What is the biggest fear for expectant mothers when undergoing prenatal ultrasound during pregnancy?

The doctor watched as he suddenly stopped, repeatedly observing a place, and remained silent for a long time

「What’s wrong with the child? There won’t be any problems here, will there」

Lying on the examination bed, expectant mothers have to speculate for half a day.

Most of the time, there was no danger, and Xiaoshu (pseudonym) passed the first 37 weeks of pregnancy smoothly like other expectant mothers.

This is Xiaoshu’s second child, with the experience of having a first child, Xiaoshu is very calm about her pregnancy this time. Unexpectedly, during Xiaoshu’s late pregnancy, prenatal examination revealed a lump in the fetal abdominal cavity. On the advice of the doctor, she was transferred to Shenzhen Maternal and Child Health Hospital for treatment.

Can the baby stay with a benign or malignant abdominal tumor detected during prenatal examination?

Xiaoshu introduced that after the prenatal ultrasound examination revealed a lump, she underwent magnetic resonance imaging. Both results showed that there was a lump in the baby’s abdominal cavity, which was quite large, measuring 3.9 * 2.7 * 2.7 cm. The lump was closely related to the stomach and liver.  

•     ● Why does the fetus grow tumors?
•     ● Is this tumor benign or malignant?
•     ● Can the child be saved?

These problems troubled Xiaoshu and her family, and they quickly came to Shenzhen Maternal and Child Health Hospital for treatment.

Shenzhen Maternal and Child Health Hospital, through multidisciplinary consultations, believes that the tumor cannot be determined as benign or malignant at the moment and requires further examination after birth to confirm the diagnosis.

After listening to the doctor’s advice, Xiao Shu thought of the day and night spent with her child during pregnancy. She had heard the child’s heartbeat and felt the child rolling and kicking in her stomach. This was a fresh life, and she couldn’t bear to give up. She and her family are very determined to give birth to the child. She believes in hospitals and believes that there are ways to receive treatment after a child is born.

Multi department collaboration, laparoscopic liver resection on the 13th day of birth, the smallest in the country

At 38 weeks of pregnancy, Xiaoshu’s child was born smoothly, weighing 3885 g. After birth, the child underwent ultrasound and CT examinations and found that the tumor had significantly enlarged, measuring 3.6 * 4.7 cm, located in the left lobe of the liver, adjacent to the heart above and the stomach below.

The tumor is increasing, which is a bad signal.

Qu Zhenfan, deputy chief physician of pediatric surgery of Shenzhen Maternal and Child Health Care Hospital, said that through multidisciplinary consultation, it was malignant from the image, afraid of metastasis and diffusion, and in general, it should be removed as soon as possible.

Shenzhen Maternal and Child Health Hospital urgently held a case discussion, and after consultation and discussion among multiple departments including Neonatology, Anesthesiology, Imaging, and Pediatrics, it was decided to perform laparoscopic assisted liver tumor resection surgery under general anesthesia.

Liver tumors are very rare in newborns, and this is also the youngest pediatric patient to undergo liver tumor surgery since the establishment of Shenzhen Maternal and Child Health Hospital. The difficulty coefficient and risk of surgery are extremely high.

The tumor happens to grow in the left liver, and compared to other areas, the accuracy and safety of the surgery are a bit higher. After the diagnosis is clear, we issued a surgical notice. The child’s parents have excellent compliance and trust us very much. "Qu Zhenfan said, after confirming the need for surgery, the next step is to discuss the surgical plan.

Qu Zhenfan introduced that the abdominal cavity space of newborns is very small, and the blood vessels around liver tumors are particularly abundant. However, babies who are not yet full moon can tolerate very low amounts of bleeding. How can we avoid the surrounding blood vessels to minimize the amount of bleeding and successfully "remove" this tumor? Can newborns tolerate anesthesia, surgery, and postoperative rehabilitation treatment (such as chemotherapy) as their organs are not yet fully developed? These are all challenges facing doctors.

"Most of the liver tumor removal operations for neonates are traditional open surgery, but this will leave huge scars on the abdomen of the child, affecting the beauty. Laparoscopy only needs to open a few holes as large as the nail cover in the abdomen of the child, implant laparoscopic and hand instruments, and complete the operation under the direct vision of the endoscope outside the body, with little damage and fast recovery," said Qu Zhenfan.

With years of experience, on the 13th day of the child’s birth, Qu Zhenfan led a pediatric surgical team to closely cooperate with the anesthesia department. After 2 hours, the liver tumor was completely removed, and the intraoperative bleeding volume was less than 40 ml.

This is currently the smallest known laparoscopic liver tumor resection surgery for newborns in China. Postoperative pathology confirmed hepatoblastoma, which is a common malignant tumor in liver tumors.

The occurrence of liver tumors in newborns is already very rare, and now it has been confirmed as malignant tumors, which is undoubtedly another fatal news for the Xiaoshu family. However, due to the complete removal of the tumor during the surgery, there were no abnormalities in the baby’s preoperative systemic examination and no metastasis was found, so postoperative chemotherapy was not performed.

If fetal problems are detected during pregnancy, surgical treatment is required, and comprehensive evaluation should not panic

Hepatoblastoma is a common malignant tumor of the liver in children. It is often Asymptomatic in the early stage. Surgical resection is the main treatment. At present, the etiology is complex and uncertain, so it cannot be prevented. Hepatoblastoma is often Asymptomatic in its early stage. Many children seek medical treatment for huge tumors, or even find it when the whole body metastasizes. However, once treatment is delayed, the prognosis is poor. Only through examination, early detection, early treatment, and minimizing the risk as much as possible.

This article is reprinted from "Dingxiangyuan"

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