Fetal therapy最新文献

The discovery of a twin pregnancy by ultrasound at the intake procedure for chorionic villus sampling or amniocentesis is not unusual because of the raised incidence of dizygotic twins at increased maternal age. Since the conception of dizygotic twins is genetically a separate and unrelated event, the risk of abnormalities in each twin is independent, but additive. In advanced maternal age, the risk of chromosomal aneuploidy in one of both fetuses varies between 2 and 6% [1]. This case report discusses the early prenatal diagnosis of twins discordant for Down's syndrome.

Fetal behavior was studied in 17 cases of fetal abnormalities including nonimmune hydrops fetalis and in 11 cases of intrauterine growth retardation (IUGR) in comparison to 30 healthy fetuses. Breathing movements, rapid eye movements and trunk movements were observed ultrasonically and analyzed using a computer-assisted system. The cases with central nervous system anomalies showed a markedly different behavioral pattern. In the fetal abnormalities without chromosomal anomalies, the cases without major behavioral disorders were cured by neonatal treatment. IUGR cases with decreased trunk, breathing and REM period were finally diagnosed as having fetal distress by fetal heart rate monitoring. The findings on fetal behavior hint at the possibility of diagnosing abnormalities in neural development as well as in well-being.

The analysis of urine obtained from fetuses with hydronephrosis, seen on ultrasound, can give a misleading assessment of residual renal function. Additional parameters for assessment of fetal renal function would be helpful. We have used SDS-polyacrylamide gel electrophoresis to separate urinary proteins from a fetus with obstructive uropathy and severe oligohydramnios, already present at 18 weeks of gestation. The dilated urinary bladder of the fetus was successfully shunted in utero with a double pigtail catheter which worked for 17 weeks, and a boy without renal or pulmonary insufficiency was born at 36 weeks. In this case the prenatal protein analysis by electrophoresis was a better indicator of the ultimate good pregnancy outcome than the evaluation of urinary electrolytes and osmolarity alone. We therefore suggest the addition of this test to the profile of renal function studies performed on fetal urine.

The pathogenesis of the prune belly syndrome is unclear. The proposed etiologies include a distal obstructive uropathy or a mesodermal defect of the anterior abdominal wall and urinary tract. Detection of increased intravesicular pressure might identify those fetuses with an obstructive etiology who, therefore, would benefit from shunting.

Using pulsed Doppler ultrasound velocimetry, we set out to examine (a) the significance of velocimetry as a monitor of fetal management (including fetal therapy), and (b) the correlation between the occurrence of abnormal blood flow values and perinatal morbidity. We compared the incidence of abnormal values between a control group of normal pregnant women (59 cases) and an 'abnormal pregnancy' group (60 cases), composed of patients exhibiting maternal complications, IUGR, and fetal distress. The incidence of abnormal values was 23.7% in the control group and 71.7% in the abnormal group. Our results indicate clearly that velocimetry of the middle cerebral artery is the most reliable way to diagnose fetal distress. Also, when high or multiple abnormal values are detected by velocimetry, the incidence and degree of perinatal morbidity increases.