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P40Fetal treatment for hydrops fetalis assisted by interventional ultrasound
Author(s) -
Tanemura M.,
Suzumori K.
Publication year - 2000
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2000.00004-1-40.x
Subject(s) - medicine , hydrothorax , hydrops fetalis , fetus , thoracentesis , pleural effusion , pulmonary sequestration , chylothorax , surgery , oligohydramnios , fetal surgery , radiology , lung , pregnancy , in utero , ascites , biology , genetics
Background Fetal hydrops has many causes including hydrothorax and cardiac abnormality. Our fetal treatment experience with such disorders associated with hydrops fetalis is reviewed and the efficacy of new interventional ultrasound is presented. Methods Case 1 . A case of fetal lung tumor. Color Doppler analysis and MRI were introduced for differential diagnosis. Case 2. A case of severe pleural effusion. Detailed examination of intrathoracic fluid led to a diagnosis of congenital fetal chylothorax. Fetal treatment by intrapleural injection of OK‐432 was introduced. Case 3. A case of fetal tachyarrhythmia. We introduced transmaternal‐abdominal fetal ECG and administered transplacental medication. Results Case 1. Color Doppler analysis revealed an anomalous arterial supply from the aorta to tumor, leading to a diagnosis of pulmonary sequestration. Only reduction amniocentesis was repeated, with the circulatory failure spontaneously improving. Case 2. The pleural effusion was reduced by adhesion of the intrathoracic space, with pulmonary hypoplasia successfully prevented by OK‐432. Case 3 . Transmaternal‐abdominal fetal ECG led to a diagnosis of fetal PSVT. Transplacental propranolol stopped fetal PSVT quickly, while digoxin slightly improved fetal cardiac function. Conclusions OK‐432 may be considered as an alternate intrauterine therapeutic option to shunt insertion for severe fetal hydrothorax. Fetal ECG was also useful for the diagnosis of fetal tachyarrhythmia. Since some untreated cases show spontaneous improvement, the indications for fetal treatment should be reconsidered.