Fetal Atrial Flutter Associated With Atrial Septal Aneurysm

Objective: To provide evidence that fetal atrial flutter (AF) caused by atrial septal aneurysm (ASA) can be completely cured by delivery. Cases: Three fetuses with ASA complicated by AF in late gestation, including hydrops fetalis in one case, were collected and completely followed up. AF in all cases completely disappeared shortly after birth. New insights gained from this study are as follows: 1) PACs or bigeminy associated with ASA can progressively change to AF. 2) AF associated with ASA can cause hydrops fetalis and intrauterine treatment is needed but delivery is definitive treatment. 3) AF associated with ASA completely resolves after birth. Conclusion: This report may have clinical impact because of providing evidence that 1) In case of AF associated with ASA, the prognosis is much better than other causes and delivery should be strongly considered. 2) Fetuses diagnosed with AF should always be looked for the presence of ASA. 3) PAC/bigeminy related to ASA, different from isolated PAC, needs close follow-up for development of SVT and AF. 4) The fetuses remote from term can benefit from intrauterine treatment to avoid hydrops fetalis, and to prolong gestation for maturity and early delivery is recommended once lung maturity is confirmed.

Risk Factors for Incidence of Intrauterine Fetal Distress in Hospital of Pamekasan

Fetal distress during intrauterine is related to many factors. Knowing the risk factors will provide an effort to prevent and detect early fetal distress cases. The objective was to determine the risk factors for fetal distress during intrauterine treatment at dr. H. Slamet Martodirdjo Pamekasan. The method used is analytic observational with a cross-sectional method and the sample is simple random sampling. Samples taken were 184 patients in the delivery room dr. H. Slamet Martodirdjo general hospital Pamekasan. Data was taken by observation from patient medical records during 2018. Through this study, 92 patients experienced intrauterine fetal distress. The main risk factors for fetal distress was umbilical cord twists (p: 0.003, OR: 6,857, 95% CI: 1,914-24,572) and protective factors were maternal anemia (p: 0.018, OR: 0.141, 95% CI : 0.028-0.714). There are several risk factors for fetal distress during the intrauterine process at dr. H. Slamet Martodirdjo Pamekasan, the main factor was umbilical cord twisting where pregnant women with umbilical cord twists have a 6 times risk of experiencing fetal distress compared to those who do not.

Twin-twin transfusion syndrome - a University Hospital experience with intrauterine treatment

ABSTRACT Introduction: twin-to-twin transfusion syndrome (TTTS), defined by combination of polyhydramnios-oligohydramnios, is the most prevalent (5%-35%) of the abnormalities due to placental vascular anastomoses and the most lethal (80%-100% mortality) if untreated. Fetoscopic laser ablation of abnormal vasculature using the Solomon technique is the gold standard approach. It consists of interrupting the intertwin blood flow. Objectives: to present our initial experience at the Fetal Surgery Service of the Hospital de Clinicas of the Federal University of Parana (HC-UFPR) and to compare our results with those reported in the literature. Methods: we conducted a retrospective analysis of pregnancies who had undergone laser ablation, assessing data on Quintero’s staging, gestational age at diagnosis and at the time of the procedure, placental position, immediate post-procedure survival, and survival after the neonatal period. We then compared these data with the most recent data available in the literature. Results: we analyzed ten TTTS cases. The diagnosis was performed before the 26th week of pregnancy (median 20.8 weeks) and treatment occurred in a median of 9.5 days later. The distribution by the Quintero’s staging was of three cases in stage II, five in stage III, and two in stage IV. In 50% of the gestations, at least one of the fetuses survived through the neonatal period. Conclusion: the treatment of TTTS in the HC-UFPR had a positive impact in the survival of the affected fetuses, although the results were worse than the ones reported in the literature, probably due to the delay in referencing the patients to our service, leading to a prolonged interval between diagnosis and treatment.

Iatrogenic fetal goiter. Conservative management and spontaneous resolution

ObjectivesWe aim to report a case of a fetal goiter with postpartum spontaneous resolution. Fetal goiter can be secondary to maternal treatment and range from clinically asymptomatic or cause alterations in the fetus, from impaired swallowing to difficulty in vaginal delivery and even perinatal asphyxia due to the mass effect. The need for intrauterine treatment remains controversial.Case presentationWe present a case of fetal goiter with postpartum resolution. A 34-year-old multigravida presented to the emergency department with hiperemesis gravidarum at 10 weeks’ gestation. During evaluation for severe vomiting, Graves disease was diagnosed and treated with propylthiouracil. A routine ultrasound scan at 28 weeks gestation revealed a fetal anterior neck mass suggesting a fetal goiter. Cordocentesis showed fetal iatrogenic hypothyroidism. Conservative treatment was decided. Pregnancy concluded uneventful and the mass resolved spontaneously in the newborn.ConclusionsThe fetal thyroid gland is a structure that usually goes unnoticed during the process of prenatal diagnosis. In cases of maternal Graves diseases, fetal thyroid needs monitoring during pregnancy and conservative treatment is an option. Fetal goiter should be searched for secondary to thyroid alterations of the gravida, and in selected cases it can be managed without intrauterine treatment.