Fetus-in-fetu. Imaging and pathology

Fetus-in-fetu [FIF], also known as endoparasitic twin, is a form of asymmetric fetal duplication in which the abnormal developing embryo parasitizes the normal co-twin by attaching internally. Here, we report a case of FIF presented as an intra-abdominal cystic mass, which was first detected during an antenatal ultrasound examination of a 32-year-old Saudi mother. At 34 weeks and 4 days of gestation, she had spontaneous labor and delivered a baby boy. The x-ray and CT examination of the baby boy clearly suggested the presence of limbs, vertebral column, and anomalous blood supply to the mass. After laparotomy and surgical removal, the intra-abdominal mass was subjected to detailed pathological examination. Microscopic studies further showed the presence of brain tissue, gut-like structures, fingers, and limbs. The mass was finally confirmed as FIF

Multiple pregnancy and preterm labor

Multiple gestations are high risk pregnancies, which may be complicated by pre-maturity, low birth weight infants, pre-eclampsia, anemia, postpartum hemorrhage, intrauterine growth restriction, neonatal morbidity and high perinatal, neonatal and infant mortality. This study was carried out to determine the incidence and effect of multiple pregnancies on pre-term labor in tertiary care hospitals. Retrospective case record analysis of 375 cases of multiple pregnancies that were reported at Armed Forces Hospital and King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, between January 2000 and December 2001. The data was analyzed to determine the incidence of multiple pregnancies and its effect on pre-term delivery. The over whole incidence of twins was 14/1000 births. Premature labor in multiple pregnancies was 7 times greater than singletons [42% versus 6.4%]. Almost half of multiple pregnancy cases were delivered by cesarean section [49% versus 14%]. Pregnancy was induced in 34% of cases. Cervical cerclage was applied in only 8% of cases and betamemetics were administered to only 11% of cases. Fetal distress in labor, abnormal presentation and previous uterine scar were the main indications for cesarean section. Fifty percent had no antenatal complications, gestational diabetes complicated 16%, and anemia was reported in 22% of cases. Preterm delivery remains the most serious complication of multiple pregnancies. Multiple gestation children may suffer long term sequel of prenatal complications, including cerebral palsy and hearing disabilities. Every effort should be made to reduce the risk of multiple gestation and pre-term labor through proper control and close monitoring of fertility drugs, limiting number of embryo transfer to maximum of 3 or only 2, improving the socioeconomic status of expectant mothers, reduce cigarette smoking, relieve maternal stress, restriction of maternal activity, frequent contact with health care personnel and treatment of any obstetric or medical disorders

Outcome of intravascular transfusion in the severely isoimmunized fetus.

To assess and evaluate the outcome of pregnancies complicated with severe rhesus-isoimmunization treated with intrauterine blood transfusions. A retrospective study Riyadh Armed Forces Hospital The study population comprised 39 patients with 48 severely isoimmunized pregnancies In all, 159 intrauterine transfusions including 114 intravascular and 45 intraperitoneal transfusions Complications of the procedure and outcome of the pregnancies Overall survival rate was 79.2%. Procedure-related mortality rate 6.2% Intravenous fetal transfusion is a safe procedure and in most cases leads to delivery of a mature healthy newborn requiring minimal treatment during the neonatal period