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PubMedDate not supplied

Lung pathology in patients with congenital diaphragmatic hernia treated with fetal surgical intervention, including tracheal occlusion.

Fetal intervention for congenital diaphragmatic hernia was developed to lessen the high morbidity and mortality of pulmonary hypoplasia. Lung pathology and morphometry in patients treated with fetal intervention have not been described. We report clinical and autopsy findings, as well as basic lung morphometry in 16 cases of congenital diaphragmatic hernia with fetal intervention (12 cases tracheal occlusion; 4 cases hernia repair), and 19 cases of congenital diaphragmatic hernia without fetal intervention. All patients who underwent fetal intervention were born premature. Lung enlargement with increased lung-to-body weight ratio was observed with fetal tracheal occlusion, accompanied by lower than normal radial alveolar counts and increased alveolar size. Patients treated with tracheal occlusion also had early alveolar development (at 29.8, 30.6, and 30.9 wk postconceptual age) as well as mucous fluid pooling in airways and alveoli. All cases showed severe alveolar septal widening, more extensive in patients without fetal intervention. When grouped by postconceptual age, no statistically significant difference was found between patients with and without fetal intervention with respect to lung-to-body weight ratio, radial alveolar count, mean alveolar length, and relative arteriolar media thickness. Lung enlargement has been observed with fetal tracheal occlusion sonographically; our studies suggest that this is due in part to emphysema and mucous fluid pooling. The lung remains abnormal with low radial alveolar counts and increased alveolar size. Tracheal occlusion did not prevent development of lung pathology associated with pulmonary hypoplasia.

Female↗
PubMed1975

Recognition of meconium staining of the liquor aminii at amnioscopy.

The results of a prospective investigation into the reliability of amnioscopy in the detection of meconium staining of the liquor amnii is presented. Under the conditions which prevail in most obstetric units, amnioscopy was found to be an unreliable method of detecting meconium staining of the liquor amnii. False-positive findings are infrequent but false-negative findings are common.

Amnion↗
PubMed1980

Contact hysteroscopy: another method of endoscopic examination of the uterine cavity.

Recently there has been renewed interest in hysteroscopy which, since its discovery a century ago, has been in a state of uncertainty. Classical hysteroscopes all require the dilatation of the uterine cavity by the injection of a fluid under pressure. With contact hysteroscopy, the image is obtained by the applciation of the end of the apparatus against the uterine mucosa. This simplifies the equipment and opens up new possibilities. The results of more than 1,000 contact hysteroscopies done in the various circumstances of gynecology and the pathology of pregnancy are presented. The facility of this technique should contribute to the increased use of visual exploration of the uterine cavity, the advantages of which have already been shown.

Congenital Abnormalities↗
PubMed1981

Evaluation of elective repeat cesarean section as a standard of care: an application of decision analysis.

The rationale for routine repeat cesarean section (RCS) is avoidance of uterine rupture during labor. However, the incidence of uterine rupture following modern cesarean section is low, and the charge for cesarean section is greater than that for a trial of labor (TOL). The technique of decision analysis was used to investigate strategies of elective RCS and TOL with precautionary monitoring. Hypothetical cohorts of 10,000 pregnant women with previous low-transverse cesarean incisions were assumed. Probability data were obtained from the literature. In the TOL cohort, 6,623 patients were delivered vaginally. Uterine rupture occurred in 73 patients. In spite of this, TOL resulted in 37 fewer perinatal deaths and 0.7 fewer maternal deaths than elective RCS. The excessive perinatal mortality in the RCS cohort was related to iatrogenic prematurity that is now avoidable with the lecithin/sphingomyelin test. Direct costs were $5 million greater in the RCS cohort. We concluded that in contemporary practice mortality rates are essentially equal for both delivery practices. However, substantial cost savings are available with TOL.

Cesarean Section↗
PubMed1982

The association between the absence of amniotic fluid bacterial inhibitory activity and intra-amniotic infection.

We studied the relationship of amniotic fluid bacterial inhibition in 50 patients with intra-amniotic infection to that in 50 matched control patients. Amniotic fluid was collected through a transcervical intrauterine catheter. All infected patients had clinical signs of intra-amniotic infection and greater than or equal to 10 2 colony-forming units per milliliter of a high-virulence organism. None of the control patients became infected. The matching characteristics for the intra-amniotic infection group versus the control group were: interval from rupture of the membranes to delivery (14.30 +/- 7.96 versus 15.00 +/- 7.19 hours, NS), interval from rupture of the membranes to collection of amniotic fluid (12.41 +/- 6.37 versus 12.16 +/- 6.46 hours NS), and gestational age (40.3 +/- 1.6 versus 40.0 +/- 1.6 weeks, NS). All patients were in labor. We tested each sample of amniotic fluid for inhibitory activity to Escherichia coli by a plate-count technique. Thirty-five samples (70%) of intra-amniotic infection fluid were noninhibitory, whereas 16 samples (32%) of control fluid were noninhibitory. The conclusion was that amniotic fluid from patients with intra-amniotic infection was significantly less likely to be inhibitory to E. coli (p less than 0.001).

Adolescent↗
PubMed1982

Midtrimester intrauterine exchange transfusion of the fetus.

Thirty-seven fetuses, 15 to 23 weeks' gestation, were subjected to intrauterine exchange transfusion under direct vision with a fetoscope prior to therapeutic abortion. A maximum of 30 ml of blood was exchanged, so that as much as 95% of the blood in the fetoplacental circulation was of donor origin. The technique clearly has potential value in the management of severe rhesus-hemolytic disease of newborn infants.

Blood Transfusion, Intrauterine↗
PubMed1983

Fetoscopic visualization in second-trimester pregnancies.

Fetoscopic visualization may be required for the prenatal diagnosis of external fetal malformations which cannot be clearly defined by ultrasound. The synchronous use of real-time ultrasound guidance during the fetoscopic procedure has permitted successful visualization to be achieved in pregnancies of greater than 18 weeks' gestation. The chances of successful visualization and the influence of advancing gestational age have been critically evaluated. Between 18 and 23 weeks', when these techniques were used, advancing gestational age did not appear to exert a significant effect on the chances of successful visualization. Analysis of placental position indicated that an anterior placenta did not significantly affect bloodstaining of the fluid or preclude access to placental vessels for blood sampling.

Adolescent↗
PubMed1984

The management of severe rhesus isoimmunization by fetoscopic intravascular transfusions.

Twenty-five severely rhesus-isoimmunized fetuses, including 15 with hydrops fetalis, underwent a total of 77 intrauterine transfusions between 19 and 32 weeks' gestation. Fifty-eight of the procedures were fetoscopically directed intravascular transfusions, nine were ultrasound-guided intraperitoneal transfusions, and 10 were a combination of intravascular transfusion, fetal paracentesis, and intraperitoneal transfusion. The average number of antenatal procedures per patient was three (range, one to five). The survival rate for the 19 fetuses that received their initial intrauterine transfusion at or before 25 weeks' gestation was 84%; 11 of the 13 hydropic fetuses and five of the six fetuses without antenatal evidence of hydrops survived. In six cases hydrops fetalis was reversed in utero. The outcome in patients referred after 25 weeks' gestation was poor; neither of the two hydropic fetuses and only two of the four nonhydropic ones survived, which suggests the importance of early referral to a team experienced in the management of this problem. However, most of these fetal losses occurred early in the series. Seven of the 20 neonates were hydropic, and nine had severe thrombocytopenia (platelet count, less than 50,000 X 10(6)/L). The mean cord blood hematocrit and bilirubin of the neonates were 25.1% and 82 mumol/L, respectively. The babies required a total of 69 exchange transfusions (range, 0 to 9) and 68 simple transfusions (range, 0 to 25). One newborn infant who had had ultrasound evidence of hydrops fetalis at 22 weeks' gestation did not require any exchange transfusions. Nine patients required intermittent positive pressure ventilation (eight had respiratory distress syndrome and one had apnea) for a range of 1 to 86 days. The neonatal survival rate was 90% (18/20).

Blood Transfusion, Intrauterine↗
PubMed1994

Transvaginal ultrasonography and transabdominal embryoscopy in the first-trimester diagnosis of Smith-Lemli-Opitz syndrome, type II.

OBJECTIVE: Our goal was to demonstrate the efficacy of transabdominal embryoscopy in the first trimester of pregnancy. STUDY DESIGN: A patient at risk for Smith-Lemli-Opitz syndrome, type II, was referred for prenatal diagnosis at 11 weeks 5 days of gestation. RESULTS: A transvaginal ultrasonographic examination revealed the presence of a nuchal membrane and bilateral polydactyly. A transabdominal embryoscopy confirmed the diagnosis of polydactyly. The patient had an unremarkable postprocedure course before termination of pregnancy 5 days later. In a second pregnancy embryoscopy revealed a normal fetal hand despite a suggestion on transvaginal ultrasonography that there was polydactyly. On the basis of this information the patient elected to continue the pregnancy, and a normal baby was delivered at 35 weeks. CONCLUSION: This case validates the efficacy of noninvasive and invasive techniques, used adjunctively, in the first-trimester diagnosis of a lethal fetal condition composed of subtle phenotypic manifestations.

Abnormalities, Multiple↗
PubMed1995

Percutaneous fetal cystoscopy and endoscopic fulguration of posterior urethral valves.

Percutaneous fetal cystoscopy was performed in a male fetus with ultrasonographic evidence of lower urinary tract obstruction at 19 weeks of gestation. The diagnosis of posterior urethral valves was confirmed. Percutaneous endoscopic fulguration of the valves was successfully performed at 22 weeks of gestation, and urethral patency was established. This case illustrates the feasibility of performing diagnostic and therapeutic endoscopic procedures within the human fetus for the management of a congenital anomaly. While we believe that fetal cystoscopy may improve our diagnostic, prognostic, and therapeutic capabilities in the management of fetuses with lower obstructive uropathy, studies are needed to establish the actual value, risks, and limitations of this new approach in fetal medicine.

Adult↗