Congenital Pouch Colon in a Neonate

Congenital Pouch Colon (CPC) is a rare anorectal malformation (ARM) in which a part of or the entire colon is replaced by pouch-like dilatation. Males are more likely to be diagnosed with the condition compared to females. The highest incidence of the disease is in South Asia, with a significant number of cases reported from India. Early diagnosis can be made when there are hypoechogenic lesions on antenatal ultrasound scans. We report a case of a neonate with routine antenatal scans who presented with a distended abdomen and inability to pass feces. The diagnosis was made in the early neonatal period, followed by surgical management. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5771 How to cite this:Niaz S, Naz S, Raziq RA. Congenital Pouch Colon in a Neonate. Pak J Med Sci. 2022;38(2):426-429. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5771 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Alobar Holoprosencephaly with Cebocephaly in a Neonate Born to an HIV-Positive Mother in Eastern Uganda

Background. Holoprosencephaly (HPE) is a rare cerebrofacial abnormality resulting from the complete or partial failure of the diverticulation and cleavage of the primitive forebrain. It has an incidence at birth of 1:16000. Case Presentation. We report a case of a 2600 g newborn female delivered by an HIV-infected mother in whom an antenatal ultrasound scan at 34 weeks’ gestation reported features of fetal alobar holoprosencephaly. The neonate was born with cebocephaly, a monkey-like head, and did not survive for more than 30 minutes following delivery by caesarian section despite oxygen therapy. Conclusion. Alobar HPE with cebocephaly remains incompatible with life. In this resource-limited setting, the diagnosis was made clinically, and only an ultrasound scan was performed to confirm the diagnosis. Chromosomal analysis could have given more information.

Cord Blood Ischemia-Modified Albumin Levels in Preterm Infants with Intrauterine Growth Restriction

Background Intrauterine growth restriction (IUGR) is one of the causes of perinatal mortality and morbidity. It is the failure of the fetus to achieve intrinsic growth potential. Since IUGR neonates are more likely to suffer complications including perinatal asphyxia, cold stress, hypoglycemia, hypocalcaemia, hyperbilirubinemia, feed intolerance, NEC, sepsis and even mortality. So, it is important that these infants are identified and managed appropriately at birth. Purpose The present study aims to determine the possible association between cord blood ischemia-modified albumin (IMA) levels and intrauterine growth restriction (IUGR) in preterm infants with or without complicated gestations. Patients and Method Eighty mothers and their preterm neonates (<37 weeks’ gestation) identified in 2 groups according to antenatal ultrasound: a group with prospective antenatal diagnosis of IUGR and the other group with normal fetal development, after consideration of inclusion and exclusion criteria. Cord blood Albumin and Ischemia modified albumin were estimated by double-antibody sandwich Enzyme-Linked Immunosorbent Assay (ELISA). Results Cord blood IMA was significantly higher in IUGR group compared to control group. Consequently, albumin level was significantly lower in IUGR group compared to other group. IMA was inversely correlation with Hb level and albumin level was inversely correlated with liver function tests (ALT and AST). Conclusion There is a positive association between IMA level and IUGR. This sent a message that combined antenatal ultrasound and serum IMA is a better predictor of intrauterine growth restriction and subsequent better care of neonates with IUGR.

Non-immune fetal hydrops in late pregnancу: antenatal ultrasound monitoring and pregnancy outcomes in a series of 14 cases

Background. Fetal hydrops is the accumulation of extracellular fluid in two or more fetal cavities, often in combination with subcutaneous edema. An isolated accumulation of fluid only in the abdominal, pleural, or pericardial cavities is described as ascites, pleural effusion (hydrothorax), pericardial effusion (hydropericardium). Features of the pathogenesis of non-immune hydrops fetalis (NIHF) are the follow: high hydrophilicity of fetal tissues, obstruction of the lymphatic vessels, impaired lymph return, congestive heart failure, obstruction of venous return, changes in fetal venous pressure. All these factors lead to the release of fluid from cells and tissues into the «third» spaces – the abdominal, thoracic, pericardial cavities, as well as the subcutaneous space. The oncotic pressure of fetal plasma proteins is not of great importance in the formation of the fetal circulating blood volume. Currently, all the links in the pathogenesis of hydrops fetalis syndrome with various etiological factors are not fully known. The prevalence of NIHF is unknown because it is difficult to collect relevant data; many cases of the disease are not diagnosed until intrauterine fetal death or may spontaneously resolve during the prenatal period. Currently, up to 90% of all cases of fetal dropsy are attributed to NIHF. Purpose – acquaintance of the medical community with the diagnosis and treatment of non-immune hydrops as well as the analysis of clinical features, ultrasound monitoring and perinatal outcomes of 14 cases of non-immune fetal hydrops onset in a second half of pregnancy. Materials and methods. The material for the study were publications and results of clinical trials found in the databases Scopus, Web of Science Core Collection and PubMed for the period 2009–2020 and the analytic report of the own series of 14 cases of non-immune hydrops fetalis (NIHF) of various origins. During the period of 2005–2020 under the supervision in the Ultrasound Department of Kharkiv regional hospital with regional perinatal center there were 14 pregnant women with NIHF diagnosed in a second half of pregnancy. Clinical features are described, ultrasound images and Doppler monitoring are given, perinatal / postnatal results are studied. Results and discussion. The analysis of clinical features, ultrasound monitoring and pregnancy outcomes of 14 cases of non-immune fetal hydrops developed in the second half of pregnancy in presented series was carried out. 6/14 fetuses had structural anatomical defects (lung sequestration, СDH, myasthenia gravis, megacystis and hydronephrosis, epidermolysis bullosa, meconium peritonitis, intestinal atresia). Mortality rate (including perinatal and infant losses) was as high as 9/14 cases (64.2%): 3 of antenatal, 4 of neonatal, 2 of infant death). Surgical treatment was performed on 2 newborns. 5 newborns had apparently a favorable clinical postnatal outcome. In 2 cases, spontaneous resolution with complete regression of hydrops was observed (parvovirus-B19 and idiopathic NIHF). Complete recovery of fetus (spontaneous regression of hydrops without any deterioration and pathological consequences) was observed in 1 case. Conclusions. Antenatal ultrasound monitoring of fetus with NIHF is based on the assessment of PSV CMA, ductus venous, umbilical vein, atrioventricular flow. According to the results of the study, it was revealed that the cardiovascular profile of the fetus with NIHF is disturbed earlier, and the placental profile and arterial Doppler-later. Normal umbilical artery Doppler do not exclude the possibility of an adverse outcome, including intrauterine fetal demise. Extended Doppler monitoring is essential at NIHF. All neonates with NIHF in an antenatal anamnesis require postnatal follow-up.

Comparison Between Fetal Biometric Measurements (BPD, HC and FL) of Male and Female Fetuses in Population of Pakistan on Antenatal Ultrasound, A Multicentric Study

Objective: The aim of this study was to compare the fetal biometric growth measurements (Head Circumference, Bi-Parietal Diameter, and Femur Length) between male and female fetuses on antenatal ultrasound in our population. Methodology: This was an observational study carried out in the Department of Radiology CMH Malir, Karachi and Ziauddin hospital, Karachi from July 2016 till July 2018 using non-probability sampling technique. A total of 510 pregnant women with second and third trimester were enrolled for the study. The biometric parameters of fetus i.e., Bi-Parietal Diameter, Head Circumference, and Femur Length were established through two-dimensional ultrasound. Chi-square and t tests were used to analyze differences in biometric parameters in both genders. Results: The study results showed significant differences in the Bi-Parietal Diameter and Head Circumference between male and female fetuses (p=0.006 and p=0.003, respectively). Mean Bi-Parietal Diameter in males was 71.47±13.70 and in females it was68.30±11.90cm, mean Head Circumference in males was 264.23±47.87and in females it was 252.03±44.91cm. It has also been observed that there was an insignificant difference in the femur length between male and female fetuses (p= 0.605). Mean femur length was 52.74±12.39 in males and 52.19±11.38 in females. Conclusion: This study concluded that male fetuses have considerably larger bi-parietal diameter and head circumference as compared to female fetuses however, no variation in femur length is observed in both genders. Keywords: Fetal Gender, Bi-Parietal Diameter, Head Circumference, Femur Length.

Diagnostic Challenges of an Abdominal Pregnancy in the Second Trimester

Abdominal pregnancies are a rare form of ectopic pregnancy, which presents a significant risk of maternal morbidity and mortality. We describe an unusual case of a late diagnosis of an abdominal pregnancy in the second trimester, which due to diagnostic challenges, was not detected on 1st trimester and subsequent antenatal ultrasound scans (USS). The abdominal pregnancy was later diagnosed at the repeat anomaly scan and confirmed with a pelvic MRI. This case of abdominal pregnancy is unique when compared to other reported cases, as the fetus was initially enclosed within the amniotic sac with normal liquor volume. Both transvaginal and transabdominal scans appeared to demonstrate an intrauterine pregnancy. The diagnosis of abdominal pregnancy was only made possible following rupture of the amniotic sac, leading to anhydramnios, which resulted in the repositioning of the fetus to the upper maternal abdomen. This case represents the challenges faced by obstetricians in diagnosing, managing, and counselling a woman when faced with an abdominal pregnancy.

Reasons Pregnant Women seek Prenatal Sonographic Gender Disclosure in Makurdi, Nigeria

Fetal gender disclosure, a non-medical prenatal ultrasonography indication, although largely ethically unjustifiable, continues to grow and thrive in demand due to its request by pregnant women. The study aims at establishing the proportion of women who want to know fetal gender during prenatal ultrasound. This was twelve months` prospective study of all pregnant women, 16weeks and above who presented at our facility for antenatal ultrasound in Makurdi from 7th May 2019 to 6th May 2020. A structured questionnaire was used to obtain information on factors influencing their willingness to know the gender of their unborn children. The information collated was entered into statistical package for social science (SPSS) version 23.0 for analysis. P-values=0.005 was considered significant for the study population. Two hundred and fifty (250) pregnant women were recruited for the study. Majority of the women 233(93.2%) showed marked interest in knowing the gender of the fetus, while 17(6.8%) did not. The main reason for wanting to know the sex of the fetus was for easier choice of clothing and naming; whereas the main reason for not wanting sex disclosure was because any child is good. There was no statistically significant correlation between gender preferences and the other variables such as age, educational attainment, tribe and previous miscarriages (P=0.136, 0.485, 0.275 and 0.942 respectively). Majority of the women 233(93.2%) want fetal gender disclosure due to ease of choice of clothing and naming. The deliberate policy of non-disclosure on account of non-medical indication during prenatal ultrasonography is untenable in our environment.

A CASE REPORT: PRENATAL DIAGNOSIS OF FETAL CARDIAC RHABDOMYOMA

Fetal cardiac rhabdomyoma is a rare disease, and most of the cases are detected incidentally during the antenatal ultrasound. This is a case discovered during antenatal ultrasonography at 29 weeks of gestation. Multiple hyperechoic round shape masses were seen in the cardiac. After birth, the baby had been under a paediatric cardiologist follow-up with regular echocardiography. Management was mainly conservative at the time being as there was no sign of obstruction.

Rare Fetus-in-Fetu: Experience From a Large Tertiary Pediatric Referral Center

Objective: Fetus-in-fetu (FIF) is an extremely rare disease, and most prior publications are single case reports. Here, we describe the clinical characteristics, imaging manifestations, and the treatment and related complications of FIF from a large tertiary pediatric referral center.Materials: After institutional review board approval, patients with a diagnosis of FIF between January 2010 and November 2019 were further selected and reexamined. We analyzed the general clinical characteristics, imaging manifestations, treatment, and prognosis of the patients.Results: A total of seven (four male and three female) patients with FIF were included in the study. All patients were diagnosed with FIF during the antenatal ultrasound examination along with an abnormal increase in alpha fetoprotein, and it was confirmed by subsequent pathological examination. The median gestation period when FIF was first diagnosed was 25 (range: 22–32) weeks. Ultrasound, computed tomography, and magnetic resonance imaging were the main pre-operative diagnostic techniques used. All patients underwent FIF resection within 1 month after birth: four patients had open surgery and three had laparoscopic surgeries (one case was converted to open surgery); only one patient developed ascites after surgery. All patients are growing up healthy and without tumor recurrence at the last follow-up. The level of alpha fetoprotein decreased to normal within 1 year (range 3-10 months) after surgery performed.Conclusion: As the size of the FIF increases, it can be found and diagnosed in antenatal ultrasound examination. Surgery is an important curative treatment for FIF and generally results in excellent long-term quality of life.