Hypoplastic left heart syndrome: prenatal diagnosis, clinical profile, and management

Article Abstract:

Hypoplastic (underdeveloped) left heart syndrome is a congenital defect that can range from nearly a normal left heart and valves with constricted aorta to the complete absence of valves and severe underdevelopment of the left ventricle (the lower chamber that supplies the major pumping action of the heart.) This syndrome, the major cause of death from heart disease in newborns, can now be diagnosed prenatally with high-resolution ultrasound imaging. Early identification of affected pregnancies necessitates parental counseling and affects evaluation and treatment plans. Five years of experience with prenatal diagnosis of hypoplastic left heart in 20 fetuses are reviewed. Cases were referred for fetal echocardiography usually because of heart abnormalities detected during normal obstetric ultrasound imaging. Fourteen cases were diagnosed before viability, at 24 weeks. Additional abnormalities, including chromosomal, occurred in six fetuses. Nine of the 14 pregnancies were electively terminated, three others resulted in intrauterine fetal death. Two others fetuses were delivered at term, but died eight days after birth. Where autopsies were done, structural dimensions of the heart could not be obtained due to the extremely small size. Of the six cases diagnosed after 24 weeks, two had other abnormalities and there was one intrauterine death at 30 weeks gestation. Of the five delivered live, two underwent early surgical intervention, one remained alive at 2.5 years, while another died of congestive heart failure at 2.5 years after multiple heart operations. Early diagnostic information allows parents to make more informed decisions about this severe complication. Treatment of affected newborns is evolving, but the long-term results of new procedures including transplants in newborns are not known. Fetal echocardiography allows counselling of parents and preparation for newborn surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Prognosis, Hypoplastic left heart syndrome

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Elevated amniotic fluid nitric oxide metabolites and cyclic guanosine 3',5'-monophosphate in pregnant women with intraamniotic infection

Article Abstract:

Amniotic fluid tests for cyclic guanosine monophosphate, nitrite and nitrate might be useful for identifying pregnant women at-risk for amniotic infections. Cyclic guanosine monophosphate, nitrate, nitrite, pH and glucose levels and white blood cell count and activity were measured in 72 women in premature labor, 14 of whom had amniotic infections. Infected women had higher cyclic guanosine monophosphate, nitrate, and nitrite levels than did uninfected women. Women with these higher values also had lower glucose levels and higher white blood cell counts and activity.

Analysis, Infection, Measurement, Nitric oxide, Cyclic guanylic acid, Cyclic guanosine monophosphate, Amniotic fluid

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The effect of uterine contractions on intrapartum fetal heart rate analyzed by a computerized system

Article Abstract:

Uterine contractions appear to decrease fetal heart rate (FHR) variability. Researchers used the Sonicaid System 8000 computerized FHR monitoring system to compare FHR variability as normal labor progressed. Twenty-six healthy women underwent childbirth without analgesia while FHR was monitored. As uterine contractions intensified, large accelerations in FHR became less common, and episodes of varied heart rate became less frequent. Computerized monitoring may be more sensitive and accurate than qualitative monitoring of heart rate tracings by physicians.

Fetal heart rate monitoring, Electronic fetal monitoring, Uterine contractions

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