Gastroschisis and omphalocele: does either antenatal diagnosis or route of delivery make a difference in perinatal outcome?

Article Abstract:

Two congenital abnormalities involving abdominal wall defects are gastroschisis and omphalocele. Gastroschisis is a congenital fissure in the abdominal wall which remains open, and omphalocele is a congenital hernia of the navel. The optimal route of delivery, vaginal or cesarean, is controversial for fetuses with either gastroschisis or omphalocele. These two conditions are usually diagnosed antenatally, i.e. before birth. Sixty-one pregnancies complicated by either gastroschisis or omphalocele were reviewed to determine the prognosis of the fetuses with respect to the timing of the diagnosis and any difference between the two routes of delivery. Fetal gastroschisis was present in 33 pregnancies and omphalocele in 28 pregnancies. Lower birth weights were noted in the infants with omphalocele but not in those with gastroschisis. The route of delivery did not affect the outcome of infants born with either of the two congenital conditions. Antenatal diagnosis allows physicians to plan the route and timing of delivery, to refer the infant to a tertiary care center if necessary, and to assess the bowel throughout the gestation period. Seventy-one percent of fetuses with gastroschisis and 59 percent with omphalocele were delivered vaginally. Routine cesarean delivery of these infants has been previously recommended, although it is controversial; however, in the patients studied, there was good outcome even with a high vaginal delivery rate. Antenatal diagnosis of gastroschisis is not associated with a worse outcome than postnatal diagnosis; however, the authors state that the same cannot be said for omphalocele. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Birth defects, Abdomen, Navel, Umbilical hernia

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Prenatal diagnosis of fetal hyperthyroidism using funipuncture

Article Abstract:

Graves disease is an autoimmune disorder associated with the production of antibodies that stimulate the thyroid gland. The fetuses of women with Graves disease are at risk for thyrotoxicosis (hyperactivity of the thyroid gland) when they reach the point in development at which their own glands can respond to the maternal antibodies. This point begins approximately halfway through pregnancy. Growth retardation, cardiac failure, and death can result from thyrotoxicosis in the fetus. However, diagnosis of the extent to which a fetus is affected is difficult, and treatment that is started inappropriately can have unfavorable consequences for both fetus and mother. One promising method of evaluating the condition of the fetus relies on fetal blood sampling from the fetal umbilical cord (funipuncture). Two case studies are presented, demonstrating different approaches to managing patients who are noncompliant with their treatment, as both women were. The endocrine status of the fetuses was different from that of the mothers, making the advantages of direct diagnosis obvious. Repeated funipuncture allowed evaluation of the therapeutic measures taken, which consisted primarily of the administration of propylthiouracil, an antithyroid drug. When women with Graves disease become pregnant, avoiding congenital hyperthyroidism in their babies should be a primary goal of the clinician. This cannot be done on the basis of test results from the mother. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Case studies, Physiological aspects, Autoimmune diseases, Pregnancy, Pregnancy, Complications of, Pregnancy complications, Graves' disease, Autoimmune diseases in pregnancy

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Magnetic resonance imaging of fetuses with intracranial defects

Article Abstract:

Magnetic resonance imaging (MRI) is a diagnostic imaging procedure that is able to finely differentiate tissues. It was initially thought that MRI would be very useful in evaluating fetuses, but fetal movement inhibits image quality, and MRI is costly. MRI is very useful for imaging the brain, however, and has been suggested for use in clarifying abnormalities in fetuses revealed by ultrasound. This study examined whether MRI images of fetuses could be improved if the fetuses were first paralyzed with the drug pancuronium, and if MRI images of the intracranial region of fetuses with abnormalities detected by ultrasound provide enough additional diagnostic information to warrant their cost. Thirteen fetuses with intracranial abnormalities showing up on ultrasound tests were further examined with MRI after being paralyzed with pancuronium. Results showed that MRI and ultrasound findings were the same for six cases. In four other cases, MRI results were superior to those of ultrasound, and provided additional information in three others. All MRI images were clear and distinct. These results indicate that paralyzing a fetus with pancuronium during MRI yields clearer images, and that MRI is more accurate and provides more information in most cases of intracranial defects in fetuses. The costs of MRI can be justified when results of ultrasound are unclear or questionable or when more detailed information is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Magnetic resonance imaging, Fetal brain, Prenatal ultrasonography

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