产前超声诊断胎儿颅后窝积液的临床意义

目的　探讨产前超声诊断胎儿颅后窝积液的临床意义。方法　对 2 0 0 0年 1月至 2 0 0 1年 1月在我院就诊的妊娠 2 0周以上的 5 40 0例孕妇行常规产前超声检查 ,发现胎儿颅后窝积液超过5mm者纳入研究对象 ,共 1 1 0例。每 2～ 3周动态观察这 1 1 0例胎儿颅后窝积液的变化及其他异常情况 ,直至足月分娩 ,并对新生儿行出生后随访。结果　胎儿颅后窝积液的发生率为 2 0 % ,首次发现颅后窝积液的孕周最早为 2 2周 ,最迟为 41周 ,平均 (31± 4)周 ;颅后窝积液以妊娠 2 9～ 32周最多见(42例 ,占 38 2 % ) ,积液量最多也在孕 2 9～ 32周 (39例 ,占 35 5 % ) ;颅后窝积液量 6～ 2 6mm ,平均(1 1± 3)mm ,其中 1 0～ 1 4mm者最多 (79例 ,占 71 8% ) ;颅后窝积液在 <1 0mm ,1 0～ 1 4mm和≥ 1 5mm3种情况时 ,其不良围产儿的发生率分别为 4 0 %、7 6 %和 83 3 %。结论　 (1 )胎儿颅后窝积液于孕2 9～ 32周最易发现 ,且积液量最多。 (2 )积液量越多 ,不良围产儿的发生率越高。建议对胎儿颅后窝积液量大于 1 0mm者严密随访 ,凡大于 1 5mm者 ,胎儿异常的可能性大 ,需引起高度重视。     

磁共振检查在确定胎儿脑室扩张疾病诊断中的临床适应证探讨

目的 通过对产前超声筛查出的脑室扩张胎儿行磁共振检查,探讨其确定诊断的适应证和应用价值.方法 2006年3月至2007年10月在中国医科大学附属盛京医院行产前超声检查的胎儿26 072例,其中产前超声筛查出胎儿脑室扩张104例,超声筛查孕龄为22周+2～39周+5,平均32周+1.按Gaglioti标准对104例脑室扩张胎儿进行分组:脑室扩张10～12 mm组66例,13～15 mm组22例,16～20 mm组14例,21～25 mm组2例;按脑室扩张部位不同分为单侧脑室扩张组75例,双侧脑室扩张组29例.在超声筛查48 h内对各组胎儿行磁共振检查以确定中枢神经系统疾病诊断,并随访妊娠结局.结果 (1)胎儿脑室扩张的发生率为0.39%(104/26 072).(2)脑室扩张10～12 mm组确定诊断3例(5%,3/66),分别为小脑发育不良、脑血管畸形及胸腹联合畸形各1例,单纯脑室扩张63例;13～15 mm组确定诊断5例(23%,5/22),分别为胼胝体缺如、脑出血、脑出血合并脑脊膜膨出、脑脊膜膨出及颅内占位各1例,单纯脑室扩张17例;16-20 mm组确定诊断6例(43%,6/14),分别为胼胝体缺如4例、脑出血1例、胼胝体缺如合并脑室出血1例,单纯脑室扩张8例;21～25 mm组确定诊断2例(2/2),分别为胼胝体缺如1例、脑出血1例,无单纯脑室扩张.10～12 mm组确定诊断率与其他3组比较,差异有统计学意义(P＜0.01).(3)单侧脑室扩张组中确定诊断4例(5%,4/75),双侧脑室扩张组中确定诊断12例(41%,12/29),两组比较,差异有统计学意义(P＜0.01).(4)104例脑室扩张胎儿中磁共振确定中枢神经系统疾病诊断16例,诊断率为15%.16例疾病胎儿中引产15例,尸体检查结果与磁共振确定疾病诊断完全相同;1例为胼胝体缺如,脑室扩张15 mm,在观察下妊娠至足月分娩,为正常新生儿;其余88例均妊娠至足月分娩,为健康新生儿.结论 超声筛查胎儿侧脑室扩张≥16 mm或双侧脑室扩张时,建议行磁共振检查以确定胎儿中枢神经系统的疾病诊断;脑室扩张≤12 mm的单纯侧脑室扩张不必行磁共振检查,可行超声动态观察,当发现胎儿脑室扩张程度有增加趋势时再行磁共振检查以明确诊断.     

胎儿肾积水的产前超声诊断及预后评估

目的 探讨胎儿肾积水的产前超声诊断的临床意义及其预后评估价值.方法 2004年12月至2005年11月在浙江大学医学院附属妇产科医院就诊的妊娠20周以上的9526例单胎孕妇行常规产前超声检查,发现胎儿肾盂前后径≥8 mm者诊断为肾积水而纳入本研究.并按Grignon分级法进行分级,定期检查和记录妊娠结局,直至分娩.结果 (1)胎儿肾积水的发生率及Grignon分级:9526例中共有162例胎儿发生肾积水,发生率为1.7%.于肾积水高峰期行Grignon分级,1级71例,2级59例,3级7例.4级3例,5级22例.(2)发生肾积水的孕周分布:初次发现胎儿肾积水的孕周平均为(33±5)周.肾积水程度达到最高峰的孕周平均为(36±3)周.110例(68%)胎儿肾积水在妊娠期即自行消失,消失孕周平均为(37±4)周.(3)不良妊娠结局:162例肾积水胎儿中有不良妊娠结局40例(25%),其中11例初次发现于孕20～24周中有3例(27%),20例初次发现于孕25～28周中有6例(24%),53例初次发现于孕29～32周中有14例(26%),48例初次发现于孕33～36周中有11例(23%),30例初次发现于孕37～40周中有6例(20%).胎儿肾积水Grignon分级越高,不良妊娠结局发生率也越高,3级及以上者不良妊娠结局发生率达100%.(4)随访结果 :分娩健康新生儿122例(75%,122/162),为110例出生前肾积水自行消失者和12例出生后1周内肾积水自行消失者,随访2年以上其生长发育正常,无泌尿系统后遗症;分娩肾积水新生儿20例(12%,20/162),为出生后1周内超声复查仍存在肾积水者,其中Grignon分级在3级及以下者11例,肾积水消失时间在出生后3个月至12个月不等,患儿生长发育均与同龄儿无明显差异,无泌尿系统症状.结论 胎儿肾积水初次发现的孕周越早,程度越严重,胎儿预后越差.应用Grignon分级法对胎儿肾积水程度进行分级可用于评估肾积水胎儿的预后,以指导临床处理.     

脑室扩张胎儿的MRI诊断及预后

目的 探讨超声发现的脑室扩张胎儿行MRI检查的临床价值,并观察脑室扩张胎儿的预后.方法 选择2006年3月至2008年7月在中国医科大学附属盛京医院行超声检查发现有胎儿脑室扩张的孕妇135例,产前检查孕周平均为32周.为进一步明确诊断行MRI检查.MRI检查发现胎儿单侧或双侧侧脑室三角区宽度为10～15 mm者诊断为轻度脑室扩张,16～20 mm者诊断为中度脑室扩张,>20 mm者诊断为重度脑室扩张.采用病例对照研究方法,对MRI诊断为单纯轻度脑室扩张胎儿和无异常胎儿,在出生后半年至1年进行丹佛智能发育筛查量表(DDST)检测,以判断单纯轻度脑室扩张胎儿在婴幼儿期的智力及生长发育状况.结果 (1)MRI诊断胎儿脑室扩张的准确率:135例超声诊断的脑室扩张胎儿中,MRI检查无明显异常56例(41.5%,56/135),单纯脑室扩张60例(60/135,44.4%),脑室扩张合并脑出血5例(3.7%,5/135),脑室扩张合并胼胝体异常12例(8.9%,12/135),脑室扩张合并小脑发育不良2例(1.5%,2/135).MRI诊断胎儿脑室扩张共79例,其中合并胼胝体异常率为15.2%(12/79).(2)MRI检查胎儿脑室扩张的分度:MRI诊断胎儿单纯脑室扩张60例,其中55例(91.7%,55/60)为轻度脑室扩张,5例为中度脑室扩张(8.3%,5/60);脑室扩张合并脑出血的5例胎儿中,1例为轻度脑室扩张、4例为中、重度脑室扩张;脑室扩张合并胼胝体异常的12例胎儿中,8例(66.7%,8/12)为中度脑室扩张,4例为重度脑室扩张(33.3%,4/12);脑室扩张合并小脑发育不良的2例胎儿均为中度脑室扩张.(3)DDST检测结果:55例单纯轻度脑室扩张胎儿中,符合随访条件的30例为病例组.无异常的56例中随访到38例,同期因其他原因行MRI检查无异常的胎儿42例,共计80例为对照组.病例组婴儿中DDST检测结果为可疑或异常4例(13.3%,4/30),正常26例(86.7%,26/30);对照组婴儿中DDST检测结果为可疑或异常10例(12.5%,10/80),正常70例(87.5%,70/80).两组分别比较,差异均无统计学意义(P>0.05).(4)MRI检查确诊的79例单纯脑窜扩张胎儿的临床结局:79例脑室扩张胎儿中,30例轻度脑室扩张胎儿及5例中度脑室扩张胎儿均妊娠至足月,出生后随访未发现婴儿异常;另有7例拒绝合作,6例孕妇坚决要求引产,失访12例.合并胼胝体发育异常的12例胎儿中,3例继续妊娠,胎儿出生后复查MRI,其诊断结果与胎儿期的MRI检查结果相同;8例孕妇坚决要求引产,失访1例.合并脑出血的5例胎儿均按孕妇意愿选择引产,尸体检查结果均证实MRI诊断正确.合并小脑发育不良的2例胎儿,1例要求继续妊娠,足月分娩,生后半年婴儿确诊为脑瘫,另有1例引产.结论 对超声发现的脑室扩张胎儿进一步行MRI检查有重要的临床验证和补充诊断价值;胎儿单纯轻度脑室扩张在出生后6～12个月期间,智力及生长发育与同龄儿无异.     

双胎妊娠胎儿不同孕周的适宜体重与妊娠并发症和妊娠结局的探讨

目的探讨双胎妊娠胎儿不同孕周的适宜体重及其妊娠并发症和妊娠结局。方法回顾性分析2004年1月至2020年12月在北京大学第一医院分娩的1 225例双胎妊娠孕妇不同孕周的胎儿体重及相关的妊娠并发症和妊娠结局, 包括妊娠期高血压疾病、妊娠期糖尿病(GDM)、胎儿生长受限(FGR)、胎儿窘迫、早产及新生儿窒息。双胎妊娠胎儿不同孕周的适宜体重使用616例无妊娠并发症(除早产)双胎妊娠孕妇的1 232例新生儿出生体重进行分析, 以第10～90百分位数表示, 并比较小于胎龄儿(SGA)、大于胎龄儿(LGA)与适于胎龄儿(AGA)双胎妊娠的妊娠并发症及不良妊娠结局的发生风险, 以及不同年份间妊娠并发症及不良妊娠结局发生率的变化。结果双胎妊娠不同孕周新生儿适宜体重分别为孕28周910～1 255 g、孕29周996～1 518 g、孕30周1 105～1 785 g、孕31周1 295～1 825 g、孕32周1 336～2 000 g、孕33周1 754～2 321 g、孕34周1 842～2 591 g、孕35周1 913～2 615 g、孕36周2 150～2 847 g、孕37周2 350～3...     

羊水过少妊娠及分娩经过

为研究羊水过少对妊娠、分娩经过及围产结局的影响，250例羊水过少妊娠妇女(妊娠30～40周)纳入研究(Ⅰ组)，其中中度羊水过少者92例(Ⅰa组)，重度158例(Ⅰb组)，Ⅱ组为150例羊水量正常孕妇。超声测量胎儿、羊水量，计算出羊水指数，评价胎儿宫内发育迟缓(IUGR)的程度。多普勒测量母体-胎盘-胎儿系统血流，计算脐动脉、胎儿大脑中动脉及孕     

51例胎儿肠管增宽妊娠结局分析

目的:探讨胎儿肠管增宽的临床表现与妊娠结局之间的相关性,为临床咨询、判断预后和指导治疗提供依据。方法:回顾分析2015年10月至2019年6月于华中科技大学附属同济医院胎儿系统超声诊断为肠管增宽的51例孕妇的临床资料。结果:51例孕妇中,19例妊娠结局良好,32例出现不良妊娠结局(引产、胎死宫内、新生儿死亡、出生后需手术治疗等),占62.7%。胎儿十二指肠增宽的不良结局发生率为100%,明显高于小肠增宽(54.2%)及结直肠增宽(25.0%)。孕32周前诊断胎儿肠管增宽不良妊娠结局发生率为72.7%,而孕32周后检出者为44.4%。胎儿肠管增宽合并羊水过多22例,不良结局发生率为86.4%,明显高于羊水量正常孕妇(40.0%)。10例孕妇行羊膜腔穿刺产前诊断均未发现异常,2例十二指肠增宽新生儿行基因检查为21-三体综合征。结论:产前超声诊断胎儿肠管增宽与消化系统畸形及妊娠结局密切相关,及时发现、密切随访、早期处理极为重要。     

双胎妊娠结局及分娩时机与分娩方式对新生儿窒息的影响

目的:探讨双胎妊娠结局及不同分娩时机与分娩方式对新生儿窒息的影响。方法:回顾性分析本院462例双胎妊娠孕妇晚期流产及分娩结局资料,以1分钟Apgar评分≤7分为标准诊断新生儿窒息,对比分析不同孕周的晚期流产率,及在不同分娩孕周采用不同分娩方式的新生儿窒息率。结果:(1)双胎妊娠孕妇孕28周前流产42例,主要集中于孕26～27~(+6)周(18例)。(2)孕28周后分娩的活产新生儿共834例,其剖宫产新生儿窒息率(2. 16%)低于阴道分娩(12. 77%)(P0. 05),其中孕28～29~(+6)、孕32～33~(+6)周剖宫产与阴道分娩的新生儿窒息率差异有统计学意义(P0. 05)。新生儿窒息率在孕36～37~(+6)周(0. 44%)明显低于其他孕周(P0. 05)。(3)大胎儿和小胎儿的剖宫产新生儿窒息率均低于阴道分娩(P0. 05),剖宫产中大胎儿新生儿窒息率低于小胎儿(P0. 05)。剖宫产中大胎儿在孕34～35~(+6)周的新生儿窒息率(0)明显低于其他孕周(P0. 05),剖宫产中小胎儿在孕36～37~(+6)周的新生儿窒息率(0)明显低于其他孕周(P0. 05)。结论:双胎妊娠应加强孕期监护,防止晚期流产的发生。双胎妊娠无明显并发症时可尽量延长孕周至36～37~(+6)周,但不宜过迟,采取剖宫产方式可降低新生儿窒息率的发生。     

多胎妊娠妇女孕中期选择性减胎术的临床应用

目的 通过对多胎妊娠妇女于孕中期行选择性减胎术,研究其手术指症、时机、安全性、目标胎儿的选择标准和减灭胎儿数,探讨选择性减胎术在改善多胎妊娠结局中的作用.方法 对37例孕12周+1～25周多胎妊娠孕妇(6例双胎、21例三胎、8例四胎、2例五胎,共117个胎儿)在超声引导下经腹行选择性减胎术,按产科医疗指征,在拟被减的46个胎儿心脏内注射10%氯化钾2～5 ml,见胎心逐渐减慢至停跳视为减胎术成功.术后定期产前检查和监测凝血功能,记录妊娠期并发症及妊娠结局.结果 (1)成功率:共减去胎儿46个,减胎成功率为100%(46/46个胎儿),已有27例孕妇分娩,获24个健康新生儿,妊娠成功率为88.9%(24/27).(2)分娩孕周:＞36周分娩者15例;32～36周7例;28～32周3例;＜28周流产者2例;正在妊娠中10例.平均分娩孕周(34.9±4.1)周,孕28周后分娩率为92.6%(25/27).(3)新生儿平均出生体重:单胎妊娠新生儿平均出生体重为(3014±640)g,双胎妊娠为(2557±573)g,三胎妊娠中除1例两个胎儿存活(出生体重分别为1400及1500 g)外,其余均死亡.(4)安全性:除2例单羊膜囊双胎在减灭1个胎儿后,另1个胎儿随即死亡外,其余多胎妊娠妇女的保留胎儿均未发生胎死宫内.(5)并发症:37例多胎妊娠妇女中仅3例发生子痫前期,减胎术后均无凝血功能障碍发生.(6)阴道流血:有13例孕妇减胎术前发生阴道流血,其中1例在妊娠13周强烈要求减胎,减胎术后于孕22周流产;另12例均在阴道流血停止1周以上后施行减胎.结论 (1)孕中期选择性多胎妊娠减胎术,可以有效减少多胎妊娠胎儿数目、避免异常胎儿出生,降低孕产妇并发症,提高新生儿出生体重.(2)胎儿保留数目以达双胎为好.(3)减胎术前有阴道流血者,避免在流血期间减胎,应选择在流血停止1周以上进行.(4)孕中期多胎妊娠减胎术不会造成孕妇的凝血功能障碍,也不会造成保留胎儿的宫内死亡,安全性好;减胎术后子痫前期的发病率明显下降.     

胎儿骶尾部畸胎瘤的产前诊断和预后影响因素分析

目的探讨胎儿骶尾部畸胎瘤(SCT)的产前诊断和预后因素。方法回顾性分析2014年1月至2021年9月就诊于浙江大学医学院附属妇产科医院并经产前超声诊断(诊断孕周≤28周)为胎儿SCT且继续妊娠的孕妇41例, 分析其产前影像学特征和妊娠结局, 包括肿瘤体积与胎儿体重比(TFR)、肿瘤实性部分占比、肿瘤生长速率(TGR)、是否存在胎儿水肿、胎盘增厚以及羊水过多。采用受试者工作特征(ROC)曲线分析确定TFR、TGR预测胎儿不良结局的临界值。结果 (1)41例妊娠SCT胎儿孕妇的超声诊断孕周为(24.2±2.9)周(范围:18～28周), 其中1例孕22周进展为胎儿水肿引产, 1例孕29周发生胎儿宫内死亡引产, 39例继续妊娠直至分娩。39例继续妊娠的孕妇中, 1例因妊娠晚期发生恶性羊水过多、胎儿心胸比增大于孕31周行剖宫产术, 1例因胎儿心力衰竭于孕32周行剖宫产术, 1例因胎儿心力衰竭合并水肿于孕32周行剖宫产术;其余36例均于新生儿出生后3周内行手术切除肿瘤, 预后均良好。(2)妊娠28周前TFR>0.12可预测胎儿预后不良, 敏感度为100.0%, 特异度为86.1%, 曲线下...     

Intraperitoneal fetal transfusion under direct ultrasound guidance

The outcomes of 77 fetal intraperitoneal transfusions in 35 pregnancies managed with direct ultrasound guidance and intensive perinatal management were reviewed. Patients were monitored with amniocentesis, and standard indications were used for timing of transfusions. The mean gestational age at first transfusion was 27.3 weeks (range 22-33). The overall mortality rate was 14% (five of 35). No immediate transfusion-related deaths occurred; all fetuses who were not hydropic at first transfusion survived (26 of 26). The mean gestational age at delivery was 33.6 weeks (range 25-36). One infant developed respiratory distress syndrome (RDS). Transfusion-related complications occurred in five cases (fetal colon infusions in two, fetal retroperitoneal infusion in two, and fetal abdominal wall hematoma in one). None of these infants required urgent delivery or suffered long-term sequelae. In nonhydropic fetuses, intraperitoneal transfusions under direct ultrasound guidance had a low incidence of morbidity and no mortality. These results should provide baseline data against which to compare new techniques, such as direct cord transfusion. With neonatal mortality rates of 10% and significant morbidity rates of 10-20% in infants delivered at 32 weeks who develop RDS, intraperitoneal transfusion should be considered in the 32- to 33-week fetus with marked pulmonary immaturity.     

Outcome of fetuses with abnormal biophysical profile

Sonographic observation of fetal behavior as a possible indicator for the state of fetal health was quantified with a modified biophysical profile (BPP). The observation time was extended to 40 min, as the fetal rest-activity cycle implies that inactivity may last that long. Gestational age ranged 27-43 weeks. Cardiotocography (CTG) was performed subsequent to an abnormal BPP (ultrasound score 0-4). Reactivity, indicating favorable fetal outcome, was more common in near-term fetuses, suggesting that BPP should be interpreted in relation to gestational age. Therefore, fetuses with an abnormal BPP (n = 29) were each matched and compared with 2 fetuses of same gestational age but normal BPP (ultrasound score 6-8; n = 58). The perinatal mortality and morbidity were significantly higher in infants with abnormal score than in infants with normal score (p less than 0.01). BPP by third trimester sonography helps to diagnose acutely endangered fetuses, and an abnormal fetal movement pattern should lead to further evaluation, i.e. CTG. While BPP scoring, as compared to CTG, is less favorable as a primary surveillance technique and not superior for identifying the hypoxic fetus, additional information is obtained with BPP by diagnosing the growth-retarded and/or malformed fetus.     

In utero progression of mild fetal ventriculomegaly.

OBJECTIVE: To evaluate the progression in utero of mild isolated fetal ventriculomegaly (defined as a transverse diameter of the atrium of the lateral ventricle measuring between 10 and 15 mm), and to estimate the proportion of fetuses that normalize (diameter decreasing to less than 10mm), stabilize (remaining between 10 and 15 mm), or progress to more severe ventriculomegaly (becoming greater than 15 mm). METHODS: The obstetric databases of 3 institutions were queried for any studies mentioning ventriculomegaly or hydrocephalus. Reports and original images were reviewed to verify cases of isolated mild ventriculomegaly, with no other anomalies on comprehensive ultrasonographic examination. Fetuses that had 2 or more evaluations more than 3 weeks apart were included. RESULTS: A total of 63 fetuses met the criteria for isolated mild ventriculomegaly. The mean gestational age and ventricular measurements were 24.7+/-3.7 weeks and 11.8+/-1.1mm, respectively, at the initial scan and 34+/-2.9 weeks and 12.1 +/-3.8mm, respectively, at the final scan. The mean number of scans was 3.75 per fetus (range, 2-6). Amniocentesis revealed the deletion of 5p, which causes the cri du chat, in 1 of 21 fetuses; 26 fetuses (41%) showed normalization of the lateral ventricles; 10 fetuses (16%) showed progression; and 27 (43%) appeared stable. shows the statistics of the individual groups. Three of the fetuses that "stabilized" improved from 15 mm to 11, 11.5, and 11.7 mm, respectively. Two worsened from 10.2 to 14 mm and from 11.4 to 13 mm. CONCLUSIONS: More than 40% of the cases of mild isolated fetal ventriculomegaly resolved in utero. The significant overlap in measurements for the different groups precludes prediction in individual cases. However, of the 13 cases where the transverse diameter measured 13 mm or more, only 1 normalized, while 9 of the remaining 12 cases stabilized and 3 progressed.     

Perinatal outcome in fetuses with megacystis in the first half of pregnancy

OBJECTIVE: To present the outcome of a consecutive series of 19 fetuses referred to our center for megacystis in the first half of the pregnancy. STUDY DESIGN: Retrospective analysis. METHODS: 19 cases of early fetal megacystis were reviewed. Inclusion criteria were the visualization of an enlarged bladder with a maximum longitudinal diameter >10 mm and a gestational age of no more than 19 weeks. RESULTS: The median gestational age at diagnosis was 16 weeks (range 12-19 weeks). The median maximum longitudinal diameter of the fetal bladder at the time of diagnosis was 21 mm (range 11-35 mm). The fetal megacystis was associated with another extra renal anomaly in six cases (30%). There was no fetus with abnormal karyotype. Termination of pregnancy was performed in 11 cases because of the severity of the renal disease. One spontaneous intrauterine death occurred. A vesicoamniotic shunt was inserted in three cases, two of which died in utero. The surviving fetus that was shunted died in the neonatal period from acute renal failure. In the remaining four fetuses, resolution of the megacystis occurred spontaneously (n = 2) or following serial single-needle aspiration (n = 2). One of these had renal insufficiency requiring kidney transplantation. CONCLUSION: The outcome of fetuses with early obstructive uropathy is poor, with or without in utero therapy. Pathophysiology, clinical presentation and outcome of fetuses with early uropathy may differ from those previously described in the latter part of pregnancy.     

First-trimester transabdominal multifetal pregnancy reduction: a report of 85 cases

Eighty-five cases of multifetal pregnancy reduction were performed transabdominally at 9.5-13 weeks' gestation. All pregnancies consisted of three or more fetuses (28 triplets, 47 quadruplets, four quintuplets, four sextuplets, one septuplet, and one nontuplet), and all except five were reduced to twins. Forty-five women have delivered viable infants and eight lost all of the fetuses; 32 pregnancies are ongoing. No temporal relationship was noted between the pregnancy losses and the procedures. The mean gestational age at delivery was 35.7 weeks; 16 women (35.5%) delivered at or after 37 weeks, 16 (35.5%) between 34.5-37 weeks, nine (20%) between 32-34.5 weeks, and four (9%) before 32 weeks. There were no perinatal deaths, and all infants are healthy except for one who developed sequelae of severe hyaline membrane disease.     

Screening for fetal aneuploidies and fetal cardiac abnormalities by nuchal translucency thickness measurement at 10-14 weeks of gestation as part of routine antenatal care in an unselected population.

OBJECTIVES: To evaluate first trimester pregnancy screening for fetal aneuploidy and congenital heart defects by maternal age and nuchal translucency measurement and screening for fetal aneuploidies and congenital heart defects by ultrasound in an unselected population. DESIGN: A prospective study. SETTING: Fetal medicine unit, St George's Hospital, London. SAMPLE: 4523 consecutive viable fetuses at 10-14 weeks with a crown-rump length between 38 and 80 mm were scanned transabdominally (93%) or transvaginally (7%). METHODS: Screening was performed by calculating the background risk from maternal age, gestational age and obstetric history, which was then adjusted with the nuchal translucency measurement in relation to crown-rump length (adjusted risk). MAIN OUTCOME MEASURES: Measurements of crown-rump length and nuchal translucency thickness. An adjusted risk of > 1:270 was considered as a positive screening test. Pregnancy outcome was obtained through karyotyping, outcome questionnaires and examination of the newborn infants. RESULTS: Mean maternal age was 29-4 years and mean gestational age 12.2 weeks. Screening was positive in 230/4523 fetuses (5.1%), when the adjusted risk (mean 1:2649) was > 1:270. Fetal karyotype was abnormal in 23 (0.51%) cases, including twelve with trisomy 21, five trisomy 18, one trisomy 13, one trisomy 10, one monosomy X and two triploidies. For a false positive rate of 4.7%, the sensitivity of this test was 78% in detecting any fetal aneuploidy. Only one out of nine major congenital heart defects in this population was found within the 110 euploid fetuses with increased nuchal translucency thickness (> 2.5 mm). CONCLUSION: Screening for fetal aneuploidy by maternal age and nuchal translucency measurement can be effective in an unselected population. However, our results do not support its effectiveness in the detection of cardiac abnormalities.     

Ultrasonographic assessment of gestational age with the distal femoral and proximal tibial ossification centers in the third trimester

A prospective sonographic evaluation of the distal femoral and proximal tibial epiphyseal ossification centers in 228 normal pregnant women was carried out from 28 to 40 weeks' gestation. The mean gestational age at which the distal femoral epiphysis and proximal tibial epiphysis were imaged was 34 and 38 weeks, respectively. The distal femoral epiphysis was not identifiable before 28 weeks but was observed in 72% of fetuses at 33 weeks and in 94% of fetuses at 34 weeks' gestation. The presence of a distal femoral epiphysis measuring 1 or 2 mm was associated with a gestational age of greater than 33 weeks in 87.0% of fetuses, whereas a distal femoral epiphysis measuring greater than or equal to 3 mm was associated with a gestational age greater than 37 weeks in 85% of fetuses. The proximal tibial epiphysis, which was absent before 34 weeks' gestation, was observed in 56% of fetuses at 36 weeks, in 80% of fetuses at 37 weeks, and in 100% of fetuses at 39 weeks of gestation. The presence of a proximal tibial epiphysis of 1 or 2 mm was associated with a gestational age of greater than 36 weeks in 88% of fetuses, whereas a proximal tibial epiphysis greater than or equal to 3 mm was associated with a gestational age of greater than 38 weeks in 94% of fetuses. The sonographic evaluation of distal femoral epiphysis/proximal tibial epiphysis can be used as independent markers for estimation of gestational age during the third trimester, a period in which standard fetal biometric estimates of gestational age are least accurate.     

An aggressive interventional protocol for early midtrimester premature rupture of the membranes using gelatin sponge for cervical plugging

OBJECTIVE: This study was performed to evaluate a protocol for treatment of previable premature rupture of membranes (PROM) that includes the administration of gelatin sponge to retard the loss of fluid from the amniotic cavity. STUDY DESIGN: Women with PROM at or=24 weeks, 53%), with six of these newborn infants surviving to hospital discharge (30%) and two suffering intrauterine death. The average gestational age of delivery for survivors was 31.8 +/- 4.3 weeks, range 25 to 36 weeks. Talipes equivarus was observed in three survivors (50%). Bilateral hip dysplasia and torticollis were also diagnosed in two infants. Respiratory distress syndrome was diagnosed in all cases delivered at less than 32 weeks but was not observed thereafter. No adverse sequelae have been attributed to gelatin sponge exposure. CONCLUSION: The observed survival rate with this interventional approach in a population at highest risk for pregnancy loss justifies further study of this treatment strategy. This protocol may not reduce the rate of musculoskeletal abnormalities.