All five digits of the hands of fetuses with Down syndrome are short.

OBJECTIVE: To compare mid-gestation sonographic measurements of all five digits of the hands of fetuses with Down syndrome with those of normal controls. METHODS: Twenty-nine fetuses between 17 and 26 weeks' gestation which had been confirmed by karyotyping to have Down syndrome were included in this prospective study. Each fetus was scanned once and the digits of only one hand were measured. Measurements were compared with those of 302 previously reported normal controls matched for gestational age. All measurements were expressed in multiples of the gestation-specific normal median (MoM) for each digit. RESULTS: Compared to 1 MoM for the length of Digits 1 to 5 from the normal population, the respective values in the Down syndrome digits were: 0.94, 0.85, 0.92, 0.88 and 0.85 MoM, representing values significantly lower than normal (P < 0.05; t-test). CONCLUSIONS: All five digits of the hands of fetuses with Down syndrome are shorter than are those of euploid fetuses. Integration of fetal digit measurement into the antenatal assessment of selected high-risk cases may be of value although confirmation of our findings should be obtained before this measurement is incorporated into Down syndrome screening in the general population.     

Prenatal age-specific reference intervals for measuring all five digits of the fetal hand.

OBJECTIVE: To construct prenatal age-specific reference intervals for measurement of five digits in normal fetuses. PATIENTS AND METHODS: Prospective cross-sectional study of fetuses assessed at an antenatal ultrasound unit in a university-affiliated general hospital. The study cohort comprised 302 pregnant women attending our clinic for routine fetal biometry or anomaly scan between December 1997 and June 2000. They all fulfilled the study inclusion criteria: singleton fetuses with normal anatomy, accurate gestational age and no medical complications of pregnancy. Each fetus was scanned once only and the finger measurements of one hand were obtained. Electronic calipers were placed on the outer margin of the proximal phalanx to the outer margin of the distal phalanx level. Those measurements and the relevant gestational age were registered in a computerized database. RESULTS: The linear increase of size of each of the five fingers was plotted across the evaluated range of gestation (P < 0.001; r2 between 0.85 and 0.86 for fingers I to V). Tables showing the 5th, 50th and 95th centiles of finger lengths between 14 and 27 weeks' gestation were created based on the reference interval charts. CONCLUSIONS: Second-trimester measurement of all five digits of the fetal hand is feasible. This may assist in the evaluation of fetuses that are primarily suspected of having genetic abnormalities that might be expressed by deviation in finger length.     

Controversies and problems in the current management of tubal pregnancy

The two main conservative treatment alternatives for tubal pregnancy,methotrexate administration and laparoscopic salpingostomy areunder constant review. Recently, expectant management of tubalpregnancy has become increasingly popular. In this review, weassess the outcome of conservative management modalities fortreatment with methotrexate and operative laparoscopy. Outcomesof extrauterine pregnancy were obtained from a review compiledfrom the English literature identified by directed Medline search.Methotrexate and laparoscopic salpingostomies yield good finaltreatment rates of 85-95% respectively and relatively low ratesfor further surgical complication (5-10% respectively). Tubalpatency, as well as future fertility performance, are quitesimilar after both techniques. Although they appear to suitthe demands of the 21st century, each one has its own benefitsand contraindications. With adequate patient selection, expectantmanagement of the tubal pregnancy is a reasonable approach withgood results. Although the morbidity rate after tubal pregnancytreatment is decreasing and the main concern is to reduce thedecline in fertility potential, the real future challenge remainsprevention of the disease, especially among the high risk patients,such as those undergoing infertility treatment. Keywords: assisted reproductive techniques/conservative treatment/methotrexate/operativelaparoscopy/tubal pregnancy     

Transvaginal sonographic assessment of cervical length changes during triplet gestation

The current study aimed to evaluate the contribution of transvaginal sonography (TVS) for monitoring cervical changes during the second half of triplet gestation. Forty-five pregnant women with triplets pregnancies were prospectively scanned by TVS from approximately 26 weeks gestation and were longitudinally followed-up until delivery. Based on a receiver-operating curve it was found that a cervical length of 25 mm is the most accurate parameter (94% sensitivity and 45% specificity) for predicting premature delivery < or =33 gestational weeks. Thus, a single cervical length measurement of < or =25 mm at 26 weeks gestation correlated well with premature delivery at < or =33 weeks (chi(2); P = 0.002). Using the linear regression model, a mathematical equation [(Week of delivery = 27.4 + 1.6 x cervical length; R(2) = 0.46; P = 0.01)] for predicting the gestational age of delivery (dependent variable) was determined based on mid-gestation cervical measurements (predictors). In parturient women with triplet gestation, TVS assessment of the uterine cervix offers insight into the cervical status and provides valuable information for prenatal care. This includes both monitoring the cervical changes throughout third trimester as well as predicting the likelihood of premature delivery.     

The prognostic role of the extent of Y microdeletion on spermatogenesis and maturity of Sertoli cells

Substantial involvement of the Y chromosome in sexual development and spermatogenesis has been demonstrated. Over the last decade, varying extent of Y chromosome microdeletions have been identified among infertile patients with azoospermia or oligozoospermia. These microdeletions were clustered in three main regions named AZFa, AZFb, and AZFc. Analysis of the Y chromosome microdeletion was found to be of prognostic value in cases of infertility, both in terms of clinical management as well as for understanding the aetiology of the spermatogenesis impairment. However, the accumulated data are difficult to analyse, due to the variable extent of these deletions, the different sequence-tagged sites (STS) used to detect the microdeletions, and the non-uniformity of the histological terminology used by different investigators. This debate discusses the chances of finding testicular spermatozoa in men with a varying extent of Y chromosome microdeletions. The genotype and germ cell findings in men with AZFa microdeletions as well as those that include more than a single AZF region are reviewed, as is the effect of Y chromosome AZF microdeletions on the maturity of the Sertoli cells.     

Can nuchal cord cause transient increased nuchal translucency thickness?

When detected in a first trimester scan, an increased thickness of nuchal translucency (NT) may be associated with chromosomal, cardiac or genetic disorders. However, less attention has been devoted to the outcome of those fetuses who have confirmed normal anatomies and karyotyping, but have abnormal first trimester scans. Thus, a challenging new issue is how to counsel such cases of transient increased NT in which the translucency rapidly vanishes with no evidence of other underlying abnormalities. Two cases of transient increased thickness of NT are reported. In both, a nuchal cord was ultrasonographically demonstrated and a thorough work-up revealed chromosomally and anatomically normal fetuses. The pathophysiological theories behind these observations and their significance are discussed. Based on these observations, we suggest that transvaginal sonography combined with Doppler flow studies should be utilized for the presize detection of cord patterns to accomplish the work-up in cases of increased NT.     

Is there a correlation between time of delivery and newborn cord pH?

Purpose: Since more senior and attending physicians work in labor wards during morning shifts, we expect a better delivery outcome during that time period.

Materials and methods: A retrospective study was conducted between 1/2005 and 12/2014. Records of 56 428 singleton deliveries from a tertiary hospital in which cord blood pH was routinely measured at birth were analyzed. Time of birth was divided into shifts: 7 AM–3?PM (morning shift), 3?PM–11?PM (afternoon shift), and 11?PM–7 AM (night shift). Additional stratification compared weekdays and weekend deliveries.

Results: 19?601, 18?429, and 18?398 neonates were born during morning, afternoon, and night shifts, respectively. There was no significant difference in maternal age, neonatal weight, or mean 5-min Apgar score among the three shift periods. Furthermore, there was no correlation between shift time of delivery and newborn acidosis with respect to cord pH less than 7 (0.1% in each time periods, p?=?0.67). Despite the above, instrumental deliveries and cesarean sections were more common in the morning shift compared to the afternoon and night shift, respectively (p?=?0.001 each).

Conclusions: Although shift time of delivery was found to be related to mode of delivery it was not related to either 5-min Apgar score or newborn acidosis as reflected by cord pH.