First-trimester and early second-trimester diagnosis of nuchal cystic hygroma by transvaginal sonography: diverse prognosis of the septated from the nonseptated lesion

Fetal cystic hygroma is a congenital malformation of the lymphatic system appearing as a single or multiloculated fluid-filled cavity, most often in the nuchal region. The malformation is believed to arise from failure of the lymphatic system to communicate with the venous nuchal system. Sometimes the lesion progresses to fetal hydrops, causing fetal death. To further delineate the cause and natural history of this disorder, we have prospectively studied eight cases of cystic hygroma of the neck, detected at gestational ages of 9 to 15 weeks by transvaginal sonography. Three of the eight fetuses survived (37.5%) and were normal at birth. Either hydrops fetalis or intrauterine fetal death occurred in the other five fetuses. In one of these five, therapeutic abortion was induced because of trisomy 21. In another fetus of these five, trisomy 18 was diagnosed by amniocentesis. This pregnancy ended in intrauterine fetal death. The ultrasonic evaluation of the cystic hygromas revealed that those that were reabsorbed in the three ultimately normal viable fetuses were nonseptated cysts, whereas all the four cystic hygromas ending in fetal death or associated with aneuploidy were septated, multilocular hygromas. In another fetus with nonseptated hygroma, nonimmune hydrops developed, which resulted in premature delivery and early neonatal death.

Meconium peritonitis due to meconium ileus presenting as fetal ascites: a case report

A case of meconium peritonitis due to meconium ileus is described. The condition was detected antenatally as fetal ascites on ultrasonography. Plain X-ray of abdomen post-natally showed specks of calcification mainly at the flanks, while on ultrasonography specks of high echogenic areas were seen throughout the abdomen which has been described as "snow-storm sign". The aetiology of meconium ileus is briefly discussed.

Atraumatic antepartum subdural hematoma causing fetal death

A case of atraumatic antenatal fetal subdural hematoma, severe enough to cause death, is reported. Although it is often associated with traumatic delivery, its occurrence before labor suggests that assumptions of causation require some medical investigation or corroboration before trauma is accepted as the etiologic factor.

Fetal urine output in hydramnios

Fetal urine output was evaluated in 12 pregnancies complicated by hydramnios. Six of these pregnancies were twin gestations with markedly elevated fetal urine output of the hyperperfused fetus. All six fetuses had urine output greater than the 95th percentile for their gestational age. These six patients were evaluated prior to and during the 29th week of pregnancy. Three singleton gestations had upper gastrointestinal obstruction and normal fetal urine output of 18.7, 18.0, and 12.3 mL/hour at 35, 35, and 31 weeks' gestation, respectively. Markedly elevated fetal urine output of 18 mL/hour (tenth to 95th percentile at 26 weeks, 4-7 mL/hour) was present in one fetus that was subsequently found to have diabetes insipidus. The remaining two singleton pregnancies with idiopathic hydramnios had upper limits of normal fetal urine output of 10 and 13 mL/hour at 31 and 32 weeks, respectively. It appears that hydramnios may be the result of polyuria of the hyperperfused twin in cases of twin-twin transfusion or diabetes insipidus. In upper gastrointestinal obstruction or idiopathic hydramnios, increased fetal urination does not appear to be present.

Fetal lung growth in laryngeal atresia and tracheal agenesis

Three cases of airway obstruction in fetuses born at 21, 32 and 40 weeks gestation are reported. The first had laryngeal atresia, cystic dysplastic kidneys, oligohydramnios and immense fluid-filled lungs. The second had upper tracheal agenesis, a tracheo-oesophageal fistula, a cystic dysplastic horseshoe kidney, oligohydramnios and normal-sized lungs. The third had a pin-hole mucosal tract through an otherwise atretic larynx, normal kidneys, no oligohydramnios and normal-sized lungs. Lung weight:body weight ratios, radial alveolar or radial canalicular counts and point-counting of sections of lungs in cases 1 and 2 show that laryngeal or tracheal obstruction may prevent or reduce the pulmonary hypoplasia associated with renal dysplasia, and in cases 2 and 3, that grossly enlarged, hyperplastic lungs may not be seen unless obstruction is complete.

A case of recurrent infantile polycystic kidney associated with hydrops fetalis

Nonimmune hydrops fetalis is becoming a predominant form of fetal hydrops due to the declining incidence of immune hydrops fetalis triggered by Rh isoimmunization. Infantile polycystic kidney appeared to be related to hydrops fetalis whether it is causal or merely coincidental and may represent another entry to differential diagnoses. Infantile polycystic kidney was diagnosed by an elevated maternal serum alpha-fetoprotein (AFP) value coupled with an ultrasonographic abnormality scanned as a multicystic mass with ascites in the fetal abdomen antenatally. This study presents a case of infantile polycystic kidney that resulted in a stillborn baby with hydrops fetalis and extensive placental calcification; it was the first case in Korea in which nonimmune hydrops fetalis was associated with infantile polycystic kidney in consecutive siblings by autosomal recessive inheritance in one family. In addition, this paper comprehensively reviews the incidence, etiology, prenatal diagnosis and proper management of nonimmune hydrops fetalis.

Fetal bradycardia during antepartum testing. Further observations

One hundred twenty-one cases of antepartum fetal bradycardia, occurring at 36 weeks' gestation or greater, were prospectively managed by active intervention and delivery. There were no fetal deaths. Intrapartum complications were similar at all gestational ages, regardless of whether the bradycardia was associated with a reactive or nonreactive nonstress test. Only the incidence of low five-minute Apgar scores was significantly higher in the nonreactive group. The incidence of cord compression patterns (variable decelerations) in labor was higher than that of uteroplacental insufficiency patterns (late decelerations). Intervention with delivery in the presence of fetal bradycardia should be considered in all cases with evidence of fetal lung maturity.

Fetal renal failure associated with intrauterine growth retardation

Four preterm infants with severe intrauterine growth retardation had renal failure from birth. The amount of asphyxia associated with the birth process did not fully explain the renal failure. Before delivery all for fetuses had severe oligohydramnios and an empty urinary bladder. These observations strengthen the view that severe intrauterine growth retardation may be accompanied by oligohydramnios caused by fetal renal failure.

Fetal atrial septal aneurysm: a cause of fetal atrial arrhythmias

Atrial arrhythmias are commonly found during fetal echocardiography performed during pregnancy to evaluate fetal arrhythmias. An association between atrial arrhythmias and an atrial septal aneurysm has been noted in children and adults. In this study, 105 fetuses were evaluated by fetal echocardiography, 39 (37%) referred to evaluate fetal arrhythmia and 66 (63%) to rule out congenital heart disease. An atrial septal aneurysm was found in 42 (40%) of the fetuses and an atrial arrhythmia in 37 (35%). An atrial septal aneurysm was found in 25 (64%) of the 39 fetuses referred to evaluate a fetal arrhythmia compared with only 17 (26%) of the 66 fetuses referred to rule out congenital heart disease. In this study, the association of an atrial septal aneurysm with an atrial arrhythmia was highly significant (p less than 0.001).

Erythroblastosis and reticulocytosis in anemic fetuses

The fetal blood erythroblast and reticulocyte counts were determined in umbilical cord samples obtained at 17 to 36 weeks' gestation from 127 pregnancies complicated by red blood cell isoimmunization. The reticulocyte count increased linearly with fetal anemia, and the erythroblast count increased exponentially. Significant erythroblastosis was observed only when the hemoglobin concentration deficit was greater than 7 gm/dl. Of the 52 fetuses with a hemoglobin concentration deficit greater than 7 gm/dl, 35 had ultrasonographic evidence of hydrops. These data suggest that medullary hematopoiesis is stimulated by mild anemia and that recruitment of extramedullary sites occurs when anemia is severe. Extensive hepatic erythropoiesis may be the cause of fetal hydrops in red blood cell isoimmunization.

Prenatal gastric dilatation and infantile hypertrophic pyloric stenosis

Fetal sonography showed persistent gastric dilatation with no other abnormalities. Following uneventful pregnancy and delivery, the patient presented with typical clinical and radiologic features of infantile hypertrophic pyloric stenosis. Literature review indicates that this association was never reported.

Changes in the long bones due to fetal immobility caused by neuromuscular disease. A radiographic and histological study

The long bones in eleven newborn infants who had neuromuscular disease were studied and were found to be thin, hypomineralized, and elongated. In most of the bones, there were multiple diaphyseal or metaphyseal fractures, or both. By light microscopy, the outstanding findings were fractures through the growth plate and diaphysis and thinning of the cortices. The etiology of the fractures and the insufficient substance of the bone is the reduction in the intrauterine motion of the fetus, which leads to fragility of the bones and contractures of the joints. The severity of the alterations may have been related to the time of the onset of the abnormalities and to the duration and degree of the intrauterine akinesia.

Congenital hydrocephalus secondary to prenatal intracranial haemorrhage

A high incidence of intracranial haemorrhage in utero of uncertain aetiology has been previously identified as an important cause of stillbirth in infants of immigrant Pacific Islanders in New Zealand. Congenital hydrocephalus is now described as a consequence of intracranial haemorrhage in 2 stillborn Pacific Islander infants. A large intracerebral haemorrhage, hydrocephalus and hydrops in one infant was first recognized prenatally by ultrasonography and caused intrauterine death at 26 weeks' gestation. Severe hydrocephalus in the other infant was first identified just before labour at term but the pathological findings were of old intraventricular haemorrhage with narrowing of the aqueduct of Sylvius as a reaction to the haemorrhage. Prior intracranial haemorrhage may be the cause of an increased incidence of hydrocephalus in Pacific Islander stillbirths and of some otherwise unexplained cases of congenital hydrocephalus in other races.

Antenatal origin of neurologic damage in newborn infants. I. Preterm infants

Currently, the diagnosis of white matter necrosis may be performed with echoencephalography when cysts are observed in the white matter adjacent to the lateral ventricles. One hundred twenty-seven infants with a gestational age less than 36 weeks (mean [+/- SE] gestational age = 31 +/- 3.2 weeks) were studied in the neonatal period with echoencephalography to determine the incidence of white matter necrosis and the perinatal variables associated with this complication. Twenty-three infants (18.3%) had white matter necrosis. Thirteen (10.3%) had cysts by day 3 (11 on day 1), indicating that the onset of white matter necrosis occurred antenatally. The incidence of antenatal white matter necrosis was inversely related to birth weight and was more frequent in infants weighing less than 1000 gm (19%). Stepwise logistic regression analysis of 31 antenatal variables showed that placental vascular anastomoses in multiple pregnancies, funisitis, and purulent amniotic fluid were the only complications associated with antenatal white matter necrosis. Follow-up neurologic evaluations were abnormal in four of six patients with antenatal white matter necrosis. The findings in this study focus attention on prenatal, rather than intrapartum and postnatal, factors as causative agents of neurologic morbidity and emphasize the importance of early and sequential evaluation of neonatal brain structures.

A case of hydrops fetalis due to placental chorioangioma

A case of an infant born in association with a large chorioangioma of the placenta is reported. The mother was complicated with polyhydramnios and premature labor. The fetal complications were congestive heart failure and hydrops fetalis. This case serves to emphasize that it is necessary to examine the placenta in every perinatal autopsy case.

[Esophageal duplication with pleural effusion in antenatal diagnosis]

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.

Accuracy of ultrasound diagnoses in pregnancies complicated by suspected fetal anomalies

Referral of pregnancies complicated by suspected fetal anomalies to level III perinatal centres for further evaluation and management is increasing as use of real-time ultrasound spreads, but the sensitivity and specificity of the prenatal diagnoses made in this population are unknown. We undertook a prospective study that followed pregnancies referred to a designated programme dealing with suspected fetal abnormalities. Follow-up of 257 pregnancies revealed that 282 separate anomalies were accurately diagnosed in 212 cases. Normal anatomy was correctly predicted in 42 cases, 16 per cent of the referred population. False-positive and false-negative rates were 1.5 per cent (4/257) and 2 per cent (1/46), respectively. However, 37 per cent of those infants born with anomalies had additional problems not prenatally detected by ultrasound. These results indicate that prenatal ultrasound diagnoses are remarkably accurate overall but that they may be insensitive to associated anomalies in individual cases.

Adult schizophrenia following prenatal exposure to an influenza epidemic

In the context of a Finnish birth cohort, we tested the hypothesis that viral infection during the latter two thirds of fetal development would increase the risk of adult schizophrenic outcome. Psychiatric hospital diagnoses were recorded for all individuals in greater Helsinki who were fetuses during the 1957 type A2 influenza epidemic. Those exposed to the viral epidemic during their second trimester of fetal development were at elevated risk of being admitted to a psychiatric hospital with a diagnosis of schizophrenia. This was true for both males and females and independently in several psychiatric hospitals. The second-trimester effect was seen in the elevated proportion of schizophrenics among those admitted to a psychiatric hospital and also in higher rates of schizophrenia per 1000 live births in the city of Helsinki. The study has several limitations: (1) We have no direct evidence that the subjects actually suffered a viral infection. (2) The psychiatric data were obtained only for subjects up to the age of 26 years, 56 days. (3) The findings are based on hospital diagnoses. (4) The determination of stage of gestation at time of exposure to the epidemic is based on date of birth. The viral infection might have occurred outside the official epidemic window; the infant may have had a preterm or postterm delivery. These sources of error, however, should not serve to enhance the findings. The observed viral effect is interpreted as being one of many potential perturbations of gestation. We suggest that it is less the type than the timing of the disturbance during fetal neural development that is critical in determining risk for schizophrenia.

Spastic hemiparesis and presumed prenatal embolisation

An infant with clinical evidence of prenatal right subclavian arterial occlusion subsequently developed left hemiparesis with cystic infarction of the territory of the right middle cerebral artery. Perinatal strokes have not been reported with signs of limb ischaemia at birth; this finding may be a warning of possible simultaneous cerebral infarction.

Use of furosemide in pregnancies complicated by oligohydramnios

To differentiate pregnancies complicated by oligohydramnios due to intrauterine growth retardation from those due to renal agenesis, the authors administered furosemide intravenously to eight pregnant women (19-25 weeks gestation) with oligohydramnios. The fetal abdomen was scanned with ultrasound to demonstrate the fetal urinary bladder. In six fetuses, sonography failed to demonstrate the bladder: two fetuses had growth retardation with normal kidneys and bladder, and four had renal anomalies. It is concluded that administration of furosemide to the mother fails to induce diuresis in growth-retarded fetuses of 19-23 weeks gestation and that failure to see the fetal bladder after furosemide administration does not necessarily indicate absent fetal kidneys.

Seasonality, birth complications and schizophrenia in a high risk sample

It has been suggested that viral infections, more prevalent in the winter months, might increase pregnancy and birth complications, which might in turn be responsible for the excess of winter-born patients with schizophrenia. In this study it was found that the rate of schizophrenia among high risk winter-urban births who had suffered a perinatal complication was significantly greater than that for those who had not, thus supporting the hypothesis.

Electroencephalographic study of 137 patients with thalidomide embryopathy

EEG examinations were carried out on 137 patients with thalidomide embryopathy aged between 7 and 22 with a mean age of 17.0. Waking and sleep EEGs were normal in 82 (59.9%), and abnormal in 55 (40.1%). The incidence of abnormal EEG was significantly high in the patients associated with mental retardation, and it increased in proportion to the severity of mental retardation. The most frequent abnormal EEG finding was slowing of the basic activity (35/137; 24.8%). The incidence of slowing was significantly higher in the patients with a sensorineural hearing impairment (26/74; 35.1%) than in those with dysmelia (9/62; 14.5%). Slowing appeared frequently in the patients with various cranial nerve symptoms (30/84; 35.7%). The incidence of slowing was found significantly high in the patients with borderline or subnormal intelligence (8/16; 50.0%), and it correlated with the severity of mental retardation. Many patients (48/84; 57.1%) showed unilateral or asymmetrical neurological symptoms. However, asymmetry or focal abnormality in EEG was shown in only 8 patients. Positive spikes appeared frequently in the patients with gonadal dysplasia. Other somatic symptoms, past medical history and family history were not related to the incidence of abnormal EEGs. Eight patients had had epileptic seizures prior to this examination. Another 2 patients had nocturnal enuresis and showed epileptic EEG abnormalities in this examination. The incidence of epilepsy was significantly higher in the patients we examined than among the general population. It is concluded that ingestion of thalidomide during pregnancy affected not only the morphological development of the limbs of the fetus, but the functions of its central nervous system, causing hearing impairment, other cranial nerve symptoms, mental retardation or epilepsy.

Ethical conflicts between mother and fetus in obstetrics

Conflicts between the interests of mother and fetus can create difficult ethical problems for obstetricians. Several types of problems are discussed, with the aim of identifying major viewpoints and arguments supporting each view. Approaches are defended that involve balancing maternal and fetal interests in individual cases, and factors that might be considered in such balancing are identified.

Does an expanding fetal abdominal mass produce pulmonary hypoplasia?

Fetal pulmonary hypoplasia has been related to multiple factors. In an effort to define which fetuses may benefit from prenatal intervention to prevent or reverse pulmonary hypoplasia, we studied the relative contribution of an enlarging abdominal mass in the fetus. We produced abdominal masses in fetal rabbits at 24 days gestation by two methods. In one group, a small cylindrical chip of Takasen, (a synthetic polymer that expands to 50 times its size in 1 week; Grobeast, Pop Art Co, Cleveland, OH) was inserted into the peritoneal cavity of the fetal rabbit; in another group, the bladder neck was obstructed with a surgical clip. Amniotic fluid volume was restored at the surgical procedure. Sham-operated littermates served as controls. At cesarean delivery on day 30, fetal lung, liver, and body weights were measured, and the abdominal masses were quantitated by volume displacement of the removed mass or bladder. In both groups large abdominal masses of comparable size were produced. Newborns with the synthetic abdominal mass did not have significant pulmonary hypoplasia, but often had a prune belly deformity of the abdominal wall, whereas newborns with bladder obstruction had significant pulmonary hypoplasia. Liver weight was not significantly affected. We conclude that a fetal abdominal mass does not independently produce pulmonary hypoplasia, possibly because the "mass effect" is relieved by distension of the abdominal wall rather than elevation of the diaphragm; the pulmonary hypoplasia that occurs in bladder outlet obstruction is probably due to the associated oligohydramnios rather than the mass effect of the dilated urinary tract; and prenatal decompression of an abdominal mass or dilated urinary tract is not justified to prevent pulmonary hypoplasia in the absence of oligohydramnios.

[Acute hydramnios in the 2d half of pregnancy]

95 patients were prospectively examined from 1982-1986 in a diagnostic programme. These patients showed a clinically and ultrasonically established acute hydramnios during the second half of their pregnancy period. Possible important causes of an acute hydramnios can be confirmed or excluded via on-target sonography; at the same time, a diabetic condition must be excluded and the amniotic fluid must be examined to exclude acute viral or specific bacterial infections. In 8 cases (8%) we found that the mother had diabetes mellitus requiring insulin, the hydramnios being the main pointer towards the metabolic disturbance. Gestation diabetes was confirmed in 23 patients (25%) on the basis of the polyhydramnios. Chromosomal anomalies were seen in 12 eucyeses (13%) and in 2 polycyeses. In 8 pregnancies (8%) we found a pattern of non-immunological hydrops fetalis with pleural effusions and ascites. In three patients (3%) there was an immunological hydrops fetalis with polyserositis within an Rh incompatibility pattern. Severe foetal malformations associated with a normal karyotype were sonographically found in 12 pregnancies--encyeses and twins--(12%). Cardiac disturbances (tachyarrhythmia) resulted in polyhydramnios in 8 cases of eucyesis (8%). Finally, 10 cases only remained unclarified (11%). 14 cases (15%) had twin pregnancy. In this connection we observed on the average an earlier onset of acute hydramnios (27 weeks) compared with the eucyeses (on the average during the 30th week). Timely and adequate treatment may become possible if we know the aetiology of the acute hydramnios, especially in cases of diabetes mellitus and gestation diabetes, as well as in certain foetal malfunctions, such as e.g. pleural effusions and generalised hydrops fetalis and disturbances of cardiac rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)

Does fetal gut obstruction cause hydramnios and growth retardation?

In order to study the effects of impaired fetal intestinal absorption of amniotic fluid, two series of neonates (551 from Liverpool and 172 from Rome) with different types of congenital gut obstruction were divided into two groups and compared. Group A consisted of patients with complete obstruction at or above the proximal jejunum (within 15 cm of the ligament of Treitz). Patients of group B had either incomplete obstruction at group A level or either incomplete or complete obstruction at a lower level. Maternal hydramnios and fetal growth retardation rates were found to be significantly higher in group A than in group B. Maternal hydramnios was associated with an increased prematurity rate (P less than .001). Fetal growth retardation was not related to the presence of additional anomalies. In group A growth retardation was more frequent in babies born after 37 weeks of gestation (P less than .05). No differences were found between the Liverpool and Rome series of patients. These findings suggest that fetal gut function not only contributes to the control of amniotic fluid volume but also, in the final stages of pregnancy, to normal fetal growth. Maternal hydramnios may be the cause of premature delivery of fetuses with upper gut obstructions.

Intellectual outcome in children with fetal hypothyroidism

Eighty children with congenital hypothyroidism detected by newborn screening were grouped for presence of fetal hypothyroidism using skeletal maturity at the time of diagnosis as the index. Forty-five children with bone age less than 36 weeks were assigned to the delayed group; 35 with bone age 37 weeks to term were assigned to the nondelayed group. Although most children with athyrosis were found in the delayed group, the groups did not differ in birth weight, hormone levels, or family background. Assessments of intellectual and behavioral characteristics at 1, 2, 3, 4, and 5 years of age revealed that, although children in the delayed group performed within the normal range, their scores were significantly lower than those of the nondelayed group from age 2 years on. Perceptual-motor, visuospatial, and language areas were most affected. There were no differences in behavior or temperamental characteristics.

Etiologic and preventive aspects of epilepsy in the child--bridging the gap between laboratory and clinic

Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.

Fetal dystocia

Fetal dystocia is the result of an unfortunate relationship between fetal anatomy and maternal pelvic capacity. Most commonly, arrest of labor progress occurs at a point at which the problem is solved without significant risk to maternal-fetal welfare by abdominal delivery. This article has, in part, focused upon some rare exceptions and on how to anticipate and deal with them as well as possible.

Association of adverse perinatal events with an empty sella turcica in children with growth hormone deficiency

High-resolution computed tomography (HR-CT) of the hypothalamo-pituitary region was performed in 26 consecutive children presenting with growth hormone deficiency (GHD) at one clinic. 58% had an empty sella turcica (ES) and 42% a full sella turcica (FS). There was no difference between the ES and FS groups for mean (+/- 95% confidence limits) presentation age (ES 6.7 (+/- 1.8) years, FS 5.6 (+/- 2.2) years), height standard deviation score (SDS) (ES -3.9 (+/- 0.8), FS -3.3 (+/- 0.5] nor head circumference SDS (ES -1.9 (+/- 1.1), FS -0.7 (+/- 1.1]. There were significant associations between the ES group and a history of adverse perinatal events (p less than 0.001) and multiple pituitary deficiency (p = 0.014). Growth hormone response to an acute growth hormone releasing factor test showed no association with HR-CT diagnosis. Sella turcica volumes were calculated from the HR-CT scans. All sella volumes were small; mean SDS for height was -2.6 (+/- 0.2). There was no difference in sella volume SDS between the ES and FS groups (ES -2.9 (+/- 0.3), FS -2.5 (+/- 0.4]. Adverse perinatal events may cause an ES and GHD by compromising the blood supply to the pituitary gland or infundibulum.

Ureteropelvic junction obstruction in the fetus

Ureteropelvic junction (UPJ) obstruction is being detected with increasing frequency before birth. To clarify the natural history of fetal UPJ obstruction, we reviewed our experience managing 28 fetuses; there were 16 bilateral cases for a total of 44 renal units. None required decompression before birth. We found that fetal bilateral UPJ obstruction is associated with significant morbidity and mortality; resolution of fetal hydronephrosis secondary to UPJ obstruction is rare; antenatal diagnosis of UPJ obstruction improves clinical management by allowing early detection and appropriate treatment of otherwise clinically undetectable disease; oligohydramnios in the mature fetus with bilateral UPJ obstruction is an indication for early delivery and immediate repair; and prenatally diagnosed UPJ obstructions should be repaired as early as possible after birth.

Fetal ventricular pacing for hydrops secondary to complete atrioventricular block

The advent of ultrasound recording has expanded the capabilities for treatment of the fetus in utero. The diagnosis of specific disease processes has allowed for prenatal intervention by new techniques designed to improve fetal survival. The application of ventricular pacing in a hydropic fetus with complete atrioventricular (AV) block is reported. Complete AV block resulted from maternal collagen vascular disease. The application of ventricular pacing was to allow for further in utero development and for reversal of hydrops fetalis after improvement in cardiac output. Despite fetal death 4 hours after placement of the ventricular pacing lead, this procedure when applied earlier in the development of hydrops may allow for fetal survival. Ventricular pacing was accomplished without apparent trauma to mother or fetus and no evidence of fetal injury was seen at necropsy. Therefore, in the fetus who would otherwise die in utero before the point of viability ex utero, fetal ventricular pacing may be a rational alternative to current observation.

Antenatal perforation of Meckel's diverticulum presenting as an inflamed hydrocele

A newborn baby presented with an inflamed left hydrocele, which contained intestinal material. This was due to a Meckel's diverticulum that had perforated or separated from the umbilicus sometime before birth causing sterile meconium peritonitis.

Genetic prenatal aqueductal stenosis with hydrocephalus in rat

A recessive mutation which arose in Wistar albino rats was variably expressed in the homozygous state as prenatal stenosis of the aqueduct with resultant hydrocephalus. The condition was often compatible with survival to adulthood and with successful reproduction. Mildly sparse hair was the constant gene marker. Eye defects and sometimes foot deformities occurred. The first observable ultrastructural alteration was a disruption of the integrity of the neuroepithelial basal lamina in the cephalic neural tube of affected embryos as early as the 11th fetal day (16-24 somite pairs). The hydrocephalic syndrome closely resembled that produced by giving folic acid analogs to, or producing vitamin B12 deficiency in, pregnant rats in the period including the 11th day. Neither vitamin B12 nor folate, nor certain metabolites closely related to their metabolism, prevented the gene's expression. Homozygote mutants mated with homozygote mutants produced 70% hydrocephalic (dome-shaped heads) offspring, but if the mother was heterozygote, there was a "protective" effect and the number of hydrocephalic young was disproportionately smaller.