Evaluation of Fetal Growth and Fetal Well-Being

This article reviews the actual knowledge and future developments of ultrasound techniques for the evaluation of fetal growth and well-being. Sonography allows the visualization of the fetus in utero and is utilized worldwide for the evaluation of fetal growth and well-being. Fetal biometry assessment is performed in the second half of pregnancy when deviations of fetal growth can be best recognized through alterations of fetal abdominal circumference growth. Doppler velocimetry of utero-placental vessels identifies alterations of placental perfusion and is valuable in the assessment of fetal brain, heart, and liver perfusion, thus being utilized in the timing of delivery. Recently, three-dimensional ultrasound evaluation of fetal organs and placenta is being developed.     

Fetal transesophageal echocardiography: clinical introduction as a monitoring tool during cardiac intervention in a human fetus.

Because of insufficient imaging by maternal transabdominal fetal echocardiography (TAE) in a human fetus with aortic atresia, imperforate atrial septum and progressive cardiac failure, we assessed the feasibility of fetal transesophageal echocardiography (TEE) as a monitoring tool during fetal cardiac intervention at 24 + 6 weeks of gestation. Percutaneous fetoscopic intraesophageal deployment of the ultrasound catheter was achieved and did not result in any maternal or fetal complications. Fetal TEE permitted substantially clearer definition of fetal cardiac anatomy and intracardiac device manipulations than conventional maternal TAE. Despite the employment of various devices, no sufficiently large opening could be achieved within the atrial septum. Although the fetus tolerated the procedure remarkably well and satisfactory fetoplacental flow could be documented at the end of the procedure, the fetus died from progressive cardiac failure 3 days after the intervention. Fetoscopic TEE is feasible in the human fetus and permits substantially clearer definition of fetal cardiac anatomy and intracardiac manipulations than conventional maternal TAE. Based on the observation of spontaneous closure of multiple iatrogenic perforations of the atrial septum, specialized devices are required in order to improve the technical success rate of septoplasty methods and hence the survival odds of these high-risk patients.     

Language and literacy intervention program facilitates phonological awareness and literacy development in children with Fetal Alcohol Spectrum Disorder

Abstract

Despite the overwhelming research evidence discrediting the validity of Facilitated Communication (FC), Lilienfeld, Marshall, Todd and Shane (2015 Lilienfeld, S. O., Marshall, J., Todd, J. T., &; Shane, H. C. (2015). The persistence of fad interventions in the face of negative scientific evidence: Facilitated communication for Autism as a case example. Evidence-Based Communication Assessment and Intervention. [Google Scholar]) have demonstrated that the use of FC is still prevalent in disability service and educational settings. They have comprehensively examined the persistence of FC, provided reasons for its persistence, and formulated key recommendations to address the insidious spread of FC. We concur with Lilienfeld et al. as depressing as it may be, particularly regarding the continued use of FC by clinicians, educators and researchers. Drawing upon our experience as practitioners in the field of intellectual and developmental disability, we offer the view that it is important to argue against FC from a human rights perspective using the United Nations Convention on the Rights of Persons with Disabilities (2006 United Nation Convention on the Rights of Persons with Disabilities and Optional Protocol (2006). Geneva, Switzerland. [Google Scholar]). Put simply, FC is an abuse of human rights.     

Fetal Monitoring

The severe risk situations characterized by fetal growth retardation are outlined. The small fetus, whether growth retarded or severely premature, is best delivered where both fetal monitoring and newborn resuscitation are available. The moderate risk fetus can be monitored at home base with clinical skills described in this article.     

Fetal Surgery

As prenatal diagnosis has become increasingly sophisticated and as technological advances have enhanced the range of diagnostic capabilities, invasive therapies have developed from our expanded understanding of the natural history and pathophysiology of structural anomalies. This article presents a comprehensive review of the treatment options currently available for the entire spectrum of fetal diagnoses that are potentially surgically correctable. The current indications, contraindications, and outcomes for shunting procedures, open fetal surgery, and fetoscopic surgeries are reviewed.     

Fetal imaging

Presently, MRI is an adjunct to prenatal sonography. It provides information that can aid in the diagnosis of fetal anomalies, affect prenatal counseling and management of the pregnancy, and guide prenatal intervention and delivery planning. With further advances in technology, particularly shorter scan times and better image resolution, the applications for fetal imaging are likely to increase.     

Fetal Megacystis

The purpose of our retrospective observational series was to determine whether the sonographic characteristics of fetal megacystic bladders can be used to reliably establish the most likely diagnosis in fetuses with this condition. The sonographic records of pregnant patients referred to our institutions over a 10‐year period who were found on initial 2‐dimensional sonography to be carrying fetuses with megacystis were examined for evidence of a keyhole sign, bladder thickness, amniotic fluid index, and fetal sex. When available, 3‐/4‐dimensional sonography, Doppler angiography, tomographic ultrasound imaging, virtual organ computer‐aided analysis, and automatic volume calculation were used as part of the detailed fetal anatomic survey. Twenty fetuses with megacystis were identified. Seventeen were male; 2 were female; and 1 had ambiguous genitalia. All male fetuses with megacystis originally had a diagnosis of prune belly syndrome. The diagnosis for 10 male fetuses with a keyhole sign was changed to megacystis secondary to posterior urethral valves. The fetus with ambiguous genitalia had prune belly syndrome. One of the female fetuses had a diagnosis of urethral atresia, and the diagnosis for the other female fetus was megacystis‐microcolon‐intestinal hypoperistalsis syndrome. In conclusion, in fetuses with megacystic bladders, it is possible to distinguish between cases with prune belly syndrome, posterior urethral valves, urethral atresia, and megacystis‐microcolon‐intestinal hypoperistalsis syndrome by a detailed anatomic survey using 2‐ and 3‐/4‐dimensioinal sonographic techniques.     

Fetal Electrocardiography

Fetal electrocardiography is a simple, rapidly performed procedure for determining fetal viability and multiple pregnancy. It is safe for both mother and fetus and can be regularly repeated. Diagnostic accuracy of the technic correlates with the period of gestation. In the series of patients reported in this paper, the percentage of correct diagnoses, confirmed by delivery, was 95.25.     

Fetal Polydactyly

Records of 24 pregnancies with fetal polydactyly were reviewed for the type of polydactyly, family history, associated sonographic findings, genetic testing, and postnatal/postmortem examination findings. The importance of fetal polydactyly can be mainly elucidated by the family history and absent or associated anomalies on a specialized malformation scan. Fetal karyotyping diagnoses frequent chromosomal anomalies in about half of cases with additional malformations, and array comparative genomic hybridization may be a future means of detecting cryptic chromosomal aberrations. Syndromic disorders of monogenic origin demand a careful interdisciplinary clinical assessment for establishing a clinical diagnosis and prognosis for the outcome of the child.     

Fetal surgery

Fetal surgery has emerged from the realm of medical curiosity into an exciting, multidisciplinary specialty now capable of improving patient outcomes for a wide variety of diseases. Recent advances allow prenatal providers to both accurately diagnose and treat many fetal anomalies while maintaining maternal safety. As the initial postnatal health care providers to the majority of these newborns, neonatologists need to be familiar with some of the more recent state-of-the-art procedures currently being used. In this review, the authors discuss the prenatal evaluation process and various operative approaches (ie, open hysterotomy, fetoscopy, and percutaneous) to conduct fetal surgery. They then analyze the effectiveness of some of the more established and experimental prenatal therapies that are being performed for a number of fetal anomalies, including twin-twin transfusion syndrome, thoracic malformations, airway obstruction, congenital diaphragmatic hernia, myelomeningocele, and aortic valve stenosis.     

Fetal Imaging

Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging (MRI) in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and MRI in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost effectiveness, and to identify research opportunities. This article is the executive summary of the workshop.