E. Katorza

Head progression distance in prolonged second stage of labor: relationship with mode of delivery and fetal head station

To evaluate the clinical significance of fetal head progression distance (HPD), measured by transperineal ultrasound, during prolonged second stage of labor.

Early detection by diffusion‐weighted sequence magnetic resonance imaging of severe brain lesions after fetoscopic laser coagulation for twin–twin transfusion syndrome

Monochorionic twins treated by fetoscopic laser coagulation (FLC) for twin–twin transfusion syndrome (TTTS) are at increased risk of neurodevelopmental impairment. Our aim was to evaluate the additional value of diffusion‐weighted imaging (DWI) over fetal sonography and T2 magnetic resonance imaging (MRI) in the detection of acute ischemic cerebral lesions shortly following FLC.

Pubic arch angle in prolonged second stage of labor: clinical significance

To evaluate the clinical significance of the pubic arch angle (PAA) measured by transperineal ultrasound during prolonged second stage of labor.

Comparison between two protocols for thawed embryo transfer: natural cycle versus exogenous hormone replacement

Abstract Introduction: There are two most popular protocols for Frozen Embryo Transfer: the natural and the E2&P4 replacement cycles. There is still a controversy whether one is superior over the other. Purpose: To compare the outcome in patient groups undergoing FET following these protocols. Methods: About 1235 FET cycles were retrospectively analyzed during a period of 12 years. In 798 cycles (group A), the natural cycle protocol was used, and in 437 cycles (group B), the exogenous E2&P4 administration protocol was used. Results: The average patient age was 32.11 ± 0.27 years in group A and 32.94 ± 0.19 years in group B (p < 0.05). The endometrial thickness was 9.54 ± 0.11 mm and 8.95 ± 0.13 mm in groups A and B, respectively (p < 0.001). The peak serum E2 level was 162.51 ± 8.97 pg/mL and 250.78 ± 33.67 pg/mL in groups A and B, respectively (p < 0.001). The implantation, clinical pregnancy, and ongoing pregnancy rates in groups A and B were 6.47%, 12.91%, and 10.4% versus 4.26%, 8.47%, and 5.95%, respectively (p < 0.05). Conclusions: Natural endometrial preparation yields better outcome in compare with exogenous E2&P4 in FET cycles with higher endometrial thickness, implantation, and clinical pregnancy rates.

Fetal Brain MRI: Novel Classification and Contribution to Sonography

PURPOSE 1) To evaluate and classify the indications for fetal brain MRI in a tertiary referral center. 2) To assess the contribution of fetal brain MRI to fetal neurosonography. MATERIALS AND METHODS A retrospective study in a tertiary medical center during a two-year period (2011 - 2012) included pregnant women who underwent fetal brain MRI. MRI was implemented at 32 weeks of gestation unless a severe abnormality possibly requiring earlier medical intervention was suspected. RESULTS 633 patients were included, 40 (6.3%) underwent repeated examinations with a total of 733 fetal MRI scans. Patients were classified to three main indication cohorts: Suspected primary brain anomaly (52.9%), non-CNS disorders (32.5%) and obstetrical complications (14.6%). These cohorts were further divided into 16 separate groups with lateral ventricle abnormalities being the most common (23.7%), followed by exposure to TORCH (17.5%) and cerebral cortex abnormalities (13%). 149 (19.3%) fetal MRI scans demonstrated additional findings. Repeated examinations were commonly implemented in complicated monochorionic-biamniotic (MCBA) twin pregnancies (34.6%) and in cases of supra-tentorial cysts (19%). The average gestational age for MRI scan in the MCBA group was 26 ± 5 weeks in comparison to ≥ 31st weeks in all other groups (p < 0.001). CONCLUSION The current study describes a detailed picture of fetal brain MRI indications. Most patients were referred because of CNS anomalies. The impressive diversity of 16 separate entities emphasizes the expanding use of fetal brain MRI. Complicated MCBA pregnancies, which may have dramatic events, constitute a unique challenge due to early and repetitive MRI examinations and may serve as a role model for the contribution of fetal MRI during antenatal evaluation. The contribution of MRI to prenatal evaluation in various indications is discussed.

Early pregnancy scanning for fetal anomalies--the new standard?

For many years, significant efforts have been made toward attempts at early detection of chromosomal and structural malformations, to lower the rate of these defects in newborns. Traditionally, the main ultrasound examination during pregnancy was performed in the second trimester, using transabdominal transducers. The development of high-frequency and high-resolution (5 to 9 MHz; 6 to 12 MHz) transvaginal probes along with substantial improvements in image and signal processing have opened new possibilities for the investigation of early pregnancy. Up until the recent past, many defects were considered unidentifiable early in pregnancy. A large number of those can now be diagnosed already in the first trimester. Early detection of fetal anomalies enables karyotyping by chorionic villus sampling and, in those patients in whom findings are abnormal, simpler procedures for termination of pregnancy may be performed. This may reduce physical and psychological morbidity associated with second-trimester abortions.

Cryopreservation of day 2–3 embryos by vitrification yields better outcome than slow freezing

Abstract Objective: To compare the outcome of vitrification versus slow freezing cryopreservation for cleavage stage day 2–3 embryos. Design: A retrospective observational study. Setting: All thawed embryos assisted reproduction cycles between January 2010 and December 2012 at a single IVF laboratory of a Tertiary Medical Center. Patients: Five hundred and thirty-nine cycles of day 2–3 thawed embryos. Interventions: In 327 of the thawed cycles, the embryos were vitrified and in 212 of the cycles the embryos were derived from slow freezing embryos. Main outcomes measure: Embryo survival rate, blastomere surviving rate and pregnancy rate. Results: Embryo survival rate was significantly higher after vitrification compared with slow freezing (81.6%, 647/793 versus 70.0%, 393/562 embryos, p < 0.0001). The clinical pregnancy rate per ET was significantly higher following vitrification compared to slow freezing, 20.0%, 63/314 versus 11.9%, 23/193, respectively (p = 0.02). Conclusions: Vitrification of day 2–3 cleavage stage embryos yields better cycle outcome in all the parameters compared to slow freezing.

Late diagnosis of fetal central nervous system anomalies following a normal second trimester anatomy scan

The aim of this study was to describe the nature of central nervous system (CNS) anomalies diagnosed during the third trimester following a normal anatomy scan at 21–24 weeks of gestation.

More than a gut feeling – sonographic prenatal diagnosis of imperforate anus in a high‐risk population

The objective of this article is to investigate whether sonographic identification of the fetal anal mucosa (AM) can assist in the diagnosis of anal atresia (AA) in fetuses referred for congenital anomalies of kidney and urinary tract (CAKUT) malformation.

Neurodevelopmental outcome of isolated ventriculomegaly: a prospective cohort study

Data regarding the neurodevelopmental outcome of children diagnosed in utero with isolated ventriculomegaly (IVM) are limited and principally founded on ultrasound‐based studies. Here, we endeavored to assess the outcome of such cases in a large‐scale, magnetic resonance imaging (MRI)‐based study.