bluuebunny/crossref_metadata_2025 huggingface dataset:
Coenzyme Q10 Fetal Plasma Levels
Authors: Noia Giuseppe , Romano Domenico , De Santis Marco , Mariorenzi Sara , Caruso Alessandro , Mancuso Salvatore
Published: April 2003

Objective: This study aims at determining a cutoff value differentiating the fetal from the adult coenzyme Q10 (CoQ10) values and comparing substantial increases in CoQ10 plasma levels in fetuses with hypoxic hypoxia and nonimmune fetal hydrops. Methods: We have selected 61 pregnancies and determined the CoQ10 levels in fetal and maternal samples obtained by cordocentesis. Our study included a control group and pregnancies with intrauterine growth retardation, Rh isoimmunization, nonimmune fetal hydrops, and fetal malformations. Results: To differentiate the fetal from the adult values we have set 0.3 mg/ml as the cutoff value. The CoQ10 were higher only in fetuses with hypoxic hypoxia and nonimmune hydrops. Conclusion: Normal fetal CoQ10 plasma levels are lower than 0.3 mg/ml.
Pregnancy Outcome and Total Parenteral Nutrition in Malnourished Pregnant Women
Authors: Caruso Alessandro , De Carolis Sara , Ferrazzani Sergio , Trivellini Carmen , Mastromarino Carmen , Pittiruti Mauro
Published: April 2003

Objective: We evaluated pregnancy outcome and fetal growth in women requiring total parenteral nutrition (TPN). Methods: Eleven malnourished pregnant women were treated with TPN in a single institution, starting at a mean gestational age of 20 ± 8 weeks (± SD). Serial ultrasound evaluations of fetal growth (biparietal diameter, femur length, abdominal circumference) were performed. The paired Student t test and Wilcoxon signed-rank test were used for the statistical analysis: p values <0.05 were considered significant. Results: The duration of TPN ranged from 14 to 220 days. Maternal nutritional state was well preserved and no complications were related to treatment. A gestational age of 35 ± 3 weeks at delivery (mean ± SD), birth weight of 2,251 ± 670 g (mean ± SD) and birth percentile of 29 ± 16 (mean ± SD) were observed. One intrauterine death occurred. The comparison between the sonographic findings, before and 2 weeks after starting TPN, showed a fetal percentile gain with a statistically significant increase in the abdominal circumference percentile (p < 0.05) from a median percentile of 2 (range 2–32) to 33 (range 2–78). Conclusions: TPN proved to be helpful and lifesaving in malnourished pregnant women and promoted fetal growth, as shown by the longitudinal ultrasonographic evaluations.
Comparison of Doppler Sonographic Examinations of the Umbilical and Uterine Arteries in High-Risk Pregnancies
Authors: Joern Hendrik , Rath Werner
Published: April 2003

Objective: To determine the value of Doppler ultrasonographic examinations of the uterine artery in high-risk collectives and their importance as compared to examinations of the umbilical artery. Methods: In 142 patients with fetal growth retardation (birth weight <10th percentile) and/or pre-eclampsia/HELLP syndrome (as defined by ACOG criteria), the umbilical artery and the uterine arteries were examined bilaterally using a 3.5/5-MHz color Doppler system (Acuson 128). The patients were assigned to six groups according to the Doppler findings (uterine artery unilaterally/bilaterally normal/pathologic and umbilical artery normal/pathologic). For each group, the median of the birth weight and the gestational age at delivery was determined and the frequency of occurrence of complications was calculated. Results: In cases with pathologic results in all three vessels, the median gestational age at delivery and the median birth weight were significantly lower than in all other subgroups. Of the cases with pathologic findings in the umbilical artery only, 6% had pre-eclampsia/HELLP syndrome. However, this complication developed in 90% of the cases with pathologic findings in both uterine arteries. If only the umbilical artery was examined (and not the uterine arteries) the Doppler results were normal in 40 (28%) of the patients in our high-risk group, thus incorrectly simulating undisturbed placental hemodynamics. Conclusions: Examination of both uterine arteries is an indispensable element of Doppler examination to assess placental performance and risk to the fetus.
Transvaginal Sonographic Fetal Biparietal Diameter/Kidney Length Ratio in Early Pregnancy as a Screening Tool for Renal Malformations
Authors: Guariglia Lorenzo , Rosati Paolo
Published: April 2003

Objective: The aim of the study was to produce by 7.0 MHz high resolution transvaginal scan early in pregnancy normal values of biparietal diameter/kidney length ratio that can be used as reference ranges. Methods: In this prospective cross-sectional study, a transvaginal high-resolution sonography was performed between 11 and 16 weeks’ gestation in 807 pregnant women with a history of regular cycles, singleton pregnancies and absence of fetal malformations. Measurements of kidney length and biparietal diameter were obtained in all cases and biparietal diameter/kidney length ratio was plotted against gestational age. Results: The values of biparietal diameter/kidney length ratio were found to be fairly constant throughout the period evaluated. Conclusion: Our results indicate that this new age-independent ratio can be useful in the early detection of some fetal kidney malformations affecting normal growth.
Fetal Thyrotrophin: The Best Indicator of Long Term Thyroid Function after in utero Exposure to Iodine-131?
Authors: Welch C.R. , Hocking M. , Franklyn J.A. , Whittle M.J.
Published: April 2003

A woman treated with radioiodine for thyrotoxicosis was subsequently found to be 19 weeks pregnant at the time of treatment. Fetal thyroid hormone levels in utero were normal or mildly elevated but fetal thyrotrophin (TSH) levels were very high. The baby remained euthyroid after birth, but required treatment with thyroid hormone replacement to normalise the TSH level. Neurodevelopment was normal at age 36 months.
A Case of Congenital Familial Short Femur Diagnosed Prenatally
Authors: Makino Yasuo , Inoue Toshio , Shirota Kyoko , Kubota Syuhei , Kobayashi Hideki , Kawarabayashi Tatsuhiko
Published: April 2003

A fetus at 24 weeks of gestation had been suspected of congenital familial bilateral short femur. The Japanese mother, 41 years old and 139 cm in height presented with bilateral short femur herself. The mother had two affected aunts and one affected daughter in her family history. Ultrasound examination was given to the mother for the first time at 24 weeks of gestation and it revealed bilateral short femur of 30 mm in length on the right and 31 mm on the left femur of the fetus. Other examinations were entirely normal and the pregnancy resulted in a full-term spontaneous vaginal delivery to a male baby. Birth weight was 2,790 g and the 1 and 5 min Apgar scores were at 8 and 10. Diagnosis was confirmed by skeletal radiographs.
Effect of in utero Infusion Route on Lymphocyte Distribution in Fetal Rat Tissues
Authors: Aboussaouira T. , Gerard A. , Gerard H.
Published: April 2003

Infusion of cells into the fetus is a new form of intrauterine therapy for several genetic disorders. The effect of in utero infusion routes on labelled lymphocyte distribution in fetal rat organs was investigated. Fetuses, 14–16 days of gestation, were infused in utero with a Hoechst 33342 (bis-benzamide) labelled lymphocyte and FITC-labelled polystyrene bead mixture via four routes: intraperitoneal, intraplacental, intra-amniotic, and intravenous. The distribution within tissues was evaluated in frozen sections of placenta and fetal organs. Our results suggest that among the four routes tested, the intravenous route offered the possibility to reach easily fetal organs without any cell loss and yielded higher cell and bead concentrations in fetal organs, especially in the liver and in the kidney. In conclusion, the intravenous route seems to be appropriate for hematopoietic cell transplantation in the developing fetus.
Does the Hemoglobin Concentration in Fetal Blood Interfere with the Accuracy of Fetal Reflection Pulse Oximetry?
Authors: Arikan Guerkan M. , Haeusler Martin C.H. , Haas Josef , Scholz Heinz
Published: April 2003

Objective: Our goal was to investigate the influence of the fetal hemoglobin (Hb) concentration on the accuracy of reflection pulse oximetry. Methods: 179 fetuses were monitored by a reflection pulse oximetry system (RPOX MK2). Pulse oximetry measurements (SO2POX) were compared with the oxygen saturation and pH of umbilical artery and vein (UA-, UV-SaO2) immediately after delivery. Correlation and linear regression analyses were performed. Because it is unknown whether low or high Hb concentrations might interfere with the SO2POX measurements, the influence of the Hb level on the correlations was evaluated by weighting the linear regression in both ways; by Hb concentrations as weighting factor and as an inverse weighting factor (1/Hb). Results: There was a significant correlation between SO2POX and UV-SaO2 (for the last 10 min of delivery, r = 0.45, p < 0.0005) but not with pH or UA-SaO2. Linear regression analysis between SO2POX and UV-SaO2 showed a multiple R of 0.45. Hb concentration in fetal blood ranged from 9.2 to 20.5 mg/dl. The weighted regression indicated a multiple RHb of 0.49, which did not differ by the inverse weighting (multiple Rinverse Hb: 0.49). Conclusions: Pulse oximetry measurements seem to reflect oxygen saturation in fetal blood, however further improvement is necessary. The Hb concentration in fetal blood does not interfere with the accuracy of fetal pulse oximetry and need not be taken into consideration in calibration curves.
Changes in Uterine Artery Doppler Velocimetry in Pregnant Patients Undergoing Glucose Tolerance Test May Predict Adverse Outcome in Later Pregnancy: A Preliminary Study
Authors: Jaffe Richard , Friedman Zvi
Published: April 2003

Objective: Previous studies have demonstrated that high glucose levels often cause increased placental resistance to blood flow. The present study was undertaken to assess whether any changes in placental vascular resistance would occur following a standard glucose tolerance test. Methods: Doppler velocimetry of uterine, intraplacental and umbilical vessels was performed before and after administration of glucose tolerance test. Results: The uterine circulation demonstrated abnormal indices in patients that later developed placental insufficiency. Conclusion: This preliminary study demonstrated that following a glucose tolerance test significant changes seem to occur in the uteroplacental but not in the fetoplacental circulation of pregnancies destined to develop preeclampsia or intrauterine growth restriction.
Detection and Measurement of Fetomaternal Hemorrhage following Diagnostic Cordocentesis
Authors: Chitrit Yvon , Caubel Patrick , Lusina Daniel , Boulanger Marie-Christine , Balledent Françoise , Schwinte Anne Lyse , Herrero Rafael
Published: April 2003

Objective: The aim of this study was to investigate the effect of cordocentesis on fetomaternal hemorrhage (FMH). Methods: One hundred and three diagnostic cordocenteses, without any other associated procedure, were performed at 23–40 weeks’ gestation. FMH was detected using the Kleihauer-Betke staining of maternal blood taken immediately before and after cordocentesis. Results: Significant FMH occurred after 40 (38.8%) of the 103 procedures. An increased risk of fetal bleeding was associated with both an anterior placenta (odds ratio (OR) 5.89; 95% confidence interval (CI) 2.27–15.3; p < 0.001) and a transplacental cordocentesis (OR 37.0; 95% CI 2.15–636; p < 0.001). The volume of FMH was greater after cordocentesis with an anterior placenta (90th percentile 6.20 ml) than after cordocentesis with a lateral (90th percentile 4.58 ml) or posterior placenta (90th percentile 1.35 ml) (p < 0.001). After fetal blood sampling, significant FMH occurred more frequently with a procedure duration of 3 min or more (OR 4.45; 95% CI 1.70–11.7; p = 0.002) and with two or more needle insertions (OR 4.65; 95% CI 1.80–12.1; p = 0.001). Conclusion: FMH following cordocentesis may be related to placental injuries. This event is influenced by placental location, procedure duration and the number of needle insertions.
Enrichment of Fetal Nucleated Red Blood Cells from the Maternal Circulation for Prenatal Diagnosis: Experiences with Triple Density Gradient and MACS Based on More than 600 Cases
Authors: Gänshirt Dorothee , Smeets Frank W.M. , Dohr Angelika , Walde Corinna , Steen Imke , Lapucci Chiara , Falcinelli Christina , Sant Rosalie , Velasco Martha , Garritsen Henk S.P. , Holzgreve Wolfgang
Published: April 2003

Objective: We wanted to obtain statistically relevant data about the efficiency of our method for the isolation of fetal nucleated red blood cells (NRBCs) from the maternal circulation. Methods: More than 600 samples were investigated using a triple density gradient followed by magnetic separation of anti-CD71-labeled cells, and yields and purities of recovered NRBCs were determined. Results: The enrichment effectivity as well as the morphological condition of cells was reproducibly good, if blood samples were enriched within 48 h after sampling. The efficacy was independent of various methodological parameters and our technique was superior to other magnetic cell-sorting techniques. Mean yields and purities of NRBCs increased with increasing gestational age, ranging from 100 to 1,000 cells per 40-ml blood sample and from 0.1 to 1%, respectively, from the 6th week of gestation to term. In pregnancies with preeclampsia NRBCs were increased by a factor of 10. Conclusion: Our enrichment technique proved to be optimized with respect to various methodological parameters, which were compared in the present study, and it is efficient and reproducible for the enrichment of NRBCs from the maternal circulation in all three gestational trimesters.
2nd-Trimester Maternal Serum Marker Results Are Not Altered by Delayed Analysis
Authors: Feldman Baruch , Dvorin Elena , Phillips Tracy , Kramer Ralph L. , Johnson Mark P. , Evans Mark I.
Published: April 2003

Objective: The goal of the study was to evaluate the significance of delayed laboratory analysis of maternal serum α-fetoprotein, β-subunit of human chorionic gonadotropin, and unconjugated estriol for prenatal screening. Methods: Biochemical analysis of 30 consecutive biochemical screening specimens of maternal serum α-fetoprotein, β-subunit of human chorionic gonadotropin, and unconjugated estriol was performed immediately upon arrival to the laboratory, 7 days later, and again 14 days after maternal blood was drawn. Differences among the results of the three sets of biochemical studies were evaluated by one-way analysis of variance for repeated measures. Results: No significant differences were found among the results of immediate assays as compared with those at a 7- or a 14-day delay for all three biochemical markers. Conclusions: Our data suggest that up to a 14-day delay in the performance of the 2nd-trimester maternal serum biochemical screening assays will not alter the results significantly. The results of maternal serum screening are, thus, clinically valid even if the laboratory assays were performed several days after maternal blood was drawn.
In utero Decompression of a Cystic Grade IV Sacrococcygeal Teratoma
Authors: Garcia Anna Marie , Morgan III Walter M. , Bruner Joseph P.
Published: April 2003

Sacrococcygeal teratomas (SCT) are the most common congenital tumors in the newborn. The prevalence rate is approximately 1 per 40,000 births, with 80% occurring in females. The majority of these tumors are external, protruding from the perineal region. Intrapelvic SCTs, by contrast, are extremely rare and difficult to diagnose in utero. Only 15% of the SCTs are entirely cystic, the majority being mixed or solid tumors. We describe a case of a fetal cystic presacral (grade IV) SCT, discovered at 22 weeks of gestation, which resulted in bilateral ureteral obstruction and hydronephrosis. This is the first known reported case of prenatally decompressing a cystic SCT via an amniotic catheter to alleviate a mass effect in the fetus.
Fetal Cardiocentesis in Care of Severe Kell Immunisation
Authors: Bakos Oddvar , Ewald Uwe , Lindgren P.G.
Published: April 2003

This case report demonstrates how severe a Kell immunisation can be. Fetal anemia and hydrops fetalis in the second trimester required six intrauterine transfusions, two by cardiocentesis. At 4 years of age the child has shown no abnormalities.
Contribution of Tridimensional Sonography and Magnetic Resonance Imaging to Prenatal Diagnosis of Apert Syndrome at Mid-Trimester
Authors: Boog G. , Le Vaillant C. , Winer N. , David A. , Quere M.P. , Nomballais M.F.
Published: April 2003

A diagnosis of Apert syndrome, suspected at 24 weeks’ gestation after conventional sonography showing turribrachycephaly and syndactyly of hands and feet, was confirmed at 26 weeks’ gestation by tridimensional sonography and magnetic resonance imaging. This is only the second prenatal diagnosis reported at mid-trimester, excluding cases published from affected mothers or in connection with a context of recurrence. Additional findings have been collected from tridimensional sonography (mid-facial hypoplasia, downslanting palpebral fissures) and from magnetic resonance imaging (verticalization of the clivus and flattened angle of the cranial base).
Contraction of the Fetal Ductus arteriosus Induced by Diclofenac
Authors: Rein A.J.J.T. , Nadjari M. , Elchalal U. , Nir A.
Published: April 2003

The ductus arteriosus in the fetus may contract after administration of nonsteroidal anti-inflammatory drugs such as indomethacin and aspirin. We report a similar effect observed after a 36-week pregnant women was given diclofenac against flank pains. The ductus of this fetus was vasoconstricted with evidence of right ventricular hypertension. It resolved after cessation of the drug. Diclofenac is a cyclo-oxygenase inhibitor and thus carries the pharmacodynamic properties of other nonsteroidal anti-inflammatory drugs with inhibition of prostaglandin synthesis, resulting in vasoconstriction of the ductus arteriosus. We suggest monitoring of the fetal ductus state and velocities by fetal echocardiography in women treated with diclofenac.
High Levels of Maternal Serum Human Chorionic Gonadotropin in Down Syndrome Pregnancies: The Possible Role of a Transcription Factor on Chromosome 21
Authors: Goshen Ran , Gonik Bernard , Ariel Ilana , Weiss Yael , de-Groot Nathan , Hochberg Abraham
Published: April 2003

Increased levels of human chorionic gonadotropin (hCG) are used as markers for Down syndrome (DS) screening of low-risk populations. The pathophysiology for increased hCG levels remains unknown. In general, hCG synthesis is limited by the rate of β-chain formation. In the placenta, 2 of a total of 6 hCG β-genes are expressed. We hypothesized that in DS, a transcriptional factor may upregulate β-chain transcription by interacting with the β5-promoter. Primary cell cultures of skin fibroblasts from both normal and DS midtrimester fetuses were established and transfected with the β5-promoter linked to the chloramphenicol-acetyl-transferase reporter gene. The chloramphenicol-acetyl-transferase activity was measured. Three of six DS-derived cell cultures showed a three-fold increase in acetylation. The increase in hCG promoter activity in DS-derived fibroblasts suggests a possible role for a transcriptional factor located on the human chromosome 21 by either directly or indirectly interacting with the β5-promoter.
Efficiency of Ultrasound and Biochemical Markers for Down’s Syndrome Risk Screening
Authors: Benattar Clarisse , Audibert François , Taieb Joëlle , Ville Yves , Roberto Aline , Lindenbaum Albert , Frydman René
Published: April 2003

Objective: To evaluate the sequential combination of ultrasound screening for fetal aneuploidy at 11–14 weeks with maternal biochemistry at 12–14 and 15–18 weeks of gestation. Methods: A prospective study including 1,656 women, with a singleton pregnancy booked before 13 weeks of gestation. Nuchal translucency (NT) thickness was measured by transabdominal ultrasound examination. α-Fetoprotein, free βhCG and hCG were measured by immunoradiometric (12–14 weeks) or immunometric (15–18 weeks) assays. Derived risks were then calculated. Cutoff risks were chosen first arbitrarily at 1/250 and then adjusted for a 5% false-positive rate. Results: Seven fetal aneuploidies were diagnosed, including 5 Down’s syndromes, 1 trisomy 18 and 1 triploidy. Three Down’s syndromes had concordant high risk with the 3 screenings. One was at low risk with NT, and another was at low risk by maternal serum screening, but sequential combination of screenings led to a 100% detection rate with cutoffs of 1/240, 1/160 and 1/250 for NT, first- and second-trimester biochemistry, respectively (i.e. for a cutoff adjusted for a 5% false-positive rate). Conclusion: This preliminary study suggests a benefit in combining maternal age-related risk together with NT and biochemical markers in the first or the second trimester. The algorithm combining these risks needs to be established in a wide population.
Evaluation of Fetal Echogenic Bowel in the Second Trimester
Authors: Yaron Yuval , Hassan Sonia , Geva Eli , Kupferminc Michael J. , Yavetz Haim , Evans Mark I.
Published: April 2003

Previous studies cite different possible etiologies for fetal echogenic bowel (FEB). The purpose of this study was to evaluate the possible etiologies for second-trimester FEB, and to provide clinical guidelines for evaluation of this finding. The study included 79 patients diagnosed with FEB in the second trimester. Fifteen cases (19%) were associated with maternal vaginal bleeding. Of these, 12 patients underwent amniocentesis, 9 of which had visible blood products in the amniotic fluid. Seven cases (8.9%) had associated severe malformation. Seven other cases (8.9%) were noted in multifetal pregnancies. Five fetuses (6.3%) had evidence of bowel obstruction or perforation not associated with cystic fibrosis (CF). Chromosomal aberrations were found in 5 fetuses (6.3%). Intrauterine infection with cytomegalovirus, herpes simplex virus, varicella-zoster virus, or parvovirus B-19 was documented in 5 patients (6.3%). Three cases (3.8%) were associated with subsequent unexplained stillbirth. Two fetuses (2.5%) were found to be affected by CF. Finally, in 30 cases (38%), no obvious reason for FEB was found. We conclude that the evaluation of second-trimester FEB should include targeted ultrasound for associated malformations, infectious studies, DNA analysis for CF mutations, amniocentesis for chromosomal analysis and evaluation of the amniotic fluid for degraded blood products, and an autopsy in cases of stillbirth. Even when no apparent reason is found, pregnancies should be considered at high risk for poor outcome.
Maternal Fertility Is Not Affected by Fetal Surgery
Authors: Farrell Jody A. , Albanese Craig T. , Jennings Russell W. , Kilpatrick Sarah J. , Bratton Barbara J. , Harrison Michael R.
Published: April 2003

The purpose of this report is to assess the impact of fetal surgery on future maternal fertility, subsequent pregnancy outcome, and the incidence of pregnancy complications. Retrospective data were collected on 70 mothers who underwent fetal surgery between April 1981 and June 1996. Indications for open hysterotomy fetal surgery included congenital diaphragmatic hernia (n = 44), congenital cystic adenomatoid malformation of the lung (n = 11), urinary obstruction (n = 9), sacrococcygeal teratoma (n = 4), heart block (n = 1), and acardiac-acephalic twin reduction (n = 1). The following data were obtained: number of pregnancy attempts, number of successful pregnancies, pregnancy outcome including obstetrical and neonatal complications, and infertility after fetal surgery. There were 45 respondents, of whom 35 attempted subsequent pregnancies. Thirty-two were successful, resulting in 31 livebirths. Two women had a strong prefetal surgery history of infertility, 1 has only attempted to conceive for 3 months. We report this experience because the effect of open fetal surgery on futrue fertility is such an important question for our patients and referring physicians. This analysis suggests that hysterotomy and open fetal surgery has a negligible impact on maternal fertility.
Predictive Value of Uterine Artery Velocimetry at Midgestation in Low- and High-Risk Populations: A New Perspective
Authors: Caforio Leonardo , Testa Antonia Carla , Mastromarino Carmen , Carducci Brigida , Ciampelli Mario , Mansueto Donata , Caruso Alessandro
Published: April 2003

Objective: The aim of this study was to assess the value of uterine artery Doppler velocimetry performed at 18–20 and 22–24 weeks of gestation in predicting preeclampsia and adverse pregnancy outcome in low- and high-risk patients. Methods: 865 pregnant women were evaluated: 335 and 530 pregnant women represented the high- and low-risk groups, respectively. Doppler ultrasound examination of the uterine arteries was performed at 18–20 weeks of gestation in 385 patients and at 22–24 weeks of gestation in 659 patients. Pregnancy outcome was evaluated in terms of: onset of preeclampsia; birth weight <2,500 g; birth weight <1,750 g; delivery before 36 weeks, and delivery before 32 weeks. Results: At 18–20 weeks of gestation the sensitivity for the prediction of preeclampsia was 100 and 94% in low- and high-risk groups, respectively. Excellent negative predictive values towards birth weight <1,750 g (97% in low-risk and 93% in high-risk groups) and delivery prior to 32 weeks of gestation (99% in low-risk and 95% in high-risk groups) were obtained. At 22–24 weeks of gestation the sensitivity for the prediction of preeclampsia was 100 and 97% in low- and high-risk groups, respectively. Negative predictive values towards birth weight <1,750 g were 97% in low-risk and 94% in high-risk groups, whereas towards delivery prior to 32 weeks of gestation they were 98% in low-risk and 94% in high-risk groups. Conclusion: Doppler evaluation of the uterine artery at 18–20 and 22–24 weeks of gestation represents a useful predictive test in high-risk pregnancy and can also be used in prenatal surveillance of a low-risk population.
Utilization of the Nuchal Translucency Image-Scoring Method during Training of New Examiners
Authors: Herman Arie , Maymon Ron , Dreazen Eli , Zohav Efraim , Segal Octav , Segal Shmuel , Weinraub Zwi
Published: April 2003

Training of new examiners, utilizing 1st-trimester nuchal translucency ultrasound screening, is mandatory for obtaining reproducible measurements. This study examined the contribution of the nuchal translucency image-scoring method to the process of training and its utilization as an objective tool of image evaluation and a tool for approving qualification. The study included an evaluation of the performance of two new examiners (examiners A and B) before and after intervention, using the image-scoring method. The preintervention period included 75 images evaluated by two reviewers using general evaluation and the scoring method. The report of the scoring method was submitted to the examiners and was applied to 55 images performed afterwards. The agreement between two reviewers in classifying the first 75 images as ‘accepted’ or ‘rejected’ was tested using general evaluation versus the scoring method. The effect of the intervention was examined by comparing the quality of the images between the two time periods. A chart indicating final scores of 80 successive images analyzed by examiner A was used to set criteria for assessing qualification. Using general evaluation, the reviewers disagreed on 19 (25%) of the images, whereas using the scoring method they disagreed on only 5 (7%, p < 0.01). Comparison before and after application of the intervention demonstrated significant improvement expressed by the increased rate of better quality groups (p < 0.001) and improved mean scores from 4.31 ± 0.31 to 6.15 ± 0.32 (p < 0.001). Enhanced improvement of examiner’s A performance could be attributed to the intervention rather than to his learning curve. Improvement was demonstrated in all the criteria examined; however, it was significant only for images size (from 33 to 98%), amnion demonstration (from 13 to 42%), and caliper placement (from 49 to 71%). Examiner’s A chart enabled us to set standards for assessing competence, based on the scoring method. These included a minimum of 40 scans, followed by more than ten sequential images of acceptable quality. The scoring method contributed to the process of training, as it made possible to objectively evaluate the images, pointed out specific erros, served as an efficient tool of intervention, and might be used for ascertaining competence. We recommend to consider its utilization in centers running 1st-trimester ultrasound screening during training new examiners.
Hemangioma of the Umbilical Cord: Stenotic Change of the Umbilical Vessels
Authors: Kamitomo Masato , Sueyoshi Kazunobu , Matsukita Sumika , Matsuda Yoshio , Hatae Masayuki , Ikenoue Tsuyomu
Published: April 2003

We report a rare case of an umbilical cord hemangioma diagnosed by ultrasound at 16 weeks of gestation. The umbilical cord consisted of a hemangioma nodule and pseudocysts near the placental insertion, a large gelatin-like swelling adjacent to the nodule on its fetal side, and a short normal part extending to the navel. At 17 weeks of gestation, this condition resulted in the intrauterine death of the fetus. Microscopically, there were communications between the capillary of the hemangioma and the umbilical vessels, verifying the origin of the tumor. Moreover, the umbilical vein and one of the arteries changed stenotically due to the intravascular proliferation of the hemangioma. These findings indicate the possibility of a pathological association between the umbilical cord hemangioma and fetal demise due to impaired umbilical circulation.
Intrauterine Growth Retardation and Fetal Cardiac Function
Authors: Severi F.M. , Rizzo G. , Bocchi C. , D’Antona D. , Verzuri M.S. , Arduini D.
Published: April 2003

Intrauterine growth retardation is a pathology which is found in 3–10% of all pregnancies and it is associated with around 20–25% of all fetal intrauterine deaths and with long-term neurologic sequelae. It presents an increased risk of distress during labor and delivery and a greater risk of perinatal mortality. The causes of IUGR and the cardiac and venous Doppler in normal fetuses are analyzed, and the hemodynamic cardiac modifications in IUGR fetus are discussed. The fetal cardiac function in intrauterine growth retardation shows a redistribution of the fetal cardiac output, which tends to favor the left ventricle as the mechanism to compensate for the uteroplacental insufficiency. The Doppler velocity indices are modified as the fetal condition progressively deteriorates and they represent an important tool for the management of the complicated pregnancy.
Prenatal Diagnosis of a Subamniotic Hematoma
Authors: van den Bosch Thierry , van Schoubroeck Dominique , Cornelis Ann , Dubin Marleen
Published: April 2003

A case of a subamniotic hematoma was diagnosed at 34 weeks of gestation. Pregnancy and delivery were uneventful. The ultrasound features of a subamniotic hematoma, and the differential diagnosis with lesions of less favorable outcome are described.
Amniotic Fluid Pressure in Both Cavities of Twin-to-Twin Transfusion Syndrome: A Vote against Septostomy
Authors: Hartung John , Chaoui Rabih , Bollmann Rainer
Published: April 2003

Objective: To report our results of the measurement of the amniotic fluid pressure in twin-to-twin transfusion syndrome before and after amniodrainage and the separate measurement in the cavity of the stuck twin and the recipient, respectively, in 2 cases. Method: Six patients with severe TTS underwent therapeutic amniodrainage. Amniotic fluid pressure was obtained before and after reduction of the fluid volume. In 2 of these cases we were able to calculate the pressure separately in both amniotic cavities, the donors (stuck twin) and the recipients. Results: In all cases of TTS, amniotic pressure was high before and reduced after amniodrainage. The pressure was equal in the donors and in the recipients cavity. Conclusion: Amniotic pressure seems to be high in TTS, but equal in both cavities. Therefore, amniotic septostomy is probably of low value, especially if a high-risk monoamniotic situation is artificially created.
Molecular and Fetal Tissue Biopsy Capabilities Are Needed to Maximize Prenatal Diagnosis of Junctional Epidermolysis bullosa: Fetal Skin Biopsy Using a 1-mm Microendoscope
Authors: Seubert David E. , Feldman Baruch , Krivchenia Eric L. , Evans Mark I. , Barki Gerard , Leach Richard , Johnson Mark P.
Published: April 2003

Objective: To describe a minimally invasive micro-endoscopic technique for fetal skin biopsy and direct examination for a lethal skin condition. Materials and Methods: Direct fetoscopic examination of a fetus was undertaken along with full thickness skin biopsies at 19 weeks’ gestation. Results: No phenotypic expressions of the lethal condition were visualized and six full thickness skin biopsies were collected. Pathological examination revealed normal skin structures not consistent with junctional epidermolysis bullosa (JEB). Conclusion: Minimally invasive examination with the 1 mm endoscope allows direct fetal phenotypic evaluation, full thickness skin biopsies, with risks similar to amniocentesis.
Maternal Contamination at Fetal Muscle Biopsy
Authors: Overton Timothy G. , Smith Richard P. , Sewry Caroline A. , Holder Susan E. , Fisk Nicholas M.
Published: April 2003

Duchenne muscular dystrophy (DMD) can be diagnosed by fetal muscle biopsy and immunohistochemical staining showing the absence of dystrophin. We report a case of fetal muscle biopsy in which the needle gun was successfully fired within the fetal gluteal muscle but the sample was contaminated by maternal tissue. This was attributed to the design of the biopsy needle, allowing transient opening of the biopsy core as the needle penetrated the maternal rectus sheath, muscle, and myometrium. Histology showed tissue suggestive of maternal origin, confirmed by DNA analysis. Repeat sampling revealed fetal muscle with normal dystrophin expression. We recommend that care be taken during needle insertion to avoid maternal contamination, and tests be used to confirm the fetal source of the sample.
Efficacy of Oral Iodide Therapy on Neonatal Hyperthyroidism Caused by Maternal Graves’ Disease
Authors: Maragliano G. , Zuppa A.A. , Florio M.G. , Scapillati M.E. , Girlando P. , Crescimbini B. , Cafforio C. , Noia G. , Cavaliere A.F. , Tortorolo G.
Published: April 2003

Objective: To verify the efficacy of oral iodide therapy in treating a case of early neonatal hyperthyroidism due to maternal Graves’ disease. Methods: We report a case of neonatal hyperthyroidism which occurred in a 2,650-gram, female baby, born at 39 weeks’ gestational age (GA) to a 30-year-old mother affected by Graves’ disease and treated with thionamides (propylthiouracil) from the 20th week of gestation. A fetal goiter, due to maternal therapy, had been observed by ultrasound scan at 31 and 35 weeks of gestation, with contemporary low cord thyroid hormone levels. Two intra-amniotic injections of levothyroxine were then performed at 34 and 36 weeks of gestation, which led to a significant reduction of fetal goiter and to normalization of cord thyroid hormone levels. The neonatal clinical course was characterized by symptoms of hyperthyroidism from the 2nd to 3rd days of life (irritability, tachycardia, tachypnea, hyperphagia), mostly during feeding. Oral treatment with potassium iodide (KI, 8 mg × 3 times a day) was started at 23 days of life. Results: Treatment with KI led to a significant reduction of neonatal clinical symptoms and to a normalization of hormone levels within 4 days of therapy. The treatment was discontinued in 13th week of life because of neonatal well-being and normal hormone levels. Conclusions: We believe that KI therapy is effective in treating neonatal hyperthyroidism and does not cause suppression of neonatal thyroid activity, which is possible using antithyroid drugs like thionamides.
Continuous Monitoring of Fetal pH, pO2 and pCO2 Using a Fiberoptic Multiparameter Sensor in Animal Models Reproducing in utero Conditions
Authors: Devlieger R. , Gratacós E. , Wu J. , Yesildaglar N. , Ghysel C. , Barki G. , Deprest J.
Published: April 2003

Objectives: To evaluate the feasibility and accuracy of continuous fetal monitoring with a multiparameter intravascular sensor (MPIS) in animal models mimicking the fetal metabolic status. Methods: First, the accuracy of the MPIS in hypoxic conditions was tested in adult rabbits (n = 6). The carotid artery (n = 4) or vein (n = 2) was catheterized with a 20-gauge cannula, housing a 500-μm Neotrend® fiberoptic sensor for pCO2, pO2, pH and temperature. Fiberoptic readings were compared with arterial blood-gas (ABG) analyses. Secondly, the feasibility of continuous fetal fiberoptic sensing was tested during experimental fetoscopic surgery in lambs (n = 4). An identical sensor was introduced in a chorionic artery and readings were compared to ABG analyses of fetal blood samples. Results: The overall bias and precision in the first experiment (147 measurement pairs) were –4.2 and 10.9 mm Hg for pO2, +1.6 and 8.2 mm Hg for pCO2 and –0.015 and 0.031 for pH, respectively. In the sheep experiments, continuous readings for all parameters were only available during 50% of the operation time, mainly due to disturbances induced by movement, contact with vessel wall and interference by endoscopic light. 20 sample pairs were obtained resulting in an overall bias and precision of –3.9 and 4.3 mm Hg for pO2, –0.74 and 3.68 mm Hg for pCO2 and –0.0032 and 0.02 for pH. Conclusions: Fiberoptic microsensors are potentially useful for monitoring acid-base status in the low pO2 range present in fetal life.
Hepatic Mesenchymal Hamartoma Associated with Mesenchymal Stem Villous Hyperplasia of the Placenta
Authors: Kitano Yoshihiro , Ruchelli Eduardo , Weiner Stuart , Adzick N. Scott
Published: April 2003

A rare case of prenatally diagnosed hepatic mesenchymal hamartoma associated with mesenchymal stem villous hyperplasia of the placenta is presented and the literature reviewed. The placenta was noticed to have multiple cysts at 16 weeks’ gestation and elevated maternal serum α-fetoprotein was present. Cystic liver masses were first detected in the fetus at 34 weeks’ gestation. The liver mass showed a progressive enlargement during the third trimester and after birth, necessitating extended left hepatic trisegmentectomy at 3 months of age. Histological examination established the diagnosis of mesenchymal hamartoma of the liver and mesenchymal stem villous hyperplasia of the placenta. This is the first report of this association in which both lesions were diagnosed in utero and confirmed by histology after delivery. The likely pathogenesis of these strikingly similar lesions is discussed.
Nucleated Red Blood Cells inGrowth-Restricted Fetuses: Associations withShort-Term Neonatal Outcome
Authors: Minior Victoria K. , Bernstein Peter S. , Divon Michael Y.
Published: April 2003

Objective: To determine the utility of the neonatal nucleated red blood cell (NRBC) count as an independent predictor of short-term perinatal outcome in growth-restricted fetuses. Methods: Hospital charts of neonates with a discharge diagnosis indicating a birth weight <10th percentile were reviewed for perinatal outcome. We studied all eligible neonates who had a complete blood count on the first day of life. After multiple gestations, anomalous fetuses and diabetic pregnancies were excluded; 73 neonates comprised the study group. Statistical analysis included ANOVA, simple and stepwise regression. Results: Elevated NRBC counts were significantly associated with cesarean section for non-reassuring fetal status, neonatal intensive care unit admission and duration of neonatal intensive care unit stay, respiratory distress and intubation, thrombocytopenia, hyperbilirubinemia, intraventricular hemorrhage and neonatal death. Stepwise regression analysis including gestational age at birth, birth weight and NRBC count demonstrated that in growth-restricted fetuses, NRBC count was the strongest predictor of neonatal intraventricular hemorrhage, neonatal respiratory distress and neonatal death. Conclusion: An elevated NRBC count independently predicts adverse perinatal outcome in growth-restricted fetuses.
Assessment of Risk for Chromosomal Abnormalities at 10–14 Weeks of Gestation by Nuchal Translucency and Maternal Age in 5,210 Fetuses at a Single Centre
Authors: Zoppi Maria Angelica , Ibba Rosa Maria , Putzolu Monica , Floris Marcella , Monni Giovanni
Published: April 2003

Objective: To evaluate the screening of chromosomal abnormalities by nuchal translucency (NT) measurement. Methods: Assessment of risk for chromosomal abnormalities by NT and maternal age in 5,210 single fetuses with karyotype and outcome already known. Results: Risk was ≥1 in 300 in 640 (12.2%) of all fetuses, in 575 (11.1%) of the normal fetuses, in 38 (80.8%) of the fetuses affected by trisomy 21, and in 65 (89%) of the fetuses affected by chromosomal abnormalities. Risk was ≥1 in 200 in 477 (9.1%) of all fetuses, in 418 (8.1%) of the normal fetuses, in 35 (74.4%) of the fetuses affected by trisomy 21, and in 59 (80.8%) of the fetuses affected by chromosomal abnormalities. Risk was ≥1 in 100 in 270 (5.1%) of all fetuses, in 216 (4.2%) of the normal fetuses, in 33 (70.2%) of the fetuses affected by trisomy 21, and in 54 (73.9%) of the fetuses affected by chromosomal abnormalities. Conclusions: Risk generated by NT and maternal age is effective in screening for chromosomal abnormalities.
Cord Ultrasonic Transection Procedure for Selective Termination of a Monochorionic Twin
Authors: Lopoo John B. , Paek Bettina W. , Maichin Geoffrey A. , Lipshutz Gerald S. , Jennings Russell W. , Farmer Diana L. , Sandberg Per L. , Feldstein Vickie A. , Filly Roy A. , Farrell Jody A. , Harrison Michael R. , Albanese Craig T.
Published: April 2003

Placental vascular communications can present a life-threatening problem in monochorionic twins when one fetus has a lethal anomaly. Although selective feticide is the best option for salvaging the normal twin, techniques normally employed (i.e. intracardiac potassium, air embolism) are not prudent given the common circulatory system. Furthermore, in monoamniotic, monochorionic twin gestations it is important to transect the umbilical cord completely to prevent entanglement of the dead fetus around the cord of the normal twin. We present two cases of monochorionic twins in which the cords were transected with a harmonic scalpel under ultrasonic guidance via one trocar. The harmonic scalpel is an instrument which can simultaneously coagulate and cut blood vessels or tissues. The cord ultrasonic transection procedure is a novel, minimally invasive technique which offers several advantages over the methods currently used for selective feticide in discordant monochorionic twin gestations.
In utero Repair of Rectal Atresia after Complete Resection of a Sacrococcygeal Teratoma
Authors: Chiba Toshio , Albanese Craig T. , Jennings Russell W. , Filly Roy A. , Farrell Jody A. , Harrison Michael R.
Published: April 2003

Purpose: A case of a fetus with a prenatally diagnosed sacrococcygeal teratoma that produced high-output cardiac failure, hydrops, rectal atresia, and urinary tract obstruction is presented. The unique prenatal surgical management along with the embryogenesis of tumor-related rectal atresia is discussed. Case Report: A large fetal sacrococcygeal teratoma with a significant intrapelvic component was detected at routine ultrasound in a 35-year-old gravida 3 para 2. Fetal hydrops developed rapidly due to high-output cardiac failure from the vascular ‘steal’ by the growing tumor. The urinary tract was obstructed due to the intrapelvic tumors mass. At 27 weeks’ gestation, the female fetus underwent hysterotomy, resection of the entire mass and urinary diversion via bilateral flank ureterostomies. The rectum was found to be completely atretic due to apparent encasement by the tumor. Pull-through anorectoplasty was carried out concurrently. At 30 weeks’ gestation, the mother developed preterm labor and a 1.8-kg was delivered by cesarean section. The baby did very well for 3 days but had a cardiac arrest and died due to an atrial perforation by a transfemoral venous catheter. Conclusions: To our knowledge this is the first report of a complete prenatal resection of a sacrococcygeal teratoma with concomitant pull-through anorectoplasty for rectal atresia.
The Development of a Genetic Profile of Placental Gene Expression during the First Trimester of Pregnancy: A Potential Tool for Identifying Novel Secreted Markers
Authors: Page Nigel , Butlin David , Manyonda Isaac , Lowry Philip
Published: April 2003

Objectives: Many of the maternal serum markers used in prenatal screening have been developed or evolved based on serendipity. This study determines the feasibility of developing a genetic profile of placental gene expression during early pregnancy; such a gene repertoire may serve as a tool for identifying novel secreted markers. Methods: RNA fingerprinting was used to produce a differential expression map in normal aborted placentae of weeks 9 and 13. Results: Out of 212 gene expression differences, 115 were up-regulated at week 9 and the remaining 97 up-regulated at week 13. Ninety-four were found to be previously characterised genes and 118 were expressed sequence tags or novel genes. Seven of the known genes were found to be secreted proteins and included well-characterised pregnancy markers. mRNA levels of these secreted proteins were found to correlate with levels found in maternal serum. Conclusion: This approach enabled the identification of known secreted markers leaving open the possibility of finding new markers. With the human genome project nearing completion, it will be vital to use a systematic approach to understand the actual pattern of gene expression during pregnancy. This will also allow a more ordered and precise identification of novel prenatal diagnostic markers.
The Effect of Fetal Hydrops on the Rate of Fall of Hemoglobin after Fetal Intravascular Transfusion for Red Cell Alloimmunization
Authors: Abdel-Fattah Sherif A. , Carroll Stephen G. , Kyle Phillipa M. , Soothill Peter W.
Published: April 2003

Objective: We aimed to assess whether there is a difference between hydropic and nonhydropic fetuses in the rate of fall of hemoglobin (Hb) following intravascular transfusions. Methods: Eighty-three intravascular transfusions in 34 fetuses were analyzed. The pretransfusion and posttransfusion Hb values, the gestational age, the volume of blood transfused, the number of days between transfusions and the rate of fall of Hb per day following a transfusion were assessed. Hb levels were expressed as multiples of standard deviation from the normal mean for gestational age. Results: Eleven fetuses were hydropic at presentation and 23 were not. Twenty-three transfusions were undertaken in the 11 fetuses while they were hydropic and 60 transfusions were performed in nonhydropic fetuses. Comparisons of transfusion variables between the two groups were performed both for the first transfusion only and also for the total number of transfusions. The rate of Hb fall per day following a transfusion was similar in the two groups on both comparisons. The posttransfusion Hb level tended to be lower and the intervals between transfusions were a little shorter in the hydropic group, but these differences were not statistically significant. Conclusion: The posttransfusion Hb tended to be lower in the hydropic fetuses, but the fall in Hb was not faster in these cases. Therefore, with a similar rate of daily Hb decline in both groups, the hydropic fetuses are expected to become anemic again sooner than the nonhydropic fetuses only because of the lower posttransfusion Hb. The timing of the next transfusion should therefore be based on the posttransfusion Hb and the normal predicted drop per day irrespective of the presence or absence of hydrops.