The megalencephaly-capillary malformation (MCAP) syndrome is a rare disorder characterized by prenatal overgrowth, somatic and cerebral asymmetry, cutaneous vascular malformations, and connective tissues abnormalities.(1) The central nervous system (CNS) and cutaneous manifestations dominate the clinical picture during postnatal life. Structural cardiac, pulmonary, and lymphatic abnormalities are not commonly seen, although two previously reported patients were noted to have fetal hydrops or fetal pleural effusions. This article is protected by copyright. All rights reserved.

OBJECTIVES:

To evaluate whether a relationship exists between season at conception and occurrence of Isolated Spina Bifida (ISB).

STUDY DESIGN:

All fetuses with prenatal diagnosis of ISB were analyzed according to date of conception. We compared the seasonal rates of conception between ISB fetuses and a control group consisting of a cohort of fetuses delivered during the same period 1992-2009.

RESULTS:

In the control group, conceptions were equally distributed among the four seasons. Chi-square analysis showed a significantly higher rate of ISB conceptions in the fall compared with the control group (16/36, 44% vs 12467/50533, 25%, OR 2.44, 95% CI 1.21-4.92). Not a single woman with a fetus affected by ISB took preconceptional supplement of folic acid.

CONCLUSIONS:

Seasonality affects the frequency of ISB. We hypothesize that the seasonal differences may reflect dietary and climate changes with reduced intake of folic acid in the fall. This article is protected by copyright. All rights reserved.

Recently, a new subgroup of Gaucher's disease type 2 with early manifestations during fetal life has been reported. This report illustrates the diversity of fetal malformations observed in this entity, also called perinatal lethal Gaucher's disease, and, because of phenotypic variability, the autopsy with histological examination is useful to discuss this diagnosis. This article is protected by copyright. All rights reserved.

OBJECTIVE:

To compare the angio-architecture of monochorionic placentas of spontaneous twin anaemia-polycythemia sequence (TAPS) with placenta of Twin to Twin Transfusion Syndrome (TTTS) with residual anastomoses after laser coagulation and placentas of uncomplicated monochorionic twin pregnancies.

METHODS:

This case-control study compares the angio-architecture of monochorionic placentas of spontaneous TAPS (n = 12) with that of monochorionic placentas of TTTS treated by laser coagulation with residual anastomoses (TTTS + RA; n = 20) and placentas of monochorionic pregnancies without complications (n = 24), matched for gestational age. Placental sharing and angioarchitecture were assessed by injection of colored dye.

RESULTS:

The median diameter of the arterio-venous anastomoses in TAPS placentas was 2.26, 0.215 with TTTS + RA and 4.17 mm in normal monochorionic pregnancies (p < .03). The mean diameter of the arterio-arterial (AA) anastomoses in monochorionic placentas with spontaneous TAPS was 0.2 mm versus 0.15 mm in TTTS + RA and 2.0 mm in normal pregnancies, respectively (p < 0.03, p < 0.007). The number of AA anastomoses was lower with TAPS (0.3 versus 0.50 and 1 respectively, p < 0.015, p < 0.0001). Besides, unequal sharing was more frequent in TAPS as compared to monochorionic normal pregnancies (75 % versus 29 %, p = 0.03).

CONCLUSION:

Age matched placentas of spontaneous TAPS are characterized by very small AV anastomoses and very few AA anastomoses of smaller diameter than placentas of monochorionic twins with TTTS or without obvious complications.This article is protected by copyright. All rights reserved.

OBJECTIVES:

To review the association between associated ultrasound findings, placental pathology and prognosis in pregnancies complicated by massive subchorionic thrombo-hematoma(MTH)/Breus' mole.

METHOD:

We identified 14 cases of MTH from January 2004 to December 2012. MTH was defined by: > 1 cm thickness hematoma, and extensive (≥ 50%) involvement of the fetal surface of the placenta. Patient information, details of initial presentation and perinatal outcome were obtained from the manual and electronic chart records. Ultrasound findings were related to pregnancy outcomes and associated placental pathology. Participants were stratified based on birth outcome into survivors (live births, n = 7) and non-survivors (NND or IUFD/TOP, n = 7).

RESULTS:

All 14 cases of MTH were suspected on ultrasound and confirmed by pathology assessment. All cases in the non-survivors group had abnormal umbilical artery Doppler waveforms compared to none in the survivors (p = 0.02). All cases in the non-survivor group had extreme preterm deliveries (p = 0.02). Birth weight was significantly reduced in the non-survivor group (p = 0.001), and 5/7 cases were diagnosed with severe intrauterine growth restriction, compared to none in the survivor group (p = 0.02).

CONCLUSION:

MTH/Breus' mole may be diagnosed in the second trimester by ultrasound assessment of the placenta. Normal fetal growth and umbilical artery Doppler waveforms are associated with perinatal survival. This article is protected by copyright. All rights reserved.

OBJECTIVES:

To assess the association between serum pregnancy-associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin (free β-hCG) in the first trimester and perinatal complications in post-date pregnancies.

METHODS:

4948 women, who delivered after 40 gestational weeks, were included. Labor was not induced routinely until 42 weeks. Serum levels of PAPP-A and free β-hCG were determined at the first-trimester screening for Down syndrome. Neonatal complications were obtained from specific registration forms filled out by senior neonatologists.

RESULTS:

In post-date pregnancies, PAPP-A < 0.4 MoM was associated with Apgar score of less than 7 at 5 minutes (ORadj 5.4, 95% CI 2.0 - 14.3), admission to the NICU (ORadj 1.5, 95% CI 1.0-2.3), and newborn hypoglycaemia (ORadj 3.4, 95% CI 1.8-6.4). In neonates with SGA, the risk of hypoglycaemia was further increased (OR 14.6, 95% CI 3.4-58.0). Similar analyses were made with free β-hCG, but no statistically significant associations were found.

CONCLUSIONS:

Low first trimester serum PAPP-A was associated with increased neonatal morbidity in post-date pregnancies, particularly in newborns with SGA. Thus, PAPP-A may qualify the timing of induction of labor in these pregnancies. This article is protected by copyright. All rights reserved.

OBJECTIVES:

To study the impact of online audit and feedback on fetal four-chamber view image quality

METHODS:

Ultrasonographers uploaded a set of four-chamber views from ten consecutive screening examinations, and a second set three months later. They were randomised to receive (group A) or not (group B) a feedback for their first set. The primary outcome was the difference in image mean score and in percentage of inadequate images between the first and the second set, comparing the groups with and without feedback.

RESULTS:

258 ultrasonographers completed the trial (group A: 122; group B: 136). 5160 images were audited. In both groups, the mean score increased. In group A, it rose from 17.0 to 18.5 (p < 0.0001), and in group B from 17.6 to 18.3 (p < 0.0001). The improvement was greater in group A than in group B (1.5 versus 0.7, p = 0.0007). The mean percentage of inadequate images decreased in both groups. In group A, it dropped from 32% to 19% (p < 0.0001) and in group B, from 26% to 21% (p = 0.012). The decrease was greater in group A than in group B (13% versus 5%, p = 0.007).

CONCLUSIONS:

Image quality improved following online audit, the improvement being slightly greater with feedback. This article is protected by copyright. All rights reserved.

OBJECTIVES:

The aim of our study was to evaluate placental three-dimensional power Doppler indices in diabetic pregnancies in the second and third trimester and to compare them with those of the normal controls.

METHODS:

Placental vascularisation of pregnant women were determined by three-dimensional power Doppler ultrasound technique. The calculated indices included vascularisation index, flow index and vascularisation flow index. Uncomplicated pregnancies (n = 113) were compared to pregnancies complicated by gestational diabetes mellitus (n = 56) and diabetes mellitus (n = 43).

RESULTS:

The three-dimensional power Doppler indices were not significantly different between the two diabetic subgroups. All the indices in diabetic patients were significantly reduced compared to those in non-diabetic individuals (p < 0.001). Placental three-dimensional power Doppler indices are slightly diminished throughout diabetic pregnancy (regression coefficients: -0.23 (FI), -0,06 (VI) and -0.04 (VFI) and normal pregnancy (regression coefficients: -0.13 (FI), -0,20 (VI) and -0.11 (VFI). The uteroplacental circulation (umbilical and uterine artery) was not correlated significantly to the three-dimensional power Doppler indices. If all placental indices are low during late pregnancy, then the odds of the diabetes is significantly high (adjusted odds ratio: 1.10).

CONCLUSIONS:

A decreased placental vascularisation could be an adjunct sonographic marker in the diagnosis of diabetic pregnancy in mid and late gestation This article is protected by copyright. All rights reserved.

OBJECTIVE:

This study aims to evaluate the utility of first trimester cervical ultrasonography in predicting preterm delivery by separate analysis of measurements of cervical and isthmus length.

METHODS:

This is a cohort study based on data collected prospectively on singletons between 1 July 2011 and 1 February 2013. Mean cervical, isthmus and cervico-isthmic complex length were measured for deliveries before and after 37 weeks.

RESULTS:

A total of 1494 pregnancies were analysed, including 51 cases of spontaneous preterm delivery (3.4%). The cervico-isthmic complex in the first trimester was significantly shorter in patients who delivered before term (43.8 mm vs 47.5 mm, p = 0.04). This difference is related to differences in length at the isthmus (10.7 mm vs 14.1 mm, p = 0.005) rather than at the cervix proper (34.5 mm vs 35.0 mm, p = 0.56).

CONCLUSIONS:

Measurement of the cervico-isthmic complex enables detection of a number of patients who will go on to deliver before term. Further studies are necessary to confirm that isthmic length and not cervical length is predictive of preterm delivery. © 2013 John Wiley & Sons, Ltd.