Ureterocele: antenatal diagnosis and management.

Ureteroceles are cystic dilations of the intravesical submucosal ureter. Most cases are associated with complete ureteral and renal duplication, and association with ureterohydronephrosis is frequent. The authors describe the 4 cases of fetal ureterocele diagnosed from March 2008 to March 2012. Mean gestational age at diagnosis was 23 weeks (16-34 weeks). One of 4 cases progressed to severe hydronephrosis with megacystis and was referred to a Fetal Medicine Center for fetoscopy and laser ureterocelotomy. The remaining 3 cases did not need fetal therapy. Mean gestational age at delivery was 37 weeks. One case abandoned follow-up; 2 children were submitted to cystoscopic ureterocele incision and the child submitted to fetal therapy needed heminephrectomy due to recurrent urinary tract infections. In those 3 cases renal function was preserved. When a fetal ureterocele is diagnosed, close sonographic surveillance should be offered to monitor the possible urinary tract obstruction and assess the need for prenatal intervention. Fetal diagnosis is important to program the timing of delivery and postnatal care.

Limb constriction secondary to pseudoamniotic band syndrome after selective fetoscopic laser surgery: report of a case with a favorable outcome.

Pseudoamniotic band syndrome (PABS) is an iatrogenic complication that causes entanglement of fetal parts in a constrictive sheet of detached or ruptured amniotic membrane after an invasive procedure, namely amniocentesis, amnioreduction or septostomy in twins. The incidence and risk factors for PABS after fetoscopy-guided laser have not been documented [Winer et al.: Am J Obstet Gynecol 2008;198:393.e1-393.e5]. We report a case of monochorionic biamniotic twin pregnancy submitted to selective fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome at 16 weeks of gestation. The procedure was complicated by the death of one of the fetuses at 24 weeks of gestation. Moreover, the surviving twin was diagnosed postnatally with pseudoamniotic band syndrome, presenting with affected limbs. The newborn was submitted to surgical correction of these lesions with a successful outcome and was discharged on day 15.

Ultrasonographic diagnosis of fetal ovarian cysts: five cases in five years.

OBJECTIVE: To evaluate the outcome of ultrasonographically diagnosed fetal ovarian cysts within a 5-year period. METHODS: This was a retrospective evaluation of the prenatal and postnatal medical records of the five cases of fetal ovarian cyst diagnosed at our institution from January 2002 to December 2006. RESULTS: The mean gestational age at diagnosis was 31.6 weeks. One of the patients had type I diabetes and another had chronic hypertension and preeclampsia. The mean cyst diameter at diagnosis was 38.3 mm (range 29-60 mm). When diagnosed, four of the cysts were simple and the other was septated. During pregnancy, the septated cyst and two of the simple cysts became hemorrhagic. Postnatally the septated cyst and two of the simple cysts underwent spontaneous remission; the other two cases, corresponding to hemorrhagic cysts, were surgically removed after birth. CONCLUSIONS: The best clinical approach to a fetal ovarian cyst is controversial. In this small series, three of the five cysts regressed spontaneously, including a hemorrhagic one. Once a fetal ovarian cyst is diagnosed, ultrasonographic monitoring should be provided in order to identify complications and define the best therapeutic approach.

Prenatal ultrasonographic diagnosis of abdominal cystic lymphangioma: a case report.

Abdominal lymphangioma is a rare tumor of the lymphatic vessels. A case of an abdominal cystic lymphangioma identified at 22 weeks of gestation is reported. Ultrasonographic monitoring showed a progressive increase of mass size during the gestation. Pregnancy was terminated at 38 weeks and the newborn was submitted to a laparotomy with resection of all cystic structures. At the present time the infant is three years old and is doing well.