The antenatal and postnatal prognosis for fetuses with chest noncardiac anomalies varies widely, depending of the type of lesion present. An important issue is to establish an accurate prenatal diagnosis, which allows an appropriate counseling of the couple, fetal karyotyping and eventually in utero fetal therapy, if possible. Also, another important feature is preparation for delivery in a tertiary center or an appropriate perinatal institution, able to provide care to the immediate neonatal consequences in such cases. The ultrasound exam is not only crucial in the diagnosis of such lesions, but also important in the serial antenatal follow up, some of them being progressive, and having the potential to lead to compromise of cardiac function and eventually to fetal death. Thus, the sonographer has an important role in the management of such difficult cases. Currently, perinatal centers provide multidisciplinary teams, with maternal fetal specialists, neonatologists, pediatric surgeons, all involved in counseling parents about the outcome and the management options for a fetus with a diagnosis of thoracic anomalies. Although the precise prenatal diagnosis is often possible, this does not necessarily ensure improvement of the postnatal outcome, due to associated pulmonary hypoplasia.
Part of the book: Congenital Anomalies
Even though controversies surrounding the polycystic ovary syndrome are not yet close to be solved, its clinical manifestations are well known—insulin resistance and obesity, hirsutism, irregular and anovulatory menstrual cycles. The treatment of polycystic ovarian syndrome (PCOS) is mainly symptomatic as its etiology is not yet clear. Lifestyle changes are the primary therapy in overweight and obese women with PCOS. According to majority of the studies, lifestyle changes are the most effective form of treatment not only for weight loss but also for the improvement of insulin sensitivity, decreasing incidence of metabolic syndrome and type 2 diabetes. Studies also show that weight loss has fertility benefits by restoring ovulatory cycles. Although initial studies researching pharmacologic treatment were showing excellent results concerning the weight loss, maintenance of weight loss and reduction of cardiovascular risks, some of these drugs were in the end, has proven to actually increase the risk for cardiovascular events and were removed from the market. Bariatric surgery has been demonstrated to improve or even cure type 2 diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea. More so, there are studies that reported complete resolution of all features of PCOS, even hirsutism, hyperandrogenism, anovulation, and menstrual irregularity.
Part of the book: Debatable Topics in PCOS Patients