Three-dimensional ultrasonography measurement of fetal nasal bone length during the midtrimester in Taiwanese women

ObjectiveTo evaluate the normal range of the fetal nasal bone length (NBL) in Taiwanese women using three-dimensional (3D) ultrasound, and compare the NBL of normal fetuses with Down syndrome to determine its significance in screening for trisomy 21.Materials and MethodsA total of 102 consecutive fetuses and another 7 fetuses with trisomy 21, determined by karyotyping at 15–22 weeks' gestation, were evaluated with 3D ultrasound before amniocentesis at Changhua Christian Hospital between November 2003 and April 2004.ResultsThe normal range for NBL in the second trimester in the Taiwanese population was investigated, and a linear relationship with gestational age was noted. The NBL increased with advancing gestational age (NBL in cm = 0.0264 × gestational age in weeks –0.042 (R² = 0.2416). The median of the biparietal diameter/nasal bone length ratio had a stable value which tended to change minimally between 15 and 22 weeks of gestation. Chromosomally normal fetuses had statistically longer nasal bones than fetuses with Down syndrome (p = 0.014).ConclusionWe present a reference range for 3D ultrasound measurement of the fetal NBL. A short nasal bone at 15 to 22 weeks is associated with a high risk of trisomy 21.     

Diagnostic anténatal de mégavessie au premier trimestre de la grossesse. Étude rétrospective sur six années

ObjectiveA fetal megacystis is defined by a longitudinal bladder diameter more than 7 mm. The purpose of this study is to describe the prenatal ultrasound findings of this early fetal pathology and to assess pronostic and aetiologycal criteria.Patients and methodsBetween January 2003 and December 2008, 12 cases of early fetal megacystis were identified in our referral fetal medicine unit (Saint-Étienne hospital, France).ResultsThere were two cases of spontaneous resolution and one case wasn’t a fetal megacystis. Termination of pregnancy for medical indications was realised for another cases because of associated malformations and bad evolution (six cases) and three chromosomal abnormalities (two cases of trisomy 18 and one of trisomy 21).Discussion and conclusionSonographic follow-up and fetal karyotyping are important to evaluate prognosis. However, our data suggest that fetal megacystis is a severe condition when diagnosed in early pregnancy.     

Quistes de plexos coroideos y riesgo de cromosomopatía

IntroductionSince they were first described in 1984, the presence of choroid plexus cysts during pregnancy have stimulated considerable debate concerning their possible relationship with chromosomal anomalies, mainly trisomy 18. Even today, the controversy persistsObjectiveTo identify which associated factors (cyst characteristics, associated anomalies and maternal age at diagnosis) should be considered to justify invasive karyotyping, bearing in mind that these techniques carry a risk of fetal lossMaterial and methodsWe analyzed data from one decade (January 1991-December 2000) corresponding to 26,500 fetuses who underwent ultrasound examination between weeks 14 and 22 of gestation. Choroid plexus cysts were considered as an ultrasound-negative formation of at least 3 mm in diameter located within the choroid plexusResultsChoroid plexus cysts were found in 366 fetuses (1.38%). Of these, eight fetuses presented chromosomal anomalies: six presented trisomy 18, one presented trisomy 21 and one showed chromosomal deletion at 6p. In all eight patients, choroid plexus cysts were bilateral and associated anomalies were detected. Mean maternal age was 36.5 yearsConclusionsWhen choroid plexus cysts are detected in the second trimester, detailed fetal investigation must be performed to find other possible markers of chromosomal anomalies even though some are difficult to detect ultrasonographically. Because the risk of fetal loss after amniocentesis is estimated at 1%, when other markers are absent, our results suggest that invasive karyotyping does not seem justified in pregnant women without additional risk factors     

Prenatal diagnosis of fetal congenital cystic adenomatoid malformation of the lung using three-dimensional ultrasound: Comparison between the 20th and 21st centuries

ObjectiveCongenital cystic adenomatoid malformation of the lung (CCAML) is one of the most common lung lesions diagnosed prenatally. In order to compare the trends and improvements of prenatal diagnosis of CCAML, we herein retrospectively reviewed our cases of fetal CCAML detected by three-dimensional ultrasound (3-D US) between two centuries.Materials and MethodsWe reviewed our computer database of prenatal diagnosis of CCAML in National Cheng Kung University Hospital from October 1994 to November 2011. All of the fetuses were initially scanned by two-dimensional (2-D) US to locate the region-of-interest (ROI). Then, the 3-D probe was used to scan all of the ROI systematically and mechanically, and the images were stored in the laser discs for further 3-D visualization and reconstruction. To compare the characteristics at prenatal diagnosis of CCAML between the 20th and 21st centuries in our hospital, Chi-square tests were undertaken. A p value <0.05 was considered as statistically significant.ResultsIn total, 58 fetuses with CCAML were depicted by 3-D US in utero (12 cases were diagnosed in the 20th century and 46 cases in the 21st century). The ranges of gestational age at prenatal diagnosis of CCAML by 3-D US in the 20th century were between 15 and 36 weeks (mean = 24 weeks), and were between 16 and 31 weeks (mean = 22 weeks) in the 21st century. Moreover, nine cases (75%) were diagnosed at the second trimester in the 20th century, whereas 44 cases (96%) were diagnosed at the second trimester in the 21st century.ConclusionThe advancement of 3-D US has remarkable advantages in adding novel visual depiction of a 3-D lesion of a 3-D fetus in 3-D US after reconstruction, and thus assists substantially in the prenatal diagnosis and genetic consultation of CCAML. Furthermore, the trend analysis in this series showed a significantly earlier gestational age at prenatal diagnosis of CCAML in the 21st century than that in the 20th century.     

Nuchal Translucency Thresholds in Prenatal Screening for Down Syndrome and Trisomy 18

ObjectiveTo determine if nuchal translucency (NT) can be used as a first trimester triage marker in prenatal screening for Down syndrome and trisomy 18.MethodsData from first trimester prenatal screening in 77 443 women were stratified by maternal and gestational ages. They were then analyzed to identify NT thresholds above or below which only positive (high-risk) or negative (low-risk) results were reported by a first trimester prenatal screening test combining PAPP-A, free β-hCG and NT.ResultsCombined prenatal screening was always positive for Down syndrome when NT thickness exceeded 4.0 mm. As women aged, this upper NT threshold value changed according to gestational age. In women aged 35 to 37 years, combined prenatal screening was always positive when NT exceeded 2.8 mm, 3.0 mm, and 3.4 mm at 11, 12, and 13 weeks of gestation, respectively. In women over 42 years of age, the upper threshold value for NT was 1.8 mm, 2.4 mm, and 2.7 mm at 11, 12, and 13 weeks of gestation, respectively. In women less than 35 years of age, we identified lower threshold values below which combined prenatal screening for Down syndrome was always negative.ConclusionIn prenatal screening for Down syndrome and trisomy 18, it is possible to identify NT threshold values above which biochemical screening provides no additional benefit. In pregnancies in which NT is above the established upper cut-offs, invasive prenatal screening can be offered without delay.     

Monozygotic twins with trisomy 18 of paternal origin: prenatal diagnosis and molecular cytogenetic characterization in a pregnancy with one structurally abnormal living fetus and one intrauterine fetal demise

ObjectiveTo present prenatal diagnosis and molecular cytogenetic characterization of trisomy 18 in a monozygotic twin pregnancy, with one structurally abnormal living fetus and one intrauterine fetal demise.Case ReportA 38-year-old woman was referred for amniocentesis at 16 weeks of gestation because of advanced maternal age. Prenatal ultrasound revealed a monozygotic twin pregnancy, with one structurally abnormal living fetus, and one fetal demise. The body structure details of the dead fetus could not be identified, whereas holoprosencephaly and omphalocele were identified in the living fetus on prenatal ultrasound. Quantitative fluorescent polymerase chain reaction assays using polymorphic DNA markers specific for chromosome 21 and chromosome 18, were applied to the uncultured amniocytes in the amniotic cavity of the living fetus and the cultured amniocytes in the amniotic cavity of the fetus with intrauterine fetal demise. The specimen showed a dosage ratio of 2:1 (paternal:maternal) for chromosome 18-specific markers in both twins. The result was consistent with monozygosity and trisomy 18, and the trisomy 18 was possibly caused by a paternal second meiotic division non-disjunction error or a postzygotic mitotic error. Conventional cytogenetic analysis revealed a karyotype of 47,XY,+18 in both twins. The pregnancy was terminated at 19 weeks of gestation, and a 2 g small-for-date macerated twin A and a 166 g malformed twin B were delivered. Twin A manifested cebocephaly and omphalocele, and twin B manifested premaxillary agenesis and omphalocele.ConclusionThe present case provides evidence that fetal wastage may occur in one of the co-twins in monozygotic twins associated with trisomy 18, and this may in part explain the very rare occurrence of living monozygotic twins with trisomy 18.     

Retard de croissance intra-utérin du deuxième trimestre : malformations associées et syndromes sous-jacents

ObjectivesTo determine the incidence of chromosomal abnormalities, syndromic association and fetal defects associated with second trimester fetal growth restriction (FGR) in a tertiary referral center.Patients and methodsRetrospective review of all cases referred between 14 and 27 weeks with an abdominal circumference (AC) < 5^th centile between 2008 and 2012. Multiple pregnancies were excluded. Medical records were retrieved to look for the presence of associated malformations, aneuploidy and outcomes.ResultsA total of 8626 fetuses had ultrasonographic examination between 14 and 27 weeks. Of these, there were 239 cases (2.8%) with evidence of FGR as based on AC measurement. Thirty-seven fetuses had an abnormal karyotype or an identified syndromic association (15%). The most common chromosomal defect was Trisomy 18 (10 cases, 4.2%), 67 had at least one associated morphological abnormality without aneuploidy or syndromic association (28%). Most common associated abnormalities were relative short femur (5%), omphalocele (5%) and gastroschisis (4%). Last 135 cases were isolated fetal growth retardation (5%). Maternal age was higher (33 yr ± 5 yr versus 31 yr ± 5.6 yr, P < 0.01) and the z-score for the AC lower (2.5 ± 1 versus 2.15 ± 0.6) in the group with abnormal karyotype or syndromic association than in the group without associated malformation. Amniotic fluid was more often increased in the group with an abnormal karyotype or associated malformation (14% and 17%) than in the group without malformations (0%, P < 0.01).Discussion and conclusionThis study describes abnormalities and outcomes associated with second trimester fetal growth retardation in a large population of patients. Our results suggest that the absence of associated malformation, degree of growth restriction, maternal age and the amniotic fluid index may help in the prenatal management and counseling of this high risk population.     

Herlyn-Werner-Wunderlich syndrome: 3D ultrasonographic diagnosis in premenarche

IntroductionUterine malformations are a heterogeneous group of congenital anomalies resulting from abnormal development of Mullerian ducts. Herlyn-Werner-Wunderlich syndrome is a rare condition that includes the triad of uterus didelfus, blind hemivagina and ipsilateral renal agenesis. We report a case with premenarche diagnosis and treatment and make a review of the illness.Case reportA premenarche 11 year old female was referred for pediatric nephrology and neurodevelopment consultation due to prenatal diagnosis of left renal agenesis. A pelvic ultrasound was performed and an anomalous uterus and a cystic pelvic mass was incidentally discovered. A 3D trans-rectal ultrasound identified a bicolis didelfus uterus and mucocolpos. A unidigital vaginal exam revealed a single cervix with soft bulging of the left apical vaginal wall. Using monopolar knife, an incision was done allowing drainage of the cavity. A part of the apical vaginal septum was removed and a normal cervix was seen.CommentsA high degree of clinical suspicion is important for the diagnoses. 3D ultrasound or MRI are the imaging diagnostic exams of choice, helped by a careful bimanual pelvic examination. An early diagnosis is important to prevent chronic pelvic pain and perhaps severe endometriosis.     

Prediction of fetal anemia by middle cerebral artery Doppler

ObjectivesTo assess the value of peak systolic velocity in the middle cerebral artery (MCA) in prediction of fetal anemia as a non invasive method in non hydropic fetuses.MethodsThe study included 30 pregnant women with non hydropic fetuses and with known red cell antibodies. Full ultrasound examination was done and peak velocity of systolic cerebral blood flow in MCA was measured. If severe anemia was suspected, fetal blood sampling by cordocentesis was performed.ResultsThirty fetuses were examined, 22 were anemic and eight had a hemoglobin value within a normal range. The mean MCA peak systolic velocity for fetus with the normal hemoglobin (Hb) was 48.98 ± 13.94 while that for the anemic fetus was 64.79 ± 11.97 and P = 0.004.Sensitivity of increased peak velocity of systolic blood flow in MCA for prediction of fetal anemia was 90.5% and specificity was 78.6%.ConclusionDoppler of peak velocity of systolic blood flow in MCA can be reliable in predicting anemia so delaying invasive methods until treatment (blood transfusion) is expected to be necessary.     

La qualité du suivi de la grossesse interfère-elle avec les issues de la grossesse,en Guadeloupe ?

ObjectivesTo assess the rate of pregnant women not having accurate prenatal care utilization. The others goals were to assess the impact of an inadequate quantitative or qualitative prenatal care on obstetrical outcomes.Patients and methodsHistorical cohort study with a prospective data registration. Hospitalised patients at the maternity ward of the University Hospital of Pointe-à-Pitre were eligible if they gave birth after 22 weeks (or ≥ 500 g) at home, outside a maternity ward or in another maternity ward. Early postpartum maternal transfers were included but not medical abortions. The principal outcome was preterm birth (before 37 weeks’ gestation).ResultsPatients without an appointment before 15 weeks or without an appointment each month before their delivery represented 27.4% of women (n = 2344). We stressed more preterm deliveries outside the maternity ward among the group with an inadequate prenatal care utilization vs. the other group (3,89% vs. 0,88%) (p < 0,0001). We did not find any difference concerning the perinatal outcomes among the women with an inadequate quality prenatal care.Discussion and conclusionOur study did not stress a difference concerning perinatal outcomes among women with an inadequate quantitative or qualitative prenatal care utilization.     

Prenatal diagnosis of 17q12 duplication and deletion syndrome in two fetuses with congenital anomalies

ObjectiveThe objective of this study was to characterize the genetic abnormalities in two fetuses with congenital anomalies in prenatal screening.Materials and methodsThe mother of Fetus 1 was 26 years old and had a second trimester serum screening that indicated the fetus was at low risk. The prenatal ultrasound and magnetic resonance imaging (MRI) at 28 weeks of gestation showed mild ventriculomegaly, microcephaly, and agenesis of the corpus callosum. The mother of Fetus 2 was 25 years old and also had a second trimester serum screening that indicated the fetus was at low risk. The prenatal ultrasound at 32 weeks of gestation showed the presence of hyperechogenic and enlarged kidneys with multicystic renal dysplasia bilaterally and a persistent left superior vena cava (PLSVC). Both pregnant women underwent cord blood samplings because of the abnormal imaging results. Karyotype analysis revealed normal results in the two fetuses. Chromosome microarray analysis (CMA) was then performed to provide genetic analysis of the cord blood and parental blood samples. Ultimately, the pregnancies were both terminated.ResultsCMA detected a 1.56-Mb duplication at 17q12 in Fetus 1 and a 1.93-Mb deletion of 17q12 in Fetus 2. Both the duplicated and deleted regions included the HNF1B and LHX1 genes. Neither the duplication nor deletion was inherited from the parents.ConclusionThis study is the first to report the prenatal diagnosis of a 17q12 duplication syndrome. Our results further confirmed that genes in this region, including HNF1B and LHX1, are essential for normal brain and kidney development, and also indicated some genes that may be associated with the cardiovascular abnormality. Combined with imaging examination, the use of CMA will improve the diagnosis of submicroscopic chromosomal aberrations in fetuses with congenital anomalies.     

A de novo duplication of chromosome 21q22.11→qter associated with Down syndrome: prenatal diagnosis, molecular cytogenetic characterization and fetal ultrasound findings

ObjectivesTo present prenatal diagnosis and molecular cytogenetic characterization of de novo partial partial trisomy 21q (21q22.11 → qter) associated with clinodactyly and hypoplastic midphalanx of the fifth fingers, midface hypoplasia, and an intracardiac echogenic focus on prenatal ultrasound.Materials, Methods, and ResultsA 34-year-old gravida 2, para 1 woman underwent amniocentesis at 20 weeks of gestation because of fetal structural abnormalities on prenatal ultrasound. A level II ultrasound at 20 weeks of gestation showed polyhydramnios, clinodactyly and hypoplastic midphalanx of the fifth fingers, midface hypoplasia, and an intracardiac echogenic focus. Amniocentesis revealed an aberrant derivative chromosome 9, or der(9). Parental karyotypes were normal. Spectral karyotyping (SKY) and fluorescence in situ hybridization (FISH) analyses revealed that the der(9) contained a segment of chromosome 21 distal to chromosome 9q, and FISH analysis additionally showed that the distal subtelomeric region of 9q was not deleted. Array comparative genomic hybridization (aCGH) demonstrated a 14.8-Mb duplication of distal 21q encompassing the Down syndrome critical region (DSCR) but no genomic imbalance in the distal euchromatic region of chromosome 9. The karyotype was 46,XX,der(9)t(9;21) (q34.3;q22.11)dn. Polymorphic DNA marker analysis revealed the maternal origin of the aberrant chromosome. The pregnancy was subsequently terminated. A malformed female fetus was delivered with a characteristic phenotype of Down syndrome.ConclusionSKY, FISH and aCGH are useful in prenatal investigation of the nature of a de novo aberrant derivative chromosome. Partial trisomy 21q encompassing the DSCR may present characteristic Down syndrome features on prenatal ultrasound.     

Impact of prenatal diagnosis of transposition of the great arteries on obstetric and early postnatal management

ObjectivesA growing percentage of cases of transposition of the great arteries (TGA) are being diagnosed prenatally. A decrease in the percentage of spontaneous deliveries has been reported, but the rate of cesarean section (c-section) in this population has never been studied. Our goal was to determine whether prenatal diagnosis affects delivery and immediate neonatal management of TGA neonates.Study designA series of 121 TGA arterial switch candidates were included over a 6-year period. Variables on delivery, clinical status at ICU admission, arrival time and atrial septostomy were recorded retrospectively. Comparisons between the two groups were made by Student's t or Chi-squared test.ResultsA cohort of 121 patients was enrolled (48 prenatal and 73 postnatal diagnoses). Induced delivery and c-section were more frequent in the prenatal (54.1% and 31%) than in the postnatal diagnosis group (19.4% and 8%; p < 0.0002 and p < 0.001, respectively).The mean interval between birth and ICU admission was 2 h 30 min in the prenatal compared to 26 h in the postnatal diagnosis group (p < 0.001). Arrival times were similar in both groups. Atrial septostomy by umbilical route was more often feasible in the prenatal (81%) than in the postnatal diagnosis group (51%; p < 0.001), with a higher rate of failure in the latter.ConclusionPrenatal awareness of TGA was associated with a higher percentage of induced deliveries and a major increase in the rate of c-section, without any impact on the newborn except easier umbilical atrial septostomy and earlier ICU admission.     

Place de l’échocardiographie fœtale au premier trimestre pour les situations à risque accru de cardiopathie congénitale

ObjectiveTo describe the preliminary results of fetal cardiac scanning in the first trimester of pregnancy for fetuses at higher risk for congenital heart defect (CHD).Patients and MethodsEchocardiographic examination was performed at 12 to 14 + 6 in 67 patients at higher risk for fetal CHD. The indications for referral were: increased nuchal translucency more or equal to 99^e centile (56 cases), risk of recurrence for CHD (eight cases), embryonic toxic exposure (eight cases), maternal disease (four cases).ResultsComplete examination of the fetal heart was possible in 54/55 cases. Fetal cardiac examination was normal in 58 cases (87 %). Six cases of severe CHD were diagnosed: hypoplastic left heart syndrome, pulmonary atresia with intact septum, complex univentricular CHD leading to termination of pregnancy, conotroncal Fallot like abnormality, and transposition of great arteries. Post-mortem examination was performed in three cases and confirmed the cardiac anomalies.Discussion and conclusionOur preliminary results confirmed that fetal heart scanning is feasible at the end of the first trimester of pregnancy. Severe CHD are amenable to prenatal diagnosis in the first trimester in the population at higher risk for CHD.     

Diagnóstico ultrasonográfico de quiste ovárico fetal: reporte de caso

Ovarian cysts are the most frequently diagnosed abdominal tumours in the female foetus, with an estimated incidence of 1 in 1,000-2,600 pregnancies. The probability of malignancy is extremely low and the association with malformations is exceptional.A case is presented of an ovarian cyst in the prenatal ultrasound diagnosis, with an anechoic image of 89 mm diameter and 242 cc of volume being observed in the fetal pelvic region with the two-dimensional ultrasound. The most important benefit is to make an optimal differential diagnosis in order to establish the treatment of the case.     

Prenatal diagnosis of fetal multicystic dysplastic kidney in the era of three-dimensional ultrasound: 10-year experience

ObjectiveTo demonstrate the usefulness of three-dimensional (3D) ultrasound in prenatal diagnosis of fetal multicystic dysplastic kidney (MCDK) disease.MethodsIn our previous study, we demonstrated that using 3D ultrasound in conjunction with traditional two-dimensional (2D) ultrasound can facilitate the diagnosis of MCDK. In this study, we followed all the MCDK cases diagnosed in our center in the recent decade (from 2002 to 2011) and compared the results with the data collected in the prior decade (from 1995 to 2002).ResultsBetween 2002 and 2011, a total of 39 cases with fetal MCDK diagnosed by 2D and 3D ultrasound were retrospectively analyzed. The average gestational age when the diagnosis of MCDK was made was 23.6 weeks of gestation (95% confidence interval: 22.09–25.09). The Pearson chi-square test revealed a borderline nonsignificant difference statistically in the categorized gestational age at diagnosis (p = 0.052) as compared to the gestational age in the prior study. The average amniotic fluid index in fetuses with unilateral and bilateral MCDK was 16.76 ± 3.34 and 4.78 ± 5.82, respectively (p < 0.001). MCDK was not found to be associated with gestational age or chromosomal anomalies in our study.ConclusionThe surface-rendering mode of 3D ultrasound is very useful in prenatal diagnosis and counseling for MCDK.     

Vitamin D Insufficiency Is Prevalent among Pregnant African American Adolescents

Study ObjectiveRecent attention has focused on vitamin D insufficiency but few data exist on vitamin D status among pregnant minority youth.DesignA screening study was undertaken in adolescents having prenatal blood samples drawn for other routine tests obtained during the second trimester (18 ± 1.8 week gestation, n = 44) or third trimester of pregnancy (28.4 ± 2.1 week gestation, n = 36). Serum 25- hydroxyvitamin D (25(OH)D) was measured and significant determinants of vitamin D insufficiency in this cohort were identified.SettingUrban prenatal clinic.ParticipantsEighty pregnant African American adolescents (≤ 18 y of age).Main Outcome Measure(s)Vitamin D status, STDs, hemoglobin, season, birth weightResultsSerum 25(OH)D in this group averaged 21.6 ± 8 ng/mL (age 16.5 ± 1.1 y, n = 80), and did not significantly differ between the second (20.95 ± 8.2 ng/mL, n = 44) and third trimester cohorts (22.5 ± 7.9 ng/mL, n = 36). Vitamin D insufficiency (< 20 ng/mL) was evident in 46.25% and vitamin D deficiency (<15 ng/mL) was evident in 21.25% of those studied. Significant predictors of suboptimal vitamin D status included sampling during the winter months (P = 0.004), lower hemoglobin concentration (P = 0.019), and higher second trimester leptin levels (P = 0.018). Inverse associations between 25(OH)D and bacterial vaginosis were evident when controlled for season of sampling (P = 0.02, n = 80).ConclusionsVitamin D insufficiency was prevalent among urban pregnant minority adolescents. Further studies are needed to address the impact of this finding on maternal and neonatal calcium homeostasis and bone health.     

Is Obesity a Further Cardiovascular Risk Factor in Patients with Erectile Dysfunction?

IntroductionErectile dysfunction (ED) and, in particular, arteriogenic ED have been proposed as new markers of risk for incident major adverse cardiovascular events (MACE). Reduced penile blood flow is more common in obese people than in leaner ED subjects.AimTo explore the interaction of overweight/obesity and penile blood flow in the prediction of incident MACE.MethodsThis is an observational prospective cohort study evaluating a consecutive series of 1,687 patients attending our andrological unit for ED. Different clinical, biochemical, and instrumental (penile flow at color Doppler ultrasound: PCDU) parameters were evaluated.Main Outcomes MeasuresAccording to body mass index (BMI), subjects were divided into three groups: normal weight (BMI = 18.5–24.9 kg/m²), overweight (BMI = 25.0–29.9 kg/m²), and obese (BMI ≥ 30.0 kg/m²). Information on MACE was obtained through the City of Florence Registry Office.ResultsAmong patients studied, 39.8% were normal weight, while 44.1% and 16.1% showed BMI 25–29.9 and 30 kg/m² or higher, respectively. During a mean follow-up of 4.3 ± 2.6 years, 139 MACE, 15 of which were fatal, were observed. Cox regression model, after adjusting for age and Chronic Diseases Score, showed that obesity classes along with the presence of arteriogenic ED (peak systolic velocity at PCDU <25 cm/second) were significantly and independently associated with incident MACE (hazard ratio = 1.47 [1.1–1.95], P < 0.05 and 2.58 [1.28–5.09], P < 0.001, respectively). When a separate analysis was performed for classes of obesity, reduced peak systolic velocity at PCDU (<25 cm/second) was significantly associated with incident MACE in obese (BMI ≥ 30 kg/m²), but not in leaner, subjects.ConclusionsIn obese subjects, more than in leaner ED subjects, impaired penile blood flow is associated with an increased risk of incident cardiovascular disease. The interaction with concomitant risk factors, such as obesity, should be taken into account when assessing the predictive value of penile blood flow for cardiovascular diseases. Corona G, Monami M, Boddi V, Balzi D, Melani C, Federico N, Balzi D, Sforza A, Rotella CM, Forti G, Mannucci E, and Maggi M. Is obesity a further cardiovascular risk factor in patients with erectile dysfunction?     

Cardiac function at term in human pregnancy

ObjectivesWe have previously demonstrated deterioration in cardiac function at term in human pregnancy. To explore further, we investigated central arterial hemodynamics and association with maternal weight during gestation.Study designPrimiparous women (n = 32) were recruited in a tertiary referral obstetric hospital and a longitudinal cohort study with analyses at median 16 and 37 weeks gestation undertaken. Subgroups of normal body mass index, <25 kg/m², and overweight, ?25 kg/m², at 16 weeks were created.Main outcome measuresWe performed 2D speckle tracking echocardiography strain analysis and tonometric measures of central arterial pressures, waveforms and pulse wave velocity.ResultsA reduction in cardiac strain (2P = 0.002) from 16 to 37 weeks gestation was associated with increased systemic vascular resistance (2P = 0.008), reduced arterial compliance (2P = 0.004) and increased central arterial pressures (2P < 0.001) and augmentation index (2P = 0.001).ConclusionsBy 37 weeks, compared with values in earlier pregnancy, overweight women had higher systemic vascular resistance (2P < 0.05). Additionally, their central diastolic pressure was higher (2P < 0.05) and their ventricular strain was lower (2P < 0.05) than in normal weight pregnant women. An increase in systemic vascular resistance and central arterial pressures by term may contribute to the observed deterioration in cardiac function. This appears more prominent in overweight women.     

Expectant management in pregnant women with early and severe preeclampsia and concomitant risk factors

AimThe aim of this study was to demonstrate that women with severe early-onset preeclampsia and concomitant risk factors benefit from expectant management.MethodsThis retrospective study was conducted between January 2009 and December 2010. Stable women with severe preeclampsia between 23 + 6 and 33 + 6 weeks of gestation were admitted to the IOCU for conservative management. They were classified into two groups: those with concomitant risk factors, i.e. associated medical conditions, HELLP syndrome, severe oligohydramnios, fetal growth restriction and multiple pregnancies (group A) and those without (group B). P values lesser than 0.05 were considered statistically significant.ResultsNo significant differences were found in maternal and perinatal outcomes between groups. Neither were differences observed in pregnancy prolongation (mean: 8.42 days (SD ± 7.462) in group A and 10.5 days (SD ± 8.235) in group B (p = 0.391)). At the start of expectant management, 31.8% of fetuses had an abnormal middle cerebral artery Doppler; prior to delivery, this percentage was 77.4%.ConclusionPregnant women with severe early-onset preeclampsia and associated risk factors benefited from expectant management. During expectant management using a continuous magnesium sulfate regimen, the majority of fetuses showed cerebral vasodilatation. The exact clinical value of this finding should be clarified in further studies