Jodi Abbott

Central nervous system abnormalities assessed with prenatal magnetic resonance imaging.

OBJECTIVEnTo determine the frequency at which magnetic resonance imaging (MRI) provides additional information in fetuses with suspected central nervous system (CNS) abnormalities on ultrasound.nnnMETHODSnBetween May 1, 1996, and March 26, 1999, 83 women with 90 fetuses (including seven sets of live twins) had 91 ultrasonographic and MRI examinations of the fetal CNS. Eight women were studied twice, one for two different indications. If referrals came from outside our institution, a confirmatory sonogram was obtained. Indications for examination were ventriculomegaly (n = 25), suspected neural tube defect (n = 16), arachnoid cyst (n = 12), large cisterna magna (n = 11), and miscellaneous indications (n = 20).nnnRESULTSnMagnetic resonance imaging findings led to changed diagnoses in 26 (40%) of 66 fetuses with abnormal confirmatory sonograms. Magnetic resonance imaging findings not found by ultrasound included partial or complete agenesis of the corpus callosum (n = 11), porencephaly (n = 6), hemorrhage (n = 5), tethered cord (n = 3), cortical gyral abnormality (n = 2), cortical cleft (n = 2), midbrain abnormality (n = 2), and partial or complete agenesis of the septi pellucidi (n = 3), as well as holoprosencephaly, cerebellar hypoplasia, subependymal and cortical tubers, vascular malformation, and vermian cysts (one case each). Abnormalities better delineated by MRI than ultrasound included three cephaloceles, a dural arteriovenous malformation, one distal sacral neural tube defect, and the mass effect of three arachnoid cysts. That information was used to alter patient counseling and at times management.nnnCONCLUSIONnWhen a CNS anomaly is detected by sonography or suspected on ultrasound, MRI findings might lead to altered diagnosis and patient counseling.

Posterior Urethral Valves: Inaccuracy of Prenatal Diagnosis

This study was undertaken to determine the specificity of prenatal diagnosis of posterior urethral valves. Twenty-two fetuses were diagnosed in utero with posterior urethral valves due to the presence of persistent megacystis and hydronephrosis. Ten cases had oligohydramnios and 12 had normal or increased fluid. Confirmation of diagnosis was not available in 3 fetuses. Only 8 of 19 fetuses had postnatal confirmation of posterior urethral valves. Other anomalies included urethral atresia, ureteral duplication, megacystis/megaureter, reflux and multicystic dysplastic kidney. We conclude that in utero evidence of megacystis and hydronephrosis with or without oligohydramnios is not diagnostic of posterior urethral valves.

Antenatal diagnosis of fetal hepatic hemangioma treated with maternal corticosteroids

BACKGROUNDnInfantile hepatic hemangioma is a benign liver tumor with potentially fatal complications. Response of these lesions to steroid therapy has been well documented in infants. Successful antenatal treatment of a fetal hepatic hemangioma with maternal corticosteroids is reported.nnnCASEnA 36-year-old woman, gravida 2, para 1, had an ultrasound at 17 weeks which showed a fetal hepatic hemangioma. Because of increase of the tumor and enlarged fetal heart, maternal oral corticosteroid therapy was commenced at 28 weeks, which progressively decreased the mass. The infant was delivered at 36 weeks with no evidence of heart failure, and at 7 months the tumor was barely seen on ultrasound.nnnCONCLUSIONnWhen an enlarging fetal hepatic hemangioma is detected antenatally, maternal corticosteroid therapy should be considered.

Low-Density Lipoprotein Apheresis Therapy During Pregnancy

Pregnancy in patients with severe hypercholesterolemia and coronary artery disease results in multiple problems both for mother and fetus; the most potent agents for low-density lipoprotein (LDL) cholesterol reduction, the HMG-CoA reductase inhibitors (statins) cannot be used during pregnancy. We present a case in which LDL apheresis via heparin-induced extracorporeal LDL precipitation was employed safely and efficaciously during pregnancy in a woman with heterozygous familial hypercholesterolemia and stable coronary artery disease.

Risk of Cranial Ultrasound Abnormalities in Very-low-birth-weight Infants Conceived With Assisted Reproductive Techniques

OBJECTIVE: To evaluate risks of cranial ultrasound abnormalities among very-low-birth-weight (VLBW) infants conceived with fertility therapy (ovulation induction only or with assisted reproductive techniques [ART]) and of multiple gestation pregnancies.STUDY DESIGN: The incidences of cranial ultrasound abnormalities in 1473 VLBW infants conceived with and without fertility therapy and born of multiple versus singleton pregnancies were compared, using logistic regression models.RESULTS: Infants conceived with ART were less likely to have intraventricular hemorrhage (IVH). Twins and triplets had risks of cranial ultrasound abnormalities similar to those of singletons. Twins and triplets conceived with ART were at lower risk of IVH.CONCLUSION: VLBW infants conceived with ART do not appear to be at increased risk of cranial ultrasound abnormalities. Likewise, twins and triplets were not at increased risk of these abnormalities.

Conservative management of a uterine arteriovenous malformation diagnosed in pregnancy.

Uterine arteriovenous malformations (AVMs) are usually diagnosed in women with unexplained vaginal bleeding and are frequently life threatening. 1 , 2 When AVMs are diagnosed during pregnancy, there is concern that they could grow or bleed. 3 - 6 To our best knowledge, there has been no reported case of an initial diagnosis of an asymptomatic AVM in a pregnant woman with a normal outcome. This case illustrates our experience with conservative management of a uterine AVM.

Obstetric outcome after failed termination of pregnancy—A reprot of two cases

Unsuccessful therapeutic abortion resulting in continued viability of the fetus is rare. No case of a live birth after unsuccessful vacuum curettage has been published. We report two cases with persistent pregnancies after failed termination, with outcomes complicated by premature rupture of membranes and preterm delivery.