Ultrasound and fetal diagnosis of perinatal infection.

Prenatal ultrasound can aid the clinician in evaluation of the patient with a suspected in utero TORCH infection, particularly toxoplasmosis, syphilis, and CMV. Demonstration of characteristic ultrasound findings in the high risk patient has a high predictive value for fetal infection and also may have prognostic significance. The sonologist should understand the limitations of ultrasound, discuss them with the patient, and document the discussion in the medical record. Patients should be counseled that ultrasound is not a sensitive test for fetal infection and that a normal fetal anatomy survey cannot predict a favorable outcome. In the low-risk patient, fetal infection should be considered when multiple organ system anomalies, fetal growth restriction, placental enlargement, or abnormalities of amniotic fluid volume are demonstrated.

Capillary hemangioma of the neck: prenatal MR findings.

Prenatal MR findings of a case of extracranial capillary hemangioma simulating an encephalocele at sonography are reported. MR imaging had an adjunctive diagnostic role in excluding the possibility of an encephalocele. The capillary hemangioma had diffuse T2 hypointensity prenatally, which is atypical of postnatal imaging findings.

Recurrent severe infantile cortical hyperostosis (Caffey disease) in siblings.

Infantile cortical hyperostosis (ICH), Caffey disease, is a multifocal, inflammatory skeletal process with classic onset before the fifth month of life and resolution by the age of 3 years. A severe phenotype with early prenatal onset has also been described. Inheritance is generally accepted a autosomal dominant with variable expression and penetrance. However, occurrence in siblings with no family history has been reported, raising the possibility of heterogeneity and the existence of a severe autosomal recessive form. We describe a third family with prenatally diagnosed ICH in two siblings, providing further evidence for this form of inheritance.

Effect of rapid intravenous crystalloid infusion on uteroplacental blood flow and placental implantation-site oxygen delivery in the pregnant ewe.

OBJECTIVE: Our purpose in this study was to investigate the effects of rapid intravenous crystalloid infusion on placental implantation-site blood flow and oxygen delivery in the near-term pregnant ewe. STUDY DESIGN: Maternal left ventricular, femoral arterial and venous, and bilateral fetal hind limb arterial catheters were placed in nine near-term ewes 5 days before the start of the study. Maternal and fetal arterial blood gas values, maternal hemodynamic measurements, and maternal organ blood flows (microsphere technique) were obtained before and after the intravenous infusion of 2.0 to 2.5 L of normal saline solution. Myometrial and placental implantation-site vascular resistances and oxygen delivery were calculated. The t test for paired comparisons was used for statistical analysis, with p < or = 0.05 considered significant. RESULTS: Significant postinfusion increases in maternal mean arterial pressure, placental implantation-site blood flow, and skin, skeletal muscle, and renal blood flows were recorded. In the six animals that demonstrated a fall in hemoglobin concentration, a significant increase in placental implantation-site oxygen delivery and a significant decrease in placental implantation-site vascular resistance were also seen. No significant changes were seen in myometrial blood flow or myometrial vascular resistance. CONCLUSION: Rapid intravenous crystalloid infusion selectively increases placental implantation-site blood flow in the near-term pregnant ewe and may improve oxygen delivery to the fetus, especially if hemodilution occurs.