G. Pilu

Prenatal diagnosis and outcome of fetal posterior fossa fluid collections

To evaluate the accuracy of fetal imaging in differentiating between diagnoses involving posterior fossa fluid collections and to investigate the postnatal outcome of affected infants.

Counseling in fetal medicine: agenesis of the corpus callosum

In this Review, we aim to provide up‐to‐date and evidence‐based answers to common questions regarding the diagnosis and prognosis of prenatally detected agenesis of the corpus callosum (ACC). A systematic literature search was performed to identify all reports of ACC and reference lists of articles were identified. ACC involves partial or complete absence of the main commissural pathway that connects the two cerebral hemispheres, and can be isolated (with no other abnormalities) or complex (coexisting with other abnormalities). It is a rare finding and the prevalence is difficult to estimate because of selection bias in reported series. The corpus callosum (CC) can be assessed on ultrasound by direct visualization, but indirect features, such as ventriculomegaly, absence of the cavum septi pellucidi or widening of interhemispheric fissure, are often the reason for detection in a screening population. Careful imaging in a center with a high level of expertise is required to make a full assessment and to exclude coexisting abnormalities, which occur in about 46% of fetuses. When available, magnetic resonance imaging appears to be an important adjunct as it allows direct visualization. It can reduce false‐positive rates on ultrasound and can confirm ACC, it can assess whether this is complete or partial and it can help in detecting coexisting brain abnormalities not seen on ultrasound. The overall rate of chromosomal abnormality in fetuses with ACC is 18%, but this high rate includes both isolated and complex ACC; more recent studies suggest that chromosomal abnormalities are rare in isolated cases. Nevertheless, postnatal follow‐up studies suggest that about 15% of cases thought to be isolated prenatally were found to have associated abnormalities after birth. Neurodevelopmental outcome in isolated ACC was recently reported in a systematic review and suggested normal outcome in about 65–75% of cases. Findings need to be considered in light of the several limitations of existing studies, in terms of study design, selection bias, varying definitions and imaging protocols, ascertainment bias and lack of control groups. These uncertainties mean that antenatal counseling is difficult and further large prospective studies are needed.

Brainstem-vermis and brainstem-tentorium angles allow accurate categorization of fetal upward rotation of cerebellar vermis

To evaluate the role of the brainstem–vermis (BV) and brainstem–tentorium (BT) angles in the differential diagnosis of upward rotation of the fetal cerebellar vermis.

Intrapartum sonographic imaging of fetal head asynclitism

Anterior asynclitism was suspected on digital examination of a laboring woman with late arrest of dilatation and no evidence of fetal head progression. Clinical examination revealed a fixed non‐engaged fetal head (station − 1), with a transverse posterior sagittal suture. A static three‐dimensional volume was obtained by translabial ultrasound, offline analysis of which confirmed the clinical diagnosis of anterior asynclitism. Owing to the posterior twisting of the head towards the sacrum, the midline echo could only be obtained by cutting the volume with an oblique line, the direction of which was not perpendicular to the pubis as expected in cases of synclitic head. The sonographic appearance of the midline echo approaching the sacrum in a non‐engaged transverse fetal head strongly supports the clinical suspicion of anterior asynclitism. Copyright

The pregnancy outcome in women with incidental diagnosis of septate uterus at first trimester scan

BACKGROUNDnSeptate uterus seems to be strongly associated with an adverse pregnancy outcome. However, the possible relationship between septate uterus and miscarriage has only been retrospectively ascertained. The aim of our study was to describe the reproductive outcome in women with incidental diagnosis of malformed uterus at first trimester scan.nnnMETHODSnWomen at their first pregnancy attending our centre for a routine viability scan with an incidental suspicion of uterine anomaly at standard sonography were submitted to transvaginal volume ultrasound. All the cases with a 3D diagnosis of septate uterus were prospectively recruited and followed up.nnnRESULTSnOverall 24 patients with a single intrauterine pregnancy were included at a median gestational age of 8.2 weeks. The cumulative pregnancy progression rate, as quoted by Kaplan-Meier algorithm, was 33.3% due to the occurrence of early (≤ 13 weeks) or late miscarriages (14-22 weeks) in 13 and 3 cases, respectively.nnnCONCLUSIONnThe pregnancy outcome is poor if a septate uterus is incidentally diagnosed in the early stage of a viable intrauterine pregnancy.

Normal morphometry of fetal posterior fossa at midtrimester: brainstem–tentorium angle and brainstem–vermis angle

To standardize the evaluation of normal tentorium insertion and normal rotation of the cerebellar vermis over the brainstem, using two novel measurements: the brainstem–tentorium angle (BT angle) and the brainstem–vermis angle (BV angle). We also aimed to test the reproducibility of these measurements.

Increased uterine artery pulsatility index at 34 weeks and outcome of pregnancy

To evaluate pregnancy outcome in patients with increased uterine artery (UtA) pulsatility at 34 weeks gestation as an isolated finding.

Accuracy of fetal gender determination in the first trimester using three-dimensional ultrasound

To evaluate the accuracy of three‐dimensional (3D) ultrasound in fetal gender assignment in the first trimester.

Higher circulating mRNA levels of placental specific genes in a patient with placenta accreta

Giuliana Simonazzi1*, Antonio Farina1, Alessandra Curti1, Gianluigi Pilu1, Donatella Santini2, Cinzia Zucchini1, Akihiko Sekizawa3 and Nicola Rizzo1 1Department of Obstetrics and Gynecology, St. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy 2Department of Pathology, St. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy 3Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan

The effect of the contents of exomphalos and nuchal translucency at 11–14 weeks on the likelihood of associated chromosomal abnormality

Previous publications suggest that exomphalos containing the liver as less likely to be associated with aneuploidy. The objective of the study was to explore the influence of exomphalos contents and nuchal translucency (NT) on the likelihood of aneuploidy.