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A pregnancy with fetal homozygous protein C deficiency was complicated in the third trimester by fetal ventriculomegaly, intraorbital thrombosis and placental infarcts, which could be imaged by combined use of ultrasonography and MRI. Copyright © 2000 John Wiley & Sons, Ltd.

A woman presented during two pregnancies (at 25 and 23 weeks' gestation, respectively) because the fetuses had rapid, irregular tachycardia and hydrops. After maternal drug treatment and achievement of slower fetal heart rates, the hydrops gradually resolved. Both babies were born full term with continuing atrial fibrillation. In the first, an ectopic atrial rhythm was temporarily achieved during high dose flecainide treatment but, in the younger sibling, all medications and repeated cardioversions failed even temporarily to convert the atrial fibrillation with an almost isoelectric baseline in ECG to sinus rhythm. Good rate control has been achieved with digoxin in both patients. No infective, immunological, or structural cause was found in either case, and thus an inherited aetiology is probable. (Heart 1998;79:195-197) Keywords: atrial fibrillation; arrhythmias; fetal atrial fibrillation; familial arrhythmias Atrial fibrillation is rarely diagnosed in the fetus. No published data exist on the success rates of medical rhythm conversion during fetal life. In adults, it is known that the chances of maintaining sinus rhythm are small after a long period of atrial fibrillation.1 Atrial tachycardia with an early fetal onset may cause extensive remodelling of the atria. These antepartum changes can impair postnatal cardiac structural and functional development. We report a case of two siblings, both with fetal atrial fibrillation and hydrops, whose ventricular heart rates were controlled with maternal drug treatment, and who were born full term in good clinical condition. In both patients, atrial fibrillation continued postnatally as the permanent rhythm. PatientsFetal tachycardia was noticed at a routine antenatal visit at 25 weeks' gestation in a 24 year old woman. The ventricular rate of the fetus was irregular at 180-240 beats/min and the frequency of atrial contractions was 400 beats/min according to M mode echocardiographic recording of the fetal heart-that is, there was atrial flutter with a varying atrioventricular block. Later, no clear atrial contractions could be documented (fig 1). The ventricular rhythm remained irregular but with only slightly varying intervals between the beats (fig 2). A small pericardial eVusion was present during the first weeks of treatment. Later no signs of hydrops were observed. With maternal digitalisation the fetal heart rate fell to 210 beats/min and after adding flecainide it fell to 160-200 beats/min. The mother had serum drug concentrations in the therapeutic range when receiving digoxin 0.75 mg and flecainide 200 mg daily. Delivery occurred at 40 + 6 weeks of gestation by caesarean section because of prolonged labour and declining scalp pH values, and an accelerated fetal heart rate (210 beats/min).After birth the heart rate of the female baby was irregular at an average of 180 beats/min. Intravenous loading with flecainide resulted in a drop in heart rate to 105 beats/min with a fairly regular rhythm ( fig 3A). No P waves were observed on a surface ECG. Howev...

Lung function evaluated by FEV% and FEF25-75 was lower and responses to cold air were more common at the median age of 16 years in twins with impaired intrauterine growth.