[Experience with fetal pulsoxymetry]. / Foetalis pulzoxymetria alkalmazásával nyert tapasztalataink.

The authors have had the opportunity to do research on an embryonic pulsoxymetre in twenty cases when traditional cardiotocographic observation and clinical symptoms had indicated intrauterine risk. The results obtained have been compared with those of a control group where embryonic pulsoxymetrical observation was not effected. The comparison was effected using the same criteria. The experiment aimed at defining how specific embryonic pulsoxymetrical observation may be if used as a screening method as well as whether its application would decrease the number of Cesarian sections. During the process of pulsoxymetrical observation, with positive change of the embryonic heart function with clear as well as meconium stained amniotic fluid, if the embryonic oxygen saturation reached levels over 30%, no Cesarian section was performed. At a saturation level under 30%, two Cesarian sections were required. In the control group without pulsoxymetrical analysis four Cesarian sections had to be performed. The oxygen saturation level of the umbilical cord artery blood of babies who underwent pulsoxymetrical observation and of those born with a Cesarian delivery were almost the same, the blood pH level was acidotic. On conclusion uterine pulsoxymetrical observation objectively reflects the intrauterine distress through fetal blood oxygenation and consequently, influences the number of Cesarian sections.

Ventriculomegaly with radial and renal defects: prenatal diagnosis in two consecutive sibs.

We describe two consecutive mid-trimester fetuses of different sexes with identical anomalies of the upper limbs and the kidneys in association with severe ventriculomegaly. We compare this apparently autosomal recessive syndrome to VACTERL-H association, Fanconi anemia, and two other, so far unparalleled syndromes. Taking into account the absence of chromosome breaks, the associated changes of the amniotic fluid, and the renal histology, we conclude that we are dealing with a different entity.

[Successful twin delivery following reduction of quadruplet pregnancy]. / Négyesiker-terhesség redukciója után kiviselt kettósiker-terhesség.

The authors report first time in the Hungarian literature on multifetal pregnancy reduction: a quadruplet pregnancy was reduced to twins on transabdominal way in the 16th week of gestation on request of the parents. The quadruplets resulted from a forcefully induced ovulation. First weeks of gestation were complicated by a severe but effectively treated ovarian hyperstimulation syndrome. Following the successful and uncomplicated intervention the course of pregnancy was undisturbed, two living healthy babies were delivered in the 35th gestation week. Placentae of the liveborn as well as of the stillborn fetuses were pathologically examined. On occasion of the case report theoretical and practical questions of multifetal pregnancy reduction are discussed in details from indications through technical implementation to a review of legal, ethical and also psychological relations of that intervention. A standpoint for the national practice is also framed by the authors.

Spontaneous haematoma of the umbilical cord with a single umbilical artery.

A rare example of the partial rupture of the umbilical vein resulting in a cord haematoma is reported. CTG alterations made possible to anticipate the deterioration of the foetal condition and a healthy infant was delivered by emergency caesarean section. Cross sections of the umbilical cord revealed the lack of one of the umbilical arteries and the haematoma having interfered with the foetal circulation.

[Determination of the functional state of the uterine tube by hysteroscopy]. / A tuba uterina funkcionális állapotának megítélése hiszteroszkópos vizsgálat során.

The authors present their observations on the uterine os and signs of patency of the Fallopian tubes based on 240 cases of infertility examined by hysteroscopy. The shape of the cornual region, the adjacent pathological structures, ie., adhesions, polyps, fibroids etc., the outflow of the distending medium towards the Fallopian tubes and the movement of the tubal os were visualised. Intrauterine pressure and flow data were recorded in order to judge tubal patency. The funnel-shaped (in contrast with the flat type) cornual region, rhythmic contraction of the tubal os, the outflow of distending medium, intrauterine pressure under 100-120 Hgmm and standard 25-50 ml/min medium flow were evaluated as characteristic diagnostic signs of tubal patency.

Incidence and associations of single umbilical artery in prenatally diagnosed malformed, midtrimester fetuses: a review of 62 cases.

The absence of one umbilical artery (SUA) is the most common malformation of the umbilical cord. It may accompany other abnormalities or occur as an isolated defect. We examined 885 fetuses, terminated following the prenatal diagnosis of serious or lethal malformations between April 1977 and March 1989, for the presence of SUA. We found 62 cases of SUA. This represents an incidence of 7.01% (62/885). The most common abnormalities found in association with SUA were: (1) multiple malformations (8/11 cases, SUA incidence = 72.7%), (2) ADAM complex (7/14 cases, SUA incidence = 50.%), (3) multicystic renal dysplasia (5/20 cases, SUA incidence = 25.%), and (4) Potter sequence (5/21 cases, SUA incidence = 23.8%). These associations have not been documented previously. In 6 fetuses the Meckel syndrome was diagnosed, and SUA was present in 2 of these. Therefore, SUA may represent an additional anomaly in Meckel syndrome that has not been reported previously.

[Selective termination of the development of the defective fetus in discordant twin pregnancies]. / A beteg magzat fejlödésének szelektív leállítása fejlödési rendellenességre discordans ikerterhességekben.

Selective termination of the affected fetus in twin pregnancies was performed in the second trimester of seven pregnancies. The malformations included anencephaly/exencephaly (2 cases), hydrocephalus (1 case), thoracoabdominopagus of "B" and "C" cotwins (1 case), urethral obstruction sequence (1 case) and hygroma colli (2 cases). Intrauterine intervention on the affected fetus was done by transabdominal intracardial injection of 20% NaCl solution in the 15--24 weeks of gestation. All cases had dichorionic placentation. Unaffected co-twin infants were delivered at term with normal weight in 4 cases. In 2 cases the affected fetus was found in the lower gestational sac and both pregnancies, as well as the triplet pregnancy were lost 1--6 weeks and 3 weeks after the intervention, respectively. In the other cases, neither the mother, nor the survived fetus showed any complications. We believe that using hypertonic saline is lethal for the affected fetus but carries little or no risk either the other fetus or the mother, even if small amounts of the solution might inadvertently enter their circulation.

Familial occurrence of bilateral renal agenesis.

The 58 cases of bilateral renal agenesis (Potter syndrome) registered in the Genetic Counselling unit of our institute in the last 12 years are reviewed. The only familial recurrent case which has been prenatally diagnosed is described in detail. A urinary bladder anomaly like that of the subsequent third child has not been previously reported. The authors analyze the possible inheritance patterns. They suggest the malformation is a genetically heterogeneous entity. They emphasize that nowadays the birth of a newborn with bilateral renal agenesis can be prevented in all cases.

[Familial occurrence of bilateral renal agenesis]. / Kétoldali veseagenesia családi elöfordulása.

The 58 cases of bilateral renal agenesis (Potter syndrome) registered in the Genetic Counselling of our institute in the last 12 years are reviewed. The only recurrent case which has been prenatally diagnosed is described in details. An urinary bladder anomaly like that of the subsequent child has not been reported in such a family previously. The authors analyze the possible inheritance patterns taking into account the previous references, too. They suggest the malformation is a genetically heterogeneous entity. They emphasize that nowadays the birth of a newborn with bilateral renal agenesis can be prevented in all cases.

Prenatal diagnosis by ultrasound of midface defects associated with holoprosencephaly.

Authors present cases of cyclopia, cebocephaly associated with holoprosencephaly, diagnosed prenatally by ultrasound. A detailed description of ultrasound findings is given. When intracranial anatomy appears abnormal, the orbits must be visualized, the interorbital diameter must be measured and facial malformations should be looked for.

Pathological consequences of the vanishing twin.

Fetus papyraceus is a mummified, compressed fetus occurring in association with a viable twin. The death of the fetus usually occurs early in the second trimester. A co-twin dying earlier may be absorbed completely, whilst later fetal death usually results in macerated, but not compressed fetuses. This course of events can be well demonstrated by ultrasonography. The death of one fetuses may be associated with minor malformations of the surviving one. After termination of twin pregnancies the detailed check-up of the newborn and histopathological examination of the placenta is essential.

Prenatal diagnosis of X linked hydrocephalus without aqueductal stenosis.

The outcome of four successive pregnancies in a woman heterozygous for X linked hydrocephalus is described. The last two were scanned by ultrasound. In one, a good prognosis was given; the fetus was male but there was no evidence of dilated cerebral ventricles. In the other, hydrocephalus was diagnosed. The absence of aqueductal stenosis in this case supports the hypothesis that in this X linked condition communicating hydrocephalus is the primary defect and aqueductal stenosis is secondary.

Amniotic bands associated with early rupture of amnion due to an intrauterine device.

Amniotic bands in consequence of early rupture of amnion-membrane was found in a spontaneously aborted gestational sac. This case seems to confirm the theory that amniotic bands develop due to amnion rupture principally caused by exogenous less frequently by endogenous factors. In the reported case the exogenous factor was an intrauterine device, the resulting inflammation presumably responsible for rupture of amnion.

Exencephaly in human fetuses.

In some anencephalic fetuses exposed neural tissue mass of varied size can be demonstrated. This is known as exencephaly. The authors diagnosed by ultrasound 10 typical exencephalic cases prenatally between 14 and 21 weeks of gestation. Nine singular pregnancies were terminated and in the twin pregnancy a selective feticide of the exencephalic co-twin was carried out. The pregnancy continued to term and a healthy newborn infant and a fetus papyraceus were born. The mummified co-twin was anencephalic and showed only the remnants of the exposed brain. Authors suggest that, as in experiments with animals, the exencephaly in humans, by the degeneration of the exposed neural tissue converts to anencephaly and in this process the macrophages in fetal circulation and in the amniotic fluid may play a significant role. The large number of these actively phagocytic macrophages can be demonstrated in the amniotic fluid samples from exencephalic fetuses.

Prenatal diagnosis and pathoanatomy of iniencephaly.

The authors discuss the diagnostic criteria of iniencephaly based on data from the literature and eleven additional, new cases. The most important differential diagnostic problems involve anencephaly with spinal retroflexion and the Klippel-Feil syndrome. Ultrasound indicated cranio-spinal alterations while amniotic fluid AFP estimation and exfoliative cytology substantiated abnormal closure of the neural tube, thus comprising helpful means for prenatal diagnosis of iniencephaly. The authors emphasize the need for median-sagittal sectioning through the spinal column for accurate evaluation of vertebral abnormalities. This, together with close observation of the occiput and the foramen magnum, helps the precise diagnosis of iniencephaly and once regularly applied will most likely result in more frequent recognition of this developmental abnormality.