PubMed · 5201456
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1970. The moral muddle.. https://pubmed.ncbi.nlm.nih.gov/5201456/
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Dicephalus twinning is an extremely rare type of conjoined twins. Early prenatal diagnosis of this condition is important to provide an opportunity for pregnancy termination. We present such a case, which was diagnosed by ultrasound examination at 12 weeks of gestation. The ultrasonographic criteria are discussed together with implications for management.
BACKGROUND/PURPOSE: The natural history of parenchymal lung lesions such as congenital cystic adenomatoid malformation (CCAM) and pulmonary sequestration (PS) has been altered by the advent of antenatal ultrasonography. Initial reports were characterized by a high (about 30%) incidence of adverse features (eg, hydrops) and a poor outcome and did not accord with our recent experience. The authors have reviewed the outcome of fetuses that had been diagnosed in a large tertiary referral fetal medicine unit with the aim of delineating current experience. The term cystic lung disease was used throughout to avoid unjustifiable histologic precision. METHODS: The scans of all fetuses that had been diagnosed with cystic lung disease between January 1995 and July 2001 were reviewed. The outcome of each pregnancy was established, and, where possible, all infants underwent appropriate investigations, including thoracic computed tomography (CT) scans. RESULTS: Sixty-seven fetuses had a cystic lung abnormality diagnosed from January 1995 to July 2001. The median (range) age at diagnosis was 21 (19 to 28) weeks. The lesion was right sided in 29 (43%), left in 36 (54%), and bilateral in 2 (3%); it was characterized as dominantly macrocystic in 27 (40%), microcystic in 35 (52%), and mixed in 5 (8%). Mediastinal shift was present in 30 fetuses (45%). Severe signs of fetal distress (eg, hydrops) were present in 5 fetuses (7%). Antenatal intervention was performed in 4 fetuses (thoraco-amniotic shunts [n = 3] and percutaneous intrauterine laser therapy [n = 1]). Sixty-four (96%) of the fetuses were born alive. There was 1 termination of pregnancy and 2 intrauterine deaths (all severe microcystic lesions). Forty-two infants (63%) underwent thoracotomy and appropriate excisional surgery at a median of 7.5 months (range, 1 day to 34 months). Two infants (which included the fetus having intrauterine laser therapy) died early in the postnatal period. Both were large microcystic lesions and had antenatal features of severe fetal distress. Twelve infants were investigated in the postnatal period but did not undergo surgery. Ten infants were not appropriately investigated or were lost to follow-up. Histologic examination showed definitive diagnostic features of CCAM (n = 25) or PS (n = 6). Other lesions with hybrid features of both were also seen (n = 11). There was a degree of correlation between antenatal ultrasound features (size of cyst [P =.03], in-utero behavior [P =.06], mediastinal shift [P = 0.05]) and the need for surgery but not with the final histologic diagnosis. Surgical excision was required in 45% of lesions showing late-gestation "resolution." CONCLUSIONS: Antenatally diagnosed "cystic lung disease" has an excellent prognosis in the absence of signs of severe fetal distress. The need for surgery should be based on appropriate postnatal investigations (eg, CT scans), rather than on antenatal behavior.
BACKGROUND: First-trimester abortion in women with cervical stenosis results in difficult or impossible suction curettage. We present the case of an early pregnancy in a woman with cervical stenosis after cone biopsy in which the pregnancy was terminated by transvaginal needle aspiration of the gestational sac under echographic guidance. CASE: A 31-year-old woman, gravida 6, para 3, abortus 2, with a history of grade 3 cervical intraepithelial neoplasia after cervical conization, presented at 6 weeks' gestation and requested pregnancy termination. A cervical examination disclosed that the cervix was difficult to outline and that the external os could not be identified. Under the guidance of endovaginal sonography, a 16-gauge needle was introduced into the gestational sac through the anterior portion of the vagina. Intracardiac injection of potassium chloride was first attempted to stop fetal cardiac activity. The sac tissue was then aspirated, followed by repeated normal saline irrigation. The patient's postoperative course was smooth and was monitored in the outpatient department. CONCLUSION: For termination of early pregnancy complicated by cervical stenosis, whether due to blighted ovum, intrauterine fetal death or elective abortion, needle aspiration under the guidance of transvaginal sonography is safe and effective.