Prenatal management of diaphragmatic rhabdomyosarcoma presenting with fetal hydrops.

Fetal malignant tumors are rare. We present a case of intrauterine diagnosis of a diaphragmatic tumor presenting with fetal hydrops at 32 weeks' gestation. The sonographic findings were bilateral pleural effusion, ascites and skin edema. A large right-sided diaphragmatic tumor was identified. Owing to the findings on ultrasound and magnetic resonance imaging a solid malignant tumor was suspected. The pleural effusions were drained and malignant cells identified. Because of rapid tumor progression Cesarean section was performed and a hydropic female newborn was delivered at 34 + 0 weeks' gestation. There was no sign of metastatic disease. Postnatally tumor biopsy revealed an alveolar rhabdomyosarcoma. Therapy included chemotherapy and secondary surgical intervention. After a good primary response with complete remission after 6 months, the rhabdomyosarcoma relapsed at 12 months with cerebral metastasis. The prognosis was poor.

[Hereditary holoprosencephaly--late diagnosis in spite of recurrence]. / Familiäre Holoprosencephalie--Späte Diagnose trotz Wiederholungsfall.

Holoprosencephaly (HPE) is a serious malformation of the central nervous system which occurs between the 18th and 28th day of gestation. HPE can appear in different manifestations within one family. The diagnosis of HPE can be performed in an early sonographic scan between the 12th and the 14th week of gestation, according to the guidelines for the examination of the foetal nervous system. The history of a pregnant woman with a previous birth of a foetus with cerebral malformation and having a partner with minor signs for HPE justifies an intensified sonographic examination and molecular analysis. An amniocentesis was done just for the basic analysis, not for further genetic testing. However, it is very important to have information about a recurrency risk for every subsequent pregnancy.

[Doppler studies of gestational diabetes in the third trimester]. / Plazentare Widerstandsmessung bei Gestationsdiabetes im III. Trimenon.

PURPOSE: Gestational diabetes (GDM) is related to increased maternal and neonatal morbidity. Maternal hyperglycemia causes fetal hyperglycemia and consequently fetal hyperinsulinism. The impaired glucose metabolism will lead to prenatal and postnatal complications. The main issue of this study is the influence of GDM in evaluating Doppler flow measurements in the umbilical artery (UA). MATERIALS AND METHODS: Pregnancies from gestational age > 34 + 0 were included in this case control study. The study period was 18 months. The last Doppler measurement in pregnancies with GDM (diet-controlled and insulin-dependent) was compared to the healthy control group. Our collected data included the last prenatal Doppler flow recordings (resistance index (RI) in the umbilical artery (UA)). RESULTS: In women with diet-controlled GDM, a significant decrease in the RI (p = 0.002) in the UA has been observed. Insulin-treated diabetic and healthy control pregnancies showed no difference in the RI. CONCLUSION: Doppler flow examinations with RI measurements in patients with GDM differ significantly with respect to healthy controls. In insulin-treated women the RI indices are not different from the control group, while in the diet-controlled group a significant decrease was noted and additionally might show a possible maternal metabolic dysfunction.

Serum intercellular adhesion molecule-1 levels and histologic chorioamnionitis.

OBJECTIVE: To compare the diagnostic value of intercellular adhesion molecule (ICAM)-1 with that of C-reactive protein (CRP) and white blood cell (WBC) count for detecting histologic chorioamnionitis in serum of women with preterm labor. METHODS: Maternal blood was collected from 97 consecutive women admitted with preterm delivery before 37 weeks' gestation, and 50 women after normal term delivery (38-41 weeks' gestation). Intercellular adhesion molecule-1, CRP, and WBC count were measured before delivery. RESULTS: Histologic chorioamnionitis was diagnosed in 48 of 97 women (48%) who delivered preterm and in none who delivered at term. Maternal serum levels of ICAM-1 (median 169 ng/mL, range 94-510 ng/mL, P <.001), CRP (median 2.8 ng/mL, range 0.5-13.2 mg/dL, P <.001) and WBC count (12.6 x 10(3)/microL, range 6.4-30.6 x 10(3)/microL, P <.02) were statistically significantly higher in women with histologic chorioamnionitis than those without it (ICAM-1 median 70 ng/mL, range 23-107 ng/mL; CRP median 0.7 mg/dL, range 0.5-6.7 mg/dL; WBC count median 10.9 x 10(3)/microL, range 4.3-22.2 x 10(3)/microL). The sensitivity and specificity of maternal serum ICAM-1 (cutoff 106 ng/mL), CRP (cutoff 1.1 mg/dL), and WBC count (cutoff 11.8 x 10(3)/microL) for diagnosing histologic chorioamnionitis were 98.0% and 93.8%, 75.5% and 71.4%, and 63.3% and 61.2%, respectively. CONCLUSION: In women with preterm labor, ICAM-1 is a more reliable indicator of histologic chorioamnionitis than CRP or WBC count.

[Risk management in gynecology and obstetrics. Forensic questions in connection with operative gynecology and obstetrics]. / Risikomanagement in Gynäkologie und Geburtshilfe. Forensische Fragen in Zusammenhang mit operative Gynäkologie und Geburtshilfe.

Due to the avalanche-like increase of malpractice suits, it has become mandatory for doctors in hospitals and private practices to acquire a profound knowledge relating to modern management and to become familiar with the legal aspects of medical procedures. The article at hand reviews the standards of medical documentation and risk information within the scope of operative gynaecology and obstetrics and provides guidelines for a structured behaviour once an incident has occurred. The typical sources of complications are presented and strategies to avoid them are outlined: professional clinical management including the definition of competences for all therapists working together in a hospital. By observing these principles a professional medical level even in administrative respect is provided and thus enables an atmosphere of mutual confidence among doctors and patients.

Retrochorionic hematoma in congenital afibrinogenemia: resolution with fibrinogen concentrate infusions.

Without treatment, pregnancies in patients with congenital afibrinogenemia terminate in miscarriage at 5-6 weeks of gestation. Animal model studies have suggested that implantation site bleeding contributes to miscarriage in afibrinogenemia; however, retrochorionic hematoma in human congenital afibrinogenemia has not been previously observed. A patient with congenital afibrinogenemia receiving fibrinogen prophylaxis developed a retrochorionic hematoma in the first trimester. With continuous intensified fibrinogen concentrate replacement the hematoma resolved over 6 weeks, and the patient delivered a healthy infant. Median fibrinogen levels in the first trimester were 48 mg/dL and in second and third trimester 44 mg/dL. Median fibrinogen levels under 60 mg/dL may be adequate to maintain pregnancy in patients with congenital afibrinogenemia, although it is possible that higher levels might reduce the risk of hemorrhagic events.

[Intercellular adhesion molecular 1, a diagnostic serum marker in chorioamnionitis, pre-eclampsia and HELLP syndrome]. / Intercellular-Adhesion-Molecule-1, ein diagnostischer Serummarker bei Chorioamnionitis, Präeklampsie und HELLP-Syndrom.

INTRODUCTION: Chorioamnionitis and pregnancy-induced hypertension both are extremely feared complications of human pregnancy. Activation or disturbance of normal endothelial cell function may be involved in the pathogenesis of both kinds of disease. The aim of our study was to compare the diagnostic value of soluble intercellular-adhesion-molecule-1 (ICAM-1) with that of C-reactive protein (CRP) and white blood cell count for the detection of chorioamnionitis in patients with preterm labor. In addition, we examined if concentrations of ICAM-1 were also increased in case of preeclampsia or HELLP-syndrome. MATERIALS AND METHODS: ICAM-1, CRP and leucocyte count were estimated in 50 cases of normal term delivery, 97 cases of uncontrollable preterm labor, 16 cases of preeclampsia and 9 cases of HELLP-syndrome before delivery. RESULTS: From 97 women delivering preterm, chorioamnionitis was histologically confirmed for 48 women. Maternal serum levels of ICAM-1 (p < 0.001), CRP (p < 0.001) and leucocyte count (p < 0.02) were significantly higher in the group of preterm delivering patients (< 37 weeks gestation) with histologically confirmed chorioamnionitis in comparison to preterm delivering patients in the absence of chorioamnionitis. In the group of patients delivering preterm (< 37 weeks gestation) because of preeclampsia or HELLP-syndrome, ICAM-1 (p < 0.001), as well as CRP (p < 0.006) concentrations were also significantly increased in comparison to patients delivering preterm in the absence of chorioamnionitis. CONCLUSIONS: Elevated levels of ICAM-1 in the serum of pregnant women may be considered as an important risk factor for the development of complications in pregnancy associated with inflammatory induced changes of maternal endothelial cell functions.

3D real-time imaging of the fetal heart.

OBJECTIVE: The aim of this study was to evaluate the clinical utility of a novel 3D scanner system for real-time 3D fetal echocardiography. METHOD: In a prospective study, 13 single, healthy 20- to 24-week-old fetuses were examined with conventional 2D and real-time 3D echocardiography. The visualization rates and imaging quality of standard cardiac views were compared between both methods. RESULTS: The visualization rates of standard cardiac planes were found to be slightly increased and more easily obtainable in 3D imaging whereas the image quality showed better results with conventional 2D echocardiography. CONCLUSION: Our data show that real-time 3D fetal echocardiography can be considered a useful tool in the evaluation of the fetal heart with the necessity for further refinement of the resolution quality