Diagnosis of fetal urinary tract malformations: prenatal management and postnatal outcome.

OBJECTIVE: To evaluate prenatal management and to define the criteria of gravity for accurate assessment of the renal and overall prognosis of fetuses presenting malformations of the urinary tract. METHODS: We carried out a retrospective study of 127 cases of urinary tract malformation. We carried out descriptive statistical and univariate analyses as a function of severity criteria and the outcome of pregnancy. RESULTS: One-third of fetuses presented associated extrarenal malformations and 10% of the karyotypes were abnormal. There were more abortions in case of decrease in amniotic fluid volume (p < 0.001), extent of renal damage (p < 0.05), presence of associated extrarenal malformations (p < 0.05), early diagnosis of the malformation (p < 0.001) and presence of chromosomal syndrome (p = 0.01). In our study, there was an excellent correlation between prenatal data and pathological findings for the fetus following abortions for medical reasons or obtained during the surveillance of live-born children. Fetal biochemistry made very little contribution. CONCLUSION: In cases of urinary tract malformation, this work confirms the need for regular and frequent ultrasound scans, checking for the echographic factors indicative of gravity and for adapted karyotyping. It also demonstrates that pluridisciplinary management is necessary for the prenatal evaluation of renal and overall fetal prognosis.

[Prenatal diagnosis of sirenomelia]. / Diagnostic anténatal d'une sirénomélie.

Sirenomelia sequence associates a fusion of inferior legs with renal anomalies until bilateral agenesis. It is a rare and lethal polymalformation. The purpose of the ultrasonographic study is to identify the sirenomelia as early as possible during pregnancy and to differentiate it from caudal regression syndrome. A case of sirenomelia diagnosed early is reported together with a review of the literature. The ultrasonographic diagnosis, associated defects, the interest of color Doppler study of abdominal vasculature are discussed. Antenatal ultrasonographic diagnosis should be obtained as early as possible, before 20th gestational week at the latest. Color Doppler is helpful to confirm the diagnosis in case of bilateral renal agenesis. The main differences between sirenomelia and caudal regression syndrome (which requires a very different genetic counselling) are summarized in a table.

[Antenatal metastatic neuroblastoma: prognostic criteria. A case report]. / Le neuroblastome métastatique anténatal: critères pronostiques. A propos d'un cas.

Neuroblastoma, the most common malignant tumor in the neonatal period is metastatic in 25 to 50% of cases. While the prognosis of antenatal neuroblastoma is often considered as favorable, included in the most common metastatic stage (Stage IV S), it can lead to fetal or neonatal death. We report a case of a fetus with a stage IV neuroblastoma who died in utero. The most important prognostic factor is tumor stage, making sonographic detection of metastasis essential. Nevertheless, accurate staging remains difficult by sonography. When metastatic neuroblastoma is suspected, sonographic survey has to be reinforced, and if serious criteria such as massive hepatomegaly, placentomegally or hydrops appear, delivery must be considered.

Antenatal diagnosis of abdominothoracic alimentary tract duplication: a case report.

Alimentary tract duplications are rare, linked in their tubular form with a disturbance of organogenesis at the time of the separation of the notochord during the 4th week of gestation. Its division leads to the formation of a supernumerary esophagus, situated in the posterior mediastinum, associated with vertebral malformations and connected at its distal extremity with the alimentary tract. We report a case of esophageal duplication revealed antenatally as an ultrasound image of fluid tonality in the posterior mediastinum, causing a major pleural effusion. The other diagnostic possibilities are discussed in terms of the anatomy, embryogenesis and ultrasonographic appearance of the lesion.

[Prenatal echographic study of esophageal duplication. A case report]. / Aspect échographique anténatal d'une duplication oesophagienne. A propos d'un cas.

We report a case of abdomino-thoracic oesophageal duplication revealed by prenatal ultrasonography as a liquid mass in the posterior mediastinum, responsible for a major chylothorax. Tow our knowledge, this is the first thoroughly documented case occurring in the prenatal period. The various possible ultrasonographic diagnoses and the possibility of therapeutic drainage of pleural effusions are discussed in the light of anatomy, embryogenesis and ultrasonographic images of the lesion.

[Esophageal duplication with pleural effusion in antenatal diagnosis]. / Duplication oesophagienne avec épanchement pleural de révélation anténatale.

The authors report the case of a patient in whom an antenatal ultrasound showed a mediastinal tumor then a pleural effusion. At birth, the baby was intubated for adequate ventilation and pleural effusion was drained. Ultrasound, oesophagogram, CT scan permitted the diagnosis of tubular oesophageal duplication which was confirmed by surgery and pathologic examination. Review of the literature did not find such antenatal finding. The role of oral contraception during the first weeks of pregnancy is discussed.

[The 7th pregnancy was in the tube!!]. / La 7e était dans la trompe!!

The authors report a case of ovarian hyperstimulation leading to 6 endo-uterine pregnancies and one extra-uterine pregnancy. After embryonic reduction, and salpingectomy, a twin pregnancy was carried through, in a bifid uterus. Review of the literature enables to emphasize the difficulties in diagnosing heterotopic pregnancies, and to discuss the indications and techniques of selective embryonic reduction, along with the ethical and legal problems it raises.