Boris Petrikovsky

Fetal hydrops secondary to human parvovirus infection in early pregnancy.

Parvovirus B19 infection has been associated with fetal anaemia, hydrops, and in some cases demise. Most of the reported cases of fetal hydrops were detected in second‐trimester fetuses. We report a series of three cases in which human parvovirus infection was associated with hydropic changes at an earlier gestational age. Spontaneous resolution of hydrops occurred in all fetuses. A greater understanding of the natural history of human parvovirus infection is needed prior to deciding on the mode of therapy (conservative management versus in utero fetal therapy).

In utero Surfactant Administration to Preterm Human Fetuses using Endoscopy

Our purpose was to assess the feasibility of the endoscopic delivery of surfactant directly to the fetus during active preterm labor. A gas-sterilized intraoperative fiberscope was introduced through the cervical canal into the amniotic cavity after spontaneous rupture of membranes during preterm labor in 3 patients. The flexible fiberscope was inserted under constant endoscopic visual control to avoid possible trauma to the fetus and the mother. Surfactant was injected into the mouths of 3 preterms fetuses through a catheter placed through the biopsy channel of the fiberscope. Fetal heart rate tracings as well as neonatal and maternal outcome are reported for each case. In utero surfactant placement was successful in each case. The fetal heart rate remained normal throughout the procedure. No maternal or neonatal complications/infections were detected. Our preliminary experience indicates that in utero endoscopic delivery of surfactant to a preterm human fetus is feasible. The usefulness of intrapartum endoscopy in the prophylactic administration of surfactant directly to the fetus, prior to the first breath, has to be assessed in a prospective controlled study.

Prenatal diagnosis and clinical significance of hypoplastic umbilical artery.

This study reports the maternal, fetal, and neonatal outcomes in cases with hypoplastic umbilical artery. The sonographic finding of a three‐vessel umbilical cord showing an artery‐to‐artery diameter difference of more than 50 per cent was defined as hypoplastic umbilical artery. All fetuses diagnosed with hypoplastic umbilical artery underwent genetic amniocentesis and ultrasound. Fetal, maternal, and neonatal outcomes were analysed. Twelve fetuses with hypoplastic umbilical artery were detected over a 6‐year period (1989–1995). Associated abnormalities included trisomy 18 (one case), polyhydramnios (three cases), congenital heart disease (one case), and fetal growth restriction (two cases). Maternal diabetes was detected in four cases. The pregnancy was terminated in one case; one neonate with severe fetal growth restriction expired; and one survived with congenital heart disease. The presence of hypoplastic umbilical artery was associated with increased perinatal morbidity and congenital abnormalities. Diabetes was frequently detected. Fetal surveillance and echocardiography are indicated in cases of hypoplastic umbilical artery.

First-trimester diagnosis of duodenal atresia.

The earliest diagnosis of duodenal atresia, at 14 weeks of pregnancy, is reported. An attempt to diagnose this entity should be considered in the first trimester, which will allow ample time for counseling, genetic testing, and decision making.

Cordocentesis Using the Combined Technique: Needle Guide-Assisted and Free-Hand

Two hundred and sixteen diagnostic cordocenteses were performed using the following technique: A guide was used to deliver the distal end of the needle to the immediate vicinity of the umbilical cord, after which the needle was released from the guide and a free-hand technique was used to enter the umbilical cord. The vessel punctured was identified by its sonographic appearance and flow direction using color Doppler technology. All procedure-related losses which occurred within 2 weeks were analyzed. The gestational age at the time of cordocentesis ranged from 18 to 42 weeks. Most punctures (62%) were performed at the placental insertion of the umbilical cord. In 32% of fetuses the free-floating loop was sampled and in 6% the puncture was performed at the site of cord entry into the fetus. Two fetuses died shortly after cordocentesis. One death occurred at 28 weeks in a fetus with severe cytomegalovirus infection. The other death was due to premature rupture of the membranes after the procedure in a very premature fetus. The overall fetal loss rate was 0.93%. In conclusion, the combination of the two cordocentesis techniques appears safe and highly successful in obtaining fetal blood samples.

SIZE DISPARITY OF THE CHOROID PLEXUSES OF THE LATERAL VENTRICLES: PRENATAL DIAGNOSIS AND NEONATAL OUTCOME

Fetal choroid plexuses have attracted the attention of perinatologists and geneticists because of the reported association between intrachoroid cysts and chromosomal abnormalities. This report deals with another variation in choroid plexus sonographic appearance—size variation. Sonographic follow‐up results as well as neonatal outcome were analysed in five fetuses with these findings. All fetuses had a normal karyotype. Disparate choroid plexuses were not associated with other structural anomalies. None of the fetuses developed ventriculomegaly.

Fetal breasts in normal and Down syndrome fetuses

To assess the validity of fetal breast size measurement as a sonographic marker in fetuses with Down syndrome. Methods: Fetal breasts were studied in 26 fetuses with trisomy 21 and 78 fetuses with normal chromosomes. Breasts were identified and measured in a cross‐sectional plane of the fetal chest at the level of the four‐chamber view of the heart. Normal fetuses had a mean breast size of 3.8 mm ± 1.1 mm. Fetuses with Down syndrome had a mean breast size of 1.9 mm ± 0.7 mm (p ⩽ 0.0001). Diminished breast size measured by ultrasound in the second trimester may be helpful in identifying fetuses with Down syndrome.

Prenatal diagnosis of intra‐atrial cardiac echogenic foci

Intra‐atrial echogenic foci were detected in 3 out of 15 706 fetuses (prevalence 0·019 per cent). In all cases, they were located in the right atrium. Normal chromosomes and negative TORCH titres were observed in all affected cases. Fetuses with intra‐atrial echogenic foci demonstrated adequate intra‐uterine growth and had normal neonatal outcome. Intra‐atrial echogenic foci seem to represent a normal variant of fetal cardiac development.

Clinical significance of echogenic foci in fetal lungs

We reviewed our experience with echogenic foci in fetal lungs.

Single-needle insertion technique for thoracocentesis for bilateral pleural effusions

A 28-week fetus with hydrops and bilateral pleural effusions underwent drainage of both pleural spaces via a single-needle supradiaphragmatic insertion technique. The traditional approach was not feasible due to a persistently unfavorable fetal position. The dependent pleural effusion was drained by a needle which coursed through the nondependent pleural effusion. The needle traversed the midline pleura through an avascular plane. Thereafter the needle was withdrawn into nondependent pleural effusion which was drained. Both lungs expanded with favorable neonatal outcome.