A case in which the diagnosis of anencephaly was missed on a standard obstetrical sonogram performed at 12.5 menstrual weeks is described. Prompted by this case, we retrospectively reviewed the appearance of the cephalic pole of normal fetuses in 47 pregnancies ranging in menstrual age from 11 weeks to 16 weeks. Results indicate that the abnormal cephalic pole in the index case was similar to the appearance of many normal fetuses of similar menstrual age. We conclude that while anencephaly may be diagnosed as early as 11 menstrual weeks to 12 menstrual weeks, this defect may be difficult to diagnose on sonograms using standard sonographic techniques prior to 14 menstrual weeks.
Ten fetuses with gastroschisis on whom a prenatal sonographic diagnosis and evaluation were available and who delivered at the University of California, San Francisco, were evaluated retrospectively. Six fetuses were delivered vaginally without mortality and minimal or absent morbidity. Four were delivered abdominally, 2 for unrelated obstetrical indications. A 3rd fetus had a suspected prenatal bowel perforation and was the sole mortality. Only 1 mother underwent primary cesarean section, specifically due to the fetal gastroschisis. Umbilical cord pH values were normal in those delivered vaginally. With careful ultrasound examination and immediate neonatal surgical capability in a level III perinatal center, vaginal delivery of fetuses with gastroschisis can be associated with excellent outcome. A multinational randomized study of the delivery mode of fetuses with gastroschisis is necessary and appropriate at this time.
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