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Shen AW, Kothari A, Flint A, Kumar S. Prenatal imaging features and perinatal outcomes of foetal volvulus-A literature review. Prenat Diagn 2022; 42:192-200. [PMID: 34981841 DOI: 10.1002/pd.6083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/04/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To conduct a review of the literature on foetal volvulus with emphasis on prenatal imaging, pregnancy characteristics and clinical outcomes. METHODS A review of all published cases of foetal volvulus diagnosed prenatally and indexed in Medline, EBSCOhost, CINAHL, SOCIndex and Healthy Policy Reference Centre. Studies without antenatal sonographic signs of foetal volvulus and without a postpartum surgical diagnosis were excluded. Data were analysed for frequencies and distributions and tested for statistical significance. RESULTS Eighty-eight cases of foetal volvulus were identified from 58 published case reports/series. The most common ultrasound findings were dilated bowel/stomach (77.3%), polyhydramnios (30.7%) and whirlpool/snail sign (28.4%). Median gestation at diagnosis was 31.9 weeks (IQR 27-34) and mean gestation at delivery was 34.5 weeks (SD 2.8). Underlying aetiology included intestinal malrotation (15.9%), cystic fibrosis (14.8% of all cases, 32.5% of tested cases) and abnormal mesenteric fixation (12.5%). Complications included intestinal atresia (36.4%) and foetal anaemia (9.1%). The overall perinatal mortality rate was 14.5%. CONCLUSION Foetal volvulus is a rare condition with high rates of preterm birth and perinatal mortality. Intestinal malrotation and cystic fibrosis are common predisposing causes, although the majority are idiopathic. Bowel and/or gastric dilatation is by far the most common sonographic finding.
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Affiliation(s)
- Andrew Wang Shen
- Department of Obstetrics and Gynaecology, Redcliffe Hospital, Redcliffe, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Alka Kothari
- Department of Obstetrics and Gynaecology, Redcliffe Hospital, Redcliffe, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Anndrea Flint
- Department of Paediatrics, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Sailesh Kumar
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia.,Mater Research Institute/University of Queensland, South Brisbane, Queensland, Australia.,Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
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Pahl A, Wildin R, Wills M, Barkhuff W. Case 1: A 31-week Fetus with Intestinal Atresia and Sudden Fetal Hemorrhage. Neoreviews 2020; 21:e761-e764. [PMID: 33139513 DOI: 10.1542/neo.21-11-e761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Robert Wildin
- Departments of Pediatrics and.,Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Marcia Wills
- Department of Pathology, Shore Regional Health, University of Maryland Medical System, Baltimore, MD
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Prenatal Diagnosis of Umbilical Cord Ulcer: A Report of Two Cases. Case Rep Obstet Gynecol 2019; 2019:3768761. [PMID: 31929926 PMCID: PMC6939419 DOI: 10.1155/2019/3768761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/21/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
Umbilical cord ulcer is related to fetal intestinal atresia or meconium; perforation of the ulcer causes fetal deterioration leading to fetal and neonatal death owing to fetal hemorrhage. However, to the best of our knowledge, a method to diagnose umbilical cord ulcer prenatally is not available. No reports exist about the prenatal findings before perforation of umbilical cord ulcer using ultrasonography. We encountered two cases of umbilical cord ulcer showing ultrasonographic finding of a linear echo around the umbilical cord. Umbilical cord ulcers with an exposed umbilical cord artery in the first case and with perforation of the artery in the second case were diagnosed postnatally. When we encounter such ultrasonographic finding, especially with polyhydramnios and high amniotic bile acid concentration in cases of fetal intestinal atresia, risk of perforation of the umbilical cord ulcer should be included in the differential diagnosis.
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Hemorrhage from Umbilical Cord Ulceration Identified on Real-Time Ultrasound in a Fetus with Duodenal Atresia. Case Rep Obstet Gynecol 2019; 2019:2680170. [PMID: 30906606 PMCID: PMC6393896 DOI: 10.1155/2019/2680170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/15/2019] [Indexed: 11/17/2022] Open
Abstract
Umbilical cord ulceration has been associated with congenital upper intestinal (duodenal or jejunal) atresia and can lead to fatal fetal intrauterine hemorrhage. We report a case of spontaneous hemorrhage from the umbilical cord, incidentally noted at the time of ultrasound in a 33-week fetus with suspected duodenal atresia, in which immediate delivery resulted in a good outcome. Despite many reports in the literature of congenital upper intestinal atresia and its association with umbilical cord ulceration, the propensity for this lesion for fetal hemorrhage, and the resulting perinatal morbidity and mortality, there appears to be a gap in the dissemination of this knowledge. In fetuses with suspected congenital upper intestinal atresia, recognition of the entity of umbilical cord ulceration may be improved by ultrasound with special attention to the amount of Wharton's jelly within the cord. Routine antepartum fetal surveillance may reduce perinatal morbidity and mortality from this condition. A high index of suspicion is needed to make the diagnosis of umbilical cord ulceration in association with congenital upper intestinal atresia. The role of amniotic fluid bile acids in the genesis of this disorder needs further study.
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Aronowitz D, Dolgin S, Bornstein E, Little-Richardson A, Bajaj J, Williamson A, Naves-Ruiz E, Edelman M. Perinatal hemorrhage from ulceration of the umbilical cord: A potentially catastrophic association with duodenal and jejunal obstruction. J Pediatr Surg 2018; 53:1669-1674. [PMID: 29241965 DOI: 10.1016/j.jpedsurg.2017.11.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/01/2017] [Accepted: 11/09/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to review published reports and contribute new cases of umbilical cord ulceration (UCU) with perinatal hemorrhage into the amniotic cavity in the setting of duodenal or jejunal obstruction because knowledge of this sequence is poorly disseminated and could be lifesaving. METHODS Published reports of UCU with hemorrhage associated with congenital duodenal or jejunal obstruction were reviewed. Chart review was conducted for the cases encountered at our institutions between January 2008 and March 2017. We noted perinatal complications, method of delivery, gestational age, birth weight, gender, number, location, and pathologic description of umbilical cord ulcers, and outcome. RESULTS Thirty-one reports and 7 new cases were studied. Perinatal complications included: preterm labor or preterm premature rupture of membranes: 63%; fetal distress: 95%; mean gestational age: 33weeks; premature gestation: 95%; bloody amniotic fluid: 90%. Pathological analysis of UCUs revealed solitary, multifocal, helical and punched-out lesions. There were 12 neonatal deaths (32%), and 12 intrauterine deaths (32%). Survival rate was 37%. CONCLUSIONS UCU with perinatal hemorrhage is associated with duodenal and jejunal obstruction. Knowing the typical clinical signs of this potential catastrophic complication could prompt lifesaving delivery. TYPE OF STUDY Prognostic LEVEL OF EVIDENCE: IV.
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Affiliation(s)
| | - Stephen Dolgin
- Division of Pediatric General, Thoracic and Endoscopic Surgery, Cohen Children's Medical Center, New Hyde Park, NY; Lenox Hill Hospital, New York, NY.
| | - Eran Bornstein
- Division of Maternal/Fetal Medicine, Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY
| | - Amanda Little-Richardson
- Division of Maternal/Fetal Medicine, Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY
| | - Jaya Bajaj
- Division of Anatomical Pathology, Pediatric Pathology, Cohen Children's Medical Center, Hofstra-Northwell School of Medicine, New Hyde Park, NY
| | - Alex Williamson
- Division of Anatomical Pathology, Pediatric Pathology, Cohen Children's Medical Center, Hofstra-Northwell School of Medicine, New Hyde Park, NY
| | | | - Morris Edelman
- Division of Anatomical Pathology, Pediatric Pathology, Cohen Children's Medical Center, Hofstra-Northwell School of Medicine, New Hyde Park, NY
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Nakamura E, Samejima K, Takayanagi N, Ono Y, Matsunaga S, Nagai T, Takai Y, Saitoh M, Baba K, Seki H. Retrospective study of umbilical cord ulceration related to congenital intestinal atresia: A single-center report. J Obstet Gynaecol Res 2018. [PMID: 29516584 DOI: 10.1111/jog.13611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Umbilical cord ulceration (UCU) is a disease in which an ulcer forms in the umbilical cord in the pregnant uterus and is accompanied by hemorrhaging from the same site. UCU occurs in fetuses with congenital upper-intestinal atresia (CUIA); however, its onset mechanism remains unclear. Here, we report our investigation of cases of UCU in our hospital. METHODS Among the 9825 deliveries performed between 2007 and 2016 at this hospital, 20 fetuses were diagnosed with CUIA, 4 (20%) of which had UCU. There was no difference in the backgrounds of the fetuses with UCU (UCU group: 4 fetuses) and those without (non-UCU group: 16 fetuses). RESULTS There was no intergroup difference in gestational age at delivery. Four cases in the UCU group had maternal age 35 weeks (26-39), weeks of delivery 35 weeks (35-36) and weight 2178.5 g (1600-2640); three out of four fetuses were female; and the location of gastrointestinal obstruction was in the duodenum in one case and in the jejunum in three cases. Death occurred in three of four fetuses in the UCU group versus none in the non-UCU group. CONCLUSION We performed a retrospective statistical investigation on the risk of UCU onset in cases from this hospital; however, we could not identify any prognostic factors for its onset. We investigated a total of 27 past reported UCU cases and the 4 cases in this study. Mean gestational age at onset was 33.3 ± 2.7 for all 27 cases. Various methods for the early discovery of UCU have been reported in the past; however, there is currently no gold standard. Based on this report and a review of past papers, for CUIA, it is desirable to perform in-hospital management from gestational week 30 onward and decide proper delivery timing on a case-by-case basis.
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Affiliation(s)
- Eishin Nakamura
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kouki Samejima
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Natsuko Takayanagi
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yoshihisa Ono
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shigetaka Matsunaga
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tomonori Nagai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yasushi Takai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masahiro Saitoh
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kazunori Baba
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroyuki Seki
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Umbilical cord ulceration: An underdiagnosed entity. Obstet Gynecol Sci 2016; 59:388-92. [PMID: 27668202 PMCID: PMC5028646 DOI: 10.5468/ogs.2016.59.5.388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/23/2015] [Accepted: 05/19/2015] [Indexed: 11/08/2022] Open
Abstract
Umbilical cord ulceration is a rare condition presenting with sudden fetal bradycardia due to fetal hemorrhage and in most cases leading to intrauterine death. A strong association with intestinal atresia has been reported. Most cases present after 30 weeks of gestation, with preterm labor or rupture of membranes followed by sudden fetal bradycardia. We report two such cases of umbilical cord ulceration and review the available literature. One of the cases interestingly presented at 26 weeks, much earlier than what is reported in the world literature. In view of high perinatal mortality and morbidity, awareness of this condition is mandatory for timely and appropriate management to improve the fetal outcome.
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Ohuoba E, Fruhman G, Olutoye O, Zacharias N. Perinatal survival of a fetus with intestinal volvulus and intussusception: a case report and review of the literature. AJP Rep 2013; 3:107-12. [PMID: 24147247 PMCID: PMC3799706 DOI: 10.1055/s-0033-1349367] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/05/2013] [Indexed: 01/11/2023] Open
Abstract
Fetal intestinal volvulus is a rare life-threatening condition. Late diagnosis of volvulus contributes to high rate of morbidity and mortality. It has variable degrees of presentation and survival. Intrauterine volvulus may be complicated by intestinal atresia due to ischemic necrosis. To our knowledge, there are three reported cases of term fetal demise. We report a case of fetal intestinal volvulus with perinatal survival of the largest term infant described with this complication to date. The volvulus was associated with type 3A jejunal atresia and intestinal pathology was noted on prenatal ultrasound. The infant was born via urgent cesarean delivery at 37(6/7) weeks of gestation and underwent emergent exploratory laparotomy with resection of small bowel and primary end-to-end anastomosis. Intrauterine intestinal volvulus may be suspected on prenatal ultrasound but only definitively diagnosed postnatally. Signs of fetal distress and volvulus are rarely associated with reports of survival in the term fetus. We review reported cases of prenatally suspected volvulus in infants documented to survive past the neonatal period. As fetal volvulus and most intestinal atresias/stenoses manifest during the third trimester, we recommend that the limited fetal anatomical survey during growth ultrasounds at 32 to 36 weeks routinely include an assessment of the fetal bowel.
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Affiliation(s)
- Esohe Ohuoba
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas ; Esohe Ohuoba and Gary Fruhman contributed equally to this manuscript
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