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Diagnosis and Management of 2 Cases of Spontaneous Septostomy: Monochorionic/Dichorionic Hybrid Twin Gestation and Dichorionic Triamniotic Triplet Gestation. 两例自发性隔膜造口术的诊断和处理:单绒毛/双绒毛混合双胎妊娠和双绒毛三胞胎妊娠。
IF 2.2 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-01 Epub Date: 2023-09-26 DOI: 10.1159/000534234
Vanessa R Layoun, Roya Sohaey, Emily Edwards, Raphael C Sun, Andrew H Chon

Introduction: Spontaneous septostomy is a rare complication of multiple gestations. Related complications include cord entanglement and preterm delivery. Limited data exist to guide the management of these high-risk patients. The majority of spontaneous septostomy cases have been reported in monochorionic diamniotic twins. We present 2 cases of spontaneous septostomy occurring in a monochorionic/dichorionic hybrid twin gestation (chorionicity transitions from dichorionicity to monochorionicity within the placenta) and in a dichorionic triamniotic triplet gestation.

Case presentation: Case 1 was a monochorionic/dichorionic hybrid twin gestation with a septostomy complicated by fetal parts of one twin protruding into the co-twin's sac as well as symptomatic polyhydramnios. Fetal magnetic resonance imaging confirmed the septostomy. Case 2 was a dichorionic triamniotic triplet gestation with septostomy and cord entanglement. Both patients were managed akin to a pseudo-monoamniotic gestation with serial ultrasound surveillance and eventual inpatient admission for heightened fetal monitoring. Case 1 underwent elective scheduled cesarean delivery at 33 weeks, and case 2 underwent emergent cesarean delivery for fetal heart rate decelerations at 28 weeks.

Conclusion: With a high degree of clinical suspicion, spontaneous septostomy can be diagnosed in uncommon settings such as hybrid twin gestations and higher order multiples. Management of such patients is individualized and may include a combination of heightened outpatient and inpatient surveillance.

引言:自发性隔膜造口术是多胎妊娠的一种罕见并发症。相关并发症包括脐带缠绕和早产。指导这些高危患者管理的数据有限。大多数自发性隔膜造口术的病例都是在单斜性羊水过少的双胞胎中报告的。我们报告了两例发生在单绒毛/二绒毛混合双胎妊娠(胎盘内绒毛膜从二绒毛向单绒毛过渡)和二绒毛三胞胎妊娠中的自发性隔膜造口术。病例介绍:病例1为单绒毛/双绒毛混合双胞胎妊娠,其中一对双胞胎的胎儿部分突出到同卵双胞胎的囊中,并伴有症状性羊水过多。胎儿核磁共振证实了隔膜造口术。病例2为二型羊水过少的三胎妊娠,伴有隔膜造口术和脐带缠绕。这两名患者都接受了类似于假性单胺妊娠的治疗,进行了连续的超声监测,并最终住院接受强化胎儿监测。病例1在33周时接受了选择性计划剖宫产,病例2在28周时因胎儿心率减慢而接受了紧急剖宫产。结论:在高度临床怀疑的情况下,自发性隔膜造口术可以在罕见的情况下诊断出来,如混合双胎妊娠和高阶多次妊娠。对此类患者的管理是个性化的,可能包括加强门诊和住院监测的组合。
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引用次数: 0
A Novel Fetal Magnetic Resonance Imaging Lung Volume Nomogram Stratified by Estimated Fetal Weight. 按估计胎儿体重分层的新型胎儿核磁共振肺容积提名图。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-01 Epub Date: 2024-06-06 DOI: 10.1159/000539709
Sivan Farladansky-Gershnabel, Praveen Jayapal, Max Zalcman, Richard A Barth, Erika Rubesova, Susan R Hintz, Jiaqi Zhang, Stephanie A Leonard, Yasser Y El-Sayed, Yair J Blumenfeld

Introduction: Fetal magnetic resonance imaging (MRI) lung volume nomograms are increasingly used to prognosticate neonatal outcomes in fetuses with suspected pulmonary hypoplasia. However, pregnancies complicated by fetal anomalies associated with pulmonary hypoplasia may also be complicated by fetal growth restriction (FGR). If a small lung volume is suspected in such cases, it is often unclear whether the lungs are "small" because of underlying lung pathology, or small fetal size. Existing MRI lung volume nomograms have mostly been stratified by gestational age (GA), rather than estimated fetal weight (EFW). Therefore, we aimed to develop a novel fetal lung volume nomogram stratified by EFW.

Methods: Consecutive fetal MRIs performed at a quaternary medical center from 2019 to 2021 were analyzed. MRIs performed due to fetal lung anomalies and cases with FGR were excluded. All MRIs were performed without IV contrast on GE 3 or 1.5 Tesla scanners (GE Healthcare). Images were reviewed by three experienced fetal radiologists. Freehand ROI in square centimeter was drawn around the contours of the lungs on consecutive slices from the apex to the base. The volume of the right, left and total lungs were calculated in mL. Lung volumes were plotted by both EFW and GA.

Results: Among 301 MRI studies performed during the study period, 170 cases met inclusion criteria and were analyzed. MRIs were performed between 19- and 38-week gestation, and a sonographic EFW was obtained within a mean of 2.9 days (SD ± 5.5 days, range 0-14 days) of each MRI. Nomograms stratified by both EFW and GA were created using 200 g. and weekly intervals respectively. A formula using EFW to predict total lung volume was calculated: LV = 0.07497804 EFW0.88276 (R2 = 0.87).

Conclusions: We developed a novel fetal lung volume nomogram stratified by EFW. If validated, this nomogram may assist clinicians predict outcomes in cases of fetal pulmonary hypoplasia with concomitant FGR.

导言:胎儿磁共振成像肺容积提名图越来越多地被用于预测疑似肺发育不全胎儿的新生儿预后。然而,与肺发育不全相关的胎儿畸形也可能并发胎儿生长受限。在这种情况下,如果怀疑胎儿肺容积过小,往往不清楚肺容积 "过小 "是由于潜在的肺部病变,还是由于胎儿过小。现有的核磁共振肺容积提名图大多是根据胎龄(GA)而非估计胎儿体重(EFW)分层的。因此,我们旨在开发一种新型的以 EFW 为分层的胎儿肺容积提名图:方法:对一家四级医疗中心从 2019 年至 2021 年连续进行的胎儿 MRI 进行了分析。排除了因胎儿肺部异常而进行的磁共振成像以及FGR病例。所有核磁共振成像均在通用电气 3 或 1.5 特斯拉扫描仪(通用电气医疗保健公司)上进行,无静脉注射造影剂。图像由三位经验丰富的胎儿放射科医生审阅。以平方厘米为单位,在肺部轮廓周围绘制从顶部到底部的连续切片的自由ROI。以毫升为单位计算右肺、左肺和总肺的体积。肺容积由 EFW 和 GA 两种方法绘制:在研究期间进行的 301 次核磁共振成像检查中,有 170 例符合纳入标准并进行了分析。核磁共振成像在妊娠19周至38周之间进行,每次核磁共振成像后平均2.9天(SD±5.5天,范围0-14天)内获得超声EFW。分别以 200 克和每周为间隔,绘制了按 EFW 和 GA 分层的提名图。利用 EFW 计算出预测肺总量的公式:LV=0.07497804 EFW0.88276 (R2=0.87):结论:我们开发了一种新的胎儿肺容积提名图,以 EFW 为分层。结论:我们开发了新的以 EFW 为分层的胎儿肺容积提名图,如果得到验证,该提名图可帮助临床医生预测胎儿肺发育不全合并 FGR 病例的预后。
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引用次数: 0
Three-Dimensional Fractional Moving Blood Volume: A Robust Bedside Tool for Evaluation of Fetal Multiorgan Perfusion. 三维分数移动血容量(3D-FMBV):用于评估胎儿多器官灌注的强大床旁工具。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-01 Epub Date: 2024-06-20 DOI: 10.1159/000539271
Emily Smelt, Samantha Thomas, Tracie Barber, Gordon Stevenson, Alexandria Bao-Ngoc Cung, Alec William Welsh

Introduction: Three-dimensional fractional moving blood volume (3D-FMBV) may provide superior noninvasive measurement of feto-placental perfusion compared to current methods. This study investigated the feasibility and repeatability of producing 3D-FMBV measurements of the placenta, fetal liver, kidney, and brain in a single ultrasound consultation.

Methods: The placenta, fetal liver, kidney, and brain were scanned in triplicate using 3D power Doppler ultrasound (3D-PDU) in 48 women ≥22 weeks of gestation with healthy fetuses. 3D-FMBV was calculated by two analyzers. Feasibility was assessed as the percentage of cases where 3D-FMBV could be evaluated; repeatability (intraobserver and interobserver) using two-way mixed measure intraclass correlation coefficients (ICCs).

Results: 3D-FMBV was calculated for 100% of scanned organs. Intraobserver ICCs (95% CI) were good to excellent; 0.93 (0.88-0.96) and 0.87 (0.78-0.92) for placenta, 0.95 (0.92-0.97) and 0.98 (0.96-0.99) for fetal liver, 0.96 (0.94-0.98) and 0.91 (0.85-0.95) for fetal kidney, and 0.98 (0.97-0.99) and 0.97 (0.95-0.98) for fetal brain. Interobserver ICCs (95% CI) were 0.50 (0.08-0.73), 0.92 (0.85-0.96), 0.89 (0.78-0.94), and 0.71 (0.46-0.85) for placenta, fetal liver, kidney, and brain.

Conclusion: Feto-placental perfusion assessment with 3D-FMBV is highly reliable in healthy pregnancies ≥22 weeks of gestation and can be feasibly calculated in four feto-placental vascular beds in a single ultrasound consultation.

简介:与目前的方法相比,三维-分型移动血容量(3D-FMBV)可提供更优越的无创胎儿-胎盘灌注测量。本研究探讨了在一次超声会诊中对胎盘、胎儿肝脏、肾脏和大脑进行三维-FMBV 测量的可行性和可重复性:方法:使用三维动力多普勒超声(3D-PDU)对 48 名妊娠≥ 22 周且胎儿健康的妇女的胎盘、胎儿肝脏、肾脏和大脑进行扫描,扫描结果一式三份。3D-FMBV 由两台分析仪计算。可行性以可评估 3D-FMBV 的病例百分比进行评估;可重复性(观察者内和观察者间)采用双向混合测量类内相关系数 (ICC):结果:100% 的扫描器官都计算出了 3D-FMBV 值。胎盘的观察者内相关系数(95% CI)为 0.93(0.88-0.96)和 0.87(0.78-0.92),胎儿肝脏的观察者内相关系数(95% CI)为 0.95(0.92-0.97)和 0.98(0.96-0.99),胎儿肾脏的观察者内相关系数(95% CI)为 0.96(0.94-0.98)和 0.91(0.85-0.95),胎儿大脑的观察者内相关系数(95% CI)为 0.98(0.97-0.99)和 0.97(0.95-0.98)。胎盘、胎儿肝脏、肾脏和大脑的观察者间ICC(95% CI)分别为0.50(0.08-0.73)、0.92(0.85-0.96)、0.89(0.78-0.94)和0.71(0.46-0.85):结论:在妊娠≥22周的健康孕妇中,使用3D-FMBV进行胎盘-胎盘灌注评估非常可靠,并且可以在一次超声会诊中计算出四个胎盘-胎盘血管床的灌注。
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引用次数: 0
Acknowledgement to the Reviewers 向审稿人致谢
IF 2.2 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-02-23 DOI: 10.1159/000529540

Fetal Diagn Ther 2022;49:536–537
胎儿诊断,2022;49:53 - 537
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引用次数: 0
Contents 内容
IF 2.2 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-02-01 DOI: 10.1159/000529572
Ş. Uzan, Ramen Chmait, Mahesh A. Choolani
Ali Alhousseini – Michigan State Universrity College of Human Medicine, Bloomfield Hills, MI, USA Rabih Chaoui – Centre for Prenatal Diagnosis and Human Genetics, Berlin, Germany Magda Sanz Cortes – Baylor College of Medicine, Houston, TX, USA Rogelio Cruz-Martinez – Instituto Medicina Fetal Mexico, Guadalajara, Mexico Andrea Dall’Asta – University of Parma, Parma, Italy Jimmy Espinoza – McGovern Medical School at the University of Texas Health, Houston, TX USA Francesc Figueras – University of Barcelona, Barcelona, Spain Allan W. Flake – Children’s Hospital of Philadelphia, Philadelphia, PA, USA Jon A. Hyett – Royal Prince Alfred Hospital, Sydney, NSW, Australia Anthony Johnson – McGovern Medical School at the University of Texas Health Science Center Houston (UTHealth), Houston, TX, USA Francois I. Luks – Brown Medical School, Providence, RI, USA Martin Meuli – Universitätskinderspital Zürich, Zürich, Switzerland Dick Oepkes – Leiden University Medical Center, Leiden, The Netherlands Stefan Verlohren – Charité University Medicine, Berlin, Germany R. Douglas Wilson – University of Calgary, Calgary, AB, Canada
Ali Alhousseini——美国密歇根州布鲁姆菲尔德山密歇根州立大学人类医学院Rabih Chaoui——德国柏林产前诊断和人类遗传学中心Magda Sanz Cortes——美国德克萨斯州休斯顿贝勒医学院Rogelio Cruz Martinez——墨西哥瓜达拉哈拉胎儿医学院Andrea Dall’Asta——帕尔马大学,意大利吉米·埃斯皮诺萨-美国得克萨斯州休斯顿得克萨斯大学麦戈文医学院Francesc Figueras-西班牙巴塞罗那大学Allan W.Flake-美国宾夕法尼亚州费城儿童医院Jon A.Hyett-新南威尔士州悉尼皇家阿尔弗雷德王子医院,澳大利亚安东尼·约翰逊-美国德克萨斯州休斯顿得克萨斯大学健康科学中心麦戈文医学院Francois I.Luks-美国RI普罗维登斯布朗医学院Martin Meuli-瑞士苏黎世苏黎世苏黎世大学Dick Oepkes-莱顿大学医学中心,荷兰Stefan Verlohren–德国柏林Charité大学医学院R.Douglas Wilson–加拿大卡尔加里卡尔加里大学
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引用次数: 0
Quincke versus Diamond-Tip Needles for Entry in Placental Laser Surgery for Twin-to-Twin Transfusion Syndrome. 双胎输血综合征胎盘激光手术中昆克针与钻石针的对比。
IF 2.2 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-01-01 DOI: 10.1159/000530548
Madushka Y De Zoysa, Clifton O Brock, Eric P Bergh, Anthony Johnson, Edgar Hernandez-Andrade, Anthony Nobles, Ramesha M Papanna
Introduction: Chorioamniotic membrane separation (CAS), preterm prelabor rupture of membranes (PPROM), and preterm delivery (PTD) remain as major complications of fetoscopic laser photocoagulation (FLP) for twin-to-twin transfusion syndrome (TTTS). We sought to examine whether use of Quincke-tip needles for initial entry during FLP reduces the risk of these complications. Methods: This is a secondary analysis of prospectively collected data from patients that had FLP for TTTS at a single tertiary care center (2011–2021). We excluded patients for whom direct trocar entry was used. Patients for whom a Quincke-tip needle was used were compared to those for whom a diamond-tip needle was used during Seldinger entry. Demographics, ultrasound findings and operative characteristics were compared between groups. Postoperative outcomes and complications (including CAS, PPROM, and PTD) were also compared. Multivariate logistic regression models were fit to assess independent risk factors for complications. Results: 386 patients met inclusion criteria; Quincke-tip needles were used in 81 (21.0%) cases, while diamond-tip needles were used in 305 (79.0%). Rates of CAS (11.1 vs. 9.5%, p = 0.67) and PPROM (44.4 vs. 41.0%, p = 0.57) were similar between groups. Patients in the Quincke-tip group delivered 1.5 weeks earlier than those in the diamond-tip group (30.5 vs. 32.0 weeks, p = 0.01). However, these patients were more likely to be delivered for maternal (35.9 vs. 19.0%) and fetal (23.1 vs. 15.3%) indications (p < 0.01). In multivariate analysis, needle type was not identified as an independent risk factor for PPROM. However, Quincke-tip needle use was associated with PTD less than 32 weeks (aOR 1.74, 95% CI: 1.02–2.97, p = 0.043). Conclusion: Membrane complications following FLP were not associated with the needle type used for entry. Earlier delivery in the Quincke-tip group was likely attributable to higher rates of delivery for maternal and fetal indications, and not membrane complications. The needle chosen for entry is likely best determined by operator preference.
简介:绒毛膜-羊膜分离(CAS),早产,产前胎膜破裂(PPROM)和早产(PTD)仍然是胎镜激光光凝(FLP)治疗双胎输血综合征(TTTS)的主要并发症。我们试图检查在FLP期间首次使用quincke针尖是否可以降低这些并发症的风险。方法:这是对在单一三级医疗中心(2011-2021年)前瞻性收集的TTTS FLP患者数据的二次分析。我们排除了使用直接套管针置入的患者。将使用昆克针的患者与使用塞丁格针的患者进行比较。比较两组患者的人口学特征、超声表现及手术特点。比较了两组的术后结局和并发症(包括CAS、PPROM和PTD)。采用多变量logistic回归模型评估并发症的独立危险因素。结果:386例患者符合纳入标准;使用昆克针81例(21.0%),使用金刚石针305例(79.0%)。两组间CAS发生率(11.1 vs 9.5%, p = 0.67)和PPROM发生率(44.4 vs 41.0%, p = 0.57)相似。Quincke-tip组比diamond-tip组提前1.5周分娩(30.5周比32.0周,p = 0.01)。然而,这些患者更有可能因产妇(35.9% vs. 19.0%)和胎儿(23.1 vs. 15.3%)指征而分娩(p <0.01)。在多变量分析中,针头类型未被确定为PPROM的独立危险因素。然而,使用Quincke-tip针头与PTD少于32周相关(aOR 1.74, 95% CI: 1.02-2.97, p = 0.043)。结论:FLP术后膜并发症与入针方式无关。Quincke-tip组较早分娩可能是由于产妇和胎儿指征的分娩率较高,而不是膜并发症。入针的选择可能最好由操作人员的偏好决定。
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引用次数: 0
Implementing Preeclampsia Screening in Switzerland (IPSISS): First Results from a Multicentre Registry. 在瑞士实施子痫前期筛查(IPSISS):来自多中心注册的初步结果。
IF 2.2 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-01-01 Epub Date: 2023-07-24 DOI: 10.1159/000533201
Fabienne Trottmann, Pauline Challande, Gwendolin Manegold-Brauer, Sara Ardabili, Irene Hösli, Heidrun Schönberger, Sofia Amylidi-Mohr, Joachim Kohl, Markus Hodel, Daniel Surbek, Luigi Raio, Beatrice Mosimann

Introduction: The Fetal Medicine Foundation (FMF) London developed a first trimester combined screening algorithm for preterm preeclampsia (pPE) that allows a significantly higher detection of pregnancies at risk compared to conventional screening by maternal risk factors only. The aim of this trial is to validate this screening model in the Swiss population in order to implement this screening into routine first trimester ultrasound and to prescribe low-dose aspirin 150 mg (LDA) in patients at risk for pPE. Therefore, a multicentre registry study collecting and screening pregnancy outcome data was initiated in 2020; these are the preliminary results.

Methods: Between June 1, 2020, and May 31, 2021, we included all singleton pregnancies with pPE screening at the hospitals of Basel, Lucerne, and Bern. Multiple of medians of uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP), placental growth factor (PlGF), and pregnancy-associated plasma protein A (PAPP-A) as well as risks were analysed as calculated by each centre's software and recalculated on the FMF online calculator for comparative reasons. Statistical analyses were performed by GraphPad Version 9.1.

Results: During the study period, 1,027 patients with singleton pregnancies were included. 174 (16.9%) had a risk >1:100 at first trimester combined screening. Combining the background risk, MAP, UtA-PI, and PlGF only, the cut-off to obtain a screen positive rate (SPR) of 11% is ≥1:75. Outcomes were available for 968/1,027 (94.3%) of all patients; 951 resulted in live birth. Fifteen (1.58%) developed classical preeclampsia (PE), 23 (2.42%) developed PE according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) definition.

Conclusion: First trimester combined screening for PE and prevention with LDA results in a low prevalence of PE. The screening algorithm performs according to expectations; however, the cut-off of >1:100 results in a SPR above the accepted range and a cut-off of ≥1:75 should be considered for screening. More data are needed to evaluate, if these results are representative for the general Swiss population.

伦敦胎儿医学基金会(FMF)开发了一种针对早产子痫前期(pPE)的妊娠早期联合筛查算法,与仅通过母体危险因素进行常规筛查相比,该算法可显著提高对高危妊娠的检测。本试验的目的是在瑞士人群中验证这种筛查模型,以便在常规妊娠早期超声中实施这种筛查,并在有pPE风险的患者中开低剂量阿司匹林150mg (LDA)。因此,一项收集和筛查妊娠结局数据的多中心登记研究于2020年启动;这些是初步结果。方法:在2020年6月1日至2021年5月31日期间,我们纳入了在巴塞尔、卢塞恩和伯尔尼医院进行pPE筛查的所有单胎妊娠。分析各中心软件计算的子宫动脉搏动指数(eta - pi)、平均动脉压(MAP)、胎盘生长因子(PlGF)、妊娠相关血浆蛋白A (pap -A)的中位数倍数及风险,并在FMF在线计算器上重新计算,以进行比较。使用GraphPad Version 9.1进行统计分析。结果:研究期间纳入单胎妊娠患者1027例。174例(16.9%)在妊娠早期联合筛查时风险为1:100。仅结合背景风险、MAP、UtA-PI和PlGF,获得11%的筛查阳性率(SPR)的截止值≥1:75。所有患者中有968/ 1027(94.3%)获得了结果;951导致活产。根据国际妊娠高血压研究协会(ISSHP)的定义,15例(1.58%)发展为经典先兆子痫(PE), 23例(2.42%)发展为PE。结论:妊娠早期合并PE筛查和LDA预防可降低PE患病率。筛选算法按预期执行;然而,1:100的临界值导致SPR高于可接受范围,应考虑≥1:75的临界值进行筛查。这些结果是否能代表瑞士的一般人群,还需要更多的数据来评估。
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引用次数: 0
Fetal Laryngoscopy and Endoscopic Tracheal Intubation to Avoid ex utero Intrapartum Treatment in the Management of Fetuses with Suspected Airway Obstruction. 胎儿喉镜检查和内镜气管插管避免子宫外分娩时处理疑似气道阻塞的胎儿。
IF 2.2 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-01-01 Epub Date: 2023-08-04 DOI: 10.1159/000533348
Rogelio Cruz-Martínez, Savino Gil-Pugliese, Rosa Villalobos-Gómez, Miguel Martínez-Rodríguez, Alejandra Márquez-Dávila, Hugo López-Briones, Eréndira Chávez-González, Antonio Méndez-González, Hugo Pineda-Alemán, Carlos Rebolledo-Fernández, Ernesto Barrios-Prieto, Sergio Fajardo-Dueñas

Introduction: Large congenital neck tumors can cause neonatal death due to airway obstruction. The aim of this study was to report outcomes of the first cohort of fetuses with neck masses and suspected airway obstruction managed with fetal laryngoscopy (FL) and fetal endoscopic tracheal intubation (FETI) to secure fetal airways and avoid ex utero intrapartum treatment (EXIT) procedure.

Methods: A prospective observational cohort of consecutive fetuses with neck masses that were candidates for an EXIT procedure due to suspicion of laryngeal and/or tracheal occlusion on ultrasonographic (US) or magnetic resonance imaging (MRI) examination were recruited for FL in a tertiary referral center in Queretaro, Mexico. FETI was performed if the obstruction was confirmed by FL. Maternal and perinatal outcomes were evaluated.

Results: Between January 2012 and March 2023, 35 cases with neck masses were evaluated. Airway obstruction was suspected in 12/35 (34.3%), either by US in 10/35 (28.6%) or by fetal MRI in 2/35 (5.7%). In all cases, FL was successfully performed at the first attempt at a median gestational age (GA) of 36+5 (range, 33+5-39+6) weeks+days, with a median surgical time of 22.5 (12-35) min. In 4 cases, airway patency was confirmed during FL and an EXIT procedure was avoided. In 8/12 cases (66.7%), airway obstruction was confirmed during fetoscopy and FETI was successfully performed at a median GA of 36+3 (33+2-38+5) weeks+days, with a median surgical time of 25.0 (range, 12-45) min. No case required an EXIT procedure. All patients underwent conventional cesarean delivery with no maternal complications and all neonates were admitted to the neonatal intensive care unit with a correctly positioned endotracheal tube (ETT) immediately after delivery. Three neonatal deaths (37.5%) were reported due to postnatal unplanned extubation, failed ETT replacement, and tumoral bleeding.

Conclusion: In fetuses with neck masses and suspected airway obstruction, FL and FETI are feasible and could replace EXIT procedures with good maternal and perinatal outcomes.

大型先天性颈部肿瘤可因气道阻塞导致新生儿死亡。本研究的目的是报告第一组有颈部肿块和疑似气道阻塞的胎儿的结果,这些胎儿采用胎儿喉镜检查(FL)和胎儿气管内窥镜插管(FETI)来保护胎儿气道并避免宫内治疗(EXIT)程序。方法:在墨西哥克雷塔罗的一家三级转诊中心招募了一组连续出现颈部肿块的胎儿,这些胎儿由于超声检查(US)或磁共振成像(MRI)检查怀疑喉部和/或气管闭塞而需要进行退出手术。如果FL证实梗阻,则进行FETI。评估产妇和围产期结局。结果:2012年1月至2023年3月,对35例颈部肿块进行了评估。12/35(34.3%)怀疑气道阻塞,10/35超声检查(28.6%)或2/35胎儿MRI检查(5.7%)。在所有病例中,FL在第一次尝试时成功进行,中位胎龄(GA)为36+5(范围,33+5-39+6)周+天,中位手术时间为22.5(12-35)分钟。4例患者在FL期间确认气道通畅,避免了EXIT手术。在8/12例(66.7%)中,在胎镜检查期间确认气道阻塞,FETI成功进行,平均GA为36+3(33+2-38+5)周+天,平均手术时间为25.0(范围12-45)分钟。没有病例需要退出手术。所有患者均接受常规剖宫产,无产妇并发症,所有新生儿在分娩后立即接受正确放置气管内管(ETT)的新生儿重症监护病房。据报道,3例新生儿死亡(37.5%)是由于产后计划外拔管、ETT置换失败和肿瘤出血。结论:对于颈部肿块和疑似气道阻塞的胎儿,FL和FETI是可行的,可以替代EXIT手术,产妇和围产儿预后良好。
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引用次数: 0
The Utility of the Ultrasound "Superimposed-Line" Sign at the Junction of the Vomer and Maxilla in First-Trimester Screening for Fetal Cleft Palate: A Case-Control Study. 上颚和下颚交界处超声“叠加线”标志在妊娠早期胎儿腭裂筛查中的应用:一项病例-对照研究。
IF 2.2 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-01-01 DOI: 10.1159/000528901
Lirong Hu, Weichen Zhou, Xiaojuan Ma, Yu Luo, Qin Zhou

Introduction: The current retrospective case-control study evaluates the diagnostic value of screening for a fetal cleft palate by using the ultra-sound-based observation of the "superimposed-line" sign appearing at the junction of the vomer and maxilla in the first trimester of pregnancy.

Methods: Retrospective analyses were performed of ultrasonographic images of nuchal translucency obtained during the first trimester of pregnancy (11-13+6 weeks) from 45 fetuses with a cleft palate later confirmed following parturition or induced labor (cases) and 4,500 normal fetuses confirmed after parturition (controls). Ultrasonographic features of the "superimposed-line" sign were observed and recorded, and between-group comparisons were performed.

Results: The "superimposed-line" sign was absent in 39 cases (86.67%), including 4 (8.89%) with simple secondary hard palate cleft and 35 (77.78%) with secondary hard palate cleft complicated by a primary cleft palate. The "superimposed-line" sign was shown in 6 cases (13.33%), including 2 (4.44%) with a simple secondary soft palate cleft, 1 (2.22%) with a simple secondary bifid uvula, and 3 (6.67%) with a simple primary cleft palate. Among the 4,500 controls, 31 fetuses showed an absence of the "superimposed-line" sign (0.69%) and 4,469 showed the "superimposed-line" sign (99.31%). The between-group difference was significant (p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive values of the "superimposed-line" sign in the first trimester of pregnancy for predicting fetal cleft palate were 86.67% (39/45), 99.31% (4,469/4,500), 55.71% (39/70), and 99.86% (4,469/4,475), respectively.

Conclusion: The "superimposed-line" sign did not appear in fetuses with secondary hard palate cleft and primary cleft palate only when a secondary hard palate cleft is present. The sign appeared in normal fetuses and those with a simple primary cleft palate, simple secondary soft palate cleft, or a simple secondary bifid uvula. Based on these results, we propose that the "superimposed-line" sign in the mid-sagittal plane of the fetal face in the first trimester of pregnancy (11-13+6 weeks) is an important tool in screening for fetal cleft palate, especially secondary hard palate cleft.

摘要:本回顾性病例对照研究评价了超声检查胎儿上颌和下颚交界处出现的“迭线”征象对妊娠早期胎儿腭裂的诊断价值。方法:回顾性分析45例产后或引产后确诊的腭裂胎儿(例)和4500例产后确诊的正常胎儿(对照组)妊娠早期(11-13+6周)颈部半透明超声图像。观察并记录“叠加线”征象的超声特征,并进行组间比较。结果:39例(86.67%)无“迭线”征,其中单纯继发硬腭裂4例(8.89%),继发硬腭裂合并原发性腭裂35例(77.78%)。单纯性继发软腭裂2例(4.44%),单纯性继发小舌裂1例(2.22%),单纯性原发性腭裂3例(6.67%),有“迭线”征6例(13.33%)。在4500个对照组中,31个胎儿没有“叠加线”标志(0.69%),4469个胎儿有“叠加线”标志(99.31%)。组间差异有统计学意义(p < 0.05)。妊娠早期“叠加线”征候预测胎儿腭裂的敏感性为86.67%(39/45),特异性为99.31%(4469 / 4500),阳性预测值为55.71%(39/70),阴性预测值为99.86%(4469 / 4475)。结论:继发性硬腭裂和原发性腭裂胎儿仅在继发性硬腭裂存在时才出现“迭线”征。该征象出现在正常胎儿和单纯性原发性腭裂、单纯性继发性软腭裂或单纯性第二性小舌裂的胎儿中。基于以上结果,我们建议妊娠前3个月(11-13+6周)胎儿面部正中矢状面“叠加线”征象是筛查胎儿腭裂,特别是继发性硬腭裂的重要工具。
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引用次数: 0
Prenatal Diagnosis of Gómez-López-Hernández Syndrome. Gómez-López-Hernández综合征的产前诊断。
IF 2.2 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-01-01 DOI: 10.1159/000530643
Leo Pomar, Wawrzyniec Rieder, Estelle Dubruc, Fabienne Giuliano, Isis Atallah, Sébastien Lebon, Yvan Vial

Introduction: Gómez-López-Hernández syndrome (GLHS), also known as cerebello-trigeminal-dermal dysplasia, is an extremely rare neurocutaneous disease, classically described by the triad of rhombencephalosynapsis (RES), bilateral focal alopecia, and trigeminal anesthesia. The clinical and radiographic spectrum of GLHS is now known to be broader, including craniofacial and supratentorial anomalies, as well as neurodevelopmental issues.

Case presentation: Here, we present a case of antenatally diagnosed GLHS with RES, hydrocephaly, and craniofacial anomalies identified on ultrasound (low-set ears with posterior rotation, hypertelorism, midface hypoplasia, micrognathia, and anteverted nares) which were confirmed by autopsy after termination of pregnancy at 23 weeks of gestation.

Discussion: As no known genetic causes have been identified and the classical triad is not applicable to prenatal imaging, prenatal diagnosis of GLHS is based on neuroimaging and the identification of supporting features. In presence of an RES associated with craniofacial abnormalities in prenatal (brachycephaly, turricephaly, low-set ears, midface retrusion, micrognathia), GLHS should be considered as "possible" according to postnatal criteria.

Gómez-López-Hernández综合征(GLHS),也称为小脑-三叉神经-真皮发育不良,是一种极其罕见的神经皮肤病,典型表现为斜形脑突触症(RES)、双侧局灶性脱发和三叉神经麻醉。现在已知GLHS的临床和影像学范围更广,包括颅面和幕上异常,以及神经发育问题。病例介绍:在这里,我们报告了一例产前诊断为GLHS的病例,伴有RES,脑积水,超声发现颅面异常(低置耳后旋,远距过大,面中部发育不全,小颌和前倾),在妊娠23周终止妊娠后尸检证实。讨论:由于没有确定已知的遗传原因,经典的三联征不适用于产前影像学,产前诊断GLHS是基于神经影像学和支持性特征的识别。如果RES伴有产前颅面异常(短头畸形、尖头畸形、低耳、中脸后缩、小颌),则应根据产后标准考虑GLHS为“可能”。
{"title":"Prenatal Diagnosis of Gómez-López-Hernández Syndrome.","authors":"Leo Pomar,&nbsp;Wawrzyniec Rieder,&nbsp;Estelle Dubruc,&nbsp;Fabienne Giuliano,&nbsp;Isis Atallah,&nbsp;Sébastien Lebon,&nbsp;Yvan Vial","doi":"10.1159/000530643","DOIUrl":"https://doi.org/10.1159/000530643","url":null,"abstract":"<p><strong>Introduction: </strong>Gómez-López-Hernández syndrome (GLHS), also known as cerebello-trigeminal-dermal dysplasia, is an extremely rare neurocutaneous disease, classically described by the triad of rhombencephalosynapsis (RES), bilateral focal alopecia, and trigeminal anesthesia. The clinical and radiographic spectrum of GLHS is now known to be broader, including craniofacial and supratentorial anomalies, as well as neurodevelopmental issues.</p><p><strong>Case presentation: </strong>Here, we present a case of antenatally diagnosed GLHS with RES, hydrocephaly, and craniofacial anomalies identified on ultrasound (low-set ears with posterior rotation, hypertelorism, midface hypoplasia, micrognathia, and anteverted nares) which were confirmed by autopsy after termination of pregnancy at 23 weeks of gestation.</p><p><strong>Discussion: </strong>As no known genetic causes have been identified and the classical triad is not applicable to prenatal imaging, prenatal diagnosis of GLHS is based on neuroimaging and the identification of supporting features. In presence of an RES associated with craniofacial abnormalities in prenatal (brachycephaly, turricephaly, low-set ears, midface retrusion, micrognathia), GLHS should be considered as \"possible\" according to postnatal criteria.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":"50 2","pages":"92-97"},"PeriodicalIF":2.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9793428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Fetal Diagnosis and Therapy
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