ultrasound diagnosis of fatal anomalies

DRUGS
1
2
3
4
5
tions, CNS anomalies, limb defects, anomalies affecting
the eye and growth restriction.
Ultrasound findings: Most fetuses exposed to
these drugs shownormal development. The following
anomalies have been observed: CNS
anomalies: cerebral infarcts and intracranial
bleeding, porencephaly, hydrocephalus, hydranencephaly,
microcephaly, agenesis of the
corpus callosum, encephalocele and others. In
addition, shortening or amputation of limbs, intestinal
atresia, meconium peritonitis; cleft lip
and palate; growth restriction and oligohydramnios;
premature rupture of membranes.
Clinical management: Karyotyping (differential
diagnosis). Further ultrasound screening including
fetal echocardiography. Serial scans (growth
restriction). Increased risk of placental abruption.
Procedure after birth: Increased risk of fetal distress
during labor. Necrotizing enterocolitis is
seen frequently in newborns after maternal cocaine
abuse. Neonatal withdrawal syndrome occurs
after heroin abuse.
Prognosis: Perinatal mortality is high due to premature
delivery, placental abruption and growth
restriction.
References
Bennett DS, Bendersky M, Lewis M. Children’s intellectual
and emotional-behavioral adjustment at 4 years
as a function of cocaine exposure, maternal characteristics,
and environmental risk. Dev Psychol 2002;
38: 648–58.
Chasnoff IJ, Chisum GM, Kaplan WE. Maternal cocaine
use and genitourinary tract malformations. Teratology
1988; 37: 201–4.
Chiriboga CA, Brust JC, Bateman D, Hauser WA. Dose–
response effect of fetal cocaine exposure on newborn
neurologic function. Pediatrics 1999; 103: 79–85.
Church MW, Crossland WJ, Holmes PA, Overbeck GW,
Tilak JP. Effects of prenatal cocaine on hearing, vision,
growth, and behavior. Ann N Y Acad Sci 1998; 846:
12–28.
Fantel AG, Macphail BJ. The teratogenicity of cocaine.
Teratology 1982; 26: 17–9.
Hume RFJ, Martin LS, Bottoms SF, et al. Vascular disruption
birth defects and history of prenatal cocaine exposure:
a case control study. Fetal Diagn Ther 1997;
12: 292–5.
Hunter ES, Kotch LE, Cefalo RC, Sadler TW. Effects of cocaine
administration during early organogenesis on
prenatal development and postnatal growth in mice.
Fundam Appl Toxicol 1995; 28: 177–86.
Jacobson SW, Chiodo LM, Sokol RJ, Jacobson JL. Validity
of maternal report of prenatal alcohol, cocaine, and
smoking in relation to neurobehavioral outcome. Pediatrics
2002; 109: 815–25.
Joseph H, Stancliff S, Langrod J. Methadone maintenance
treatment (MMT): a reviewof historical and
clinical issues [review]. Mt Sinai J Med 2000; 67:
347–64.
Lipshultz SE, Frassica JJ, Orav EJ. Cardiovascular abnormalities
in infants prenatally exposed to cocaine. J
Pediatr 1991; 118: 44–51.
Loebstein R, Koren G. Pregnancy outcome and neurodevelopment
of children exposed in utero to psychoactive
drugs: the Motherisk experience. J Psychiatry
Neurosci 1997; 22: 192–6.
Lutiger B, Graham K, Einarson TR, Koren G. Relationship
between gestational cocaine use and pregnancy outcome:
a meta-analysis. Teratology 1991; 44: 405–14.
Morgan RE, Garavan HP, Mactutus CF, Levitsky DA,
Booze RM, Strupp BJ. Enduring effects of prenatal cocaine
exposure on attention and reaction to errors.
Behav Neurosci 2002; 116: 624–33.
Morild I, Stajic M. Cocaine and fetal death. Forensic Sci
Int 1990; 47: 181–9.
Oats JN, Beischer NA, Breheny JE, Pepperell RJ. The outcome
of pregnancies complicated by narcotic drug
addiction. Aust N Z J Obstet Gynaecol 1984; 24: 14–6.
Ornoy A, Segal J, Bar-Hamburger R, Greenbaum C.
Developmental outcome of school-age children born
to mothers with heroin dependency: importance of
environmental factors. Dev Med Child Neurol 2001;
43: 668–75.
Rizk B, Atterbury JL, Groome LJ. Reproductive risks of
cocaine. Hum Reprod Update 1996; 2: 43–55.
Yanai J, Steingart RA, Snapir N, Gvaryahu G, Rozenboim
II, Katz A. The relationship between neural alterations
and behavioral deficits after prenatal exposure
to heroin. Ann NY Acad Sci 2000; 914: 402–11.
Zuckerman B, Frank DA, Mayes L. Cocaine-exposed infants
and developmental outcomes: “crack kids” revisited.
JAMA 2002; 287: 1990–1.
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