J. M. G. van Vugt

Elevated C-reactive protein levels during first trimester of pregnancy are indicative of preeclampsia and intrauterine growth restriction

C-reactive protein (CRP) is a marker of tissue damage and inflammation. Maternal levels of CRP are elevated in overt preeclampsia, but there is still debate about its use as a predictive marker for preeclampsia during the first and second trimesters of pregnancy. In this study, we measured CRP levels during the first trimester of pregnancy in women who later developed preeclampsia or gave birth to a growth-restricted baby. In total, 107 women from a low-risk population participated in the study, six women developed preeclampsia and nine gave birth to a growth-restricted baby. Although there is a large overlap in measured CRP levels between the three groups, mean CRP levels were significantly elevated in women who later developed preeclampsia (P=0.031) or delivered a growth-restricted baby (P=0.041) when compared with women from the control group, matched for maternal and gestational age, parity, and gravidity. This study shows that in a low-risk population, CRP levels are already elevated between weeks 10 and 14 in pregnant women who develop preeclampsia or deliver a growth-restricted baby.

A systematic analysis of the feasibility of four‐dimensional ultrasound imaging using spatiotemporal image correlation in routine fetal echocardiography

To investigate the feasibility of incorporating spatiotemporal image correlation (STIC) into a tertiary fetal echocardiography program.

Ultrafast Scan Magnetic Resonance in Prenatal Diagnosis

Objective: To determine whether magnetic resonance (MR) can give additional information in prenatal diagnosis of congenital anomalies, when the ultrasound (US) analysis is not conclusive. Methods: Ultrafast MR scanning examined 39 pregnant women with 41 fetuses in whom US was suspicious of fetal congenital abnormalities. Two techniques were used namely (1) HASTE inversion recovery sequence and (2) FISP 2D. Results: Thirty-nine patients with 41 fetuses were referred for MR because of an equivocal US with regard to brain, spine, skeletal and miscellaneous anomalies. In 1 twin pregnancy, 1 co-twin has not been examined with MRI because of its demise. In 22 of them, additional information was obtained by MR. In 9 the MR was confirmative with the US examination. Four were false negative, comparing with the postnatal diagnosis. Three failed because of maternal claustrophobia and in 2 a diagnosis could not be made. From the 40 fetuses in this study, 38 were examined postnatally by MR, US, plain X-ray or autopsy was performed to confirm the prenatal diagnosis. Conclusion: The use of MRI in obstetrics has been limited, until recently. With fast MRI sequences it is not necessary to sedate the fetus. It is advisable in cases where US is equivocal concerning congenital anomalies of the fetus to use MR with fast or ultrafast scan technique, especially when the central nervous system is concerned.

Normal fetal lung volume measured with three-dimensional ultrasound.

To construct reference intervals for fetal lung volumes measured longitudinally using three‐dimensional (3D) ultrasound, and to evaluate the effect of gender on lung size.

Fetal cardiac function assessed with four-dimensional ultrasound imaging using spatiotemporal image correlation

The goal of this study was to use spatiotemporal image correlation (STIC) to provide reference values for left and right ventricle volumes, and indices of fetal cardiac function.

Increased nuchal translucency and distended jugular lymphatic sacs on first-trimester ultrasound

To investigate the presence and volume of jugular lymphatic sacs (JLS) in first‐trimester fetuses with normal nuchal translucency thickness (NT) and in those with increased NT.

Maternal Serum CA125 and CA15-3 Antigen Levels in Normal and Pathological Pregnancy

Objective: To evaluate the value of maternal serum CA125 and CA15-3 concentrations for discriminating pathological from normal pregnancies. Methods: Serum samples from 120 women, in whom pregnancy outcome was pathological, i.e. spontaneous abortion, fetal death, intrauterine growth retardation, chromosomal and structural abnormalities, and (pre)eclampsia, were assessed for CA125 and CA15-3 and compared with levels found in 350 women with a normal pregnancy outcome matched for age and duration of pregnancy. Results: Maternal CA125 serum values were significantly higher in the first and the third trimester of pregnancy (median 23.0 and 21.0 U/ml; p < 0.00001 and p < 0.001, respectively), compared to those in the second trimester (median 14.0 U/ml), but not significantly different from those obtained in pathological pregnancies. Maternal serum CA15-3 values were significantly higher during the third trimester (median 26.0 U/ml) compared to the first and second trimester of pregnancy (median 14.0 and 15.0 U/ml; p < 0.0001); CA15-3 serum levels in normal and pathological pregnancies showed no significant difference. Conclusion: Maternal serum levels of CA125 are higher during the first and third trimester of pregnancy. CA15-3 maternal serum levels are higher during the third trimester compared to the first and second trimester. Maternal CA125 and CA15-3 serum levels showed no relation with a pathological outcome of pregnancy.

Single-Needle Insertion: An Alternative Technique for Early Second-Trimester Genetic Twin Amniocentesis

Single-needle insertion as an alternative technique for genetic amniocentesis in twin gestation has been evaluated in 27 pregnancies. A 22-gauge needle was inserted into the most proximal sac and amniotic fluid was aspirated. The needle was then traversed through the dividing membrane to enter the second sac and amniotic fluid was aspirated. This technique avoids the use of dye and ensures tapping of both sacs. No fetal losses attributable to the procedure occurred during the trial. In comparison with the double-needle insertion, it is a swift and easy procedure and reduces discomfort to the patient.

Fetal lung volume: three-dimensional ultrasonography compared with magnetic resonance imaging

An accurate and reliable method for measuring fetal lung volumes would be helpful in predicting the outcome in cases with suspected impaired lung growth. Recent studies show that it is possible to obtain fetal lung volume estimations with magnetic resonance imaging (MRI) and three‐dimensional (3D) ultrasonography. The purpose of this study was to assess the agreement of lung volumes measured with 3D ultrasonography and MRI in uncomplicated pregnancies.

Early first‐trimester free β‐hCG and PAPP‐A serum distributions in monochorionic and dichorionic twins

In the Netherlands, prenatal screening for trisomy 21 in the first trimester of pregnancy for singletons is conducted through a combined test based on maternal age, nuchal translucency measurement and maternal serum free β‐hCG and PAPP‐A. In our clinic risk calculations in twins are currently based on the NT of both fetuses instead of the combined test. In this study we looked at differences in early first‐trimester free β‐hCG and PAPP‐A between mono‐ and dichorionic twins.