Online versus offline spatiotemporal image correlation (STIC) M-mode for the evaluation of cardiac longitudinal annular displacement in fetal growth restriction

Purpose: Our first aim was to compare online M-mode with offline spatiotemporal image correlation (STIC) M-mode for assessing longitudinal annular displacement (LAD) in growth-restricted fetuses (FGR). Our second aim was to compare LAD measures of FGR cases with controls.

Materials and methods: Prospective study including 40 FGR cases (defined estimated fetal weight and birth weight <10th centile) and 72 normally grown fetuses matched to cases by gestational age at scan. LAD was measured with online M-mode and offline STIC M-mode at the left and right ventricular free walls and septum in all fetuses.

Results: FGR cases had a significant decrease in LAD by STIC in all sites as compared to controls (e.g. right LAD in FGR mean 6.7?mm (SD 1.2) versus controls 7.2?mm (1.2), p?=?.033). There was a non-significant trend for lower values in FGR when using online M-mode (e.g. right LAD in FGR 6.9?mm (1.5) versus controls 7.4?mm (1.5), p?=?.084).

Conclusions: STIC M-mode seems a better method than online M-mode for detecting subtle changes in myocardial motion. STIC presents more precise results and allows an ideal placement of the M-mode arrow. These results confirm previous data suggesting decreased longitudinal motion in FGR.     

Reference values for the volumes of foetal heart atrial wall by three-dimensional ultrasound using STIC and VOCAL methods between 20w0d and 33w6d weeks of gestation

Objective: To establish reference values for the volumes of foetal heart atrial wall by three-dimensional (3D) ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods.

Methods: We performed a retrospective cross-sectional study with 170 normal singleton pregnancies between 20 weeks?+?0 days (20w0d) and 33 weeks?+?6 days (33w6d) of gestation. Foetal heart atrial wall volume was obtained by VOCAL method with 30-degree rotation (six planes) subtracting the internal volume from the atrium volume. Polynomial regression with adjustments by determination coefficient (R²) was performed. To calculate the interobserver reproducibility, concordance correlation coefficient (CCC) was applied.

Results: The mean?±?standard deviation (SD) for the left atrium wall volume (cm³) ranged from 0.54?±?0.21 at 20w0d–20w6d to 2.17?±?0.30 at 33w0d–33w6d. The mean?±?SD for the right atrium wall volume (cm³) ranged from 0.45?±?0.16 at 20w0d–20w6d to 2.17?±?0.62 at 33w0d–33w6d. We observed a satisfactory interobserver reproducibility with CCC?=?0.69 and 0.58 for the left and right volumes of foetal heart atrial wall, respectively. The best-fit models were first-degree: volume for the left atrium wall?=??2.194?+?0.139*GA (R^2?=^?0.41) and volume for the right atrium wall?=??2.757?+?0.155*GA (R^2?=^?0.37).

Conclusion: Reference values for the volumes of foetal heart atrial wall by 3D ultrasound using STIC and VOCAL methods between 20w0d and 33w6d weeks of gestation were established.     

Fetal cardiac function and septal thickness in diabetic pregnancy: a controlled observational and reproducibility study

Objective To determine the reproducibility of duplex Doppler waveform analysis and fetal cardiac interventricular septal thickness measurement and to compare these parameters in matched pregnancies with and without well-controlled maternal Type 1 diabetes at 18–20 weeks of gestation.
Design A prospective blind twin cohort study and a blinded inter-observer and intra-observer agreement study.
Setting A tertiary referral prenatal diagnostic unit within a university hospital.
Results Good inter- and intra-observer agreement was found for the measurement of transvalvular peak flow velocities and the duration of ventricular ejection in the fetal heart. Inter-observer agreement for aortic flow acceleration rate was poor. M-mode measurement of interventricular septal thickness showed moderate reproducibility. The mean (SD) width of the interventricular septum in the fetuses of well controlled diabetic women was 2.1 mm ( 0.2 mm), and was significantly greater (   P = 0.01  ) when compared with the corresponding value in matched controls [1.9 mm (0.2 mm)]. No cardiac functional differences were evident.
Conclusions On-screen video analysis of Doppler cardiac flow waveforms and M-mode measurement of intraventricular septal thickness demonstrated good reproducibility. The fetuses of well controlled diabetic pregnancies demonstrated signs of altered cardiac morphology early in pregnancy, before any evident alterations in cardiac function.     

Assessment of cardiomyopathy in fetuses of women with false positive oral glucose loading test

Objective

To evaluate fetal asymmetric septal hypertrophy in women with a false positive oral glucose loading test (OGL).

Study design

OGL was applied to 79 pregnant women at gestational age between 24 and 28 weeks. The first study group consisted of patients with a normal OGL. Cases having glucose levels above 130 mg/dL after 50 g OGL but a normal 100 g oral glucose tolerance test (OGTT) formed a second group. M-mode echocardiography was then performed. Fetal septal and left ventricular posterior wall (LVPW) thicknesses in Group 1 and Group 2 were compared.

Results

Mean septal and LVPW thickness was slightly higher in the second group but there was no statistically significant difference between the two groups.

Conclusions

Although statistically not significant, there is some increase in septal and ventricular wall thickness in cases with high OGL but normal OGTT. The study also provides evidence of the absence of prominent septal and ventricular thickening in these cases with minimal glucose intolerance.     

The usefulness of plasma asymmetric dimethylarginine (ADMA) levels and tissue doppler echocardiography for heart function in term infants born to mothers with gestational diabetes mellitus

Abstract

Objective: The aim of this study was to examine whether asymmetric dimethylarginine (ADMA) concentrations are associated with ventricular function in the infants of mothers with gestational diabetes.

Method: Twenty-five term newborns of mothers with gestational diabetes and term newborns as the control group (n?=?25) with normal general health status were evaluated at two time points, on the 3rd postnatal day, at the 3th months. Echocardiographic evaluations of all participants were performed and ADMA level was measured.

Results: In the first analysis, 10 patients (40%) had a septal thickness of 6?mm or more, indicating septal hypertrophy. In the first and second analysis, interventricular septum end-diastolic thickness (IVSTd) and the left ventricular posterior wall end-diastolic thickness (LVPWTd) in the patient group were higher than the control group. ADMA level measurement was not significantly different between the groups the first and second analysis. There was no difference in ADMA levels of the group with septal thickness ≥6?mm and the group with <6?mm.

Conclusion: Newborn cardiac wall thickness was increased in pregnancies complicated by Gestational diabetes mellitus (GDM), and the increase was independent of glycemic control. Diastolic newborn cardiac function was impaired in GDM, and this effect was independent of septal thickness. We found no association between ADMA levels and cardiac systolic, diastolic functions or septum thickness in the GDM newborn.     

Influence of difficulty of instrumentation with vacuum on the rate of levator ani muscle avulsion identified by 3–4 d transperineal ultrasound

Objectives: Evaluation of the influence of difficulty of instrumentation with vacuum on the rate of levator ani muscle (LAM) avulsions.

Materials and methods: Prospective observational study with 86 nulliparous women with at term gestation who required instrumentation with vacuum to complete fetal extraction. After every delivery, each explorer reported the number of vacuum tractions needed to complete fetal extraction, as well as the subjective complexity of the instrumentation. LAM avulsion rate was assessed by 3D–4D transperineal ultrasound evaluation 6 months after delivery.

Results: Seventy nine cases were evaluated and classified as either “easy” delivery (below three vacuum tractions; n?=?49) or “difficult” delivery (three or more vacuum tractions; n?=?30). No differences in obstetric characteristics were observed between study groups, with the following exceptions: fetal head circumference (34.8?±?2.7 versus 35.2?±?1.1; p?=?.013) and fetal weight at birth (3260?±?421 versus 3500?±?421; p?=?.016). No statistically significant differences between study groups were observed in LAM avulsion rate (36.7 versus 30%) and levator hiatus area (cm²) at rest (18.44?±?3.95 versus 17.75?±?3.90).

Conclusions: The number of vacuum tractions needed to complete fetal extraction is not associated to a higher LAM avulsion rate nor with differences in levator hiatus area.     

Association between fetal myocardial performance index and fetal heart rate monitoring: a prospective observational cohort study

Objective: To evaluate whether the left myocardial performance index (MPI) changes in association with the fetal heart rate (FHR) tracing during labor.

Study design: Women with term, singleton pregnancies, in labor were recruited to this prospective cohort study. Primary outcome: difference in left MPI between Category of fetal heart rate tracings. Secondary outcomes: differences in left MPI by FHR characteristics. Participants underwent ultrasound examination, during which fetal MPI was measured.

Results: Twenty-four laboring patients were recruited. There were 13 patients with Category I FHR, 11 patients with Category II FHR, and 0 patients with Category III FHR. Demographics were similar between the groups. MPI was not significantly different between fetuses with Category I or Category II FHR (0.67 versus 0.65, p?=?.385). MPI was significantly higher in fetuses with accelerations versus those without (0.71 versus 0.59, p?=?.045). MPI was not significantly different for fetuses with or without decelerations (0.65 versus 0.68, p?=?.350), between deceleration type (0.50 versus 0.64 versus, 0.75, p?=?.421), or between variability type (0.56 versus 0.68, p?=?.113).

Conclusions: MPI of fetuses in term, laboring patients did not vary with differing FHR characteristics except for the presence or absence of accelerations.     

Evaluation of the regional ventricular systolic function by two-dimensional strain echocardiography in gestational diabetes mellitus (GDM) fetuses with good glycemic control

Objective: The aim is to quantitatively assess regional ventricular systolic function by two-dimensional strain (2DS) echocardiography in gestational diabetes mellitus (GDM) fetuses with good glycemic control.

Methods: We studied 60 consecutive normal fetuses and 35 fetuses of GDM mothers with good glycemic control by echocardiography. M-mode and two-dimensional echocardiography were used to measure ejection fraction and wall dimensions of left ventricle and right ventricle. Both left and right ventricle peak systolic myocardial strain values were obtained by 2DS echocardiography.

Results: Compared with normal fetuses, the thickness of the interventricular septum (IVS) and the thickness of right ventricular wall were significantly increased in GDM fetuses (p?<?0.05). Compared with those of normal fetuses, the peak systolic myocardial strain decreased significantly in the apical segments of the IVS and the apical segments of the left ventricular lateral wall in GDM fetuses (p?<?0.05), as well as the apical and middle segments of right ventricular wall in GDM fetuses (p?<?0.05). Peak negative 2DS values in 60 normal fetuses increased with the gestational age, showing a significant linear correlation(r?=?–0.625, p?<?0.001). The average ventricular strain was not correlated to ventricular wall thickness (r?=?0.127, p?=?0.394).

Conclusions: 2DS is a feasible approach to assess regional ventricular systolic function in the fetal hearts and it can be used to examine cardiac systolic function in GDM fetuses with good glycemic control.     

Does vitamin D deficiency affect placental inflammation or infections among very low birth weight infants?

Objective: Examine the association between placental inflammation and neonatal infections, and 25OH vitamin D (25OH D) levels at birth among very low birth weight infants (VLBWI).

Study design: Serum 25OH D levels were measured in 89 VLBWI (≤1250?g) and 47 mothers on day one, and in 78 infants on day 21. Placentas were examined for maternal and fetal inflammation. Infants were divided into deficient (≤10?ng/ml) and adequate (>10?ng/ml) groups based on 25OH D levels on day 1.

Results: Mean?±?SD maternal levels of 25OH D (21?±?9?ng/ml) correlated with infants’ levels (15?±?8?ng/ml), (p?p?=?.011). Infants’ 25OH D levels rose significantly by day 21 (p?p?>?.05). Logistic regression analyses revealed no association between deficient 25OH D levels and the odds of maternal or fetal inflammation or other infections. Levels of 25OH D did not correlate with severity of placental inflammation.

Conclusions: Deficient levels of 25OH D at birth are not associated with the occurrence of placental inflammation or neonatal infections among VLBWI.     

Scheduling GnRH antagonist cycles by a short course of oral estradiol administration during early follicular phase: a comparative study with non-scheduled cycles

Abstract

This hypothesis generating study investigated whether GnRH antagonist cycles can be scheduled by a short course of oral estradiol administration during the follicular phase without impairing treatment outcome. Thirty-five women who underwent follicular phase estrogen scheduling (ES) of GnRH antagonist cycles were retrospectively matched for age and number of prior failed cycles with 35 women who underwent unscheduled GnRH antagonist cycles. ES group was given 6?mg/day estradiol orally from cycle day 2 until (including) one day before the scheduled start of stimulation. Gonadotropins were started on cycle days 2–3 in the control group. Flexible GnRH antagonist protocol was employed in both groups. ES group received estradiol for a median of 5 days. Total gonadotropin consumption was similar but one more GnRH antagonist injection was required in the ES group. Endometrial thickness on the day of hCG injection was increased in the ES group (12 versus 10?mm, p?<?0.01). Number of oocytes, metaphase II oocytes and transferred embryos were similar. Embryo implantation rates were 44.8% versus 34.4% (p?=?0.3), and clinical pregnancy rates were 48.6% versus 37.1%, (p?=?0.33) in the ES and control groups, respectively. All women in the ES group had oocyte retrieval and embryo transfer within the desired period.     

Automated 3D ultrasound measurement of the angle of progression in labor

Objectives: To assess the feasibility and reliability of an automated technique for the assessment of the angle of progression (AoP) in labor by using three-dimensional (3D) ultrasound.

Methods: AoP was assessed by using 3D transperineal ultrasound by two operators in 52 women in active labor to evaluate intra- and interobserver reproducibility. Furthermore, intermethod agreement between automated and manual techniques on 3D images, and between automated technique on 3D vs 2D images were evaluated.

Results: Automated measurements were feasible in all cases. Automated measurements were considered acceptable in 141 (90.4%) out of the 156 on the first assessments and in all 156 after repeating measurements for unacceptable evaluations. The automated technique on 3D images demonstrated good intra- and interobserver reproducibility. The 3D-automated technique showed a very good agreement with the 3D manual technique. Notably, AoP calculated with the 3D automated technique were significantly wider in comparison with those measured manually on 3D images (133?±?17° vs 118?±?21°, p?=?0.013).

Conclusions: The assessment of the angle of progression through 3D ultrasound is highly reproducible. However, automated software leads to a systematic overestimation of AoP in comparison with the standard manual technique thus hindering its use in clinical practice in its present form.     

Maternal obesity is not associated with increased crown-rump length in first-trimester ultrasounds of singleton gestations

Objective: To evaluate whether or not obesity affects fetal growth in the first trimester of pregnancy.

Study design: A retrospective cohort study of obese versus non-obese women in our ultrasound database was performed to compare crown-rump length (CRL), a surrogate of fetal growth, at the first-trimester genetic screening.

Results: A total of 50 obese and 50 non-obese women were included. CRL for both groups was performed at an average of 12wk5d?±?3 d. A linear regression analysis demonstrated that there was no difference between the cohorts in respect to CRL in the first trimester (p?=?.482). However, the estimated fetal weight at second-trimester anatomy ultrasound and the neonatal birth weight were increased in obese women (p?Conclusion: Maternal obesity does not significantly alter the fetal CRL. However, maternal obesity appears to be associated with increased fetal growth as early as the second trimester.     

Prelabour myocardial deformation and cardiac output in fetuses that develop intrapartum compromise at term: a prospective observational study

Objective: Redistribution of cardiac output is responsible for the “brain sparing” effect seen during periods of acute or chronic fetal stress. We investigated the relationship between prelabour cardiac function in fetuses that subsequently developed intrapartum fetal compromise (IFC).

Methods: A blinded, prospective, observational, cohort study, at Mater Mother’s Hospital, Brisbane, Australia. A cohort of 284 women with uncomplicated singleton pregnancies underwent ultrasound every 2 weeks from 36 weeks until delivery. Fetal cardiac output was assessed by conventional Doppler ultrasound and myocardial deformation was measured using velocity vector imaging.

Results: Two hundred and seventy three women were included in the final analysis, of which 19% had an emergency operative delivery for intrapartum fetal compromise (IFC). Global left ventricular strain (?12.1%, interquartile ranges (IQR)???10.3 to ?14% versus 13%, IQR ?11.3 to ?14.2%, p?=?.01) and strain rate (?1.00, IQR 0.85–1.16?s^?1 versus ?1.11, IQR ?1.00 to ?1.21?s^?1, p??1 versus 1.13?±?0.22?s^?1, p?p?p?Conclusion: Lower global left ventricular strain and strain rate and cardiac output are associated with IFC and poorer condition of the newborn. Assessment of fetal cardiac function may be useful for risk stratification for intrapartum fetal compromise in apparently “low risk” term pregnancies.     

Assessment of human placental perfusion by intravoxel incoherent motion MR imaging

Purpose: To provide functional information on the human placenta, including perfusion, and diffusion, with no contrast agent injection, and to study correlations between intravoxel incoherent motion (IVIM) placental parameters and fetal growth.

Materials and methods: MRI was performed in women undergoing legal termination of pregnancy at 17–34 weeks, including a 4-b-value and 11-b-value DW sequences. The apparent diffusion coefficient (ADC), the restricted diffusion coefficient (D), the pseudoperfusion coefficient (D*), and the perfusion fraction (f) were calculated. Their relationships with gestational age, Z-scores for fetal and placental weight were evaluated by means of regression analysis. Logistic regression analysis was used to assess the ability of IVIM parameters to predict/detect intrauterine growth retardation (SGA).

Results: Fifty-five pregnant women, including nine cases of SGA (16%), were included in the study. The ADC (n?=?55) showed a quadratic correlation with gestational age (p?p?=?.02). Mean ADC values were significantly different between normally growing and SGA fetuses (2.37?±?0.25 versus 2.29?±?0.33 10^?3.mm².s^?1, p=.048). The perfusion fraction f (n?=?23) showed a quadratic correlation with gestational age (p?=?.017) and a linear correlation with the fetal weight Z???score (p?=?.008). Mean f values differed significantly between normally growing and SGA fetuses (42.55?±?9.30% versus 27.94?±?8.76%, p?=?.002). The receiver operating characteristics (ROC) curve for f to predict SGA was produced (area under the ROC curve?=?0.9).

Conclusions: The observed association between f and fetal weight suggests that fMRI could be suitable for studying placental insufficiency and for identifying risk of SGA.

Trial registration: ClinicalTrials.gov identifier: NCT01092949.     

The feasibility of using 5D CNS software in obtaining standard fetal head measurements from volumes acquired by three-dimensional ultrasonography: comparison with two-dimensional ultrasound

Objective: To evaluate the performance of a new software (5D CNS) developed to automatically recognize the axial planes of the fetal brain from three-dimensional volumes and to obtain the basic standard biometric measurements. The accuracy, reproducibility, and time required for analysis of 5D CNS were compared with that of two-dimensional (2D) ultrasound.

Methods: This was a prospective study of 120 uncomplicated singleton pregnancies undergoing routine second trimester examination. For every pregnancy standard biometric measurements including biparietal diameter, head circumference, distal lateral ventricle width, transverse cerebellar diameter and cisterna magna width were obtained using 2D ultrasound and three-dimensional (3D) ultrasound with 5D CNS software. Reliability and agreement of the two techniques were evaluated using intraclass correlation coefficients (ICCs) and proportionate Bland–Altman plots were constructed. The time necessary to complete the measurements with either technique was compared and intraobserver and interobserver agreements of measurements calculated.

Results: In 118/120 (98.3%), 5D CNS successfully reconstructed the axial diagnostic planes and calculated all the basic biometric head and brain measurements. The agreement between the two techniques was high for all the measurements considered (all ICCS?>?0.920). The time necessary to measure the biometric variables considered was significantly shorter with 5D CNS (54 versus 115?s, p?<?0.0001) than with 2D ultrasonography. No significant differences were found in 5D CNS repeated measurements obtained either by the same observer or by two independent observers.

Conclusion: 5D CNS software allows us to obtain reliable biometric measurements of the fetal brain and to reduce the examination time. Its application may improve work-flow efficiency in ultrasonographic practices     

Five-dimensional long bones biometry for estimation of femur length and fetal weight at term compared to two-dimensional ultrasound: a pilot study

Background/objective: This study aimed to evaluate accuracy of five-dimensional long bones (5D LB) compared to two-dimensional ultrasound (2DUS) biometry to predict fetal weight among normal term women.

Methods: Fifty six normal term women were recruited at Ain Shams Maternity Hospital, Egypt from 14 May to 30 November 2015. Fetal weight was estimated by Hadlock’s IV formula using 2DUS and 5D LB. Estimated fetal weights (EFW) by 2DUS and 5D LB were compared with actual birth weights (ABW).

Results: Mean femur length (FL) was 7.07?±?0.73?cm and 6.74?±?0.67?cm by 2DUS and 5D LB (p?=?.02). EFW was 3309.86?±?463.06?g by 2DUS and 3205.46?±?447.85?g by 5D LB (p?=?.25). No statistical difference was observed between ABW and EFW by 2DUS (p?=?.7) or 5D LB (p?=?.45). Positive correlation was found between EFW by 2DUS, 5D LB, and ABW (r?=?0.67 and 0.7; p?p?=?.15).

Conclusions: 2DUS and 5D LB had same accuracy for fetal weight estimation at normal term pregnancy.     

Assessment of motoric and hemodynamic parameters in growth restricted fetuses – case study

Abstract

Objective: In order to more accurately assess fetal neurological status in five fetuses with severe intrauterine growth restriction (IUGR), combined assessment of their hemodynamics and motor activity was undertaken in this study.

Method: Hemodynamic changes in the placental and fetal cerebral vessels were evaluated using the umbilical artery resistance index (URI), and the middle cerebral artery resistance index (CRI). The blood flow redistribution towards the fetal brain in response to fetal hypoxia was detected by the C/U (cerebro – umbilical) ratio, expressed as CRI/URI.

Motoric parameters were assessed by new antenatal neurologic scoring test named Kurjak Antenatal Neurodevelopmental Test (KANET), based on evaluation of spontaneous motor activity using four-dimensional (4D) ultrasound.

Results: KANET has potential in recognizing pathologic and borderline behavior in IUGR fetuses with or without blood flow redistribution towards the fetal brain. Very low values of C/U ratio and abnormal KANET score have indicated adverse pregnancy outcome.

Conclusion: In some pregnancies complicated with IUGR, estimation of the risk of hypoxia versus prematurity can be extremely puzzling. Combined assessment of hemodynamic and motoric parameters in IUGR fetuses could allow construction of an algorithm, which would be helpful in the decision making process of pregnancy termination.     

Fetal middle cerebral and umbilical artery Doppler after 40 weeks gestational age

Abstract

Objective: To determine the value of fetal Doppler indices named middle cerebral artery (MCA)-PI, umbilical artery (UA)-PI and MCA-PI/UA-PI ratio, and amniotic fluid volume assessment in pregnancies 280–294?d and their correlation with the mode of delivery and perinatal outcome.

Study design: Prospective observational study conducted on 100 whose gestational age (GA) from 40 to 42 weeks. MCA and UA Doppler and MCA-PI/UA-PI ratio, amniotic fluid volume (AFV) were assessed. They were divided into two groups based on the presence or absence of adverse perinatal outcome.

Results: Women with adverse perinatal outcome showed lower MCA-PI (0.92 versus 1.29), MCA-PI:UA-PI ratio (1.04 versus 1.83), lower gestational age when assessed by ultrasound (37.82 versus 39.48 weeks), lower neonatal birth weight (2705 versus 3108?g), fetal biophysical profile (BPP) (4.55 versus 7.21) when compared to women with normal perinatal outcome. They also had higher cases with oligohydramnios (34 versus 5), and higher UA-PI (0.89 versus 0.72).

Conclusion: Women with adverse neonatal outcome had higher UA-PI and lower MCA-PI, MCA-PI:UA-PI ratio, GA (by US), AFV, BPP, estimated fetal weight, neonatal birth weight when compared to those with normal perinatal outcome. Women with adverse neonatal outcome had a higher rate of cesarean section mostly due to fetal distress and induced VD due to oligohydraminos compared to the normal outcome group.     

Comparison of right ventricular measurements and SFRV in fetuses with and without tricuspid regurgitation at 11+0 and 13+6 weeks’ gestation

Abstract

Objectives: To compare right ventricular dimensions and systolic shortening fraction of the right ventricle (SFRV) in fetuses with tricuspid regurgitation (TR [+]) to those without tricuspid regurgitation (TR [?]).

Methods: Unselected patients presenting for first trimester screening between 11?+?0 and 13?+?6 weeks’ gestation were examined for the presence or absence of fetal tricuspid regurgitation using a standard approach. Only euploid fetuses without structural anomalies were included in the study. The heart was examined with the aid of M-mode using a previously described method. The right ventricular diastolic diameter (RVDD) and right ventricular systolic diameter (RVSD) were measured on stored M-mode images and the SFRV was calculated using the following formula [(RVDD?RVSD)/RVDD]?×?100.

Results: A total of 69 fetuses (n?=?44 (TR [?]); n?=?25 (TR [+])) were examined. The two groups were similar in maternal age, gestational age and nuchal translucency (NT) measurements. The SFRV was noted not to change with gestational age and there was no statistical difference between the two groups. Both the RVDD and the RVSD increased with gestational age. The calculated delta RVDD was statistically larger in the TR [+] group (mean: 0.29, CI 95%: 0.054–0.532) than the TR [?] group (mean: 0.013, CI 95%: ?0.128 to 0.154) (p?<?0.05). This was not true for the delta RVSD: TR [+] (mean: 0.17, CI 95%: 0.015–0.325) versus TR [?] group (mean: 0.035, CI 95%: ?0.061 to 0.131). However, there was a trend towards larger RVSD in the TR [+] group (p?=?0.13).

Conclusions: The presence of TR appears to be associated with an increased RVDD in normal fetuses between 11?+?0 and 13?+?6 weeks’ gestation.     

Fetal hydrops and the risk of severe preeclampsia

Objective: To assess the incidence and severity of preeclampsia in pregnancies complicated by fetal hydrops.

Methods: We performed a retrospective cohort study of singleton gestations from 2005 to 2008 in California. The primary predictor was fetal hydrops and the primary outcome was preeclampsia. Selected adverse maternal and neonatal events were assessed as secondary outcomes. Potential confounders examined included fetal anomalies, polyhydramnios, race/ethnicity, nulliparity, chronic hypertension, and gestational or pregestational diabetes mellitus.

Results: We identified 337 pregnancies complicated by fetal hydrops, 70.0% had a concomitant fetal anomaly and 39.8% had polyhydramnios. Compared to the general population, hydrops was associated with an increased risk for severe preeclampsia (5.26 versus 0.91%, p?p?=?.29). In multivariable analysis, fetal hydrops remained an independent risk factor for severe preeclampsia (as adjusted odds ratios (aOR) 3.13, 1.91–5.14). Hydrops was also associated with increased rates of eclampsia, acute renal failure, pulmonary edema, postpartum hemorrhage, blood transfusion, preterm birth, and neonatal death.

Conclusions: We find that fetal hydrops is an independent risk factor for severe preeclampsia. In light of serious concerns for maternal and neonatal health, heightened surveillance for signs and symptoms of severe preeclampsia is warranted in all pregnancies complicated by fetal hydrops.