Multiple cardiac rhabdomyomas detected in utero

Prenatal fetal echocardiography studies detected large multiple cardiac rhabdomyomas and led to the diagnosis of tuberous sclerosis. Despite episodes of bradyarrhythmias and severe lung compression in utero, the neonate did well and was discharged home on day 20 of life. On day 30 of life, the infant expired at home from cardiac arrest secondary to arrhythmia.

Transverse vaginal septum: case report and review of the literature

A case of perforated complete transverse vaginal septum in the upper third of the vagina in a patient presenting at 19 years of age for evaluation of primary infertility. Diagnosis was made by hysterosalpingography. The patient was treated surgically and conceived 2 months after the procedure. The finding of transverse vaginal septum in an asymptomatic infertility patient is highly unusual. We reviewed the literature since 1966 and summarized 73 cases. The review confirms the benign characteristics of this rare anomaly and supports the embryonic origin of the transverse septum from the vaginal plate.

Mood disorders, psychiatric symptoms, and distress in women presenting for infertility evaluation

Women who undergo treatment for infertility frequently report depression, but it is crucial to distinguish between subjective distress, symptoms, and clinical depressive disorders. In the initial assessment of a prospective, longitudinal study, 59 women presenting for infertility treatment were compared with 35 women presenting for routine gynecological care. Infertility patients and controls were not significantly different on self-report measures of partner satisfaction, sexual functioning, or self-esteem. There was also no difference in psychiatric symptomatology, or in the percentage of subjects who were currently experiencing or had ever experienced a major depressive episode. However, the infertility patients perceived themselves to have been already quite affected by their inability to conceive. For instance, 49.2% reported changes in their sexual functioning and 74.6% reported changes in their mood.

Elevated alpha-fetoprotein in pregnancy complicated by aplasia cutis after exposure to methimazole

A case of aplasia cutis after exposure to methimazole (Tapazole) in early pregnancy is described. Elevated maternal serum alpha-fetoprotein (MSAFP) and amniotic fluid alpha-fetoprotein (AFP) were found. Elevated MSAFP and amniotic fluid AFP in women exposed to methimazole may suggest this rare fetal condition.

Prenatal diagnosis of sickle hemoglobinopathies: the experience of the Columbia University Comprehensive Center for Sickle Cell Disease

We report here an evaluation of 55 pregnancies at risk for a sickle hemoglobinopathy prenatally diagnosed by restriction-endonuclease analysis, with the endonucleases MstII and HpaI, of amniocyte DNA. The diagnosis was completed in all cases. Eleven fetuses were predicted to be affected, of which six were terminated. Forty-one of the 55 cases were confirmed. One false-negative was reported in a case predicted to be hemoglobin AS but that was determined to be hemoglobin SS at birth. We estimate that the 55 cases represent only 5% of the pregnancies at risk for a sickle hemoglobinopathy in the New York metropolitan area during the study period. We conclude that the prenatal diagnosis of sickle hemoglobinopathies by molecular methods is reliable. However, the efficiency of utilization and effectiveness of prenatal testing is dependent on the early prospective identification of couples at risk and on the education of communities concerning the significant morbidity of the sickle hemoglobinopathies and the reproductive choices now available to them.

Herrmann-Opitz syndrome: report of an affected fetus

In 1969, Herrmann and Opitz described a syndrome of acrocephaly, oligosyndactyly, hypertelorism, and mental retardation. We report on a second case, a fetus with cleft palate, urethral astresia, oligohydramnios, and intrauterine death.

Hydrolethalus (Salonen-Herva-Norio) syndrome: further clinicopathological delineation

Two brothers with severe CNS abnormalities, cleft lip/palate, polydactyly, and lung hypoplasia are reported as examples of the hydrolethalus syndrome, an autosomal recessive disorder. Death from cardiopulmonary arrest occurred in patient 1 at age 4 months and in patient 2 at age 17 days. Detailed radiological and neuropathological description is provided on patient 2. We recommend realtime ultrasonography and, when indicated, fetoscopy for antenatal detection of the craniofacial and limb malformations associated with this syndrome.

Improved methods of direct and cultured chromosome preparations from chorionic villous samples

A new method is described for preparing direct mitotic chromosome spreads from chorionic villous samples, which has resulted in sufficiently high yields of well-banded metaphases to permit a complete standard chromosomal diagnosis in 20 of 20 cases. A method of establishing monolayer cultures from this material that can be harvested from 3 to 7 days after initiation is also presented.

Genetic counseling before prenatal diagnosis for advanced maternal age: an important medical safeguard

Genetic counseling before amniocentesis has been advocated by many geneticists with little evidence to support their contention. Records of patients referred exclusively for advanced maternal age were evaluated for additional diagnostic information obtained from the genetic counseling process that could place these patients at additional risks for previously unsuspected fetal abnormalities. A significant number of patients (43.3%) were at additional risk or had significant concerns regarding one or more hereditary or congenital disorders requiring extensive genetic counseling. The results of the present study provide a scientific basis for the consideration of genetic counseling as a standard part of all prenatal diagnostic procedures.