Prognostic indicators of the resolution of nonimmune hydrops fetalis and survival of the fetus

Article Abstract:

Nonimmune hydrops fetalis is the accumulation of fluid in fetal tissues, which occurs in the absence of immunological reaction to red blood cells. Occurring in 1 in 3000 deliveries, there are over 800 causes, and the death rate is 40 to 90 percent. No particular finding has been available to discriminate a good from poor outcome in nonimmune hydrops fetalis. Ultrasonograms and echocardiograms from 19 cases of nonimmune hydrops fetalis were reviewed to identify features associated with a good outcome of the disorder. Of 19 cases diagnosed prenatally, 13 died. Of the six survivors, only one had a disorder known to cause nonimmune hydrops fetalis, while causes were identified in all 13 deaths. Among the survivors, two underwent prenatal surgery to drain fluid, neither of which experienced reaccumulation. Among the deaths, four underwent similar procedures, which were followed by prompt fluid reaccumulation. All fetuses that had enlargement of the outer diameter of the heart ventricles died, while all but one with normal ventricular diameters lived. The level of fetal anemia, previously postulated to be related to the extent of fluid accumulation, did not predict outcome among these infants. The surviving infants, aged 8 months to 2.5 years, have progressed in a manner similar to their siblings, but have not been formally evaluated. The study indicates that ventricular diameter measured by echocardiography is an excellent predictor of fetal outcome in nonimmune hydrops fetalis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Echocardiography, Heart ventricles, Hydrops fetalis

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Fetal choroid plexus cysts in the second trimester of pregnancy: a cause for concern

Article Abstract:

The choroid plexus is a mass of small blood vessels located in the ventricles of the brain. Cysts in the choroid plexus are common and they usually do not cause any symptoms or problems. This type of cyst can occur in the developing fetus and can be identified with ultrasound. In most cases, the cysts decrease in size or disappear by week 24 to 26 of pregnancy. The majority of these cysts are benign (noncancerous), but some may be related to chromosome abnormalities. To determine the incidence of aneuploidy (abnormal number of chromosomes) in fetuses that also have choroid plexus cysts, ultrasound was performed on 7,350 women between week 15 and 22 of pregnancy. Cysts were identified in 71 (1 percent) of the cases, and amniocentesis was performed in 62 of these. The results of the amniocentesis showed that four of the fetuses had chromosome abnormalities. One had trisomy 21 (an extra copy of chromosome 21) and three had trisomy 18. Previous studies have reported that heart abnormalities occur in up to 50 percent of the fetuses with trisomy 21, in 90 percent of those with trisomy 13, and in 99 percent of those with trisomy 18. Another study reported that 90 percent of the fetuses with aneuploidy can be identified by examining the fetal heart using a procedure called echocardiography. It is concluded that amniocentesis and genetic counseling should be offered to women with ultrasound test results that indicate fetal choroid plexus cyst. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Ultrasound imaging, Fetus, Birth defects, Amniocentesis, Choroid plexus, Aneuploidy

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Quantifiable polyhydramnios: diagnosis and management

Article Abstract:

Polyhydramnios, a complication of pregnancy marked by an increased amount of amniotic fluid surrounding the fetus, is associated with fetal abnormalities and a poor fetal outcome. Ultrasonography, the use of high frequency sound to visualize internal structures, produces images of four fluid pockets around the fetus. A single amniotic fluid pocket measuring eight centimeters (cm) or more is the current value used to diagnose polyhydramnios. Patients fulfilling this criteria are referred for genetic evaluation of the fetus. To evaluate the accuracy of the current diagnostic criteria and to help define polyhydramnios, the pregnancy outcome of 112 non-diabetic women with increased amniotic fluid were studied. Of the total 112 women, 49 had an amniotic fluid index of greater than 24 cm, which was defined by the authors as significant polyhydramnios. None of the seven women with a total amniotic index of less than 24 cm but with one fluid pocket measuring more than eight cm had a poor fetal outcome. Therefore, a total amniotic fluid index of 24 cm is favored over a single fluid pocket value greater than eight centimeters, for diagnosing polyhydramnios. It is suggested that women with a total amniotic fluid index of 24 cm or more should have a detailed ultrasonographic evaluation by an experienced sonographer. If an abnormality is detected during fetal imaging, genetic analysis of fetal cells and close pregnancy surveillance should follow. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pregnancy, Complications of, Pregnancy complications, Amniotic fluid, Hydramnios

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