Significance of the ‘line sign’ in the diagnosis of congenital imperforate anus on prenatal ultrasound

Background The prenatal diagnosis of foetal imperforate anus is difficult. Most previous studies have been case reports. To provide useful information for diagnosing foetal imperforate anus, a retrospective review of diagnostic approaches was conducted. Ultrasonography was performed in 19 cases of foetal imperforate anus from 2016 to 2019 at our prenatal diagnostic centre. The prenatal sonographic features and outcomes of each case were collected and evaluated. Result The anal sphincter of a normal foetus shows the ‘target sign’ on cross-sectional observation. Of the 19 cases of imperforate anus, 16 cases were diagnosed by the ultrasound image feature called the ‘line sign’. 1 case with tail degeneration was low type imperforate anus with the irregular ‘target sign’ not a real ‘target sign’. There was two false-negative case, in which the ‘target sign’ was found, but irregular. Conclusion In this study, we find that the anus of a foetus with imperforate anus presents a ‘line sign’ on sonographic observation. The absence of the ‘target sign’ and then the presence of the ‘line sign’ can assist in the diagnosis of imperforate anus. The ‘line sign’ can be used as a secondary assessment to determine the type of the malformation following non visualization of the ‘target sign’. The higher the position of the imperforate anus is, the more obvious the ‘line sign’. It is worth noting that the finding of the short ‘line sign’ and irregularr ‘target sign’ can not ignore the low type imperforate anus.

Twin reversed arterial perfusion sequence: the heartless twin

To report a case of twin reversal arterial perfusion sequence and its management by means of laser coagulation of the vascular malformation in the placenta. Twin reversed arterial perfusion sequence is a rare form of twin to twin transfusion syndrome occurring primarily in Monochorionic monoamniotic twins. The prevalence is about 1 in 35,000 pregnancies. The significance of this condition is that there is a normal foetus and an acardiac foetus. The blood is shunted from the normal twin to the acardiac twin through vascular malformations in the placenta. The normal twin faces a high risk of both morbidity and mortality due to cardiac failure. A case of twin reversal arterial perfusion sequence diagnosed at 22 weeks following a target scan underwent laser photocoagulation and gave birth vaginally at 30 weeks without any complications. Early detection of this condition can lead to timely intervention and thereby improve the outcome. In Twin reversal arterial perfusion sequence, the normal or the pump twin has a high chance of mortality due to cardiac failure. As the size of the acardiac twin increases, there is a higher chance of mortality of the pump twin. There is a need for regular follow up with ultrasonography and foetal echocardiography along with early therapeutic interventions to ensure the survival of the normal twin. In our case, despite the large size of the acardiac twin, we had a successful pregnancy outcome for the normal twin due to timely intervention.

Hydatidiform mole coexisting with normal foetus: A rare presentation of a case report from University of Maiduguri Teaching Hospital

A twin pregnancy comprising a complete hydatidiform mole coexisting with a foetus is a rare obstetric condition with an incidence of 1 in 22,000 to 1 in 100,000 pregnancies. The management of such case is challenging due to the associated risk of maternal and foetal complications. We report a case of a 25-year-old woman, gravida 2, para 1 with a normal intrauterine pregnancy coexisting with complete hydatidiform mole. An ultrasound scan demonstrated normal foetus and placenta along with coexistent intrauterine echogenic mass with features of hydatidiform mole. The microscopic examination of the abnormal placenta confirmed complete hydatidiform mole. Although twin pregnancy with complete hydatidiform mole and coexistent foetus is associated with increased risk of developing maternal and foetal complications, continuation of pregnancy may be an acceptable option under close monitoring to detect early signs of complications.

STUDY THE CORRELATION BETWEEN PLACENTAL THICKNESS AND ESTIMATED FETAL WEIGHT BY 2D ULTRASONOGRAPHY ON NORMAL FOETUS MORE THAN 16 WEEKS OF AGES

Objectives: To evaluate the development of foetus (BPD, AC, AAD, FL) and placenta (placental thickness - PT) and the correlation between placental thickness and fetal estimated weight. Materials and Method: Ultrasonographic study 1224 singleton pregnancies with normal developing foetus by cross-sessional describtive method from 01/05/2009 to 20/08/2010. Results: The first pregnancies consist of 59.07%, the second – 29.66 %, the third -11.28%. The fetal and placental ultrasonographic parameters continuously increase from 16 weeks to 38 weeks of age and get satistic meaning with p<0.01. There is closed agreeable correlation between BPD, AAD, AC, FL, PT and fetal ages (w) with r = 0.9829, 0.9895, 0.9882, 0.9827, 0.9689 p<0.0001 correlatively. Conclusion: Ultrasonographic fetal parameters strongly correlate with fetal ages. Placental thickness agreable correlation with fetal ages and FEW.

CORTICOSTEROID PRODUCTION BY THE HUMAN FOETUS: EVIDENCE FROM ANALYSIS OF URINE FROM WOMEN PREGNANT WITH A NORMAL OR AN ANENCEPHALIC FOETUS

SUMMARY The quantities of nine corticosteroids in 24 h urine samples collected by pregnant women (nine with normal foetuses and nine with anencephalic foetuses) were measured after hydrolysis with β-glucuronidase and separation by paper chromatography. The excretion (μmol/24 h, mean ± s.d.) of pregnanetriol (0·85 ± 0·17), 3α,17α-dihydroxy-5β-pregnan-20-one 17α-hydroxypregnanolone, 0·55 ± 0·17), 3α,17α,21-trihydroxy-5β-pregnan-20-one (tetrahydro-11-deoxycortisol, 0·17 ± 0·14) and tetrahydrocorticosterone (0·65 ± 0·26) by women with an anencephalic foetus was significantly lower (P < 0·01 or <0·05) than the excretion of these compounds by women with a normal foetus (pregnanetriol, 2·42 ± 0·62; 17α-hydroxypregnanolone, 2·72 ± 0·69; tetrahydro-11-deoxycortisol, 0·56 ± 0·37; tetrahydrocorticosterone, 1·95 ± 0·94). These differences suggest that the adrenal of the normal foetus contributes to the quantity of pregnanetriol, 17α-hydroxypregnanolone, tetrahydro-11-deoxycortisol and tetrahydrocorticosterone in maternal urine. The excretion of tetrahydrocortisol, tetrahydrocortisone, tetrahydrodeoxycorticosterone, cortol and cortolone were similar in both groups of subjects. No evidence was obtained therefore to indicate the secretion of cortisol or deoxycorticosterone by the foetal zone of the adrenal of the undisturbed human foetus in late gestation.