The AEDV in the umbilical artery or the foetal aorta is considered to be the most severe waveform abnormality. Using pulsed Doppler, we found such a waveform in 51 foetuses out of 954 high-risk pregnancies (33/51 in both vessels, 17/51 aorta only and 1/51 umbilical artery only). A reverse flow was registered in 24 foetuses. The outcome was compared with that of a control group (n = 72) showing normal Doppler findings. The following parameters were highly significant (p less than 0.001): Rate of Caesarean section owing to foetal distress (85.3% to 4.8%), of growth retardation (IUGR) (66.7% to 6.0%), of premature delivery (73.5% to 7.5%), of low postnatal pH- and Apgar score (73.5 to 12.1%), of admission to the neonatal intensive care unit (94.1% to 8.6%), of morbidity (35.3% to 2.3%) and of mortality (41.1% to 0%). We observed 17/51 intrauterine and 4/51 postnatal deaths. The rate of malformations was 35.3% with 4 cases of aneuploidy. Considering the malformations, the rate of corrected mortality was 23%. We found, that the association of an AEDV and the absence of severe IUGR is highly suspicious of malformation. We also observed, that congenital heart diseases (CHD) could lead to an AEDV too. An AEDV precedes a pathological cardiotocogram (CTG) with a latency of 0 to 35 days (mean 9.5 days). This latency is not predictable, but we think, that a reliable assessment of jeopardy is possible by analysing further vessels (Aa. arcuatae, A. renalis, A. carotis interna): 72.5% of the foetuses with AEDV had high indices in the carotid artery and 93.1% among these showed a pathological CTG pattern.(ABSTRACT TRUNCATED AT 250 WORDS)
Pulsed Doppler ultrasound was used in the differential diagnosis of 22 cases suspected of bilateral malformations of the foetal kidneys. In cases of kidney malformations, the pulsatility indices (PI) of the umbilical artery and the foetal aorta were in the normal range. In cases showing pathological PI values of both vessels, we found a severe intrauterine growth (IUGR) retardation with oligohydramnion. These results underline the importance of pulsed Doppler as a non invasive means in the management of oligohydramnions to differentiate among bilateral kidney malformations and IUGR.
The Ebstein's malformation occurs in 0.5% of patients with congenital heart disease. The prenatal diagnosis of such a malformation in the 33rd week of pregnancy is reported. The fetal echocardiography was performed owing to a severe nonimmune hydrops fetalis. The typical distal displacement of the annular attachment of the tricuspid valve leaflets could be viewed in the apical four-chamber view. The application of the pulsed Doppler ultrasound enables the analysis of the cardial haemodynamics and thus the assessment of the severity and prognosis of the diagnosed malformation. In our case the prognosis was interdisciplinary estimated as being very poor (severe cardiac lesion with congestive heart failure already in utero); In the following days intrauterine death occurred. The autopsy confirmed all the prenatal findings.
The use of flowmetry of the foetal renal artery offers a diagnostic improvement by analysing intrauterine centralisation of the foetal circulation. We used the examination results of 82 pregnant women, who were in intensive prenatal care, to check the prediction of foetal distress using the flowmetry of the renal artery. In foetuses showing an increased flow resistance of the aorta and a pathological flow of the renal artery, the rate of caesarian section, necessitated by foetal distress, was 63.6%. By the forming of quotients from the pulsatility indices of the internal carotid artery and the aorta on the one hand, and the renal artery and the internal carotid artery on the other hand, it seems to be possible to get information about the severity of the centralisation of the foetal circulation by existence of an intrauterine hypoxia. The rate of the operative delivery as a consequence of a foetal distress rises from 6.6% with normal PI quotients to 83.4% if both quotients are outside the double standard deviation.
This case report describes the prenatal diagnosis of an oesophageal atresia with the previously unpublished associated malformation of tracheal atresia. The knowledge of associated malformations or deformations in prenatally diagnosed oesophageal atresia can considerably improve the prognosis by an optimised post partum care of the newborn. Tracheal atresia can at present not be diagnosed prenatally; the possibility to identify it remains an isolated case and must therefore be taken into consideration whenever an oesophageal atresia is observed.
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