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Prenatal diagnosis of Klippel–Trenaunay–Weber syndrome with Kasabach–Merritt syndrome in utero. J Med Ultrason (2001) 2014; 42:109-12. [DOI: 10.1007/s10396-014-0557-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/04/2014] [Indexed: 12/20/2022]
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Abstract
INTRODUCTION Klippel-Trenaunay-Type Syndrome (KTTS) is a rare congenital anomaly with variable expression and an unknown etiology characterized by capillary and venous malformations and hypertrophy of bone and soft tissue. Pregnancy has been rarely reported in patients with KTTS and since 1989 there have been only 13 case reports of pregnancy in women with KTTS reported in the literature. Concurrent pregnancy is associated with adverse perinatal outcomes. To the best of our knowledge this is the second reported, and largest, series of cases. STUDY DESIGN After a thorough review of the literature, the medical records of four obstetrical patients with KTTS were reviewed. RESULTS The obstetrical course of women with KTTS varies. Complications include bleeding, DIC, thromboembolic events, and pain. CONCLUSIONS The maternal and fetal risks associated with pregnancy in women with KTTS are proportional to the severity of disease, which can be exacerbated by pregnancy. Thoughtful preconceptional counseling, along with methodical and systematic intrapartum and postpartum care are keys to reducing mortality and morbidity.
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Affiliation(s)
- Susan R Stein
- Department of Obstetrics & Gynecology, Banner Good Samaritan Medical Center, Phoenix, Arizona 85006, USA.
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Peng HH, Wang TH, Chao AS, Chang YL, Shieh SC, Chang SD. Klippel-Trenaunay-Weber syndrome involving fetal thigh: prenatal presentations and outcomes. Prenat Diagn 2006; 26:825-30. [PMID: 16832837 DOI: 10.1002/pd.1512] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We analyzed the prenatal presentations and perinatal outcomes of Klippel-Trenaunay-Weber syndrome involving fetal thigh in order to provide relevant information for prenatal counseling. METHODS We reviewed our own cases and searched for cases from Medline that met the criteria of Klippel-Trenaunay-Weber syndrome involving fetal thigh. Those with isolated hemangioma, hemangioendothelioma, and hemangiolymphangioma were excluded. RESULTS The cases of Klippel-Trenaunay-Weber syndrome involving fetal thigh, totaling 21, were collected for analysis. These included 19 cases from Medline search and two cases from our institution. The cases with lesions involving right thigh, left thigh, and both thighs were 12:8:1. The gender of affected fetuses was 9 male, 9 female, and 3 unknown. Among the 21 cases, 6 fetuses (28.57%, 6/21) had isolated thigh lesions, and the other 15 cases (71.43%, 15/21) had extensive lesions involving pelvis, abdomen, retroperitoneum, or thorax. Prenatal presentations varied with hypoechoic cystic mass with limb asymmetry, 95.23% (20/21); polyhydramnios, 38.09% (8/21); cardiomegaly, 19.04% (4/21); thick placenta, 9.52% (2/21); nonimmune hydrops fetalis, 9.52% (2/21); and oligohydramnios, 4.76% (1/21). Ten cases (47.62%, 10/21) underwent termination of pregnancy. For those who continued with pregnancy, the rate of complications with Kasabach-Merritt syndrome was 36.36% (4/11) and the mortality rate in the neonatal period was 45.45% (5/11). The causes of neonatal mortality in these five cases included consumption coagulopathy (Kasabach-Merritt syndrome), cardiac failure, sepsis, and prematurity. CONCLUSIONS Klippel-Trenaunay-Weber syndrome involving fetal thigh is rare. Our review showed that the location of involvement on the right thigh is more than on the left. Males and females were equally affected. Nearly three fourths of the cases had extensive involvement over other parts of the body. Prenatal ultrasound finding of a raised thigh mass of significant size and limb asymmetry were the most important features. The mortality rate was as high as 45.45% in the neonatal period.
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Affiliation(s)
- Hsiu-Huei Peng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Lin-ko Medical Center, Tao-Yuan, Taiwan
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Martin WL, Ismail KM, Brace V, McPherson L, Chapman S, Kilby MD. Klippel-Trenaunay-Weber (KTW) syndrome: the use of in utero magnetic resonance imaging (MRI) in a prospective diagnosis. Prenat Diagn 2001; 21:311-3. [PMID: 11288124 DOI: 10.1002/pd.48] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The diagnosis of the Klippel-Trenaunay-Weber (KTW) syndrome is rarely made antenatally. We report the use of both ultrasound and in utero magnetic resonance imaging (MRI) in the prenatal diagnosis of this syndrome. This is the first report of the use of prenatal MRI in the diagnosis of this condition. There was concordance in the findings of both modalities, with limb hypertrophy, and multiple haemangiomata - both subcutaneous and internally - demonstrated with ultrasound and MRI. The patient elected to terminate the pregnancy because of associated oligohydramnios and a small fetal chest noted at 20 weeks. The postmortem examination confirmed the antenatal diagnosis.
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Affiliation(s)
- W L Martin
- Department of Reproductive and Child Health, Birmingham Women's Hospital, Metchley Lane, Edgbaston, Birmingham B15 2TG, UK
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Shih JC, Shyu MK, Chang CY, Lee CN, Lin GJ, Chen WH, Fan YT, Hsieh FJ. Application of the surface rendering technique of three-dimensional ultrasound in prenatal diagnosis and counselling of Klippel-Trenaunay-Weber syndrome. Prenat Diagn 1998; 18:298-302. [PMID: 9556049 DOI: 10.1002/(sici)1097-0223(199803)18:3<298::aid-pd251>3.0.co;2-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Klippel Trenaunay-Weber syndrome is a complex developmental disorder characterized by a triad of cutaneous haemangioma, varicosities of the body, and unilateral limb hypertrophy. We describe the prenatal diagnosis of Klippel-Trenaunay-Weber syndrome at 15 weeks' gestation using the surface rendering technique of three-dimensional ultrasound. The vivid three-dimensional images of the affected fetus are invaluable in prenatal diagnosis and parental counselling.
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Affiliation(s)
- J C Shih
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University Hospital, Taipei
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Christenson L, Yankowitz J, Robinson R. Prenatal diagnosis of Klippel–Trénaunay–Weber syndrome as a cause forin utero heart failure and severe postnatal sequelae. Prenat Diagn 1997. [DOI: 10.1002/(sici)1097-0223(199712)17:12<1176::aid-pd202>3.0.co;2-h] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Jorgenson RJ, Darby B, Patterson R, Trimmer KJ. Prenatal diagnosis of the Klippel-Trenaunay-Weber syndrome. Prenat Diagn 1994; 14:989-92. [PMID: 7899273 DOI: 10.1002/pd.1970141015] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The Klippel-Trenaunay-Weber syndrome is a complex developmental disorder of the vascular and skeletal systems. While many features of the syndrome are congenital, it has not been diagnosed often before birth. This paper describes a case of Klippel-Trenaunay-Weber syndrome diagnosed at 19 weeks' gestation on the basis of sonographic findings and family history. The clinical variability of the syndrome is emphasized and the importance of family history in differential diagnosis is stressed.
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Yankowitz J, Slagel DD, Williamson R. Prenatal diagnosis of Klippel-Trénaunay-Weber syndrome by ultrasound. Prenat Diagn 1994; 14:745-9. [PMID: 7527539 DOI: 10.1002/pd.1970140816] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Ultrasound examination due to an elevated maternal serum alpha-fetoprotein level showed lower extremity asymmetry. The findings were felt to be consistent with Klippel-Trénaunay-Weber syndrome. The pregnancy was terminated based on these findings. The ultrasound findings, confirming post-mortem examination, and counselling issues are discussed.
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Affiliation(s)
- J Yankowitz
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City 52242-1080
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Hayashi M, Kurishita M, Sodemodo T, Kozu H, Kumasaka T, Saiki S. Prenatal ultrasonic appearance of the Klippel-Trenaunay-Weber syndrome mimicking sacrococcygeal teratoma with an elevated level of maternal serum hCG. Prenat Diagn 1993; 13:1162-3. [PMID: 8177838 DOI: 10.1002/pd.1970131217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Bybee DE, Metzger BE, Freinkel N, Dooley SL. Amniotic fluid prolactin in the third trimester of pregnancies complicated by gestational or pregestational diabetes mellitus. Metabolism 1990; 39:714-8. [PMID: 2195293 DOI: 10.1016/0026-0495(90)90106-m] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Amniotic fluid concentrations of immunoreactive prolactin were measured during the third trimester in 184 diabetic gravidas and correlated with concurrent levels of prolactin in maternal plasma. Prolactin measurements concorded with previously published estimates in normal gravid women and averaged 825 +/- 32 ng/mL (mean +/- SEM) in amniotic fluid and 168 +/- 6.5 ng/mL in simultaneously sampled plasma. Cross-sectional and longitudinal analyses indicated that the prolactin levels in amniotic fluid of pregnant diabetics declined significantly between weeks 32 and 40 of gestation, whereas plasma levels did not change consistently during the same interval. Mean values for amniotic fluid prolactin did not correlate with simultaneous prolactin concentrations in plasma, nor with maternal age, clinical estimates of polyhydramnios, amniotic fluid creatinine content, or lecithin/sphingomyelin (L/S) ratios or subsequent birth weight of the offspring. Clear-cut correlations with overall maternal glucose regulation could not be demonstrated. However, subtle effects may be operative since amniotic fluid prolactin displayed weak but significant correlations with concurrent levels of maternal plasma glucose, and mean values for hemoglobin A1c (HbA1c) but not with mean values for fasting plasma glucose (FPG). Amniotic fluid prolactin concentrations were significantly greater in patients with pregestational diabetes (White classes C, D, and F) than in women with gestational diabetes mellitus (GDM) (our classes A1, A2, and B1). The differences could not be accounted for by differences in metabolic regulation, maternal age, or weights of these two populations.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D E Bybee
- Center for Endocrinology, Metabolism and Nutrition, Northwestern University Medical School, Chicago, IL 60611
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Baxi LV, Fairne D, Frantz AG, Freda V, Stark R. Amniotic fluid prolactin levels in rhesus isoimmunized patients. Int J Gynaecol Obstet 1989; 30:313-6. [PMID: 2576538 DOI: 10.1016/0020-7292(89)90816-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The concentration of prolactin in the amniotic fluid (AFPRL) was measured in 75 samples obtained in the third trimester of 14 isoimmunized women. There was a uniform decline in prolactin levels with advancing gestation in each pregnancy (r = -0.89 to -0.99). The decline in AFPRL was similar in uncomplicated pregnancies. AFPRL levels were not predictive of umbilical cord hemoglobin or bilirubin levels and amniotic fluid lecithin/sphingomyelin ratio.
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Affiliation(s)
- L V Baxi
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York
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Fadel HE, Saad SA, Davis H, Nelson GH. Fetal lung maturity in diabetic pregnancies: relation among amniotic fluid insulin, prolactin, and lecithin. Am J Obstet Gynecol 1988; 159:457-63. [PMID: 3044115 DOI: 10.1016/s0002-9378(88)80108-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Insulin, prolactin, and lecithin phosphorus levels were measured in 97, 62, and 44 amniotic fluid samples from third trimester normal, gestational diabetic, and insulin-dependent diabetic patients, respectively. There was no difference in lecithin phosphorus concentration (index of fetal lung maturity) among the three groups. The amniotic fluid insulin level was significantly higher in insulin-dependent diabetic patients, whereas there was no difference in amniotic fluid prolactin levels among the groups. Correlations of amniotic fluid prolactin levels with both lecithin phosphorus and insulin levels were not statistically significant in any of the groups. This is probably because amniotic fluid prolactin is decidual, rather than fetal, in origin. Even though amniotic fluid insulin levels, which reflect fetal levels, were significantly higher in insulin-dependent diabetic patients, there was no difference in the amniotic fluid lecithin phosphorus concentration in diabetic pregnancies compared with that in normal pregnancies. Moreover, there was a positive, and not a negative, correlation between amniotic fluid insulin and amniotic fluid lecithin phosphorus levels in diabetic pregnancies. These results do not support the theory that fetal hyperinsulinemia results in delayed pulmonic maturation in diabetic pregnancies.
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Affiliation(s)
- H E Fadel
- Department of Obstetrics and Gynecology, Medical College of Georgia Hospital and Clinics, Augusta
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Ogren L, Talamantes F. Prolactins of pregnancy and their cellular source. INTERNATIONAL REVIEW OF CYTOLOGY 1988; 112:1-65. [PMID: 3045043 DOI: 10.1016/s0074-7696(08)62005-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- L Ogren
- Department of Biology, University of California, Santa Cruz 95064
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Handwerger S, Freemark M. Role of placental lactogen and prolactin in human pregnancy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1987; 219:399-420. [PMID: 3324681 DOI: 10.1007/978-1-4684-5395-9_19] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In summary, studies from our and other laboratories strongly suggest that placental lactogen has direct effects on fetal growth and metabolism as well as on maternal metabolism. Prolactin may be important in the regulation of water and ion transport across the amnion, the production of surfactant by the fetal lung, and the immune response during pregnancy. A summary of the postulated effects of placental lactogen on maternal and fetal physiology is depicted in Figure 9 and a summary of the postulated effects of prolactin during pregnancy is shown in Table 6. Undoubtedly, future studies of the physiology of placental lactogen and prolactin will uncover new functions for these hormones during gestation.
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Affiliation(s)
- S Handwerger
- Department of Pediatrics, Duke University Medical Center, Durham, NC
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Andersen JR, Borggaard B, Olsen EB, Stimpel H, Nyholm HC, Schroeder E. Amniotic fluid prolactin, decidual prolactin content and decidual prolactin secretion into hypo-, iso-, and sodium chloride hyperosmotic media in vitro in pregnant diabetics at term. ACTA DIABETOLOGICA LATINA 1986; 23:301-7. [PMID: 3551426 DOI: 10.1007/bf02582063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study evaluated in pregnant women with diabetes mellitus (DM) the prolactin (PRL) concentration in amniotic fluid (A-PRL), the initial decidual PRL content (D-PRL), and the decidual PRL secretion (D-PRL-s) in vitro into isosmotic (315 mmol/kg), hyperosmotic (426 mmol/kg) and hyposmotic (252 mmol/kg) media. Decidual tissue was collected at term from 18 normal pregnancies and from 23 women with DM (White's classification: 7 of class A (without insulin treatment) and 16 of the classes B-F. Twelve of the women with DM had signs of hydramnion. Amniotic fluid specimens were collected from 52 normal pregnancies and 17 of the women with DM. No significant difference was found between normals and diabetics when D-PRL, D-PRL-s into isosmotic medium and A-PRL were compared. No trends could be detected when the insulin treated women were grouped according to White's classification. The increment of D-PRL-s into hyperosmotic medium was 15% in normals (p less than 0.001 compared with isosmotic medium), in the DM group 23% for the non-insulin-treated women (p less than 0.05 when compared with normals) and 25% for the insulin treated women (p less than 0.01). In normals the hyposmotic medium reduced D-PRL-s by secretion 19% (p less than 0.001 compared with isosmotic medium) but no significant difference was observed between normals and diabetic groups (p greater than 0.10). In the group of diabetics no significant difference was found in any of the PRL quantities investigated between those with and without hydramnion.(ABSTRACT TRUNCATED AT 250 WORDS)
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Johnson JW, Tyson JE, Mitzner W, Beck JC, Andreassen B, London WT, Villar J. Amniotic fluid prolactin and fetal lung maturation. Am J Obstet Gynecol 1985; 153:372-80. [PMID: 3840333 DOI: 10.1016/0002-9378(85)90073-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Concentrations of prolactin in amniotic fluid, fetal plasma, and maternal plasma were determined in 34 rhesus monkeys delivered by hysterotomy under general anesthesia at gestational ages of 110 to 160 days (term, 165 days). Included were 15 cases (gestational ages 110 to 143 days) in which the mothers received 2 mg of betamethasone intramuscularly daily for 3 days prior to delivery. Fetal lung maximum volumes were determined in addition to the following indices of fetal lung surfactant: lung alveolar stability, lung phosphatidylcholine concentrations, lung extract surface tensions, and amniotic fluid lecithin to sphingomyelin ratios. Amniotic fluid prolactin was found to correlate significantly with lung alveolar stability (r = 0.51; p less than 0.01), lung phosphatidylcholine (r = 0.51; p less than 0.01), lung extract surface tension (r = -0.39, p less than 0.05) and amniotic fluid lecithin/sphingomyelin ratio (r = 0.50; p less than 0.01). These correlations remained statistically significant even when the effects of gestational age were taken into account. These findings suggest that amniotic fluid may modulate fetal production of surfactant via its prolactin content.
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Seoud M, Santos-Ramos R, Friedman JM. Early prenatal ultrasonic findings in Klippel-Trenaunay-Weber syndrome. Prenat Diagn 1984; 4:227-30. [PMID: 6087308 DOI: 10.1002/pd.1970040312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Routine sonography prior to genetic amniocentesis revealed the presence of a large complex mass with pulsating channels over the anterior fetal chest wall. This led to early termination of pregnancy in a fetus affected with the rare Klippel-Trenaunay-Weber Syndrome.
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