Jennifer McNamara

Discussion: ‘Congenital toxoplasmosis’ by Berrébi et al

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Berrébi A, Assouline C, Bessières M-H, et al. Long-term outcome of children with congenital toxoplasmosis. Am J Obstet Gynecol 2010;203:552.e1-6.

The effect of breech presentation on the accuracy of estimated fetal weight.

To determine whether fetal presentation affects the accuracy of ultrasonographic estimated fetal weight (EFW). This is a retrospective cohort study of singleton pregnancies that underwent ultrasonographic EFW within 3 weeks of delivery at a single institution from 1993 to 2008. Breech presenting fetuses were compared with those presenting cephalic. EFW using the Hadlock formula was compared with actual birth weight (ABW) and reported as mean difference and mean percentage difference. Differences were also considered categorically. Subgroup analyses were performed of women who delivered within 4 days of scan and excluding women with comorbidities. Ability to detect small and large for gestational age infants was compared. Evaluation of 3770 patients, 183 (4.9%) breech presenting and 3587 (95.1%) cephalic presenting revealed no difference in mean gram difference (-222.1 g ± 312.6 vs. -210.7 g ± 793.2, p = 0.084), respectively, or ability to accurately predict within 10% of ABW (adjusted odds ratio [AOR] 1.23; 95% CI, 0.89,1.69; p = 0.208). Subgroup analyses revealed similar results. There was no difference in the ability to detect small and large for gestational age infants. Presentation does not demonstrably affect the accuracy of ultrasonographic EFW when utilizing the Hadlock formula.

Sonographic Evaluation and the Pregnancy Complicated by Diabetes

Sonography is a fundamental tool in the management of pregnancies affected by maternal diabetes. Purposeful use of ultrasound in each trimester provides an invaluable amount of information about the developing fetus including gestational age and growth patterns, anatomical structure and function, assessment of fetal well-being, and prediction of adverse outcome. There are great ongoing research efforts in this field of prenatal diagnosis and management, yet even more are needed.