Ana Carolina Rabachini Caetano

Fetal growth restriction: current knowledge

BackgroundFetal growth restriction (FGR) is a condition that affects 5–10% of pregnancies and is the second most common cause of perinatal mortality. This review presents the most recent knowledge on FGR and focuses on the etiology, classification, prediction, diagnosis, and management of the condition, as well as on its neurological complications.MethodsThe Pubmed, SCOPUS, and Embase databases were searched using the term “fetal growth restriction”.ResultsFetal growth restriction (FGR) may be classified as early or late depending on the time of diagnosis. Early FGR (<32 weeks) is associated with substantial alterations in placental implantation with elevated hypoxia, which requires cardiovascular adaptation. Perinatal morbidity and mortality rates are high. Late FGR (≥32 weeks) presents with slight deficiencies in placentation, which leads to mild hypoxia and requires little cardiovascular adaptation. Perinatal morbidity and mortality rates are lower. The diagnosis of FGR may be clinical; however, an arterial and venous Doppler ultrasound examination is essential for diagnosis and follow-up. There are currently no treatments to control FGR; the time at which pregnancy is interrupted is of vital importance for protecting both the mother and fetus.ConclusionEarly diagnosis of FGR is very important, because it enables the identification of the etiology of the condition and adequate monitoring of the fetal status, thereby minimizing risks of premature birth and intrauterine hypoxia.

Heart stroke volume, cardiac output, and ejection fraction in 265 normal fetus in the second half of gestation assessed by 4D ultrasound using spatio-temporal image correlation

Objectives. The aim of this study was to establish nomograms for fetal stroke volume (SV), cardiac output (CO), and ejection fraction (EF) using four-dimensional ultrasound with spatio-temporal image correlation (STIC) modality. Methods. The fetal heart was scanned using STIC modality, starting with classic four-chamber view plane, during fetal quiescence with abdomen uppermost, at an angle of 20–30°, without color Doppler flow mapping. In post-processing virtual organ, computer-aided analysis technique was used to obtain a sequence of six sections of each ventricular volume in end-systolic volume (ESV) and end-diastolic volume (EDV). The SV (SV = EDV–ESV), CO (CO = SV × fetal heart rate), and EF (EF = SV/EDV) for each ventricle were then calculated. Intra- and interobserver agreement were then calculated. Results. Two hundred sixty-five fetuses, ranging in gestational age (GA) from 20 to 34+6 weeks, were included in the study. The left and right SV and CO increased exponentially with gestation and EF remained fairly stable through gestational. Mean left and right SV increased from 0.211 ml and 0.220 ml at 20 weeks to 1.925 ml and 2.043 ml, respectively, at 34 weeks. Mean left and right CO increased from 30.25 ml/min and 31.52 ml/min at 20 weeks to 268.49 ml/min and 287.80 ml/min, respectively, at 34 weeks. Both left and right mean EF remained constant at around 0.63 with advancing GA. Nomograms were created for LSV, RSV, LCO, RCO, LEF, and REF vs. gestational age. Intra- and interobserver agreement reached 95%. Conclusions. Four-dimensional ultrasound using STIC represents a simple and reproducible method for estimating fetal cardiac function. STIC seems to overcome many of the pitfalls of conventional ultrasound methods and has the potential to become the method of choice.

Evaluation of passage of fetal erythrocytes into maternal circulation after invasive obstetric procedures.

The aim of this study was to evaluate the passage of fetal erythrocytes into the maternal circulation after invasive obstetric procedures, using the Kleihauer–Betke test, flow cytometry and α‐fetoprotein concentration in maternal blood.

Reference ranges of fetal adrenal gland and fetal zone volumes between 24 and 37 + 6 weeks of gestation by three-dimensional ultrasound

Abstract Objective: To establish reference ranges of the fetal adrenal gland (AG) and fetal zone (FZ) volumes using three-dimensional ultrasound (3DUS). Methods: We performed a prospective cross-sectional study with 204 normal singleton pregnancies between 24 and 37 + 6 weeks of gestation. The fetal AG and FZ volumes were obtained using the virtual organ computer-aided analysis method with a 30° rotation. To establish reference ranges as the function of gestational age (GA), quantile regression was performed with the adjusted coefficient of determination (R2). Intra- and inter-observer repeatability was performed using the intraclass correlation coefficient (ICC). Results: The mean results of fetal AG and FZ values were 0.42 cm3 (0.04–1.22) and 0.10 cm3 (0.02–0.47), respectively. The best-fit quantile regression models for fetal AG and FZ volumes as the function of GA were in first-degree models: AG = −0.937 + 0.041 × GA (R2 = 0.124) and FZ = −0.201 + 0.009 × GA (R2 = 0.127), respectively. We observed good intra-observer repeatability of fetal AG and FZ volumes, with an ICC of 0.996 and 0.989, respectively. We also observed good inter-observer repeatability, with an ICC of 0.972 and 0.966 for AG and FZ, respectively. Conclusion: The reference ranges of AG and FZ volumes using 3DUS between 24 and 37 + 6 weeks of gestation were established and exhibited good repeatability.

Assessment of Intracranial Structure Volumes in Fetuses With Growth Restriction by 3-Dimensional Sonography Using the Extended Imaging Virtual Organ Computer-Aided Analysis Method

To assess intracranial structure volumes by 3‐dimensional (3D) sonography in fetuses with growth restriction.

Prenatal Diagnosis and Postnatal Ultrasound Findings of Cloacal Anomaly: A Case Report

Cloacal malformation is an extremely rare fetal pathological condition that presents as a variety of defects. It predominantly affects females, with prevalence of 1 in 50,000 births. Prenatal ultrasonography on a 20-year-old caucasian woman (G4P1A2) at 33 weeks of pregnancy showed the fetus having a large cystic mass in the lower abdomen with a single septum, bilateral hydronephrosis, ambiguous genitalia, and a single umbilical artery. The pregnancy developed accentuated oligohydramnios, and presence of a fetal brain-sparing effect was diagnosed using arterial Doppler velocimetry. The newborn showed abdominal distension, ambiguous genitalia, and rectal atresia, with a single perineal opening. Pelvic ultrasound done on the first day after delivery revealed the presence of a large retrovesical septated cystic mass of dense content in the fetal abdomen, and bilateral hydronephrosis. Hysterotomy was performed, and 70 mL of dense liquid was drained through an abdominal colostomy. The infant died on the 27th day of life as a result of infectious complications. Prenatal diagnosing of female urogenital anomalies is usually difficult because of their rarity, different types of manifestation, and lack of characteristic ultrasound signs. Presence of a septated cyst with dense content in the fetal abdomen confirms the finding of hydrometrocolpos, thus raising clinical suspicion of a cloacal anomaly.

Assessment of modified myocardial performance index in foetuses with growth restriction

AIM To evaluate the modified myocardial performance index (Mod-MPI) in foetuses with growth restriction and compare this index with appropriate for gestational age foetuses. MATERIAL AND METHODS A prospective cross-sectional case-control study was conducted involving 76 singleton foetuses between 24 and 34 weeks of gestation divided into three groups (24 appropriate growth foetuses, 30 foetuses with estimated weight between the 3rd and 10th percentiles and 22 foetuses with estimated weight < 3rd percentile, according to the Hadlock table). The Mod-MPI was obtained in the plane of the four chamber view, and the spectral Doppler sample volume was placed in the lateral wall of the aorta, close to the mitral valve. Doppler of umbilical artery was normal in all cases. Analysis of variance (ANOVA) was used to compare the groups and the intra-class correlation coefficient (ICC) was used to assess intra- and inter-observer reproducibility. RESULTS The mean Mod-MPI in the groups of appropriate for gestational age, estimated weight between the 3rd and 10th percentiles, and estimated weight < 3rd percentile was 0.32 +/- 0.05, 0.35 +/- 0.05 and 0.36 +/- 0.06, respectively; there was no statistical difference between the groups (p = 0.072). There was good intra- and inter-observer reproducibility (ICC = 0.726 and 0.760, respectively). CONCLUSION Mod-MPI was not significantly different between foetuses appropriate for gestational age and those with growth restriction. Mod-MPI proved to be a feasible and reproducible technique.

Assessment of maternal Doppler parameters of ophthalmic artery in fetuses with growth restriction in the third trimester of pregnancy: A case–control study

The aim of this study was to assess the Doppler parameters of the ophthalmic artery of pregnant women carrying fetuses with growth restriction (FGR) compared with normal fetuses.

Fetal thigh and upper-arm volumes by three-dimensional ultrasound to predict low postnatal body mass index

Abstract Objective: To assess the usefulness of estimating fetal upper arm and thigh volumes as predictors of low postnatal body mass index (BMI) using three-dimensional ultrasonography (3DUS) with extended imaging virtual organ computer-aided analysis (XI VOCAL). Methods: This prospective cross-sectional study analyzed 300 singleton pregnancies between 33 and 41 weeks of gestation. The Hadlock 4 formula was used to estimate fetal weight. The XI VOCAL 10 planes method was used to assess fetal upper arm and thigh volumes. After delivery, the newborns’ BMI was evaluated and considered low (≤10th percentile) or normal (>10th percentile). We determined receiver operating characteristics (ROC) curves and respective areas under the curves for the percentiles of fetal weight and fetal thigh and upper arm volumes. Results: Of the 300 newborns, BMI was ≤10th percentile for 21 and >10th percentile for 279 newborns. The area under the ROC curve for fetal weight, obtained using the Hadlock formula, and fetal upper arm and thigh volumes, obtained by 3DUS, were 0.801, 0.930 and 0.924, respectively. We determined the sensitivity and specificity of the three parameters for predicting low postnatal BMI and found values of 85.70% and 65.60%, respectively, for fetal weight, 90.48% and 88.17%, respectively, for fetal thigh volume, and 76.19% and 92.47%, respectively, for fetal upper arm volume. Conclusion: Fetal upper arm and thigh volumes estimated using 3DUS with XI VOCAL were effective predictors of low postnatal BMI.