J. Wisser

Fetal ultrasound biometry: 1. Head reference values

Objective To create reliable reference ranges and calculate Z scores for fetal head ultrasound biometry using a large sample size which is evenly distributed from 12 to 42 weeks of pregnancy.

Fetal ultrasound biometry: 2. Abdomen and femur length reference values

Objective To create reliable reference ranges and calculate Z scores for fetal abdomen and femur ultrasound biometry using a large sample size which is evenly distributed from 12 to 42 weeks of pregnancy.

Outcome of fetal renal pelvic dilatation diagnosed during the third trimester

The aim of this study was to evaluate renal function and the need for postnatal treatment—antibiotic therapy and/or surgery—in relation to the grade of fetal renal pelvic dilatation (RPD) found on third‐trimester ultrasound examination.

Perinatal care at the limit of viability between 22 and 26 completed weeks of gestation in Switzerland 2011 Revision of the Swiss recommendations

Perinatal care of pregnant women at high risk for preterm delivery and of preterm infants born at the limit of viability (22-26 completed weeks of gestation) requires a multidisciplinary approach by an experienced perinatal team. Limited precision in the determination of both gestational age and foetal weight, as well as biological variability may significantly affect the course of action chosen in individual cases. The decisions that must be taken with the pregnant women and on behalf of the preterm infant in this context are complex and have far-reaching consequences. When counselling pregnant women and their partners, neonatologists and obstetricians should provide them with comprehensive information in a sensitive and supportive way to build a basis of trust. The decisions are developed in a continuing dialogue between all parties involved (physicians, midwives, nursing staff and parents) with the principal aim to find solutions that are in the infants and pregnant womans best interest. Knowledge of current gestational age-specific mortality and morbidity rates and how they are modified by prenatally known prognostic factors (estimated foetal weight, sex, exposure or nonexposure to antenatal corticosteroids, single or multiple births) as well as the application of accepted ethical principles form the basis for responsible decision-making. Communication between all parties involved plays a central role. The members of the interdisciplinary working group suggest that the care of preterm infants with a gestational age between 22 0/7 and 23 6/7 weeks should generally be limited to palliative care. Obstetric interventions for foetal indications such as Caesarean section delivery are usually not indicated. In selected cases, for example, after 23 weeks of pregnancy have been completed and several of the above mentioned prenatally known prognostic factors are favourable or well informed parents insist on the initiation of life-sustaining therapies, active obstetric interventions for foetal indications and provisional intensive care of the neonate may be reasonable. In preterm infants with a gestational age between 24 0/7 and 24 6/7 weeks, it can be difficult to determine whether the burden of obstetric interventions and neonatal intensive care is justified given the limited chances of success of such a therapy. In such cases, the individual constellation of prenatally known factors which impact on prognosis can be helpful in the decision making process with the parents. In preterm infants with a gestational age between 25 0/7 and 25 6/7 weeks, foetal surveillance, obstetric interventions for foetal indications and neonatal intensive care measures are generally indicated. However, if several prenatally known prognostic factors are unfavourable and the parents agree, primary non-intervention and neonatal palliative care can be considered. All pregnant women with threatening preterm delivery or premature rupture of membranes at the limit of viability must be transferred to a perinatal centre with a level III neonatal intensive care unit no later than 23 0/7 weeks of gestation, unless emergency delivery is indicated. An experienced neonatology team should be involved in all deliveries that take place after 23 0/7 weeks of gestation to help to decide together with the parents if the initiation of intensive care measures appears to be appropriate or if preference should be given to palliative care (i.e., primary non-intervention). In doubtful situations, it can be reasonable to initiate intensive care and to admit the preterm infant to a neonatal intensive care unit (i.e., provisional intensive care). The infants clinical evolution and additional discussions with the parents will help to clarify whether the life-sustaining therapies should be continued or withdrawn. Life support is continued as long as there is reasonable hope for survival and the infants burden of intensive care is acceptable. If, on the other hand, the health care team and the parents have to recognise that in the light of a very poor prognosis the burden of the currently used therapies has become disproportionate, intensive care measures are no longer justified and other aspects of care (e.g., relief of pain and suffering) are the new priorities (i.e., redirection of care). If a decision is made to withhold or withdraw life-sustaining therapies, the health care team should focus on comfort care for the dying infant and support for the parents.

Continuous independent quality control for fetal ultrasound biometry provided by the cumulative summation technique

To apply the cumulative summation (CUSUM) technique for an evaluation of the learning process of sonographic fetal weight estimation at term in combination with the z‐scores of biometry determinants and to assess the time of appearance and sources of errors.

Sonographic prediction of macrosomia cannot be improved by combination with pregnancy-specific characteristics

To evaluate the predictive value of a combination of sonographic, clinical and demographic data for detecting fetal macrosomia compared to ultrasound fetal weight estimation alone.

WS14-07Volume sonography of the female pelvic floor after childbirth

Objective

WS15-09Three-dimensional ultrasound examination of fetal and placental vessels

Objective

LSD- und Cannabis-Konsum während der frühen Schwangerschaft mit gutem perinatalen Ausgang

Im dargestellten Fall geht es um eine 27jährige Patientin, die bis zum Zeiptunkt des positiven Schwangerschaftstests, entsprechend 74/7 Schwangerschaftswochen (p.c.), täglich einen Joint (Cannabis) und 20 Zigaretten (Tabak) geraucht hat. Am 20. Tag p.c. erfolgte ein LSD-Minitrip. Das Sichten der Literatur ergab beim Tier in vitro Chromosomenaberrationen mit LSD. Beim Menschen stehen Fehlbildungen an den Extremitäten und Augendysplasien an vorderster Stelle. Cannabis verursacht beim Tier und beim Menschen eine Veränderung der dopaminergen Aktivität. Unsere Empfehlung lautete daraufhin, das Kind in utero auszutragen, aber gut zu überwachen. Die Patientin gebar schliesslich spontan am Termin einen lebensfrischen Knaben mit einem Geburtsgewicht zwischen der 5. und 50. Perzentile und einer Länge zwischen der 50. und 90. Perzentile, normalen pH-Werten von Nabelschnurarterie und -vene und Apgar-Werten von 7/9/10. Das Kind wies keine äusserlichen Fehlbildungen auf und verhielt sich unauffällig. Im Zusammenhang mit einem vermuteten LSD-Konsum soll die Aufmerksamkeit auf Skelett- und Augendysplasien gerichtet werden. Sowohl für LSD als auch insbesondere für Cannabis gilt es, die intellektuelle Entwicklung der Kinder im Auge zu behalten.