In-utero development of the fetal colon and rectum: sonographic evaluation

OBJECTIVE

To construct a normal range for the internal diameter of the fetal descending colon and rectum during gestation.

SUBJECTS AND METHODS

This was a prospective, cross-sectional study including 379 healthy pregnant women with normal singleton pregnancies at 19-40 weeks of gestation. Measurements of the fetal descending colon (maximum internal diameter) and the fetal rectum (at the level of the bladder, measuring the anteroposterior diameter), were performed by high-resolution transabdominal sonography.

RESULTS

Adequate bowel measurements were obtained in all 379 fetuses. The diameter of the descending colon and rectum plotted as a function of gestational age had a sigmoid curve; the curve estimation was expressed by a cubic regression equation with R(2) of 0.848 and 0.831, respectively (P < 0.0001). The normal mean and the 95% prediction limits were defined.

CONCLUSION

The present data provide a normal range of fetal bowel (descending colon and rectum) diameters from the early second trimester of pregnancy onwards. They may allow intrauterine assessment of the development of the fetal colon and may serve as reference values in the detection of anomalies of the fetal bowel.

Acute adrenal insufficiency during pregnancy and puerperium: case report and literature review

Acute adrenal dysfunction during pregnancy is rare. Nevertheless, adrenal insufficiency can present as an adrenal crisis, and may be life threatening. There is a wide range of clinical symptoms and signs, and the differential diagnosis is challenging. A full adrenal and pituitary evaluation, both structural and hormonal, must be performed to reach the correct diagnosis, and appropriate treatment must not be delayed. A case is presented of acute adrenal insufficiency that occurred 24 hours after a cesarean delivery. The initial symptoms included hypoglycemic seizures and coma. The workup, both hormonal and structural, revealed isolated adrenocorticotrophic hormone deficiency. This considers this case and reviews the differential diagnosis, diagnostic workup, and the treatment of adrenal dysfunction in pregnancy and the puerperium, as well as the obstetric outcome in women suffering from this disorder.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader will be able to understand the various presentations of hypopituitarism, the various etiologies of this condition, and the appropriate work up and management of a patient with hypopituitarism.

Anaphylactic shock during hysteroscopy using Hyskon solution: case report and review of adverse reactions and their treatment

Dextran 70 (Hyskon) solution, as many other substances, is in current use as distension medium during hysteroscopy. The advantages of Hyskon solution are its nonconductivity and immiscibility with blood, allowing good visibility during operative hysteroscopy. Adverse reactions to Hyskon are mainly attributable to the drug's antigenic properties and include severe anaphylactic reactions and fatalities. We report a case of anaphylactic shock during hysteroscopy using Hyskon solution as the distension medium, review the adverse reactions of Hyskon and summarize the treatment modalities used to decrease the incidence of the rare but serious adverse reactions with its use.

Ultrasound evaluation of the width of the fetal nose

The aim of the study was to construct a normal range for the width of the fetal nose during gestation. The study group included 229 healthy pregnant women with normal singleton pregnancies at 15-42 weeks of gestation. The ultrasound measurements were taken at the level of the lower border of the ala nasi, using the modified coronal view. Routine biometric measurements were obtained from the participants, including biparietal diameter, head and abdominal circumferences, cerebellum and femur lengths. Our results were used to construct objective measurements of the fetal nasal width across all gestational ages. We conclude that the nasal width can be easily measured from 15 weeks of gestation using the modified coronal view. A linear growth relationship was found between nasal width and gestational age, biparietal diameter, head and abdominal circumferences, and transcerebellar and femoral lengths. We feel that such measurements may prove useful in the diagnosis of cases at high risk for fetal facial abnormalities.

Asymptomatic paroxysmal atrial fibrillation during intravenous magnesium sulfate treatment in preeclampsia

Magnesium sulfate is commonly used as the anticonvulsant drug of choice for preeclampsia and eclampsia. It is effective, nontoxic to both mother and fetus, and side effects are rare within the therapeutic range. This report describes paroxysmal atrial fibrillation occurring at low serum levels of the drug during the treatment of preeclampsia.

Endometrial ablation using hysteroscopic instillation of hot saline solution into the uterus

OBJECTIVE

To evaluate the clinical effectiveness and safety of endometrial ablation by hysteroscopic instillation of hot saline using the Hydro-Therm-Ablator (HTA) system.

METHODS

A total of 14 patients with menorrhagia, underwent the HTA procedure under general anethesia. Follow up of 9-18 months is reported. Three patients had undergone tubal ligation years before the procedure and one underwent it immediately after HTA at the same session.

RESULTS

One procedure was cancelled due to technical problems, and roller-ball ablation was performed. There were no procedure related complications. A total of 11 patients reported significant reduction in bleeding, or amenorrhea, 9-18 months after the HTA procedure. One patient, although eumenorrheic after the ablation, considered the procedure a failure and requested hysterectomy. One patient with menorrhagia 3 months after the procedure, had a second HTA ablation and is now amenorrheic.

CONCLUSIONS

This series of patients who underwent HTA ablation had successful reduction of menorrhagia to oligomenorrhea or amenorrhea.

Nuchal fold thickness at 14-16 weeks' gestation as measured by transvaginal sonography

OBJECTIVE

To establish normal values of fetal nuchal fold thick-ness at 14-16 weeks of gestation by transvaginal sonography.

METHODS

Transvaginal sonography was used to measure nuchal fold thickness in 182 normal pregnancies at 14-16 weeks of gestation. Nuchal fold thickness was measured as the distance from the outer skull bone to the outer skin surface in the transverse axial image in the suboccipital-bregmatic plane of the head.

RESULTS

There was no significant association between nuchal fold thickness and gestational age (r = 0.084; P = 0.258). The mean (standard deviation) was 2.2 (0.5) mm and the 95th centile was 3.0 mm.

CONCLUSIONS

The 95th centile of nuchal fold thickness measured by transvaginal sonography at 14-16 weeks is 3.0 mm.

Prenatal sonographic diagnosis of persistent right umbilical vein with varix

Persistence of the right umbilical vein is variably associated with life-threatening malformations of the fetal genitourinary, gastrointestinal, cardiac, and skeletal systems. Varices of the intraabdominal umbilical vein, although not necessarily associated with other malformations, do seem to carry a risk of fetal mortality, especially if they are large or appear early during the pregnancy. We report the prenatal diagnosis of the rare combination of persistence and varix of the right umbilical vein in an otherwise healthy infant.

Normal cardiac flow velocities at 14-16 weeks of gestation measured by transvaginal ultrasound

OBJECTIVE

Doppler ultrasound has been used to study the flow velocities through the valves and arteries of the fetal heart. Using transvaginal sonography, we sought to determine normal values for flow velocities through the fetal heart valves at 14-16 weeks of gestation.

METHODS

Eighty-seven normal fetuses were examined. The flow velocity waveforms were visualized using Doppler ultrasound with the sample volume calipers placed just distally to the four fetal valves. Peak E- and A-wave velocities were recorded for the tricuspid and mitral valves and peak systolic flow velocities were recorded for the ascending aorta and pulmonary arteries. Linear regression for comparison of flow velocities with gestational age was performed.

RESULTS

There was no significant correlation between any of the velocities and gestational age.

CONCLUSIONS

Flow velocities through the fetal cardiac valves remain unchanged at 14-16 weeks of gestation as measured by transvaginal Doppler sonography.