Frequency and preciseness of prenatal detection of foetal tumours increases due to improvement of sophisticated imaging methods. As correct diagnosis impacts the course of care in utero, it is essentially to improve diagnostic workout in a case of detected foetal anomalies. Here we report the case of partly involuting congenital haemangioma of foetus, which antenataly caused foetal secondary cardiomegaly. Pregnant woman was referred to Riga Maternity Hospital with unexplained tumour on the surface of foetal head at 24+2 weeks of gestation. Ultrasound exam revealed tubular structure without solid components between calvarium and skin under the left ear with very rich vascularization. Magnetic Resonance Image demonstrated enhancing multi-cystic lobulated mass. Hypertrophic secondary cardiomegaly was present without any additional structural abnormality. The foetus remained stable until 36+4 weeks of gestation, when the size of tumour succeeded 85 mm × 46 mm. Haemangioma was confirmed after delivery as round raised and infiltrating vascular lesion. After birth MRI demonstrated its connection with a. carotis externa. Propranolol was recommended with continuing follow-up. At 2 years and 3 months of age the lesion decreased by size noticeably, but still persists. Accurate diagnosis lets obstetricians to optimize antenatal care by providing an opportunity for planning deliveries, preparing family and medical staff for appropriate postpartum therapy and management.
VACTERL association includes at least three of the following congenital anomalies: vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal and limb abnormalities. The objective of article is to demonstrate the perinatal outcome of VACTERL case in 38-year-old pregnant woman with a history of infertility. Pregnancy has occurred after intracytoplasmic sperm injection and embryoscopy before embryo transfer. The 1st trimester ultrasound demonstrated right forearm anomaly-aplasia of the right radius and thumb. The normal female karyotype (46XX) was obtained. Increasing amniotic fluid index and invisible stomach from 26 weeks confirmed the suspicion of VACTERL association. After reduction of 900 ml of amniotic fluids at 34 +4 weeks of gestation the symptoms of premature separation of placenta occurred. The newborn weight was 2,360 g according to Apgar scale assessment 5/5 at 1 st and 5 th minutes. Multiple reconstructive operations were performed after birth. Among them sigmostomy, gastrostomy, ezofageotraheal fistulae plastic, that were followed by bronchoscopy and fibrogastroscopy. VACTERL association is a sporadic phenomenon, but among ICSI pregnancies fetal structural abnormalities occurrence is slightly higher. Our case demonstrates that the different components included into VACTERL association can be visualized at different gestational age, allowing to suspecting this association later in the pregnancy and often not prior to delivery. The family must has to understand the consequences of complications and their impact on the quality of child life.
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