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Objective: To determine the clinical outcomes and decisions of families of fetuses with prenatally-diagnosed cardiac abnormalities., Methods: Prenatally diagnosed cases (n=155) with congenital heart disease were retrospectively categorized according to the Allan-Huggon grading system: Group A (cardiac disease associated with severe / lethal extracardiac disease); Group B1 (low risk with a postnatal prognosis); Group B2 (moderate risk, amenable to surgical repair with a low mortality); and Group B3 (high risk, associated with high mortality after surgery). Neonatal outcomes, including termination of pregnancy, were recorded for 18 months of follow-up after counseling the parents. Student's t-test, Mann-Whitney U, Pearson's Chi-square test and Fischer's exact Chi-square test were used for statistical analyses., Results: One hundred forty-five cases completed follow up. Thirty-nine cases (Group A) were associated with extracardiac lethal defects and the pregnancies were terminated; these cases were excluded from statistical evaluation. Twenty parents in Group B3 opted also for termination. The survival rates of ongoing pregnancies after 18 months of follow-up between the three cardiac abnormality Groups (Group B1, n=37; Group B2, n=12; and Group B3, n=37) were 89.2%, 66.7%, and 13.5%, respectively. Significance was present between the survival rates of the three Groups [Group B3 vs. Group B1: p=0.0001; OR: 52.8 (12.9-214.5); Group B3 vs. Group B2: p=0.0009; OR: 12.8 (2.8-58.9); Group B2 vs. Group B1: p=0.087; OR: 4.12 (0.84-20.2)]., Conclusion: Our practice and the findings reported herein support the efficacy of this staging system and counseling parents of fetuses for congenital heart diseases.

Objective: To assess the indications and distribution of cases chosen for termination of pregnancy and reasons delaying until third trimester termination. Methods: Retrospective study of cases between 2002 and 2006 in the hospital council. Cases were divided in two groups , as early termination (<23 weeks of gestation) and late termination (≥23 weeks of gestation). All pregnant women who underwent termination were classified according to related systemic pathology and chorionicity. Reasons for delaying until third trimester termination were evaluated in four groups. Results: During this five year period 1.449 complicated pregnancies were counseled and in 713 cases termination was offered. Of 677 cases (94.95%) with termination, 412 cases (60.09%) had early and 265 cases (39.91%) late termination. The most frequent indications were central nervous system abnormalities (51.7%), chromosomal abnormalities (11.7%), and urogenital abnormalities (8.4%). The main reason for delaying termination was failure of screening by ultrasound (65.6%). Conclusion: Systematic screening for fetal anomalies is the main step for prevention of affected pregnancies. Information given to parents for TOP is important, but the decision for TOP is influenced by many factors. [ABSTRACT FROM AUTHOR]

Objective: We have aimed to evaluate perinatal outcome of selective fetocide in monochorionic diamniotic twins discordant for major fetal anomalies. Materials and Methods: The study group included nine cases of monochorionic diamniotic twin (triplet) pregnancies discordant for major fetal anomalies including anencephaly (n=2), inencephaly (n=1), lumbar meningomyolocele (n=1), hydrops fetalis (n=1), acardiac twin (n=2), twin-to-twin transfusion syndrome (stage III, n=1) and monochorionic triamniotic triplet discordant for anencephaly (n=1). For bipolar coagulation of the umbilical cord, we used 3.5 mm laparoscopic trocar and 3.0 mm bipolar forcep. The procedures were performed under the guidance of transabdominal ultrasonography. Results: The mean gestational age of the cases at intervention and at delivery were 20 weeks (R=16-24) and 34 weeks (R=22-38), respectively. The procedure of bipolar coagulation was carried out in mean 20 min (R=15-40 min) without maternal complication. One case was aborted at 20 weeks of gestation because of preterm premature rupture of membrane after the procedure. Another case was delivered before 32 weeks, at 28+4 week of gestation, and died six months postnatally which was unrelated to the intervention. The other seven cases were delivered after 32 gestational weeks. In eight cases, the procedures were performed without fetal complication. Perinatal outcome was as 88.8% (n=8/9) live births. Postnatal ages of surviving seven babies were between 8-40 months, and they have been growing up as healthy. Discussion: Ultrasonographic guided bipolar cord coagulation as a selective fetocide can be succesfully performed to increase the survival rate or prevent morbidity of healthy co-twin in the cases of monochorionic diamniotic (triplets), discordant major fetal anomalies candidate for selective termination, and should be offered as a choice of prenatal therapy after the parents were informed of the intervention or follow up. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prenatal findings, associated anomalies, and prognosis of right aortic arch (RAA) anomalies. Material and Methods: All cases referred for detailed ultrasonography and fetal echocardiography between October 2006 and July 2009 were systematically examined for aortic arch anomalies and associated cardiac and extracardiac anomalies. Prenatal findings of all cases with aortic arch anomalies and intracardiac and extracardiac findings were prospectively registered in an electronic database that included fetal echocardiography. Outcomes of the cases were collected postnatally from the patients' obstetricians, neonatal unit archieves, and pediatric cardiologists. Results: We detected 12 cases of RAA (0.37%; n=12/3200). Mean gestational age at diagnosis was 24 weeks (range, 21-33 weeks). Of the 12 cases of RAA, five (41.7%) had a major cardiac defect, including tetralogy of Fallot (n= 3), atrioventricular septal defect (n=1), and ventricular septal defect (n=1). An extracardiac anomaly was observed in three cases (25%). The fetal karyotype was trisomy 21 in one case with increased nuchal translucency (6.6 mm). Microdeletion 22q11 analyses performed in three cases were normal. The postnatal courses of the cases with isolated RAA were uneventful. Two cases associated with major cardiac and extracardiac anomalies were lost in the early neonatal period. The case of trisomy 21 was terminated. The other four cases of RAA with an associated cardiac anomaly are currently in follow up. Conclusion: Aortic arch anomalies, particularly RAA, can be diagnosed by fetal echocardiography. The prognosis for isolated RAA is relatively good compared with that for RAA with associated anomalies. [ABSTRACT FROM AUTHOR]