[Show abstract][Hide abstract] ABSTRACT: To establish the reference range of intracranial translucency (IT) in the Korean population, and to evaluate whether Volume IT™ is a reliable technique for measuring IT.
We retrospectively analyzed the IT of 93 singleton fetuses at 10.5 to 12.6 weeks of gestation using previously obtained three-dimensional volume data. The IT was measured manually and automatically using Volume IT™ in each fetus by one experienced and one beginner operator. We measured the IT values according to the crown-rump length and evaluated whether Volume IT™ can successfully measure the IT. Inter-observer agreement and intra-observer reproducibility were analyzed using the intraclass correlation coefficients (ICC), and the IT measurements obtained by the experienced operator using the manual and automated methods were then compared using the Bland-Altman plot and ICC.
Among 93 cases, 2 were lost to follow-up after the first trimester scan and were excluded from further evaluation. Both operators identified the fourth ventricle in all 91 cases using Volume IT™. The experienced and beginner operators were able to measure the IT in 89 (98%) fetuses, with 4 and 13, respectively, requiring adjustments. The IT values increased with gestational age (correlation coefficient, r=0.491, P <0.0001). Inter-operator agreement was moderate (ICC=0.580 for automated and 0.546 for manual measurements), and intra-operator reproducibility was highest for automated measurements by the experienced operator (ICC=0.944). Agreement of the IT values between the manual and automated methods was high (ICC=0.950).
Our results provide the reference range of IT in the Korean population. The Volume IT™ may be a reliable technique for measuring IT.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the outcome in a cohort of fetuses with isolated sacrococcygeal teratoma (SCT) in relation to the need for in utero intervention.
We retrospectively analyzed a cohort of fetuses prenatally diagnosed with SCT between September 2000 and December 2010. Postnatal outcomes were evaluated in relation to the need for intervention in utero by reviewing medical records.
Of the 35 fetuses diagnosed with SCT during the study period, ten were lost to follow up and three had been misdiagnosed as SCT. Among the remaining 22 cases, in utero interventions were performed in eight, including radiofrequency ablation (RFA) in four, shunt operations in two, RFA plus cyst aspiration in one, and RFA with subsequent shunt operation in one. Tumors of cases undergoing in utero intervention were larger with rapidly growing, more frequently vascular, and with associated polyhydramnios or cardiomegaly. The rate of preterm births was higher in the cases that underwent interventions compared with those that did not (7/8 vs 2/14). Only one tumor showed regression after RFA while the other seven increased in size. Median tumor size at birth was significantly larger in the intervention group than in the nonintervention group (136 mm vs 80 mm). The neonatal survival rate was 6/8 for the prenatal intervention group and 14/14 for the nonintervention group. Resection of SCT was required in all neonates. The most common complication after postnatal surgery was fecal incontinence.
Fetuses with SCT undergoing in utero intervention have worse prognostic features, yet their neonatal outcome is similar to those of fetuses not requiring intervention.
[Show abstract][Hide abstract] ABSTRACT: Despite the good survival rate of fetuses with gastroschisis, the length and cost of hospitalization for surgically repaired gastroschisis are high. In gastroschisis, prolonged exposure of the intestine to amniotic fluid (AF) containing intestinal waste products results in intestinal damage, including intestinal wall thickening and fibrous peel formation. The deleterious effects of AF on gastroschisis can be prevented by lowering the concentration of intestinal waste products. We describe the treatment of a case of fetal gastroschisis by repeated AF exchange and infusion. Following repeated, successful transabdominal AF exchange and infusion, the concentrations of various intestinal waste products were decreased. AF exchange and infusion may prevent intestinal damage and improve postnatal outcome in gastroschisis by diluting the AF, probably by lowering the concentrations of intestinal waste products.