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1.
Rev. méd. Maule ; 36(2): 34-40, dic. 2021. graf, tab
Article in Spanish | LILACS | ID: biblio-1377959

ABSTRACT

Introduction: Obstetric ultrasound is part of the screening to select the population at high risk of having a congenital malformation. Considering that fetal defects occur in approximately 2-4 out of every 100 live newborns, and are the cause of 35-40% of perinatal mortality in Chile, it is therefore justified to perform the second trimester ultrasound, which presents a high index prenatal screening (56%), with few false positives. Methods: A retrospective, cross-sectional and descriptive study was carried out, by reviewing 6,385 ultrasound scans, which were performed during one year (June 2020-June 2021), at the Regional Hospital of Talca, where 126 fetuses with suspected malformation were detected. Results: Of the total number of patients evaluated, a congenital malformation rate of 1.9% was detected, with cardiac malformations the most frequent, and diabetes mellitus the main risk factor. Conclusions: Antenatal ultrasound study is essential in the first and second trimesters of pregnancy, followed by a referral to an ultrasound committee, emphasizing early and interdisciplinary management. The frequencies found are similar to those reported in the international bibliography


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Congenital Abnormalities/genetics , Congenital Abnormalities/diagnostic imaging , Fetal Diseases/diagnostic imaging , Comorbidity , Chile , Retrospective Studies , Ultrasonography, Prenatal , Chromosome Disorders/genetics
2.
Rev. bras. ginecol. obstet ; 43(4): 317-322, Apr. 2021. graf
Article in English | LILACS | ID: biblio-1280043

ABSTRACT

Abstract Fetal thyroid complications in pregnancy are uncommon, and are commonly related to the passage of substances through the placenta. The excessive iodine intake during the pregnancy is a well-known mechanism of fetal thyroid enlargement or goiter, and invasive procedures have been proposed for the treatment of fetal thyroid pathologies. In the present report, we demonstrate two cases from different centers of prenatal diagnosis of fetal thyroid enlargement and/or goiter in three fetuses (one pair of twins, wherein both fetuses were affected, and one singleton pregnancy). The anamnesis revealed the ingestion of iodine by the patients, prescribed from inadequate vitamin supplementation. In both cases, the cessation of iodine supplement intake resulted in a marked reduction of the volume of the fetal thyroid glands, demonstrating that conservative treatmentmay be an option in those cases. Also, clinicians must be aware that patients may be exposed to harmful dosages or substances during pregnancy.


Resumo As complicações fetais da tireoide na gravidez são incomuns e são comumente relacionadas à passagem de substâncias pela placenta. A ingestão excessiva de iodo durante a gravidez é um mecanismo bem conhecido de aumento da tireoide ou bócio fetal, e procedimentos invasivos foram propostos para o tratamento de patologias da tireoide fetal. No presente relato de caso, demonstramos dois casos de diferentes centros de diagnóstico pré-natal de aumento da tireoide fetal e/ou bócio em três fetos (um par de gêmeos, em que ambos os fetos foram afetados, e uma gravidez única). A anamnese revelou a ingestão de iodo pelos pacientes prescrita por suplementação inadequada de vitaminas. Nos dois casos, a interrupção da ingestão de suplemento de iodo resultou em uma redução acentuada do volume das glândulas tireoides fetais, demonstrando que o tratamento conservador pode ser uma opção nestes casos. Além disso, os médicos devem estar cientes de que as pacientes podem ser expostas a doses ou substâncias nocivas durante a gravidez.


Subject(s)
Humans , Female , Pregnancy , Adult , Prenatal Care/methods , Dietary Supplements/adverse effects , Goiter/etiology , Iodine/adverse effects , Self Care/adverse effects , Magnetic Resonance Imaging , Ultrasonography, Prenatal , Imaging, Three-Dimensional , Diseases in Twins/etiology , Diseases in Twins/diagnostic imaging , Fetal Diseases/etiology , Fetal Diseases/diagnostic imaging , Goiter/diagnostic imaging , Iodine/administration & dosage
3.
Rev. bras. ginecol. obstet ; 42(12): 805-810, Dec. 2020. tab
Article in English | LILACS | ID: biblio-1156066

ABSTRACT

Abstract Objective To analyze the most frequent referrals for fetal echocardiography, including advanced maternal age and its association with abnormal results. Methods We included all pregnant women referred to perform fetal echocardiography (gestational age 22-32 weeks) in 2 health centers in Rio de Janeiro, from June 2015 to June 2016. Advanced maternal age was considered when age was > 35 years at the time of delivery). Referral reasons and results were recorded, according to the Brazilian Fetal Cardiology Statement. Crude and adjusted prevalence ratios were calculated (Poisson regression). We considered p < 0.05 as significant. Results A total of 1,221 tests were analyzed. Abnormal fetal echocardiography was observed in 14.82% of the cases. The most frequent abnormalities were interventricular septal defect (6.39%), septal hypertrophy (3.35%) and atrioventricular septal defect (1.14%). Routine exams were performed in 559 women, 289 were referred for advanced maternal age and 373 were referred according to the Brazilian FetalCardiology Statement criteria. An obstetric ultrasound suggesting fetal cardiacabnormality, maternal diabetes, increased nuchal translucency, and obstetric ultrasound suggesting a noncardiac abnormality were strongly associated with an abnormal fetal echocardiography. Abnormal results were not more frequent in women with advanced maternal age when compared with the rest of the study group. Conclusions It was observed that routine exams and advancedmaternal age referrals were very frequent. Those exams were not associated to fetal echocardiography abnormalities. In this scenario, when the obstetric ultrasound suggests a fetal cardiac


Resumo Objetivo Analisar as indicações mais frequentes para realização de ecocardiografia fetal, incluindo idade materna avançada, e a associação destas com exames alterados. Métodos Foram incluídas todas as gestantes que realizaram ecocardiografia fetal na idade gestacional entre 22 e 32 semanas, em 2 centros de referência no Rio de Janeiro, no período de junho de 2015 a junho de 2016. Foi considerada idadematerna avançada se no momento do parto a idade materna fosse> 35 anos. As indicações e os resultados dos exames foram registrados, segundo a Diretriz Brasileira de Cardiologia Fetal. Foramcalculadas as razões de prevalência brutas e ajustadas através da regressão de Poisson, considerando-se p < 0,05. Resultados Um total de 1.221 exames foram analisados. A frequência de exame ecocardiográfico alterado foi 14,82%. As alterações mais frequentes foram defeito do septo interventricular (6,39%), hipertrofia septal (3,35%) e defeito do septo atrioventricular (1,14%). Quinhentos e cinquenta e nove exames foram realizados com indicação de rotina, 289 por idade materna avançada e 373 preenchiam critério de acordo com a Diretriz Brasileira de Cardiologia Fetal. O exame ecocardiográfico alterado foi associado ao ultrassom obstétrico sugerindo cardiopatia fetal, ao diabetes materno, à translucência nucal aumentada e ao ultrassom obstétrico sugerindo alteração extracardíaca. Não foi observada maior frequência de exame ecocardiográfico alterado nas gestantes com idade materna avançada, comparado ao restante da amostra. Conclusão Constatou-se elevada frequência de indicações de rotina, e por idade materna avançada isoladamente, que não foram associados a alterações da ecocardiografia fetal. Em nosso meio, quando o ultrassom obstétrico sugere cardiopatia fetal, é muito provável que a ecocardiografia fetal tambémseja anormal. Portanto, o ultrassom obstétrico é um bom método de rastreio pré-natal.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Ultrasonography, Prenatal , Maternal Age , Heart Defects, Congenital/epidemiology , Brazil/epidemiology , Echocardiography , Prevalence , Cross-Sectional Studies , Gestational Age , Fetal Diseases/epidemiology , Fetal Diseases/diagnostic imaging , Heart Defects, Congenital/diagnostic imaging
4.
Säo Paulo med. j ; 137(5): 391-400, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1059105

ABSTRACT

ABSTRACT BACKGROUND: The prevalence of congenital abnormalities in general populations is approximately 3-5%. One of the most important applications of obstetric ultrasound is in detection of fetal structural defects. OBJECTIVE: To assess fetal structural anomalies diagnosed using ultrasound in the three trimesters of pregnancy. DESIGN AND SETTING: Retrospective cohort study at the Mário Palmério University Hospital of the University of Uberaba (Universidade de Uberaba, UNIUBE), from March 2014 to December 2016. METHODS: Ultrasound data at gestational weeks 11-13 + 6, 20-24 and 32-36 were recorded to identify fetal anomalies in each trimester and in the postnatal period. The primary outcome measurements were sensitivity, specificity, positive predictive value and negative predictive value for detection of fetal anomalies and their prevalence. RESULTS: The prevalence of anomalies detected using ultrasound was 2.95% in the prenatal period and 7.24% in the postnatal period. The fetal anomalies most frequently diagnosed using ultrasound in the three trimesters were genitourinary tract anomalies, with a prevalence of 27.8%. Cardiac anomalies were diagnosed more often in the postnatal period, accounting for 51.0% of all cases. High specificity, negative predictive value and accuracy of ultrasound were observed in all three trimesters of pregnancy. CONCLUSION: Ultrasound is safe and has utility for detecting fetal anomalies that are associated with high rates of morbidity and mortality. However, the low sensitivity of ultrasound for detecting fetal anomalies in unselected populations limits its utility for providing reassurance to examiners and to pregnant women with normal results.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Congenital Abnormalities/diagnostic imaging , Ultrasonography, Prenatal/methods , Fetal Diseases/diagnostic imaging , Fetus/abnormalities , Pregnancy Trimester, Second , Pregnancy Trimester, Third , Pregnancy Trimester, First , Congenital Abnormalities/epidemiology , Brazil/epidemiology , Prevalence , Retrospective Studies , Fetus/diagnostic imaging
6.
Int. braz. j. urol ; 44(4): 812-818, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-954081

ABSTRACT

ABSTRACT Purpose: To assess the need for postnatal evaluation and the medium term outcome in patients with isolated unilateral low grade prenatally detected hydronephrosis. Materials and Methods: We prospectively selected 424 patients (690 kidney units) with a prenatal diagnosis of urinary tract dilatation between 2010 and 2013. We included only those patients with isolated unilateral low-grade hydronephrosis who underwent at least 2 postnatal ultrasound examinations. The Society for Fetal Urology (SFU) grading system was utilized for assessment of the hydronephrosis. We excluded patients with bilateral dilation or other urological abnormalities. The fate of hydronephrosis including resolution, stability or worsening was documented. Results: A total of 66 infants (44 boys and 22 girls) with antenatally diagnosed unilateral urinary tract dilation (23 right and 43 left) were identified. Ultrasounds showed SFU grade 1 hydronephrosis in 32 patients (48%) and SFU grade 2 hydronephrosis in 34 (52%). After a mean follow-up period of 32 months (range 12 to 60), 37 patients (56%) had complete resolution of hydronephrosis while the remaining 29 were stable (44%). None of our patients developed UTIs during follow-up and none required surgical intervention. Conclusions: Prenatally detected, isolated unilateral low-grade hydronephrosis usually have a favorable prognosis. All cases in our cohort showed either stability or resolution of hydronephrosis without any harmful consequences. Based on our findings on medium-term in this category of patients, long-term follow-up is not warranted.


Subject(s)
Humans , Male , Female , Ultrasonography, Prenatal/standards , Aftercare/standards , Fetal Diseases/diagnostic imaging , Hydronephrosis/embryology , Hydronephrosis/diagnostic imaging , Time Factors , Severity of Illness Index , Sex Factors , Prospective Studies , Gestational Age , Risk Assessment , Kaplan-Meier Estimate , Fetal Diseases/pathology , Hydronephrosis/pathology
8.
Rev. bras. ginecol. obstet ; 39(11): 596-601, Nov. 2017. tab
Article in English | LILACS | ID: biblio-898840

ABSTRACT

Abstract Objective To investigate the clinical and sonographic parameters associated with adverse fetal outcomes in patients with congenital parvovirus B19 infection managed by intrauterine transfusion. Methods This was a single-center retrospective study conducted from January 2005 to December 2016 that assessed patients with singleton pregnancies with fetal parvovirus infection confirmed by a polymerase chain reaction of the amniotic fluid or fetal blood samples who underwent at least one intrauterine transfusion. The maternal characteristics, sonographic findings and parameters related to intrauterine transfusion were compared between the two groups (recovery/non-recovery), who were categorized based on fetal response after in-utero transfusions. Progression to fetal death or delivery without fetal recovery after the transfusions was considered nonrecovery and categorized as an adverse outcome. Results The final analysis included ten singleton pregnancies: seven of which were categorized into the recovery group and three of which into the non-recovery group. The baseline characteristics were similar between the groups. All fetuses were hydropic at the time of diagnosis. No significant differences related to sonographic or intrauterine transfusion parameters were identified between the groups; however, the nonrecovery group tended to have an increased number of sonographic markers and lower fetal hemoglobin and platelet levels before the transfusion. Conclusion We were unable to firmly establish the clinical or sonographic parameters associated with adverse fetal outcomes in patients with parvovirus infection managed with intrauterine transfusions; however, edema, placental thickening and oligohydramnios may indicate greater fetal compromise and, subsequently, adverse outcomes. However, further studies are necessary, mainly due to the small number of cases analyzed in the present study.


Resumo Objetivo Investigar os parâmetros clínicos e ultrassonográficos associados ao desfecho fetal adverso em pacientes com infecção congênita por parvovírus B19 manejada por meio de transfusão intrauterina. Métodos Trata-se de um estudo retrospectivo de um único centro realizado entre janeiro de 2005 e dezembro de 2016, que avaliou pacientes com gestação única com infecção fetal por parvovírus confirmada por reação em cadeia da polimerase de líquido amniótico ou amostras de sangue fetal submetidas a pelo menos uma transfusão intrauterina. As características maternas, os achados ultrassonográficos e os parâmetros relacionados à transfusão intrauterina foram comparados entre os dois grupos (recuperação/não recuperação), que foram categorizados com base na resposta fetal após transfusão intrauterina. A progressão para morte fetal ou parto sem recuperação fetal após transfusões foi considerada não recuperação, e categorizada como um desfecho adverso. Resultados A análise final incluiu dez gravidezes únicas: sete foram categorizadas no grupo de recuperação, e três, no grupo de não recuperação. As características basais foram semelhantes entre os grupos. Todos os fetos estavam hidrópicos no momento do diagnóstico. Não foram identificadas diferenças significativas entre os grupos em relação aos parâmetros ultrassonográficos ou os das transfusões intrauterinas; Entretanto, o grupo de não recuperação tendeu a ter um número aumentado demarcadores ultrassonográficos e níveis mais baixos de hemoglobina e plaquetas fetais antes da transfusão. Conclusão Não foi possível estabelecer firmemente os parâmetros clínicos ou ultrassonográficos associados ao desfecho fetal adverso em pacientes com infecção por parvovírus manejada por meio de transfusões intrauterinas. Entretanto, edema de pele, espessamento placentário e oligoidrâmnio podem indicar maior comprometimento fetal e, posteriormente, desfechos fetais adversos. No entanto, estudos adicionais são necessários, principalmente devido ao pequeno número de casos analisados neste estudo.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Parvovirus B19, Human , Parvoviridae Infections/congenital , Fetal Diseases/virology , Prognosis , Retrospective Studies , Ultrasonography, Prenatal , Parvoviridae Infections/diagnostic imaging , Fetal Diseases/diagnostic imaging
9.
Rev. chil. obstet. ginecol. (En línea) ; 82(3): 313-321, jun. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899911

ABSTRACT

Los rabdomiomas son los tumores benignos cardíacos más frecuentes encontrados en vida fetal y postnatal, asociándose frecuentemente a esclerosis tuberosa. A propósito de un caso manejado en nuestra maternidad el año 2014 se revisó la literatura existente sobre su diagnóstico, manejo, implicancias pronósticas. Se trata de una embarazada de 23 años que fue referida a las 25 semanas a nuestro servicio, el estudio ecográfico revela tres imágenes cardiacas concordantes con rabdomiomas en las paredes ventriculares y el septum. No se detectan otras anormalidades y se controla en forma seriada con ultrasonido. Se realiza a las 33 semanas resonancia nuclear magnética fetal con el objetivo de evidenciar signos de esclerosis tuberosa los cuales se evidencian en el examen y se confirman en exámenes postnatales. Se comenta el diagnóstico diferencial con otros neoplasias benignas cardiacas como teratomas, fibromas y hemangiomas. Las posibles complicaciones de los rabdomiomas dependerán de su ubicación y tamaño, produciendo alteraciones en flujo o bien menos frecuentemente arritmias. La asociación más importante de esta patología es con esclerosis tuberosa de manera que se debe realizar una cuidadosa anamnesis familiar, estudios de imágenes que deben abarcar el SNC, corazón y riñones. Finalmente en ese contexto realizar la mejor consejería a los padres.


Rhabdomyomas are the most common benign cardiac tumors found in fetal and postnatal life, frequently being associated with tuberous sclerosis. In relation to a case handled in our maternity unit in 2014, existing literature on cardiac rhabdomyomas diagnosis, management and prognostic implications, was revised. The case concerned a 25 week pregnant 23 year old patient, who was referred to our facility; ultrasound examination reveals three cardiac images consistent with rhabdomyomas in the ventricular walls and the septum. No other abnormalities are detected and the patient is monitored with a series of ultrasound. At 33 weeks a fetal magnetic resonance imaging is performed in order to show signs of tuberous sclerosis which are noted in the examination and confirmed in post natal tests. Differential diagnosis with other benign cardiac neoplasms such as teratomas, fibromas and hemangiomas is discussed. Possible complications of the rhabdomyomas will depend on its location and size, producing changes in flow or less frequent arrhythmias. The most important association of this pathology is with tuberous sclerosis, therefore the family medical history must be carefully evaluated, and imaging controls that should include the CNS, heart and kidneys. Finally in this context give the best counseling to the parents.


Subject(s)
Humans , Female , Pregnancy , Adult , Rhabdomyoma/diagnostic imaging , Tuberous Sclerosis/diagnostic imaging , Fetal Diseases/diagnostic imaging , Heart Neoplasms/diagnostic imaging , Rhabdomyoma/complications , Tuberous Sclerosis/complications , Ultrasonography, Prenatal , Heart Neoplasms/complications
12.
Rev. bras. ginecol. obstet ; 38(4): 196-200, Apr. 2016. graf
Article in English | LILACS | ID: lil-783881

ABSTRACT

Abstract Cytomegalovirus (CMV) is the most common congenital viral infection, causing hearing, visual and psychomotor impairment. Preexisting maternal CMV immunity substantially reduces, but not eliminates, the risk of fetal infection and affectation. This article is about a case of nonprimary maternal CMV infection during pregnancy, with vertical transmission, resulting in severe fetal affectation. Preconceptional analysis indicated maternal CMV past infection. Pregnancy progressed uneventfully until the 20th week ultrasound (US), which revealed cerebral abnormalities: thin and hyperechogenic cerebral cortex with prominent lateral ventricles, bilateral periventricular hyperechogenicities, cerebellar vermis hypoplasia and absent corpus callosum. The MRI suggested these findings were compatible with congenital infection rather than primary brain malformation. The fetal karyotype was normal. The title of CMV's IgG antibodies almost tripled. Since the first semester,analysisof the polymerasechainreaction(PCR)forCMVDNAintheamniotic fluid was negative. The pregnancy was terminatedat 23weeks. Neuropathologicalfindings at autopsy showed severe brain lesions associated with CMV infection.


Resumo O citomegalovírus (CMV) é a infeção viral congénita que mais comumente causa deficiência auditiva, visual e psicomotora. A preexistência de imunidade materna reduz substancialmente, mas não elimina, o risco de infeção e afetação fetal. Trata-se de um caso de infeção materna não primária por CMV durante a gravidez, com transmissão vertical, resultando em afetação fetal severa. As análises preconcepção indicavam infecção passada por CMV. A gravidez decorreu sem intercorrências até a ecografia efetuada na 20ª semana, que revelou alterações cerebrais: córtex cerebral fino e hiperecogénico com ventrículos laterais proeminentes, hiperecogenecidades periventriculares bilaterais, hipoplasia do vérmis cerebeloso e ausência de corpo caloso. A ressonância magnética sugeriu que estes achados eram mais favoráveis a uma infeção congénita do que com uma malformação cerebral primária. O cariótipo fetal era normal. O título de anticorpos IgG para CMV havia triplicado desde a dosagem do primeiro trimestre. O PCR para o DNA do CMV no líquido amniótico foi negativo. A gravidez foi interrompida na 23ª semana. Os achados neuropatológicos na autópsia mostraram lesões cerebrais severas associadas a infeção por CMV.


Subject(s)
Humans , Female , Pregnancy , Adult , Cytomegalovirus Infections/transmission , Fetal Diseases/virology , Infectious Disease Transmission, Vertical , Cytomegalovirus Infections/diagnostic imaging , Fetal Diseases/diagnostic imaging , Severity of Illness Index , Ultrasonography, Prenatal
13.
Rev. Méd. Clín. Condes ; 26(4): 432-441, jul. 2015. ilus, tab
Article in Spanish | LILACS | ID: biblio-1129069

ABSTRACT

El diagnóstico y manejo prenatal de enfermedades raras involucra un estudio multidisciplinario. Desde una visión obstétrica, herramientas de imagenología como la ultrasonografía y en menor medida la resonancia magnética fetal (RMF) son esenciales para el diagnóstico de anomalías morfológicas y sospecha de defectos cromosómicos. Para el diagnóstico de enfermedades cromosómicas el estudio de cariograma obtenido de vellosidades coriales, líquido amniótico o sangre fetal mediante técnicas invasivas tal como biopsia corial, amniocentesis o cordocentesis ha sido hasta hace poco el gold standard del diagnóstico. Nuevas técnicas moleculares capaces de detectar microdeleciones como es el microarray nos ha permitido aproximarnos al origen de las enfermedades raras. Se revisarán además algunos de los defectos anatómicos raros y su enfoque neonatal.


Prenatal diagnosis and management of rare diseases is a multidisciplinary task. From the obstetric vision, prenatal diagnosis is based on fetal images obtained by ultrasound or magnetic resonance and fetal chromosomes study. The study of fetal morphology allows us the diagnosis of fetal abnormalities and the suspicion of chromosomal defects. Fetal chromosomal study is obtained either by chorionic villus sampling, amniocentesis and cordocentesis, all associated to fetal risk. New screening techniques such as fetal DNA on maternal blood or the study of fetal micro deletions using micro Array on amniotic fluid has extended diagnostic opportunity of rare fetal diseases. We will review some of the most common rare diseases and the neonatal approach.


Subject(s)
Humans , Female , Pregnancy , Rare Diseases/diagnostic imaging , Fetal Diseases/diagnostic imaging , Magnetic Resonance Imaging , Mass Screening , Chromosome Aberrations , Ultrasonography , Rare Diseases/genetics , Fetal Diseases/genetics , Hernia, Diaphragmatic/diagnostic imaging , Nervous System Diseases/diagnostic imaging
14.
Rev. Méd. Clín. Condes ; 26(4): 442-451, jul. 2015. tab, ilus
Article in Spanish | LILACS | ID: biblio-1129070

ABSTRACT

El Mielomeningocele (MMC) es una malformación congénita frecuente asociada a morbimortalidad importante. El manejo post natal estándar no ha ofrecido cambios significativos en sus resultados en los últimos años. La publicación del MOMS (Management of Myelomeningocele study) en 2011 demostró que la cirugía fetal del MMC disminuía la necesidad de derivativa de líquido cefalorraquídeo, revertía la herniación del tronco cerebral y mejoraba la calidad de la marcha a los 30 meses de vida, a pesar de un mayor número de parto prematuro y complicaciones maternas. Estos resultados motivaron a nuestro grupo a iniciar una experiencia en cirugía fetal del MMC. Este trabajo generó un protocolo de manejo en Clínica Las Condes contabilizando a la fecha 26 casos operados con resultados alentadores. Los avances en esta técnica siguen adelante en pos de disminuir la incidencia de parto prematuro, abriendo la posibilidad al tratamiento intrauterino de otras patologías.


Myelomeningocele (MMC), is a common congenital malformation associated with significant morbidity and mortality. The standard postnatal management has offered no significant changes in its results in the last years. The publication of the MOMS (Management of Myelomeningocele study) in 2011 showed that fetal surgery for MMC decreased the need for shunt of cerebrospinal fluid, reversed brainstem herniation and improved ride quality at 30 months, despite a greater number of premature delivery and maternal complications. These results encourage our group to start an experience in fetal surgery for MMC. This work generated a management protocol at Clínica Las Condes accounting to date 26 cases operated with encouraging results. The advances in this technique are continuing towards reducing the incidence of premature delivery and opening the possibility of intrauterine treatment for other fetal pathologies.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Meningomyelocele/surgery , Neurosurgical Procedures/standards , Fetal Diseases/surgery , Arnold-Chiari Malformation , Prenatal Diagnosis , Pregnancy Outcome , Clinical Protocols , Spinal Dysraphism , Meningomyelocele/diagnostic imaging , Fetal Diseases/diagnostic imaging , Hydrocephalus
15.
Bahrain Medical Bulletin. 2013; 35 (2): 91-93
in English | IMEMR | ID: emr-142640

ABSTRACT

An ultrasound of a twenty-three weeks fetus showed a cystic mass having a "cyst within a cyst" arising from the distal spine. The posterior fossa was normal with no hydrocephalus. Postnatal MRI confirmed the presence of terminal myelocystocele [TMC]. TMC should be considered in a fetus with a cystic mass over the lower spine especially when a "cyst within a cyst" appearance is present. We present the antenatal ultrasound and postnatal MRI appearance of TMC. As the definitive diagnosis of TMC may be difficult to make on antenatal ultrasound other cystic masses, such as, meningocele, myelomeningocele and cystic sacrococcygeal teratoma should be considered


Subject(s)
Humans , Female , Spinal Dysraphism/diagnosis , Cysts/diagnostic imaging , Magnetic Resonance Imaging , Ultrasonography, Prenatal , Fetal Diseases/diagnostic imaging , Diagnosis, Differential , Gestational Age
16.
KMJ-Kuwait Medical Journal. 2013; 45 (4): 300-306
in English | IMEMR | ID: emr-139622

ABSTRACT

Antenatal ultrasound is an essential tool for detection of fetal anomalies. Early detection of congenital anomalies can reduce the expected morbidity and mortality. To highlight the role of antenatal ultrasound in detection and characterization of fetal anomalies, and to study the incidence and distribution of congenital anomalies at King Abdulaziz University Hospital [KAUH], Jeddah, Kingdom of Saudi Arabia [KSA] Cross-sectional observation study. Department of Diagnostic Radiology and Fetal Medicine Unit at KAUH, Jeddah, KSA during the period 2008-2011. Antenatal ultrasound. Five thousand and thirty pregnant females were subjected to antenatal ultrasound [US] at KAUH diagnostic radiology department and fetal medicine unit from January 2008 to September 2011. The age of participating females ranged from 16 to 49 years. Data were collected and statistically analyzed using SPSS 10.0 program. Statistical significance was accepted if p-value < 0.05. The incidence of congenital anomalies. Cardiac and umbilical cord anomalies have statistically significant relation with maternal age [p-value < 0.05]. The most frequent abnormalities detected are of the brain [40.6%], the urinary system [39.4%] and the cardiovascular system [37.5%]. The high prenatal detection rates for common congenital anomalies of the CNS, cardiovascular and urinary systems are similar to those found in previous reports. Unexpectedly, abdominal anomalies were the fourth largest anomalies detected. By using more sophisticated, highly sensitive machines in addition to greater expertise, well-trained radiologists and sonographers specialized in obstetrics, more specific and early detection of different anomalies can be possible in the future


Subject(s)
Humans , Female , Fetal Diseases/diagnostic imaging , Congenital Abnormalities/diagnostic imaging , Sensitivity and Specificity , Early Diagnosis , Cross-Sectional Studies , Hospitals, University
17.
Journal of Kerman University of Medical Sciences. 2012; 19 (6): 584-591
in Persian | IMEMR | ID: emr-142519

ABSTRACT

Hydronephrosis is a common problem in prenatal and newborn infants diagnosed by ultrasonography. Bladder to ureter reflux, the upper or lower urinary tract obstruction, and neurogenic bladder are the most common causes of hydronephrosis in newborns and infants. In this study, 100 neonates and infants with hydronephrosis were observed clinically and laboratorically for one year. Patients were allocated to two groups of fetal and newborn infants by the time of detection of hydronephrosis. Classification of the severity of hydronephrosis was based on the anteriorposterior diameter of renal pelvis including: mild hydronephrosis [5-9 mm], moderate [10-15 mm], and severe [more than 15 mm]. Fifty four patients were boy and 46 were girl. Mean age of patients in first visit of fetal and newborn infants hydronephrosis were respectively 2.5 [79% asymptomatic] and 5 month [100% symptomatic]. Causes of fetal hydronephrosis were: bladder to ureter reflux [45%], idiopathic hydronephrosis [41%], ureteropelvic junction obstruction [UPJO] [3.11%], physiological hydronephrosis [7.5%], and posterior urethral valve [8.3%]. Bladder to ureter reflux was the most common cause of hydronephrosis in all of the patients [57%]. The most common causes of mild and severe hydronephrosis were bladder to ureter reflux and ureteropelvic junction obstruction, respectively. In patients with fetal hydronephrosis, 100%, 30% and 6% of cases of severe, moderate, and mild hydronephrosis need surgery, respectively. Using ultrasonography in pregnancy led to the discovery of most asymptomatic fetal hydronephrosis more than infant hydronephrosis


Subject(s)
Humans , Male , Female , Ultrasonography, Prenatal , Fetal Diseases/diagnostic imaging , Urinary Bladder, Neurogenic/complications , Infant, Newborn , Follow-Up Studies , Kidney/embryology , Pregnancy , Vesico-Ureteral Reflux/complications
19.
Article in English | IMSEAR | ID: sea-39177

ABSTRACT

Fetal echocardiography has been accepted as a prenatal noninvasive diagnostic tool of cardiovascular diseases in fetuses for more than three decades. There are limited data in Thailand. A retrospective study of prenatal, natal and postnatal data of pregnant women who had fetal echocardiography at Siriraj Hospital, Bangkok, Thailand, from January 1999 to July 2005 was conducted. In total, there were 117 pregnant women who had fetal echocardiography under standard indications. Median age of pregnant women was 30.2 (17.3-44.2) years old. Median gestational age at the first fetal echocardiography was 29 (17-40) weeks. Median number of time the women had fetal echocardiography was 1 (1-10). Indications for fetal echocardiography were; obstetricians suspected of fetal cardiovascular diseases, multiple anomalies, family history of congenital heart diseases, chromosome anomalies, hydrops fetalis, and other indications (53.8%, 12%, 11.1%, 8.5%, 8.5% and 6.0% respectively). There were 49 (41.8%) cases who had abnormal cardiovascular problems, i.e., structural heart diseases 26 cases, rhythm disturbance 15 cases, and cardiac masses 8 cases. Upon comparison with postnatal echocardiography and/or autopsy findings, fetal echocardiography had a sensitivity of 96.9%, specificity of 90.6%, and accuracy of 92.8%. There was various degrees of risk to have cardiovascular problems for each of the indication taking fetal echocardiography and postnatal data into consideration. Fetal echocardiography had an impact on the management in 57.3% of cases. Conclusion: Fetal echocardiography is a reliable prenatal diagnostic tool for cardiovascular problems with high accuracy and has an impact on the management at prenatal, natal and postnatal period. Different indications for fetal echocardiography have an effect on the relative risk of fetal cardiovascular diseases.


Subject(s)
Adolescent , Adult , Cardiovascular Diseases/diagnostic imaging , Female , Fetal Diseases/diagnostic imaging , Fetal Heart/diagnostic imaging , Gestational Age , Humans , Ultrasonography, Prenatal
20.
Saudi Medical Journal. 2005; 26 (2): 308-10
in English | IMEMR | ID: emr-74816

ABSTRACT

A 32-year-old Bahraini lady with a large fetal intra-abdominal cyst detected antenatally on ultrasound examination at 16 weeks of gestation. The cyst was simple anechoic, increasing in size and causing progressive displacement of the fetal thoracic organs. A successful intrauterine needle aspiration was carried out under ultrasound guidance at 30 weeks gestation without maternal or fetal morbidity. Cytology of the cyst fluid showed luteinized granulosa cells and biochemistry demonstrated high concentrations of estradiol, progesterone, and testosterone that confirmed the etiology of the cyst as ovarian. There was no evidence of recurrence following aspiration and no further need for postnatal surgery


Subject(s)
Humans , Female , Ovarian Cysts/diagnostic imaging , Decompression, Surgical , Suction , Fetal Diseases/surgery , Fetal Diseases/diagnostic imaging , Ultrasonography, Prenatal
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