In utero diagnosis and management of fetal subdural hematoma

Article Abstract:

A subdural hematoma is a swelling or mass of blood pooled beneath the dura mater, the outer membrane covering the spinal cord and brain. The presence of subdural hematoma in the fetus can be detected before birth by transvaginal ultrasonography, a diagnostic method in which sound waves are used to visualize internal structures. In transvaginal ultrasonography, the ultrasonic transducer (the device that sends and receives sound waves) is inserted into the vagina. The cranium or skull of the fetus in a head-down position can be completely visualized using this technique. Magnetic resonance imaging (MRI), another diagnostic method, involves the use of electromagnetic energy to visualize internal structures, and helps to confirm a diagnosis of subdural hematoma in the fetus. During MRI, the fetus is momentarily paralysed with the drug pancuronium, which is administered into the umbilical cord to prevent fetal movement. The outcome of a fetus with subdural hematoma depends on the severity of the bleeding and the underlying cause, but it is often poor. However, brain function can not be predicted on the basis of ultrasonography findings, and efforts should be made to increase the survival of the fetus with subdural hematoma. The fetus should be delivered as soon as the lungs have matured. Fetal blood should be monitored for the development of anemia (decreased number of red blood cells) and coagulation disorders. Blood transfusion should be provided if necessary. Because of head enlargement, the fetus should be delivered by cesarean section. A case is described in which fetal subdural hematoma was diagnosed by transvaginal ultrasonography and MRI. The fetal blood was monitored and blood transfusion was performed. Although there was evidence of fetal lung maturation, delivery was delayed to prevent other complications of prematurity. The infant was delivered nine days after the transfusion, but died six hours after birth due to massive bleeding within the brain. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Ultrasound imaging, Diagnosis, Fetus, Subdural hematoma

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Transabdominal thin-gauge embryofetoscopy: a technique for early prenatal diagnosis and its use in the diagnosis of a case of Meckel-Gruber syndrome

Article Abstract:

Thin-gauge embryofetoscopy may be more effective than other techniques for viewing a fetus in utero during the first trimester of pregnancy. This technique involves the insertion of a small needle-delivered endoscope into the uterus. A study examined the effectiveness of thin-gauge embryofetoscopy in 28 patients who terminated their pregnancy during the first or second trimester. Twenty women were less than 14 weeks pregnant, and eight were between 16 and 20 weeks pregnant. Thin-gauge embryofetoscopy was effective in visualizing the anatomy of 85% of the fetuses between seven and 13 weeks old. Use of this technique enabled prenatal diagnosis of Meckel-Gruber syndrome in an 11-week-old fetus. The presence of extra fingers and toes could clearly be seen on the hands and feet. Protrusion of the brain though an opening in the skull could also be seen.

Usage, Fetoscopy

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The impact of prenatal alcohol exposure on frontal cortex development in utero

Article Abstract:

Prenatal ultrasound can detect fetal brain abnormalities caused by the mother's alcohol use. In a study of 167 pregnant women, 23% of the fetuses exposed to alcohol had a small frontal cortex, compared to only 4% of the fetuses who were not exposed to alcohol.

Research, Abnormalities, Pregnant women, Fetal alcohol syndrome, Alcohol use, Frontal lobes

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