Prenatal diagnosis and therapy for a fetal hepatic vascular malformation.
BACKGROUND
Congenital hepatic arteriovenous malformations complicated by high-output heart failure and hematologic derangements are associated with up to 90% mortality. Prenatal diagnosis alerts the pediatrician to the need for early neonatal intervention.


METHODS
A fetal hepatic arteriovenous malformation with associated high-output cardiac failure was diagnosed at 29 weeks' gestation using real-time and color flow Doppler sonography. Hydrocortisone injected directly into the umbilical vein and the amniotic sac resulted in appreciable improvement in hemodynamic and hematologic indices. The pregnancy ended in a preterm delivery at 31 weeks with no evidence of heart failure at birth.


CONCLUSIONS
The compromised preterm fetus with a hepatic arteriovenous malformation can be treated in utero, avoiding early emergency delivery.
Mejides
A A
AA
Department of Obstetrics and Gynecology, University of Miami School of Medicine, Florida, USA.
Adra
A M
AM
O'Sullivan
M J
MJ
Nicholas
M C
MC
D000792:Angiography; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000188:drug therapy; D006332:Cardiomegaly / Q000000981:diagnostic imaging; D004452:Echocardiography; D005260:Female; D006391:Hemangioma / Q000000981:diagnostic imaging / Q000188:drug therapy; D006499:Hepatic Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D006503:Hepatic Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D007275:Injections, Intravenous; D011247:Pregnancy; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed; D016216:Ultrasonography, Prenatal; D014471:Umbilical Veins
D006854:Hydrocortisone