow were as follows:(1) All acardias had no blood perfusion in body and umbilical cord, were absence of the fetal head (acephalous) and heart (acaidia), without skin edema, and a linear object resemble as umbilical cord extend from umbilical region of acardia to plcenta could be seen. Four (case 2-5) had lower limbs or dysplasia of lower limbs (two had spine), and one (case 1) had an irregular mass with bone. (2) Four pump twins had no obvious abnormity, while one had two clubfeet (case 2). Three died in uterus, one underwent induced labor due to oligohydramnios and heart dysfunction, and another one survived. Prenatal ultrasound images were consistent with MRI, X-ray examination, autopsy and postnatal neonatal examination results. Conclusions Acardia without blood lfow which was generally misdiagnosed as single gestation in utero can be diagnosed according to the special disformity of acardia and the linear umbilical cord extend from umbilical region to placenta, besides, it still need to strengthen monitoring the pump twin even if there was no blood perfusion to acardia.
ABSTRACT
Objective To investigate the fetal ultrasonographic features in pregnancies with Toxoplasma (TOX), rubella virus (RV), cytomegalovirus (CMV) and herpes simplex virus (HSV) infection. Methods From January 2011 to March 2013, prenatal ultrasound examination was performed in 545 fetuses with mothers of speciifc positive IgM of TOX, RV, CMV and HSV, detected by enzyme-linked immune sorbent assay (ELISA) in Nanjing Medical University Affiliated Suzhou Hospital. Ultrasonographic features were summarized and pregnancy outcome was followed up in fetuses with abnormal ifndings. Results Among the 545 fetuses, 56 cases with abnormal sonographic ifndings:6 cases with central nervous systerm abnormalities (2 intracranial calcifications, 4 hydrocephaly);9 cases with digestive system abnormalities (1 intrahepatic calcifications, 8 echogenic bowel);2 cases with heart abnormalities (1 interventricular septal defect, 1 right heart enlargement);17 cases with abnormal amniotic fluid volume (16 polyhydramnios, 1 oligohydramnios);3 cases with placental abnormality (1 thick placenta, 2 placenta abnormal calciifcation);13 cases with urinary systerm abmormality appearing as renal sinus separation;and 6 cases with other systerm abnormalities (1 neck lymphatic hygroma, 1 single umbilical artery, 1 sacrococygeal teratoma and 3 intrauterine growth restriction);2 cases of complicated abnormalities. Conclusions Prenatal ultrasonography is signiifcant in detecting serious fetal malformations, such as hydrocephaly, heart abnormalities and characteristic ultrasound features such as intracranial calciifcations, echogenic bowel, placenta abnormal calciifcation complicated with TOX, RV, CMV and HSV infection, providing valuable information for further clinical treatment, such as induced labour.
ABSTRACT
Objective To explore the ultrasonographic features of fetal gastrointestinal tract dilatation and associated abnormalities. Methods From July 2009 to June 2013, 118 cases of fetal bowel dilatation of detected by prenatal ultrasound in our hospital were followed up for their ultrasonographic changes and pregnancy outcomes. The features of fetal bowel dilatation with associated abnormalities and their impact on pregnancy outcomes were summarized. Results Among the 118 cases of fetuses, 101 cases had small bowel dilatation, including 4 cases with adverse pregnancy outcomes. One case had cleft lip and palate and was aborted during 25th week of pregnancy. The other 3 cases had continuous excess of amniotic lfuid and progressive widening of bowel, the average inner diameter of which was above 30.0 mm. In the 3 cases, 2 cases ended with intrauterine death during 34th week of pregnancy and 1 case ended with death at one week after birth. Among the 97 cases of pregnant women with good pregnancy outcomes, 66 cases (66/97) were solitary bowel dilatation, while the remaining 31 cases (31/97) were associated with abnormal soft markers, e.g., excess or decrease of amniotic lfuid, fetal echogenic bowel, fetal uronephrosis, short femur, single umbilical artery, fetal widened lateral ventricles and placenta overripe, etc. Among the 17 cases of colonic dilatation, 1 case had exessive amniotic lfuid and“double-leaf sign”clumps in abdomen during the second trimester and was proved to be anal atresia post partum, while the remaining 16 cases had the colonic dilatation which were found after 34th week of pregnancy and the widest inner diameter of colon was less than 30.0 mm associated with abnormal soft markers like excess or decrease of amniotic lfuid and fetal echogenic bowel, etc., and associated with good pregnancy outcomes. Conclusions Most fetuses with mild to moderate bowel dilatation had favorable outcomes. During ultrasonic examination, the degree and dynamic change of bowel dilatation shall be observed. If bowel dilatation or increment of amniotic fluid continues or worsens, greater risk of poor prognosis is indicated. The larger inner diameter of the small bowel, the greater risk of poor prognosis. If the fetus with bowel dilatation had echogenic bowel before, the risk of intestinal obstruction is comparatively lower. For the fetus suspected for colonic obstruction and anal atresia, it is more meaningful to observe the intestinal morphology and its changes.