Esther Shih C. Ho

Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound

Objective  The aim of this study was to evaluate the efficacy of transabdominal color Doppler ultrasound in diagnosing placenta previa accreta.

Internal iliac artery embolization before hysterectomy for placenta accreta.

Six patients with early sonographic diagnosis of invasive placenta previa increta/percreta before fetal viability were offered hysterectomy to terminate the pregnancy with prophylactic internal iliac artery embolization (IIAE). The mean gestational age at treatment was 19.7 weeks (range, 14-23). Among these six patients undergoing hysterectomy, the mean estimated blood loss was 1,767 mL +/- 1,213 (range, 300-3000), and the mean transfusion requirements were 4.33 U +/- 4.08. With this limited experience, we are encouraged by the apparent reduction in operative blood loss and fewer transfusion requirements after the use of prophylactic IIAE compared with historical controls. These preliminary findings are based on a small number of patients, and therefore further investigation is needed to determine the effectiveness of this procedure.

Diagnosis of an asymptomatic uterine rupture in a twin pregnancy with four-dimensional ultrasound examination and magnetic resonance imaging.

in the posterior neck region was visible. Typical findings in left isomerism (bilateral left-sidedness) are bilateral morphological left atrial appendages (left atrial isomerism), viscerocardiac heterotaxy, multiple cardiac anomalies (with a predominance of atrioventricular septal defects and pulmonary stenosis), junctional rhythm due to hypoplasia of the sinoatrial node, congenital heart block, bilateral morphological left (bilobed) lungs, polysplenia, intestinal malrotation, and interruption of the inferior vena cava (IVC) with azygos continuation2,3. The IVC is interrupted in its intrahepatic part and blood flows via the azygos (former right supracardinal vein) or hemiazygos (former left supracardinal vein) into the superior vena cava, and then in the majority of cases into the atrium. The condition arises embryologically from a failure of the right vitelline vein to anastomose with the right subcardinal vein, together with persistence of the supracardinal veins. The hepatic veins, mainly the right hepatic vein, are connected to the right-sided atrium directly via a persisting sinus venosus. The separate entrance of the right hepatic vein into the right-sided atrium is always present in left atrial isomerism, with an interrupted IVC found in 80% of cases3. Rhythm disturbances are common in left isomerism, since the sinus node is hypoplastic in cases of two left atria. Heart block is more frequently observed in left isomerism with atrioventricular septal defects4. Slow atrial rates associated with junctional escape, as seen in the present case, are common and do not alter the prognosis5. The outcome in left isomerism is dependent on the presence of heart block and hydrops, major cardiac malformations6 and extrahepatic biliary drainage. The mechanism for reversible early fetal decompensation in the present case (early thoracic fluid, increased nuchal translucency, negative a-wave in the ductus venosus) is most likely the result of a temporary right ventricular cardiac failure7,8 or of a lymphatic disorder, given that the persistence of lateral neck cysts at 15 weeks of gestation were described as a jugular lymphatic distension, where the jugular sacs fail to connect with the jugular veins9. Of particular interest in this case was the excellent neonatal outcome following early fetal decompensation. I. Witters†*, P. Debois‡, J. P. Fryns†, K. Devriendt† and M. Gewillig§ †Center for Human Genetics and §Department of Pediatric Cardiology, University Hospital Leuven, Leuven and ‡Department of Obstetrics and Gynecology of A. Z. KLINA, Brasschaat, Belgium *Correspondence. (e-mail: Ingrid.Witters@skynet.be) DOI: 10.1002/uog.4069 Published online 31 July 2007