Prenatal detection of bladder wall involvement in invasive placentation with sequential two-dimensional and adjunctive three-dimensional ultrasonography.

OBJECTIVE: The purpose of this study was to determine the diagnostic capability of sequential two-dimensional (2D) and adjunctive three-dimensional (3D) ultrasonography (US) in identifying the location and extent of placental invasion of the bladder. MATERIALS AND METHODS: Forty-five patients at risk of placenta previa were examined sequentially with 2D US and then with a targeted scan of the region of interest with adjunctive 3D US to determine whether those patients suspected of having advanced invasive placentation by conventional ultrasonographic evidence had placental invasion of the bladder. The images were coded as positive, negative or indeterminate (equivocal) for bladder invasion. Follow-up postoperative outcomes were obtained. RESULTS: Seven of the 45 patients exhibited characteristic ultrasonographic findings for placenta increta/percreta. Among these seven patients with advanced invasive placentation, a targeted scan with adjunctive 3D US correctly provided additional corroborative information to the 2D US indeterminate diagnosis in patients who were found with variable degrees of bladder wall involvement at surgery. CONCLUSION: 3D US may be a useful adjunctive tool in refining 2D ultrasonographic techniques to identify the extent and degree of placental invasion of the bladder. The advantages of 3D US are: (1) a multiplanar image display allows viewing of sections from sagittal, coronal and axial planes at the same time, thereby more accurately determining the location and extent of placental invasion; (2) the viewing planes of the spatial angioarchitecture network can be arbitrarily manipulated to better delineate the aberrant vessels protruding into the bladder; (3) 3D reconstruction images can be clearly displayed by live 3D in a rotation mode for a better illustrative effect.

Prenatal diagnosis and perinatal management of maternal-fetal congenital parvovirus B19 infection.

OBJECTIVE: In nonimmune pregnant woman, the primary infection with parvovirus B19 may lead to transplacental transmission to the fetus with variable outcomes, including congenital anemia, hydrops fetalis, fetal death or spontaneous resolution. CASE REPORT: The first case was of a 28-year-old woman, gravida 2, para 1, whose fetus was found to have left-sided pleural effusion on a sonogram at 29 weeks of gestation. A sample of aspirated pleural fluid was positive for parvovirus B19 by polymerase chain reaction. Cordocentesis showed fetal hemoglobin level of 5.0 g/dL. Intraperitoneal transfusion (IPT) was performed, because access to the fetal circulation was difficult. Thirty milliliters of group O, Rh-positive packed red cells were transfused into the peritoneal cavity. A non-hydropic baby weighing 2,680 g was delivered at 33 weeks of gestation. The neonates complete blood count examination showed a hemoglobin level of 16.3 g/dL. The newborn baby was discharged in stable condition. The second case was of a 31-year-old woman, gravida 2, para 1, whose fetus was found to have ascites, hypertrophic cardiomyopathy, and placentomegaly on a sonogram at 23 weeks of gestation. An amniotic fluid sample was positive for parvovirus B19 DNA by polymerase chain reaction. Fetal ascites and hypertrophic cardiomyopathy gradually resolved after maternal iron supplementation and 2 weeks of intrauterine digitalization therapy. A healthy infant weighing 3,198 g was delivered at 37 weeks of gestation. The neonates complete blood count examination showed a hemoglobin level of 10.3 g/dL. CONCLUSION: Termination of pregnancy is rarely indicated, because B19 virus is not teratogenic. Although intravascular transfusion offers obvious theoretical advantages, in some cases in which access to the fetal circulation is difficult or impossible, IPT should be performed combined with appropriate medical treatment. Thus, there is still a place for IPT in modern management of the severely anemic fetus, and this technique should not be neglected.