Joseph T. Thomas

Absent ductus venosus - outcomes and implications from a tertiary centre

Absent ductus venosus (ADV) has been reported as case reports and series with suggestions that the outcome is variable. The prognosis depended on the associated abnormalities with ADV and the type of umbilical venous drainage.

The Outcome of Isolated Primary Fetal Hydrothorax: A 10-Year Review from a Tertiary Center

Introduction: The management of primary fetal pleural effusion remains a challenge for clinicians given the paucity of clinical information to guide practice. Materials and Methods: A retrospective descriptive study of cases referred for management to our fetal therapy center over a 10-year period. Survival to hospital discharge was evaluated against case characteristics and prenatal intervention. For this study, we categorized the severity of the pleural effusion at diagnosis as mild, moderate or severe, and the clinical course as regression, stable or progression. Results: Forty-five of the 103 pregnancies complicated by fetal pleural effusions during the study period were managed for primary effusions. Termination of pregnancy was requested in 6 cases. Thirty-nine pregnancies continued management, with 14 undergoing prenatal intervention. The overall survival rate to hospital discharge was 51%, including 7 survivors after prenatal intervention. The rate of survival was low if the effusion was categorized as severe at diagnosis or if there was progression of the clinical course. Conclusions: Case characteristics at the time of diagnosis and clinical course can be used to guide patient counseling and decision-making regarding fetal therapy. Prenatal intervention may improve the chance of survival in cases with characteristics associated with a poor prognosis.

Prenatal extra-abdominal bowel dilatation is a risk factor for intrapartum fetal compromise for fetuses with gastroschisis

The aim of this study was to investigate the prenatal ultrasound features that were associated with intrapartum fetal distress in fetuses with gastroschisis.

Complete Penoscrotal Transposition: Case Report and Review of the Literature

Penoscrotal transposition is a rare congenital abnormality. We report a case presenting prenatally with ambiguous genitalia and renal anomaly on obstetric ultrasound and fetal MRI and discuss the postnatal examination and autopsy findings. We present a review of the literature, including associated gene abnormalities.

Is the third trimester repeat ultrasound scan for placental localisation needed if the placenta is low lying but clear of the os at the mid‐trimester morphology scan?

It is unclear whether women with a low‐lying placenta (not overlapping the internal cervical os) at the mid‐trimester scan need follow‐up. The aim of the study was to determine the rate of placenta praevia, vasa praevia and cord prolapse in the third trimester in this cohort of women.

Prominent cervical mucous and its impact on cervical length measurement: Findings of a national survey

Cervical length measurement by transvaginal scanning (TVS) has been proposed by some as a universal screening test for preterm labour. The presence of prominent cervical mucous may affect assessment of the cervix; however, the exact technique to measure the cervix when there is prominent mucous or funnelling has not been described. We evaluated the level of agreement in cervical length measurements amongst Australian specialists and sonographers reporting on cervical assessment using an online survey.

Large Umbilical Artery Aneurysm with a Live Healthy Baby Delivered at 31 Weeks

Umbilical artery aneurysm is a rare structural anomaly. We report a case of a large cord mass monitored closely with MCA PSV aiding the decision for delivery in an appropriately grown fetus.

If not parthenogenesis why not “In Vivo Embryogenesis” with Mary as a birth mother

The editorial written by Benagiano and Dallapiccola ‘‘Can modern biology interpret the mystery of the birth of Jesus’’ [1] is both enlightening and bold in attempting to answer a complex issue surrounded by tradition and mystery. The extensive review of literature with reference to mechanisms of gender differentiation in various species is intriguing. I do agree that we should endeavour to break down all the barriers between science and religion and seek to understand the mechanisms behind natural and supernatural phenomenon. From Edward and Steptoe to Dolly and Polly the cloned sheep and the elucidation of the human genome we have come a long way with what is humanly achievable [2,3]. The field of Assisted Reproductive Technology has given us insights into donor eggs, donor sperms and biological mothers or surrogate/birth mothers. The elucidation of the human genome and techniques of genetic engineering has now taken designer babies out of science fiction into possibilities within the near future. Our understanding of the events surrounding the conception of Jesus convinces us that Joseph (the ‘‘father’’ of Jesus) had no contribution to make to the genetic make-up of Jesus, and in this editorial Benagiano and Dallapiccola explore the concept of ‘‘parthenogenesis’’ with genetic contribution from Mary (the ‘‘mother’’ of Jesus). Could I dare to postulate that Mary possibly had no genetic contribution to make to the formation of Jesus? Indeed, if a sperm was not needed in the conception of Jesus, why do we strive to understand how an egg could form a conceptus? Benagiano and Dallapiccola quote from the gospel of Luke the ‘‘Power of the Most High shall overshadow you’’ [4] similar to what is stated in Genesis when the spirit of God hovered over the earth in creation [1]. Could Mary have been a surrogate mother of Jesus with the power of the Holy Spirit creating an entirely new totipotential cell; a whole new human genome, ready for cell replication and organogenesis? Indeed, Mary is the mother of Jesus; the birth mother of Jesus not necessarily the biological mother. The historic, geographic and the cultural context of the birth of Christ cannot be denied and needed to occur in Bethlehem within the nation of Jews in a time place context. Joseph and Mary brought up the baby Jesus and cared for him till he left home as a carpenter as his adoptive parents. I postulate further that the first Adam and Eve were created with a perfect set of human genome without any mutations or copy number variants [5]. The onset of mutations, variations in genes, single gene disorders and multifactorial disease inheritance as well as the triggering of the aging gene is likely to have occurred after the cessation of the perfect conditions [6]. I fully concur with Benagiano and Dallapiccola in their disagreement that parthenogenesis is unlikely to have been the pathway that the conception of Christ occurred. I postulate that the mechanism is likely to have been a de novo ‘‘In Vivo Embryogenesis’’.

P10.02: Idiopathic polyhydramnios and antenatal Bartter syndrome: diagnostic criteria?

Further meticulous examination of the vertebrae ossification centres revealed triangular bone structure, smaller than a vertebral body, which acts as a wedge against the normal vertebral bodies. Six out of 8 fetuses (75%) had other anomalies: 4 have multiple anomalies, 1 case had a missing rib, 1 case had single umbilical artery and the other 2 cases had no associated anomalies. In the group of multiple abnormalities one fetus had VACTERL syndrome and two Trisomy 18 and one amniotic band syndrome. After counselling 5 couples opted for termination of pregnancy. One pregnancy ended in fetal demise at 16 weeks and remaining 2 continued to delivery at term. Conclusions: Hemivertebrae manifests as an angulation of spine on coronal section and it can be detected in the late first trimester scan because the ossification centres of the vertebrae can be visualised after 12 weeks’ gestation. Comprehensive sonographic examination of the fetus allows early prenatal diagnosis of hemivertebra, detection of associated anomalies and provides parents with helpful information for their decision regarding the fate of the pregnancy.

Tracheal Atresia with Segmental Esophageal Duplication: An Unusual Anatomic Arrangement

An unusual anatomic configuration of segmental tracheal agenesis/atresia with esophageal duplication on autopsy in a fetus that demised in utero at 29 weeks is reported. The mother was scanned initially for a cardiac anomaly at 20 weeks and on follow-up scan at 27 weeks had polyhydramnios and underwent amnioreduction. The final autopsy diagnosis was vertebral, ano-rectal, cardiac, tracheoesophageal, renal, and limb malformations (VACTERL). We discuss the autopsy findings along with the embryological mechanisms and compare the configuration with Floyds classification for tracheal agenesis. The difficulties in prenatal diagnosis are discussed.