PERINATAL AND MATERNAL OUTCOME FOLLOWING ABRUPTIO PLACENTAE

Objective: To characterize the maternal and fetal presentation of abruptio placentae and associated maternal and fetal morbidity and mortality by mode of delivery and fetal status on admission.

Study Design: Perinatal data (gestational age > 24 weeks) from women with abruptio placentae at a tertiary referral center were analyzed. For the purpose of evaluating fetal morbidity and mortality, group 1 included women with hypertensive disorders of pregnancy (preeclampsia or chronic hypertension), PROM, cocaine abuse, and > 20% abruptio placentae without regard to fetal status on admission (reassuring, nonreassuring, or stillborn). In group 1, either umbilical artery pH < 7.0, Apgar < 3⁵, or base excess > 12 mmol/L represented perinatal hypoxia for this evaluation. Group 2 included women with stillborn fetuses on admission without regard to etiology or size of abruptio placentae. Comparisons between groups were made with one-way analysis of variance, Kruskal–Wallis, or χ² tests; p < 0.05 was considered significant.

Results: Group 1 was comprised of 342 women; 58.4% of fetuses had abnormal fetal heart rate tracings. Overall, the sensitivity of an abnormal fetal heart rate tracing to predict perinatal hypoxia was 87.2%, specificity was 33.9%, positive predictive value was 22.2%, and negative predictive value was 92.5%. Of parameters suggestive for perinatal hypoxia, 17.3% of neonates had Apgar < 3⁵, 13.0% had umbilical artery pH < 7.0, and 9.9% had base excess > 12 mmol/L. Overall, neonatal survival was 84.7%; 12.0% of fetuses were stillborn. For those fetuses alive on admission, cesarean delivery was associated with a significant reduction in neonatal mortality: odds ratio of 0.10 (95% confidence interval: 0.05–0.20) and p = 0.0001. Group 2 was comprised of 61 women. Women presenting with a stillborn infant on admission were more likely to require transfusions and suffer the complications (disseminated intravascular coagulopathy, acute renal failure, and acute respiratory distress syndrome) than women presenting with a live fetus.

Conclusion: Cesarean delivery appeared to reduce neonatal mortality. Whether emergent cesarean delivery resulted in the birth of compromised fetus cannot be evaluated from this study. Composite maternal morbidity is increased when a stillborn fetus is present on admission.     

Second trimester maternal serum inhibin-A in fetal anemia secondary to hemoglobin Bart’s disease

Abstract

Objective: To compare the levels of inhibin-A between pregnancies with fetal anemia secondary to Hb Bart’s disease and pregnancies with normal non-anemic fetuses.

Methods: Sixty-five pregnancies at risk of fetal Hb Bart’s disease scheduled for cordocentesis at 18–22 weeks were prospectively recruited into the study. Inhibin-A levels were measured from maternal blood drawn before cordocentesis. Fetal blood samples were collected for fetal Hb typing and hemoglobin (Hb) levels.

Results: Maternal serum inhibin-A was significantly higher in women with fetal Hb Bart’s disease than those with unaffected fetuses (1.03?MoM (multiple of median) and 0.75 MoM, respectively, p?=?0.001). The relationship between maternal serum inhibin-A and fetal Hb level was a quadratic equation; inhibin-A?=?5.248?–?9.415(Hb)?+?4.919(Hb)² (r²?=?0.274, p?<?0.001). Maternal serum inhibin-A did not correlate with cardiomegaly but was significantly associated with placental thickness; inhibin-A?=?1.372?–?0.751(Pl)?+?0.214(Pl)² (r²?=?0.237, p?=?0.007).

Conclusions: Maternal serum inhibin-A levels were significantly higher in pregnancies with fetal Hb Bart’s disease. The elevation of inhibin-A was likely to be a consequence of fetal anemia and placentomegaly. Since inhibin-A is commonly used as a component of quadruple test; the calculated risk of Down’s syndrome may be unreliable in pregnancies with fetal Hb Bart’s disease or possible fetal anemia.     

Subarachnoid space diameter in chromosomally abnormal fetuses at 11–13 weeks’ gestation

Objectives: To examine the subarachnoid space diameters in chromosomally abnormal fetuses at 11–13 weeks’ gestation.

Methods: Stored three-dimensional (3D) ultrasound volumes of the fetal head at 11–13 weeks’ gestation from 407 euploid and 88 chromosomally abnormal fetuses (trisomy 21, n?=?40; trisomy 18, n?=?19; trisomy 13, n?=?7; triploidy, n?=?14; Turner syndrome, n?=?8) were analyzed. The subarachnoid space diameters, measured in the sagittal and transverse planes of the fetal head, in relation to biparietal diameter (BPD) in each group of aneuploidies was compared to that in euploid fetuses. A total of 20 head volumes were randomly selected and all the measurements were recorded by two different observers to examine the interobserver variability in measurements.

Results: In euploid fetuses, the anteroposterior, transverse and sagittal diameters of the subarachnoid space increased with BPD. The median of the observed to expected diameters for BPD were significantly increased in triploidy and trisomy 13 but were not significantly altered in trisomies 21 and 18 or Turner syndrome. In triploidy, the subarachnoid space diameters for BPD were above the 95th centile of euploid fetuses in 92.9% (13 of 14) cases. The intraclass reliability or agreement was excellent for all three subarachnoid space diameters.

Conclusion: Most fetuses with triploidy at 11–13 weeks’ gestation demonstrate increased subarachnoid space diameters.     

Echogenicity changes in the fetal brain,a 6-year follow-up study

Abstract

Objective: To asses the relation between echogenicity changes in the fetal brain and neurodevelopmental outcome until 6 years of age.

Methods: Fetuses (n?=?124) from pregnancies affected by hypertensive disorders (n?=?64) or preterm labor (n?=?60) at risk for preterm birth (26–34 weeks gestation) were studied. Moderate echogenicity changes (periventricular grade IB, II; intraventricular grade II–III; local basal ganglia/thalami) in the fetal and neonatal brain were related to neurological outcome and Griffiths mental developmental scales quotients at 1, 2 and 6 years. Multiple regression analysis tested the influence of moderate echogenicity changes and perinatal clinical characteristics on composite outcome (death or abnormal neurodevelopment).

Results: Moderate echogenicity changes were present in 37/124 (30%) fetuses. Median gestational age and weight at birth were respectively 31 weeks (range 26–43), 1314?g (range 550–4330), mortality was 19%, follow-up loss 10%. Composite outcome was abnormal in 47/124 (38%). Fetal and neonatal moderate intraventricular echodensities were related to cerebral palsy at 6 years (p?<?0.04). In the multiple regression analysis only gestational age was related to composite outcome (p?=?0.005).

Conclusions: Moderate intraventricular echodensities in the fetal brain related to cerebral palsy at 6 years of age. Gestational age at birth was the main predictor of abnormal composite outcome.     

Differential expression of cord blood neurotrophins in gestational diabetes: the impact of fetal growth abnormalities

Objective: Gestational diabetes mellitus (GDM) may induce fetal macrosomia or growth restriction and is associated with later offspring neurodevelopmental disorders. We aimed to determine whether neurotrophins brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF) and neurotrophin-4 (NT-4) are differentially expressed in cord blood samples at birth in large-for-gestational-age (LGA), intrauterine-growth-restricted (IUGR) and appropriate-for-gestational-age (AGA) offspring of diabetic mothers, as compared to AGA controls from non-diabetic mothers.

Methods: BDNF, NGF and NT-4 concentrations were prospectively determined in 80?cord blood samples from LGA (n?=?15), IUGR (n?=?12) and AGA (n?=?33) diabetic, as well as from AGA normal (controls, n?=?20) singleton full-term pregnancies.

Results: Fetal BDNF concentrations considerably decreased in GDM, as compared with normal pregnancies [(b?=??2.836, 95%CI ?5.067 to (?0.604), p?=?0.013)] and were higher in females (b?=?2.298, 95%CI 0.357–4.238, p?=?0.021). Cord blood NGF concentrations were lower in IUGR than AGA infants (p?=?0.038).

Conclusions: BDNF is down-regulated in the fetus exposed to GDM, independently of the fetal growth pattern, probably representing a candidate mechanism underlying the association between maternal diabetes and later psychopathology. IUGR fetuses born to diabetic mothers present with NGF deficiency, which may contribute to their long-term neurodevelopmental sequelae. Gender-dependent differences in fetal BDNF may partly explain the higher prevalence of adverse neurodevelopmental outcomes following brain insults in male infants.     

Perinatal sclerostin concentrations in abnormal fetal growth: the impact of gestational diabetes

Objective: To prospectively evaluate maternal and cord blood concentrations of sclerostin – an osteocyte-secreted factor, inhibiting osteoblast differentiation and bone formation and associated with adverse metabolism – in pregnancies with normal and abnormal fetal growth.

Methods: Plasma sclerostin concentrations were determined by ELISA in 80 maternal and 80?cord blood samples from asymmetric intrauterine-growth-restricted (IUGR, n?=?30), large-for-gestational-age (LGA, n?=?30), and appropriate-for-gestational-age (AGA, n?=?20) singleton full-term pregnancies. Fourteen out of 30 mothers with LGA offspring presented with gestational diabetes mellitus (GDM).

Results: Maternal and fetal sclerostin concentrations did not differ among LGA, IUGR, and AGA groups. Fetal concentrations were higher than maternal. In LGA group, maternal concentrations were elevated in cases of GDM (b?=?13.009, 95%CI 1.425–24.593, p?=?.029). In a combined group and the IUGR group, maternal concentrations were elevated in older mothers (b?=?0.788, 95%CI 0.190–1.385, p?=?.010, and b?=?0.740, 95%CI 0.042–1.438, p?=?.039, respectively).

Conclusions: Maternal and fetal sclerostin concentrations may not be differentially regulated in pregnancies complicated by abnormal fetal growth. Circulating maternal levels are higher in cases of GDM, probably implying reduced bone formation. Sclerostin up-regulation with aging may be one of the molecular pathways responsible for the observed age-related decline in bone synthesis, leading to accelerated bone loss in humans.     

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.     

Divergence of estimated fetal weight and birth weight in singleton fetuses

Objective: To evaluate differences in distribution of estimated fetal weight (EFW) and birth weight (BW) of ongoing fetuses and neonates of the same gestational age.

Methods: Reference curves for EFW (Hadlock BPD-HC-AC-FL formula, N?=?1191) and BW (N?=?1036) in singleton pregnancies from 24⁺⁰ to 40⁺⁶ gestational weeks were calculated. Multiple pregnancies, fetuses with major or multiple abnormalities or syndromes and iatrogenic preterm deliveries due to preeclampsia or abnormal fetal Doppler were excluded. The standardized residuals for EFW and BW were calculated and compared.

Results: EFW and BW can be accurately described by quadratic equations (R²?=?0.944 and 0.807, respectively). The distribution of standardized residuals for BW using the EFW formula was negative from 28⁺⁰ to 35⁺⁶ weeks. The 50th and 5th centiles of BW were lower than those of EFW throughout prematurity, and they converged at approximately 38 gestational weeks. The 5th centile for BW was 30% lower than the 5th centile for EFW at 27 weeks, 27.5% lower at 30 weeks and 19.4% at 34 weeks.

Conclusions: Preterm infants have lower BW distribution compared to the expected EFW of ongoing pregnancies of the same gestational age, supporting the concept of hidden intrauterine morbidity for a proportion of these infants.     

Ultrasound measurement of fetal adrenal gland in fetuses with intrauterine growth restriction,an early predictive method for adverse outcomes

Objectives: Comparing the sonographic measurements of fetal adrenal gland in pregnancies with intrauterine growth restriction (IUGR) versus healthy controls and to assess whether the changes in adrenal gland measurements could predict adverse pregnancy outcomes in IUGR fetuses.

Methods: This prospective cohort study evaluated 97 pregnant women (48 with IUGR pregnancies and 49 healthy controls) during their third gestational trimester. All mothers underwent two dimensional ultrasonography of the fetal adrenal gland, and the fetal zone in transverse, sagittal, and coronal planes. Adrenal gland volume (AGV) and fetal zone volume (FZV) were calculated and corrected (c) for fetal weight. The mothers were then followed until delivery.

Results: Fetuses in the IUGR group had larger corrected adrenal gland volume (c_AGV) and smaller corrected fetal zone volume (c_FZV) compared to the fetuses in the control groups (p?p?Conclusions: Third trimester fetal adrenal gland sonography could potentially be used as an easy noninvasive method for identifying those IUGR fetuses who might have poorer outcomes.     

Outcomes in the absence of the ductus venosus diagnosed in the first trimester

Purpose: To clarify the outcomes of the absence of the ductus venosus (DV) diagnosed in fetuses suspected to have a structural abnormality during a morphological assessment in the first trimester.

Methods: Infants in whom ultrasound fetal morphological assessments were attempted in the first trimester (11 to 13–6 weeks of gestation) and who were subsequently delivered between 2013 and 2015 at Showa University Hospital were enrolled. In cases in which the absence of the DV was diagnosed in the first trimester, the prognosis was assessed.

Results: First-trimester ultrasound screening was performed in a total of 2610 cases between 2013 and 2015. Fetal edema (n?=?38), hydrops (n?=?16), abnormal four-chamber view findings (n?=?2), and tricuspid regurgitation (n?=?1) were observed in a total of 52 cases (2.0%). In 4 of the 52 cases with abnormal ultrasound findings, the absence of the DV was detected.

Conclusion: If fetal edema or hydrops in early pregnancy is found without any other structural abnormalities, not only chromosomal abnormalities should be suspected but also an evaluation for the absence of the DV should be included. In addition, absence of the DV with fetal edema may be associated with the outcomes of cardiac dysfunction, chromosome abnormalities, and intrauterine sudden death. Severe fetal edema is associated with a poor prognosis, and the family must be carefully informed of the potential outcomes.     

The potential of 4D sonography in the assessment of fetal behavior in high-risk pregnancies

Objective.?To assess differences of fetal behavior in normal and high-risk pregnancies.

Methods.?In the 1-year period (1 January 2007–31 December 2007), four-dimensional ultrasound has been used to assess Kurjak antenatal neurodevelopmental test (KANET) in low- and high-risk pregnancies after randomization in prospective longitudinal cohort study. Based on the KANET scores, the fetuses were considered as normal (≥14 points), borderline (6–13), or abnormal (0–5).

Results.?Comparison of KANET scores in low- and high-risk pregnancies were expectedly statistically significant. The largest incidence of fetuses with abnormal KANET was in the group of fetuses who had siblings with cerebral palsy. The largest incidence of the borderline KANET has been found in the group of fetuses whose mothers had fever during pregnancy. The following parameters of KANET test significantly differed between the fetuses from low- and high-risk pregnancies: overlapping cranial sutures, head circumference, isolated eye blinking, facial expressions, mouth movements, isolated hand movements, isolated leg movements, hand to face movement, finger movements, and general movements.

Conclusion.?KANET test has the potential to detect and discriminate normal from borderline and abnormal fetal behavior in normal and in high-risk pregnancies.     

Influence of fetal acidemia on fetal heart rate analyzed by computerized cardiotocography in pregnancies with placental insufficiency

Abstract

Objective: To determine the influence of fetal acidemia on fetal heart rate (FHR) parameters analyzed by computerized cardiotocography (cCTG) in pregnancies with placental insufficiency.

Methods: This was a cross-sectional study of 46 pregnancies with placental insufficiency between 26 and 34 weeks gestation by abnormal umbilical artery Doppler [pulsatility index (PI)?>?95th percentile].

Results: Twenty fetuses had acidemia at birth, pH?<?7.20 (43.5%) and 26 had normal pH (56.5%). In the analysis of FHR parameters, fetal movements (FM) per hour was significantly lower in the group with acidemia (median?=?2) when compared with the group with normal pH (median?=?15, p?=?0.019). The values of pH correlated positively with FM (ρ?=?0.35; p?=?0.019, 95% CI: 0.061 to 0.577) and basal FHR (ρ?=?0.37, p?=?0,011, 95% CI: 0.090 to 0.597) and negatively with the ductus venosus (DV) PI for veins (PIV) z-score (ρ?=??0.31, p?=?0,036, 95% CI: ?0.550 to ?0.021). Logistic regression showed that the DV PIV z-score (p?=?0.0232) and basal FHR (p?=?0.0401) were independent variables associated with acidemia at birth.

Conclusions: The present results suggest that cCTG parameters may be useful in the management of cases with early onset placental insufficiency in association with Doppler velocimetry assessment, and that basal FHR and DV-PIV are most clearly in association with acidemia at birth.     

The profiles of soluble adhesion molecules in the “great obstetrical syndromes”*

Objective: The objective of this study was to determine the profiles of maternal plasma soluble adhesion molecules in patients with preeclampsia, small-for-gestational-age (SGA) fetuses, acute pyelonephritis, preterm labor with intact membranes (PTL), preterm prelabor rupture of the membranes (preterm PROM), and fetal death.

Materials and methods: A cross-sectional study was conducted to determine maternal plasma concentrations of sE-selectin, sL-selectin, and sP-selectin as well as sICAM-1, sVCAM-1, and sPECAM-1 in patients with (1) an uncomplicated pregnancy (control, n?=?100); (2) preeclampsia (n?=?94); (3) SGA fetuses (in women without preeclampsia/hypertension, n?=?45); (4) acute pyelonephritis (n?=?25); (5) PTL (n?=?53); (6) preterm PROM (n?=?24); and (7) fetal death (n?=?34). Concentrations of soluble adhesion molecules and inflammatory cytokines (tumor necrosis factor (TNF)-α and interleukin (IL)-8) were determined with sensitive and specific enzyme-linked immunoassays.

Results: In comparison to women with a normal pregnancy, (1) women with preeclampsia had higher median concentrations of sE-selectin, sP-selectin, and sVCAM-1, and a lower concentration of sL-selectin (all p values?p values?p values?p values?p values?p values p values?Conclusions: The results of this study show that endothelial cell activation/dysfunction reflected by the plasma concentration of sE-selectin is not specific to preeclampsia but is present in pregnancies complicated by SGA fetuses, acute pyelonephritis, and fetal death. Collectively, we report that each obstetrical syndrome appears to have a stereotypical profile of soluble adhesion molecules in the peripheral circulation.     

Gender differences in amniotic fluid cytokine levels

Objective: Placental trophoblast invasion and amniotic fluid cytokine receptor levels have been reported to vary with fetal gender. We investigated whether fetal gender affects amniotic fluid levels of the inflammatory cytokines interleukin (IL)-6 and IL-10 and the pro-angiogenesis cytokine angiogenin.

Methods: Specimens from singleton gestations undergoing mid-trimester amniocentesis for genetic indications were used. Inclusion criteria were (1) outcome information available, (2) no structural or chromosomal anomaly and (3) no conditions associated with preterm delivery. Amniotic fluid IL-6, IL-10 and angiogenin levels were measured by immunoassay. Statistical analysis included the Mann–Whitney U test and Fisher's exact test with p?<?0.05 indicating significance.

Results: A total of 74 samples were analyzed. Angiogenin levels were significantly lower in amniotic fluid samples from pregnancies with a male than with a female fetus (median (range): 22.2 (5.9–66.4) vs. 32.0 (11.4–159.2) ng/ml, p?=?0.007), in contrast to no differences in amniotic fluid IL-6 and IL-10 levels (p?=?0.4 and p?=?0.1, respectively). In pregnancies with male fetuses delivering preterm (<?37 weeks), angiogenin was also detected at lower levels (p?=?0.02). There were no gender differences with respect to race, nulliparity or maternal age.

Conclusion: Angiogenin levels, but not IL-6 or IL-10 levels, are significantly lower in second-trimester amniotic fluid of women with male compared with female fetuses, including those women delivering preterm.     

Demographic factors determining termination of pregnancy following the detection of lethal fetal malignancy

Abstract

Objective: To identify demographic and clinical variables differentiating pregnant Polish women who decided to terminate the pregnancy in the case of lethal fetal malformation from those who preferred to continue the pregnancy in such a situation.

Study design: Cross-sectional study.

Results: The group of women who decided to abort contained a higher fraction of multiparas than the group of patients who chose to continue their pregnancies, and was characterized by significantly lower mean gestational age at diagnosis of lethal fetal malformation. The only demographic variable approaching statistical significance was the presence of siblings, which was significantly more frequent amongst women who decided to terminate the pregnancy.

Conclusions: As the decision-making process on pregnancy termination is multimodal, pregnant women require particular support in the case of detecting lethal malformation in their fetuses.     

A management strategy for fetal immune-mediated atrioventricular block

Introduction.?The purpose of this study is to describe an in utero management strategy for fetuses with immune-mediated 2° or 3° atrioventricular (AV) block.

Methods and results.?The management strategy as applied to 29 fetuses consisted of three parts. First, using fetal echocardiography and obstetrical ultrasound, we assessed fetal heart rate (FHR), heart failure, growth and a modified biophysical profile score (BPS) assessing fetal movement, breathing and tone. Second, we treated all fetuses with transplacental dexamethasone, adding terbutaline if the FHR was?<56 bpm. Digoxin and/or intravenous immune globulin (IVIG) was added for progressive fetal heart failure. Third, we delivered fetuses by cesarean section for specific indications that included abnormal BPS, maternal/fetal conditions, progression of heart failure, or term pregnancy. We assessed perinatal survival, predictors of delivery and maternal/fetal complications in 29 fetuses with 3° (n?=?23) or 2° (n?=?6) AV block. There were no fetal deaths. In utero therapy included dexamethasone (n?=?29), terbutaline (n?=?13), digoxin (n?=?3) and/or IVIG (n?=?1). Delivery indications included term gestation (66%), fetal/maternal condition (14%), low BPS (10%) and progression of fetal heart failure (10%). An abnormal BPS correlated with urgent delivery.

Conclusion.?These results suggest that applying this specific management strategy that begins in utero can improve perinatal outcome of immune-mediated AV block.     

Weight gain regardless of pre-pregnancy BMI and influence of fetal gender in response to labor induction in postdate pregnancy

Abstract

Objective: To evaluate whether maternal weight and body mass index (BMI) and their increase throughout pregnancy are associated with the response to labor induction in postdate pregnancies.

Methods: A total of 376 nulliparous women carrying singleton postdate pregnancies with unfavorable cervix were enrolled. We considered as primary outcome vaginal delivery within 24?h after induction, and outcomes were divided into responders (n?=?258) and non-responders (n?=?107) to the induction of labor to perform the statistical analyses.

Results: In the total population of study, women who successfully delivered within 24?h differed significantly from the remaining patients in terms of maternal weight gain (p?=?0.009) and BMI increase (p?=?0.02) during pregnancy. In addition, males were significantly more (p?=?0.005) than females among newborns of women not responding to induction of labor. In the multivariate analysis, maternal weight gain and fetal sex significantly influenced the induction response. The occurrence of a failed induction of labor was more likely in patients presenting a greater maternal weight gain (cut-off 12?kg) and male fetus.

Conclusion: Weight gain over 12?kg regardless of pre-pregnancy weight and male fetal gender are two novel potential risk factors for the prediction of failure to induction of labor in postdate pregnancy.     

Are there any relationships between umbilical artery Pulsatility Index and macrosomia in fetuses of type I diabetic mothers?

Abstract

Objective: To establish whether there are relationships between umbilical artery Pulsatility Index (PI) and fetal macrosomia in pregnancies complicated by type I diabetes.

Methods: In a retrospective observational study, 102 singleton pregnant women with type I diabetes were considered. Umbilical artery PI was measured by Doppler ultrasonography within one week from delivery and related to neonatal weight. Pregnancies were grouped according to birtweight in macrosomic group (≥4000?g) and normal growth group (<4000?g). Relationships between umbilical artery PI and birth weight and birth weight centile were tested by Pearson’s correlation analysis. Further umbilical artery PI values were compared between macrosomic and normally grown fetuses.

Results: Birth weight was ≥4000?g in 24 pregnancies (23.5%). A significant relationship was found between umbilical artery PI and neonatal weight (r?=?0.512; p?<?0.01) and neonatal weight centile (r?=?0.400; p?<?0.01). Umbilical artery PI were significantly lower (t?=??6.013; p?<?0.001) in the macrosomic group (0.78; 95% confidence interval (CI) 0.73–0.84) than in the normal growth group (1.00; 95% CI 0.97–1.04).

Conclusions: In pregnancies complicated by type I diabetes there is a significant relationship between umbilical artery PI value before delivery and absolute birth weight and birth weight centile. Macrosomic fetuses show a significant reduction in umbilical artery PI when compared with diabetic pregnancies without fetal overgrowth.     

Prenatal diagnosis and outcome of lymphangiomas and its relationship with fetal chromosomal abnormalities

Objectives: Our aim was to evaluate ultrasound findings and perinatal outcome after prenatal diagnosis of lymphangioma.

Methods: This was a retrospective case series study. We searched the archives of our ultrasound database at our center for cases with the prenatal diagnosis of the lymphangioma in the period between January 2008 and November 2014. We described maternal, fetal and perinatal variables for all cases.

Results: Nine fetuses with lymphangioma were identified. All cases were diagnosed during the second and third trimesters with the average gestational age of 22.6?±?3.9 weeks. The average diameter of lymphangioma was 55.4?±?20.1?mm at the time of diagnosis. Five fetuses (55.6%) had lymphangioma on the neck, and four fetuses (44.4%) had lymphangioma on other localizations. Normal fetal karyotype was detected in all cases. There were a total of six live births, one intrauterine death and two medical terminations of pregnancy following the diagnosis of lymphangioma. No abnormal Doppler finding or hydrops were detected in the antenatal follow-up of remaining six cases.

Conclusion: The risk of chromosomal abnormalities is very low in pregnancies with isolated lymphangioma. The outcome of pregnancies with lymphangioma is generally favorable and prognosis depends on their locations and size.     

Potential prognostic biomarkers of cardiovascular disease in fetal macrosomia: the impact of gestational diabetes

Objective: Fetal macrosomia is associated with cardiac hypertrophy and increased cardiovascular risk. Cardiac biomarkers may play diagnostic/prognostic role in cardiovascular disease. We tested whether cardiac biomarkers are differentially expressed in cord blood samples of full-term singleton large-for-gestational-age (LGA), as compared to appropriate-for-gestational-age (AGA) pregnancies.

Methods: Cardiotrophin-1 (CT-1), Titin, pentraxin (PTX-3) and soluble CD36 (sCD36) concentrations were determined in 80?cord blood samples from a) LGA pregnancies due to maternal diabetes (n?=?8), overweight/obese (n?=?11), excessive weight gain (n?=?7), without specific pathology (n?=?14), b) AGA normal pregnancies (controls, n?=?40). Neonates were classified as LGA or AGA based on customized birth weight (BW) standards.

Results: CT-1 and Titin concentrations were higher in LGA than AGA pregnancies (p?p?=?.023, respectively). A subgroup analysis (in the LGA group) showed increased CT-1 concentrations only in diabetic pregnancies. PTX-3 and sCD36 concentrations were similar in LGA and AGA fetuses. In the LGA group, PTX-3 concentrations positively correlated with birth-weight (r?=?.416, p?=?.008) and respective sCD36 concentrations (r?=?.443, p?=?.004).

Conclusion: Higher Titin concentrations in LGAs possibly represent a candidate molecular mechanism underlying the association between fetal macrosomia and cardiomyocyte/diastolic dysfunction. CT-1 is up-regulated only in LGAs exposed to maternal diabetes. PTX-3 and sCD36 are probably not affected by excessive fetal growth.