Amniotic fluid embolism: A case report of good outcome with timely intensive multidisciplinary team involvement.

OBJECTIVE: Amniotic fluid embolism is one of the most serious pregnancy complications. It can cause sudden maternal collapse with high mortality and morbidity. We present a case report regarding the important of prompt decision making and multidisciplinary team work for management of amniotic fluid embolism to yield favorable maternal and neonatal outcome. CASE REPORT: This is a 35-year-old, gravida 2, para 1, woman underwent labor induction at gestational age of 37 + 6 weeks due to elective induction. She had sudden facial cyanosis and shortness of breath right after artificial rupture of membrane. Prompt decision of urgent cesarean section, aggressive and timely massive blood transfusion and multidisciplinary team work had spared patient from extracorporeal membrane oxygenation placement and prolonged hospitalization. A male infant was born with Apgar score 3' -> 5' with estimate body weight of 2958 gm; he was hospitalized for 10 days and no other complications was found at follow up pediatric outpatient clinic. CONCLUSION: One of the most dreadful, but rare pregnancy complications is amniotic fluid embolism (AFE). It can cause serious maternal and neonatal morbidity and mortality. Rapid recognition and multidisciplinary team management are essential to maternal and neonatal prognosis.

Acute chorioamnionitis complicated with symmetrical peripheral gangrene.

OBJECTIVE: Symmetrical peripheral gangrene (SPG) is an uncommon but important clinical syndrome. We present a case of acute chorioamnionitis complicated with SPG. CASE REPORT: A 33-year-old female (gravida 5, para 2) was admitted with preterm premature rupture of membranes (PPROM) at 20 weeks and four days of gestation. She received cervical cerclage four days ago. Seven days after the diagnosis of PPROM, she developed fever, tachypnea and tachycardia. Termination of pregnancy was decided for clinical diagnosis of sepsis. After the abortus was born, gangrene change on the nose was noticed. Afterwards, this patient developed acrocyanosis of extremities. SPG developed following sepsis with intravascular disseminated coagulation (DIC). After intensive care, the patient underwent hyperbaric oxygen therapy and fasciectomy of the left forearm. CONCLUSION: We suggest awareness of SPG associated with acute chorioamnionitis. Early recognition of SPG, multidisciplinary care, and treatment of its underlying conditions are the mainstays of management.

Three-dimensional ultrasonography measurement of fetal nasal bone length during the midtrimester in Taiwanese women.

OBJECTIVE: To evaluate the normal range of the fetal nasal bone length (NBL) in Taiwanese women using three-dimensional (3D) ultrasound, and compare the NBL of normal fetuses with Down syndrome to determine its significance in screening for trisomy 21. MATERIALS AND METHODS: A total of 102 consecutive fetuses and another 7 fetuses with trisomy 21, determined by karyotyping at 15-22 weeks' gestation, were evaluated with 3D ultrasound before amniocentesis at Changhua Christian Hospital between November 2003 and April 2004. RESULTS: The normal range for NBL in the second trimester in the Taiwanese population was investigated, and a linear relationship with gestational age was noted. The NBL increased with advancing gestational age (NBL in cm=0.0264×gestational age in weeks -0.042 (R(2)=0.2416). The median of the biparietal diameter/nasal bone length ratio had a stable value which tended to change minimally between 15 and 22 weeks of gestation. Chromosomally normal fetuses had statistically longer nasal bones than fetuses with Down syndrome (p=0.014). CONCLUSION: We present a reference range for 3D ultrasound measurement of the fetal NBL. A short nasal bone at 15 to 22 weeks is associated with a high risk of trisomy 21.

Right aortic arch with aberrant left subclavian artery--prenatal diagnosis and evaluation of postnatal outcomes: report of three cases.

OBJECTIVE: To present prenatal diagnosis of a right aortic arch (RAA) with an aberrant left subclavian artery (LSCA) by the three vessels and trachea (3VT) view using routine ultrasound and the newer technique of three-dimensional power Doppler ultrasound (3D-PDU) together with a discussion of the postnatal outcome. CASE REPORTS: Three fetuses having an RAA with an aberrant LSCA were diagnosed prenatally between January 2004 and June 2009. They were all detected at between 20 and 24 weeks by routine ultrasound examination at our hospital. All of them were diagnosed via the 3VT view of the fetal upper mediastinum using ultrasound, which revealed an abnormal U-shaped pattern instead of a normal V-shaped confluence; furthermore, 3D-PDU showed an abnormal RAA and an aberrant LSCA with a vascular ring. These abnormalities were not combined with any other congenital cardiac defects in our three cases. A normal chromosome complement was present without microdeletion of chromosome 22q11.2 in all three cases. Two of the cases were genetically assessed prenatally and the other was assessed postnatally. After delivery, diagnosis was confirmed by echocardiography and three-dimensional 64-slices helical computed tomography angiography. Two of the three fetuses were asymptomatic postnatally, whereas one fetus presented with symptoms of tracheoesophageal compression caused by the vascular ring, but this had improved by 8 months of age. CONCLUSION: The 3VT view in routine prenatal ultrasound examination is important and essential for the prenatal diagnosis of an RAA with an aberrant LSCA. Moreover, 3D-PDU is able to provide a more clear-cut cardiovascular structure, which helps with the diagnosis.