Utility of fetal echocardiography in postnatal management of infants with prenatally diagnosed congenital heart disease.

OBJECTIVE: Congenital heart disease (CHD) remains a significant cause of neonatal morbidity and mortality. This study evaluates the success of fetal echocardiography (FECHO) in guiding delivery management in pregnancies complicated by CHD. METHODS: Cases with CHD diagnosed by prenatal FECHO performed at a single institution from January 2000 to June 2005 were retrospectively reviewed. The accuracy of prenatal diagnosis and the appropriateness of proposed care plans based on FECHO were compared to postnatal care plans based on neonatal echocardiograms (NECHOs). RESULTS: Of the 72 mother-infant pairs with prenatally diagnosed CHD, 53 underwent NECHO. Overall, the FECHO diagnosis matched the NECHO diagnosis in 50 out of 53 cases (94.3%). The NECHO added diagnostic or functional information in 6 of the 53 FECHO cases. Three of these were minor and would not have resulted in a significant change of delivery plans. The other three were major findings and would have resulted in a revision of delivery planning. Overall, 96% of the delivery plans based on FECHO agreed with the delivery plans based on NECHO. CONCLUSION: Fetal echocardiography has a high correlation with postnatal and neonatal echocardiographic findings. Delivery management plans may be based on fetal echocardiogram diagnoses.

Chronic hepatitis C in pregnancy.

OBJECTIVE: To estimate outcomes, to determine whether appropriate follow-up was performed for pregnant patients with hepatitis C virus (HCV), and to show that maternal and neonatal complications would be higher in the HCV-positive group. METHODS: We compared pregnant women from a drug dependence and treatment program who were HCV antibody-positive with those who were HCV antibody-negative using the University of New Mexico Perinatal Database. Maternal and neonatal outcomes were evaluated, including cholestasis of pregnancy, preterm birth, low birth weight, neonatal intensive care unit admissions, and neonatal methadone withdrawal. Variables were compared using Student t, Fisher exact, and chi(2) tests. RESULTS: Among 351 pregnancies between January 2000 and 2006, 159 (53%) were HCV antibody reactive, 141 (47%) tested nonreactive, and 51 (15%) were not screened. Hepatitis C reactivity was more common among Hispanics. Cholestasis of pregnancy was increased in HCV antibody reactive (Ab+) pregnancies (10 of 159, 6.3% compared with 0 of 141, P=.002). Among women taking methadone, there was a significantly higher incidence of neonatal withdrawal (P=.001). This was significant in mothers on low (0-30 mg) and moderate (31-90 mg) methadone doses. Despite the high cure rate with intensive therapy, only 5.7% of HCV Ab+ mothers and 1.9% of their neonates received gastroenterology referrals. CONCLUSION: In pregnant women involved in this drug treatment program, HCV reactivity was associated with Hispanic ethnicity, cholestasis of pregnancy, and increased neonatal methadone withdrawal regardless of maternal methadone dose. Gastroenterology consultation was inadequate.

Discordant middle cerebral artery peak systolic velocity Doppler studies in a fetus with RhD alloimmunization.

BACKGROUND: Doppler measurement of the fetal middle cerebral artery peak systolic velocity is a valuable tool in detecting the presence of fetal anemia in Rh-sensitized pregnancies. We present a case in which discordant left and right middle cerebral artery Dopplers complicated clinical management. CASE: An RhD-alloimmunized patient had middle cerebral artery Dopplers at 30 weeks of gestation, which showed an elevated peak systolic velocity in the left middle cerebral artery, greater than 1.55 multiples of the mean, but the right middle cerebral artery was within the normal range. The amniotic fluid change in optical density at a wavelength of 450 nm was consistent with the right middle cerebral artery Doppler. When both Dopplers were greater than or equal to 1.5 multiples of the mean, fetal blood sampling revealed a hematocrit of 28%. Postnatal cranial ultrasound examination showed normal architecture, but there was persistent discordant Dopplers in the left versus the right middle cerebral artery. CONCLUSION: Measurement of both left and right middle cerebral artery peak systolic velocities may identify patients with intrinsic variations in cranial blood vessels resulting in abnormal Doppler flows.

Consumptive coagulopathy associated with Gorham syndrome and subsequent Kasabach-Merritt syndrome during pregnancy: a case report.

BACKGROUND: Gorham and Kasabach-Merritt syndrome are rare diagnoses that can complicate pregnancy by increasing the risk of pelvic fracture and consumptive coagulopathy, respectively. CASE: A 23-year-old woman, gravida 2, para 0101, with a prenatal diagnosis of Gorham syndrome from her previous pregnancy was admitted at 32 weeks' gestation with severe back and flank pain. Computed tomographic findings revealed multiple lytic lesions of the pelvis in addition to large hemangiomas. Similar to her first pregnancy, she quickly developed consumptive coagulopathy and required prompt preterm delivery. The postoperative course was complicated by prolonged intensive care and multiple transfusions. CONCLUSION: The consumptive coagulopathy associated with Gorham syndrome and secondary Kasabach-Merritt syndrome can mimic severe preeclampsia, especially when recurrent.