ULTRASOUND Messages for August, 1998: Re: AMA aneuploidy risks

Re: AMA aneuploidy risks

From: James S Smeltzer MD

gaperina@mindspring.com

Fri Aug 14 13:34:45 1998

Your Docs will probably want to watch, with no evidence of hydrops except increased fluid (possibly from increased venous transudation pressure across the cord/placental vessels) from the chorangioma and a reactive NST and BPP of 8/10.

The main risk is fetal CHF and hypoxia from the shunt of the chorangioma. These may be manifested by increased cerebral blood flow on doppler. We use MCA doppler for this. Usually we relate this to the umbilical RI, but with chorangioma, this may not be appropriate. If the MCA RI is below .7 or the umbilical, it says the baby has distributed more blood flow to the head & needs to be watched more closely.

We also use maternal sensation of fetal movement as an action indicator in these cases. If it drops off, it may be a sign things are getting worse for the baby. We teach the count to four in one hour, and repeat if not four. If not four in two consecutive hours, evaluate or deliver, depending on circumstances.

Follow up & see how it turns out. If it has gotten this far without hydrops, it will probably not be serious.

At 12:49 AM 8/14/1998 -0500, you wrote: >Dr. Worrall and all,
>Greetings to the land of the midnight sun. I lived in Fairbanks (and
>Talkeetna, Wasilla, and Anchorage) for many years, but, alas, the state
>was not big enough for my ex husband and I both. I still visit though,
>and have many family members there.
>I work with a Perinatology fellowship. Our practice offers counseling
>and amniocentesis to all AMA patients, and if they decline
>amniocentesits they are offered a fetal echo at 22 weeks gestation to
>check for cardiac defects. Our anatomy screening at 18 weeks usually
>catches most problems, but the echo is often an anxiety reducer for the
>parents and the doctors. If problems are found our patients are not
>offered terminations here, but are offered perinatal hospice or are
>referred out. Many of our patients opt for perinatal hospice and carry
>pregnancies to their natural end, whatever that may be. The parents are
>given much moral support and compassion. We have had live births of
>some fetuses with problems incompatible with life, and the parents have
>the opportunity to hold their baby for however long they can, and be
>with him when he passes on. I find it a wonderful practice to work for
>and think the world of the doctors and Sonographers here.
>Unrelated, we are following two cases of (presumed) chorioangioma in our
>group right now. I find it odd that I have only seen this entity one
>other time in my 11 years of sonography, and now have two at once. Both
>are exhibiting fairly severe polyhydramnios at present, but no other
>signs of hydrops. Both are in the third trimester. Both fetus'
>placental cord insertion sites were adjacent to the mass, and at present
>one mass has enlarged such that the cord insertion is actually into the
>mass. Baby got 6/8 on BPP (no breathing movements) and then a
>borderline NST with low baseline and barely reactive, so the docs were
>puzzling whether to deliver or watch today (35 weeks now). Has anyone
>else seen this entity? I don't have a scanner yet, so I can't send
>images.
> mitakuye oyasin
>
>--
>Dianne Walkup, RDMS RDCS
>

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