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Sturm J, Milera H, Essmann S, Fruth A, Jahn-Eimermacher A, Selig M, Winter J, Seidmann L, Kampmann C, Kidszun A, Mildenberger E, Whybra C. A single center experience in 90 cases with nonimmune hydrops fetalis: diagnostic categories ‒ mostly aneuploidy and still often idiopathic. J Perinat Med 2022; 50:985-992. [PMID: 35405041 DOI: 10.1515/jpm-2022-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/10/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The prognosis of nonimmune hydrops fetalis (NIHF) is still poor with a high mortality and morbidity rate despite progress in perinatal care. This study was designed to investigate etiology and outcome of NIHF. METHODS A retrospective review of 90 NIHF cases from 2007 to 2019 was conducted at University Medical Center of the Johannes Gutenberg University, Mainz, Germany. Demographics, genetic results, prenatal and postnatal outcomes including one year survival as well as autopsy data were extracted. Etiology of hydrops was classified using 13 previously established categories. In 4 patients observed between 2016 and 2019, we used a next-generation-sequencing (NGS) panel for genetic evaluation. RESULTS Ninety NIHF cases were identified, with a median gestational age (GA) at diagnosis of 14 weeks. There were 25 live-born infants with a median GA of 34 weeks at birth, 15 patients survived to one year. There was aneuploidy in more than one third of the cases. All 90 cases were subclassified into etiologic categories with chromosomal 35, idiopathic 15, syndromic 11, cardiovascular 9, inborn errors of metabolism 6, lymphatic dysplasia 3, thoracic 3, infections 3, gastrointestinal 3 and hematologic 2. The NGS panel was used in 4 cases and 4 diagnoses were made. CONCLUSIONS In 90 cases with NIHF we identified an aneuploidy in more than one third of the cases. Improved techniques, such as possibly specific genetic analysis, could reduce the high rate of unexplained cases of NIHF.
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Affiliation(s)
- Julia Sturm
- Department of Neonatology, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Heiko Milera
- Department of Neonatology, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Stephanie Essmann
- Department of Neonatology, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Anja Fruth
- Department of Obstetrics and Gynecology, Johannes Gutenberg Universitat Universitatsmedizin, Mainz, Germany
| | - Antje Jahn-Eimermacher
- Department of Mathematics and Natural Sciences, Darmstadt University of Applied Sciences, Mainz, Germany
| | - Mareike Selig
- Institute of Human Genetics, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Jennifer Winter
- Institute of Human Genetics, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Larissa Seidmann
- Institute of Pathology, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Christoph Kampmann
- Pediatric Cardiology Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - André Kidszun
- Department of Neonatology, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Eva Mildenberger
- Department of Neonatology, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Catharina Whybra
- Department of Neonatology, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
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Is Fetal Hydrops in Turner Syndrome a Risk Factor for the Development of Maternal Mirror Syndrome? J Clin Med 2022; 11:jcm11154588. [PMID: 35956203 PMCID: PMC9369874 DOI: 10.3390/jcm11154588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/10/2022] [Accepted: 07/30/2022] [Indexed: 11/17/2022] Open
Abstract
Mirror syndrome is a rare and serious maternal condition associated with immune and non-immune fetal hydrops after 16 weeks of gestational age. Subjacent conditions associated with fetal hydrops may carry different risks for Mirror syndrome. Fetuses with Turner syndrome are frequently found to be hydropic on ultrasound. We designed a retrospective multicenter study to evaluate the risk for Mirror syndrome among pregnancies complicated with Turner syndrome and fetal hydrops. Data were extracted from a questionnaire sent to specialists in maternal fetal medicine in Germany. Out of 758 cases, 138 fulfilled our inclusion criteria and were included in the analysis. Of the included 138, 66 presented with persisting hydrops at or after 16 weeks. The frequency of placental hydrops/placentomegaly was rather low (8.1%). Of note, no Mirror syndrome was observed in our study cohort. We propose that the risk of this pregnancy complication varies according to the subjacent cause of fetal hydrops. In Turner syndrome, the risk for Mirror syndrome is lower than that reported in the literature. Our observations are relevant for clinical management and parental counseling.
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Sudrié-Arnaud B, Marguet F, Patrier S, Martinovic J, Louillet F, Broux F, Charbonnier F, Dranguet H, Coutant S, Vezain M, Lanos R, Tebani A, Fuller M, Lamari F, Chambon P, Brehin AC, Trestard L, Tournier I, Marret S, Verspyck E, Laquerrière A, Bekri S. Metabolic causes of nonimmune hydrops fetalis: A next-generation sequencing panel as a first-line investigation. Clin Chim Acta 2018; 481:1-8. [PMID: 29476731 DOI: 10.1016/j.cca.2018.02.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/19/2018] [Indexed: 11/24/2022]
Abstract
PURPOSES Hydrops fetalis is a life-threatening fetal condition, and 85% of all cases are classified as nonimmune hydrops fetalis (NIHF). Up to 15% of NIHF cases may be due to inborn errors of metabolism (IEM), but a large proportion of cases linked to metabolic disorders remains undiagnosed. This lack of diagnosis may be related to the limitations of conventional biological procedures, which involve sequential investigations and require multiple samples and steps. In addition, this approach is time consuming. We have developed a next-generation sequencing (NGS) panel to investigate metabolic causes of NIHF, ascites, and polyhydramnios associated to another fetal abnormality. METHODS The hydrops fetalis (HydFet) panel was designed to cover the coding regions and flanking intronic sequences of 41 genes. A retrospective study of amniotic fluid samples from 40 subjects was conducted. A prospective study was subsequently initiated, and six samples were analyzed using the NGS panel. RESULTS Five IEM diagnoses were made using the HydFet panel (Niemann-Pick type C (NPC), Barth syndrome, HNF1Β deficiency, GM1 gangliosidosis, and Gaucher disease). This analysis also allowed the identification of 8p sequence triplication in an additional case. CONCLUSION NGS combined with robust bioinformatics analyses is a useful tool for identifying the causative variants of NIHF. Subsequent functional characterization of the protein encoded by the altered gene and morphological studies may confirm the diagnosis. This paradigm shift allows a significant improvement of IEM diagnosis in NIHF.
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Affiliation(s)
| | - Florent Marguet
- Department of Pathology, Rouen University Hospital, Rouen 76000, France; Normandie Univ, UNIROUEN, CHU Rouen, INSERM U1245, 76000 Rouen, France
| | - Sophie Patrier
- Department of Pathology, Rouen University Hospital, Rouen 76000, France
| | - Jelena Martinovic
- Unit of Fetal Pathology, Antoine Beclere Hospital, South Paris University, Clamart, France
| | - Ferielle Louillet
- Department of Pediatrics, Rouen University Hospital, 76000 Rouen, France
| | - Françoise Broux
- Department of Pediatrics, Rouen University Hospital, 76000 Rouen, France
| | | | - Hélène Dranguet
- Department of Metabolic Biochemistry, Rouen University Hospital, Rouen 76000, France
| | - Sophie Coutant
- Normandie Univ, UNIROUEN, CHU Rouen, INSERM U1245, 76000 Rouen, France
| | - Myriam Vezain
- Normandie Univ, UNIROUEN, CHU Rouen, INSERM U1245, 76000 Rouen, France
| | - Raphaël Lanos
- Normandie Univ, UNIROUEN, CHU Rouen, INSERM U1245, 76000 Rouen, France
| | - Abdellah Tebani
- Department of Metabolic Biochemistry, Rouen University Hospital, Rouen 76000, France
| | - Maria Fuller
- Genetics and Molecular Pathology, SA Pathology [at Women's and Children's Hospital], 72 King William Road, North Adelaide, South Australia 5006, Australia; Department of Pediatrics, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Foudil Lamari
- Bioclinic and Genetic Unit of Neurometabolic Diseases, Pitié-Salpêtrière Hospital, APHP, Paris 75013, France
| | - Pascal Chambon
- Normandie Univ, UNIROUEN, CHU Rouen, INSERM U1245, 76000 Rouen, France; Department of Genetics, Normandy Centre for Genomic and Personalized Medicine, Rouen University Hospital, Rouen 76000, France
| | - Anne-Claire Brehin
- Normandie Univ, UNIROUEN, CHU Rouen, INSERM U1245, 76000 Rouen, France; Department of Genetics, Normandy Centre for Genomic and Personalized Medicine, Rouen University Hospital, Rouen 76000, France
| | - Laetitia Trestard
- Department of Obstetrics and Gynecology, Belvedere Hospital, Mont-Saint-Aignan, France
| | - Isabelle Tournier
- Normandie Univ, UNIROUEN, CHU Rouen, INSERM U1245, 76000 Rouen, France
| | - Stéphane Marret
- Normandie Univ, UNIROUEN, CHU Rouen, INSERM U1245, 76000 Rouen, France; Department of Neonatal Pediatrics, Intensive Care and Neuropediatrics, Rouen University Hospital, 76000 Rouen, France
| | - Eric Verspyck
- Normandie Univ, UNIROUEN, CHU Rouen, INSERM U1245, 76000 Rouen, France; Department of Obstetrics and Gynecology, Rouen University Hospital, 76000 Rouen, France
| | - Annie Laquerrière
- Department of Pathology, Rouen University Hospital, Rouen 76000, France; Normandie Univ, UNIROUEN, CHU Rouen, INSERM U1245, 76000 Rouen, France
| | - Soumeya Bekri
- Department of Metabolic Biochemistry, Rouen University Hospital, Rouen 76000, France; Normandie Univ, UNIROUEN, CHU Rouen, INSERM U1245, 76000 Rouen, France.
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Aloui M, Nasri K, Jemaa NB, Sahraoui M, Masmoudi A, Zghal D, Chelli D, Chaâbouni H, Hamida AMB, Siala Gaigi S, Marrakchi R. Fetopathological examination for the fetuses with Down syndrome in Tunisia: Epidemiological study and associated malformations. Pathol Res Pract 2017; 213:1200-1206. [PMID: 28736088 DOI: 10.1016/j.prp.2017.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 04/19/2017] [Accepted: 05/03/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND For Down syndrome (DS), traditional epidemiological studies to determine the prevalence, cause, and clinical significance of the syndrome have been conducted over the last 100 years. In Tunisia, the current work is the first in-depth study in epidemiology of DS from fetopathological data. AIM OF THE STUDY The aim of this epidemiological study was to determine the impact of some feto-maternal characteristics in occurrence of DS and to search the frequency of associated congenital malformations with this syndrome. METHODS Our retrospective study was realized for 144 fetuses with DS among 9321 autopsied fetuses in embryo-fetopathological service between 1994 and 2011. RESULTS In our study, the majority of mothers (72.91%) were 35 years and older, with a statistically significant difference (p<10-6, OR=16.7, CI=8.7-32.4). The abnormalities of extremities (31%) were the most common fetal abnormalities followed by facial (23.51%) and digestive abnormalities (19.63%). CONCLUSION One of the main conclusions of this research is that the most common risk factor for DS is maternal age. On the other hand, the type and the frequency of associated congenital anomalies with DS are still controversial.
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Affiliation(s)
- Meriem Aloui
- Faculté des Sciences de Bizerte, Université de Carthage, 7021 Zarzouna, Bizerte, Tunisia; UR 06/SP14 Troubles du développement embryo-fœtal et placentaire, Service d'embryo-fœtopathologie, Centre de Maternité et de Néonatologie de Tunis, 1007 Tunis, Tunisia.
| | - Kaouther Nasri
- Faculté des Sciences de Bizerte, Université de Carthage, 7021 Zarzouna, Bizerte, Tunisia; UR 06/SP14 Troubles du développement embryo-fœtal et placentaire, Service d'embryo-fœtopathologie, Centre de Maternité et de Néonatologie de Tunis, 1007 Tunis, Tunisia
| | - Nadia Ben Jemaa
- UR 06/SP14 Troubles du développement embryo-fœtal et placentaire, Service d'embryo-fœtopathologie, Centre de Maternité et de Néonatologie de Tunis, 1007 Tunis, Tunisia; Faculté de Médecine de Tunis, Université Tunis El Manar, 1068 Tunis, Tunisia
| | - Meriem Sahraoui
- UR 06/SP14 Troubles du développement embryo-fœtal et placentaire, Service d'embryo-fœtopathologie, Centre de Maternité et de Néonatologie de Tunis, 1007 Tunis, Tunisia
| | - Aida Masmoudi
- UR 06/SP14 Troubles du développement embryo-fœtal et placentaire, Service d'embryo-fœtopathologie, Centre de Maternité et de Néonatologie de Tunis, 1007 Tunis, Tunisia; Faculté de Médecine de Tunis, Université Tunis El Manar, 1068 Tunis, Tunisia
| | - Dorra Zghal
- Service de Gynécologie obstétrique C, Centre de Maternité et de Néonatologie de Tunis, 1007 Tunis, Tunisia
| | - Dalenda Chelli
- Service de Gynécologie obstétrique A, Centre de Maternité et de Néonatologie de Tunis, 1007 Tunis, Tunisia
| | - Habiba Chaâbouni
- Laboratoire de Génétique Humaine, Faculté de Médecine de Tunis, Université Tunis El Manar, 1068 Tunis, Tunisia
| | - Abdel Majid Ben Hamida
- Service de Médecine Préventive, Faculté de Médecine de Tunis, Université Tunis El Manar, 1068 Tunis, Tunisia
| | - Soumeya Siala Gaigi
- UR 06/SP14 Troubles du développement embryo-fœtal et placentaire, Service d'embryo-fœtopathologie, Centre de Maternité et de Néonatologie de Tunis, 1007 Tunis, Tunisia; Faculté de Médecine de Tunis, Université Tunis El Manar, 1068 Tunis, Tunisia
| | - Raja Marrakchi
- Laboratoire de Génétique, Immunologie et Pathologie Humaine, Faculté des Sciences de Tunis, Université Tunis El Manar, 1068 Tunis, Tunisia
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White SB, Tutton SM, Rilling WS, Kuhlmann RS, Peterson EL, Wigton TR, Ames MB. Percutaneous in utero thoracoamniotic shunt creation for fetal thoracic abnormalities leading to nonimmune hydrops. J Vasc Interv Radiol 2014; 25:889-94. [PMID: 24702750 DOI: 10.1016/j.jvir.2014.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To describe a transabdominal, transuterine Seldinger-based percutaneous approach to create a shunt for treatment of fetal thoracic abnormalities. MATERIALS AND METHODS Five fetuses presented with nonimmune fetal hydrops secondary to fetal thoracic abnormalities causing severe mass effect. Under direct ultrasound guidance, an 18-gauge needle was used to access the malformation. Through a peel-away sheath, a customized pediatric transplant 4.5-F double J ureteral stent was advanced; the leading loop was placed in the fetal thorax, and the trailing end was left outside the fetal thorax within the amniotic cavity. RESULTS Seven thoracoamniotic shunts were successfully placed in five fetuses; one shunt was immediately replaced because of displacement during the procedure, and another shunt was not functioning at follow-up requiring insertion of a second shunt. All fetuses had successful decompression of the thoracic malformation, allowing lung reexpansion and resolution of hydrops. Three of five mothers had meaningful (> 7 d) prolongation of their pregnancies. All pregnancies were maintained to > 30 weeks (range, 30 weeks 1 d-37 weeks 2 d). There were no maternal complications. CONCLUSIONS A Seldinger-based percutaneous approach to draining fetal thoracic abnormalities is feasible and can allow for prolongation of pregnancy and antenatal lung development and ultimately result in fetal survival.
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Affiliation(s)
- Sarah B White
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226.
| | - Sean M Tutton
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226
| | - William S Rilling
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226
| | - Randall S Kuhlmann
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226
| | - Erika L Peterson
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226
| | - Thomas R Wigton
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Aurora Baycare Medical Center Clinic, Green Bay, Wisconsin
| | - Mary B Ames
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health and Science University, Portland, Oregon; Department of Obstetrics and Gynecology, Marshfield Clinic, Marshfield, Wisconsin
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6
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Grande M, Arigita M, Borobio V, Jimenez JM, Fernandez S, Borrell A. First-trimester detection of structural abnormalities and the role of aneuploidy markers. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:157-163. [PMID: 21845742 DOI: 10.1002/uog.10070] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To determine the sensitivity of first-trimester ultrasound for diagnosing different structural anomalies in chromosomally normal pregnancies, and to establish the role of aneuploidy markers in the detection of abnormalities. METHODS This was a retrospective study of chromosomally normal singleton pregnancies with an 11-14-week scan performed in our center during 2002-2009. The ultrasound examination included an early fetal anatomy survey and assessment of nuchal translucency, ductus venosus blood flow and nasal bone. RESULTS Among 13 723 scanned first-trimester pregnancies with no genetic anomalies and complete follow-up, 439 fetuses (3.2%) were found to present with structural anomalies (194 with major anomalies and 245 with only minor anomalies). Forty-nine per cent of major structural anomalies were detected during the first-trimester scan, the highest rates corresponding to acrania (17/17), holoprosencephaly (three of three), hypoplastic left heart syndrome (10/10), omphalocele (six of six), megacystis (seven of eight) and hydrops (eight of nine). Higher than expected detection rates were obtained for skeletal (69%) and cardiac (57%) defects, coincidentally showing the highest presence of an increased nuchal translucency or abnormal ductus venosus blood flow (38% and 52%, respectively). The finding of an absent nasal bone did not appear to be associated with structural defects. CONCLUSION About half of major structural abnormalities can be diagnosed in the first trimester. Increased nuchal translucency or abnormal ductus venosus blood flow appear to be associated with cardiac and skeletal defects and may facilitate early detection.
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Affiliation(s)
- M Grande
- Department of Maternal-Fetal Medicine, Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic Barcelona, Barcelona, Catalonia, Spain
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7
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Fetal hydrops and anemia as signs of Down syndrome. J Formos Med Assoc 2011; 110:716-8. [DOI: 10.1016/j.jfma.2011.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Revised: 04/23/2009] [Accepted: 07/30/2009] [Indexed: 11/17/2022] Open
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Chen I, Chandra S, Singh A, Kumar M, Jain V, Turnell R. Successful outcome with intrauterine transfusion in non-immune hydrops fetalis secondary to congenital syphilis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:861-865. [PMID: 21050519 DOI: 10.1016/s1701-2163(16)34658-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Congenital syphilis is rare, but the incidence has increased over the last few years in Alberta. Previous reports of fetal hydrops secondary to syphilis are few and have not demonstrated the application of middle cerebral artery peak systolic velocity (MCA PSV) to monitor for fetal anemia, or reported successful management with intrauterine transfusion. CASE A 17-year-old primigravida at 28 weeks' gestational age with positive syphilis serology and fetal hydrops was treated with high-dose intravenous penicillin. An elevated MCA PSV suggested fetal anemia. Successful intrauterine cordocentesis and transfusion of packed red blood cells led to resolution of fetal hydrops. The fetus delivered spontaneously at 35 weeks' gestation with no clinical signs of congenital syphilis. CONCLUSION Syphilitic hydrops may be successfully managed with high dose intravenous penicillin, measurement of MCA PSV, and intrauterine transfusion.
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Affiliation(s)
- Innie Chen
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB
| | - Sujata Chandra
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB; Division of Maternal-Fetal Medicine, University of Alberta, Edmonton AB
| | - Ameeta Singh
- Division of Infectious Diseases, University of Alberta, Edmonton AB
| | - Manoj Kumar
- Division of Neonatal Intensive Care, University of Alberta, Edmonton AB
| | - Venu Jain
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB; Division of Maternal-Fetal Medicine, University of Alberta, Edmonton AB
| | - Roger Turnell
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB; Division of Maternal-Fetal Medicine, University of Alberta, Edmonton AB
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Wei JX, Liao C, Li DZ. Two cases of non-haematological cause of fetal hydrops in at-risk pregnancies for homozygous α0-thalassemia. J Matern Fetal Neonatal Med 2010; 23:1320-2. [PMID: 20942600 DOI: 10.3109/14767051003677954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In recent years, sonography has been successfully used as an alternative method for prenatal detection of Hb Bart's disease in areas with high prevalence of α-thalassemia. We present two cases in which the fetuses demonstrated signs of Hb Bart's disease by sonography, however, invasive procedures could not confirm it. We recommend that, in prenatal diagnosis of Hb Bart's disease by sonography, the diagnosis should always be confirmed with definitive methods to exclude false-positive findings.
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Affiliation(s)
- Jia-Xue Wei
- Prenatal Diagnostic Center, Guangzhou Maternal and Neonatal Hospital, Guangzhou Women and Children’ Medical Center, Guangzhou Medical College, Guangzhou, Guangdong, China
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10
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Masturzo B, Hyett JA, Kalache KD, Rumsby G, Jauniaux E, Rodeck CH. Increased nuchal translucency as a prenatal manifestation of congenital adrenal hyperplasia. Prenat Diagn 2001; 21:314-6. [PMID: 11288125 DOI: 10.1002/pd.54] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We present two cases of pregnant women with a previous history of congenital adrenal hyperplasia. In both cases the only abnormal feature in the initial pregnancy had been increased nuchal translucency at 10-14 weeks of gestation. The fetal karyotype was normal and a diagnosis of congenital adrenal hyperplasia was made after delivery. In their current pregnancies, both fetuses also had increased nuchal translucency and normal fetal karyotype. Diagnosis of 21-hydroxylase deficiency was made prenatally by DNA analysis. These findings in four affected fetuses suggest that congenital adrenal hyperplasia should be added to the list of genetic anomalies associated with an increase in nuchal translucency.
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Affiliation(s)
- B Masturzo
- Academic Department of Obstetrics and Gynaecology, University College London Hospitals, London, UK
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Lumbers ER, Gunn AJ, Zhang DY, Wu JJ, Maxwell L, Bennet L. Nonimmune hydrops fetalis and activation of the renin-angiotensin system after asphyxia in preterm fetal sheep. Am J Physiol Regul Integr Comp Physiol 2001; 280:R1045-51. [PMID: 11247826 DOI: 10.1152/ajpregu.2001.280.4.r1045] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined the hypothesis that the development of hydrops fetalis after asphyxia in the 0.6 gestation sheep fetus would be associated with activation of the fetal renin-angiotensin system (RAS). Fetuses were randomly assigned to either sham occlusion (n = 7) or to 30 min of asphyxia induced by complete umbilical cord occlusion for 30 min (n = 8). Asphyxia led to severe bradycardia and hypotension that resolved after release of occlusion. After occlusion, plasma renin concentration was significantly increased in the asphyxia group compared with controls (P < 0.005) after 3 min (16.3 +/- 5.3 vs. 4.1 +/- 1.3 ng. ml(-1). h(-1)), and 72 h (30.6 +/- 6.3 vs. 3.7 +/- 1.2 ng. ml(-1). h(-1)). Renal renin concentrations and mRNA levels were significantly greater in the asphyxia group after 72 h of recovery. All fetuses in the asphyxia group showed generalized tissue edema, ascites, and pleural effusions after 72 h of recovery. In conclusion, asphyxia in the preterm fetus caused sustained activation of the RAS, which was associated with hydrops fetalis.
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Affiliation(s)
- E R Lumbers
- School of Physiology and Pharmacology, The University of New South Wales, Sydney, New South Wales 2052, Australia.
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Santiago Blázquez C, González Ramírez A, Pérez Sánchez M, Fernández Soriano M, Miranda Carranza J. Diagnóstico y conducta en el hídrops fetal temprano. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2001. [DOI: 10.1016/s0210-573x(01)77056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Stanworth SJ, Hackett GA, Williamson LM. Fetomaternal alloimmune thrombocytopenia presenting antenatally as hydrops fetalis. Prenat Diagn 2001; 21:423-4. [PMID: 11360291 DOI: 10.1002/pd.84] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jauniaux E, Hertzkovitz R, Hall JM. First-trimester prenatal diagnosis of a thoracic cystic lesion associated with fetal skin edema. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2000; 15:74-77. [PMID: 10776018 DOI: 10.1046/j.1469-0705.2000.00020.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
An unusual case of chest cyst diagnosed at the end of the first trimester in a dizygotic twin pregnancy and managed conservatively is reported. Between 11 and 14 weeks of gestation, ultrasound revealed a relatively large echopoor lung cyst occupying the left side of the chest, displacing the mediastinum and the heart. This was associated with increased nuchal translucency thickness and generalized skin edema. Subsequent sonograms showed complete resolution of the cyst together with the skin edema. The fetuses were delivered at term and had an uncomplicated postnatal outcome. This case emphasizes the role of reduced venous return as a cause of early fetal hydrops. Diagnosis and follow-up of a congenital lung cyst from the end of the first trimester should enable early intervention to be made.
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Affiliation(s)
- E Jauniaux
- Academic Department of Obstetrics and Gynaecology, University College London Medical School, UK
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Jauniaux E, Hustin J. Chromosomally abnormal early ongoing pregnancies: correlation of ultrasound and placental histological findings. Hum Pathol 1998; 29:1195-9. [PMID: 9824095 DOI: 10.1016/s0046-8177(98)90245-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The pathophysiology of placental microscopic changes in chromosomally abnormal pregnancies remains poorly understood. We have reviewed the relationship between ultrasound findings and villous histological features in a group of 25 ongoing pregnancies presenting with fetal aneuploidy at 11 to 15 weeks of gestation. The chromosomal abnormalities were diagnosed by chorion villous sampling, and the data were compared with those of a group of 25 chromosomally normal pregnancies undergoing surgical termination and matched for gestational age. The aneuploid group included 10 pregnancies with trisomy 21, nine with trisomy 18, three with triploidy, two with monosomy X, and one with trisomy 13. The overall degree of agreement between the two investigators for the histological diagnosis was good (kappa, 0.64), and the sensitivity of histology ranged between 72.0% and 80.0%. Fetal and placental edema was observed on scan in 10 and 7 cases, respectively, of the aneuploid group and was systematically associated with trophoblastic hypoplasia, stromal edema, or cavitation, reduced vascularization, and ramification of the main villous trunks. Fetoplacental hydrops was not observed in the euploid group. These findings indicate that histological changes observed in the placenta of fetuses from ongoing pregnancies presenting with aneuploidy can be linked with early fetal hydrops. The villous features in these cases are probably secondary to a reduction in the villous circulation due to a cardiovascular defect and leading to generalized stromal edema. The reduced villous branching and trophoblastic hypoplasia could be secondary to the enlargement of all villous types or to a basic defect in placental development.
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Affiliation(s)
- E Jauniaux
- Academic Department of Obstetrics and Gynaecology, University College London, Medical School, UK
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Ettore G, Guarnera S, Bianca S. Diagnosis and management of non-immune hydrops fetalis. Prenat Diagn 1998. [DOI: 10.1002/(sici)1097-0223(199811)18:11<1213::aid-pd422>3.0.co;2-v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Silver R, Moses S, Gutterman D, Kambich M, Leeth E, Casele H. The right to fetal life. Prenat Diagn 1998; 18:1213-4. [PMID: 9854739 DOI: 10.1002/(sici)1097-0223(199811)18:11<1213::aid-pd438>3.0.co;2-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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