Cases reported "Fetal Diseases"

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1/14. Transabdominal amnioinfusion to avoid fetal demise and intestinal damage in fetuses with gastroschisis and severe oligohydramnios.

    BACKGROUND/PURPOSE: Despite dramatic improvement in survival rate for neonates with gastroschisis, significant postoperative morbidity and a low mortality rate still occur. Furthermore, even in recent publications, some fetal death has been reported. Does this mean that antenatal diagnosis of gastroschisis is a missed opportunity? In fact, decreased amniotic fluid (AF) volume is observed in some fetuses with gastroschisis. However, oligohydramnios is associated with an increased risk of fetal suffering. When severe oligohydramnios is observed, intrapartum amnioinfusion, to restore AF volume, may help avoid fetal complications. methods: Two fetuses with gastroschisis and severe oligohydramnios were treated antenatally with amnioinfusion of saline solution. In one case, fetal heart beat decelerations were observed at 27 weeks' gestation among with the oligohydroamnios and serial transabdominal amnioinfusions were performed. In the second case, severe oligohydramnios was observed at 31, weeks and an amnioinfusion was performed. The 2 babies were delivered at 31 and 34 weeks, respectively. RESULTS: In both cases, exteriorized bowel was nearly normal at birth, and primary closure could be performed. Outcome was favorable, and they were discharged home on day 43 and day 54, respectively. CONCLUSIONS: Because fetuses with gastroschisis and oligohydramnios are part of a particular high-risk group, serial ultrasound examination and computerized fetal heart beat monitoring are necessary during the third trimester. In selected cases of gastroschisis associated with severe oligohydramnios, serial amnioinfusion may be required.
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2/14. Fetal seizures: case report and literature review.

    We report a case of fetal seizures secondary to lissencephaly. Among the 13 published cases of fetal seizures, including ours, diagnosed at a mean gestational age of 35.5 weeks (range 20-42), a fetal heart rate tracing was available in ten and showed a normal pattern in three, low variability in two and repetitive decelerations or bradycardia in five. The most common cause of fetal seizures was congenital anomalies (seven of 13), mainly of the central nervous system (six of seven). Outcome among the 11 liveborn neonates included death by 6 months of age in eight cases, and mental or motor delay in three.
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3/14. Skew ocular deviation: a catastrophic sign on MRI of fetal glioblastoma.

    CASE REPORT: We report the prenatal observation of fetal ocular skew deviation in a case of a glioblastoma found prenatally at 33 weeks' gestation by MRI. The fetal MRI, obtained by half-Fourier single-shot turbo spin echo (HASTE) pulse sequences, showed a tumor (80 mm in maximum diameter) in the right deep cerebral hemisphere with extension to the mid-cranial fossa and tentorial hiatus in addition to severe hydrocephalus. On coronal MR images a vertical dysconjugated gaze was recognized. One week after the MRI, frequent delayed deceleration prompted an emergency cesarean section. The baby was born with left hemiparesis and central neurogenic hyperventilation, which evolved into decerebrate rigidity and apneustic breathing within 2 h. Post-mortem examination revealed a glioblastoma in the right deep hemisphere, a tumor with brain stem involvement, and transtentorial herniation. CONCLUSIONS: We suggest, therefore, that recognition of ocular skew deviation on fetal MR images would indicate brain stem involvement and poor postnatal prognosis. Early recognition of the catastrophic sign would lead to proper management.
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4/14. Fetal hemorrhage associated with congenital intestinal atresia.

    We encountered two cases of severe intrauterine hemorrhage associated with congenital intestinal atresia. In both cases, the first sign that necessitated immediate clinical management was the abnormal fetal heart rate patterns, represented by prolonged bradycardias and late decelerations. This occurred immediately after the onset of labor. An emergency cesarean section was performed on both patients and, despite being born with severe anemia, the condition of the infants was excellent. We found that continuous fetal heart rate monitoring should be performed if polyhydramniosis suspected, when the fetus is diagnosed with congenital intestinal atresia and when changes in intrauterine pressure are clinically expected, such as at the onset of labor or after amniocentesis.
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5/14. aortic valve replacement in the second trimester of pregnancy: a case report.

    A 36 year old woman with left heart failure and right-sided hemiparesis due to endocarditis of the aortic valve underwent urgent aortic valve replacement during the 24th week of gestation. High-flow high-pressure normothermic perfusion during cardiopulmonary bypass was performed. Peri-operative fetal heart rate and uterine contractions were monitored. Severe fetal heart rate decelerations and loss of variability as well as uterine contractions were observed during surgery. Uterine contractions were treated medically. pregnancy was carried to term and a healthy baby was delivered vaginally. The effect of the nonpulsating cardiac pump during extracorporeal circulation on the fetus will be discussed. Recommendations for the peri-operative management of the fetal unit are made.
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keywords = deceleration
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6/14. Chronic massive fetomaternal hemorrhage: a case report.

    We report a case of massive chronic fetomaternal hemorrhage with remarkable fetal compensation. The labor course was complicated by a fetal heart rate pattern showing decreased long- and short-term variability and the eventual development of persistent late decelerations. The fetal scalp blood pH and cord blood pH values were normal. A living male infant was delivered by cesarean section for persistent late decelerations. A Kleihauer-Betke stain on a maternal blood sample was positive at 14.5%, which is equivalent to 700 mL of fetal blood in the maternal circulation.
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ranking = 2
keywords = deceleration
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7/14. seat belts: a potential hazard to the fetus.

    The widespread introduction of seat belts for front seat passengers has undoubtedly reduced injury and death during impact but the effects on the fetus of belt restraint has been little reported. We report here a fetus whose mother was involved in a low speed head-on collision and who rapidly developed abdominal tenderness. The fetus was bradycardic and emergency cesarean section delivered an infant who was shocked due to placental abruption and who required immediate resuscitation. The baby subsequently developed renal failure and convulsions but on follow-up is entirely normal. We draw attention to the fact that maternal seat belt trauma may cause placental abruption with severe fetal compromise. Careful assessment of fetal cardiotocography should be performed in all pregnancies where a deceleration collision in the presence of a maternal seat belt restraint makes fetal injury a possibility.
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keywords = deceleration
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8/14. Combined echocardiographic and Doppler assessment of fetal congenital atrioventricular block.

    fetal heart rate monitoring was combined with fetal echocardiography for examination of atrial reactivity during labour in five fetuses with second or third degree heart block. Alterations in vagal tone accompanying uterine contraction influence atrial rate, even when the ventricle is not under atrial 'control'. Fetal echocardiography enabled diagnosis of the underlying basis of the arrhythmia and located the optimal position for recording atrial activity with an external heart rate monitor. External and internal monitoring of atrial activity demonstrated reactivity during labour. Two patients were delivered vaginally after monitoring throughout labour. One mother preferred elective caesarean delivery. Caesarean section was required in another for cephalopelvic disproportion and in the remaining woman for late decelerations. These monitoring techniques provide an assessment of fetal well-being in the presence of fetal bradycardia due to variable degrees of heart block.
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keywords = deceleration
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9/14. Intrapartum ultrasound diagnosis of nuchal cord as a decisive factor in management.

    Reported is the case of a patient who presented in labor with a fetal heart rate tracing that showed repetitive variable decelerations. time lapse between presentation and delivery was minimized by the ultrasound confirmation of a nuchal cord. Delivery by cesarean section was elected rather than making further attempts at maternal repositioning.
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keywords = deceleration
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10/14. fetal heart rate tracing during sickle cell crisis: a cause for transient late decelerations.

    A case of maternal sickle cell anemia crisis is presented. A continuous fetal heart rate (FHR) tracing demonstrates late decelerations that reversed when the mother's condition improved. The importance of recognizing this reversible late deceleration problem is discussed in terms of increasing fetal maturity.
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keywords = deceleration
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