Fetal vesicorectal fistula causing oligohydramnios in the second trimester: case report

Article Abstract:

A decrease in the amount of fluid surrounding the fetus, oligohydramnios, is associated with fetal abnormalities, premature rupture of the amniotic membranes, blockage of the fetal urinary tract, and fetal growth retardation. A 26-year-old women, pregnant with her first child, had oligohydramnios diagnosed during a routine ultrasound (the use of high frequency sound to visualize internal structures). The bladder and kidneys appeared normal when ultrasound was performed using a vaginal probe (transvaginal ultrasound). To help visualize the fetus and the rule out premature rupture of membranes, the patient consented to amnioinfusion, the infusion of warm salt solution (similar to natural amniotic fluid) to increase the volume of amniotic fluid. A sausage-shaped cystic structure was seen next to the left kidney. To see if there was a blockage in the intestinal tract, salt solution was infused directly into the fetal abdominal cavity (intraperitoneal infusion). When the fluid was removed after infusion there was no evidence of meconium, the first fetal stool. An abnormal communication between the bladder and the rectum was suspected. Amnioinfusions were continued until premature labor resulted in the delivery of a male infant. The infant had difficulty breathing and died six hours after delivery. Autopsy revealed anal atresia (incomplete anal canal) and vesicorectal fistula, an abnormal tube leading from the bladder to the rectum. The urethra (the tube that empties urine from the bladder) emptied urine into the rectum. Breathing complications were caused by underdeveloped lungs (lung hypoplasia). Lung hypoplasia can result from an inadequate amniotic fluid environment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Development and progression, Oligohydramnios

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Endocrine pancreatic function in growth-retarded fetuses

Article Abstract:

Insulin and glucagon are two endocrine hormones produced by the pancreas that regulate plasma glucose (blood sugar) levels. Glucose levels in the fetus are normally closely tied to levels in the mother. Previous studies have indicated that fetuses with retarded growth have low glucose levels, low insulin levels, and a greater difference between maternal and fetal glucose concentrations (a larger gradient). The precise relationship between growth retardation and endocrine pancreatic function is still unclear. To clarify this relationship, this study examined fetal and maternal blood in 34 women with normal-sized fetuses and 29 with fetuses with retarded growth (20 of which did not have adequate blood circulation through the umbilical artery from the placenta, resulting in a reduced supply of oxygen and nutrients). Maternal-fetal glucose gradients and fetal glucagon levels were higher, and fetal glucose and insulin levels were lower in the fetuses with retarded growth than in those with normal growth. Among the growth-retarded fetuses, glucagon levels were higher in those with poor circulation through the umbilical artery (as indicated by absence of blood-flow velocity in the artery at the end of diastole, the rest phase of the heartbeat). These results suggest that in growth-retarded fetuses, low glucose levels trigger an increase in glucagon production. Testing fetal glucagon levels appears to be a valuable indicator of the presence and severity of growth retardation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Blood flow, Physiological aspects, Fetal growth retardation, Pancreas, Hypoglycemia, Glucagon, Pancreatic secretions

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Fetofetal transfusion syndrome: Do the neonatal criteria apply in utero?

Article Abstract:

Up to 26 percent of twins and multiple births may develop fetofetal transfusion, in which one twin donates blood to the other and develops more slowly, while the other twin receives blood and develops problems related to excess fluid volume and, possibly, an unrelated blood type. Most of these cases are diagnosed postnatally, by signs such as differences in hemoglobin levels and birth weights. Signs that are evident during prenatal scanning are nonspecific, and more accurate methods of prenatal diagnosis are needed. The diagnosis of fetofetal transfusion syndrome in five twin sets and one triplet set was investigated. The syndrome was suspected following findings of asymmetric growth, discordant volumes of amniotic fluid, and other signs. Blood was sampled from nine fetuses to aid diagnosis; the hemoglobin level was abnormal in only one case. More accurate indications of fetofetal transfusion syndrome were obtained when a smaller twin was given a small amount of adult blood, which was detected rapidly in the larger twin. Additional findings were compared with those reported in previous studies. Eleven of the 13 affected fetuses died. Current aggressive treatment measures are discussed, including laser ablation of the communicating blood vessels, removal of blood from the recipient twin, and selective feticide. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Diagnosis, Fetofetal transfusion

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