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Open access

Maria Respondek-Liberska

Abstract

Polish National Registry for Fetal Cardiac Malformations ( initiated in 2004) was opened for primary practicioners as well as for the referral centers performing or basic fetal heart evaluation or targeted fetal echocardiography. None of the physicians until current era had regular education of fetal cardiology . It was necessary to create an audit - veryfication system, which was provided as a checking each record by the 3 most experienced fetal cardiologists in Poland, using randomised computer system. The aim of this analysis was a retrospective evaluation of „Negatively Verified”

Material and methods: The total number of fetuses in Registry during 2004 and 2013 was 5682 and there were 170 negative verified cases. Every „negative case” was analyzed and qualified to one of five categories: An error in classification of the severity of CHD ; computer mistakes , reported other prenatal problems but not CHD, different interpretation of the images (freezed frames or cine loops) and bad order of the labels of cardiac anomalies.

Results: The percentage of negative verifications was similar every year and total number of negative verification was 2,9% . The main reason for negative was first of all unproper fetal heart classification in 71 cases (42%). In majority the differences in interpretations were minor: but there were 5 huge differences between primary and secondary interpretation.

Conclusions:

1) Fetal heart cardiology requires prenatal heart classification instead of pediatric classification

2) Computer mistakes (missing fields, missing diagnoses, lack of freezed frames or cine-loops) shoud be picked up by the system during up-loading of the cases

3) The different interpretation of the images could be used for teaching purpose of fetal cardiology .

Open access

Comments on a report of the aorto-pulmonary window (APW ) type I coexisting with pulmonary valve stenosis and occluded arterial duct, detected prenatally at 26 weeks of gestation

Więckowska K, Węgrzynowski J, Zych - Krekora K, Kwiatkowska J, Słodki M, Respondek- Liberska M. Antenatal echocardiographic diagnosis of an aortopulmonary window combined with pulmonary stenosis in neonate. A case report. Prenat Cardio. 2015 Sep;5(3):33-37

Andrzej Rudziński

Summary

In the article a case of a little APW coincidented with pulmonary stenosis (the first such description in Poland) in 26-week-old fetus of a thirty-two-year-old woman, gravida 3, was presented1.

Open access

Joanna Szymkiewicz - Dangel, Grażyna Brzezińska - Rajszys, Bohdan Maruszewski and Agata Włoch

Open access

Kinga Bączyk-Rozwadowska

Abstract

Civil liability for medical malpractice may be attributed either to a doctor or a hospital when any of these persons’ acts or omissions cause injuries to a patient; it may be also the hospital’s liability for the damage caused by negligence of its staff (doctors and other personnel). The rules that govern this liability and the way of compensating the damage are different due to the grounds on which the doctor performs medical services and, in case of hospital’s liability, the relation between a doctor and a health care institution. A doctor who runs his private medical practice bears civil liability individually and is obliged to pay damages if any of his patient suffers injury in connection with the treatment. However, a doctor who acts as employee of a health care institution is protected by the provisions of the Labour Code and exempted from civil liability to a patient. On the other hand, a so-called independent contractor’s liability is joint and several with a hospital that has engaged him. However, case law seems to protect such doctors and treat them as hospital’s employees if certain premises are fulfilled (like de facto subordination of the doctor to the head of the ward).

Open access

Iwona Strzelecka, Maciej Słodki, Andrzej Zieliński, Iwona Maroszyńska and Maria Respondek-Liberska

Abstract

Introduction:

Prenatal diagnosis is an integral part of modern perinatal care. In the article results of questionnaires pertaining to the prenatal process of diagnosis are presented. Parents whose children were afflicted with congenital malformations of all types responded to enquiry

Materials and methods:

Between March 2014 and March 2015 150 of 355 infants were hospitalized in the Department of Pediatric Intensive Care and Congenital Malformations in Łódź, and 150 had congenital malformations.

Results:

101 parents of 150 children (67,3%) have given the feedback. Anomalies were such as: of the digestive system (37%), CHD (25%), OUN (14 %), genito-urinary (13%), skeletal system (9%) and respiratory system (2%). In 65 children of 101 the defects were detected prenatally. The obstetric US exam was the most frequently pointed out as performed (more than 1200). The biochemical markers and genetic tests in were performed in 34 pregnancies. The high percentage of ability to detect malformation was reported in the group of fetal echo examinations.

Conclusions:

1. Prenatal ultrasound exams were the least effective method of making appropriate prenatal diagnosis of congenital malformation.

2. Fetal echocardiography had a high level of sensitivity and specificity in detecting congenital malformations.

3. Prenatal cardiologists proved to be the most effective in detecting congenital malformations 89,3 % of detected abnormalities.

4. Biochemical exams had a positive result in only one case of Down Syndrome.

Open access

Lucia Manganaro

Abstract

Congenital heart defect (CHD) is one of the most common type of fetal malformations. Tissue-Doppler imaging, dynamic threedimensional (4D) echocardiography and fetal cardiac magnetic resonance imaging (MRI) are advanced modalities for the assessment of cardiac structure and function. MRI can study the cardiac morphology using T2-weighted half-Fourier single-shot turbo spin-echo sequence (HASTE) and steady-state free precession (True FISP) sequences. Also a dynamic study can be performed, through the acquisition of cine-MR sequences with real-time steady-state free precession (SSFP) oriented according to the standard projections used in fetal echocardiographic scanning. If the challenges relating to motion and cardiac gating can be overcome, MRI has the potential to provide high-resolution imaging of the fetal heart.

Open access

Iwona Strzelecka, Joanna Płużańska, Jerzy Węgrzynowski, Tomasz Moszura, Maciej Słodki and Maria Respondek-Liberska

Abstract

Most heart defects form between 4 and 6 weeks after fertilization. The detection rate is still growing. Despite significant progress in prenatal diagnosis some cases still go undetected. We present two cases of similar defects: prenatally detected and undetected, both presenting with a normal four chamber view in mid-pregnancy. We compared the follow-up of both neonates along with sustained health and economic consequences. The dynamics of the development of heart defects during prenatal life suggests the legitimacy to perform additional, late echocardiography exams (35-38 weeks of gestation)

Open access

Jakub Malinowski, Maciej Słodki, Krzysztof Szaflik and Wanda Mikołajczyk-Wieczorek

Abstract

We present a case of a female fetus with large posterior fossa cyst. After detailed diagnosis in referral center revealing normal heart anatomy and no functional abnormalities in cardiovascular system, a trial decompression of the fluid reservoir was suggested to the parents and successfully performed at the 30th week of pregnancy. Neurosurgical treatment was continued in the neonatal period. At the age of 7 months, the child presented normal physical development, and the cranial image of the CNS showed good recovery of the brain.

Open access

Agnieszka Nawara-Baran and Beata Radzymińska-Chruściel

Abstract

The aim of this study was an analysis of cardiac assessment in the first trimester, their outcomes, and comparison with literature data. Five cases were analysed from the year 2014. The exams were performed between 11-13 + 6 weeks. The analysis confirmed that the detection of CHD in 1 st trimester was possible and was verified by an early fetal echocardiogram. The most common symptoms of abnormal heart images in the early screening assessment were: axis, heart size and color Doppler assessment of the chambers and V sign. The outcome of pregnancies with early detection of fetal heart defects was poor. There was only one surviver

Open access

Maciej Słodki and Maria Respondek-Liberska

Abstract

Attempts to adapt the classifications of pediatric congenital heart defects (CHD) to prenatal cardiology have been lasting for many years. The paediatric cardiology CHD classifications are mainly based on anatomic details and/or pulmonary blood flow and are not always useful in fetal medicine. Because of these reasons and also many more, adaptation attempts of congenital heart defects of children, from pediatric to prenatal cardiology have not brought desired effects.Clinical course in utero and at delivery can now be predicted, and as a consequence, fetal medicine specialists are being asked to consider the fetus as a patient and the transition to postnatal life is an important part of care. The new prenatal classifications of CHD shows new particular group of CHD, requiring emergent procedure after birth. Thanks to organizing special delivery room with special team of specialist we can much more improve the outcome, especially in severest CHD.