1/28. A case of large placental chorioangioma with non-immunological hydrops fetalis.A 34-year-old Japanese woman (gravida 2, para 2) with polyhydramnios and non-immunological hydrops fetalis was referred to our department at 32 weeks of gestation. On admission, the blood pressure was 120/60 mmHg and there was no pitting edema of the lower extremities. An ultrasound examination disclosed a large placental tumor 5.8 cm x 4.4 cm x 4.8 cm. Fetal lung compression was suspected because the lung-thorax transverse area ratio was 0.13. The preload index of the inferior vena cava was 0.74, suggesting fetal cardiac failure. After fetal pleural effusion was aspirated, lung compression developed. cordocentesis was performed at 33 weeks of gestation, and the fetal karyotype was confirmed to be 46, XY from an umbilical blood cultivation. The patient underwent a cesarean section at 33 weeks of gestation due to severe uterine contraction after preterm PROM. The baby was a 3,840 g male with a distended abdomen. apgar score at 1 minute was 1. A chest X-ray demonstrated respiratory distress syndrome. The baby was discharged on the 69th day after birth and he is now 2 years and 9 months old and healthy.- - - - - - - - - - ranking = 1keywords = cardiac failure, cardiac (Clic here for more details about this article) |
2/28. Clinical experience with the oxytocin challenge test. II. An ominous atypical pattern.Three cases have been observed over the past 3 years at los angeles County-USC Medical Center, women's Hospital, which have shown an unusual fetal heart rate response to induced uterine contractions during the antepartum period. All 3 cases resulted in perinatal death apparently due to asphyxia. This report describes this unusual pattern and presents a discussion of its possible significance.- - - - - - - - - - ranking = 0.013489543529485keywords = heart (Clic here for more details about this article) |
3/28. Alcoholization: the choice of intrauterine treatment for chorioangioma.Chorioangioma is a vascular tumor of the placenta. Most are small and asymptomatic, whereas the large tumors are clinically significant and often associated with polyhydramnios and fetal heart failure. To prevent fetal loss from these complications, many interventions have been proposed, including intrauterine transfusion in anemic cases and fetoscopic surgery to ablate the feeding vessels. The case presented herein had large chorioangiomas, 8 and 4cm in diameter, associated with polyhydramnios and early signs of hydrops fetalis, diagnosed at 27 weeks gestation. After extensive counseling, we performed alcohol ablation of the feeding vessel of the larger tumor. Signs of fetal heart failure and hydrops fetalis disappeared dramatically. The pregnancy was extended for 2 weeks, followed by premature rupture of the membranes and spontaneous labor at 32 weeks gestation and a surviving female baby, weighing 1360g, was delivered uneventfully. This preliminary experience suggests that alcoholization may be one of the best choices for this condition due to its high efficacy, simplicity, safety and very low cost. To our knowledge, this is the first report using alcoholization for the treatment of hydrops fetalis secondary to chorioangioma.- - - - - - - - - - ranking = 0.13571113657968keywords = heart failure, heart (Clic here for more details about this article) |
4/28. Intra-uterine death resulting from placental metastases in adenocarcinoma of unknown primary.A thirty-five year old woman presented with bilateral neck, chest wall and back masses. She was 16 weeks pregnant. lymph node excision revealed metastatic poorly differentiated adenocarcinoma of unknown primary. Abdominal ultrasound showed a mildly enlarged spleen and a 2-3 cm porta hepatis node. All other investigations were negative. The lymph node and cutaneous metastases progressed rapidly so it was decided to initiate systemic chemotherapy with a view to delivery at 28 weeks gestation by Caesarean section. Shortly after the second 3-weekly cycle of cisplatinum chemotherapy the patient suffered severe lower back and hip pain with MRI scan showing multiple bony metastases in the pelvic girdle. Ultrasound revealed the fetus to have been dead for at least 10 days. The products of conception were delivered following medical induction of labour. Two days later the patient suffered a cardiac arrest from which she could not be resuscitated. Placental histology revealed extensive metastases. With the exception of melanoma this has rarely been reported in solid adult malignancy. As a cause of fetal death, placental metastases are extremely rare.- - - - - - - - - - ranking = 0.0038599381657465keywords = cardiac (Clic here for more details about this article) |
5/28. Antenatal detection of mosaic trisomy 9 by ultrasound: a case report and literature review.This paper presents a fetus with mosaic trisomy 9 diagnosed by chorionic villus sampling and confirmed by cordocentesis, and compares this case with published cases in order better to define the ultrasound markers confined to trisomy 9 syndrome. Detailed fetal ultrasound examination was carried out, revealing shortened femur, placental cysts and oligohydramnios. All published trisomy 9 cases with abnormal ultrasound findings were extracted from the medline database in the period from 1973 to 2002. We found 12 non-mosaic and 13 mosaic cases, including our case. The most frequent ultrasound abnormalities included characteristic cardiac, skeletal, craniofacial and central nervous system malformations. Intrauterine growth restriction and single umbilical artery were prevalent non-specific findings in both non-mosaic and mosaic groups. Parental chromosomal variations, as in our case, were not uncommon findings. When a fetus shows structural anomalies suggesting the presence of trisomy 9, karyotyping should be performed on both chorionic villi or amniocytes and fetal blood lymphocytes to enable a correct diagnosis to be made.- - - - - - - - - - ranking = 0.0038599381657465keywords = cardiac (Clic here for more details about this article) |
6/28. Chorioangioma and its severe infantile sequelae: case report.OBJECTIVE: This case report describes a rare clinical presentation of chorioangioma diagnosed prenatally because of raised-maternal serum (MS) alpha-fetoprotein. methods: A thirty-year-old woman gravida 2, para 1 was referred to the ultrasound unit at 18 weeks of gestation because of abnormal MS triple-test results. This included AFP level of 14.9 MoM; hCG of 3.42 MoM and uE3 of 1.01 MoM. A detailed anomaly scan revealed a singleton fetus with no sonographically detectable malformations and normal amniotic fluid.The placenta was posterior. A well-circumscribed, rounded, predominantly hypoechoic lesion near the chorionic surface measuring 5 x 5 cm and protruding into the amniotic cavity was detected. color Doppler sonogram showed no blood flow within the mass, but clear fetal waveforms in its periphery were demonstrated, and the diagnosis of chorioangioma was made. The pregnancy was followed uneventfully until 35 weeks of gestation when polyhydramnios and severe fetal cardiomegaly developed. Labor was therefore induced. RESULTS: A euploid female, who had multiple diffuse cutaneous and liver angiomatosis was born. She died at the age of one month because of cardiac failure and infection. CONCLUSIONS: The present case alerts to the interrelationship between placental and fetal angiomas. This may lead to severe infantile sequelae because of similar lesions.- - - - - - - - - - ranking = 1keywords = cardiac failure, cardiac (Clic here for more details about this article) |
7/28. Massive subchorionic hematomas following thrombolytic therapy in pregnancy.BACKGROUND: Medical therapy for thrombosed valve in pregnancy has become an acceptable alternative to surgery, especially in hemodynamically compromised patients. Placental changes after thrombolytic therapy have rarely been reported. CASES: Sonograms were done within 24 hours after administration of thrombolytic agents at 15 and 26 weeks of gestation, respectively, in 2 women whose pregnancies were complicated with thrombosis of prosthetic mitral valves. Both patients developed massive subchorionic hematomas, which persisted in 1 patient who underwent cesarean delivery at 34 weeks of gestation for cardiac indications (Apgar scores 9 and 10 at 1 minute and 5 minutes, respectively). The hematomas resolved in the other patient, who delivered at term. CONCLUSION: Massive subchorionic hematomas may be observed in patients after thrombolytic therapy. Other reports are needed to establish whether such placental findings are common lesions after such therapy and to determine their impact on pregnancy outcome.- - - - - - - - - - ranking = 0.0038599381657465keywords = cardiac (Clic here for more details about this article) |
8/28. Quantitative three-dimensional power Doppler ultrasound predicts the outcome of placental chorioangioma.The relationship of large and vascularized chorioangiomas to adverse pregnancy outcome is well recognized. We present a patient with a large placental tumor and signs of impending fetal cardiac failure. The angioarchitecture of the tumor depicted by three-dimensional (3D) power Doppler ultrasound enabled us to accurately diagnose a placental chorioangioma. During the follow-up period, quantitative flow data obtained using 3D power Doppler indicated altered hemodynamics in the tumor and concomitant improvement in the condition of the fetus, enabling us to manage the mother conservatively. Spontaneous delivery occurred at 38 weeks without any complications. This report demonstrates the potential value of 3D power Doppler in prenatal diagnosis and monitoring of pregnancies complicated by large, vascularized chorioangioma.- - - - - - - - - - ranking = 1keywords = cardiac failure, cardiac (Clic here for more details about this article) |
9/28. placenta percreta with subsequent uterine rupture at 15 weeks of gestation after two previous cesarean sections.A 25-year-old gravida 3 para 2 woman was referred to our hospital at 15 weeks' gestation with an acute abdomen and free fluid in the peritoneal cavity. On admission she was somnolent. She had a history of two cesarean sections. Fetal cardiac activity was detectable by ultrasound preoperatively. Intraoperatively, a lower uterine-segment rupture was identified in the area of the presumed prior uterine incision. The great blood loss with consecutive coagulopathy required an emergency hysterectomy and multiple blood transfusions. The placenta was located on the lower anterior uterine wall. Intervening decidual cells between placenta and maternal scar tissue were absent in the area of the prior uterine incision. Placental villous tissue deeply invaded and perforated the scar tissue. Histological examination revealed a placenta percreta. placenta percreta with subsequent uterine rupture is a rare but dramatic complication after previous cesarean section. This should be kept in mind as the rate of elective cesarean sections is rising continuously. Our patient recovered completely.- - - - - - - - - - ranking = 0.0038599381657465keywords = cardiac (Clic here for more details about this article) |
10/28. Diffuse placental chorioangiomatosis causing multiple fetal cerebral embolism: a case report.BACKGROUND: Placental chorioangiomas are benign vascular tumors. Large chorioangiomas have been reported to cause several obstetric complications, including premature labor, placental abruption, polyhydramnios, fetal hydrops, fetal growth restriction, fetal hepatosplenomegaly, cardiomegaly, a congestive heart failure and fetal death. The clinical significance of small hemangiomas is less known. CASE: Multiple small placental hemangiomas occupied 70% of the total placental volume. A shower of emboli in the fetal cerebral circulation occurred 1 week before the delivery, causing permanent brain damage. Workup failed to detect causes of the embolism other than dissemination from the placental hemangioma. The fetal heart rate tracing was reassuring a few days after the cerebral embolism. CONCLUSION: Chorioangiomas can cause fetal cerebral ischemic stroke, which, in otherwise healthy neonates, should prompt examination of the placenta. The nonstress test is not an adequate method of monitoring gestations with placental chorioangiomas. Optimal management in the presence of placental hemangiomas without fetal compromise remains undetermined.- - - - - - - - - - ranking = 0.081345111819325keywords = heart failure, heart (Clic here for more details about this article) |
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