Ji Sun We

Usefulness of additional fetal magnetic resonance imaging in the prenatal diagnosis of congenital abnormalities

ObjectiveOur aim was to compare the value of fetal magnetic resonance imaging (MRI) with detailed ultrasound in the prenatal diagnosis of congenital abnormalities.Materials and methodsThis retrospective study reviewed the medical records of pregnant women and their neonates who, after ultrasound, were suspected to have congenital abnormalities. They then underwent a detailed ultrasound examination and a fetal MRI in our institutions. Fetal MRI was performed in 81 cases. Each prenatal presumptive diagnosis, based on detailed ultrasound examination and fetal MRI, was compared with the postnatal confirmed diagnosis. In 58 cases, the data collected were confirmed by the postnatal diagnosis.ResultsSupplemental information from fetal MRI was useful in 17 of the 22 cases involving the central nervous system (CNS), two of two cases involving the thorax, nine of nine cases involving the genitourinary system, two of eight cases involving the gastrointestinal system, and ten of ten cases involving complex malformations. Fetal MRI did not provide significantly useful information or facilitate a more accurate diagnosis except for CNS abnormalities.ConclusionFetal MRI was not superior to an ultrasound examination in the prenatal detection of congenital abnormalities. A detailed ultrasound examination performed by experienced obstetricians had satisfactory accuracy in the diagnosis of fetal abnormalities compared with fetal MRI. Fetal MRI might be useful in appropriate cases in Korea. Greater effort is required to increase the ultrasound knowledge and skill of competent obstetricians.

Optimal gestational age of delivery to decrease neonatal morbidity in preterm pregnancies in Korea

Aims:  Preterm birth is the most common cause of neonatal morbidity and mortality. Neonatal morbidity and mortality are known to decrease significantly after 34 weeks in preterm births following preterm labor, and after 32 weeks in preterm births following preterm rupture of the membranes. However, these outcomes may not apply to Korean preterm neonates. This study analyzed the morbidity of preterm neonates based on gestational age to determine the optimal gestational age of delivery following preterm labor.

Right pulmonary agenesis of one fetus in a monochorionic twin pregnancy: A case report

Unilateral pulmonary agenesis is uncommon congenital malformation which refers to total absence of pulmonary parenchyma and blood vessels as well as bronchia beyond the tracheal bifurcation. And, it is rarely to make prenatal diagnosis. Indirect prenatal sonographic fi ndings in this malformation include mediastinal shift of the heart together with lack of evidence of diaphragmatic hernia. And more reliable diagnosis is obtained by Doppler sonographic fi nding with lack of branching of the pulmonary artery. Its prognosis depends largely on the presence of associated other congenital anomalies. But unilateral pulmonary agenesis does not result in the death of the infant and is compatible with long-term survival. So, selective termination is not recommended. In the case herein, right pulmonary agenesis of one fetus in a monochorionic twin pregnancy was diagnosed by prenatal sonography. We describe this case with a brief review of the literature.

A case report on successful pregnancy and delivery in a medulloblastoma patient

Medulloblastomas are rare neoplasms in adults. Medulloblastomas are treated by surgical removal of the tumor followed by radiotherapy. Because craniospinal irradiation can damage the hypothalamic-pituitary axis, uterus, and ovaries, and consequently result in infertility, the probability of pregnancy is quite low. We managed a patient who had undergone resection of a posterior fossa medulloblastoma and received craniospinal irradiation, who conceived spontaneously during follow-up. She was diagnosed with a recurrent medulloblastoma with metastasis to the spine accompanied by headaches and back pain at 26 weeks gestation. Conservative treatment measures were utilized in an effort to prolong the pregnancy. She was delivered by cesarean section due to recurrent seizure activity at 29 weeks plus 3 days gestation. The neonate made favorable progress and was discharged in good condition.

P20.13: A case of congenital depression of the neonatal skull unassociated with birth trauma

Multigravida A.P., 37 years old, was referred at 32 weeks of gestation to tertiary ultrasound unit because of BPD adequate for 38 gestational weeks. At the detailed scan absence of the right lens was diagnosed (images a, b), borderline ventriculomegaly and macrocephaly. The rest of morphology was normal. Normal male karyotype was found and TORCH screening was negative. MRI confirmed aphakia of the right eye (images c, d), as well as borderline ventriculomegaly, with no additional brain anomalies. A male infant was delivered by elective Caesarean section, 4370 gr/56 cm, AS 9/9, HC 39 cm. On the scan of the neonatal brain a diagnosis of incipient hydrocephalus was made. Ophthalmologist confirmed aphakia of the right eye, with a congenital glaucoma on the same eye. The child was closely monitored and at 20 days of age a spontaneous perforation of the right cornea developed, subsequent evisceration of the bulbus was performed. At the same time a congenital glaucoma of the left eye was diagnosed and trepanotrabeculectomia was performed. Conclusion: Ocular examination should be a part of a routine fetal scan. US and/or MRI visualisation of fetal eyes structures may be used to detect different orbital and ocular pathology. The morphological eye anomalies identified prenatally have to raise a high index of clinical suspicion of the associated functional disturbances, which can be postnatally corrected.

P28.03: A case of congenital lymphangiomatosis of the right lower limb

Lymphangiomatosis is a condition of lymphatic tissue malformation with multiple or diffuse involvement of soft tissues, visceral organs. Congenital abnormalities of the lymphatic system are very rare, and reports of congenital lymphangiomatosis are even fewer. We experienced a case of congenital lymphangiomatosis detected as edema of the right limb by prenatal ultrasonography and then diagnosed by magnetic resonance imaging.

P44.16: Combined prenatal ultrasound and fetal MR Imaging in diagnosis of fetal arachnoid cyst of 2 cases

Objectives: To describe the use of 3D ultrasound in the antenatal diagnosis of 3 cases of skeletal dysplasia. Methods: The sonographic findings of 3 cases of skeletal dysplasia are presented, including 1 case of each of the following conditions: thanatophoric dysplasia, osteogenesis imperfecta and hypochondroplasia. The distinguishing sonographic features detected on 3D ultrasound for the antenatal diagnosis of these conditions are described in addition to the 2D ultrasound findings. Results: Other than the finding of limb shortening on 2D ultrasound examination, the typical external and bony appearance of these conditions could be observed on 3D ultrasound. These include the small rib cage, flaring of the lower ribs and bowed long bones with abnormal ends in thanatophoric dysplasia, bowed bones with multiple fractures and callus formation in osteogenesis imperfecta, and short but otherwise normal bony appearance in hypochondroplasia. These sonographic findings allow antenatal diagnosis to be made more readily and facilitate patient counselling and management. Conclusions: When skeletal dysplasia is suspected antenatally, the use of 3D ultrasound in the examination of the fetal general appearance and bony structures provides additional information and facilitates antenatal diagnosis and management of the condition.