P. Kaczmarek

Diagnostic and Perinatal Management of Fetal Extrasystole

AbstractFifty fetuses referred to the Polish Mother’s Memorial Hospital for fetal echocardiography between January 1, 1991 and June 1, 1995 were evaluated. The mean fetal gestational age at the time of diagnosis of arrhythmia was 34.1 weeks, and the mean gestational age at the time of delivery was 38.7 weeks. Checkup echocardiographic examinations were performed every 10–14 days, for a mean 2.4 studies per fetus. In most cases (48/50, 96%), premature atrial contractions were present during the first echocardiography examination. The fetal heart study was normal in 30 cases; in 7 (14%) there was tricuspid valve regurgitation, in 7 (14%) an atrial septal aneurysm, in 4 congenital heart defects, in 1 myocardial hypertrophy, and in 1 disproportion in the four-chamber view. Of the 50 fetuses, 43 underwent regular echocardiographic monitoring alone; in 7 cases, based on the presence of additional echocardiographic findings, pharmacotherapy was applied (digoxin, verapamil, or both). Three neonates died after delivery owing to malformations in two cases (one critical aortic stenosis, one spina bifida plus hygroma colli) and due to myocarditis in one case. In six of seven newborns treated in utero, myocarditis was diagnosed after birth (including the one with neonatal demise). Most of the newborns were in good condition after birth, their mean Apgar score being 8.6 and the mean birth weight 3259 g. We concluded that most extrasystoles represent an isolated anomaly, not affecting the fetal condition. Their presence should not influence the obstetric care and may require only echocardiographic monitoring. In most of our cases the premature contractions subsided after birth, although sometimes they preceded fetal supraventricular tachycardia or appeared after congenital myocarditis.

Fetal functional pulmonary atresia with ascites resolving spontaneously before birth : A case report

In this case we report functional pulmonary atresia in a fetus with significant tricuspid valve regurgitation and severe ascites, with spontaneous improvement without prenatal intervention and a subsequent follow-up at 8 weeks after birth.

Can We Suspect Fetal Down Syndrome by Heart Evaluation during the Second Half of Pregnancy

Thirty fetuses with Down syndrome, who had detailed fetal echocardiography and sonography at the tertiary center with videotape recordings, were retrospective analyzed by one observer with a specially prepared flow sheet. The mean gestational age of the fetuses at the time of the study was 31 ± 5.6 (minimum 21, maximum 39) weeks. The ‘main’ fetal abnormalities were congenital heart defect (CHD): in 13 cases (43.3%) an abnormal 4-chamber view was recorded, including 6 cases (20%) of isolated CHD and 7 (23.3%) of coexisting CHD + extracardiac malformation. Of the 13 cases of CHD, there were 12 cases of atrio-ventricular canal and 1 case of ventricular septal defect. Normal heart anatomy was recorded in 17 cases (56.7%), including 2 with tricuspid value regurgitation. From the videotape recordings also some ‘minor’ abnormalities were noticed in a few cases such as: femur length shortening; sandal gap; pericardial effusion; macroglossia; echogenic bowel; absent diastolic flow in the umbilical artery, and others. The prevalence of CHD in the study group was similar to the prevalence of CHD in the comparison group of 20 newborns with Down syndrome, born during the same period of time at the same institution, who had not had prenatal scanning at all (χ2, p > 0.05). Conclusions: (1) the main ‘major’ abnormality which might be detected in a fetus with Down syndrome after 20 weeks of pregnancy is CHD, which was presented in 43.3% of this series; (2) the presence of any extracardiac malformation should prompt the sonographer for detailed heart evaluation, and (3) fetal echocardiography may increase the accuracy of ‘genetic sonogram’ in Down syndrome.

Combined screening for early and late pre-eclampsia and intrauterine growth restriction by maternal history, uterine artery Doppler, mean arterial pressure and biochemical markers

BACKGROUND Pre-eclampsia is a systemic disease connected with high maternal and fetal morbidity and mortality. Despite significant progress achieved in perinatal medicine, pre-eclampsia is still one of the most significant current problems in obstetrics. OBJECTIVES The aim of the study was to establish diagnostic algorithms for early and late pre-eclampsia (PE) and intrauterine growth restriction (IUGR). MATERIAL AND METHODS A total of 320 pregnant women between 11 + 0 and 13 + 6 weeks of gestation were recruited for a case-control study. The study group consisted of 22 patients with early PE, 29 patients with late PE and 269 unaffected controls. The following parameters were recorded: maternal history, mean arterial pressure (MAP), mean uterine artery pulsatility index (UtA-PI), and the concentrations of placental growth factor (PlGF), pregnancy-associated plasma protein A (PAPP-A) and free beta-human chorionic gonadotropin (free β-hCG). RESULTS A multivariable stepwise logistic regression analysis indicated that the best screening model for the prediction of early PE is based on a combined analysis of maternal risk factors, UtA-PI and PlGF levels (sensitivity: 91%; specificity: 84%). The best screening model for the prediction of late PE is based on a combined analysis of maternal risk factors, UtA-PI and MAP (sensitivity: 85%; specificity: 83%). The most effective screening model for the prediction of IUGR is based on a combined analysis of maternal risk factors, UtA-PI and PlGF concentrations (sensitivity: 91%; specificity: 83%). CONCLUSIONS The integrated model of screening established in this study can be a valuable method to identify patients at increased risk of developing pre-eclampsia and related complications. The ability to predict the occurrence of pre-eclampsia in early pregnancy would enable maternal and fetal morbidity to be reduced through the introduction of strict obstetric surveillance as well as planned delivery in a reference center.

Benign but fatal. A case of a newborn with congenital osteochondroma.

Osteochondroma is one of the most frequent benign bone tumors in children. Its incidence is hard to determine because this tumor usually is asymptomatic. These tumors may present as solitary, nonhereditary lesions or as hereditary multiple osteochondromas that are inherited in an autosomal dominant manner. Although osteochondromas are usually asymptomatic, significant symptoms may occur because of complications such as bone fracture, bone deformation, or joint problems. The tumor may also mechanically compress nerves or vessels. Osteochondromas growing inwardly may cause injury to internal organs. The authors present a preterm (34 weeks of corrected gestational age) neonate in whom osteochondroma, although histologically benign, caused death because of its size and location. Prenatal ultrasound imaging performed during the third trimester of pregnancy showed bilateral hydrothorax and hydroperitoneum as well as heterogeneous parenchymal area on the right side of the thorax. After birth, the neonates condition was extremely severe. Although intensive and multidirectional treatment was applied, the condition of the infant continued to deteriorate and he died 26 h after birth. The autopsy confirmed presence of the tumor - osteochondroma - that caused total mediastinal shift with significant hypoplasia of both lungs and with signs of significant compression of the superior and inferior vena cava.

F131The role of fetal echocardiography during maternal pharmacological treatment

Background

Cell-free fetal DNA testing in prenatal diagnosis: Recommendations of the Polish Gynecological Society and the Polish Human Genetics Society

This paper contains a joint position of the Polish Gynecological Society and Polish Human Genetics Society on the cell-free fetal DNA testing in prenatal diagnosis. We present situations where the cell-free fetal DNA testing should be applied and cases in which performing of the test is not useful. We indicate what diagnostic steps should be performed before the test and how the test results should be interpreted and followed.

Podejrzenie wady wrodzonej układu moczowego – postępowanie u noworodka i niemowlęcia – część II: Wady miąższu nerek

Streszczenie Zmiany w ilości i strukturze miązszu nerek u plodu są wykrywane ze znacznie mniejszą czestością niz poszerzenie ukladu kielichowo-miedniczkowego. Jeśli jednak znajdują swoje potwierdzenie w badaniach postnatalnych, mogą byc sygnalem powaznych zaburzen w czynności nerek w okresie niemowlecym, a takze sugerowac postep choroby nerek w wieku poźniejszym. W celu spojnej i szybkiej weryfi kacji grupy dzieci zagrozonych rozwojem niewydolności nerek Polskie Towarzystwo Nefrologii Dzieciecej przygotowalo zalecenia dotyczące diagnostyki pourodzeniowej w przypadku wad miązszu nerek podejrzewanych prenatalnie.

Podejrzenie wady wrodzonej układu moczowego – postępowanie u noworodka i niemowlęcia – część I: poszerzenie dróg moczowych

Streszczenie Nieprawidlowości drog moczowych u plodu są jednym z najcześciej stwierdzanych odchylen podczas wykonywanych prenatalnie badan ultrasonografi cznych. Bardzo istotne jest takie zaplanowanie postepowania u noworodka i niemowlecia, aby odpowiednio szybko wylonic i objąc wlaściwą opieką grupe dzieci wysokiego ryzyka zakazen i postepu choroby nerek. Takie dzialanie wymaga wspolpracy wielospecjalistycznej i wspolnych dla pediatrow, neonatologow i lekarzy rodzinnych schematow postepowania. Niniejszy artykul powstal na podstawie opracowanych przez Polskie Towarzystwo Nefrologii Dzieciecej i dotyczy dzialan, jakie nalezy podjąc u dziecka z prenatalnie wykrytym poszerzeniem drog wyprowadzających mocz.

„Słoniowacizna nóżki” płodu – naczyniak kapilarny u noworodka – opis przypadku

Streszczenie Przedstawiamy pierwszy w polskim piśmiennictwie przypadek prenatalnej diagnostyki ultrasonograficznej naczyniaka kapilarnego. U plodu 29-letniej ciezarnej (CI, PI), w rutynowym badaniu USG w 34 tyg. poloznik opisal zmiane torbielowato-litą okolicy pośladka lewego i z podejrzeniem potworniaka okolicy krzyzowej skierowal ciezarną do ośrodka referencyjnego. W badaniu USG + ECHO serca plodu wykonanym w 37 tyg. ciązy zmieniono wstepne rozpoznanie, opisując sloniowacizne nozki plodu, przy prawidlowej budowie i funkcji ukladu krązenia. Po konsultacji wielospecjalistycznej odstąpiono od badania NMR u plodu, a ze wzgledu na szybką progresje zmian w ciągu ostatnich 3 tygodni, zadecydowano o rozwiązaniu ciązy drogą planowego ciecia cesarskiego. Noworodek plci zenskiej urodzil sie w stanie ogolnym dobrym, ze znacznym obrzekiem i zasinieniem lewej nogi (od stopy do pośladka). W badaniu ultrasonograficznym stwierdzono obecnośc naczyniaka kapilarnego konczyny dolnej lewej. Dziewczynka zostala przeniesiona do Kliniki Onkologii Centrum Zdrowia Dziecka, gdzie pomimo proby terapii zmarla w wieku 3 miesiecy.