Rainer Bollmann

Prognostic significance of the pouch sign in fetuses with prenatally diagnosed esophageal atresia.

OBJECTIVE Esophageal atresia may be diagnosed prenatally by ultrasonographic visualization of the blind-ending esophagus during fetal swallowing, which is referred to as the pouch sign. Our purpose was to determine whether this sign can be used to predict outcomes of affected fetuses. STUDY DESIGN Four cases of esophageal atresia diagnosed in our center during the past 2 years were analyzed, in conjunction with 3 cases from published series. Ultrasonographic features of the pouch sign were categorized according to localization. RESULTS In the neck pouch group (n = 3) 1 fetus died in utero and 1 died before a corrective operation could be undertaken. In the only fetus of this group to survive a staged repair was necessary because of a long atretic gap. Conversely, 3 of the 4 fetuses with a mediastinal pouch survived after a successful corrective operation, and primary repair was possible in all cases. CONCLUSIONS The base of the proximal blind-ending esophagus can be clearly localized by means of ultrasonography. Our data suggest that a neck pouch may be associated with an adverse outcome. This information may be useful in counseling parents when esophageal atresia is diagnosed prenatally.

Prenatal Diagnosis of Right Lung Agenesis Using Color Doppler and Magnetic Resonance Imaging

Unilateral lung agenesis should be suspected in fetuses presenting mediastinal shifting and absence of evidence of diaphragmatic hernia. Confirmation of diagnosis is not possible until birth as other more common lung anomalies may have a similar appearance. We present a case with right lung agenesis diagnosed at 34 weeks of gestation. Important for precise diagnosis was the color Doppler procedure, which revealed the absence of right pulmonary vessels. This is the first case in which unilateral lung agenesis has been recognized prenatally by nonvisualization of the corresponding lung vessels. The prenatally performed magnetic resonance sonography did not offer any advantages over sonography. Postnatally, the diagnosis was confirmed, and sinus venosus defect was also found. To prevent recurrent cardiopulmonary crisis, which could be caused by mediastinal shift, a tissue expander was implanted successfully at 3 months of age.

Sonographische Messungen der Durchmesser der Aorta und des Truncus pulmonalis beim Feten

Fetal cardiac measurements derived in the five-chamber and the short-axis view were performed in uncomplicated pregnancies between the 20th and the 40th week of gestation. Using cine loop and zoom techniques, the diameters of the aortic and pulmonary valve were measured (n = 157) and the pulmonary trunk/aorta ratio calculated. Normal ranges for both parameters were constructed and correlated with gestational age. Both diameters showed a linear increase during gestation (aorta r = 0.87, pulmonary trunk r = 0.91). The mean pulmonary trunk/aorta ratio had a constant value of 1.25 and showed no changes throughout pregnancy. In 128 fetuses the heart width was further measured and the vessel diameters were presented in correlation to the heart width.

Fetal trisomy 10 mosaicism : Ultrasound, cytogenetic and morphologic findings in early pregnancy

We report the ultrasound, cytogenetic and morphologic findings in a case of trisomy 10 mosaicism prenatally detected by chorionic villus sampling (CVS). CVS sampling was carried out at the 13th week of gestation because of ultrasound diagnosis of hydrops fetalis and hygroma colli. Trisomy 10 mosaicism was diagnosed in cells from the cytotrophoblast (short‐term culture) and the chorionic villus core (long‐term culture). Fetal mosaicism was confirmed after termination of pregnancy in umbilical cord cells, placenta and fetal skin fibroblasts. Copyright

Normwertkurven für intrauterine fetale Blutgas- und Säure-Basen-Parameter im 2. und 3. Trimenon

Fragestellung: Ziel der Arbeit war die Erstellung gestationsabhangiger Referenzkurven fur fetale Blutgas- und Saure-Basen-Parameter wahrend der 2. Schwangerschaftshalfte. M

Biochemical diagnosis in prenatal uropathy

Thirty-two fetuses, six with prune-belly syndrome, seven with renal cyst, 19 with obstructive uropathy, underwent intrauterine fluid aspiration during weeks 15-37 of gestation. Fluid samples were analysed for Na, K, creatinine, urea, alpha 1-, and beta 2-microglobulin. Aspirate concentrations of sodium below 130 mmol/L and creatinine above 115 mumol/L indicate an active kidney and exclude a renal cyst. However, aspirates from fetal cysts or fetuses with obstructive uropathy showed analyte concentrations for sodium, potassium, creatinine, and urea corresponding to extracellular fluid (ECF). In conclusion fluid aspirates of fetuses with ultrasonographically detectable cystic cavities in the abdomen should be examined for sodium and creatinine to assess remaining renal function for planning of obstetric management.

OP07.04: Three‐Dimensional Power Doppler Sonography in the diagnosis of Arteriovenous Malformations of the uterus and treated by selective uterine artery embolization

Objectives: To evaluate the impediment to fertility and the outcome of pregnancies after uterine fibroid embolization for symptomatic fibroids. Study Design: A retrospective analysis of pregnancies subsequent to uterine fibroid embolization by one? interventional radiologist. Population: 54 pregnancies in 50 women from 1990 to 2005 who underwent uterine fibroid embolization were classified in two groups : group A for embolization alone (32 cases) and group B for embolization + myomectomy (22 cases) Methods: Patients were followed regarding events and outcome of pregnancy. All events and complications were recorded and analyzed. Results: In series A (32 cases), the mean age was 36 years old (21–43), average fibroid size was 45 mm (20–100), abortion occurred in 8 cases, living births represented 18 cases, normal deliveries represented 7 cases, Cesarean deliveries represented 11 cases. In series B (22 cases), the mean age was 33 years old (26–40), average fibroid size was 65 mm (20–200), abortion occurred in 2 cases, living births represented 19 cases, normal deliveries represented 0 cases, Cesarean deliveries represented 22 cases. Conclusions: Pregnancies after UFE for fibroids are generally uneventful. Women can get pregnant after UFE. No side effects on the foetuses were observed. A slightly higher risk of abnormal placentation was noted. A large number of Cesarean deliveries were attributable to identified factors. Today, embolization does not affect women’s fertility

Sonographische Untersuchung des fetalen Lungenkreislaufs

ZusammenfassungDie Arbeit gibt eine Übersicht über die pränatale Erfassung der Hämodynamik in der Lunge. Seit der Einführung der Farbdopplersonographie in die pränatale Diagnostik, konnten neue Erfahrungen auf dem Gebiet der Analyse der Lungenarterien und -venen gewonnen werden. Nach Darstellung der Entwicklung und der Besonderheiten des fetalen Lungenkreislaufs, wird in der Arbeit die systematische sonographische Beurteilung der rechten und linken Lungenarterien und -venen erläutert. Ferner werden Daten zur Biometrie der Lungenarterien, sowie zur Dopplersonographie der zentralen und peripheren Pulmonalarterien unter normalen und pathologischen Bedingungen vorgestellt. Die Beurteilung der Lungenvenen wird erklärt, nicht nur unter Berücksichtigung des Dopplerspektrums unter normalen und pathologischen Bedingungen, sondern auch unter dem Aspekt der pränatalen Diagnostik der Lungenvenenfehlmündung. Die Analyse der fetalen pulmonalen Hämodynamik könnte in Zukunft nicht nur in der Entdeckung von Fehlbildungen, sondern auch möglicherweise in der Voraussage von neonatalen Lungenerkrankungen, wie die Lungenhypoplasie oder die pulmonale Hypertension, eine wichtige Rolle spielen.

Pränatale Diagnostik von Herzfehlbildungen mit linksventrikulärer Ausflußtraktobstruktion

ZusammenfassungDie Aortenstenose, die linksventrikuläre Dysfunktion bei kritischer Aortenstenose, das hypoplastische Linksherzsyndrom und die Aortenisthmusstenose sind die wichtigsten angeborenen Herzfehler mit linksventrikulären Ausflußtrakt (LVOT)-Obstruktionen, die auch pränatal entdeckbar sind. Die Arbeit gibt eine Übersicht über die pränatale Beurteilung des LVOT in normalen und auffälligen Herzen. Auf die Bedeutung und die Zuverlässigkeit verschiedener diagnostischer Techniken wie das B-Bild, die Spektral- oder die Farbdopplersonographie wird eingegangen. In den meisten Fällen mit einer LVOT-Obstruktion erscheint der linke Ventrikel bereits auffällig in der Vierkammerblickebene, so daß in der Arbeit die Hauptmerkmale einer zuverlässigen Differentialdiagnose hervorgehoben werden. Die Einstellung der Dreigefäßblickebene unter Anwendung des Farbdopplers wird in der Beurteilung des Ausflußtrakts empfohlen, da bei den meisten schweren LVOT-Obstruktionen eine retrograde Perfusion über dem Isthmus aortae gefunden wird.

OC143: Proteomic analysis of mid‐trimester amniotic fluid for identification of subclinical intra‐amniotic inflammation followed by preterm birth

to 30 + 0) weeks + days in the TPTL group. Mean (SD) cervical length was similar in the control (36.1 (2.9) mm) and PPROM (36.6 (16.6) mm) groups, but shorter in the TPTL group (20.4 (9.2) mm; P = 0.01). Mean (SD) FMBV was lower in controls (9.4 (6.4)%) than in the PPROM (21.2 (10.0)%) and TPTL (18.9 (6.9)%) groups (P = 0.01). The median time between the first examination and delivery was 2 (range, 1–4) weeks in the PPROM group and 4 (range, 1–14) weeks in the TPTL group. In PPROM, 7/10 cases delivered within the 2 weeks after the first examination, and 6/7 had a FMBV above 18% in spite of a cervical length within normal values. In TPTL, there was a significant association between the cervical length and the time to delivery (r = 51, P = 0.001), but in most cases FMBV was similarly increased. Conclusions: In TPTL the cervical length correlated well with the time to delivery and FMBV did not improve this information. However, in PPROM an increment in FMBV appears to be independently associated with an earlier delivery.