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PubMed1992

The severely anemic and hydropic isoimmune fetus: changes in fetal hematocrit associated with intrauterine death.

Hydrops caused by isoimmune hemolytic anemia is frequently associated with fetal death following intrauterine intravascular transfusion. To identify possible predictors of procedure-related fetal death, we examined changes in fetal blood volume and hematocrit resulting from the initial transfusion performed on 19 severely anemic, hydropic fetuses. Seven fetuses (36.8%) died at 24-72 hours after transfusion, but in no case was the procedure associated with fetal distress. There were no significant differences between fetuses who died and those who survived in terms of total volume of blood transfused, volume transfused as a percentage of total fetoplacental blood volume, hematocrit of transfused blood, post-transfusion hematocrit, umbilical vein pH, or gestational age at transfusion. Significant differences were noted between hydropic fetuses who died compared with those who survived in the mean pretransfusion hematocrit, 6.7% (+/- 2.0) versus 8.7% (+/- 1.6) (P = .03), and the relative increase in post- over pre-transfusion hematocrit, 5.5-fold (+/- 1.4) versus 3.5-fold (+/- 0.8) (P = .001). Stepwise logistic regression analysis confirmed that only the relative increase in hematocrit was predictive of fetal loss. Moreover, six of seven fetal deaths occurred when the relative increase in hematocrit was greater than fourfold, whereas ten of 12 surviving fetuses had relative increases of less than fourfold. We conclude that large, acute increases in fetal hematocrit following intrauterine transfusion are associated with substantial mortality in hydropic fetuses.

Anemia↗
PubMed2001

Are the international ultrasound reference standards appropriate for Iranian fetuses.

SUMMARY: The article describes the development of ultrasound tables for biparietal diameter (BPD), femur length (FL), abdominal circumference (AC), and head circumference (HC) for fetuses in Iran. It was attempted to determine if racial differences exist between Iranian and Australian fetuses in ultrasound measurements of BPD, HC, AC, and FL. The sample for this study consisted of 70 Iranian and 93 Australian pregnant women. The Iranian women received prenatal care and delivered at Fatemieh Hospital in Shahrood, Iran during October 1998 through February 1999. All these women had an ultrasound scan for anomalies in the second trimester. We selected only those pregnancies in which the estimated date of delivery by last menstrual period was within +/-14 days of the estimated date of delivery determined by the initial ultrasound examination. The data from Australian fetuses were obtained from the ultrasound section at the Wollongong Hospital in Australia. Birth weight differences were observed, with Australian infants being heavier than Iranian infants. The results also showed Australian fetuses have longer FL and larger HC, AC, and BPD than Iranian fetuses in the third trimester. Overall, this study shows that race-specific standards for estimating gestation age (GA) may be an important consideration in improving the accuracy of ultrasound estimation of GA. Because the evaluation of retardation growth retardation is so dependent on GA, assessment using standards specific to the Iranian race may more accurately classify infants and improve the prenatal diagnosis of fetal growth disturbances. Using European or Australian standards may cause overestimation of the rate of growth-retarded fetuses in Iranian pregnancies.

Journal Article↗
PubMed2005

Doppler, cardiotocography, and biophysical profile changes in growth-restricted fetuses.

OBJECTIVE: To assess from diagnosis to delivery the Doppler studies of the umbilical artery, middle cerebral artery, umbilical vein, ductus venosus, and amniotic fluid index of fetuses with idiopathic growth restriction. METHODS: A total of 145 singleton growth-restricted fetuses with abnormal umbilical artery pulsatility indexes were studied. Cesarean delivery was performed because of abnormal biophysical profile or nonreassuring fetal heart rate pattern. RESULTS: There were 4 fetal and 50 neonatal deaths. Two growth-restricted groups were identified: Group A (n = 44) included fetuses in whom all measures became abnormal preceding an abnormal biophysical profile or nonreassuring nonstress test. Group B (n = 101) included fetuses in whom 1 or more measures were normal at the time of cesarean delivery. There was no statistically significant difference in perinatal morbidity and mortality between the 2 groups. Neonatal death was increased in fetuses with umbilical artery reversed flow (odds ratio 2.34, 95% confidence interval 1.16-4.73; P < .05) and ductus venosus reversed flow (odds ratio 4.18, 95% confidence interval 2.01-8.69; P < .05). A significant correlation was also found between low birth weight and adverse perinatal outcome. CONCLUSION: In fetuses with idiopathic growth restriction, 1) low birth weight, 2) umbilical artery reversed flow, and 3) ductus venosus absent or reversed flow are associated with an increased perinatal morbidity and mortality.

Analysis of Variance↗
PubMed2004

Renal abnormalities in rat fetuses exposed to doxorubicin.

PURPOSE: A rat model of the VATER (vertebral defects, anal atresia, tracheo-esophageal fistula with esophageal atresia, renal defects and radial limb dysplasia) association was created by exposing fetuses to doxorubicin early in gestation. Most fetuses had an absent bladder with ureters that were grossly dilated. We determined the effect of this absent bladder on kidneys development, particularly whether dysplasia was evident. MATERIALS AND METHODS: Nine timed pregnant rats were injected intraperitoneally with doxorubicin at a dose of 2 mg/kg body weight on days 6 to 9 of gestation. The control group of 3 rats received saline. Fetuses were recovered on day 21 and examined macroscopically. Quantitative measurements were taken of renal wet and dry weights, renal length and ureteral diameter. Serial sections were then taken and stained alternately with hematoxylin and eosin or trichrome. The kidneys were compared under light microscopy. Comparisons between control and treated groups were made with the Student t test. RESULTS: An absent bladder was confirmed in 50 of the 55 fetuses (91%). In most fetuses the kidneys were correctly located, although they were hydronephrotic and poorly developed. This finding was confirmed quantitatively with significant differences in treated and control fetuses in renal length (5.24 vs 4.13 mm, p <<0.01) and in the ratio of wet renal weight to body weight and dry weight (2.7 vs 3.4 mg, p <<0.01). Dilated, tortuous ureters were found bilaterally in most cases. Microscopically the kidneys had abnormal architecture and were less mature than in controls. Nephron induction was poor with abnormal configurations. Tubular differentiation was decreased and the medulla was thin and less cellular than in controls. Dilatation occurred mainly in the collecting system and ducts/tubules. There was no collagen deposition/fibrosis or aberrant tissue. CONCLUSIONS: In this rat model the kidneys are exposed to obstruction early in development since the bladder does not form. The resulting kidneys are hydronephrotic with decreased parenchyma and poor differentiation. However, there is no fibrosis or aberrant tissue.

Abnormalities, Drug-Induced↗
PubMed1986

Effect of haemorrhage on plasma lysine vasopressin and the cardiovascular responses to vasopressin in the pig fetus.

The effect of haemorrhage on plasma lysine vasopressin concentrations and the cardiovascular effects of intravenous injections of synthetic lysine vasopressin were studied in twenty-four chronically catheterized pig fetuses aged between 81 and 114 d gestation (term = 114 +/- 1 d). Removal of 15-20% of the estimated blood volume reduced mean arterial blood pressure and elevated plasma vasopressin concentrations above the mean basal value of 2.2 +/- 0.3 muu./ml. The vasopressin concentration in plasma of fetuses younger than 104 d was insignificantly affected at 30 and 60 min after the bleed, whereas the corresponding values in older fetuses were raised by 12.7 +/- 7.2 muu./ml (d.f. = 7) and 16.0 +/- 6.0 muu./ml (d.f. = 7) respectively. The pituitary concentration of vasopressin was also greater towards the end of gestation. Plasma osmolality was unaffected by fetal blood loss. Maternal concentrations of vasopressin did not change from the basal values of 1.0 +/- 0.1 muu./ml (d.f. = 16). Injection of vasopressin raised fetal blood pressure and decreased heart rate. These results demonstrate that lysine vasopressin is present in the circulation of the pig fetus at 81 d (0.72 gestation), and that near term fetuses respond to haemorrhage more rapidly, and to a greater degree than younger fetuses.

Animals↗
PubMed1989

The effects of insulin on the growth rate of the sheep fetus during late gestation.

The effects of insulin on fetal growth rates were investigated by measuring crown-rump length (CRL) chronically in sheep fetuses before and after pancreatectomy, sham operation or pancreatectomy accompanied by insulin-replacement treatment. Pancreatectomy of the fetus produced hypoinsulinaemia and reduced the daily and total increments in CRL by 40-50% over the last 20-30 days of gestation. The growth rate fell immediately after pancreatectomy and remained low throughout the rest of gestation. In contrast to the sham-operated fetus no pre-partum decline in the growth rate was observed in the pancreatectomized animal. The body weight, limb lengths and actual CRL at delivery were also significantly less after pancreatectomy than in the sham-operated animals. When fetal insulin levels were maintained after pancreatectomy by exogenous insulin infusion, the daily and total increments in CRL and the body size at delivery were restored to their normal values. Raising insulin levels above normal in the pancreatectomized fetus did not lead to additional fetal growth. When the data from all the fetuses were combined irrespective of treatment, there were significant positive correlations between the plasma insulin concentration in utero and the mean daily increment in CRL after treatment and between the former value and the body weight at delivery. These observations demonstrate that insulin is a major determinant of the growth rate in utero and that it is required throughout late gestation for the normal growth and development of the sheep fetus. They also indicate that insulin deficiency is probably the primary cause of the growth retardation observed after fetal pancreatectomy.

Animals↗
PubMed1990

Examination of fetuses after induced abortion for fetal abnormality.

OBJECTIVE: To determine the accuracy of midtrimester diagnosis of fetal abnormality by examination and investigation of fetuses after induced abortion. DESIGN: Prospective study over five years of fetuses aborted in the midtrimester because of abnormalities detected by ultrasonography and amniocentesis. Techniques included a full external examination by a clinical geneticist with experience in dysmorphology and other investigations including necropsy. SETTING: Regional genetic centre. PARTICIPANTS: Clinicians working within the North Western region who wished to use the service offered. RESULTS: 133 Fetuses were aborted because of abnormalities detected on ultrasonography and 115 because of abnormal findings on amniotic fluid analysis. In a further two cases fetal abnormality was diagnosed by molecular genetic and biochemical techniques. Among the fetuses with abnormal scans the pretermination diagnosis was changed or refined in a way which affected genetic counselling in 53 of 133 cases. Among the 115 fetuses diagnosed as abnormal by amniocentesis the pretermination diagnosis was confirmed in 112 cases and altered in three. CONCLUSION: Fetuses aborted because of abnormalities detected by screening should be examined by suitably experienced clinicians, both for accurate genetic counselling of the families and for quality control of the tests employed.

Abortion, Induced↗
PubMed2006

Fetal body volume: use at MR imaging to quantify relative lung volume in fetuses suspected of having pulmonary hypoplasia.

PURPOSE: To retrospectively determine an algorithm based on fetal body volume (FBV) by using magnetic resonance (MR) imaging to calculate relative lung volume in fetuses with normally developed lungs and prospectively assess the use of this algorithm in predicting pulmonary hypoplasia in the late second and early third trimesters for fetuses at risk for pulmonary hypoplasia. MATERIALS AND METHODS: Oral informed consent was obtained for the prospective component of this ethics committee-approved study. MR imaging lung volumetry was performed in 36 fetuses with normally developed lungs between 18 and 39 weeks gestational age by using T2-weighted single-shot fast spin-echo imaging in fetal transverse and sagittal planes. Findings were then correlated with biometric variables and gestational age. The best-performing algorithm was applied to 37 fetuses (between 18 and 29 weeks gestational age) at risk for pulmonary hypoplasia to determine observed-expected lung volume ratio. This group was stratified according to pregnancy management, and observed-expected ratios were correlated with outcome. In fetuses with isolated congenital diaphragmatic hernia (CDH) (n = 19), observed-expected ratio was correlated with lung-head ratio, neonatal survival in pregnancies managed expectantly (n = 13), and/or lung-body weight ratio at necropsy (n = 9). For that purpose, linear regression correlation was used with the Pearson correlation coefficient; P < .05 was considered to indicate a significant difference. RESULTS: Total fetal lung volume correlated best with total FBV (r = 0.96, P < .05). Observed-expected ratio based on FBV correlated with lung-head ratio in patients with CDH (r = 0.71, P < .001) and with lung-body weight ratio at necropsy (r = 0.68, P < .05) and could be used to help predict neonatal survival. CONCLUSION: FBV measured with MR imaging can be used as a single parameter in an algorithm and showed closest correlation with normal total fetal lung volume. In the transition from second to third trimester, this algorithm enabled calculation of the observed-expected ratio and prediction of outcome in fetuses at risk for pulmonary hypoplasia.

Algorithms↗
PubMed1992

Prevalence of cystic fibrosis in fetuses with dilated bowel.

The authors reviewed the ultrasonographic images and medical records of 15 consecutive fetuses with dilated loops of bowel distal to the duodenum and determined the prevalence of cystic fibrosis among them. The criteria for dilated bowel loops included both subjective criteria and luminal measurements. Five of the fetuses (33%) had cystic fibrosis. Eleven had bowel obstruction at birth, and four of those 11 (36%) also had cystic fibrosis. One of the four fetuses without bowel obstruction at birth had cystic fibrosis. There were no differences in sonographic findings between fetuses with and without cystic fibrosis, except that one third-trimester fetus with cystic fibrosis had echogenic small bowel with shadowing. All of the fetuses with dilated bowel loops persisting at birth required surgery. Further studies are indicated to determine the exact risk of cystic fibrosis in this population.

Cystic Fibrosis↗
PubMed1995

Homozygous achondroplasia: US distinction between homozygous, heterozygous, and unaffected fetuses in the second trimester.

PURPOSE: To determine if and at what gestational age prenatal ultrasonography (US) enables distinction between homozygous, heterozygous, and unaffected fetuses when both parents have heterozygous achondroplasia. MATERIALS AND METHODS: Serial US scans of 15 fetuses at 25% risk of homozygous achondroplasia were reviewed retrospectively. Femoral growth curves were established and compared with published standards to determine the gestational age, calculated according to biparietal diameter (BPD), at which femoral length crossed below the 3rd percentile. The presence and severity of achondroplasia were determined clinically after birth. RESULTS: Femoral length crossed the 3rd percentile at 14.0-16.5 weeks BPD age (mean, 15.6 weeks) in the four homozygous fetuses and at 18.2-26.2 weeks BPD age (mean, 21.5 weeks) in the eight heterozygous fetuses. In the three unaffected fetuses, femoral length did not cross percentiles as gestational age increased. CONCLUSION: Establishment of a femoral growth curve in the second trimester with serial US scans enables prenatal distinction between homozygous, heterozygous, and unaffected fetuses when both parents have heterozygous achondroplasia.

Achondroplasia↗
PubMed1999

Cortical maturation in normal and abnormal fetuses as assessed with prenatal MR imaging.

PURPOSE: To establish the appearance of normal fetal cortical development in utero and compare it with the appearance of abnormal cortical development. MATERIALS AND METHODS: Magnetic resonance (MR) images of the brain in 53 normal and 40 abnormal fetuses at 14-38 weeks gestational age (GA) were reviewed. The GAs at the time of MR imaging visualization of the fissures or sulci were compared with the GA guidelines based on neuroanatomic studies. RESULTS: In normal fetuses, the sulcation landmarks appeared on MR images in the order predicted by using anatomic studies, with a 0-8-week lag in the MR imaging visualization of the sulci compared with the reported time of visualization of the sulci in anatomic specimens. When landmarks were grouped by range of GAs, the expected MR imaging sulcation landmarks in the group with younger GAs than the actual GA were seen in 50 of 53 (94%) normal fetuses, in five of nine fetuses (56%, P < .05) with isolated mild ventriculomegaly, and in 24 of 31 fetuses (77%, P < .05) with other CNS anomalies. CONCLUSION: Normal fetal cortical maturation at MR imaging follows a predictable course that is slightly delayed compared with that described in neuroanatomic specimens. This maturation is often further delayed in fetuses with CNS abnormalities.

Agenesis of Corpus Callosum↗
PubMed2000

Echogenic intracardiac focus in 2nd-trimester fetuses with trisomy 21: usefulness as a US marker.

PURPOSE: To determine whether there is a relationship between the presence of an echogenic intracardiac focus in 2nd-trimester fetuses and trisomy 21 (Down syndrome). MATERIALS AND METHODS: A complete genetic ultrasonographic (US) scan was obtained in 3,303 consecutive fetuses with an estimated gestational age of 14.0-24.0 weeks (mean +/- SD, 17.1 weeks +/- 1.75). US was performed in a prospective fashion without any knowledge of karyotype and included assessment of any potential echogenic intracardiac focus (ie, calcified papillary muscle). Karyotypes were obtained in all fetuses. Maternal ages ranged from 13.0 to 47.4 years (mean, 35.1 years +/- 5.1). The prevalence of Down syndrome in this population was 1.6% (53 of 3,303 fetuses). RESULTS: An echogenic intracardiac focus was seen in 147 of the 3,192 karyotypically normal fetuses (4.6%) and 16 of the 53 fetuses with trisomy 21 (30%). The positive predictive value (PPV) of an echogenic intracardiac focus in this high-risk population was 9.8%; sensitivity, 30%; specificity, 95%; likelihood ratio, 6.6; and relative risk (RR), 8.2 (P <.001). For a sonographically isolated echogenic intracardiac focus, the PPV was 3.7%; sensitivity, 19%; specificity, 95%; likelihood ratio, 4.2; and RR, 4.8 (P =.002). CONCLUSION: A sonographically isolated echogenic intracardiac focus (no other anomalies or markers noted on a complete genetic sonogram) was associated in our high-risk population with a 4.8-fold (95% CI: 1.8, 12.5) increase in RR for trisomy 21 (P =.002).

Adolescent↗
PubMed1986

By 95 days of gestation CRF increases plasma ACTH and cortisol in ovine fetuses.

Plasma adrenocorticotropin (ACTH) and cortisol (F) responses to 15-min intravenous infusions of synthetic ovine corticotropin-releasing factor (CRF) were measured by radioimmunoassay in three groups of chronically cannulated ovine fetuses. Fetuses (n = 7) in group I were 107 +/- 2 days gestation (0.72 G) and fetuses (n = 7) in group II were 126 +/- 2 days gestation (0.86 G). Group III fetuses (n = 5) were studied at 5-day intervals during the last 2 wk of gestation. Resting fetal plasma ACTH levels were not significantly different among the three experimental groups. Infusions of CRF (50 ng X kg-1 X min-1) provided similar, significant increases in fetal plasma ACTH concentrations in the three groups. In the young fetuses (group I) the ACTH responses to 500 ng X kg-1 X min-1 infusions of CRF were greater than responses to 50 ng X kg-1 X min-1 infusions P less than 0.001. In group II both doses of CRF produced equivalent increases in ACTH that were comparable with the responses to 50 ng X kg-1 X min-1 infusions in Group I. This suggests that fetal ACTH responsiveness to large doses of CRF decreases between 0.72 and 0.86 G. Resting fetal plasma F levels increased during gestation (P less than 0.01). There was an F response (P less than 0.001) to CRF in all groups with greater responses observed in the older fetuses. This suggests that fetal adrenal responsiveness to ACTH or other peptides released by CRF increases during gestation.

Adrenocorticotropic Hormone↗
PubMed1984

Ouabain effect on myocardial mechanical function and sodium pump in the fetus.

Effects of ouabain (0.75, 1, 1.5, 2.5 or 5 X 10(-6) M) on the mechanical function and sodium pump were studied in the isolated arterially perfused fetal and newborn rabbit heart. Measurement of myocardial 86Rb+ active uptake was used as a marker of the sodium pump activity. The inotropic effect of ouabain in the fetus was not significantly different from that in the newborn; 2.5 X 10(-6) M ouabain caused mechanical toxicity (decrease in +dT/dtmax and increase in resting tension) in the fetus but not in the newborn. After ouabain infusion, both the inhibition of Rb+ uptake and the significant decrease in tissue potassium content were similar in the fetus and the newborn. In the fetal muscle perfused with low calcium (0.5 mM) solution, mechanical toxicity of ouabain was significantly less than in the control (1.5 mM Ca2+) solutions. High extracellular calcium (30 mM) per se caused mechanical toxicity in the fetus but not in the newborn. These data indicate that, in the isolated arterially perfused heart preparation, mechanical toxicity in the fetus is observed at lower ouabain concentrations than in the newborn. This difference in mechanical toxicity may not be explained by the age-related difference in sodium pump activity. The greater calcium toxicity in the fetus may be the reason for the increased ouabain toxicity in this age group.

Animals↗
PubMed1989

Thoracic duct lymph flow and its measurement in chronically catheterized sheep fetus.

A method was developed for chronic catheterization of the left thoracic lymph duct at the base of the neck in the sheep fetus, which did not disrupt the other major lymphatic vessels that join the venous circulation at the same location. The lymphatic catheter was connected to a catheter in a jugular vein when lymph flow was not being recorded, so that the lymph continuously returned to the fetal circulation. Special consideration of catheter size to minimize flow resistance and treatment to prevent clotting were required. Individual animals were maintained up to 17 days with lymph flow continuing. In 13 fetuses averaging 128 days gestation (term = 147 days) at the time of catheterization, lymph flow rate was measured for 1 h each day for the first 7 postsurgical days with an on-line computer technique that continuously calculated lymph flow rate. Lymph flow averaged 0.64 +/- 0.17 (SD) ml/min in fetuses weighing 2.3-4 kg and tended to undergo a nonsignificant increase with time. Lymph and plasma protein concentrations did not change with time. In individual fetuses, large spontaneous variations in lymph flow rate occurred over periods of several seconds to a few minutes. Analysis showed that these variations in flow rate were not associated with fetal breathing movements. Thus the present study describes a technique for studying the dynamics of lymph flow in the unanesthetized sheep fetus in utero over a time period limited primarily by the length of gestation. In addition, it appears that thoracic duct lymph flow rate in the fetus per unit body weight averages three to four times that in the adult.

Animals↗
PubMed1980

Functional delay in lung maturation in fetuses of diabetic rabbits.

Lung maturation was studied in fetuses of rabbits made diabetic with alloxan. Lung maturation was examined functionally with pressure-volume curves and by determining surfactant content of lung lavage on a surface balance, and biochemically by measuring disaturated phosphatidylcholine content (DSPC) and lecithin: sphingomyelin ratio (L/S) of lung lavage and DSPC content of lung tissue. Pressure-volume curves of 27.5-day fetuses of diabetic does demonstrated less deflation stability. Functional assessment of pulmonary lavage surfactant measured on a surface balance was less in diabetic fetuses at both 27.5 and 29.5 days of gestation. There were no differences in DSPC content or L/S of lung wash or DSPC in whole-lung tissue between diabetic and control fetuses. The discordance between surfactant function and concentrations of major surfactant phospholipids suggests that surfactant in fetuses of diabetic animals is qualitatively different from that in the normal fetus. These findings may explain why analysis of amniotic fluid phospholipid content sometimes fails to predict risk of respiratory distressed syndrome correctly in human diabetic pregnancies.

Alloxan↗
PubMedDate not supplied

Natural history of 70 fetuses with a prenatally diagnosed orofacial cleft.

OBJECTIVE: This study is an analysis of neonatal outcome in 70 fetuses diagnosed over a 10-year period as having cleft lip with or without cleft palate (CL-P) by ultrasonographic examination. METHODS: We describe the natural history of these 70 fetuses with orofacial clefts and select those who may be candidates for fetal surgery. The sonograms of 70 fetuses with orofacial clefts were evaluated for the nature of the CL-P and for the nature of the associated anomalies. Additionally, karyotyping was performed in 63 of 70 patients (90%). RESULTS: The frequency of additional anomalies and the mortality rate varied with the type of cleft. Also, the frequency and type of chromosomal abnormalities varied with the type of cleft. The overall mortality rate was 63% (n = 44). 3 of the surviving 26 fetuses had severe associated anomalies. In 13 of the remaining 23 cases, the fetal age at diagnosis (> or =22 weeks) excluded the fetuses from the potential benefits of fetal intervention. CONCLUSION: Of 70 fetuses with prenatally diagnosed orofacial clefts, only 10 (14%) were candidates for fetal CL-P surgery.

Adult↗
PubMedDate not supplied

Abnormal umbilical cord Dopplers may predict impending demise in fetuses with sacrococcygeal teratoma. A report of 2 cases.

OBJECTIVE: To identify factors predictive of fetal demise in fetuses with sacrococcygeal teratoma (SCT). METHOD: The recent management of monochorionic twins discordant for a large SCT and a singleton with a large SCT were reviewed. RESULTS: Serial fetal echocardiography and ultrasonography with Doppler flow measurements documented rapid growth of the SCT in both cases with a relatively modest increase in combined cardiac output. No placentomegaly or hydrops was observed at any time. In both fetuses with SCT, evolution of abnormal umbilical artery waveforms was observed with the ultimate development of reversed end-diastolic umbilical arterial flow that was followed by sudden fetal demise. CONCLUSION: Death in these 2 fetuses with large SCTs in the absence of placentomegaly/hydrops or hemodynamic changes suggestive of evolving high-output failure suggests a previously unrecognized mechanism of death in fetuses with large rapidly growing SCTs. In these cases, fetal demise may only be heralded by abnormal umbilical artery waveforms that progress to the premorbid observation of reversed diastolic umbilical artery blood flow. Umbilical artery waveform analysis should be closely monitored with other hemodynamic parameters in fetuses with large SCTs. In such fetuses, depending on the gestational age, abnormalities in umbilical artery waveform should be considered indications for early delivery or in utero intervention to prevent fetal demise.

Adult↗