Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 26 - N° 2 - p. 193

We report a successful treatment of a B19 parvovirus-induced fetal hydrops diagnosed at 16 weeks of gestation. This disease could be corrected by means of a unique intraperitoneal blood transfusion performed at 18 weeks, once diagnosis was established. The delivery occurred at 36 weeks, leading to the birth of a healthy baby. This case suggests that transfusion should be attempted, as the spontaneous fetal recovery remains uncertain and shows that intraperitoneal blood transfusion is an effective therapeutic option of the B19 parvovirus-induced anemia, in the absence of a viral myocarditis.

BACKGROUND:In performing Vecchietti's operation laparoscopically, it is important to ensure bladder and rectum integrity. We report new techniques of ultrasonography and suture retrieval that simplify and improve the ease and speed of this operation.TECHNIQUE:The pneumoperitoneum is emptied and the bladder filled with 200 mL of sterile water. The ultrasound probe is placed on the suprapubic wall for a sagittal image. The needle progresses medially through the vesicorectal space, with ultrasound guidance, and its emergence into the pelvis is controlled with laparoscopy. The nylon sutures carrying the dilation ball are threaded through the needle and brought back through the abdominal wall.EXPERIENCE:Seven patients with vaginal aplasia had this procedure. There were no complications, and the mean operative time was 43 minutes (range 35-55). Mean vaginal length was 7 cm (range 6-10). Four women defined sexual intercourse as very satisfying and two as moderately satisfying.CONCLUSION:This original technique was used for easy, safe, and rapid creation of neovaginas.

We report a case of fetal ventricular hemorrhage which occurred at 27.5 weeks gestation and caused by fetal brain contusion after a maternal traumatism. Ultrasound examination evidenced ventriculomegaly and an intraventricular clot which were confirmed by MRI. We discuss the interest of combining ultrasound and MRI of the fetal brain for the investigation and follow-up of fetal brain trauma. The patient gave birth to an eutrophic normal boy. The child is normal at 12 months follow-up.

Fetus in fetu is a very rare abnormality, and is secondary to a pathological diamniotic monochorionic pregnancy. Its discovery is usually postnatal. We report a case of prenatal diagnosis suspected at 16 gestation's week because of a voluminous omphalocele seen at 12 gestation's week.

Ultrasonography-assisted laparoscopic creation of a neavagina was performed on 6 patients suffering from vaginal aplasia. As the needle progress through the vesicorectal space, ultrasonography provided an accurate check of the bladder and rectal integrity, and improved the ease of the surgical procedure. Ultrasound can be considered an effective and reliable advance for laparoscopic management of vaginal aplasia.

We report a case of spontaneous reversal in utero of hydrops fetalis caused by parvovirus B19 maternal-fetal infection. The route leading to fetal hydrops is not fully understood. Severe anemia with hypoxemia and viral fetal myocarditis have been incriminated. Then the main issue is fetal death or spontaneous abortion. Cases of spontaneous reversal of hydrops fetalis are unusual. Fetal regenerative anemia is a good prognostic factor and emphasizes the place of conservative management.

We observed a plurifocal cystic adenomatoid malformation of the lung, Stocker class II, in a 21-week gestation fetus in association with polycystosis of a solitary medial kidney. There was no other notable abnormally. The caryotype could not be obtained. The association of these two congenital malformations is exceptional, only three similar cases have been reported in the literature. Two other cases of pulmonary adenomatoid malformations associated with nephromegaly with renal hyperlobulation have also been described. Whether this is a fortuitous association or not remains to be determined.

A case of a large vascular lesion of the skull is reported. The lesion was discovered at 22 weeks' gestation and it rapidly increased in size, reaching 8 cm a month later. Tumor echogenicity was the same as that for soft tissues and colour Doppler examination revealed intense vascularization. Cordocentesis showed features of the Kasabach-Merritt syndrome and very high plasma levels of alpha-fetoprotein. A Caesarean section was performed to avoid dystocia and led to the birth of a baby with cardiac failure in the immediate neonatal period. Biopsies of the mass led to the diagnosis of a non-malignant haemangio-endothelioma. The mass was removed and plastic surgery performed. The baby is alive and well 9 months after the operation.

Two cases of placental chorioangiomas were discovered, one echographically after in utero death at mid-term pregnancy and the second during the neonatal period associated with acute hydramniosis and a single umbilical artery. At 8 months, the new-born was in good health after persistent cholestasis at birth. A review of the literature of the macroscopic, histologic, echographic characteristics and the foetal-maternal complications of chorioangiomas revealed few cases of in utero death, especially so early in term.

This study was carried on in order to describe intrauterine fetal blood rheology, and to try to correlate these measurements with hemodynamic data obtained by doppler. Fetuses underwent cordocentesis in utero during pregnancy with a method allowing an ambulatory sampling with no premedication. Pathologic cases (malformations, fetal distress) were excluded from the study. Finally, a group of 80 'normal' fetuses was constituted, covering the period between 25 and 30 week's gestation. When compared to mothers studied at the same time, have significantly lower blood viscosity, lower plasma viscosity, lower RBC flexibility (measured by filterability) and higher hematocrit/viscosity ratio. Measurement of RBC rigidity by viscometry gave no significant differences. Fetal RBC aggregation was studied in 52 samples and was very low when compared to mothers with 'M' values equal to zero before 30 wks. The following parameters are linearly related to time : blood viscosity, hematocrit, hemoglobin count, RBC count, WBC count, eosinophil count, RBC aggregation index 'M'. A correlation between umbilical artery resistance index and both whole blood viscosity and hematocrit is also found and requires confirmation on a larger sample.

Lymphangiomas or cystic hygromas are malformations of the lymphatic vessels and are characterized by single or multiple cysts which have developed within the soft tissues. They occur most commonly in the neck (75 per cent of cases) and are often associated with hydrops or chromosomal abnormalities (Romero et al., 1988). Mediastinal or abdominal locations are rare and represent less than 5 per cent of cases in the literature (Singh et al., 1971). This paper represents the first reported case of prenatal diagnosis of a lymphangioma in the neck, mediastinum, and abdomen. Diagnosis was made before fetal viability, and allowed us to recommend termination of the pregnancy because of the poor prognosis.

Objective The effect of selective fetocide on the course of 61 multiple pregnancies.Design An observational study.Setting A tertiary centre.Subjects 61 women whose pregnancies included 37 triplets, 18 quadruplets, 5 quintuplets and 1 heptuplet; 97% followed IVF or the induction of ovulation. The aim of the procedure in most cases was to obtain twins.Interventions Selective reduction was performed before 13 weeks gestation under general anaesthesia, using either a transcervical (n = 26) or transabdominal approach (n = 35). Fifty-four twins, 4 singletons and 3 triplets were obtained after the procedure.Main outcome measure Preterm labour rate.Results The rate of unplanned fetal loss was 13% and was related to the number of suppressed embryos (P<0.05). The preterm labour rate was 56.6%, the mean gestation at delivery was 35.6 weeks. Seven deliveries were before 32 weeks and led to all neonatal deaths. A comparison with published data suggested that fetal reduction reduced the rate of preterm labour in high multiple pregnancies; in 24 twin pregnancies obtained after reduction of triplets there was probably a gain of 2 weeks gestation. Severe growth retardation occurred in 13%. The perinatal mortality rate was 10.8%.Conclusions Selective termination reduces but does not prevent early preterm labour. The procedure is of value in pregnancies with more than 3 fetuses and should be considered carefully for triplet pregnancies.

Hemangiolymphangioma is a malformation of both lymphatic and blood vessels. We present a case of fetal abdominal hemolymphangioma diagnosed by ultrasound at 27 weeks of gestation. The extensive fetal involvement, and the diagnosis before fetal viability led us to propose medical termination of pregnancy. This represents the second reported case of prenatal diagnosis of this malformation.

We present a case of prenatal diagnosis of a fetal cystic hygroma of the arm diagnosed using ultrasound scanning in the 32nd week of gestation. This represents the first reported case of cystic hygroma in this location. Ultrasonography was useful for the assessment of fetal arm mobility and for monitoring the volume of the mass during the pregnancy.