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Open access

Oskar Sylwestrzak and Maria Respondek-Liberska

Abstract

Introduction: Ultrasound assessment of fetal heart size (FHS) is widely used and recommended in many guidelines of fetal echocardiography due to its clinical value. The aim of this study was an analysis of some fetal heart measurements: ratio of heart area to chest area (HA/ CA) and transversal diameter of heart (AP) and their correlation to gestational age.

Material and methods: This retrospective study was based on database of records of ultrasound and echocardiographic examinations performed in our unit and included fetuses between 15th and 39th week of gestation with no evidence of heart defect or any abnormality.

Results: 609 ultrasound examinations were analyzed. The mean HA/CA was 0,30 ± 0,015, with no statistical difference between female and male (p>0,05), and seemed to be relatively constant with slight increase with advancing gestational age. The AP diameter in whole group correlated with gestational age (r=0,94) and there was no difference related to the fetuses gender.

Conclusion: The correlation of AP diameter and relative constancy of HA/CA ratio with gestational age presented in our normograms could be used for monitoring fetal development, but also for fetal cardiomegaly assessment.

Open access

Krzysztof Czajkowski, Ewa Helwich, Krzysztof Preis, Mariusz Grzesiak, Michał Krekora, Ewa Gulczyńska, Katarzyna Kornacka, Krzysztof Zeman, Iwona Maroszyńska and Maria Respondek-Liberska

Abstract

On 27.10.2017, in the course of the CARDIO-PRENATAL Conference at the Polish Mother’s Memorial Institute and Health Centre in Lodz, we presented, among others, the following problems:

classification of prenatal heart defects, fetal hemodynamic status evaluation in the third trimester, expected neonate’s clinical condition, planned procedures to be conducted just after birth and also planned medical staff to be present in the delivery room. Here are our main recommendations following the meeting and discussion.

Open access

Michał Krekora, Mariusz Grzesiak, Maciej Słodki, Ewa Gulczyńska, Iwona Maroszyńska, Maria Respondek-Liberska, Frank A. Chervenak and Laurence B. McCullough

Abstract

INTRODUCTION: The aim of this study was to present our current practice of counseling patients and families with the most severe congenital malformations in the 3rd trimester of pregnancy and to develop practical guidelines for our team and involved healthcare/ socialcare professionals. MATERIAL & METHODS: It was a retrospective evaluation of a series of fetal cases in 2017 from single tertiary center. Maternal obstetrical medical history, time of prenatal detection of the anomaly (1st, 2nd or 3rd trimester), time between last fetal echocardiography and delivery, type of delivery, neonatal birth weight and time of neonatal demise. The total study group was subdived into early demise (during the 1st day after delivery) or late demise > 1st day after delivery. RESULTS: Mean maternal age was 30,4 +/- 5,6 years, and varied between 26 and 38 years. No chronic maternal diseases were found in medical history and no congenital malformations were present in previous children. All women had 1st trimester ultrasound, in 9 cases, it was reported as normal (with NT measurement < 2 mm), in 2 cases extracardiac abnormalities were detected: diaphragmatic hernia and omphalocele ( in both fetal karyotype 46,XY). In nine cases, the abnormalities were detected in midgestation and with maternal wish to continue the pregnancies. There were 8 neonatal deaths within 60 minutes after delivery, including one intrapartum death and 3 “late” neonatal deaths in the intensive care unit (on 12th, 21st and 22nd day). We stress upon the prenatal team approach and counseling of future parents, in order to prepare them for poor neonatal outcome. CONCLUSIONS: 1. In the most severe cases when fetal or neonatal demise was suspected, the two different opinions of specialists might not be enough and a third opinion should be recommended before final decision. 2. A Fetal Team of specialists is necessary in cases of expected fetal/neonatal demise in order to prepare a written report of recommended perinatal management for all sides involved in this difficult problem.

Open access

Agnieszka Żalińska, Sara Korabiewska, Michał Krekora, Krzystof Michalak, Marek Kopala, Ewa Cichos, Anna Romanowicz, Maciej Słodki and Maria Respondek-Liberska

Abstract

Introduction: Fetal cardiac tumors are anomalies, that occur rarely: from Nationwide Register of Fetal Cardiological Problems in Poland in years 2004-2016 amongst 8112 fetuses with cardiological problems, there were 85 fetuses with cardiac tumors, including 52 cases of multiple cardiac tumors (0,64%) and 33 of single anomalies (0,4%). Material: This analysis included 13 cases from single tertiary fetal cardiac center Lodz in years 1993-2017. Results: Ten out of 13 fetuses with single cardiac tumors (SFCT) had cardiomegaly: on average HA/CA was 0,49. The size of the tumor was different: the smallest one - 6 x 6 mm, the biggest 47 x 47 mm. The way of the delivery: in 10 cases there was CS and in 3 cases natural delivery. Birth weight was from 2000-3950 g (average 2989,2 g). Cardiosurgical resection of the tumor was performed on 4 newborns: at 2nd, 4th, 8th and 16th day of life (average 7,5 day). Four neonatal deaths were registered (31%): in 1st 2nd and 11th day (before surgery) and in the 28th day after the operation. Conclusions: Single fetal cardiac tumors (SFCT) can be diagnosed at 20 weeks of pregnancy, which allows to start echocardiographic monitoring, taking into consideration the potential risk of hemodynamic progression. SFCT can be the first sign of tuberous sclerosis complex in later prenatal or postnatal life. SFCT other than rhabdomyoma can be asymptomatic in newborn, but may require an early cardiosurgical resection.

Open access

Paulina Kordjalik, Zdzisław Tobota and Maria Respondek-Liberska

Abstract

Introduction: Analysis have been subjected to evaluate standard data reports from the Polish National Prenatal Cardiac Pathology Registry from the year 2016, compared to previous years. Material and methods: The methodology of this work was comparison of the data from previous years that have been published in the Prenatal Cardiology and records generated in www. orpkp.pl from the year 2016. The total number of records entered in the Registry in the year 2016 was n=774. Results: Top 10 most common prenatal CHD in 2016 were such as follow: HLHS, AVSD, VSD, d-TGA, TOF, AvS, muscular VSD, Aberrant origin R subclavian artery, RAA, CoA. In the centers Lodz and Krakow the most common prenatal congenital heart defects were severe CHD requiring surgery in 1 st month of life. In the contrast, in Warsaw the first place was taken by a “critical heart defects” regardless whether cardiac surgery was planned in first week (contemporary definition of prenatal critical heart defects) or first month - contemporary definition of severe planned heart defects of postnatal life. Conclusion: The fact that in 2016 most common cause of referrals to targeted the fetal chocardiography was abnormal, large vessels view and not the abnormal 4 chamber view of the heart, suggests more and better training of hysicians performing the screening or basic study of fetal heart in Poland.

Open access

Oliver Graupner, Christian Enzensberger, Larissa Wieg, Aline Wolter, Can Yerebakan, Markus Khalil and Roland Axt-Fliedner

Abstract

Introduction: The long-term outcome of patients with HLHS (hypoplastic left heart syndrome) is mainly determined by right ventricular function. Our study examines, whether there are differences in segmental right ventricular myocardial displacement and tissue velocities of fetuses with HLHS compared to healthy fetuses during gestation. Materials and methods: A prospective study was conducted including 20 fetuses with HLHS and 20 gestational age matched controls. c-TDI (colour tissue Doppler imaging) derived systolic and diastolic velocities as well as myocardial displacement were assessed in three different locations of the right ventricle (RV). A ROI (region of interest) was placed in the basal, middle and apical part of the myocardium. Possible changes of c-TDI indices in the course of pregnancy and between the three different segments were investigated in both groups. Results: HLHS fetuses showed significantly lower e' velocities measured in the basal and middle part of the RV compared to healthy controls (p < 0.05). Basal displacement showed significantly lower values in HLHS fetuses compared to controls. In control fetuses but not in HLHS fetuses there was a significant increase of basal diastolic velocities and displacement in the course of pregnancy. According to myocardial velocities and displacement values there was a significant decrease from the base of the fetal heart to the apex pointed in both groups. Conclusions: An altered right ventricular myocardial function in HLHS fetuses within different myocardial segments could be demonstrated. An apicobasal gradient with higher velocity and displacement values in the basal part of RV myocardium could be found in both groups. The technique may be of value in the prenatal assessment of myocardial function, however its role as a monitoring tool and outcome predictor needs to be defined.

Open access

Iwona Strzelecka, Maciej Słodki, Katarzyna Zych-Krekora, Michał Krekora, Mariusz Grzesiak, Iwona Maroszyńska and Maria Respondek-Liberska

Abstract

Introduction: Congenital heart defects are the most frequent reason for deaths during the neonatal and early infancy periods. The aim of this study was to retrospectively analyze singleton pregnancy outcomes of premature neonates with congenital cardiac defects delivered by Cesarean section. Materials and methods: A retrospective analysis was performed on 10,800 fetuses evaluated in our referral fetal cardiac center between 2010 and 2016. A group of 58 singleton pregnancies was selected with the following criteria: fetal heart defect, Cesarean section (C-section), and gestation of 37 weeks or less. Exclusion criteria included labor outside of our hospital and multiple pregnancy. Results: Isolated heart defects constituted 74,1% (43 cases) of the analysed data set. The majority of newborns were delivered at 36 weeks of gestation (43,1%), with an average of 33,6 weeks. In one case (1,7%), C-section took place at 22nd week. Birth weight of newborns < 2500g constituted 51,7% (30 cases). Neonatal deaths occurred in 60,3% (35 cases). Conclusions: Preterm neonates with congenital heart defect, delivered by C-section in our reference centre, during 2010 to 2016, had generally poor outcomes and high mortality rate. The average hospital stay of surviving neonates was approximately two months. An improvement of knowledge about prenatal cardiology is necessary in obstetrician management with fetuses with congenital heart diseases.

Open access

Julia Murlewska, Maciej Słodki, Roland Axt-Fliender, Giusseppe Rizzo, Mark Sklansky, Stuart Weiner, Isaac Blickstein and Maria Respondek-Liberska

Abstract

International Prenatal Cardiology Collaboration Group (IPCCG) links specialists from prenatal cardiology all over the world. In this recommendation we would like to focus on the fetal/prenatal echocardiography official report. So far many recommendations focused mainly on technical aspects of the fetal heart examination.

Open access

Agnieszka Nawara-Baran

Abstract

Vein of Galen Malformation (VGM) it is the most common cerebral arteriovenus malformation in fetuses and children. Usually VGM causes volume overload of the heart and can induce mass effect in the brain, causing progressive neurological impairment. Modern treatment allow on earlier therapy (before the 5th monthof life). This gives the newborn with isolated VGM and heart failure a chance of survival. This work presents case of isolated vein of Galen malformation with diagnosed cardiomegaly, monophasic flow through the tricuspid valve, large right heart, pericardiac effusion, dilatation of SVC and abnormal doppler exam. Postnatal management included aggressive medical treatment of cardiac failure and early transarterial embolization of the selected vessels feeding the aneurysm at 6 days of age. The newborn is 6 month old, growing normally without neurological deficits or developmental retardation and waiting of next stage therapy. New techniques of treatment give fetuses with VGM and prenatal signs of cardiac insufficiency a chance of survival and healthy life, in a group of selected cases. The analysis of the cardiovascular system in fetuses with VGM according to uniform criteria is essential in order to assess the influence of these malformations on the survivability of newborns.

Open access

Maria Respondek-Liberska, Maciej Łukaszewski, Adam Oleś, Michał Podgórski, Piotr Grzelak and Maciej Słodki

Abstract

Introduction: Fetal echocardiography is a method of choice for diagnosing cardiovascular anomalies prenatally. However, in the majority of cases, the complexity of a defect creates a diagnostic challenge. Moreover, postnatal validation of sonographic findings rarely can be obtained. Nevertheless, the feedback is vital for improving diagnostic capabilities. Thus, the aim of this research was to compare results of prenatal echocardiography with postnatal angio-CT in patients with anomalies of great vessels. Material and methods: We retrospectively compared results of prenatal echocardiography and postnatal angio-CT in 10 patients with selected anomalies of the aortic arch. This was a qualitative analysis, thus discrepancies in recognized anomalies were compared between these two modalities. Results: In 8/10 patient diagnoses were fully consistent. Nevertheless, the tiny caliber of vessels created a diagnostic challenge (e.x. to differentiate the hypoplastic aortic arch from the aortic arch interruption). In the remaining case, the discrepancy was due to a problem with complete visualization of all branches of the aortic arch in prenatal ultrasound. Conclusions: Fetal echocardiography in tertiary center was a reliable method for assessment of great vessels anomalies. However, critically narrow vessels remain a diagnostic challenge and neonatal angio-CT seems to be the method of choice in cases of diagnostic doubts.