Contemporary management of a potentially lethal fetal anomaly: a successful perinatal approach to epignathus
Article Abstract:
Prenatal diagnosis of birth defects using ultrasound can lead to effective treatment in many cases, but some defects require additional diagnostic methods. A case report is presented in which magnetic resonance imaging (MRI, a method that provides a high-resolution image) was used to evaluate a fetus of 36 gestational weeks' age. Ultrasonographic examination indicated the presence of a breech infant (lying head-up instead of head-down) with a large mass associated with the fetal face and neck. MRI allowed the mass to be more accurately evaluated and defined, and an interdisciplinary team formulated a treatment plan for the period immediately after the cesarean delivery. This included preparation for a tracheostomy (surgical creation of an airway) in the event the mass prevented the infant from breathing normally. This was, in fact, the case; the tracheostomy was performed before the placenta was removed or the umbilical cord cut, an approach that prevented the newborn from suffering oxygen deprivation. General anesthesia had been induced in the mother for a period long enough that the infant would be maximally anesthetized. The procedure required 10 minutes, after which the cord was cut. Several hours later, the infant underwent surgery to remove the mass; the outcome was favorable. The infant had micrognathia (abnormally small lower jaw) and some other structural changes due to the mass, which was a teratoma (tumor composed of many cell types). Additional surgery will be performed before the baby reaches one year of age. Such dramatic and effective intervention depends on accurate prenatal diagnosis and a team approach for treatment. Fetal malformations are best managed in medical centers where specialists from a range of disciplines can work together. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1990
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The management of severe erythroblastosis fetalis by fetal transfusion: survival of transfused adult erythrocytes in the fetus
Article Abstract:
When a pregnant woman manufactures antibodies against her fetus's red blood cells (erythrocytes) because of incompatibility between maternal and fetal blood groups, the fetus may develop erythroblastosis fetalis, a condition in which its own red blood cells are destroyed. In such cases, the anemic fetus is given blood transfusions. A report is presented of cases in which adult blood was transfused into fetuses with erythroblastosis fetalis. Of 20 severely affected fetuses, 18 survived. The transfusion technique is described. Previous research has indicated that transfused adult erythrocytes do not survive as long in the fetus as in the adult. But in these fetuses, half the transfused red blood cells were present in the fetal circulation 43 days later, a similar longevity to that observed in adult patients. This was true regardless of the transfusion route (intravascular, or into a blood vessel, versus intraperitoneal, or into the abdominal cavity). Intraperitoneal transfusion resulted in as much as 80 percent of the blood being taken up into the fetal circulation. This approach may be advantageous because larger volumes of blood can be given in a single infusion. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1989
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