Fetal anomalies : ultrasound diagnosis and postnatal management

309 Pages·2002·7.58 MB·English

by  Max Maizels

Fetal Anomalies
Ultrasound Diagnosis and
Postnatal Management
Max Maizels, M.D.
Children’s Memorial Hospital
Division of Urology
Department of Urology
Northwestern University Medical School
Chicago, IL
Bettina F. Cuneo, M.D.
The Heart Institute for Children
University of Illinois Medical School
Chicago, IL
Rudy E. Sabbagha, M.D.
Department of OB/GYN
Northwestern University Medical School
Chicago, IL
A JOHN WILEY & SONS,INC.,PUBLICATION

Fetal Anomalies

Fetal Anomalies
Ultrasound Diagnosis and
Postnatal Management
Max Maizels, M.D.
Children’s Memorial Hospital
Division of Urology
Department of Urology
Northwestern University Medical School
Chicago, IL
Bettina F. Cuneo, M.D.
The Heart Institute for Children
University of Illinois Medical School
Chicago, IL
Rudy E. Sabbagha, M.D.
Department of OB/GYN
Northwestern University Medical School
Chicago, IL
A JOHN WILEY & SONS,INC.,PUBLICATION
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LibraryofCongressCataloging-in-PublicationData:
Fetalanomalies:ultrasounddiagnosisandpostnatalmanagement/editedbyMaxMaizels,
BettinaCuneo,RudyE.Sabbagha.
p. cm.
Includesbibliographicalreferencesandindex.
ISBN0-471-38052-0(cloth:alk.paper)
1. Fetus—Abnormalities—Ultrasonicimaging. 2. Fetus—Diseases—Diagnosis.
3. Ultrasonicsinobstetrics. 4. Postnatalcare. I. Maizels,Max. II. Cuneo,Bettina.
III. Sabbagha,RudyE.
[DNLM: 1. Abnormalities—ultrasonography. 2. FetalDiseases—diagnosis. 3. Postnatal
Care. 4. Ultrasonography,Prenatal. WQ209F41912001]
RG628.3.U58F472001
618.3(cid:2)207543—dc21
00-043433
PrintedintheUnitedStatesofAmerica.
10 9 8 7 6 5 4 3 2 1
The authors dedicate this book to the families who will come to
learn of an ultrasound finding in their unborn baby.

Contents
Preface xi
Acknowledgments xiii
Contributors xv
Abbreviations xvii
1
The First Trimester of Pregnancy—Rudy E. Sabbagha, M.D. 1
1.1 Pregnancy Dates 1
1.2 Multiple Pregnancy 1
1.3 Abnormal First Trimester Pregnancies 7
1.4 Early Detection of Fetal Anomalies 11
2
The 10- to 14-Week Scan—Rudy E. Sabbagha, M.D. 15
2.1 First Trimester Detection of Aneuploidy and Fetal Anomalies 15
3
Detection of Trisomies 21 and 18—Rudy E. Sabbagha, M.D. 21
3.1 The Likelihood Ratio and the Multiple Marker Screen 21
3.2 Trisomy 21 22
3.3 Trisomy 18 27
4
The Fetal Face and Neck 31
Section 4A. Evaluation of the Fetal Face and Neck—Rudy E. Sabbagha, M.D. 31
4A.1 The Face 31
4A.2 The Neck 37
Section 4B. Correlative Presurgical and Postsurgical Treatment of Fetal Face and
Neck Abnormalities—Jay M. Pensler, M.D. 43
4B.1 Cleft Lip and Palate 43
4B.2 Other Abnormalities 45
vii
viii CONTENTS
5
The Fetal Central Nervous System 47
Section 5A. The Head—Rudy E. Sabbagha, M.D. 47
5A.1 Evaluation of the Fetal Brain 47
5A.2 Abnormal Head Size 50
5A.3 Abnormal Lobe Development 54
5A.4 Cysts 54
5A.5 Abnormal Corpus Callosum 57
5A.6 Abnormal Posterior Fossa and Cisterna Magna 60
5A.7 Other Abnormal Brain Findings 63
Section 5B. The Spine—Rudy E. Sabbagha, M.D. 65
5B.1 Evaluation of Spina Bifida 65
5B.2 The Parasagittal Lower Spine 68
5B.3 Sacrococcygeal Teratoma 68
Section 5C. Spina Bifida: Urologic Aspects—William E. Kaplan, M.D. 70
5C.1 Diagnosis During Second Trimester 70
5C.2 Diagnosis During the Third Trimester 74
Section 5D. Spina Bifida: Orthopaedic Aspects 75
5D.1 Orthotics 75
5D.2 Ambulatory Status 76
5D.3 Spine Deformities 76
5D.4 Foot Deformities 76
6
The Fetal Chest and Abdomen—Rudy E. Sabbagha, M.D. 81
6.1 The Chest 81
6.2 The Abdomen 85
7
The Fetal Urinary Tract—Max Maizels, M.D. 93
7.1 The Normal Urinary Tract 93
7.2 Urinary Tract Ectasia 94
7.3 Development of the Urinary Tract 96
7.4 Multicystic Kidney Disease 100
7.5 Nonspecific Pyelectasis 103
7.6 Hydronephrosis 111
7.7 Megaureter 130
7.8 Ectopic Ureter 136
7.9 Ureterocele 136
7.10 Nonspecific Bladder Dilation and Megacysts 138
7.11 Vesicoureteral Reflux 140
7.12 Posterior Urethral Valves 153
7.13 Prune Belly Syndrome 157
8
Diagnosis of Fetal Structural Genital Anomalies—
D. Preston Smith, M.D., F.A.A.P., F.A.C.S. 163
8.1 Normal Development 163
8.2 Anomalous Development 165
9
Polycystic Kidney Disease and Renal Transplantation—
Richard Cohn, M.D., and Casimir F. Firlit, M.D. Ph.D. 169
Section 9A. Autosomal Recessive Polycystic Kidney Disease 169
9A.1 Clinical Forms 169
9A.2 Fetal Diagnosis 170
9A.3 Newborn Management 171
9A.4 Dilemma of Fetal Diagnosis 171