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1.
Top Magn Reson Imaging ; 28(5): 255-264, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31592992

RESUMO

In utero diffusion magnetic resonance imaging (MRI) provides unique opportunities to noninvasively study the microstructure of tissue during fetal development. A wide range of developmental processes, such as the growth of white matter tracts in the brain, the maturation of placental villous trees, or the fibers in the fetal heart remain to be studied and understood in detail. Advances in fetal interventions and surgery furthermore increase the need for ever more precise antenatal diagnosis from fetal MRI. However, the specific properties of the in utero environment, such as fetal and maternal motion, increased field-of-view, tissue interfaces and safety considerations, are significant challenges for most MRI techniques, and particularly for diffusion. Recent years have seen major improvements, driven by the development of bespoke techniques adapted to these specific challenges in both acquisition and processing. Fetal diffusion MRI, an emerging research tool, is now adding valuable novel information for both research and clinical questions. This paper will highlight specific challenges, outline strategies to target them, and discuss two main applications: fetal brain connectomics and placental maturation.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Doenças Fetais/diagnóstico por imagem , Diagnóstico Pré-Natal/métodos , Feminino , Humanos , Gravidez
2.
Top Magn Reson Imaging ; 28(5): 245-254, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31592991

RESUMO

Fetal magnetic resonance imaging (MRI) has been gaining increasing interest in both clinical radiology and research. Echoplanar imaging (EPI) offers a unique potential, as it can be used to acquire images very fast. It can be used to freeze motion, or to get multiple images with various contrast mechanisms that allow studying the microstructure and function of the fetal brain and body organs. In this article, we discuss the current clinical and research applications of fetal EPI. This includes T2*-weighted imaging to better identify blood products and vessels, using diffusion-weighted MRI to investigate connections of the developing brain and using functional MRI (fMRI) to identify the functional networks of the developing brain. EPI can also be used as an alternative structural sequence when banding or standing wave artifacts adversely affect the mainstream sequences used routinely in structural fetal MRI. We also discuss the challenges with EPI acquisitions, and potential solutions. As EPI acquisitions are inherently sensitive to susceptibility artifacts, geometric distortions limit the use of high-resolution EPI acquisitions. Also, interslice motion and transmit and receive field inhomogeneities may create significant artifacts in fetal EPI. We conclude by discussing promising research directions to overcome these challenges to improve the use of EPI in clinical and research applications.


Assuntos
Imagem Ecoplanar/métodos , Doenças Fetais/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/embriologia , Imagem de Difusão por Ressonância Magnética/métodos , Humanos , Pulmão/diagnóstico por imagem , Pulmão/embriologia
3.
Int J Pediatr Otorhinolaryngol ; 127: 109642, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479918

RESUMO

OBJECTIVE: Currently no established criteria exist to guide use of ex utero intrapartum treatment (EXIT) for fetal neck mass management. This study aims to correlate prenatal radiographic findings with incidence of ex utero intrapartum treatment and necessity of airway intervention at delivery. METHODS: We reviewed our EXIT experience between 2012 and 17. Furthermore, we performed a literature review of articles reporting incidences of fetal neck masses considered for EXIT. Articles that were included (1) discussed prenatal radiographic findings such as size, features, and evidence of compression and (2) reported extractable data on delivery outcomes and airway status. RESULTS: Ten cases at our institution were reviewed. Another 137 cases across 81 studies met inclusion criteria. These studies showed aerodigestive tract compression to be significantly associated with neck masses undergoing EXIT. Additionally, there was significantly higher incidence of airway intervention in cases where polyhydramnios, anatomic compression, and solid masses were seen on prenatal diagnostic imaging, while mass location and size did not correlate with airway intervention. CONCLUSION: With this data, we propose that any neck mass with anatomic compression on fetal imaging in the 3rd trimester should be considered for EXIT. When radiographic findings do not show compression but do display polyhydramnios or a solid neck mass (regardless of polyhydramnios), an airway surgeon should be available for perinatal airway assistance.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Doenças Fetais/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Feminino , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/etiologia , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Período Periparto , Gravidez , Centros de Atenção Terciária , Ultrassonografia Pré-Natal
4.
Diagn Pathol ; 14(1): 76, 2019 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-31299979

RESUMO

BACKGROUND: This study aims to provide genetic diagnoses for 30 cases of fetal skeletal dysplasia, and a molecular basis for the future prenatal diagnosis of fetal skeletal dysplasia. METHODS: A total of 30 cases of fetal skeletal dysplasia detected with ultrasound between January 2014 and June 2017 were analyzed. Among these fetuses, 15 fetuses had local skeletal malformations, while 15 fetuses had short limb malformations. Samples of fetal umbilical cord blood, amniotic fluid, and/or aborted tissue were collected from all cases. Karyotyping, whole genome sequencing, and targeted next-generation sequencing of skeletal disease-related pathogenic genes were performed, as needed. Blood samples were taken from the parents for verification using Sanger sequencing. RESULTS: Among the 30 cases of fetal skeletal dysplasia, two cases were diagnosed with trisomy 18. However, none of these cases were identified with any microdeletions or microreplications associated with skeletal dysplasia. Among the 28 chromosomally normal cases with fetal skeletal dysplasia, 21 cases were detected with mutations in genes related to skeletal diseases. Furthermore, collagen gene mutations were detected in six fetuses with short limb malformations, while heterozygous disease-causing mutations in the fibroblast growth factor receptor 3 (FGFR3) gene were detected in seven fetuses. The remaining fetuses carried mutations in other various genes, including tumor protein p63 (TP63), cholestenol delta-isomerase (EBP), cholinergic receptor nicotinic gamma subunit (CHRNG), filamin B (FLNB), and SRY-box 9 (SOX9). Three compound heterozygous mutations in CHRNG, COL11A2 and SOX9 were carried by phenotypically healthy parents. CONCLUSION: Targeted next-generation sequencing can significantly improve the prenatal diagnoses of fetal skeletal dysplasia, providing parents with more precision medicine, and improved genetic counseling.


Assuntos
Osso e Ossos/diagnóstico por imagem , Anormalidades Congênitas/prevenção & controle , Doenças Fetais/diagnóstico por imagem , Diagnóstico Pré-Natal/métodos , Reprodução , Osso e Ossos/anormalidades , Feminino , Doenças Fetais/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Gravidez , Medição de Risco , Análise de Sequência de DNA
5.
Medicine (Baltimore) ; 98(28): e16250, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305405

RESUMO

RATIONALE: Fetal carotid-jugular fistula is an extremely rare clinical entity that presents as an abnormal passage between the carotid artery and the jugular vein. It is difficult to treat and the chance for a cure is very low. The fetal carotid-jugular fistula causes congestive heart failure and death of the fetus. PATIENT CONCERNS: We report a case of fetal carotid-jugular fistula diagnosed at 27 weeks of pregnancy. She had no history of viral infection, no history of toxic and radiation exposure, no trauma during pregnancy, and no known family history of malformations or genetic disease. DIAGNOSES: Ultrasound revealed fetal left carotid-jugular fistula formation, massive reflux in the fetal tricuspid, a large amount of fetal pericardial effusion, fetal left ear microtia and full heart enlargement. INTERVENTIONS: The pregnant patient experienced termination of the pregnancy at 27 weeks. OUTCOMES: There were no complications in the patient. Post-termination, diagnosis of carotid-jugular fistula and left ear microtia was confirmed in the fetus. LESSONS: Our case indicated that the congenital neck artery and venous fistula of the fetus are extremely rare, and its most serious clinical symptom is congestive heart failure leading to intrauterine cessation of pregnancy. In addition, it is difficult to treat and the chance for a cure is very low. At present, there is no treatment record related to the fetal carotid artery and venous fistula, so it is very important to make a correct diagnosis as early as possible for the health of pregnant women.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Artérias Carótidas/anormalidades , Doenças Fetais/diagnóstico por imagem , Veias Jugulares/anormalidades , Ultrassonografia Pré-Natal , Aborto Induzido , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/embriologia , Microtia Congênita/diagnóstico por imagem , Evolução Fatal , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/embriologia , Adulto Jovem
6.
Cir. pediátr ; 32(3): 158-163, jul. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183737

RESUMO

Objetivo: Evaluar la importancia del diagnóstico ecográfico prenatal del feto portador de periorquitis meconial y su relevancia predictiva del seguimiento y pronóstico fetal en el contexto de una enfermedad intestinal fetal aguda. Material y métodos: En los últimos 5 años en la Unidad de Medicina Fetal se han diagnosticado tres fetos varones de periorquitis meconial cuyos diagnósticos ecográficos prenatales fueron: tumor testicular (n=1); y periorquitis meconial con perforación intestinal aguda fetal (n=2). La edad gestacional al diagnóstico fue de 33, 34 y 35 semanas. Los signos ecográficos al diagnóstico fueron: a nivel escrotal, aumento del tamaño, lesiones hiperecogénicas y permanencia del conducto peritoneo-vaginal; a nivel abdominal pueden existir signos ecográficos de enfermedad intestinal con o sin peritonitis meconial (lesiones hiperecogénicas, edemas de asas y ascitis). Los tres neonatos fueron evaluados postnatalmente mediante ecografía comparativa de los hallazgos prenatales e indicación terapéutica. Resultados: Los hallazgos ecográficos fetales influyeron en la evolución y finalización de la gestación. El diagnóstico de periorquitis meconial fue confirmado postnatalmente en los tres casos: en el 1er caso a término, se descartó patología tumoral escrotal y no requirió cirugía abdominal; en los otros dos pacientes se indicó finalizar la gestación tras el diagnóstico prenatal y se realizó cirugía inguino-escrotal y abordaje intestinal por la peritonitis meconial. Conclusión: El diagnóstico ecográfico prenatal de periorquitis meconial obliga a un seguimiento ecográfico estricto del feto al ser un marcador específico de perforación intestinal, que puede conllevar la finalización de la gestación y evitar la aparición de una peritonitis meconial complicada


Objective: To assess the importance of prenatal ultrasound diagnosis of the fetus carrying meconium periorchitis and its predictive relevance for fetal monitoring and prognosis in the context of acute fetal intestinal disease. Material and methods: Three male fetuses have been diagnosed of meconium periorchitis in our Unit of Fetal Medicine in the last 5 years. Their prenatal ultrasound diagnoses were: testicular tumor (n=1); Meconium periorchitis with acute fetal intestinal perforation (n=2). Gestational age at diagnosis was 33, 34 and 35 weeks. Ultrasound signs at diagnosis were: Increased size of scrotal zone, with hyperechogenic lesions inside and permanence of peritoneum-vaginal canal; at abdominal zone, echographic signs of intestinal disease with or without meconium peritonitis were found (hyperechogenic lesions, edema of intestinal loops and ascites). All three neonates were assessed postnatally by ultrasound and therapeutic indication. Results: Fetal ultrasound findings influenced both evolution and termination of pregnancy. The diagnosis of meconium periorchitis was confirmed postnatally in all cases: in the 1st case, delivered at term, scrotal tumoral pathology was ruled out and did not require abdominal surgery; the other 2 patients were delivered at the same week of prenatal diagnosis and an inguinal-scrotal surgery with intestinal approach because of meconium peritonitis was performed. No patient underwent orchiectomy, maintaining the teste-epididymal binomial intact. Conclusion: Prenatal ultrasound diagnosis of meconium periorchitis requires a strict ultrasound follow-up of the fetus as it is a specific marker of intestinal perforation, which can lead to the termination of pregnancy and avoid appearance of complicated meconium peritonitis


Assuntos
Humanos , Feminino , Gravidez , Adulto , Diagnóstico Pré-Natal , Orquite/diagnóstico por imagem , Mecônio/diagnóstico por imagem , Feto/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Orquite/terapia , Doenças Fetais/diagnóstico por imagem , Idade Gestacional , Neoplasias Testiculares/diagnóstico por imagem , Perfuração Intestinal/complicações , Peritonite/complicações , Peritonite/cirurgia
7.
J Obstet Gynaecol Res ; 45(8): 1619-1625, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31172617

RESUMO

Fetal seizure is rarely observed. Investigation of both video-recording of seizures and cardiotocography is crucial for a precise diagnosis. Here, we report a case of fetal seizure, and also show a video-ultrasound recording. A 40-year-old woman was admitted to us due to loss of variability in cardiotocography. Ultrasound repeatedly revealed opisthotonus-like and clonic-seizure-like movements. After the abnormal movement, tachycardia up to 210 bpm (postictal tachycardia) was noted. Ultrasound revealed a nuchal cord. A careful investigation of video-ultrasound recording by an epilepsy specialist led to the confirmation of epileptic seizures. At 364/7 , she vaginally gave birth to an infant with an umbilical artery pH of 7.22. The infant died 30 min after birth. No clear video-recordings associated with fetal seizure were available for cases reported so far in the literature. The video provided in this case may be of use for further analyses.


Assuntos
Doenças Fetais/diagnóstico , Convulsões/diagnóstico , Taquicardia/diagnóstico , Adulto , Eletrocardiografia , Feminino , Doenças Fetais/diagnóstico por imagem , Humanos , Recém-Nascido , Morte Perinatal , Gravidez , Convulsões/diagnóstico por imagem , Taquicardia/diagnóstico por imagem , Ultrassonografia Pré-Natal , Monitorização Uterina
8.
Tokai J Exp Clin Med ; 44(2): 31-33, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31250423

RESUMO

Duodenal atresia concomitant with type-A esophageal atresia (DA + TA-EA) is rare. A pronounced enlargement of a closed loop of the upper gastrointestinal tract serves as an early clue for its prenatal detection. We describe an atypical case of DA + TA-EA in which the dilatation of the upper gastrointestinal tract remained mild. Ultrasonographic examination at 28 weeks of gestation showed mild polyhydramnios. Subsequent detailed sonographic and magnetic resonance imaging studies revealed a mildly enlarged stomach and duodenum that resembled a "double bubble," mild ascites, and polydactyly of the right thumb. Fetal abdominal circumference measurements were within normal range. A female neonate born at 36 weeks gestation did not show abdominal distension. DA + TA-EA was diagnosed based on clinical characteristics and X-ray studies of the neonate; the diagnosis was confirmed by surgery. Duodenoduodenostomy and gastrostomy in the first week of life and esophagoesophagostomy at six months of age were performed with satisfactory results, and the infant developed well. Prominent and/or increasing C-shaped fluid collection in the upper abdomen is a highly useful diagnostic sign for DA + TA-EA, but it is not applicable for all fetuses with this disease. Physicians should bear this caveat in mind to avoid diagnostic delays and initiate prompt postnatal therapy.


Assuntos
Obstrução Duodenal/diagnóstico por imagem , Atresia Esofágica/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Atresia Intestinal/diagnóstico por imagem , Diagnóstico Pré-Natal , Adulto , Obstrução Duodenal/cirurgia , Duodenostomia , Atresia Esofágica/cirurgia , Esofagostomia , Feminino , Doenças Fetais/cirurgia , Gastrostomia , Humanos , Recém-Nascido , Atresia Intestinal/cirurgia , Imagem por Ressonância Magnética , Gravidez , Radiografia , Resultado do Tratamento , Ultrassonografia Pré-Natal
9.
J Obstet Gynaecol ; 39(7): 922-927, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31045471

RESUMO

To assess the accuracy of prenatal diagnosis and the prognosis of fetal-abdominal masses, we reviewed all of the cases which had been diagnosed as having abdominal masses from January 2014 to December 2016. In total, 264 cases were identified as having abdominal masses. Among them, 141 cases (53%) had received specific prenatal diagnoses by prenatal ultrasound (US). MRI had assisted in the diagnosis and prognostic evaluation in 69 cases, increasing the diagnostic rate to 65%. The prenatal diagnoses of 111 cases (65%) were concordant with the postnatal diagnoses. Surgical intervention after birth was needed in 96 cases (39%). Most outcomes were good (89%). We suggest that prenatal US can detect and identify most fetal abdominal masses and that MRI helps to further describe the masses. With early intervention after birth, the prognosis was good in most cases. Impact Statement What is already known on this subject? Fetal-abdominal masses are commonly detected in antenatal examinations. A prenatal ultrasound is the main screening tool for detecting fetal intra-abdominal cystic lesions. What the results of this study add? We suggest that MRI is more helpful in some systems to reveal locations and structures. Even prenatal diagnosis cannot reach before birth, prognosis is quite good and expectant therapy is sufficient. What the implications are of these findings for clinical practice and/or future research? Our data strengthens the current knowledge of fetal abdominal masses to help relieve anxious parents by telling them that this congenital malformation has good outcomes. But multidiscipline consultation is necessary.


Assuntos
Neoplasias Abdominais/diagnóstico por imagem , Cistos/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Ultrassonografia Pré-Natal/estatística & dados numéricos , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Adulto Jovem
10.
Neuroradiology ; 61(8): 921-934, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31076826

RESUMO

PURPOSE: To evaluate differences in diagnostic yield of intra-uterine foetal (iuMR) and post-mortem MRI (PMMR) for complex brain malformations, using autopsy as the reference standard. METHODS: In this retrospective, multicentre study spanning 2 years, we reviewed 13 terminated singleton pregnancies with a prenatal ultrasound finding of complex foetal cerebral abnormalities, referred for both iuMR and PMMR. The iuMR and PMMR studies of the brain were reported independently by two groups of radiologists, blinded to each other's reports. Descriptive statistics were used to compare differences in intracranial abnormalities with autopsy (and genetic testing, where present) as reference standard. RESULTS: The median gestational age at termination was 24.6 weeks (IQR 22-29) with median time between delivery and PMMR of 133 h (IQR 101-165). There was full concordance between iuMR and PMMR findings and autopsy in 2/13 (15.3%) cases. Partial concordance between both imaging modalities was present in 6/13 (46.2%) and total discordance in the remainder (5/13, 38.5%). When compared to autopsy, PMMR missed important key findings specifically for neuronal migration and cerebellar anomalies, whereas iuMR appeared to overcall CSF space abnormalities which were less crucial to reaching the final overall diagnosis. CONCLUSIONS: iuMR should be performed to improve foetal phenotyping where there is a prenatal ultrasound for complex foetal brain abnormalities. Reliance on PMMR alone is likely to result in misdiagnosis in a majority of cases.


Assuntos
Encéfalo/anormalidades , Encéfalo/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Imagem por Ressonância Magnética , Diagnóstico Pré-Natal , Aborto Induzido , Autopsia , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Sensibilidade e Especificidade
11.
Obstet Gynecol Clin North Am ; 46(2): 367-378, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056137

RESUMO

Diagnostic ultrasound is a powerful tool in obstetrics/gynecology. It has multiple applications, but for every use there are potential pitfalls that can have significant deleterious effects. Guidelines and certifications have been implemented to enhance the safety of this technique.


Assuntos
Ginecologia/métodos , Obstetrícia/métodos , Ultrassonografia Pré-Natal , Ultrassonografia , Colo do Útero/diagnóstico por imagem , Feminino , Desenvolvimento Fetal , Doenças Fetais/diagnóstico por imagem , Feto/anormalidades , Feto/diagnóstico por imagem , Idade Gestacional , Humanos , Erros Médicos , Placenta/diagnóstico por imagem , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Gravidez Múltipla , Nascimento Prematuro/diagnóstico por imagem
13.
Artigo em Inglês | MEDLINE | ID: mdl-30819578

RESUMO

Congenital bladder neck obstruction (or lower urinary tract obstruction [LUTO]) describes a heterogeneous group of congenital anomalies presenting with similar prenatal ultrasonographic findings of dilated posterior urethra, megacystis, hydronephrosis, oligohydramnios and often with associated renal dysplasia. Untreated LUTO has high rate of perinatal morbidity and mortality from associated pulmonary hypoplasia and early-onset renal failure in infancy. Ultrasonographic features and prospective fetal urinalysis may help in predicting the overall prognosis of congenital LUTO. Currently, fetal vesicoamniotic shunt (of various designs), and fetal cystoscopy and fulguration of the obstruction are potential prenatal interventions. Retrospective and prospective cohort studies and a relatively small randomized controlled trial have demonstrated these treatments may possibly improve perinatal survival. Despite this, concerns remain as to the high rates of renal impairment observed in paediatric survivors. A clinical prospective scoring/staging system may improve prenatal diagnostic criteria and case selection for fetal therapy.


Assuntos
Doenças Fetais/cirurgia , Terapias Fetais/métodos , Obstrução do Colo da Bexiga Urinária/cirurgia , Feminino , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/epidemiologia , Terapias Fetais/efeitos adversos , Humanos , Recém-Nascido , Masculino , Gravidez , Resultado do Tratamento , Ultrassonografia Pré-Natal , Obstrução do Colo da Bexiga Urinária/congênito , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/mortalidade
14.
J Clin Ultrasound ; 47(7): 394-398, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30838673

RESUMO

PURPOSE: This study was undertaken to evaluate the performance of indirect sonographic signs in detecting partial agenesis of the corpus callosum (pACC) at midgestation, focusing on the cavum septum pellucidum (CSP) ratio. METHODS: A retrospective case-controlled study of singleton pregnancies was conducted, examining fetuses diagnosed with isolated pACC and normal controls. At midgestational age, fetal head volumes were imaged with 3D US and stored for the evaluation of indirect sonographic findings in axial planes. RESULTS: Fifteen normal and 15 abnormal fetuses (with pACC) were analyzed. Based on a CSP ratio < 1.5, detection of pACC increased from 66.7% (10/15) to 80% (12/15). All indirect signs proved highly suspicious for pACC (risk ratios > 1). CONCLUSION: Use of indirect sonographic signs to screen for pACC at midgestation is challenging. However, a low CSP ratio may improve the detection rate, serving as a new indirect sign.


Assuntos
Agenesia do Corpo Caloso/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Septo Pelúcido/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Corpo Caloso/diagnóstico por imagem , Feminino , Humanos , Gravidez , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos , Ultrassonografia/métodos , Ultrassonografia Pré-Natal/métodos , Adulto Jovem
15.
J Gynecol Obstet Hum Reprod ; 48(6): 427-429, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30898627

RESUMO

Intraventricular hemorrhage is bleeding into the fluid-filled areas (ventricles) inside the brain. The condition occurs most often in babies that are born premature, growth restricted and twins pregnancies. Abnormal platelets number or functions are responsible greatly for this condition. We presented here a pregnant woman had thrombasthenia at 28 weeks of gestation with ultrasound findings of intraventricular haemorrhage in her both ICSI twin's fetuses.


Assuntos
Hemorragia Cerebral Intraventricular/diagnóstico por imagem , Doenças em Gêmeos/diagnóstico por imagem , Complicações na Gravidez/fisiopatologia , Gravidez de Gêmeos , Injeções de Esperma Intracitoplásmicas , Trombastenia/complicações , Adulto , Hemorragia Cerebral Intraventricular/embriologia , Doenças em Gêmeos/embriologia , Feminino , Doenças Fetais/diagnóstico por imagem , Idade Gestacional , Humanos , Hidrocefalia/diagnóstico por imagem , Gravidez , Resultado da Gravidez , Trombastenia/tratamento farmacológico , Gêmeos , Ultrassonografia Pré-Natal
16.
J Obstet Gynaecol Res ; 45(4): 931-934, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30854743

RESUMO

This report is aimed at opening a new reflexion about exploration of fetal lungs malformations with 2-D ultrasound shear wave elastography (2D-SWE) in two fetuses. These preliminary results are drawn from the ELASTOMAP study, which was designed to explore feasibility of 2D-SWE on fetal lungs. Fetus A presented Congenital Pulmonary Airway Malformation and fetus B congenital obstructive emphysema. We estimated every 3 weeks the Congenital Pulmonary Airway Malformation Volume Ratio (CVR) of the malformation and we evaluated stiffness by 2D-SWE. Stiffness of the lesion and the normal lung were compared to liver stiffness using Lung to Liver Elastography (LLE) ratio. Interestingly, CVR and LLE ratios evolved differently in these two lesions caused by distinct physiopathological processes. In both cases, LLE ratio' variations preceded that of CVR. LLE ratio of the normal lung was constant through gestation. 2D-SWE could be a promising tool to describe stiffness evolution in fetal lungs malformations.


Assuntos
Progressão da Doença , Técnicas de Imagem por Elasticidade/métodos , Enfisema/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Anormalidades do Sistema Respiratório/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Humanos , Gravidez
17.
Eur J Obstet Gynecol Reprod Biol ; 236: 139-142, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30909010

RESUMO

Fetal lymphangioma is a rare congenital malformation of lymphatic system that involve the skin and the subcutaneous tissue. The vast majority of the lymphangioma occurs in the neck. More rarely lymphangiomas may occur in the axillary region, including chest wall. Our consecutive case series study included three cases of fetal chest wall cystic lymphangiomas. In our cohort, fetal chest wall cystic lymphangiomas were the 18.8% of the all cases of lymphangiomas of axillary region. In all the three cases no other fetal abnormalities were evaluated, and the chest wall cystic lymphangiomas were unilateral, honeycombed in appearance, with multiple echo-free area of varying size in the mass, with no color flow on Doppler sonography, and with a trend to increase during the gestation. The incidence of chromosomal abnormalities was 33.3%, with one case out of the three being trisomy 21.The literature review revealed only seven cases of fetal chest wall cystic lymphangiomas. The cases were not associated with other abnormalities, nor with abnormal karyotype and only one case of fetal death was reported. Three women delivered vaginally. In summary, fetal chest wall cystic lymphangioma is a very rare malformations with only seven cases reported in the literature. This malformation is usually not associated with abnormal karyotype or other abnormalities and the neonatal outcome is favorable after surgical removal. Spontaneous vaginal delivery may be a safe approach for delivery women with fetal chest wall cystic lymphangioma. CONDENSATION: Fetal chest wall cystic lymphangioma is a very rare malformations with only seven cases reported in the literature. This malformation is usually not associated with abnormal karyotype or other abnormalities and the neonatal outcome is favorable after surgical removal. Spontaneous vaginal delivery may be a safe approach for delivery women with fetal chest wall cystic lymphangioma.


Assuntos
Doenças Fetais/diagnóstico por imagem , Linfangioma Cístico/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Adulto , Feminino , Humanos , Itália , Gravidez , Ultrassonografia Pré-Natal
18.
Kobe J Med Sci ; 64(4): E157-E159, 2019 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-30728342

RESUMO

Fetal intestinal volvulus is a rare condition, and fetal diagnosis of this disease is still challenging, especially in primary cases not accompanied by other comorbidities, such as intestinal malformations. Herein, we report a case of fetal primary small bowel volvulus associated with acute gastric dilatation detected by ultrasonography. We speculate that the mechanism of acute gastric dilatation in our case was peristatic malfunction of the whole intestine caused by a strangulated ileus resulting from fetal intestinal volvulus. In conclusion, acute gastric dilatation detected by fetal ultrasound can indicate the fetal intestinal volvulus.


Assuntos
Doenças Fetais/etiologia , Dilatação Gástrica/complicações , Volvo Intestinal/etiologia , Ultrassonografia Pré-Natal , Doença Aguda , Adulto , Feminino , Doenças Fetais/diagnóstico por imagem , Humanos , Volvo Intestinal/diagnóstico por imagem , Masculino , Gravidez
19.
J Perinat Med ; 47(4): 388-392, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-30763267

RESUMO

Background The purpose of this initial investigation was to begin to understand the routine twin anemia-polycythemia sequence (TAPS) monitoring practices of maternal-fetal medicine specialists (MFM specialists) in the United States in the absence of a formal guideline. Methods This study used an anonymous, online survey of 90 MFM specialists who were practicing in the United States. A $5 gift card to an online store was used to incentivize participants. Descriptive statistics were calculated. Results All MFM specialists reported at least some familiarity (100.00%) with TAPS. Most participants (92.94%) were familiar with methods for monitoring patients for TAPS and nearly all (97.50%) responded that they use 'Doppler MCA-PSV' to make a prenatal TAPS diagnosis. Nearly two-thirds of MFM specialists surveyed (65.06%) reported performing regular TAPS monitoring for patients with monochorionic-diamniotic (MCDA) pregnancies. Conclusion Despite no formal guidelines, the majority of American MFM specialists surveyed are using routine TAPS screening in their management of MCDA twin pregnancies, suggesting that the MFM specialists included in this study consider it a valuable diagnostic tool. Future research should further explore this possible trend toward routine TAPS monitoring amongst MFM specialists in the United States, as well as the potential value of routine TAPS monitoring in MCDA pregnancy.


Assuntos
Anemia/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Obstetrícia/estatística & dados numéricos , Policitemia/diagnóstico por imagem , Gravidez de Gêmeos , Feminino , Humanos , Obstetrícia/normas , Gravidez , Inquéritos e Questionários , Ultrassonografia Pré-Natal , Estados Unidos
20.
J Perinat Med ; 47(4): 418-421, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-30763268

RESUMO

Background There is little information on which to base the prognostic counselling as to whether an antenatally diagnosed fetal abdominal cyst will grow or shrink, or need surgery. This study aims to provide contemporary data on prenatally diagnosed fetal abdominal cysts in relation to their course and postnatal outcomes. Methods Fetal abdominal cysts diagnosed over 11 years in a single centre were identified. The gestational age at diagnosis and cyst characteristics at each examination were recorded (size, location, echogenity, septation and vascularity) and follow-up data from postnatal visits were collected. Results Eighty abdominal cysts were identified antenatally at 28+4 weeks (range 11+0-38+3). Most (87%) were isolated and the majority were pelvic (52%), simple (87.5%) and avascular (100%). Antenatally, 29% resolved spontaneously; 29% reduced in size; 9% were stable and 33% increased in size. Forty-one percent of cysts under 20 mm diameter increased in size, while only 20% of cysts with a diameter of over 40 mm increased in size. The majority of cysts were ovarian in origin (n=45, 56%), followed by intestinal (n=15, 18%), choledochal (n=3, 4%), liver (n=2, 3%) and renal/adrenal origins (n=2, 3%), respectively. In 16% (n=13), the antenatal diagnosis was not obvious. Seventy-five percent of the cysts that persisted postnatally required surgical intervention. Conclusion Most antenatally diagnosed fetal abdominal cysts were ovarian in origin. Though most disappeared antenatally, nearly three quarters required surgical intervention when present after birth. Cysts of intestinal origin are more difficult to diagnose antenatally and often require surgery.


Assuntos
Cistos/epidemiologia , Doenças Fetais/epidemiologia , Abdome/diagnóstico por imagem , Adulto , Cistos/diagnóstico por imagem , Feminino , Doenças Fetais/diagnóstico por imagem , Humanos , Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal , Reino Unido/epidemiologia
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