1/22. Successful treatment of refractory supraventricular tachycardia by repeat intravascular injection of amiodarone in a fetus with hydrops.We report the case of a fetus with supraventricular tachycardia complicated by congestive heart failure and ascites. After failure of initial transplacental treatment, the injection of amiodarone into the umbilical vein combined with evacuation of ascites achieved conversion to sinus rhythm and restored cardiac function thus allowing pregnancy to go to term. This report suggests that direct fetal therapy by umbilical vein puncture and evacuation of effusions constitutes an effective treatment for supraventricular tachycardias with massive fetal hydrops which do not respond to transplacental treatment.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/22. prenatal diagnosis and fetal therapy of congenital cystic adenomatoid malformation type I of the lung: a report of five cases.We experienced five pregnancy cases with type I congenital cystic adenomatoid malformation (CCAM) of fetuses and summarized here their clinical characteristics, pregnancy outcomes, and fetal therapies. Four of five cases were prenatally diagnosed using magnetic resonance imaging (MRI) as having lung abnormality, and the remaining case was prenatally diagnosed as having congenital diaphragmatic herniation (CDH). One fetus underwent the puncture of cysts in the lung, and two fetuses received in utero thoracoshunts between cysts and the amniotic fluid cavity (thoracoamniotic shunt). One pregnancy ended in artificial termination at 17 gestational weeks, and 4 pregnancies succeeded in live births. All these 4 infants underwent surgical operations for CCAM, and 1 infant underwent an additional operation for CDH. The MRI examinations were useful to prenatally identify CCAM, and the in utero thoracoamniotic shunt appears to be beneficial in preventing lung hypoplasia in the affected fetuses.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
3/22. Omental herniation. An unusual fetal complication of intrauterine transfusion.Amniocenteses in an Rh-sensitized woman revealed the need for intrauterine transfusion to improve fetal status. Following delivery of the infant by cesarean section 7 weeks later, herniation of a segment of omentum through the anterior abdominal wall was noted. The injury was due to needle puncture during the intrauterine transfusion. The injury was repaired, and the infant recovered.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
4/22. Prenatal puncture of a unilateral hydronephrosis leading to fetal urinoma and postnatal nephrectomy.Fetal pelvicaliceal dilatation due to ureteropelvic junction obstruction is the most common cause of antenatal hydronephrosis; it rarely leads to a spontaneous rupture resulting in urinoma formation. Antenatal intervention has been recommended only in those cases of large urinomas that seem to interfere with the function of other organ systems (eg, pulmonary hypoplasia secondary to diaphragmatic elevation). We report the case of a fetal intervention (transuterine puncture) in a unilateral massive hydronephrosis leading to a perirenal urinoma and the preterm birth of a female infant. Postnatally, mechanical ventilation and oxygen were required, as was forced percutaneous urinoma drainage. Evaluation revealed a fistula formation between the perirenal space and the kidney's collecting system, possibly due to the fetal intervention. Unfortunately the kidney function was very poor, and surgery to remove the impaired kidney and the urinoma was performed. We discuss the possible effects of fetal intervention in cases of obstructive uropathy and the postnatal risks associated with it.- - - - - - - - - - ranking = 5keywords = puncture (Clic here for more details about this article) |
5/22. Discordant fetal infection for parvovirus B19 in a dichorionic twin pregnancy.There are only a few reports of fetal parvovirus infection in the circumstance of a twin pregnancy. We report a case of differential fetal infection following maternal parvovirus B19 infection in a dichorionic twin pregnancy culminating in a dual live-birth. A 32-year-old woman was diagnosed with parvovirus infection following exposure to her infected child at 19 weeks' gestation in a dichorionic twin gestation. Maternal IgG seroconversion was documented and maternal blood parvovirus B19 dna was detected by PCR testing. fetal monitoring with serial ultrasound assessment was instituted. At 25 weeks' gestation Twin I (male) displayed minor ascites, small pericardial effusion, placentomegaly and oligohydramnios. middle cerebral artery peak systolic velocity (MCA PSV) studies were abnormal. Twin II (female) was sonographically unremarkable. A single fetal intravascular transfusion for Twin I was performed (pretransfusion Hb 80 g/L). Twin I fetal blood parvovirus B19 dna was detected by polymerase chain reaction (PCR) and serum demonstrated both B19 IgG and IgM. Following fetal transfusion the hydrops resolved, although the placentomegaly persisted. Two live infants were delivered at 37 weeks' gestation. Individual neonatal venepuncture detected B19 dna by PCR in Twin I but not in Twin II. B19 IgM was present in Twin I but not Twin II. Both neonates had B19 IgG antibodies. Placental histopathology demonstrated mild edema for Twin I but no inclusion cells. The placenta of Twin II was unremarkable. This case demonstrates the ability for differential transplacental infection of this virus and the assistance of fetal MCA flow studies to guide therapy in a multiple pregnancy at risk of parvovirus infection.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
6/22. Pseudomonoamniotic twins with cord entanglement following genetic funipuncture.amniocentesis was performed twice on a twin gestation, and twice there was cell growth failure in one of the twins. Therefore, funipuncture was attempted at 24 weeks. The anatomical relationship and position of the fetuses, placental cord insertion, and membranous septum dictated needle entry into the cord of the lower left fetus through the sac of the upper right fetus and the septum. The procedure was uneventful and the pregnancy was carried to 39 weeks. However, the septum between the twins had been disrupted, creating a pseudomonoamniotic pregnancy. This was noticed only after delivery of the first fetus, when it was found that the two umbilical cords were entangled. We believe that, whenever possible, puncture of the membrane between twins should be avoided. Should puncture be necessary, the possibility of pseudomonoamniotic twins must be considered.- - - - - - - - - - ranking = 7keywords = puncture (Clic here for more details about this article) |
7/22. Successful intrauterine therapy of a large fetal ovarian cyst.Fetal ovarian cysts can be managed in different ways, depending upon their size and clinical course: conservatively, by open surgery or by postnatal transabdominal puncture. However, in cases of large cysts detected antenatally and affecting the ongoing pregnancy, in utero transabdominal puncture can be undertaken, without increase of risk. A case of such a puncture at 30 weeks gestation is reported.- - - - - - - - - - ranking = 3keywords = puncture (Clic here for more details about this article) |
8/22. fetal blood sampling in the management of intrauterine thyrotoxicosis.graves disease is an autoimmune disorder caused by thyroid-stimulating immunoglobulins (Igs) which result in an excess production of thyroid hormones. These Igs are passively transferred to the fetus and may produce intrauterine thyrotoxicosis. Thyrotoxic fetuses are at risk for preterm delivery, intrauterine growth retardation, and perinatal death. Our patient had markedly elevated thyroid-stimulating Igs and had given birth to a preterm thyrotoxic infant in a previous pregnancy. We managed her third pregnancy with serial assessment of fetal thyroid hormones by funipuncture to identify the hyperthyroid fetus and modulate propylthiouracil therapy. We believe that this approach in selected patients with graves disease may improve the outcome of these pregnancies.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
9/22. prenatal diagnosis of fetal hyperthyroidism using funipuncture.women with graves disease who are euthyroid as a result of ablative therapy still produce thyroid-stimulating antibodies that can cross the placenta. The fetuses of such patients are at risk of hyperthyroidism. We found that fetal blood sampling for the measurement of fetal endocrine function was useful in two patients for both diagnostic and therapeutic purposes. It may be especially helpful for situations in which maternal and fetal endocrine functions are dissimilar.- - - - - - - - - - ranking = 4keywords = puncture (Clic here for more details about this article) |
10/22. umbilical cord hematoma secondary to in utero intravascular transfusion for rh isoimmunization.Direct intravascular transfusion of the fetus with Rhesus isoimmunization is becoming more widespread as the procedure of choice in the treatment of this disease. To date no direct complications of this new procedure have been reported. The authors describe a case of cord hematoma with resulting fetal compromise secondary to venipuncture of the umbilical vein. Doppler studies and review of the fetal heart rate tracings pointed toward umbilical artery vasospasm secondary to the cord hematoma as the etiology of the transient fetal bradycardia.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
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