Maternal ventilation and sedation for H1N1 influenza resulting in fetal bladder rupture and urinary ascites.

Urinary ascites in a newborn infant is unusual and most commonly results from bladder perforation following umbilical arterial catheterisation or obstructive uropathy. The following report describes a case of fetal bladder rupture with urinary ascites in a mother ventilated and sedated with narcotics and benzodiazepines for H1N1 influenza. This was associated with a unique biochemical profile of hyponatraemia and elevated serum urea and creatinine characteristic of urinary autodialysis in the neonate.

Pregnant women's knowledge of obesity and ideal weight gain in pregnancy, and health behaviours of pregnant women and their partners.

We conducted a survey among a convenience sample of 149 women and their partners (n = 136) attending antenatal services in the Canberra Hospital in 2010. Over one-third (39%) of women and 63.6% of their partners were overweight/obese, and 69.2% of women had not received advice from their caregiver on their weight. Pregnant women and their partners' health behaviours including smoking, and fruit and vegetable intake were strongly correlated (P ≤ 0.01). Pregnant women require targeted advice on their weight, ideal weight gain and impact of these on pregnancy.

Guidelines for the performance of the first trimester ultrasound.

The purpose of this document is to guide ultrasound practitioners in providing accurate information on the assessment of gestational age, viability and fetal development in the first trimester. In the presence of twins and higher order multiple pregnancies, it is also intended to assess chorionicity and amnionicity which have implications for risk assessment and continuing antenatal care. This guideline has been adopted by the ASUM Council and is applicable to all ultrasound practitioners.

Uterine cavernous haemangioma in pregnancy.

We report on the key sonographic feature of uterine cavernous haemangiomas in pregnancy, a rare condition with only 14 cases reported in the literature including this case. A key feature of our case is post-partum follow-up ultrasound investigation up to 6 months. This condition is associated with morbidity and mortality, correct identification can prevent catastrophic outcomes.

Fetal urinoma: A case report and review of the literature.

Fetal urinomas are a rare but important sonographic finding. Urinomas are peri-renal collections of urine, formed after the rupture of the kidney secondary to an underlying urinary tract obstruction or trauma. Diagnosis antenatally is important for ongoing monitoring and postnatal follow up as their presence may indicate reduced or absent kidney function in the affected kidney.

The importance of placental evaluation following perinatal death.

Although uncommon, abnormalities of the placenta are important to recognise owing to the potential for both maternal and fetal morbidity and mortality. The placenta is often overlooked in the routine evaluation of a normal gestation, receiving attention only when an abnormality is detected. During the formal scan to confirm a fetal death, the information gathering process to elucidate a possible cause of death begins, yet, even in this instance, the placenta is seldom examined. We aim to draw attention to the importance of placental assessment by presenting a case of a stillbirth where the answer to the cause of death lay in the placenta.

Congenital high airways obstruction syndrome - first and second trimester diagnosis.

Congenital High Airways Obstruction Syndrome (CHAOS) is a rare condition associated with high fetal or neonatal mortality. Prenatal diagnosis in the second trimester is made by the typical ultrasound features of large echogenic lungs, a flattened or inverted diaphragm, and fetal ascites or hydrops. We present two cases diagnosed at our institution; one in the second trimester, and a first trimester diagnosis. To the best of our knowledge, first trimester diagnosis of CHAOS has not been previously reported.

A sonographic approach to prenatal classification of congenital spine anomalies.

Objective: To develop a classification system for congenital spine anomalies detected by prenatal ultrasound. Methods: Data were collected from fetuses with spine abnormalities diagnosed in our institution over a five-year period between June 2005 and June 2010. The ultrasound images were analysed to determine which features were associated with different congenital spine anomalies. Findings of the prenatal ultrasound images were correlated with other prenatal imaging, post mortem findings, post mortem imaging, neonatal imaging, karyotype, and other genetic workup. Data from published case reports of prenatal diagnosis of rare congenital spine anomalies were analysed to provide a comprehensive work. Results: During the study period, eighteen cases of spine abnormalities were diagnosed in 7819 women. The mean gestational age at diagnosis was 18.8w ± 2.2 SD. While most cases represented open NTD, a spectrum of vertebral abnormalities were diagnosed prenatally. These included hemivertebrae, block vertebrae, cleft or butterfly vertebrae, sacral agenesis, and a lipomeningocele. The most sensitive features for diagnosis of a spine abnormality included flaring of the vertebral arch ossification centres, abnormal spine curvature, and short spine length. While reported findings at the time of diagnosis were often conservative, retrospective analysis revealed good correlation with radiographic imaging. 3D imaging was found to be a valuable tool in many settings. Conclusions: Analysis of the study findings showed prenatal ultrasound allowed detection of disruption to the normal appearances of the fetal spine. Using the three features of flaring of the vertebral arch ossification centres, abnormal spine curvature, and short spine length, an algorithm was devised to aid with the diagnosis of spine anomalies for those who perform and report prenatal ultrasound.

Pelvic congestion syndrome.

Background: The precise aetiology of pelvic congestion syndrome (PCS) remains poorly understood but is believed to be multifactorial having mechanical, hormonal and psychological components. Materials and methods: Minimally invasive techniques of embolisation or sclerotherapy of the ovarian veins has become the mainstay of treatment for PCS. Studies report a technical success rates from 89-100% and clinical success rates of 58-100%. Conclusions: Embolisation and sclerotherapy can be done as a day surgery procedure concurrently with diagnostic venography and given current evidence provide better long term pain relief than medical therapy.

Ultrasound and saline infused sonography as valuable tool to assess uterine integrity.

Introduction: Ultrasound is under utilised in assessing surgical complications such as uterine perforation resulting from surgical termination of pregnancy. Method: We found one report in literature using the following search words: pregnancy termination, uterus, perforation and ultrasound.1 The risk of perforation is considered low but the true incidence is unknown. The reported incidence is largely based on self-reporting and many perforations are not recognised. Conclusion: A South Australian study reported the perforation risk following a surgical termination as 0.05% in the first trimester and 0.32% in the second trimester (13-20 weeks).

Spontaneous expulsion of large submucosal uterine fibroid without embolisation - a case study.

Background: This case involved a 35-year-old G6P0 with multiple uterine fibroids detected at 12 weeks gestation. Fibroid growth was monitored throughout pregnancy, and intrauterine growth restriction (< 5th centile) was detected at 20 weeks. Fetal demise occurred at 22+ weeks gestation at which time the largest of fibroids measured 150 × 100 × 118 mm and labour was induced. Materials and methods: Serial ultrasounds following delivery showed features of reduced vascularity and separation of the fibroid from the myometrium, consistent with spontaneous degeneration. Our patient re-presented with severe pain and went on to expel the fibroid spontaneously 41 days post induction of labour. Histopathology confirmed fibroid degeneration. Conclusion: This case demonstrates spontaneous fibroid degeneration and expulsion without embolisation. This may have resulted from the hormonal and mechanical effects of induction of labour. This case also demonstrated the effects of large intrauterine fibroids on fetal growth and increased risk of fetal demise, highlighting the importance of closer monitoring of fetal growth in such pregnancies.

Meigs' and Pseudo-Meigs' syndrome.

Diagnosing Meigs' syndrome is challenging in that it can be mistaken for a number of other conditions. Ultrasound can identify ascites and pleural effusions, which is essential in accurate identification.

Spontaneous hemopertitoneum - a matter of life and death.

Spontaneous hemopertitoneum in pregnancy (SHiP) is a rare but potential catastrophic complication with high maternal and fetal mortality. The main cause of morbidity and mortality is delayed diagnosis and treatment. In this paper we will document the findings of an interesting case managed in our unit. We also discuss the etiology, diagnosis and management of this condition with high potential to lead to medico-legal cases.

Prenatal diagnosis of a left ventricular diverticulum.

A congenital left ventricular diverticulum is a rare prenatal finding. The four-chamber view of the heart is a standard part of the 18-20 week morphology scan, and evaluation of the heart with colour Doppler imaging has greatly enhanced the detection of rare and subtle cardiac anomalies.

Persistent left superior vena cava - considerations in fetal, pediatric and adult populations.

Persistent left superior vena cava (LSVC) is the commonest congenital anomaly of the thoracic venous system. It is within the group of anomalous systemic venous return (ASVR) and the group is subdivided in cephalic, involving the superior vena cava (SVC) and caudal, involving the inferior vena cava (IVC) types. It is also important to recognise that there can be a persistent LSVC with or without a normal right superior vena cava (RSVC). In most cases, a persistent LSVC drains into the right atrium via the coronary sinus without any clinical symptoms. In this article we discuss embryology, diagnostic and further management approaches and a review of the literature related to persistent LSVC.

Pregnancy after uterine arteriovenous malformation-case series and literature review.

Purpose: To perform a retrospective audit of cases of uterine arteriovenous malformations (UAVM) at The Canberra Hospital and review of recent literature reporting pregnancies occurring after the diagnosis of UAVM aiming to devise a diagnostic and treatment protocol to optimise pregnancy post UAVM. Methods: A retrospective audit of cases of UAVM at the Canberra Hospital from a prospectively managed patient database was performed. A search of the electronic database PubMed, for articles between 2000-2011 relating to pregnancy post UAVM. Individual case studies were analysed separately to case series. Results: The study included 28 individual studies and five case series (61 women). Average age was 29.5 ± 6.7 (range 18-42). Most women (24, 85.7%, 100% in case series) presented with abnormal vaginal bleeding; 11 (41%) individuals presented post interruption of pregnancy. All women had had a previous pregnancy (mean gravidity 3.1 ± 3.1, range 1-15 for case studies) and only four women (14.2 %) had no history of uterine trauma. Only one woman (3.6 %) did not have any ultrasound and most women underwent colour Doppler ultrasonography (20, 71.4% in case studies; 61, 83.6% in case series). Of the women, 72 (53.6 % of case studies, 78.1 % of case series) were treated with uterine artery embolisation, seven (25%) were treated expectantly. A total of 63 pregnancies occurred post treatment, seven (13.9%) ending in miscarriage. Average time to conceive post diagnosis was 19 months ± 16.3 (range 2-72). A total of 54 healthy infants were born to mothers post AVM diagnosis. Conclusion: UAVM are likely to exist on a continuum with other pregnancy related pathologies, such as sub involution of the placental bed, making a single best diagnostic and treatment plan difficult. However, this study shows that successful uncomplicated pregnancy is achievable for women after the diagnosis of UAVM.

The role of imaging in the investigation of Asherman's syndrome.

Asherman's syndrome has significant reproductive implications for patients. In most case series, the rate of fertility and full term birth directly correlates to extent of disease. However, there does not seem to be a connection between number of prior curettages, nor aetiology of adhesions in predicting outcome. Without a universally accepted classification system, comparison of research data and results for imaging modalities is difficult.

First trimester findings of combined duodenal and oesophageal atresia with a trachea-oesophageal fistula.

This case demonstrates the ability to diagnose a significant duodenal atresia coexisting with an oesophageal atresia with associated tracheo-oesophageal fistula within the first trimester, however the mechanisms underlying the sonographic features remain uncertain.