Prenatal diagnosis of gastric and small bowel atresia: a case series and review of the literature

Objective: To describe seven cases of gastrointestinal tract (GIT) obstructions and to report a skewed review of the literature.

Methods: We performed a search of our permanent perinatal database about cases with prenatal ultrasound and MRI diagnosis of gastrointestinal tract obstructions between 2006 and 2013. All cases were followed until hospital discharge and pre-natal diagnosis were confirmed by fetal MRI, postnatal imaging and/or intra-operative findings. Maternal age, parity, gestational age at diagnosis, ultrasound findings, gestational age at delivery, Apgar scores at 1 and 5?min and postnatal outcome have been recorded.

Results: We identified seven cases of gastric and small bowel atresia. Karyotype was normal in six cases and abnormal in one co-twin [46,XY dup (20) (qq13.1q13.3)dn] of a dichorionic-diamniotic pregnancy. The mean?±?SD for maternal age, gestational age at diagnosis, gestational at delivery, birth weight and Apgar scores at 1 and 5?min were 30.8?±?4.8 years, 29.8?±?3.7 weeks, 2507.5?±?727.5?g and 5.6?±?2.1, 7.6?±?1.6, respectively. All fetuses’ undergone surgical procedures in the postnatal period and all of them were discharged live from the hospital.

Conclusion: Prompted antenatal detection of gastrointestinal tract obstruction using ultrasound proved to be diagnostic in all cases. Fetal MRI aid was a useful complementary diagnostic investigation. Correct pre-natal diagnosis allows adequate counseling, delivery planning and management care by a multidisciplinary team.     

Fetal intra-abdominal cysts: accuracy and predictive value of prenatal ultrasound

Objective: The finding of a fetal intra-abdominal cyst is relatively common and it can be due to a wide variety of clinical conditions. The aims of this study were to determine the accuracy of the prenatal ultrasound (US) in identifying the etiology of fetal intra-abdominal cysts and to describe the neonatal outcomes.

Methods: All cases of fetal intra-abdominal cystic lesion referred to our center between 2004 and 2012 were reviewed. Cysts of urinary system origin were excluded. Prenatal and postnatal data were collected. Our cohort was divided into subgroups according to the prenatal suspected origin of the lesion (ovarian, mesenteric, gastro-intestinal and other locations). For each subgroup, sensitivity, specificity, positive predictive value, false-positive rate and accuracy of fetal US were calculated.

Results: In total 47 fetuses (10/37?M/F) were identified. The mean gestational age at the time of diagnosis was 33?±?4.9 weeks. Our cohort comprised of 25 ovarian cysts (10 simplex and 15 complex), 3 GI duplication, 6 mesenteric lesions, 4 meconium pseudocyst and 9 lesions of other origin. Surgery was performed in 38 cases (81%) at birth. The prenatally established diagnosis was exactly concordant with post-natal findings in 34 cases (72.3%). Sensitivity, specificity, positive predictive value and false-positive rate of US were 88.1%, 95.5%, 71% and 5.4%, respectively. Long-term outcome was good in almost 90% of the cases.

Conclusions: The etiology of fetal intra-abdominal cysts can be prenatally diagnosed in about 70% cases. Despite the high risk of surgery at birth, the long-term outcome was good in most of the cases.     

Omphalocele and gastroschisis: prenatal diagnosis and peripartal management. A case analysis of the years 1989-1997 at the Department of Obstetrics and Gynecology, University of Homburg/Saar

OBJECTIVE: The article presents a retrospective analysis (1989-1997) of the prenatal diagnosis, the course and completion of pregnancy of 26 fetuses with omphalocele and 18 fetuses with gastroschisis. SUBJECTS: 44 pregnancies with anterior fetal wall defect diagnosed by prenatal ultrasound, clinical or patho-anatomic examination between 1989 and 1997 at the Department of Obstetrics and Gynecology, University of Homburg/Saar. RESULTS: In 40 of 44 pregnancies (91%) the fetal ventral abdominal wall defect could be detected antenatally with ultrasound. Associated malformations in fetuses with omphalocele were seen in 18 cases (69%), whereas only five fetuses with gastroschisis (28%) had an associated malformation. Nineteen of 26 fetuses (73%) with omphalocele had a normal karyotype. Seven of 26 fetuses (27%) with omphalocele had an abnormal karyotype. Eleven fetuses with omphalocele were live born, three of them with minor anomalies. Ten babies with omphalocele survived. No chromosomal anomalies were detected in fetuses with gastroschisis. There were four gastrointestinal malformations and one lethal associated malformation in fetuses with gastroschisis. There were 15 live born babies with gastroschisis, all of whom have survived. In 20 of 44 cases (45%) with ventral abdominal wall defect oligohydramnios could be detected by ultrasound. In 28 of 44 cases (64%) we found fetal growth retardation <10th percentile for gestational age. CONCLUSION: In case of a fetal ventral abdominal wall defect, the detection and appropriate classification of associated fetal anomalies is of great importance for the further course of pregnancy. Fetal karyotyping should be offered in case of a fetal abdominal wall defect. Early and close prenatal consultation of the neonatologist and the pediatric surgeon will favorably influence the perinatal outcome.     

Prenatal detection of pulmonary hypoplasia in fetuses with congenital diaphragmatic hernia: A systematic review and meta-analysis of diagnostic studies

Background.?Fetuses with congenital diaphragmatic hernia (CDH) are at risk of death from pulmonary hypoplasia at birth.

Objective.?To determine the value of prenatal imaging parameters for predicting lethal pulmonary hypoplasia in fetuses with CDH.

Search strategy.?Relevant papers were identified by searching MEDLINE (1966–2008), EMBASE (1988–2008) and the Cochrane Library (2008 issue 3).

Selection criteria.?Selected studies examined diagnostic tests for the prenatal prediction of lethal pulmonary hypoplasia in fetuses with CDH. The primary outcome measure was perinatal survival.

Results. Twenty-one studies fulfilled the entry criteria, of which six examined entirely unique heterogeneous parameters and the remaining 15 examined lung–head ratios (LHR) and/or the presence of liver in the fetal thorax. The strongest association was that of LHR?≥?0.6 compared to?<0.6 (OR: 17.02; 95% CI: 2.10–137.89), although more clinically relevant was that of LHR?>1.0 (OR: 5.07; 95% CI: 2.94–8.74). The finding of liver in the fetal chest was a poor prognostic feature (survival OR: 0.32; 95% CI: 0.21–0.49).

Conclusion.?In CDH, LHR and the presence of liver in the fetal thorax may be a useful predictive indicator of perinatal survival. Future usage of developing techniques needs careful evaluation prior to usage to guide therapy.     

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

Abstract

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

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

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

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

Reference intervals of embryos/fetuses heart rate between 6 and 14 weeks of pregnancy

Abstract

Objective: To determine reference intervals for the embryos/fetuses heart rate (HR) between 6 and 14 weeks of pregnancy.

Methods: A retrospective cross-sectional study was carried in a single center with singleton pregnancies of embryos/fetuses with a crown-rump length (CRL) between 5 and 85?mm. The HR was assessed by real time M-mode or spectrum Doppler ultrasound. To evaluate the correlation between embryo/fetal HR and CRL, polynomial equations were calculated, with adjustment by the determination coefficient (R²).

Results: A total of 5867 pregnancies were assessed. The mean gestational age was 10.37?±?2.12 weeks. The mean maternal age was 26.41?±?6.78 years. The mean embryo/fetal HR (bpm) for the CRL (mm) intervals 5├15; 15├25; 25├35; 35├45; 45├55; 55├65; 65├75; 75├85 was 145.1?±?18.7; 167.2?±?10.1; 166.9?±?8.7; 165.5?±?6.9; 162.2?±?6.8; 159.2?±?6.4; 157.1?±?6.4; 154.9?±?7.3; respectively. The following third-order equation best represented the correlation between embryo/fetal HR and CRL: HR?=?119.25?+?3.596*CRL-0.07954*CRL^2?+?0.00051*CRL³ (R^2?=?0.36).

Conclusion: Reference intervals of HR in embryos/fetuses in a large sample were determined. These reference intervals can be used in high-risk early pregnancy losses.     

Pregnancy outcome after false diagnosis of fetal growth restriction

Objectives: To evaluate pregnancy outcome following false diagnosis of fetal growth restriction (FGR).

Methods: Retrospective analysis of all singleton term deliveries of appropriately grown fetuses (10–90th weight percentiles) in a single medical center (2007–2014). Elective cesarean-section, diabetes, and hypertension were excluded. Cohort was stratified based on third trimester sonographic estimated-fetal-weight (≥32 weeks). Women with false diagnosis FGR (<10th percentile) were compared with the rest (control). Induction of labor, cesarean deliveries, and short-term perinatal outcome were compared. Logistic regression analysis was performed to adjust outcome for birth weight and gestational age at delivery.

Results: Of 34,474 pregnancies, 415 were falsely diagnosed as FGR (1.2%). Women in study group delivered earlier (38.6?±?1.1 versus. 39.0?±?0.9) with lower birth weights (2856?±?270 versus 3271?±?307 grams) and increased rate of labor inductions (19.8% versus 6.4%) and cesarean deliveries (10.8% versus 5.7%). Despite appropriate birth weight, study group neonates had higher rates of NICU admissions (10.6% versus 6.8%), mechanical ventilation (1.7% versus 0.5%), transient tachypnea of the newborn (1.7% versus 0.5%), hypoglycemia (1.7% versus 0.5%), and jaundice (11.3% versus 7.0%). p?Conclusions: False diagnosis of FGR is associated with higher rates of induction of labor, cesarean deliveries, and short-term adverse neonatal outcome.     

Prenatal diagnosis and management of congenital cystic adenomatoid malformation of the lung

OBJECTIVE: Our purpose was to review the management and outcome of pregnancies with a prenatal diagnosis of fetal congenital cystic adenomatoid malformation of the lung (CCAM). STUDY DESIGN: A retrospective review was performed of all cases since 1995 with a prenatal diagnosis of fetal CCAM from the sole tertiary perinatal referral center in Western Australia. RESULTS: Twenty-one pregnancies with CCAM were identified. The gestational age at diagnosis was <22 weeks in 86% of cases. Macrocysts were seen in 76% of cases during ultrasound examination. Seventeen pregnancies continued until term. Regression of the sonographic appearances was observed in 19% of cases. Fetal hydrops complicated two cases. One neonate died within 24 hours of delivery because of pulmonary hypoplasia. Twelve children have required pulmonary lobectomies. No adverse sequelae are evident in surviving children. CONCLUSION: Most cases of prenatally diagnosed CCAM have had a good outcome. This review has positively influenced the counseling of women with this diagnosis.     

Our clinical experience about prenatal diagnosis and neonatal outcomes of fetal central nervous system anomalies

Objective.?To present a retrospective analysis of the prenatal diagnosis and the outcome of fetuses diagnosed with central nervous system (CNS) anomalies.

Materials and methods.?We reviewed the medical records and ultrasound data of 69 cases diagnosed with CNS anomalies from 2007 to 2008. We described the prenatal diagnosis, associated findings, and outcome of these patients.

Results.?Sixty-nine patients were diagnosed with CNS anomalies. Of these, 31 had ventriculomegaly + hydrocephaly, 14 had spina bifida + meningomyelosel, 5 had choroid plexus cyst, 5 had Dandy Walker malformation, 3 had sacrocoxigeal teratoma, 2 had encephalosel, 1 had microcephaly, and 1 had Arnold Chiari malformation. Eight amniocentesis, three cord blood sampling, and two fetal reduction procedure were performed. Nine pregnancy termination and 36 delivery were performed. Neurosurgical correction was performed for neonates with spina bifida, hydrocephaly and sacrocoxigeal teratoma. Twenty-one neonates were discharged with cure, 4 neonates with follow-up, 7 neonates with paraplegia, and 13 neonates died.

Conclusion.?The outcome of fetuses with CNS anomalies was shown to depend mainly on the degree of neural tube defect and the associated anomalies were the most important factors in surviving.     

Perinatal management of pregnancies with severe fetal heart defects and epigenetic aspects

Objective: To describe pregnancies with severe fetal heart defects (CHD) with respect to perinatal complications and management. To discuss epigenetic factors with respect to maternal body mass index (BMI) and assisted reproduction treatment (ART). Methods: We performed a retrospective analysis in a single centre for prenatal diagnostics. Data were collected with respect to pre- and postnatal diagnoses of CHD, preterm labour and deliveries, maternal risk factors and postnatal outcome. Results: Between 2009 and 2011 we treated 116 patients with severe fetal heart defects. Prenatal diagnoses were: Hypoplastic left heart syndrome (HLHS) in 50 fetuses (43.1%), conotruncal heart defects (CTM) in 43 (37.1%), atrial ventricular septal defects in eight cases (7.8%).There were 11 (9.9%) twin pregnancies. Premature labour occurred in 11.2%, premature deliveries 12.9%. Nine pregnancies (7.8%) were achieved by assisted reproduction treatment (ART). A body mass index (BMI) > 25 occurred in 54.3% with 3% morbid obesity. Advanced maternal age >35 was found in 33.5%. Accuracy of the prenatal diagnosis was 97%. Conclusions: Patients with ART pregnancies may be referred to fetal echocardiography. Maternal obesity poses a diagnostic problem, the incidence of CTM may be higher due to epigenetic factors. This requires further studies. As premature labour and delivery is a frequent complication, perinatal management of these pregnancies must be reserved to specialized centers.     

Pathologic ultrasound findings and risk for congenital anomalies in teenage pregnancies

Objective: To detect the number and diagnosis of fetal malformations in teenage pregnancies and to evaluate whether low maternal age or epigenetic factors have an influence on this issue. Materials and methods: We performed a retrospective analysis in a single center for prenatal diagnostics in Northern Germany. We searched our electronic databank for all pregnancies with maternal age under 20 years. Pregnancy outcome and fetal malformations are described. Results: The incidence of teenage pregnancies in our study was 638 patients (4.4%). The total of fetal malformations in teenage pregnancies was 51(8.3%). Chromosomal aberrations were found in 5 cases (0.9%). 9 cases of fetal gastroschisis as one of the most frequent malformations were followed up and neonatal outcome was uneventful. Furthermore we found 16 cases with different heart defects and 30 cases with other malformations. Patients’ body mass indices showed an increase over the years and nicotine consumption was testified in more than 50% of the patients. Conclusions: Teenage pregnancies are at risk for fetal non-chromosomal and chromosomal abnormalities. As these might be detected by first-trimester-screening prenatal care in teenage pregnancies should include at least early ultrasound examination. Epigenetic factors may play a key role in certain fetal malformations.     

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

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

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

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

The role of ultrasonography in the diagnosis of fetal isolated complete agenesis of the corpus callosum: a long-term prospective study

Objective.?To evaluate the role of a dedicated neurosonographer in prenatal diagnosis of isolated complete agenesis of the corpus callosum (iCACC) and to asses the postnatal outcome of these infants.

Methods.?Prospective study between January 2004 to December 2004 at Fetal Maternal Medical Centre ‘Artemisia’, Rome, Italy. A detailed ultrasound scan was performed in fetuses affected by iCACC by a dedicated fetal neurosonographer (CG). In all cases, magnetic resonance imaging (MRI) within 5 weeks and 13–15 months after birth was performed. A comparison was made between prenatal findings following the ultrasound scan and postnatal MRI. In these cases, a follow-up of 4-years was performed with a neurological evaluation.

Results.?Among 23 cases of ACC diagnosed at our centre in the study period, CACC was diagnosed in 17 fetuses. Two were then excluded due to associated malformations, one was lost at follow-up and one patient opted to terminate her pregnancy. Newborn MRI confirmed the ultrasonographic diagnosis of iCACC in all 13 cases. A regular development was present in 92.3% of prenatally diagnosed iCACC.

Conclusion.?A dedicated neurosonographer could diagnose the iCACC with the same accuracy as MRI and in up to 90% of cases the newborn will have a regular development.     

Proposed management for reduced fetal movements: five years' experience in one medical center

Objective.?To assess the management of reduced fetal movements (RFM) based on repeated fetal movement counts, nonstress test (NST), and ultrasound examination.

Methods.?This is a retrospective cohort study carried out in a single tertiary maternity hospital. A total of 2393 women with singleton pregnancies at?>28 weeks' were referred to obstetric triage with chief complaint of RFM. Persistent movement counts of?<5/h and abnormal results of NST or ultrasound mandated an admission for further evaluation. Women with transient RFM and normal ultrasound and NST were discharged. We compared the outcome between these two groups. Maternal and perinatal parameters were compared between women who were admitted and those who were discharged home after evaluation.

Results.?A total of 2393 women were referred to obstetric triage with chief complaint of RFM, of whom 753 (31.5%) were admitted for further evaluation. Their demographic and obstetrical parameters were similar to those of the nonadmitted women, as were the fetal demise rates. NICU admission and cesarean section rates and low Apgar scores were significantly higher among admitted patients.

Conclusion.?RFM has a clinical significance as a predictor of adverse perinatal outcome. Our study suggests that repeated fetal movement counts, NST, and ultrasonography may identify women at risk for adverse perinatal outcome.     

Antenatal assessment of liver position,rather than lung-to-head ratio (LHR) or observed/expected LHR,is predictive of outcome in fetuses with isolated left-sided congenital diaphragmatic hernia

Objectives: Respiratory morbidity in congenital diaphragmatic hernia (CDH) is associated with high mortality and adverse outcome. Accurate prenatal diagnosis is essential for prognosis and potential treatment in utero. The aim was to evaluate the prenatal ultrasound findings in assessing the respiratory prognosis in fetuses with isolated left-sided CDH.

Methods: We retrospectively analyzed the medical records of 59 prenatally diagnosed left-sided CDH cases managed at a tertiary perinatal center.

Results: Survival rate in the study group was 73% (43/59). We found no statistically significant relationship between survival and the presence of polyhydramnios, gestational age at diagnosis, lung-to-head ratio (LHR) and observed/expected LHR (O/E LHR) values, gestational age at birth and birth weight. Intrathoracic liver herniation was a statistically significant parameter adversely affecting survival (37.2% in survivors, 68.8% in non-survivors, p?=?0.031) and logistic regression confirmed this relationship. The presence of pneumothorax and severe pulmonary hypertension were significantly associated with mortality (82% non-survivors versus 15% in survivors, p?=?0.0001).

Conclusion: Intrathoracic liver herniation seems to be a reliable parameter in the prediction of survival and neonatal respiratory morbidity in fetuses with isolated left-sided CDH. In contrast, we found no significant correlation between perinatal outcome and LHR, O/E LHR values, birth weight and gestational age.     

Predicting outcome in 259 fetuses with agenesis of ductus venosus – a multicenter experience and systematic review of the literature*

Objective: To evaluate prenatal predictors of postnatal survival in fetuses with agenesis of ductus venosus (ADV).

Methods: This retrospective study reviewed our experience and the literature between 1991 and 2015. Prenatal findings were evaluated and perinatal morbidity and mortality was documented.

Results: A total of 259 cases were included in the present analysis from our centers and 49 published studies (15 patients from our retrospective cohort review and 244 from literature review). The intrahepatic and extrahepatic shunts were present in 32.0% (73/226) and 67.7% (153/226), respectively. Cardiomegaly (n?=?64/259, 24.7%), hydrops (n?=?31/259, 12.0%) and amniotic fluid abnormalities (n?=?22/259, 8.5%) were among the most frequent initial ultrasound findings. One hundred and forty-seven fetuses (56.8%) had ADV without structural anomalies while 112 (43.2%) had associated anomalies (cardiac anomalies (n?=?66), extra-cardiac anomalies (n?=?19) and both cardiac and extra-cardiac anomalies (n?=?27)). The mean gestational age (GA) at ultrasound diagnosis was 22.9?±?6.9 weeks while the mean GA at delivery was 34?±?7.5 weeks. The overall neonatal survival was 57.1% (n?=?148/259). The following factors were associated with survival: advanced maternal age, earlier GA at diagnosis, prematurity, increased nuchal translucency, pericardial effusion, associated cardiac defects (especially AVSD), chromosomal abnormalities, hydrops, hygroma and limb anomalies.

Conclusion: Fetal hydrops, the presence of associated congenital anomalies and premature delivery are associated with poor prognosis in fetuses with ADV.     

Prenatal diagnosis of fetal adducted thumbs

Purpose: One of the greatest challenges with the finding of adducted thumbs in the prenatal setting is the determination of whether this finding is associated with an underlying genetic syndrome. The aim of the present study is to describe the characteristics and outcome of prenatal sonographic diagnosis of adducted thumbs.

Methods: A retrospective study was conducted over a period of 17?years in a tertiary referral center. All fetuses diagnosed prenatally with adducted thumbs comprised the study group. Prenatal sonographic assessment and neonatal outcome are presented.

Results: Six fetuses were evaluated for adducted thumbs over the 17-year period. In three cases, the parents elected termination of pregnancy for severe associated anomalies. In one case partial resolution was observed during the third trimester. Of the remaining two fetuses, one had a single umbilical artery and in the second the adducted thumbs were an isolated finding. Post-natal evaluation in both cases revealed bilateral adducted thumbs. Apart from orthopedic follow up no further interventions were needed.

Conclusions: Prenatal diagnosis of adducted thumbs should be followed by a meticulous fetal ultrasound examination combined with genetic counseling. According to our cohort, if associated anomalies are excluded, isolated cases seem to have a favorable diagnosis.     

Clinical spectrum of fetal long QT syndrome: a single-center experience

Objective: A considerable proportion of unexplained intrauterine fetal deaths are attributed to long QT syndrome (LQTS) susceptibility. Additionally, the estimated prevalence of LQTS in newborns is 1 in 2000. Still, prenatal diagnosis of LQTS is very rare. The aim of this study was to assess the frequency of prenatal diagnosis of LQTS at our institution, present the cases, compare our findings with the existing literature and propose a possible screening approach.

Methods: We searched our fetal database between 2006 and 2013 for cases with suspected diagnosis of LQTS.

Results: During the investigation period around 26?000 fetuses were evaluated and three cases of suspected fetal LQTS identified. Two cases of familial LQTS had no or mild intrauterine manifestation of the condition, the third fetus had a de-novo mutation with severe, early-onset disease.

Conclusions: LQTS continues to be a challenging prenatal diagnosis. In fetuses who present with complex arrhythmias, a high degree of suspicion is required, and close surveillance and timely delivery in the presence of a multidisciplinary team are necessary. For asymptomatic cases or screening purposes, routine fetal heart rate registration and detailed assessment of cases with a low for gestational age baseline may be an option.     

Predicting late-onset growth abnormalities using growth velocity between trimesters

Objectives.?To determine whether growth velocity parameters derived from routine prenatal ultrasound measurements at first, second and third trimester can identify normal growth at term as well as late-onset growth abnormalities.

Material and methods.?Longitudinal study of fetal growth in normal singleton pregnancies with three normal ultrasound examinations and delivered at term. Fetuses were classified into 3 groups (?<?10th percentile, 10–90th percentile, >?90th percentile) based on birth weight. Multiple regression on birth weight classification was used to build up a prediction equation of fetal growth potential (FGP) based on fetal biometry and fetal growth velocity parameters between ultrasound examinations. Best cut-off value for FGP predicting growth restriction and macrosomia were defined.

Results.?356 pregnancies were included. Fetal biometry growth velocities between examinations were calculated for all measurements. Using best cut-off values, the estimated sensitivity, specificity and odds ratio were: 60% [44;74], 91%[89;92] and 14.55 [6.30;33.98] and 53% [36;69], 89%[88;91] and 10 [4.27;23.49] for the prediction of growth restriction and macrosomia, respectively.

Discussion.?Fetal growth potential can be derived and calculated from standard ultrasound measurements. It can improve identification of these fetuses at risk for late-onset growth abnormalities and their related morbidity.     

Aplastic anemia associated with pregnancy: maternal and fetal complications

Objective: To analyze obstetric complications associated with aplastic anemia (AA) among pregnant women and analyze the underlying factors.

Methods: A retrospective analysis of 60 pregnancies with AA. Thirty four of these patients were grouped as complicated group having obstetric complications and the rest 26 without complications as the control group. Comparative analysis was conducted to access the related risk factors, which may affect the maternal and fetal complications.

Results: The major maternal complications in this study were premature labor, gestational diabetes, pre-eclampsia, acute heart failure, postpartum hemorrhage, and severe postpartum infection. Premature birth, fetal growth restriction and stillbirths accounted for 27.3%, 5.0% and 6.7% of prenatal mortality. Twenty six of patients had uncomplicated pregnancies. Patients without complications had higher mean hemoglobin concentration (75.38?±?16.19?g/L) and platelet counts (23.92?±?14.82?×?10⁹ cells/L) than did women with complications (mean hemoglobin concentration, 61.47?±?15.15?g/L, p?=?0.001; mean platelet counts, 12.11?±?7.87?×?10⁹ cells/L, p?<?0.001).

Conclusion: Pregnancies associated with AA can carry the risk of multiple maternal and fetal complications. Low hemoglobin concentration and platelet counts may be the primary risk factors for obstetric complications in pregnancies associated with AA.