Cases reported "Fetal Diseases"

Filter by keywords:



Filtering documents. Please wait...

1/8. Prenatal percutaneous needle drainage of cystic sacrococcygeal teratomas.

    Prenatal ultrasound (US) permits in utero diagnosis of sacrococcygeal teratoma (SCT), follow-up of tumor size, and the early identification of complications, allowing for a more timely and appropriate delivery. The recommended management of large SCTs is delivery by cesarean section (CS) to prevent dystocia, tumor rupture, hemorrhage, and death. However, even delivery by CS can be difficult, necessitating a large hysterotomy that adds to maternal morbidity. The authors report two cases of cystic SCTs in which prenatal percutaneous drainage allowed for an uncomplicated vaginal delivery. In the first case, a large unilocular cystic SCT was diagnosed at 31 weeks' gestation on prenatal US. The fetal presentation was breech, and the mass was steadily increasing in size, preventing spontaneous version. At 37 5/7 weeks, the cyst was percutaneously drained under US guidance allowing for successful external version. Repeat drainage just before induction of labor permitted a successful vaginal delivery. In the second case, the cystic SCT was percutaneously drained just before induction of labor at full term, again allowing for an uncomplicated vaginal delivery. Prenatal percutaneous needle drainage of cystic SCTs offers an alternative to CS that results in decreased risks for both mother and fetus.
- - - - - - - - - -
ranking = 1
keywords = hysterotomy
(Clic here for more details about this article)

2/8. In utero repair of rectal atresia after complete resection of a sacrococcygeal teratoma.

    PURPOSE: A case of a fetus with a prenatally diagnosed sacrococcygeal teratoma that produced high-output cardiac failure, hydrops, rectal atresia, and urinary tract obstruction is presented. The unique prenatal surgical management along with the embryogenesis of tumor-related rectal atresia is discussed. CASE REPORT: A large fetal sacrococcygeal teratoma with a significant intrapelvic component was detected at routine ultrasound in a 35-year-old gravida 3 para 2. Fetal hydrops developed rapidly due to high-output cardiac failure from the vascular 'steal' by the growing tumor. The urinary tract was obstructed due to the intrapelvic tumors mass. At 27 weeks' gestation, the female fetus underwent hysterotomy, resection of the entire mass and urinary diversion via bilateral flank ureterostomies. The rectum was found to be completely atretic due to apparent encasement by the tumor. Pull-through anorectoplasty was carried out concurrently. At 30 weeks' gestation, the mother developed preterm labor and a 1.8-kg was delivered by cesarean section. The baby did very well for 3 days but had a cardiac arrest and died due to an atrial perforation by a transfemoral venous catheter. CONCLUSIONS: To our knowledge this is the first report of a complete prenatal resection of a sacrococcygeal teratoma with concomitant pull-through anorectoplasty for rectal atresia.
- - - - - - - - - -
ranking = 1
keywords = hysterotomy
(Clic here for more details about this article)

3/8. In utero repair of myelomeningocele: experimental pathophysiology, initial clinical experience, and outcomes.

    HYPOTHESIS: Experimental work raises the possibility that in utero repair of myelomeningocele (MMC) may improve lower extremity, bladder, and bowel function, ameliorate the arnold-chiari malformation, and decrease the need for postnatal shunting. DESIGN: We previously developed fetal lamb models to create and reverse lower extremity damage and the arnold-chiari malformation in utero. We then applied our extensive experience with fetal surgery, including fetal endoscopic (fetoscopic) surgical manipulation, to develop techniques for MMC repair. SETTING: A tertiary referral center. patients: All patients treated between 1998 and 2002 for a prenatally diagnosed MMC. INTERVENTIONS: Either fetoscopic MMC repair, fetoscopic patch repair, or limited maternal hysterotomy and microsurgical 3-layered fetal MMC repair was performed. MAIN OUTCOME MEASURES: gestational age at delivery, survival, neurologic outcome, and need for ventricular shunting at 1 year. RESULTS: Complete fetoscopic repair was accomplished in 1 fetus. Two other fetuses underwent partial fetoscopic procedures. The remaining 10 patients underwent limited maternal hysterotomy and microsurgical 3-layered fetal MMC repair. Four of 13 patients died, and the mean gestational age at delivery of 11 fetuses born alive was 31 weeks. Five of 9 required ventricular shunting by age 1 year. In 2 patients, lower extremity function improved by more than 2 vertebral levels compared with prenatal ultrasonography. Five of 10 patients who lived longer than 3 weeks required postnatal wound revision within 7 days after birth. CONCLUSIONS: Fetoscopic repair, although feasible, does not yet yield optimal surgical results. Open surgical repair before 22 weeks' gestation is physiologically sound and technically feasible. One third of patients appear to be spared the need for a shunt at age 1 year, but improvement in distal neurologic function is less clear. Additionally, fetal mortality is associated with this procedure. Our results complement the data published by groups at Children's Hospital of philadelphia, in pennsylvania, and Vanderbilt University, Nashville, Tenn. A National Institutes of health-sponsored prospective randomized trial is now underway at these 3 centers to compare fetal repair with postnatal repair.
- - - - - - - - - -
ranking = 2
keywords = hysterotomy
(Clic here for more details about this article)

4/8. term birth after midtrimester hysterotomy and selective delivery of an acardiac twin.

    OBJECTIVE: Our aim was to determine whether hysterotomy and selective removal of an acardiac twin could improve the outcome of the "pump" twin. STUDY DESIGN: A literature and case review of the outcome of the acardiac twin malformation was performed. When an acardiac malformation was diagnosed at 19 weeks' gestation the patient was monitored with weekly ultrasonographic examinations. At 23 weeks' gestation, no blood flow could be demonstrated to the acardiac twin and it was thought that the continued presence of the acardiac twin posed a risk to the "pump" twin. A midtrimester hysterotomy was performed and the acardiac twin was delivered. RESULTS: After the midtrimester hysterotomy, the pregnancy progressed to term and a healthy female infant was delivered by elective cesarean section at 37 weeks' gestation. CONCLUSION: Midtrimester hysterotomy may be a useful intervention in cases of twinning when one fetus is a threat to the health of the other.
- - - - - - - - - -
ranking = 8
keywords = hysterotomy
(Clic here for more details about this article)

5/8. Intrauterine shunt for obstructive hydrocephalus--still not ready.

    OBJECTIVE: To determine the safety and efficacy of ventriculoamniotic shunt placement through a hysterotomy in the second trimester of pregnancy as treatment for isolated obstructive hydrocephalus. methods: Between 1999 and 2003, four pregnancies with isolated fetal obstructive hydrocephalus in the second trimester were treated at Vanderbilt University Medical Center. Preoperatively, all fetuses underwent serial ultrasonographic examinations and an ultrafast magnetic resonance imaging to confirm isolated aqueductal stenosis. A normal fetal karyotype and negative polymerase chain reaction or culture of the amniotic fluid for cytomegalovirus and toxoplasmosis were obtained. Serial enlargement of the lateral ventricles >1.5 mm/week and fetal macrocephaly were documented. Using epidural and GETA, a standard ultrasmall ventricular catheter and valve were inserted via a hysterotomy. The distal catheter, rather than being inserted into the fetal peritoneum, exited between the fetal scapulae. patients were discharged home from the hospital, and the remainder of their prenatal care was provided by their local obstetrician. After delivery, the distal drain was converted to a ventriculoperitoneal shunt. RESULTS: Cases were performed at 23 6/7, 25 5/7, 26 4/7, and 26 5/7 weeks. Shunts performed well during pregnancy, and were intact at delivery. Deliveries occurred at 34 1/7, 27 1/7, 28, and 32 4/7 weeks. Birthweights were 2,010, 907, 1,200, and 2,220 g. All Apgar scores were normal. Case 1 developed a neonatal shunt infection, and is now developmentally delayed, with swallowing dysfunction, hearing deficits and a poor pupillary response. Case 2 developed neonatal sepsis and is now developmentally delayed. Case 3 delivered preterm due to chorioamnionitis, and neonatal death occurred from sepsis. Case 4 is developmentally delayed. CONCLUSIONS: Ventriculoamniotic shunt can be placed through a hysterotomy, overcoming many of the technical difficulties of earlier percutaneous shunts. However, recent developments in fetal imaging and molecular genetics have not improved case selection. Unless new breakthroughs occur, fetal shunting cannot reasonably be expected to improve perinatal outcome.
- - - - - - - - - -
ranking = 3
keywords = hysterotomy
(Clic here for more details about this article)

6/8. Diagnosis and management of fetal sacrococcygeal teratoma.

    Four cases of fetal sacrococcygeal teratomas were managed in kuwait Maternity Hospital in the previous 2.5 years, making an incidence of 1 in 10,000 deliveries. Three were diagnosed antenatally and one unbooked case presented during labor with dystocia. polyhydramnios and characteristic ultrasonic tumor echogenicity were documented. Two patients were delivered vaginally after partial excision of the tumor through hysterotomy. In all cases female infants were delivered. Tumor size dictated the mode of delivery being vaginal in cases with maximum tumor diameter less than 10 cm. A single infant survived after tumor excision done 48 h after delivery. All tumors were histopathologically benign. Routine antenatal ultrasonic examinations should allow early diagnosis of such cases to avoid unanticipated dystocia. In the absence of associated major anomalies amniocentesis may relieve maternal symptoms, when necessary, and postpone onset of premature labor, vaginal delivery should be allowed in cases with maximal tumor diameter less than 10 cm. This should be conducted in a center with experienced neonatal and pediatric surgical care.
- - - - - - - - - -
ranking = 1
keywords = hysterotomy
(Clic here for more details about this article)

7/8. A cranial nail for fetal shunting.

    A small number of human fetal hydrocephalics have been treated by ventriculoamniotic shunts of silastic tubing. The colorado device appears to be the one most commonly used. The original experimental device tested on a primate model resembled a hollow shingle nail. This was designed by Michedja and Hodgen, contained a spring valve, measured approximately 32 X 4 mm and was placed by hysterotomy. An attractive feature of this design was its fixation by impaction in the skull, preventing displacement by fetal activity, a reported disadvantage with the silastic devices. To our knowledge, no one has used this nail-like design and tailored it to transuterine percutaneous placement in a human case.
- - - - - - - - - -
ranking = 1
keywords = hysterotomy
(Clic here for more details about this article)

8/8. The diagnosis of fetal hydrocephalus before viability.

    A diagnosis of fetal hydrocephalus was made before viability. The diagnosis was indicated by a discrepancy between the sonographic fetal head size, the uterine size by both clinical and sonographic examination, and x-ray films. An abortion was performed by hysterotomy.
- - - - - - - - - -
ranking = 1
keywords = hysterotomy
(Clic here for more details about this article)


Leave a message about 'Fetal Diseases'


We do not evaluate or guarantee the accuracy of any content in this site. Click here for the full disclaimer.