11/78. Obstructive fetal hydronephrosis managed by amnioinfusions and bladder aspirations.BACKGROUND: Fetuses diagnosed with posterior urethral valve syndrome risk development of significant pulmonary and renal complications. Historically, medical options included expectant management, percutaneous shunting, fetal surgery, and pregnancy termination. CASE: A 34-year-old primigravida presented at 26.5 weeks' gestation with severe fetal hydronephrosis. In lieu of the aforementioned options, the patient elected to undergo serial amnioinfusion and fetal bladder aspirations. The child is now 13 months old and has no evidence of pulmonary compromise but requires peritoneal dialysis. CONCLUSION: Serial amnioinfusions combined with fetal bladder aspiration may be beneficial in selected cases of severe fetal hydronephrosis. However, this case demonstrates that fetal urinary electrolytes cannot be used reliably to predict subsequent normal renal function.- - - - - - - - - - ranking = 1keywords = gestation, pregnancy (Clic here for more details about this article) |
12/78. prenatal diagnosis of de novo mosaic deletion 13q associated with multiple abnormalities.A case of prenatal diagnosis of de novo mosaic deletion of the long arm of chromosome 13 (del(13)(q13.3)) is presented. Routine scanning in a 27-year-old primigravida at 25 weeks' gestation showed fetal bilateral hydronephrosis. Detailed anomaly scanning in our tertiary referral center further demonstrated posterior meningoencephalocele, sloping forehead, microcephaly, syndactyly and hypoplastic thumbs. Both genetic amniocentesis and cordocentesis revealed a mosaic karyotype, 46,XY/46,XY,del(13)(q13.3). Sonographic findings were confirmed by postmortem autopsy and additional abnormalities such as agenesis of corpus callosum, hypoplastic cerebellum and macroglossia were diagnosed. Detailed sonography in this case thus revealed multiple malformations that prompted fetal karyotyping at 25 weeks' gestation.- - - - - - - - - - ranking = 1.2153457617809keywords = gestation (Clic here for more details about this article) |
13/78. ureterocele causing anhydramnios successfully treated with percutaneous decompression.BACKGROUND: Ureteroceles are congenital cystic dilatations of the submucosal segment of the distal ureter. We present a case of an intravesical ureterocele causing anhydramnios at 31 weeks' gestation. CASE: A primiparous woman near 20 weeks' gestation had ultrasound evidence of a fetal duplicated right collecting system. At 31 weeks, an intravesical ureterocele was seen along with bilateral hydroureteronephrosis and anhydramnios. A single percutaneous needle decompression of the bladder and ureterocele successfully restored amniotic fluid volume. CONCLUSION: Follow-up ultrasounds are indicated when either a duplicated renal collecting system or a ureterocele is identified. In utero treatment is indicated only when amniotic fluid is compromised. Needle decompression should be first-line treatment, with more invasive methods reserved for failures of decompression.- - - - - - - - - - ranking = 1.2153457617809keywords = gestation (Clic here for more details about this article) |
14/78. Antenatal sonographic detection of vesicoureteral reflux. A case report.We report a case with vesicoureteral reflux (VUR), diagnosed antenatally. A 31-year-old Japanese woman was referred at 37 weeks' gestation because of the fetus having unilateral renal pelvis dilatation. The real-time ultrasound revealed a right renal pyelectasia with periodic changes in size over intervals lasting several minutes. The simultaneous examinations of both anteroposterior dimension of the renal pelvis and the ellipse size of urine-filled bladder area demonstrated that they varied in size in a reciprocal fashion, leading us to diagnose the fetus as having VUR. Postnatally, bilateral VUR was confirmed by the voiding cystogram. This case has typical ultrasonographic findings of fetal VUR, in which both the renal pelvis and urinary bladder dimensions change periodically in a reciprocal manner with each other, when the reflux really occurred.- - - - - - - - - - ranking = 0.60767288089046keywords = gestation (Clic here for more details about this article) |
15/78. Hardikar syndrome: a case requiring liver transplantation.We report the case of a girl with Hardikar syndrome who underwent living-donor liver transplantation at 2 years of age. This disease, described in 1992, includes a constellation of abnormalities, such as cleft lip and palate, pigmentary retinopathy, and multiple tubular stenoses (e.g., bile ducts, ureters). Other system involvement is variable. rotation anomalies of the gut and cardiac abnormalities are frequently present. Pathogenesis remains obscure. Our patient was delivered at 33 weeks of gestation by cesarean section, and was jaundiced, with low birth weight and height. On day 5 after birth, the patient underwent Ladd's surgery for intestinal malrotation. One month later, she developed pyelonephritis and urosepsis. She remained jaundiced and a liver biopsy revealed cirrhosis with regenerating nodules, portal chronic inflammation with bile duct proliferation, and lobular cholestasis. The patient underwent several corrective operations, and at 12 months of age she was diagnosed with Hardikar syndrome. She failed to thrive and had progressive cholestasis and jaundice, coagulation disorders, bilateral ureterostomies, repetitive urinary tract infections, bilateral cleft lip and palate, retinopathy, and gut malrotation. She received a liver transplant at 24 months of age from a living donor. She has had an excellent clinical outcome in liver function without further decline of growth and development.- - - - - - - - - - ranking = 0.60767288089046keywords = gestation (Clic here for more details about this article) |
16/78. Fetal urinoma as a sign of a dysplastic kidney.We describe a female neonate in whom a urinoma was first diagnosed at 20 weeks of gestation without any evidence of underlying urinary tract obstruction. The urinoma became apparent following the performance of a "bloody tap" amniocentesis. Sequential ultrasonography, both fetal and up to 3 months after birth, showed eventual resorption of the urinoma in parallel with the development of a shrunken, non-functioning kidney. Except for the onset of high-renin hypertension, which spontaneously remitted at 1 year of age, the baby's postnatal course was uneventful. Renal function was normal. The presence of a fetal urinoma as a sign of a dysplastic kidney is discussed.- - - - - - - - - - ranking = 0.60767288089046keywords = gestation (Clic here for more details about this article) |
17/78. survival in second trimester oligohydramnios secondary to bilateral pelviureteral junction obstruction.The extent and onset of obstruction in hydronephrosis determine the varying degrees of renal impairment. Bilateral hydronephrosis, especially in combination with oligohydramnios, is considered a negative predictor for pregnancy outcome. We describe a case of bilateral pelviureteral junction obstruction causing severe oligohydramnios between 25 and 29 weeks of gestation. The prenatal and postnatal findings and treatment are demonstrated. In the presence of bilateral renal impairment and oligohydramnios, our patient had an unfavorable prognosis. The respiratory and renal function, however, were better than expected. We show how urinary tract reconstruction and neonatal intensive therapy can result in an acceptable outcome.- - - - - - - - - - ranking = 1keywords = gestation, pregnancy (Clic here for more details about this article) |
18/78. Huge maternal hydronephrosis: a rare complication in pregnancy.A huge maternal hydronephrosis is uncommon in pregnancy and might be mistaken as a pelvic mass. A 21-year-old primigravida was noted at 25th week of gestation to have a visible bulging mass on her left flank. The mass was originally mistaken as a large ovarian cyst but later proved to be a huge hydronephrosis. Retrograde insertion of ureteroscope and a ureteric stent failed, so we performed repeated ultrasound-guided needle aspiration to decompress the huge hydronephrosis, which enabled the patient to proceed to a successful term vaginal delivery. nephrectomy was performed after delivery and proved the diagnosis of congenital ureteropelvic junction obstruction.- - - - - - - - - - ranking = 2.5693084764382keywords = gestation, pregnancy (Clic here for more details about this article) |
19/78. Megacystis microcolon intestinal hypoperistalsis syndrome with bilateral duplicated systems.A 29-year-old multigravida woman presented for her second prenatal ultrasound evaluation at 30 weeks of gestation. The study showed a female fetus, bilateral duplicated systems with severe hydronephrosis in the upper pole moieties and a massively distended bladder. Initial interpretation suggested ectopic/obstructing bilateral ureteroceles. To evaluate these findings further, a prenatal magnetic resonance imaging scan was obtained, documenting the absence of ureteroceles. The presumptive diagnosis of megacystis microcolon intestinal hypoperistalsis syndrome was made. After birth, contrast enema confirmed the presence of microcolon. This appears to be the first reported case of megacystis microcolon intestinal hypoperistalsis syndrome with bilateral duplex systems evaluated with prenatal magnetic resonance imaging.- - - - - - - - - - ranking = 0.60767288089046keywords = gestation (Clic here for more details about this article) |
20/78. A new technique for ureteral stent placement during pregnancy using endoluminal ultrasound.Endoluminal sonography using the IVUS is a minimally invasive procedure performed using a flexible 6.2F catheter with a 20 megahertz transducer that can easily be passed endoscopically to image the urethra, bladder, ureter and renal pelvis. In the current study, a woman patient in her third trimester of pregnancy with a renal pelvic stone and persistent colic was safely treated with placement of an indwelling ureteral stent. Because it is minimally invasive and does not require the use of roentgenograms, we believe the IVUS will be a useful tool to assist with the management of ureteral colic in patients who are pregnant in whom intervention is required.- - - - - - - - - - ranking = 1.9616355955477keywords = pregnancy (Clic here for more details about this article) |
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