Murine cytomegalovirus-induced congenital defects and fetal maldevelopment

The effects of congenital infection with cytomegalovirus on fetal development were studied by injection of murine cytomegalovirus (MCMV) into the endometrial lumina of mice in the early stages of pregnancy. The mice were later killed, and the sites of embryonic implantation were examined. Litter size was reduced and the incidence of abnormal fetuses was significantly increased among MCMV-infected animals. Morbid, moribund, severely growth-retarded, asynchronously developed, and malformed fetuses were found. Virus was reisolated from infected mothers, placentas, and fetal tissues but not from control animals that had received either heat-inactivated virus or culture medium. The recovered virus was identical to the original virus, as verified by restriction enzyme analysis. MCMV-specific DNA was detected in experimental tissue sections by in situ nucleic-acid hybridization. Seroconversion occurred in infected female mice. Thus, the presence of MCMV in the genital tract at the time of embryonic implantation causes not only embryonic infection but also fetal maldevelopment.

Congenital hydrocephalus due to prenatal intracranial hemorrhage

A 3,400-g female neonate with a large head, widened sutures, and full fontanels at the time of her delivery by cesarean section is described. Imaging with ultrasound and computed tomography at 24 and 36 hours of age showed findings typical of hydrocephalus caused by intraventricular hemorrhage occurring several days or more prior to birth. There was no direct evidence of any predisposing vascular lesion or coagulopathy. Such a phenomenon has not been previously reported.

Persistent corneal edema in the congenital rubella syndrome

Corneal edema occurring in the congenital rubella syndrome can result from coexistent glaucoma or develop in the absence of an elevated intraocular pressure. We examined a 36-week-old female infant with documented congenital rubella syndrome who had bilateral corneal stromal edema without attendant congenital glaucoma. Histopathologic examination of the cornea revealed absent Descemet's membrane, deep interstitial keratitis, stromal corneal swelling, and deranged, focally absent endothelial cells. A viral infiltration of endothelium is postulated as the mechanism of the corneal edema and keratitis.

Reversal of polyhydramnios by drainage of a fetal renal cyst. A case report

At 28 weeks' gestation a patient developed polyhydramnios associated with a large fetal renal cyst demonstrated by ultrasound. Drainage of the cyst was performed, resulting in the disappearance of polyhydramnios. The pregnancy progressed normally to term and resulted in the delivery of a healthy infant.

[Rubella and congenital cataracts]

Between April 3, 1977 and June 6, 1980, 97 children with congenital cataracts and 97 evenly matched control children were examined in order to clarify the biological criteria of congenital rubella and to estimate its importance in the etiology of congenital cataracts. Although the age limit had been fixed at 60 months, the 1978 rubella outbreak accelerated the immunization in young children and resulted in difficulties in interpreting some results. All children presenting with congenital cataracts associated with clinical symptoms of rubella embryopathy displayed anti-rubella antibodies including anti-rubella IgM up to the 13th month: they represent 16% of cases with congenital cataracts in this series. The rubella etiology could not be proven in children with clinically isolated congenital cataracts.

The predictive significance of biologic risk factors for deficits in children of a high-risk population

Two hundred forty-two high-risk children and 47 low-risk children were prospectively studied to assess the relationship between biologic risk factors that occurred during the perinatal period and the motor and cognitive deficits that were identified during the first year of life. Multiple risk factors were present in 80% of the children of the high-risk group. Provisional deficits were classified on the degree of abnormality found in a clinical and behavioral assessment that included neurological examinations, Bayley Physical and Mental Development Scales, and the Uzgiris and Hunt Scale. Provisional deficits occurred in 10% of the children of the low-risk group. High-risk children had a significantly greater incidence of provisional deficits, particularly in respect to positive deficits. In high-risk children, the probability of a deficit was 17% in those without infection or encephalopathy, 30% in those with infection, and 40% in those with encephalopathy.

The pathology of non-Rhesus hydrops

The pathological findings in 50 cases of non-Rhesus hydrops are presented. In 19, pregnancy terminated before the twenty-eighth week of gestation; there were five chromosomally abnormal fetuses and a further six with structural abnormality in this group. Three of 31 infants from the more mature group survived, 16 were stillborn and 12 died in the neonatal period. Nineteen infants had malformations, 14 of these being cardiovascular malformation. Five infants had evidence of intra-uterine infection. Intra-uterine heart failure is the commonest cause of the hydrops.

Nonimmune fetal hydrops and Down syndrome

Six infants with nonimmune fetal hydrops (NIFH) were found to have trisomy 21 (Down syndrome). A cardiac malformation was present in three of these infants. The manifestations of Down syndrome was obscured by the generalized edema at birth. The association of Down syndrome and NIFH emphasizes the need for chromosome analysis in the workup of infants or fetuses with NIFH.

Early-onset preeclampsia, triploidy and fetal hydrops

Early-onset preeclampsia (16-24 weeks) is frequently associated with fetal and placental anomalies. Hydatidiform mole, fetoplacental triploidy with partial molar changes and idiopathic hydrops fetalis are commonly associated ones. Two patients had severe, early-onset preeclampsia and ultrasonically documented fetal anomalies, one fetal triploidy, the other idiopathic hydrops with normal karyotype. The management of early-onset preeclampsia benefits from ultrasonography, and an aggressive search for fetal anomalies is recommended. Seventy-two percent of cases of early-onset preeclampsia in our institution were associated with significant fetal and placental malformations. An immunologic basis of the preeclampsia in these cases seems likely but remains unproven.

Fetal breathing movements. An update for the pediatrician

Although the presence of fetal breathing movements (FBMs) has been suspected for almost a century, the major advances in the field were made during the last decade. Experimental animal techniques of detection include instrumentation of fetuses with electronic recording equipment. Human studies use more indirect, although no less accurate, A-mode or real-time B-scan ultrasonography in the recording of FBMs. The fetus does not make breathing movements continuously; however, there are periods of FBMs interspersed with periods of apnea. Inherent to FBMs is a diurnal variation. Hypoxia and hypoglycemia diminish FBMs, while hypercarbia and hyperglycemia have the opposite effect. Caffeine, barbiturates, and general anesthetics modify FBMs by their influence on the CNS. Preliminary studies have shown the presence of FBMs to indicate a state of fetal well-being. Possibly, in the future, testing for FBMs may become a useful clinical tool in the identification of the fetus at risk.

Congenital cardiac fibroma associated with fetal arrhythmia

A congenital cardiac fibroma presented itself, antenatally by bursts of extrasystoles which were detected by the cardiotocograph during labor. Congenital cardiac tumors are extremely rare. The symptomatology of such tumors consists mainly of hemodynamic disturbances and various arrhythmias. Most of the reported cases were diagnosed in neonates or infants, usually in autopsies, none were diagnosed in utero. It seems logical to assume that some of the arrhythmias may have been present but not diagnosed antepartum. To the best of our knowledge the association of congenital cardiac tumor and fetal arrhythmia (FA) has not been reported yet.

Ovarian torsion cyst presenting as a wandering tumor in a newborn: antenatal diagnosis and post natal assessment

A case of an in-utero torsion ovarian cyst is reported. The diagnosis was made antenatally and the 4-cm cystic mass was followed by US from birth until the age of 3 months. Surgery was delayed until the baby reached a satisfactory weight. In the meanwhile, the follow-up studies showed the mass to wander in the abdomen. Surgery revealed an ovarian cyst. Ovarian torsion cysts should be considered in the differential diagnosis of wandering tumors.