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PubMed1984

Echocardiographic and anatomical correlations in fetal congenital heart disease.

In a series of 1600 pregnancies 34 cases of congenital heart disease were correctly identified by fetal echocardiography. In each case echocardiographic diagnosis was confirmed by anatomical study. Termination of pregnancy was done electively in 14 cases: in six because of the identification of a cardiac anomaly and in the remaining eight because of multiple congenital anomalies. The remaining 20 fetuses died subsequently owing either to the complexity of congenital heart disease or to associated extracardiac abnormalities, which were present in more than half the fetuses with congenital heart disease. There were eight errors in interpretation of the fetal echocardiogram. The outcome of the pregnancy was not influenced by the error in any case. Fetal echocardiography can predict correctly structural malformations of the heart. The technique is sufficiently reliable to give an accurate prognosis in early pregnancy and provide the basis for alterations in obstetric management.

Diagnostic Errors↗
PubMed1996

Fetal polycystic kidney disease associated with glutaric aciduria type II: an inborn error of energy metabolism.

The findings of hyperechoic and enlarged fetal kidneys on routine antenatal ultrasonography is a non-specific finding that alerts the physician to a differential diagnosis of various genetic and non-genetic disorders, including fetal polycystic disease and Beckwith-Wiedeman syndrome. Detection of fetal or neonatal polycystic kidneys should alert the physician to the possibility of an associated lethal autosomal recessive inborn error of fatty acid metabolism known as multiple acyl-CoA-dehydrogenase defect (MADD). We report a case of fetal nephromegaly associated with rare inborn error of MADD. This case highlights the need for appropriate laboratory investigation of hyperechoic, enlarged fetal kidneys, and neonatal polycystic disease. The association of MADD with postnatally diagnosed polycystic disease of the kidney has been reported. The antenatal detection of nephromegaly followed by the subsequent postnatal diagnosis of MADD has not been previously reported. MADD should be considered in the differential diagnosis of this antenatal finding. Appropriate diagnostic procedures should be conducted, either pre- or postnatally, in order that appropriate genetic counseling may be provided for this autosomal recessively inherited disorder.

Acyl-CoA Dehydrogenases↗
PubMed2002

Fetal malnutrition and adult chronic disease.

Since the fetal origins of adult disease hypothesis was put forward, more than 30 studies around the world have indicated low-birth-weight (LBW) infants have a higher incidence of hypertension and impaired glucose tolerance. India ranks second in incidence of LBW among South East Asian countries and is experiencing a transition of disease pattern from communicable disease to non-communicable disease. Whether this could be explained in part by LBW infants who experienced better nutrition at a later age is explored here. An earlier cohort with accurate birth weights was traced and enrolled into the study. A sample of 50 LBW and 78 normal birth weight (NBW) individuals are reported on here. Though the odds ratio (OR) estimates of risk factors for coronary heart disease and diabetes tended to be higher in LBWs who were better nourished at the time of the study, they were not statistically different. Similarly, OR estimates for risk factors tended to be higher in LBWs who put on more weight than the median of NBWs, but they were not significant. Logistic regressions with several variables indicated significant influence of body mass index on systolic (P <0.007) and diastolic (P <0.004) blood pressures. Since the risk associations are weak, more studies are needed to put the hypothesis on a firm footing.

Adolescent↗
PubMed1980

Prenatal diagnosis of disease.

We are still in the early days as far as antenatal diagnosis of fetal disease and abnormality are concerned. All of the techniques show a high degree of accuracy if used in the correct circumstances but, apart from the use of maternal blood to assess the Rhesus status and screen for neural tube defects and amniocentesis to search for age-dependent mongolism, present techniques are too cumbersome, inaccurate and dangerous to be offered as routine antenatal tests. The rapid development in ultrasound equipment and expertise and the recent advances in fetal blood sampling and biochemistry suggest that there will be continued and rapid expansion within the field.

Adult↗
PubMed1990

Evaluation of fetal structural heart disease using color flow mapping.

The technique of color flow mapping was used to diagnose 19 cases of fetal structural heart disease from a study group of 104 fetuses. Color flow mapping was 76% effective in detecting the presence of fetal structural heart disease. The colored views of a single stream in the atrioventricular canal were most impressive in cases of complete atrioventricular canal, hypoplastic left heart syndrome, mitral atresia, and tricuspid atresia. The colored views of tricuspid regurgitation were also clear in cases of endocardial fibroelastosis, pulmonary atresia with intact ventricular septum, and Ebstein's anomaly. The use of this technique resulted in the in-utero diagnoses coinciding more closely with the final diagnoses, which were made after birth. This was particularly important in those cases which required immediate management after birth.

Echocardiography, Doppler↗
PubMed1981

[Low birth-weight neonates in Tunisia (author's transl)].

From a prospective analysis performed in a maternity-hospital in Tunis, incidence, characteristic features and etiologic factors responsible for birth-weight below 2,5000 g have been studied. Incidence of low birth-weight is accepted as an indicator of the level of health care in a country; this incidence, established from 6,028 living births was 7.2%, similar to that in developed countries. On the contrary, intra-uterine growth retardation rates of 69.6% and prematures rates of 30.4% are closer to those in developing countries. Altogether, anomalies of height and of the height/head circumference ratio were present in 36 children only and, in 12 out the these, abnormalities of the placenta or membranes or evidence of fetal disease were found. A factor responsible for low birth weight was found in 182 neonates: previous severe disease in the mother (7.7%), toxemia (9.4%) twin pregnancy (22.41%), fetal pathology (3.5%) and pathology of the placenta and membranes (4.6%).

Body Height↗
PubMed1984

Use of the rebreathing method in the differential diagnosis of congenital heart disease and persistent fetal circulation.

The differential diagnosis of congenital heart disease from persistent fetal circulation is clinically difficult and cardiac catheterization is often needed. The development of a safe, new technique for use of the rebreathing method has allowed the determination of effective pulmonary blood flow, lung tissue volume, lung diffusion capacity and functional residual capacity in 7 critically ill, ventilator-dependent infants at the bedside. Analysis of the data revealed highly significant differences for lung tissue volume and diffusion capacity, a minimally significant difference for effective pulmonary blood flow and no difference for functional residual capacity between the groups. Use of this method allows not only attainment of clinically useful information but also permits better insight into the pathophysiology of the disease state.

Animals↗
PubMed2001

The fetal origins of disease hypothesis: public health implications for the Asia-Pacific region.

There has been rapid development in the Asia-Pacific region, leading to improvements in the food supply and nutrition. The high prevalence of low birth weight has been a problem in many countries and continues to be a problem in some parts of the region. In the past few years an epidemic of obesity and chronic disease has emerged. The fetal origins hypothesis links the high prevalence of low birth weight and recent increasing obesity to explain the emerging epidemic of chronic disease. One public health strategy to challenge this epidemic is the promotion of breastfeeding of all infants. Breastfeeding has been shown to protect against childhood obesity, and is "dose related", that is, the longer an infant is breastfed, the lower the risk of obesity.

Asia, Southeastern↗
PubMedDate not supplied

Fetal and neonatal liver disease.

The pathology of fetal and neonatal liver disease is reviewed and particular emphasis is laid on discriminating between diseases of known aetiology or of genetic importance and idiopathic disorders. These are discussed in relation to the particular metabolic differences between the fetal an neonatal liver and the adult liver. Common disorders such as rhesus isoimmunization are only touched on in respect of their effects on the metabolic function of the liver. The importance of iatrogenic disease in this age group is stressed.

Bile Acids and Salts↗
PubMed1987

Fetal tissue transplantation, bone marrow transplantation and prospective gene therapy in severe immunodeficiencies and enzyme deficiencies.

The successful development of fetal tissue transplantation has resulted in therapeutical solutions for patients with a variety of diseases. Fetal liver transplants as well as bone marrow transplants, can completely cure patients with severe combined immunodeficiency disease. These transplants can also be applied to treat other types of immunodeficiency, hemopathies, and inborn errors of metabolism, in association with immunosuppressive therapy. Despite complete HLA incompatibility between transplanted stem cells and host cells, functional activities of donor-derived T-lymphocytes are not restricted. In severe forms of Di George syndrome, immunological reconstitution can be obtained by fetal thymus transplantation. It is expected that, in the near future, pure stem cell transplants and gene transplants will develop and will provide remarkable solutions for the therapy of a large number of diseases.

Bone Marrow↗
PubMed2007

Fetal death.

The death of a formed fetus is one of the most emotionally devastating events for parents and clinicians. With improved care for conditions such as RhD alloimmunization, diabetes, and preeclampsia, the rate of fetal death in the United States decreased substantially in the mid twentieth century. However, the past several decades have seen much greater reductions in neonatal death rates than in fetal death rates. As such, fetal death remains a significant and understudied problem that now accounts for almost 50% of all perinatal deaths. The availability of prostaglandins has greatly facilitated delivery options for patients with fetal death. Risk factors for fetal death include African American race, advanced maternal age, obesity, smoking, prior fetal death, maternal diseases, and fetal growth impairment. There are numerous causes of fetal death, including genetic conditions, infections, placental abnormalities, and fetal-maternal hemorrhage. Many cases of fetal death do not undergo adequate evaluation for possible causes. Perinatal autopsy and placental examination are perhaps the most valuable tests for the evaluation of fetal death. Antenatal surveillance and emotional support are the mainstays of subsequent pregnancy management. Outcomes may be improved in women with diabetes, hypertension, red cell alloimmunization, and antiphospholipid syndrome. However, there is considerable room for further reduction in the fetal death rate.

Bereavement↗
PubMed1998

Inflammatory bowel disease and pregnancy.

Despite the lack of prospective studies on the relationship between inflammatory bowel disease (IBD) and pregnancy, the evidence strongly supports the conclusions that fertility is compromised in active Crohn's disease; heredity plays an important role in type and location of disease; fetal outcome is essentially no different than in the general population, except in the presence of active Crohn's disease during pregnancy; and the course of IBD during pregnancy is influenced by disease activity or lack of it before pregnancy. The major influence on outcome of pregnancy, fetal outcome, and course of IBD is the favorable effect of drug therapy on the disease. Most drugs, including sulfasalazine, 5ASA products, corticosteroids, and immunosuppressives, are safe, certainly safer than permitting the disease to be active and allowing for the possibility of surgical intervention during pregnancy. Episiotomy is contraindicated in women with Crohn's disease and perirectal complications. Cesarean section probably is indicated in most patients with Crohn's disease with colonic involvement.

Colitis, Ulcerative↗
PubMed1994

Fetal echocardiography in gravidas with historic risk factors for congenital heart disease.

All fetal echocardiograms performed at our institution between January 1, 1986, and June 1, 1991, were reviewed. The echocardiogram referral indication and results were verified for all women studied. Historic risk factors under consideration were pregestational diabetes, anticonvulsant or lithium ingestion in the first trimester, and a family history of congenital heart disease. Women with historic risk factors who had either a fetal abnormality on antenatal sonography or a known aneuploid fetus prior to the fetal echocardiograph were excluded. Of the 994 women who had a fetal echocardiogram performed during this study period, 486 (48.9%) were evaluated solely on the basis of a historic risk factor. Four of the 486 women (0.8%) were diagnosed as having a significant fetal structural cardiac malformation. Two of the four fetuses succumbed to obstetric complications. The remaining two infants were delivered at term and are doing well after postnatal cardiac surgery. In this select group of women with risk factors but no recognized fetal abnormality, the incidence of significant cardiac lesions was low. Although indications for fetal echocardiography must be evaluated on an individual basis, our data do not support a recommendation for the routine use of fetal echocardiography as a screening test in all women with historic risk factors.

Echocardiography↗
PubMed2006

Three- and four-dimensional ultrasonography for the structural and functional evaluation of the fetal face.

Ultrasonographic examination of the fetal face can provide information that may lead to the diagnosis of anomalies in other organs or systems. Thus, the fetal face represents a "diagnostic window" for fetal diseases and syndromes. Three-dimensional ultrasonography (3DUS) improves the evaluation of anatomic fetal facial anomalies over what is possible by 2-dimensional ultrasonography (2DUS). Four-dimensional ultrasonography (4DUS), by adding the temporal component to the examination, allows visualization of facial expressions that might be useful in the study of fetal behavior and maternal-fetal bonding. In this article, we evaluate the potential of 3D/4DUS for the study of structural and functional development of the fetal face.

Face↗