The study was designed to investigate the implications of the sonographic diagnosis of the two-vessel umbilical cord for patient counselling and pregnancy management. Retrospective analysis was carried out of prenatal findings and pregnancy outcomes when a two-vessel cord was diagnosed in utero. Eighty-two fetuses each with a single umbilical artery were diagnosed by ultrasound. Ten were aneuploid, including nine with visible structural defects and one with early onset intrauterine growth retardation. Of the remaining 72, 31 had other anomalies diagnosed postnatally; 27 of these had structural defects detected on ultrasound examination. However, in nine of these 27 sonographically abnormal fetuses, one or more major structural defects were missed by ultrasound examination. Among the 45 chromosomally normal fetuses with no visible defects on scan, four had anomalies diagnosed after birth. Among the chromosomally normal singletons, six of 22 with other anomalies seen on scan and seven of 38 with no other visible defects on scan had intrauterine growth retardation. Among chromosomally normal twins, one of two with other anomalies seen and two of five appearing otherwise normal had intrauterine growth retardation; one twin set was delivered at 23 weeks after the demise of both twins. Karyotyping is recommended whenever a two-vessel cord is seen in association with symmetric intrauterine growth retardation or any other defect. The fetus diagnosed with a two-vessel cord and any other anomaly by ultrasound often has additional structural defects not seen on scan. The fetus with an isolated two-vessel cord on scan seldom has unrecognized major anomalies, but is at risk for intrauterine growth retardation.
The sinusoidal fetal heart rate pattern has been described in association with severe fetal anaemia, with fetal hypoxaemia, and with the administration of parenteral narcotics. Here, we report a case of decreased fetal movement in which a sinusoidal tracing was recorded. The sonographic diagnosis of a massive fetal intracranial haemorrhage was made. A non-interventive approach was taken and the fetus died soon after in utero. We review 28 previous cases in which the prenatal sonographic diagnosis of fetal intracranial haemorrhage was made, including the underlying maternal and fetal factors and neonatal outcomes. We propose that the sinusoidal tracing in this case was due to the intracranial bleed and suggest that fetal intracranial haemorrhage be considered in the sonographic evaluation of the fetus with a sinusoidal pattern.
An intrapericardial teratoma associated with a large pleural effusion and elevated aortic outflow velocity was diagnosed at 23.6 weeks' gestation. Less than 4 weeks earlier, an obstetric scan, including a four-chamber heart view, had been normal. In less than a week following diagnosis, fetal hydrops and bradycardia developed. 'Heroic' pericardiocentesis was declined by the patient, and the fetus died. This case demonstrates the potential for rapid growth in pericardial teratomas, and illustrates the possibility of anticipating fetal compromise from tumor mass effect, when intracardiac Doppler studies are abnormal. Implications for management of these rare tumors, and specifically for the hypothetical role of fetal surgery, are discussed.
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