Twin Pregnancies are increasing these days due to recent development of the technology in treating infertility. twin pregnancies tend to cause more congenital anomalies than singleton pregnancies do. Especially when twin pregnancies are affected with one anomalous fetus combined to a normal one, the proper management and counseling are difficult. We experienced a twin pregnancy in which one anencephalic fetus was combined to a normal one, after close counseling we decided to continue the pregnancy. At 35 weeks 6 days of gestation, an anencephalic fetus was dead, so we delivered by cesarean section due to breech-cephalic presentation. The birth weight of the normal and anencephalic fetuses were 2160 gm and 600 gm, respectively. The anencephalic fetus was combined with scoliosis, absent left upper limb, and nuchal skin defect, but the healthy one showed good crying and movement and its Apgar score was 8 in 1 minute and 9 in 5 minute. Although the infant needed intensive care for 21days in the nursery room, she was finally discharged in good condition. We present this case with a brief review of the literature.
Anencephaly ; Apgar Score ; Birth Weight ; Cesarean Section ; Counseling ; Crying ; Female ; Fetus* ; Humans ; Infant ; Infertility ; Critical Care ; Nurseries ; Pregnancy ; Pregnancy, Twin* ; Scoliosis ; Skin ; Twins* ; Upper Extremity

Iniencephaly is an abnormality in cervical vertebra associated with an excessive lordosis of the cervicothoracic spine and neural tube closure defects. The incidence is one of 1,000 to 10,000 live birth. The pathogenesis is unknown. It is possible that iniencephaly is a primary defects in fetal cervical development and the resulting lordosis cause a failure of neural tube closure. Specific sonographic findings are over extended fetal head, very short and modified thorax, generally shortened fetal long bones and frequent associating anencephaly and meningomyelocele. Fetal alpha-fetoprotein elevation may be present. Iniencephaly, when diagnosed in utero, is almost always lethal. We experienced a case of iniencephaly in a fetus of intrauterine pregnancy at 17 weeks diagnosed by prenatal ultrasonography who was terminated because of ultrasonic demonstration of other multiple anomalies. Thus, we report a case with brief review of the literature.
alpha-Fetoproteins ; Anencephaly ; Animals ; Fetus ; Head ; Incidence ; Live Birth ; Lordosis ; Meningomyelocele ; Neural Tube ; Neural Tube Defects* ; Pregnancy ; Spine ; Thorax ; Ultrasonics ; Ultrasonography ; Ultrasonography, Prenatal*

Multiple gestation accounts for 1 percent of all pregnancies. But, the morbidity of congenital anomaly is more than 2 times in contrast to singleton gestation. The major congenital anomaly was developed about 2 percent in the multiple gestation. Hydrocephalus and anencephaly, known central nervous system anomaly, were seen about 0.1% each other in singleton gestation. We have experienced a case of prenatally detected concomitant hydrocephalus and anencephaly in twin pregnancy which was diagnosed by ultrasonography at 16 weeks gestation. Thus, we report a case with brief review of the literature.
Anencephaly* ; Central Nervous System ; Humans ; Hydrocephalus* ; Pregnancy ; Pregnancy, Twin* ; Ultrasonography

Pentalogy of Cantrell was very rare congenital anomaly and represent a regional prevalence of 5.5/1 million live births. The syndrome, Cantrell's pentalogy is characterized by defects in the lower sternum with ectopia cordis, anterior diaphragm defects, midline supraumbilical abdominal wall defects, defects in the diaphragmatic pericardium, and various intracardiac defects. Anencephaly involves acrania with a degenerated mass of brain tissue. Combination of both conditions are extremely rare. We experienced a case of Cantrell's pentalogy with anencephaly detected by ultrasonography at 15 weeks 1 day menstural age and confirmed at autopsy. Thus we report a case with brief review of the literature.
Abdominal Wall ; Anencephaly* ; Autopsy ; Brain ; Diaphragm ; Ectopia Cordis ; Hernia, Umbilical ; Live Birth ; Neural Tube Defects ; Pentalogy of Cantrell* ; Pericardium ; Prevalence ; Sternum ; Ultrasonography ; Ultrasonography, Prenatal*

OBJECTIVE: To determine the proportion and the types of CNS anomalies among congenital anomalies detected through prenatal ultrasonography. MATERIALS AND METHODS: Between November 1997 and December 2000, 624 cases of singleton pregnancies were terminated at Department of Obstetrics and Gynecology, CHA Hospital due to lethal congenital anomalies detected through prenatal ultrasound. Forty-three of 624 termination cases had CNS anomalies. Autopsy and chromosomal study was carried out on ten and six cases respectively. Incidence, maternal age and parity, sex ratio and body weight of the terminated fetuses, gestational age at which anomaly was detected, associated anomalies were evaluated. RESULTS: The incidence of CNS anomalies was 0.21%(43 in 20,805), and maternal age was between 30 and 34 in 20cases. The fetus was male in 25 cases, female in 11 cases and indefinite in 7 cases. Anomalies were detected between 17-20 weeks in 12 cases. Body weights of the terminated fetuses were below 500grams in 23 cases. Anencephaly was the most common with 11 cases(25.6%), hydrocephalus ranked second with 8 cases(18.6%). Two cases had associated anomalies of Meckel-Gruber syndrome features. CONCLUSION: CNS anomalies are frequent and have a severe prognosis. Contemporary ultrasound is much accurate in evaluating CNS anomalies. Still, minor anomalies and those cases without associated anomalies are difficult to detect. Even after diagnosis, CNS anomalies are mostly void of prenatal corrective treatment. Fortuitous investigation is needed for prenatal neural axis anomaly detection.
Anencephaly ; Autopsy ; Axis ; Body Weight ; Central Nervous System* ; Diagnosis ; Female ; Fetus ; Gestational Age ; Gynecology ; Humans ; Hydrocephalus ; Incidence ; Male ; Maternal Age ; Obstetrics ; Parity ; Pregnancy ; Prognosis ; Sex Ratio ; Ultrasonography* ; Ultrasonography, Prenatal

Twin pregnancies are increasing these days due to recent development of the technology in treating infertility and twin pregnancies tend to cause more congenital anomaly than singleton pregnancies do. Although anencephaly is not uncommon, occurring in about one in every 1,000 births, anencephaly developed in a twin pregnancy is very rare. We experienced a twin pregnancy which consisted of an anencephalic fetus and a normal one. This pregnancy was conceived by IVF and ET. This pregnancy was continued without having special problems and was delivered at 36 weeks of gestation by cesarean section due to SROM (spontaneous rupture of membrane). The anencephalic fetus weighed 1,430 gm and was already dead in the uterus. The other weighed 2,660 gm and showed no external anomaly. Its Apgar score was 8 in 1 minute and 9 in 5 minute. The pregnancy resulted in a cesarean section delivery of one dead anencephalic fetus and one normal healthy fetus. We report with a brief review of literature a case of a twin pregnancy, conceived by IVF and ET, in which anencephaly was associated with a normal fetus.
Anencephaly* ; Apgar Score ; Cesarean Section ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization in Vitro* ; Fetus ; Humans ; Infertility ; Parturition ; Pregnancy ; Pregnancy, Twin* ; Rupture ; Twins* ; Uterus

Congenital anomalies occur in 2-3% of neonates but this incidence increases in multiple pregnancies, especially when fetuses are monozygotic. when pregnancies are affected with one anomalous fetus combined to a normal one, the proper management and counseling is difficult.We experienced a twin pregnancy in which one anencephalic fetus was combined to a normal one. Karyotype analysis was normal in both fetus. After close counseling we decided to continue the pregnancy. Intermittent amnioreduction was done for persistent polyhydramnios. At 29 weeks of gestation membrane was ruptured prematurely and we delivered by cesarean section due to breech-cephalic presentation. The birth weight of the normal and anencephalic fetuses were 1070 gm and 1050 gm, respectively. The anencephalic fetus died immediately after birth but the healthy one showed good crying and movement and its Apgar score was 6 in 1 minute and 8 in 5 minute. Although the infant needed intensive care for 90 days in the nursery room finally discharged in good condition. We report a case of twin pregnancy in which anencephaly was associated with a normal fetus, so after close counseling we opted to continue the pregnancy resulting in the delivery of a viable fetus.
Anencephaly ; Apgar Score ; Birth Weight ; Cesarean Section ; Counseling ; Crying ; Female ; Fetus* ; Humans ; Incidence ; Infant ; Infant, Newborn ; Critical Care ; Karyotype ; Membranes ; Nurseries ; Parturition ; Polyhydramnios ; Pregnancy ; Pregnancy, Multiple ; Pregnancy, Twin* ; Twins*

PURPOSE: The purposes of this study were to compare postmortem fetal MRI findings with autopsy findings and to assess whether postmortem MRI can replace autopsy. MATERIALS AND METHODS: The study group consisted of 13 stillborn fetuses, seven that died immediately after birth, and five terminated because of anomalies seen on prenatal sonograms. A total 17 were male, and eight were female, and their gestational ages were from 20 to 41 (average; 28.2) weeks. Spin-echo T1-and T2-weight-ed axial, sagittal, and coronal MR images were obtained, and autopsy findings were divided into major and mi-nor. A major finding was defined as an anomaly or syndrome which caused fetal death or termination of the pregnancy; minor findings were classified, on the basis of gross inspection, as internal or external. MR images were retrospectively analyzed by two radiologists unaware of the autopsy findings, and by comparison with these, the postmortem MRI detection rates for major and minor findings was then determined. RESULTS: In seven of 25 fetuses, MR imaging revealed major findings, a detection rate of 100%. There were two cases of anencephaly, two of trisomy-18, and one each of hydrops fetalis with large cystic hygroma, diaphrag-matic hernia, and Dandy-Walker malformation. Twenty-three of 60 minor findings (38.3%) were detected by MRI. The detection rates for external and internal findings were 29.6%(8/27) and 45.5%(15/33), respectively. CONCLUSION: Although a limitation of our study is the low detection rate for minor findings, postmortem fetal MRI may help diagnose the major cause of fetal death.
Anencephaly ; Autopsy* ; Dandy-Walker Syndrome ; Female ; Fetal Death ; Fetus ; Gestational Age ; Hernia ; Humans ; Hydrops Fetalis ; Lymphangioma, Cystic ; Magnetic Resonance Imaging* ; Male ; Parturition ; Pregnancy ; Retrospective Studies

OBJECTIVE: To evaluate the maternal and fetal outcomes after transvaginal selective fetal reduction(SFR) in multifetal pregnancy. MATERIALS AND METHODS: Transvaginal SFR using fetal intracardiac puncture with KCl injection and aspiration of amniotic fluid was performed in 58 multifetal pregnancies achieved after assisted reproductive technology(ART). After transvaginal SFR, 55 twin and 3 singleton pregnancies were evaluated and analyzed retrospectively with the medical records of mothers and babies. RESULTS: Of 58 cases, abortion within 4 weeks after SFR occurred in 1 case(1.7%). Miscarriage of all fetuses occurred in 8 cases(13.8%) from 4 weeks after SFR until 24 weeks of gestation. Perinatal death occurred in 8 newborns from 5 mothers due to extreme prematurity in 7 cases and anencephaly in 1 case. Take-home baby rate, that is, discharge with at least 1 healthy baby, was 77.6%(45/58). CONCLUSION: Transvaginal SFR is an acceptable and effective management option in the cases of excessive multifetal pregnancy after infertility treatment. The ultimate successful outcomes of reduced multifetal pregnancy may be enhanced by more extensive experience with SFR.
Abortion, Spontaneous ; Amniotic Fluid ; Anencephaly ; Female ; Fetus ; Humans ; Infant, Newborn ; Infertility ; Medical Records ; Mothers ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Punctures ; Retrospective Studies

Congenital anomalies occur in 2-3% of neonates and have unknown and variable causes. It's occurance rate is higher in twin gestations than in singleton gestations, especially in monozygotic twins. In most cases of twin anomalies, one fetus is normal and the other fetus is not. When an anomaly is found in one fetus, various tests, such as chorionic villus sampling, amniocentesis, and umbilical cord aspiration are strongly recommended in high risk groups of chromosmal anomaly for accurate diagnosis and proper treatments. A case of congenital anomalies in both twins diagnosed in a 35 year old multiparous woman is presented with brief review of literatures.
Adult ; Amniocentesis ; Anencephaly ; Chorionic Villi Sampling ; Diagnosis ; Down Syndrome ; Female ; Fetus ; Humans ; Infant, Newborn ; Pregnancy ; Twins* ; Twins, Monozygotic ; Umbilical Cord