Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
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Ultrasound Obstet Gynecol · Sep 2005
Case ReportsPial arteriovenous fistulas: dilemmas in prenatal diagnosis, counseling and postnatal treatment. Report of three cases.
We report three cases of the antenatal appearance of a pial arteriovenous fistula (AVF). In Case 1, the diagnosis of pial AVF was made by ultrasound examination at 32 + 3 weeks of gestation and confirmed by magnetic resonance imaging (MRI) at 34 + 3 weeks of gestation. After birth, the neonate had cardiac insufficiency and an embolization was performed 8 days postpartum which was followed by extended cerebral ischemia and death. ⋯ The diagnosis should be considered in cases of unexplained cardiomegaly and it is also important to make sure that AVFs draining into the vein of Galen are not misdiagnosed as aneurysmal malformations of this vein. The complications of pial AVFs are cardiac failure and cerebral ischemia. Embolization is the treatment of choice; however it is a risky procedure in neonates.
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Ultrasound Obstet Gynecol · Jun 2005
Qualitative venous Doppler flow waveform analysis in preterm intrauterine growth-restricted fetuses with ARED flow in the umbilical artery--correlation with short-term outcome.
The aim of this retrospective study was to examine the significance of severe Doppler waveform abnormalities in the ductus venosus (DV) and the umbilical vein (UV) for the prediction of adverse outcomes in very preterm growth-restricted fetuses with absent or reversed end-diastolic flow in the umbilical artery (UA) at 24-34 weeks of gestation. ⋯ Abnormal venous Doppler waveforms in preterm IUGR fetuses with ARED flow are strongly related to adverse fetal and perinatal outcomes before 32 weeks of gestation. The possible benefit of prolonging these pregnancies can only be evaluated in a prospective randomized study.
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Ultrasound Obstet Gynecol · Jun 2005
Comparative StudyOutcome of 60 neonates who had ARED flow prenatally compared with a matched control group of appropriate-for-gestational age preterm neonates.
To describe the course and outcome of fetuses with absent or reversed end-diastolic (ARED) flow in the umbilical artery (UA) and to examine the influence of prematurity according to gestational age at delivery. ⋯ Neonates displaying ARED flow before birth are growth restricted, acidemic at delivery and are at high risk of developing bronchopulmonary dysplasia and intestinal complications. While perinatal mortality seems to be related to abnormal fetal Doppler velocimetry, age at delivery has a significant impact on short-term morbidity. After 32 weeks, morbidity is low and delivery should be considered. It could be speculated from our data that prolongation of pregnancy with Doppler velocimetry monitoring could help to reduce morbidity, although prolongation remains limited in most cases.
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Ultrasound Obstet Gynecol · May 2005
Outcome of fetal renal pelvic dilatation diagnosed during the third trimester.
The aim of this study was to evaluate renal function and the need for postnatal treatment--antibiotic therapy and/or surgery--in relation to the grade of fetal renal pelvic dilatation (RPD) found on third-trimester ultrasound examination. ⋯ The need for postnatal treatment increased significantly with the grade of antenatal RPD. Children with antenatal mild dilatation were discharged early from follow-up whereas those with moderate and severe fetal hydronephrosis needed close follow-up by a multidisciplinary team.
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Ultrasound Obstet Gynecol · Apr 2005
Multicenter StudySevere ductal constriction in the third-trimester fetus following maternal self-medication with nimesulide.
This was a multicenter series of 10 cases of constriction of the fetal ductus arteriosus occurring after maternal ingestion of one or two oral doses of nimesulide, which led to emergency delivery in four cases. ⋯ Although the true incidence of the adverse effect of nimesulide ingestion during pregnancy cannot be deduced, we believe that patients and their clinicians should be alerted to the possibility that clinically significant ductal constriction may follow maternal self-medication with just one or two oral doses of nimesulide, at least if the drug is taken near term.