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Stem cell transplants to correct fetal diseases prenatally should be done before the 13th week of pregnancy. After 13 weeks, T lymphocytes increase in number in both blood and liver.

Erythropoietic suppression rather than hemolysis may cause fetal anemia when the fetus is Kell positive and the mother is alloimmune to the Kell antigen. Erythropoiesis is the process of making red blood cells. Hemolysis breaks down the red blood cells and causes an Rh factor reaction, fetal anemia and jaundice. Erythroid suppression was determined to be the cause of fetal anemia rather than hemolysis based on the effect on certain cells. Amniocentesis is not recommended for fetuses at risk for Kell alloimmunization, unlike RhD alloimmunization. Fetal blood sampling at 20 to 24 weeks gestation is suggested instead as a means to determine fetal Kell status. Kell-positive fetuses should be monitored throughout pregnancy via ultrasound and blood sampling for evidence of fetal anemia.

Selective termination of an abnormal twin fetus or multiple fetuses in a dizygotic (fraternal) pregnancy may be safely performed by an experienced physician with injections of potassium chloride. A multicenter study of 180 fetuses that were selectively aborted correlated early gestational age at the time of the procedure with a low loss rate and with an older gestational age at birth. The study also found that the air embolization method of abortion was riskier for the surviving fetus(es) than was potassium chloride injection. Losses occurred every time for both twins when selective termination was performed to a twin of a monochorial pregnancy, in which the twins shared the same placenta. Genetic prenatal diagnosis should be performed as early as possible, using chorionic villus sampling rather than waiting to do amniocentesis. Thus, if selective termination is chosen, it can be performed early in the pregnancy. Exact identification of the fetus(es) to be aborted is also necessary, to avoid accidentally aborting the healthy fetus.

Fetal transfusions may be most effective if donor blood with a very high hematocrit is used and the fetal hematocrit is elevated to approximately 55%. Transfusing blood to a fetus through umbilical cord vessels is used to treat severe anemia in the fetus. Hematocrit is the ratio of packed red blood cells to the total volume of blood. Researchers studied samples of fetal blood before and after 95 fetal transfusions in 31 patients. The blood samples were analyzed for viscosity and levels of hematocrit, fibrinogen and proteins. Viscosity of fetal blood increased significantly after transfusion. The rise in viscosity was associated with a rise in fetal hematocrit and also with the amount of proteins in the plasma of donor blood. There was no significant change in fibrinogen levels. The transfusion of adult plasma proteins should be reduced as much as possible by cleansing donor blood of plasma and using blood with a hematocrit close to 100%.

Infusing a saline solution into the amniotic cavity may improve the prenatal diagnosis of a fetal diaphragmatic hernia or renal agenesis using an ultrasound scan. A diaphragmatic hernia is the protrusion of abdominal or retroperitoneal structures into the thorax through the esophageal opening in the diaphragm. Renal agenesis is the absence of kidneys. Among 10 fetuses between 16 and 27 weeks old that had ultrasonography in conjunction with a saline solution infusion, five had a suspected diaphragmatic hernia and five had suspected renal agenesis. A diaphragmatic hernia was demonstrated in four fetuses and kidney agenesis in four fetuses.

Levels of sodium and calcium ions and beta-2-microglobulin in fetal urine may be a useful indicator of prenatal kidney function in suspected cases of obstructive uropathy. Obstructive uropathy of the lower urinary tract can arise from urethral valves that block urination. In determining which cases of obstruction may benefit from prenatal surgery, it is important to assess kidney function. Of 25 fetuses with lower urinary tract obstructions, 23 were diagnosed with urethral valve obstruction. Of the 16 that were terminated or died before or after birth, all had urethral valve obstructions. In the urine samples, levels of sodium and calcium ions were significantly higher in those who died as newborns than those who survived. The two infants without urethral valve obstruction had normal concentrations of sodium and calcium ions in their urine. Furthermore, of the fetuses with beta-2-microglobulin levels over 13 milligrams per liter, all but one died.

OBJECTIVE: The etiology of oligohydramnios-related pulmonary hypoplasia is not understood but is known to involve chronic lung liquid loss. We tested the hypothesis that low amniotic pressure in oligohydramnios disturbs the normal tracheal-amniotic pressure gradient to increase lung liquid loss and impair lung development. STUDY DESIGN: Chronic pharyngeal catheterization with drainage to the exterior was used in 15 fetal sheep to mimic reduced amniotic pressure at the upper airway in the presence of normal amniotic fluid volume. RESULTS: Pharyngeal pressures relative to amniotic pressures were negative in all drained fetuses (mean [+ or -] SE -3.0 [+ or -] 0.6 mm Hg), in contrast to positive pressures in controls (0.7 [+ or -] 0.1 mm Hg). There was no significant difference in lung weight or deoxyribonucleic acid relative to body weight, or in lung morphometry, between 10 fetuses drained for 10 to 21 days and their control cotwins. CONCLUSION: Mimicking low amniotic pressure in the upper airway by chronic fetal pharyngeal drainage does not impair lung development in fetal sheep. (Am J Obstet Gynecol 1992;166:991-6.)

EDITOR--In 1987, Machin et al [1] reported a case of laryngeal atresia in association with an asymmetrical parietal encephalocele and limbs anomalies. Other anomalies included a horseshoe kidney and immature, [...]

Pulmonary hypoplasia, the underdevelopment of fetal lung tissue, can cause fetal death. Within the uterus the fetus is surrounded by amniotic fluid. Although there are many factors predisposing the fetus to pulmonary hypoplasia, one theory suggests that an inadequate amount of amniotic fluid, oligohydramnios, is responsible. Pulmonary hypoplasia occurs because the uterine wall compresses the fetal chest which in turn compresses the lung tissue, inhibiting growth. This theory does not explain why tissue compression does not affect the development of other organs. Another theory explains that the pressure of the amniotic fluid, amniotic pressure, is decreased when the fluid volume is reduced; decreased amniotic pressure causes too much fluid to be lost from the fetal lungs. Pressure inside the small structures of the lungs must be greater than the amniotic pressure to promote growth and function. If that balance is upset, as in oligohydramnios, too much fluid escapes from the fetal lungs. To prevent this from happening the amniotic fluid volume must be increased by adding more fluid artificially. Amniotic fluid replacement was attempted in one pregnancy with oligohydramnios. Although the fetus died from other complications, the fetal lungs had no evidence of fetal lung hypoplasia.

Adequate fetal growth requires the transfer of nutrients and oxygen from the mother to the fetus. When this is compromised, abnormal fetal growth can result. Glucose, a simple sugar, is transferred from the mother to the fetus through the placenta. Various investigators have reported contrasting results regarding the amounts of glucose concentrations found throughout pregnancy. Glucose concentrations during pregnancy were measured in 25 normal pregnancies, 13 pregnancies complicated by blood incompatibilities, and 16 showing abnormal fetal growth patterns. Although the glucose measurements in the mother were similar and adequate in all the groups, the concentrations in the fetuses differed. The growth-retarded fetuses had lower glucose concentrations and less circulating oxygen than those of normal pregnancies. The group having blood incompatibility had higher glucose concentrations. It is suggested that there is a relationship between the concentrations of glucose, oxygen-carrying capacity of the blood and growth retardation. How these altered concentrations affect fetal growth requires further investigation.

Safely targeting the fetal gastrointestinal tract during early gestation is essential to develop effective prenatal gene therapy for gastrointestinal diseases. In this study, we aimed to characterize the development of the fetal sheep stomach sonographically and to determine the optimum gestational age, as well as the shortterm morbidity and mortality of early-gestation ultrasound-guided intragastric injection.

Human growth is a continuous process. Studies defining factors influencing growth focus on discrete time points (e.g., birth), overlooking the conditional nature of the process. One thousand six hundred fifty Caucasian mothers who gave birth at term after an uncomplicated singleton pregnancy were studied using conditional analysis. Infant height, weight, and head circumference were obtained at birth and 6 mo of age. Data analysis, conditional upon birth size, was conducted as a stepped consideration of factors influencing phases of fetal and infant growth beginning with determinants of placental size. Placental weight was related to birth size. Seven percent of the variance in placental weight was explained by a combination of gestation at delivery, maternal size at first prenatal visit, paternal height (all positive), and increasing parity (negative). When centered on birth weight, 41% of the variance in placental weight was explained by birth weight, length of gestation, smoking during pregnancy (all positive), and a female baby (negative). Maternal and paternal stature equally influenced newborn and infant size. Conditional analysis reveals a series of modifiable (parity, length of gestation, and smoking) and nonmodifiable factors at different stages of the growth process.

Since the introduction of antenatal serum screening for Down’s syndrome (DS) more than two decades ago, several screening approaches have been utilized in routine clinical practice. The current DS screening strategies involve mid-trimester serum biochemistry tests, first trimester tests combining sonographic markers and serum biochemistry and integration of first and second trimester markers. In this review, we evaluate the performance of DS screening strategies according to the Serum, Urine and Ultrasound Screening Study (SURUSS), the First and Second Trimester Evaluation of Risks (FASTER) Trial and the Serum Biochemistry and Fetal Nuchal Translucency Screening (BUN) Study. We also evaluate the performance of first trimester screening in studies and meta-analyses by other groups. Specific issues related to assisted reproduction technology (ART) pregnancies are also addressed in this review.

Over the last few years, great progress has been made in imaging technology, which is changing the way prenatal visualization of the fetal heart is used for diagnosis and therapy.

The subject of misoprostol in the field of reproductive health care has courted much controversy. The aim of this review is to survey the literature published in this field over the past year, and to evaluate developments in this area. This article will cover termination of pregnancy, induction of labor and the issue of postpartum hemorrhage

Birth size and shape are commonly used as indicators of fetal growth. Epidemiologic studies have suggested a relationship between birth size and the risk of developing cardiovascular disease in later life. Certain “growth phenotypes” have been linked to the development of certain components of cardiovascular disease, particularly babies who display disproportional growth in utero. These observations are based on retrospective analysis of historical data sets. If the “Fetal Origins of Adult Disease” hypothesis is to be generalisable to the present day, then it is essential to establish whether these “growth phenotypes” exist within the normal distribution of birth size. The UCL Fetal Growth Study is a prospective study of antenatal fetal growth assessed by ultrasound at 20 and 30 wk gestation in 1650 low risk, singleton, white pregnancies. Measures of birth size were obtained and analyzed by principal components to explain shape at birth. Birth measures were also related to antenatal growth measurements to determine the strength of ultrasound evaluation in determining subsequent growth.There was significant sexual dimorphism in all measures at birth, with males heavier, longer, and leaner than females. From 20 wk of gestation onwards, males had a significantly larger head size than females. Parity, maternal height, and body mass index were important determinants of birth weight (p < 0.001). Cigarette smoking influenced birth weight, length, and head circumference (p < 0.001) but had no effect on placental size. Principal component analysis revealed that proportionality was the predominant size/shape at birth (55% of variance explained). A further 18% of variance was explained by a contrast between weight, head circumference, and length versus three skinfolds. Anthropometric measures as assessed by ultrasound at 20 and 30 wk gestation were poor predictors of birth length, weight, and head circumference (adjusted R218, 40, and 28% at 30 wk gestation scan, respectively). These predictions were not improved by including growth patterns between 20 and 30 wk. There is sexual dimorphism in a number of anthropometric measures at birth and in utero. These sex differences are important determinants of body size and shape. In a low risk population delivering at term, body shape was largely determined by proportionality between anthropometric measures. The low correlations between antenatal measures and birth size suggest that it is unwise to ascribe birth shape phenotypes to adverse events at any particular stage of gestation. The weak relationship also suggests that routine antenatal scans around 30 wk of gestation to predict growth problems are unlikely to be of benefit in the majority of cases.

Premature ovarian failure (POF) is defined as ovarian failure occurring before the age of 40 years. A genetic aetiology is suggested by the occurrence of families with two or more affected females. We have characterised the pattern of inheritance of 41 cases of familial POF and compared them to published pedigrees. In eleven families a clear genetic association of POF could be identified. In the remaining 30 families the mechanism of inheritance was obscure. We found a female sex preponderance in the siblings of 30 families with idiopathic POF and in previously published series of idiopathic familial POF. In contrast, other known causes of POF, such as blepharophimosis ptosis epicanthus and inversus and autosomal recessive gonadal dysgenesis, had no altered sex ratio. One of our series of 30 pedigrees demonstrated transmission of POF susceptibility through fathers, which we believe is the first to be described in the literature. We present a group of five consanguineous families where we assume the mode of inheritance is autosomal recessive and where there was no female sex preponderance. Female sex preponderance for idiopathic familial POF suggests an X chromosome defect is inherited as a major cause of ovarian failure.

As scientific knowledge and medicine advance so do the expectations of the general public. Advances in molecular biology, ultrasonography, access to the early gestational sac and prenatal diagnosis have helped both drive and meet these expectations. We discuss the use, advantages, potential risks and complications of invasive prenatal diagnostic procedures in early pregnancy. All invasive procedures should be performed under continuous ultrasound guidance by experienced operators. Within this context, mid-trimester amniocentesis remains the safest invasive procedure. Chorionic villus sampling (CVS) and early amniocentesis (EA) are associated with a higher risk of subsequent pregnancy loss. There is also a 10-fold increase in the risk of mosaicism with CVS compared to amniocentesis. Both CVS and EA can induce fetal structural defects and should be abandoned as routine invasive tests. Patient counselling should include an evaluation of the risk associated with each individual procedure but also the operator's personal complication rate.

Preimplantation genetic diagnosis (PGD) is usually performed on cleavage stage embryos on day 3 post-insemination. Fluorescent in situ hybridization (FISH) has revealed four groups of chromosome patterns in embryos at this stage: uniformly normal, uniformly abnormal, mosaic and chaotic. Recently, some in vitro fertilization (IVF) clinics have started to perform blastocyst stage transfer. In blastocysts, conventional karyotyping has shown that all four groups of chromosome patterns are observed. In the present study, embryos were cultured to day 5 and were subject to a two-round multicolour FISH procedure for chromosome analysis to ensure almost every nucleus was examined. Probes for chromosomes X, Y and 18 were used in the first round and those for chromosomes 13 and 21 in the second round. Twenty arrested embryos (274 cells) and 19 blastocyst stage embryos (1272 cells) were analysed. Four arrested embryos and two blastocysts were uniformly diploid. The remaining 33 embryos were mosaic, including 17 blastocysts. Most of the blastocysts had a high proportion of diploid cells while in the arrested embryos, this proportion varied widely. For PGD, this high prevalence of mosaicism persisting to the blastocyst stage may pose problems similar to mosaicism in cleavage stage embryos. Copyright © 2000 John Wiley & Sons, Ltd.

Chromosome specific probes that are used in interphase fluorescence in situ hybridization (FISH) analysis are usually tested on disomic control samples. When used for preimplantation or prenatal diagnosis the aim is to detect aneuploidy, most frequently trisomy. In this study, skin fibroblast cultures from non-mosaic trisomic and triploid fetuses were analysed by FISH to assess probe efficiency regarding interphase detection of trisomy. Skin fibroblast cultures were used because they are considered to be stable in culture. FISH experiments were performed using centromeric probes for chromosomes X, Y, 18 and locus specific probes for chromosomes 13 and 21. In metaphase nuclei, the expected signals were found in 100% of at least 30 metaphases counted on each sample and this also confirmed non-mosaicism in agreement with conventional karyotyping of the fetuses. On interphase nuclei, however, only 80–89% of nuclei per population displayed the expected signals for autosomal probes and 90% for probes for the sex chromosomes. For each probe, a range of percentages was obtained that can be regarded as indicative of non-mosaic trisomy in uncultured specimens. In the case of prenatal samples, the expected presence of maternal cells may lead to a lowering of the threshold for a trisomic diagnosis. In the case of preimplantation diagnosis, the accuracy can be improved by the use of two probes per chromosome or by the analysis of two cells from each embryo. Copyright © 2000 John Wiley & Sons, Ltd.

Objective To determine 1. the relationship between maternal serum leptin concentrations and maternal anthropometry and 2. the relationship between cord serum leptin concentrations at birth and neonatal anthropometry.

The future of academic departments of obstetrics and gynaecology will be determined by a number of sometimes conflicting forces. On the present funding model, departments may become entirely research centred with the major undergraduate teaching being provided by the National Health Service. Such departments could be run by non-clinical staff. An alternative scenario may be teaching-only departments with minimal research commitment. A third option is the integration of clinical research, teaching and practice in a university hospital structure where the head of department is the head of service. This model has proven to be very successful but is an expensive option as it functions well only with high funding and staffing levels.

Fetal imaging technology is evolving rapidly, and new techniques are being evaluated to establish their role in the assessment of the fetus. It is essential that these methods of fetal imaging are carefully assessed to ascertain if they provide additional information to assist in the clarification or understanding of fetal disease states that is not already provided by current conventional imaging techniques.

In the past year, the results of the European trial comparing chorionic villus sampling and amniocentesis have been published, supporting the findings of the Canadian Collaborative Study of an increased risk associated with chorionic villus sampling. The reporting of an increase in limb reduction abnormalities with chorionic villus sampling before 9 weeks has made us review our current practice. Other developments covered by this review include the management of mild cerebral ventriculomegaly, the treatment of tachyarrhythmias, and developments in fetal surgery. Throughout, the needs for continued collaboration, pooling of data, and the formation of international registers to extend the database from which both doctors and patients may benefit are highlighted.

Doppler blood cell velocities were measured in the aortas, inferior vena cavas, and umbilical veins of fetuses from isoimmunized pregnancies and related to the hematocrit levels of the fetal blood determined at fetoscopy. Pourcelot Index of flow in the umbilical artery was similarly studied. The mean velocities in the descending aortas and the Pourcelot Indexes of the umbilical arteries of both normal and affected fetuses correlated with fetal age. These velocities and indexes of affected fetuses also correlated inversely with the fetal hematocrit levels independently of the correlation with fetal age. The affected fetuses had higher mean velocities in the aorta and in the inferior vena cava than did normal fetuses. A simple model of multiple regression predicted the fetal hematocrit levels with a mean error of 3.8 hematocrit units (volume ).

Real time ultrasonography was used to examine the ovaries of 50 patients at the calculated time for artificial insemination with donor semen (AID). Forty-two (84%) had one or more follicles>13mm in diameter. Both ovaries were monitored daily until the main follicle had ruptured (mean number of examinations, 2.4 per patient; range, 1 to 5). Seven women became pregnant (mean follicular diameter, 21.6mm; range, 18 to 25mm). The fecundability rate was 12%, compared with 6% for a corresponding group of 50 patients who were not examined with ultrasound. Seven patients experienced mittelschmerz, and in 39 the leading follicle had ruptured before the rise in basal body temperature (BBT). Ultrasonography may be used to confirm the presence or absence of a preovulatory follicle prior to treatment.

Objective To assess amniotic fluid for evidence of an inflammatory exudate in association with fetal gastroschisis.

One hundred and twelve fetuses with structural anomalies (n = 84), intrauterine growth retardation (n = 21) or amniotic fluid volume disorders (n = 7) detected by ultrasound underwent blood sampling from the intrahepatic vein for rapid karyotyping. The procedure was successful in 95.5%. 12.5% of the fetuses had an abnormal karyotype. Fetal bradycardia was observed in two fetuses (1.8%) and intraperitoneal bleeding in three (2.7%). There were three procedure-related losses but these were not due to the intrahepatic vein sampling itself. Fetal blood sampling is the method of choice for rapid karyotyping in the second and third trimesters, and the intrahepatic vein is an alternate site when access is difficult or failure to sample occurs at the placental cord insertion. Additional advantages of fetal blood sampling at the intrahepatic vein include absence of cord complications, reduced risk of fetal blood loss and fetomaternal haemorrhage, and the lack of need to confirm the fetal origin of the sample.

To examine Fcγ receptor (FcγR) classes that direct immunoglobulin (Ig) G anti-D-mediated red blood cell interaction with fetal mononuclear phagocytes.

Amniotic pressure was measured in 49 pregnancies with abnormal quantities of amniotic fluid. Among 17 with polyhydramnios, the pressure was always above the normal mean for gestation and exceeded the upper limit of normal in nine. In polyhydramnios, amniotic pressure correlated positively with the depth of the deepest pool (r0.65, P.04) and negatively with fetal PO2(r-0.57, P.03) and pH (r-0.56, P.04). Amniotic pressure was raised in all those with a deepest pool of greater than 15 cm, and was normal in all with a deepest pool less than 15 cm. Amniotic pressure fell significantly with drainage of amniotic fluid in those with raised pressure (mean 12.7 mmHg, 95 confidence interval 7.0-18.3; P.002) but not in those with normal pressure (mean 0.3, 95 confidence interval -3.2 to 3.9; P ~ .82). Restoration of normal amniotic pressure in one pregnancy was accompanied by marked improvement in fetal acid-base status. Among 24 pregnancies with severe oligohydramnios, amniotic pressure was always below the normal mean, falling below the lower limit of normal in eight; whereas in another eight pregnancies with mild/moderate oligohydramnios, amniotic pressure was scattered evenly within the normal range. Amnioinfusion of 55-500 mL of normal saline in cases of severe oligohydramnios led to a significant rise in pressure (4.7 mmHg, 95 confidence interval 3.5-5.9; P<.0001). We conclude that amniotic pressure is high in polyhydramnios and low in oligohydramnios. Pressure monitoring may be beneficial during amnioinfusion and therapeutic amniocentesis.

Fetal plasma ferritin concentrations were measured in 43 normal fetuses at 18-36 weeks and in 78 blood samples collected before transfusion from 23 fetuses with Rh alloimmunization. Among controls, there was a significant correlation between fetal serum ferritin and gestational age (r0.39, P.009), consistent with an increase in fetal storage of iron during normal pregnancy. In Rh-alloimmunized fetuses, the ferritin concentration was above the reference range in 63 of the samples. Before the first transfusion, the fetal ferritin concentration was increased compared with controls (mean multiples of the mean2.6, range 1-26) and showed a negative correlation with fetal hematocrit (r-0.43, P<.05), suggesting that the worse the fetal anemia, the higher the iron store. Serial transfusions were associated with further increase in serum ferritin, which correlated primarily with the total volume of blood transfused. Three fetuses had plasma serum ferritin concentrations above 1 mgL, a level compatible with a diagnosis of iron overload in children. These observations suggest that there is a potential risk of iron overload in Rh-alloimmunized fetuses undergoing intrauterine blood transfusion.

To investigate whether nonhydropic trisomic fetuses display specific alterations of acid-base and/or hematologic values.

Mean red cell volume (MCV) was determined in 264 fetuses between 15–41 weeks. After exclusion of anemic, hypoxic, and chromosomally abnormal fetuses, the MCV in 208 umbilical venous samples was shown to decrease with gestation (r = 0.64; P< .001), and a normal range was constructed by linear regression analysis. An elevated MCV was found in both fetuses with triploidy, in four of five with monosomy X, and in four of ten with trisomies 18 or 21. The MCV was similarly raised in four of five fetuses with gross anomalies in whom cytogenetic cultures had failed. Significant correlations were found in chromosomally abnormal fetuses between the elevation in MCV and both the nucleated red cell (r= 0.69; P< .01) and reticulocyte counts (r= 0.57; P< .05). There was a similar correlation with nucleated red cells in 16 severely anemic fetuses with Rh disease, 12 of whom had a raised MCV. Elevation in MCV was unrelated to hypoxia. Macrocytosis had a sensitivity of 71 and a specificity of 95 in the second trimester for predicting an abnormal karyotype in nonanemic fetuses (kappa index 0.60). Fetal MCV may provide clinically useful information while one awaits culture results. We suggest that karyotyping be considered in fetuses undergoing blood sampling for other indications in whom the MCV is raised.

Objective:To examine Fcγ receptor (FcγR) classes that direct immunoglobulin (Ig) G anti-D—mediated red blood cell interaction with fetal mononuclear phagocytes.

Mutations in the three genes (LAMA3, LAMB3, and LAMC2) that encode the three chaises (α3, β3, and γ2, respectively) of laminin 5, a protein involved in epidermal-dermal adhesion, have been established as the genetic basis for the inherited blistering skin disorder, Herlitz junctional epidermolysis bullosa (H-JEB). In this study, we performed mutational analysis on genomic DNA from a child with H-JEB and identified a nonsense mutation in the α3 chain gene (LAMA3) consisting of a homozygous C-to-T transition resulting in a premature termination codon (CGA → TGA) on both alleles. The parents were shown to be heterozygous carriers of the same mutation. Direct mutation analysis was used to perform DNA-based prenatal diagnosis from a chorionic villus biopsy at 10 weeks' gestation in a subsequent pregnancy. The fetus was predicted to be genotypically normal with respect to the LAMA3 mutation. Copyright 1995, 1999 Academic Press

To investigate whether rectally administered misoprostol is an effective treatment for postpartum hemorrhage unresponsive to conventional first-line management.

Bilateral pleuroamniotic shunting was performed at 33 weeks' gestation in a fetus with bilateral hydrothorax, hydrops, and gross polyhydramnios. The procedure was successful but acute amniotic fluid leakage into the maternal peritoneal cavity occurred soon after.this produced marked maternal discomfort and trasient oligohydramnios, with consequent fetal distress.expectant management was adopted in view of fetal lung immaturity.resolution of matermal ascites occurred within 24 hours and the fetal heart rate normalized as amniotic fluid reaccumulated the pregnancy progressed uneventfully thereafter.