Fetal Splenomegaly: A Review.

Enlargement of the fetal spleen is usually found secondary to systemic diseases and is frequently associated with hepatomegaly. By far, the most common causes of fetal splenomegaly are infectious. Other etiologies responsible for this sign are hemolytic anemia, congestive cardiac failure, metabolic disorders, and rarely, leukemia, lymphoma, and histiocytosis.We report a case of prenatal splenomegaly diagnosed at 35 weeks, confirmed in the postnatal period. The postnatal workup showed the newborn had a familial type 3 form of hemophagocytic lymphohistiocytosis (HLH).Hemophagocytic lymphohistiocytosis is an aggressive and life-threatening syndrome of excessive immune activation. The genes implicated in the hereditary forms of the disease act in an autosomal recessive fashion.

Prenatal Diagnosis of Vesicorectal Fistula.

Anorectal malformations are a rare condition difficult to diagnose in the prenatal period. It can be suspected if distal bowel appears dilated in the first-trimester ultrasound or if intraluminal echogenic foci are detected during the second-trimester scan. We report a case with these ultrasound signs (dilated sigmoid at the first trimester and intraluminal echogenic calcifications at the second trimester), in which a vesicorectal fistula image was obtained. This is the first published prenatal image of a vesicorectal fistula.

Prolactinoma and pregnancy - a series of cases including pituitary apoplexy.

The objective of this article is to evaluate the impact of pregnancy in women with prolactinoma, the possible consequences of therapy maintenance/discontinuation during pregnancy and to assess the type of delivery and maternal-foetal obstetrical outcome. A retrospective study of all pregnant women with prolactinoma in our Centre between 2006 and 2014 was made. We had 35 cases of pregnant women with prolactinoma, two of which had an episode of pituitary apoplexy during the second trimester. At the time of conception, most women were being treated with 5 mg bromocriptine. The majority of women had suspended medication in the 8th week of gestation. Caesarean rate was 48.6%. The maternal foetal outcome was favourable in all cases.

Is it Worth to Evaluate the Fetal Heart With Color Doppler Scan at 11 to 13+6 Weeks?

This study was conducted to try to achieve the success rate to detect fetal cardiac malformations and/or tricuspid regurgitation with color Doppler during first trimester ultrasound scan within a short period (less than 3 minutes) in a general low-risk population. For this purpose, we started a prospective study, evaluating 240 consecutive single pregnancies, by a single examiner, during the first trimester ultrasound scan (crown to rump length between 45 and 84 mm) using a Voluson E8 system (GE Healthcare, Zipf, Austria) with a 2- to 8-MHz RAB 4-8-D transabdominal probe. Pulsed-wave and color Doppler flow mapping was used to assess the blood flow through the tricuspid valve. In addition, color Doppler was used to evaluate the 4-chamber view, the great vessels ("V sign"), and the right subclavian artery. Blood flow in the tricuspid valve could be examined in 206 cases (85.8%). Of these, tricuspid regurgitation was detected in 17 cases (7.1%) with both pulsed-wave and color Doppler. The 4-chamber view, the V sign, and the right subclavian artery could be evaluated in 188 cases (78.3%). One case of aberrant right subclavian artery and 2 suspicious of cardiac malformations were detected. In our opinion, using color Doppler during first trimester ultrasound scan, even for a short period (<3 minutes), probably adds important information about the fetal heart.

Which Factors Influence the Type of Delivery and Cesarean Section Rate in Women with Gestational Diabetes?

OBJECTIVE: To discover the differences between women with gestational diabetes mellitus (GDM) who delivered vaginally and those who delivered by cesarean section, and to assess the cesarean rate in this group of women. STUDY DESIGN: We divided all pregnant women with GDM into 2 groups: those who had vaginal delivery and those who gave birth by cesarean section (retrospective study of 6 years). RESULTS: We evaluated 460 births at term (≥ 37 weeks' gestation), for a total of 240 vaginal births and 220 cesarean births. All occurred in our institution. Of all the variables that were compared between the 2 groups, we found statistically significant differences (p < 0.05) in the following factors: previous history of macrosomia and gestational age at the time of beginning insulin treatment. CONCLUSION: Pregnant women with GDM and previous history of macrosomia are more likely to be submitted to cesarean section. Also, the initiation of insulin treatment at an early gestational age is associated with a higher chance of a woman delivering by cesarean section. The cesarean section rate in women with GDM was 47.8%.

Pregnancy after hydrosalpinx treatment with Essure.

We present a case of a 29-year-old woman, with a history of ectopic pregnancy, which required left salpingectomy, and with a tortuous and impermeable right fallopian tube, compatible with hydrosalpinx. As hydrosalpinx itself can compromise a future pregnancy, treatment with Essure was proposed before passing to medically assisted procreation techniques. Five months after placement of Essure in the right fallopian tube, an in vitro fertilisation cycle was successfully completed and the woman had a singleton pregnancy and vaginal delivery without intercurrences.

Large Gartner cyst.

Gartner cyst is usually an asymptomatic vaginal cyst, measuring less than 2 cm, frequently found during a routine gynaecological examination. Very rarely, as these cysts are closed structures, they may increase in size because of mucus production. We describe here a case of a large Gartner cyst of approximately 8 cm, its differential diagnosis, investigation and vaginal surgical approach (with illustrations), that progressed uneventfully.

Idiopathic thrombocytopenic purpura during pregnancy.

Idiopathic thrombocytopenic purpura is a very rare disease, especially during pregnancy. It is characterised by low platelet count and predominantly muco-cutaneous bleeding. There are many forms to monitor and treat these patients. Here, we present a case of a pregnant woman, with idiopathic thrombocytopenic purpura, who was submitted to treatment only when the platelet count was below 10,000/µl, with human intravenous immunoglobulin. During the evolution of pregnancy, caesarean delivery and puerperium were favourable.