RESUMO
Isolated fetal ascites was diagnosed at 20 weeks in a primiparous woman with no significant medical history. Progressive fetal ascites worsened after 28 weeks and resulted in fetal hydroceles. Delivery was by caesarian section at 33 weeks, preceded by reduction of fetal ascites under ultrasound guidance. Following delivery, the baby required further reduction of abdominal fluid and endotracheal intubation to provide respiratory support. An extensive set of investigations, including metabolic and genetic screening, was performed; all results were negative. On day two of life, the baby developed bilious aspirates and an abdominal radiograph suggested intestinal obstruction. At laparotomy, an 'apple peel' jejunal atresia, abnormal mesentery with precarious blood supply and a proximal perforation were identified and the perforation 'sewn over'. The postoperative course was unremarkable, with Monogen feeds tolerated three weeks later. The baby continued to thrive at one year, tolerating increasing amount of long-chain fatty acids in diet.
Assuntos
Ascite/cirurgia , Fetoscopia/métodos , Atresia Intestinal/cirurgia , Obstrução Intestinal/cirurgia , Ultrassonografia Pré-Natal/métodos , Ascite/complicações , Ascite/embriologia , Feminino , Humanos , Recém-Nascido , Atresia Intestinal/complicações , Atresia Intestinal/embriologia , Obstrução Intestinal/etiologia , Jejuno/patologia , Jejuno/cirurgia , Laparotomia/métodos , Mesentério/anormalidades , Mesentério/irrigação sanguínea , GravidezRESUMO
BACKGROUND: Prenatal ultrasound (US) diagnosis of fetal intra-abdominal calcification (iAC) is frequently caused by an in utero perforation causing meconium peritonitis. Our ability to predict which fetuses will require postnatal surgery is limited. The aim of our study is to correlate iAC and associated US findings with postnatal outcome. METHODS: A single centre retrospective review of all cases of fetal iAC diagnosed between 2004 and 2010 was performed. Maternal demographics, fetal US findings, and outcomes (need for surgery and mortality) were collected. Descriptive and comparative statistical analyses were performed. RESULTS: Twenty-three cases of iAC were identified. There were no cases of fetal demise or postnatal deaths. Three liveborns (13%) required abdominal surgery at a median of 2 days (0-3) for intestinal atresia. US findings of iAC and dilated bowel with (p=0.008) or without (p=0.005) polyhydramnios predicted a need for postnatal surgery as did the combination of iAC, polyhydramnios, and ascites (p=0.008). Conversely, iAC alone or associated with oligohydramnios, polyhydramnios, ascites, or growth restriction did not predict need for postnatal surgery. CONCLUSION: The majority of fetuses with iAC on prenatal US do not require surgery. Associated US findings (bowel dilation) can be used to select fetuses for delivery in neonatal surgical centres.
Assuntos
Abdome/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Salas de Parto/estatística & dados numéricos , Parto Obstétrico , Doenças Fetais/diagnóstico por imagem , Salas Cirúrgicas/estatística & dados numéricos , Seleção de Pacientes , Ultrassonografia Pré-Natal , Abdome/embriologia , Abdome/cirurgia , Ascite/embriologia , Ascite/epidemiologia , Calcinose/embriologia , Calcinose/etiologia , Calcinose/cirurgia , Dilatação Patológica/embriologia , Dilatação Patológica/epidemiologia , Diagnóstico Precoce , Feminino , Doenças Fetais/etiologia , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Atresia Intestinal/diagnóstico por imagem , Atresia Intestinal/embriologia , Atresia Intestinal/cirurgia , Perfuração Intestinal/complicações , Perfuração Intestinal/embriologia , Masculino , Mecônio , Oligo-Hidrâmnio/epidemiologia , Peritonite/complicações , Peritonite/embriologia , Poli-Hidrâmnios/epidemiologia , Gravidez , Estudos Retrospectivos , Resultado do TratamentoRESUMO
In utero diagnosis of incarcerated congenital diaphragmatic hernia has never been reported. In our case, congenital diaphragmatic hernia presented at 34 weeks of gestation with dilated bowel loops, pleural effusion, and ascites on fetal ultrasound. Preterm delivery and emergency exploration revealed a tight posterolateral diaphragmatic defect with extensive bowel infarction.
Assuntos
Hérnia Diafragmática/embriologia , Infarto/embriologia , Intestinos/irrigação sanguínea , Ultrassonografia Pré-Natal , Anastomose Cirúrgica , Ascite/diagnóstico por imagem , Ascite/embriologia , Ascite/etiologia , Cesárea , Emergências , Idade Gestacional , Hérnia Diafragmática/diagnóstico por imagem , Hérnia Diafragmática/cirurgia , Hérnias Diafragmáticas Congênitas , Humanos , Hidropisia Fetal/etiologia , Recém-Nascido , Infarto/diagnóstico por imagem , Infarto/etiologia , Intestinos/cirurgia , Laparotomia , Masculino , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/embriologia , Derrame Pleural/etiologia , ReoperaçãoRESUMO
PURPOSE: The purpose of the present study was to evaluate the prognostic factors and review the outcome of primary isolated fetal ascites. METHODS: A retrospective cohort study was conducted for fetuses with primary isolated ascites with a prenatal diagnosis between 1994 and 2009. The patients were divided into the favorable group (Group I) whose ascites were resolved by medical treatment alone and an unfavorable group (Group II) who required surgical intervention after birth due to refractory ascites. RESULTS: There were seven patients in Group I and five patients in Group II. Six of seven patients who developed ascites after 30 weeks' gestation were categorized in Group I, and four of five infants who developed ascites before 30 weeks' gestation were categorized in Group II. There was a negative correlation between the gestational age at diagnosis and the severity of the fetal abdominal distention. In Group II, the ascites resolved in two cases and was reaccommodated in another two cases after surgery. An infant with trisomy 21 received continuous drainage and eventually died of infection. CONCLUSIONS: The prognosis of primary isolated fetal ascites can be predicted based on the gestational age at diagnosis and the severity of the fetal abdominal distention.
Assuntos
Ascite/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Ultrassonografia Pré-Natal , Ascite/embriologia , Diagnóstico Diferencial , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Gravidez , Prognóstico , Estudos RetrospectivosRESUMO
This report describes a case of fetal mediastinal teratoma complicated by hydrops fetalis managed successfully by aspiration of the tumor cyst fluid. Fetal mediastinal teratomas are rare tumors that cause hydrops fetalis or fetal demise in the prenatal period and respiratory distress in the neonatal period. The patient presented with a large cystic mass in the thoracic cavity complicated by hydrops fetalis. The hydrops resolved after fetal aspiration of the tumor cyst fluid. The infant was born without respiratory distress, and tumor resection was performed at the age of 30 days. The postoperative course was uneventful, and the patient was in good health 6 months postoperatively.
Assuntos
Terapias Fetais , Hidropisia Fetal/etiologia , Neoplasias do Mediastino/embriologia , Neoplasias do Mediastino/cirurgia , Sucção , Teratoma/embriologia , Teratoma/cirurgia , Adulto , Amniocentese , Ascite/embriologia , Edema/embriologia , Feminino , Humanos , Hidropisia Fetal/diagnóstico , Hidropisia Fetal/diagnóstico por imagem , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Poli-Hidrâmnios/etiologia , Gravidez , Teratoma/diagnóstico , Teratoma/diagnóstico por imagem , Teratoma/patologia , Ultrassonografia Pré-NatalRESUMO
Meconium peritonitis (MP) is defined as a sterile inflammatory reaction in the fetal abdomen that is seen in cases of intrauterine bowel perforation. Recently, there have been increasing numbers of fetuses with MP prenatally diagnosed by ultrasonography. Massive fetal ascites in MP may cause hydrops and hypoplastic lungs. However, antepartum management of MP has not yet been established. We encountered a fetus with MP and massive ascites. Repeated paracentesis between 29 weeks and 4 days and 31 weeks and 6 days of gestation prevented the progression to fetal hydrops and hypoplastic lungs, which may occur due to massive meconium ascites with an increased preload index. Amniocentesis was also performed in patients with polyhydramnios for treatment of preterm labor. These observations suggest that aggressive therapy can prolong the gestation period and improve MP treatment outcomes.
Assuntos
Ascite/cirurgia , Doenças Fetais/cirurgia , Doenças do Íleo/complicações , Perfuração Intestinal/complicações , Mecônio , Paracentese , Peritonite/cirurgia , Adulto , Ascite/diagnóstico por imagem , Ascite/embriologia , Feminino , Doenças Fetais/diagnóstico por imagem , Idade Gestacional , Humanos , Doenças do Íleo/embriologia , Doenças do Íleo/cirurgia , Lactente , Perfuração Intestinal/embriologia , Perfuração Intestinal/cirurgia , Trabalho de Parto Induzido , Nascido Vivo , Masculino , Peritonite/diagnóstico por imagem , Peritonite/embriologia , Gravidez , Reoperação , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler de Pulso , Ultrassonografia Pré-NatalRESUMO
Megacystis is a typical prenatal sonographic finding in cases of lower urinary tract obstruction. Urinary bladder perforation represents a rare complication in this condition. We report on a boy with in utero bladder perforation and urinary ascites secondary to posterior urethral valves. The pre- and postnatal therapy is described and the current literature is reviewed.
Assuntos
Ascite/etiologia , Doenças Fetais , Uretra/anormalidades , Doenças Uretrais/complicações , Doenças da Bexiga Urinária/etiologia , Bexiga Urinária/embriologia , Ascite/diagnóstico por imagem , Ascite/embriologia , Cesárea , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Recém-Nascido , Gravidez , Ruptura Espontânea , Ultrassonografia Pré-Natal , Uretra/diagnóstico por imagem , Uretra/embriologia , Doenças Uretrais/diagnóstico por imagem , Doenças Uretrais/embriologia , Bexiga Urinária/diagnóstico por imagem , Doenças da Bexiga Urinária/diagnóstico por imagem , Doenças da Bexiga Urinária/embriologiaRESUMO
Prenatal molecular genetic diagnosis for Noonan syndrome I is reported. Noonan syndrome was suspected because of large cystic hygroma colli, massive pleural effusion and ascites at 23 weeks of gestation and normal karyotype (46,XX). DNA was prepared from amnion cells and screened for mutations in the PTPN11 gene. In exon 8, a missense mutation (S285F) was found. Delivery was induced at 33 weeks of gestation because of silent cardiotocography (CTG). Despite immediate drainage of the hydrothorax, mechanical ventilation was insufficient and the child died 9 h after birth due to severe pulmonary hypoplasia. Pleural punctate was enriched for small lymphocytes and thus was characterized as chylus. Prenatal ultrasound findings in Noonan syndrome usually are unspecific and rarely lead to a diagnosis. However, with the combination of cystic hygroma, pleural effusion, ascites and normal karyotype Noonan syndrome should be considered and DNA testing for PTPN11 mutations may be appropriate. Malformations of lymphatic vessels and/or chylothorax in Noonan syndrome seem to be more frequent than usually anticipated.
Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Síndrome de Noonan/diagnóstico , Diagnóstico Pré-Natal , Anormalidades Múltiplas/embriologia , Adulto , Ascite/diagnóstico por imagem , Ascite/embriologia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Recém-Nascido , Peptídeos e Proteínas de Sinalização Intracelular/genética , Cariotipagem , Linfangioma Cístico/diagnóstico por imagem , Linfangioma Cístico/embriologia , Mutação , Síndrome de Noonan/diagnóstico por imagem , Síndrome de Noonan/embriologia , Síndrome de Noonan/patologia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/embriologia , Gravidez , Segundo Trimestre da Gravidez , Proteína Tirosina Fosfatase não Receptora Tipo 11 , Proteínas Tirosina Fosfatases/genética , UltrassonografiaRESUMO
Apresentamos um caso de regressao espontânea de hidropisia fetal provavelmente causada por infecçao materno-fetal pelo paravirus B 19. Além de hidropisia, observamos anemia e hipocontratilidade cardíaca no feto. O diagnóstico foi estabelecido pela soma dos achados ultra-sonográficos, detecçao do vírus no soro materno, hemograma fetal e dosagem de enzimas hepáticas fetais.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Infecções por Parvoviridae/congênito , Infecções por Parvoviridae/diagnóstico , Parvovirus , Complicações Infecciosas na Gravidez , Ascite/diagnóstico , Ascite/embriologia , Cordocentese , Transmissão Vertical de Doenças Infecciosas , Ultrassonografia Pré-NatalRESUMO
Few reports concerning intrauterine shunting are available. We investigated the impact of this method. In order to evaluate intrauterine shunting and the complication rate for different indications, we sent a questionnaire to all German-speaking level 3 centres. In four level 3 centres, 52 intrauterine catheters were inserted in 34 fetuses. The indications were uni- or bilateral hydrothorax in nine cases, cystic adenomatoid malformation of the lung in four cases, infravesical stenosis in 13 cases, and fetal ascites in eight cases. In three cases (6 per cent), difficulties occurred when the drain was inserted. In 15 cases (29 per cent), the function of the drain was reduced by dislocation or occlusion. The mortality rate caused by shunting was as high as eight per cent (four cases). The application of an intrauterine shunt currently represents a rarely performed ultrasound-guided therapeutic intervention in the fetus. In all cases, the indication for shunting is to avoid compression of normal tissue by cystic structures. A high complication rate restricts the application of drainage to selected cases.