Cases reported "Fetal Diseases"

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1/74. The outcome after perinatal management of infants with potential airway obstruction.

    Masses in the head and neck are being detected prenatally with increasing frequency, necessitating the need for management of potential upper airway obstruction at delivery. Establishment of the airway at delivery and its maintenance thereafter are critical. This should optimally be performed with the baby still attached to the placental circulation. The importance of multidisciplinary team management, including a high risk obstetrician, neonatologist, pediatric otolaryngologist, pediatric thoracic surgeon, and an anesthetist, cannot be overemphasized. Endotracheal intubation is attempted first, if unsuccessful then is followed by insertion of a rigid bronchoscope. tracheotomy should be reserved for airway obstructions, which are not amenable to endotracheal intubation or in babies in whom exchange from a bronchoscope to endotracheal tube cannot be safely performed. The management of six infants with prenatally diagnosed potential airway obstruction is presented. morbidity and mortality still ultimately depend on the severity of the existent anomalies.
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ranking = 1
keywords = mortality
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2/74. In utero treatment of fetal complete heart block with terbutaline. A case report.

    BACKGROUND: Isolated fetal complete heart block is an uncommon finding, with a mortality rate of 20-30%. Various treatment modalities have been reported, with no consistent success. CASE: Fetal complete heart bock was diagnosed in a 30-year-old woman at 29 weeks' gestation. She had an elevated antinuclear antibody and anti-SSA antibody titer. Fetal cardiac decompensation was detected at 32 weeks. After a trial of intravenous isoproterenol without significant side effects, she was treated with oral terbutaline. An increase in the fetal ventricular rate and complete resolution of hydrops fetalis occurred. A male infant was delivered by cesarean section, at term, and underwent cardiac pacemaker implantation at 4 days of age. CONCLUSION: The treatment of fetal complete heart block is controversial. Premature delivery with cardiac pacing is associated with high morbidity and mortality. We report prenatal treatment with oral sympathomimetic medication, which allowed delivery to be delayed until term, with a successful outcome.
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ranking = 2
keywords = mortality
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3/74. role of fetal echocardiography in the management of isolated fetal heart block with ventricular rate <55 bpm.

    Persistent bradycardia is an uncommon cardiac problem in fetuses but carries a high mortality in those with a ventricular rate <55 bpm. fetal heart block is one of the most common causes of persistent fetal bradycardia (PFB). An optimal method for assessing and monitoring cardiovascular compensation in the setting of PFB due to heart block has not been fully established. We report the application of two-dimensional and Doppler echocardiography in close monitoring of cardiac function and hemodynamics in a third-trimester fetus with a ventricular rate <55 bpm due to heart block, which assisted in successful management of the pregnancy to term. Hemodynamic and cardiac adaptive changes in compromised fetuses, particularly due to heart block, are discussed.
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ranking = 1
keywords = mortality
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4/74. Idiopathic intracranial haemorrhage in the fetus.

    Intracranial haemorrhage in the fetus has been reported with associated mortality and morbidity. This case report describes idiopathic subdural haematomas diagnosed at 32 weeks of gestation, with delivery by caesarean section of a live male infant in good condition at 34 weeks.
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ranking = 1
keywords = mortality
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5/74. Successful management of fetal cervical teratoma using the EXIT procedure.

    Fetal cervical teratoma is a cause of polyhydramnios, premature labor, and newborn airway obstruction. Formation of a multispecialty team and use of the EXIT procedure is essential for survival of the neonate. Without a team, there is little hope for fetal survival; mortality will be 80-100%. early diagnosis and planning are essential. Cervical teratomas can contribute to pulmonary insufficiency and chondromalacia because of a mass effect in utero and underdevelopment of the fetal lungs.
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ranking = 1
keywords = mortality
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6/74. Acardiac twinning where the pump twin dies in utero due to thrombosis in the umbilical arteries.

    A case of acardiac twinning where the pump twin dies in utero due to massive thrombotic occlusion of umbilical arteries at a site of umbilical cord stricture of the intact twin. In acardiac twinning the morbidity and mortality of the pump twin can be reduced by some invasive or medical approaches. The authors believe that in this interesting case the death of the pump twin could not be prevented by antenatal treatment.
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ranking = 1
keywords = mortality
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7/74. 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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ranking = 1
keywords = mortality
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8/74. Complications of intrauterine intervention for treatment of fetal obstructive uropathy.

    The intrauterine surgical placement of vesicoamniotic shunts in the treatment of fetal obstructive uropathy associated with prune-belly syndrome to avoid such complications as renal damage and oligohydramnios remains controversial. We present a case of an infant born with prune-belly syndrome at 33 weeks and 5 days of estimated gestational age to a mother of two by vaginal delivery after a pregnancy complicated by fetal obstructive uropathy with attempted intrauterine intervention. After sonographic and laboratory diagnostic and prognostic evaluations, an intrauterine procedure was performed in which a vesicoamniotic shunt was placed under ultrasound guidance. Complications included dislodgment of the initial shunt, with a failed subsequent attempt at placement, oligohydramnios, preterm labor and delivery, and traumatic gastroschisis through the surgical abdominal wall defect. His hospital stay was further complicated by chronic renal insufficiency, prematurity, respiratory distress, bowel malrotation, an episode of gram-negative sepsis with enterobacter cloacae, signs of liver failure, an exploratory laparotomy for severe enterocolitis, and orchiopexy for bilateral undescended testes. At present, it is unclear whether vesicoamniotic shunt placement can provide any significant improvement in the morbidity or mortality for patients with prune-belly syndrome. A large, prospective, randomized trial is needed to determine its efficacy.
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ranking = 1
keywords = mortality
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9/74. Vanishing gastroschisis and short-bowel syndrome.

    BACKGROUND: gastroschisis occurs in 1 of every 4000 live births resulting in a neonate with an abdominal wall defect that requires repair. Surgical correction has high survival rates. CASE: An 18-year-old primigravida had a fetus with gastroschisis detected by ultrasound performed for elevated maternal serum alpha-fetoprotein. Subsequent ultrasound found resolution of the classic sonographic features of gastroschisis and evidence of intestinal obstruction. At birth, no obvious abdominal wall defect was seen. laparotomy was done because of clinical and radiographic evidence of bowel obstruction, and we found significant bowel loss that resulted in short-bowel syndrome. CONCLUSION: gastroschisis diagnosed antenatally can resolve in utero causing necrosis of portions of the small and large bowels, causing short-bowel syndrome and increased morbidity and mortality.
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ranking = 1
keywords = mortality
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10/74. Percutaneous laser ablation of fetal congenital cystic adenomatoid malformation: too little, too late?

    OBJECTIVE: Congenital cystic adenomatoid malformation, type III (CCAM III) lesions are large, bulky tumors which can cause mediastinal shift, prevent normal pulmonary growth, and compress the esophagus, thus leading to complications of nonimmune hydrops, pulmonary hypoplasia and polyhydramnios. Because the mortality rate of untreated fetuses with CCAM and hydrops is high, early delivery or intrauterine resection of the enlarged pulmonary lobe (lobectomy) is indicated; however, open fetal resection of CCAM at less than 30 weeks is associated with perioperative mortality that approaches 40%, as well as the usual maternal and fetal morbidity of open fetal surgery. As an alternative, percutaneous laser ablation of a CCAM III lesion with hydrops was attempted. methods: A 30-year-old G3 P1011 with CCAM III in the left fetal hemithorax developed mediastinal shift, hydrops and polyhydramnios at 23 weeks' gestation. After pregnancy termination and open fetal resection were declined, an 18-gauge needle was placed into the fetal tumor percutaneously under real-time ultrasonographic guidance, using sterile technique with light sedation. A cleaved 400-microm Nd:YAG laser fiber was passed through the needle lumen, and using a power setting of 15 W, a total of 2,943 J of laser energy was delivered in pulses of 1.0 s at 0.2-second intervals over two sessions one week apart. RESULTS: Although tumor size decreased, the hydrops worsened and fetal death occurred. CONCLUSIONS: The fetus with CCAM complicated by hydrops is already so compromised by the advanced state of the disease that insufficient time is available for necrotic tissue reabsorption after minimally invasive therapy with laser energy. Until earlier markers for intervention are determined, percutaneous laser debulking of CCAM is unlikely to be successful.
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ranking = 2
keywords = mortality
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