abdominal wall defects

腹壁缺损
  • 文章类型: Case Reports
    先天性腹壁缺损的发生率正在增加,但在非洲人口中报道的病例很少。
    作者报告了一例足月新生儿腹裂病例,该新生儿在远程医疗机构通过自发阴道分娩(SVD)分娩,然后转移到乌干达的三级医院。虽然没有环境暴露于致畸剂,胃裂的主要危险因素,新生儿出生体重低,艾滋病毒暴露,母亲在孕早期没有补充叶酸,已知的腹裂危险因素。体格检查除了发现腹壁缺损外,还发现宫内生长受限。
    在这种情况下,由于新生儿的基本护理延迟而错过了许多机会,延迟手术修复,并转移到三级外科中心。在三级外科中心,采用延迟二次闭合的改良筒仓技术修复缺损,但是新生儿在完成生命的第七天之前仍然遇到了死亡。
    这起腹裂病例表明,在资源有限的环境中,对出生时患有严重先天性结构异常的新生儿的诊断和治疗仍然是可取的,因为缺乏先进的医疗服务来帮助在怀孕期间的早期发现和出生时的早期手术干预,以防止相关的死亡率。作者讨论了经验教训,并为改善腹壁缺陷和其他先天性出生缺陷新生儿的护理提供了建议。
    UNASSIGNED: The incidence of congenital abdominal wall defects is increasing, but few cases have been reported in the African population.
    UNASSIGNED: The authors report a case of gastroschisis in a term neonate who was delivered through spontaneous vaginal delivery (SVD) in a remote health facility before transfer to a tertiary hospital in Uganda. Although there was no environmental exposure to teratogens, the major risk factor of Gastroschisis, the neonate was low birth weight, HIV-exposed, and the mother had not received folic acid supplementation during the first trimester, known risk factors of gastroschisis. Physical examination revealed intrauterine growth restriction in addition to the findings of the abdominal wall defect.
    UNASSIGNED: There were many missed opportunities in the management of this case which was marred by delayed essential care of the newborn, delayed surgical repair, and transfer to the tertiary surgical centre. At the tertiary surgical centre, a modified silo technique with delayed secondary closure was used to repair the defect, but the neonate still met its death before completing day 7 of life.
    UNASSIGNED: This case of gastroschisis shows how the diagnosis and management of neonates born with major congenital structural abnormalities in resource-limited settings is still desirable due to lack of sophisticated medical care services to assist in early detection during pregnancy and early surgical intervention at birth to prevent associated mortality. The authors discuss the lessons learnt and provide recommendations for improvement in the care of neonates born with abdominal wall defects and other congenital birth defects.
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  • 文章类型: Journal Article
    这项研究分析了计划中的选择性早产后复杂和简单的腹裂的早期新生儿结局,与产前超声评估肠道状况有关。61例产前诊断为腹裂的新生儿的回顾性研究出生,从2011年到2021年,单个三级中心的管理显示,生存率为96.72%,没有宫内死亡。大多数病例(78.7%)为单纯性腹裂。与简单的腹裂-75.4天对35.1天和58.1天对24.1天相比,患有复杂腹裂的新生儿的住院时间和完全肠内喂养时间更长,分别。在外科医生和围产学家的肠道状况评估之间达到了86.90%的高度一致性。剖腹产方案证明了安全性,高存活率,初级闭合,以及与其他报告相比的有利结果。产前超声可有效评估肠道状况并确定复杂的胃裂病例。
    This research analysed early neonatal outcomes of complex and simple gastroschisis following planned elective preterm delivery in relation to prenatal ultrasound assessment of bowel conditions. A retrospective study of 61 neonates with prenatal gastroschisis diagnosis, birth, and management at a single tertiary centre from 2011 to 2021 showed a 96.72% survival rate with no intrauterine fatalities. Most cases (78.7%) were simple gastroschisis. Neonates with complex gastroschisis had longer hospital stays and time to full enteral feeding compared to those with simple gastroschisis-75.4 versus 35.1 days and 58.1 versus 24.1 days, respectively. A high concordance of 86.90% between the surgeon\'s and perinatologist\'s bowel condition assessments was achieved. The caesarean delivery protocol demonstrated safety, high survival rate, primary closure, and favourable outcomes compared to other reports. Prenatal ultrasound effectively evaluated bowel conditions and identified complex gastroschisis cases.
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  • 文章类型: Journal Article
    背景:腹裂和脐膨出是两种最常见的先天性胎儿腹壁缺损。两种畸形通常都与胎龄小的新生儿有关。然而,生长受限的程度和原因在腹裂和脐膨出中仍然存在争议,没有相关的畸形或非整倍体。
    目的:本研究旨在研究胎盘和出生体重与胎盘重量比在腹壁缺陷胎儿中的作用。
    方法:本研究包括2001年1月至2020年12月在我院检查的所有腹壁缺损病例,并从医院软件中检索数据。有任何其他合并先天性异常的胎儿,已知的染色体异常,或失去随访被排除。总的来说,28例单胎妊娠伴腹裂和24例单胎妊娠伴脐膨出符合纳入标准。对患者特征和妊娠结局进行了回顾。主要结果是研究分娩后测量的腹壁缺陷妊娠中出生体重与胎盘重量之间的关系。校正胎龄并比较胎盘总重量,计算了单胎中给定胎龄的观察出生体重和预期出生体重之间的比率.将缩放指数β与参考值0.75进行比较。使用GraphPadPrism(8.2.1版;GraphPad软件,圣地亚哥,CA)和IBMSPSSStatistics。<.05的P值表示统计学显著性。
    结果:胎儿腹裂的孕妇明显更年轻,更常见的是未产。此外,在这个群体中,分娩的胎龄明显提前,几乎完全用于剖宫产.28个孩子,13例(46.7%)出生时小于胎龄,其中只有3例(10.7%)胎盘重量<10%。出生体重百分位数和胎盘体重百分位数之间没有相关性(P=不显著)。然而,在脐膨出组中,24名儿童中有4名(16.7%)出生时小于胎龄(<10%),所有儿童的胎盘重量也<10%。出生体重百分位数与胎盘体重百分位数之间存在显著相关性(P<0.0001)。出生体重与胎盘体重的比率在诊断为腹裂的妊娠和诊断为脐膨出的妊娠之间存在显着差异(4.48[3.79-4.91]vs6.05[5.38-6.47],分别;P<.0001)。异速代谢缩放显示,并发腹裂的胎盘和并发脐膨出的胎盘不随出生体重而缩放。
    结论:腹裂胎儿宫内发育受损,这似乎不同于经典的胎盘功能不全生长限制。
    BACKGROUND: Gastroschisis and omphalocele are the 2 most common congenital fetal abdominal wall defects. Both malformations are commonly associated with small-for-gestational-age neonates. However, the extent and causes of growth restriction remain controversial in both gastroschisis and omphalocele without associated malformations or aneuploidy.
    OBJECTIVE: This study aimed to examine the role of the placenta and the birthweight-to-placental weight ratio in fetuses with abdominal wall defects.
    METHODS: This study included all cases of abdominal wall defects examined at our hospital between January 2001 and December 2020, retrieving the data from the hospital\'s software. Fetuses with any other combined congenital anomalies, known chromosomal abnormalities, or lost to follow-up were excluded. Overall, 28 singleton pregnancies with gastroschisis and 24 singleton pregnancies with omphalocele met the inclusion criteria. Patient characteristics and pregnancy outcomes were reviewed. The primary outcome was to investigate the association between birthweight and placental weight in pregnancies with abdominal wall defects as measured after delivery. To correct for gestational age and to compare total placental weights, ratios between the observed and expected birthweights for the given gestational age in singletons were calculated. The scaling exponent β was compared with the reference value of 0.75. Statistical analysis was performed using GraphPad Prism (version 8.2.1; GraphPad Software, San Diego, CA) and IBM SPSS Statistics. A P value of <.05 indicated statistical significance.
    RESULTS: Women pregnant with a fetus with gastroschisis were significantly younger and more often nulliparous. In addition, in this group, the gestational age of delivery was significantly earlier and almost exclusively for cesarean delivery. Of 28 children, 13 (46.7%) were born small for gestational age, only 3 of them (10.7%) had a placental weight <10th percentile. There is no correlation between birthweight percentiles and placental weight percentiles (P=not significant). However, in the omphalocele group, 4 of 24 children (16.7%) were born small for gestational age (<10th percentile), and all children also had a placental weight <10th percentile. There is a significant correlation between birthweight percentiles and placental weight percentiles (P<.0001). The birthweight-to-placental weight ratio differs significantly between pregnancies diagnosed with gastroschisis and pregnancies diagnosed with omphalocele (4.48 [3.79-4.91] vs 6.05 [5.38-6.47], respectively; P<.0001). Allometric metabolic scaling revealed that placentas complicated by gastroschisis and placentas complicated by omphalocele do not scale with birthweight.
    CONCLUSIONS: Fetuses with gastroschisis displayed impaired intrauterine growth, which seemed to differ from the classical placental insufficiency growth restriction.
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  • 文章类型: Journal Article
    腹壁缺陷是严重的出生缺陷,住院时间长,医疗系统费用高。医院感染(NI)可能是加剧患有此类畸形的新生儿进化的另一个危险因素。
    方法:为了分析可能导致NI发生的因素,我们进行了32年(1990-2021年)的回顾性研究,在三级儿童医院;302例新生儿脐膨出和腹裂符合研究条件。
    结果:总共33.7%的患者感染了一种或多种细菌或真菌。这些物种是肠杆菌科,铜绿假单胞菌和不动杆菌属。,葡萄球菌属。,肠球菌属。或念珠菌属。,但在1990-2010年和2011-2021年期间,NI率显著下降(p=0.04).手术数量的增加与脐膨出和腹裂的NI数量的增加有关;在腹裂的情况下,手术时年龄超过6小时会增加感染风险(p=0.052,边际统计学意义).此外,对于腹裂,贫血患者发生NI的风险高4.56倍(p<0.01),发生急性肾功能衰竭患者的NI风险高2.17倍(p=0.02),超过14天的住院时间会使NI风险增加3.46倍(p<0.01);超过4天的TPN会使NI风险增加2.37倍(p=0.015).使用对脐膨出患者的逻辑回归模型,我们发现血型为0的人的NI风险增加(OR=3.8,p=0.02),在住院时间(LH)≥14天(OR=6.7,p<0.01)和存在贫血(OR=2.5,p=0.04)的患者中;我们模型中的所有三个独立变量对NI风险的贡献为38.7%.
    结论:尽管在过去的32年中,我们已经看到腹壁缺损的转归得到了转变性改善,仍有许多因素需要特别注意纠正。
    Abdominal wall defects are serious birth defects, with long periods of hospitalization and significant costs to the medical system. Nosocomial infection (NI) may be an additional risk factor that aggravates the evolution of newborns with such malformations.
    METHODS: in order to analyze the factors that may lead to the occurrence of NI, we performed a retrospective study over a period of thirty-two years (1990-2021), in a tertiary children\'s hospital; 302 neonates with omphalocele and gastroschisis were eligible for the study.
    RESULTS: a total of 33.7 % patients were infected with one or more of species of bacteria or fungi. These species were Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter spp., Staphylococcus spp., Enterococcus spp. or Candida spp., but the rate of NI showed a significant decrease between the 1990-2010 and 2011-2021 period (p = 0.04). The increase in the number of surgeries was associated with the increase in the number of NI both for omphalocele and gastroschisis; in the case of gastroschisis, the age of over 6 h at the time of surgery increased the risk of infection (p = 0.052, marginal statistical significance). Additionally, for gastroschisis, the risk of NI was 4.56 times higher in the presence of anemia (p < 0.01) and 2.17 times higher for the patients developing acute renal failure (p = 0.02), and a hospitalization period longer than 14 days was found to increase the risk of NI 3.46-fold (p < 0.01); more than 4 days of TPN was found to increase the NI risk 2.37-fold (p = 0.015). Using a logistic regression model for patients with omphalocele, we found an increased risk of NI for those in blood group 0 (OR = 3.8, p = 0.02), in patients with a length of hospitalization (LH) of ≥14 days (OR = 6.7, p < 0.01) and in the presence of anemia (OR = 2.5, p = 0.04); all three independent variables in our model contributed 38.7% to the risk of NI.
    CONCLUSIONS: although in the past 32 years we have seen transformational improvements in the outcome of abdominal wall defects, there are still many factors that require special attention for corrections.
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  • 文章类型: Journal Article
    UNASSIGNED: The present study is conducted to introduce a common disease of abdominal wall which has received less attention in scientific resources. In traditional medicine sources Some scholars believe that this condition occurs due to the movement of the abdominal muscle near the umbilicus or nave laterally movement of nave.
    UNASSIGNED: A case series study.
    UNASSIGNED: the study did not receive any funding. This study was a case series study. The study population was all patients who following repeated hospital visits did not improve, and for their last try, they visited a traditional clinic, and were diagnosed with umbilical hernia during a period of 5 months. Data were collected using demographic information questionnaire, and a complete health history taking.
    UNASSIGNED: nave sliding is an abdominal wall defect and gastrointestinal and psychological problems are listed as the most prominent sign and symptoms. higher body mass index and presence of a first-degree relative with the same problem could be a predictor factor.
    UNASSIGNED: Nave sliding is a common disease that there are a few scientific literatures about it and needs more attention from clinicians to avoid false diagnoses and requires more academic research to clarify any ambiguous side about it to promote the treatment process in a more scientific and approved methods.
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  • 文章类型: Journal Article
    同时存在Omphalocele和Meckel憩室并非闻所未闻,但相对罕见。已经报道了一些它们共存的情况。由于不常见的双重演示,很容易延误甚至错过诊断,拖延管理。如果脐膨出有肠口,应考虑Meckel憩室。
    方法:在这里,我们介绍了一名初生男婴,他被转诊给我们,表现为漏出粪便的脐膨出。婴儿也有唇裂和腭裂。他在足月出生时是一位30岁的母亲,母亲的怀孕本来是正常的。吻合的脐膨出经手术修复,孩子继续做得很好。
    脐膨出和Meckel憩室都是相对罕见的先天性畸形,并不常见。其他先天性畸形可能相关;因此,在有资源的情况下,应进行彻底的调查。寻找相关的畸形不应延迟病理的管理,因为它可能对儿童的健康和结果产生严重后果。
    结论:Meckel憩室在脐膨出时很少见。治疗包括手术切除和修复。尽管应该调查其他合并症,病因和其他合并症的调查不应延误手术。
    UNASSIGNED: The concurrent existence of Omphalocele and Meckel\'s diverticulum is not unheard of but is relatively uncommon. A few cases of their coexistence have been reported. Due to the uncommon dual presentation, it is easy to delay or even miss the diagnosis, delaying management. Meckel\'s diverticulum should be considered if there is a bowel opening on an omphalocele.
    METHODS: Herein we present a newborn male baby who was referred to us presenting with an omphalocele that was leaking faeces. The baby also had a cleft lip and palate. He was born at term to a 30-year-old mother whose pregnancy was otherwise normal. The fistulated omphalocele was surgically repaired, and the child continued to do well.
    UNASSIGNED: Omphalocele and Meckel\'s diverticulum are both relatively rare congenital malformations that are uncommonly present together. Other congenital malformations can be associated; hence thorough investigations should be carried out when resources are available. The search for associated malformation should not delay the management of the pathology as it can have serious consequences on the health and outcome of the child.
    CONCLUSIONS: Fistulation of Meckel\'s diverticulum on an Omphalocele is rare. Treatment involves surgical resection and repair. Though other co-morbidities should be investigated, investigation for cause and other co-morbidities should not delay surgery.
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  • 文章类型: Journal Article
    应用合成或生物网格是修复和重建腹壁缺损的主要疗法,手术中的常见病。目前,没有理想的材料可用,迫切需要找到合适的药物来满足临床需求。静电纺丝支架在软组织重建中引起了人们的关注。在这项研究中,我们开发了一种使用热响应水凝胶制造复合静电纺丝支架的新方法,聚(N-异丙基丙烯酰胺)-嵌段-聚(乙二醇),和一种可生物降解的聚合物,聚乳酸(PLA)。这种支架不仅提供了高的表面积/体积比和三维纤维基质,而且还提供了高的生物相容性和足够的机械强度。并能模拟天然细胞外基质,加速细胞粘附和增殖。此外,将大鼠脂肪干细胞(ADSCs)接种在复合电纺支架中,通过定向诱导ADSCs进入内皮细胞来增强缺损修复和再生。此外,我们发现早期血管形成过程中受到缺氧诱导因子-1α(HIF-1α)/血管内皮生长因子(VEGF)通路的调节。在我们的研究中,使用慢病毒系统在ADSCs中HIF-1α/VEGF的过表达促进了电纺支架中的早期血管形成。总的来说,我们希望我们的复合仿生支架方法将适用于腹壁缺损的再生和修复。
    Application of synthetic or biological meshes is the main therapy for the repair and reconstruction of abdominal wall defects, a common disease in surgery. Currently, no ideal materials are available, and there is an urgent need to find appropriate ones to satisfy clinical needs. Electrospun scaffolds have drawn attention in soft tissue reconstruction. In this study, we developed a novel method to fabricate a composite electrospun scaffold using a thermoresponsive hydrogel, poly (N-isopropylacrylamide)-block-poly (ethylene glycol), and a biodegradable polymer, polylactic acid (PLA). This scaffold provided not only a high surface area/volume ratio and a three-dimensional fibrous matrix but also high biocompatibility and sufficient mechanical strength, and could simulate the native extracellular matrix and accelerate cell adhesion and proliferation. Furthermore, rat adipose-derived stem cells (ADSCs) were seeded in the composite electrospun scaffold to enhance the defect repair and regeneration by directionally inducing ADSCs into endothelial cells. In addition, we found early vascularization in the process was regulated by the hypoxia inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) pathway. In our study, overexpression of HIF-1α/VEGF in ADSCs using a lentivirus system promoted early vascularization in the electrospun scaffolds. Overall, we expect our composite biomimetic scaffold method will be applicable and useful in abdominal wall defect regeneration and repair in the future.
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  • 文章类型: Journal Article
    腹壁缺损是常见的先天性异常,最常见的是腹裂和脐膨出。尽管两者都是胎儿腹壁胚胎发育过程中错误的结果,腹裂和脐膨出是具有不同临床后遗症的独特疾病。胃裂通常是一种孤立的异常,其产后结局与脱垂肠的潜在完整性有关。相比之下,脐膨出通常与其他结构异常或遗传综合征相关,这些综合征比脐膨出缺陷本身对产后结局的贡献更大。尽管它们的胚胎学差异,腹裂和脐膨出均代表胎儿发育异常,受益于多学科和转化护理方法,出生前和出生后。虽然腹壁缺陷的明确管理目前仍在产后领域,产前诊断和治疗的进步可能有一天会改变这一点。这篇综述侧重于最近的进展,新颖的技术,以及目前与胃裂和脐膨出的产前诊断和管理有关的争议。
    Abdominal wall defects are common congenital anomalies with the most frequent being gastroschisis and omphalocele. Though both are the result of errors during embryologic development of the fetal abdominal wall, gastroschisis and omphalocele represent unique disorders that have different clinical sequelae. Gastroschisis is generally a solitary anomaly with postnatal outcomes related to the underlying integrity of the prolapsed bowel. In contrast, omphalocele is frequently associated with other structural anomalies or genetic syndromes that contribute more to postnatal outcomes than the omphalocele defect itself. Despite their embryological differences, both gastroschisis and omphalocele represent anomalies of fetal development that benefit from multidisciplinary and translational approaches to care, both pre- and postnatally. While definitive management of abdominal wall defects currently remains in the postnatal realm, advancements in prenatal diagnostics and therapies may one day change that. This review focuses on recent advancements, novel techniques, and current controversies related to the prenatal diagnosis and management of gastroschisis and omphalocele.
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  • 文章类型: Journal Article
    有效修复全厚度腹壁缺损需要具有足够机械强度和抗粘连特性的补片,以避免形成疝和腹内并发症,例如肠梗阻和瘘。然而,由聚合物或生物衍生材料制成的贴片可能无法满足这些要求,并且缺乏腹壁的仿生特性。
    在这项研究中,我们报道了使用聚己内酯(PCL)制备双层结构纳米纤维膜(GO-PCL/CS-PCL)的连续电纺方法,氧化石墨烯(GO)和壳聚糖(CS)。为了扩大补片(GO-PCL/NAC-CS-PCL)的生物功能(血管生成/减少活性氧),N-乙酰半胱氨酸(NAC)用于修复大鼠模型的全层腹壁缺损(2×1.5cm)。
    双层贴片(GO-PCL/NAC-CS-PCL)显示出优异的机械强度和生物相容性。两个月后,用补片治疗的大鼠表现出预期的修复效果,没有疝形成,粘连较少(粘连评分:1.50±0.50,P<0.001),胶原蛋白沉积较多(胶原蛋白沉积百分比:34.94%±3.31%,P<0.001)。
    本研究中提出的双层纳米膜具有良好的抗疝和抗粘连作用,以及改善体内微环境。It,因此,对于腹壁缺损的修复具有良好的前景,并作为术后抗粘连剂提供了很有前途的关键。
    UNASSIGNED: Effective repair of full-thickness abdominal wall defects requires a patch with sufficient mechanical strength and anti-adhesion characteristics to avoid the formation of hernias and intra-abdominal complications such as intestinal obstruction and fistula. However, patches made from polymers or bio-derived materials may not meet these requirements and lack the bionic characteristics of the abdominal wall.
    UNASSIGNED: In this study, we report a consecutive electrospun method for preparing a double-layer structured nanofiber membrane (GO-PCL/CS-PCL) using polycaprolactone (PCL), graphene oxide (GO) and chitosan (CS). To expand the bio-functions (angiogenesis/reducing reactive oxygen species) of the patch (GO-PCL/NAC-CS-PCL), N-acetylcysteine (NAC) was loaded for the repair of full-thickness abdominal wall defects (2×1.5cm) in rat model.
    UNASSIGNED: The double-layered patch (GO-PCL/NAC-CS-PCL) showed excellent mechanical strength and biocompatibility. After 2 months, rats treated with the patch exhibited the desired repair effect with no hernia formation, less adhesion (adhesion score: 1.50±0.50, P<0.001) and more collagen deposition (percentage of collagen deposition: 34.94%±3.31%, P<0.001).
    UNASSIGNED: The double-layered nanomembranes presented in this study have good anti-hernia and anti-adhesion effects, as well as improve the microenvironment in vivo. It, therefore, holds good prospects for the repair of abdominal wall defects and provides a promising key as a postoperative anti-adhesion agent.
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  • 文章类型: Case Reports
    肢体壁复合体(LBWC)是一种罕见的,以体壁缺陷为特征的致命畸形,颅面和肢体异常,有或没有各种其他器官异常。我们报告了一例双胎双胎双胎妊娠不一致的LBWC,在妊娠21周时通过超声(US)诊断并通过MRI确认,预期管理,并在35周时通过紧急剖腹产分娩,对未受影响的双胞胎有良好的结局。异常双胞胎,他出生后不久就去世了,有相当大的胸腹壁缺损,胎盘上的肝脏和肠管内脏,短绳,异位,肺发育不全,脊柱侧后凸,右上肢鞍区和左马蹄内翻足,多指。当由于胎儿位置不利而对美国有限制时,MRI有助于更好地显示胎儿形态。多胎妊娠,母亲肥胖或减少酒。在双胞胎怀孕中,管理将取决于确保未受影响的双胞胎的生存。
    Limb body wall complex (LBWC) is a rare, lethal malformation characterised by body wall defects, craniofacial and limb anomalies with or without various other organ anomalies. We report a case of dichorionic diamniotic twin pregnancy discordant for LBWC, diagnosed by ultrasound (US) and confirmed by MRI at 21 weeks\' gestation, managed expectantly and delivered at 35 weeks by emergency caesarean section with a favourable outcome of the unaffected twin. The anomalous twin, who died soon after birth, had a sizeable thoracoabdominal wall defect, eviscerated liver and bowel loops attached to the placenta, short cord, ectopia cordis, lung hypoplasia, kyphoscoliosis, right upper limb amelia and left clubfoot with polydactyly. MRI helps to demonstrate the fetal morphology better when there are limitations to the US due to unfavourable fetal position, multifetal gestation, maternal obesity or reduced liquor. In twin pregnancies, the management will depend on ensuring the survival of the unaffected twin.
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