M. Hoopmann

First-trimester ultrasound images using HDlive.

The image on the cover of this month’s Journal shows a 7-week embryo obtained using a Voluson E8 (GE Medical Systems, Zipf, Austria) ultrasound machine equipped with a new surface render mode, ‘HDlive’ (Figure 1). Figure 2 shows another case at 10 weeks, obtained using the same technique. The HDlive system uses an adjustable light source, giving the operator the opportunity to create lighting and shadowing effects and thereby increasing depth perception. In both images it is clear to see that this capacity to adjust lighting, combined with use of new

Performance of 36 Different Weight Estimation Formulae in Fetuses with Macrosomia

Introduction: The aim of this retrospective clinical study was to compare the accuracy of 36 commonly used weight estimation formulae in macrosomic fetuses. Material and Methods: Ultrasound estimation of fetal weight (FW) was carried out within 7 days up to delivery in 350 singleton fetuses with a birth weight (BW) of ≧4,000 g. The accuracy of the different formulae for FW estimation was compared by, firstly, the mean percentage (MPE) and mean absolute percentage error (MAPE), secondly, by the frequency distribution of differences between estimated FW and fetal BW, and thirdly by comparing detection and false positive rates in screening for fetuses with a BW of 4,000, 4,300 and 4,500 g or more. Results: MPE ranged from –62.2 to 9.6% and was closest to 0 with the Hart formula. With 12 of 36 weight estimation formulae, MAPE was 10% or less, and was smallest with the Hart formulae (3.9%). The mean detection rate among all formulae for fetuses with a BW ≧4,000, ≧4,300 and ≧4,500 g was 29, 24 and 22%, respectively, and the false positive rate was 12% (for ≧4,300 g) and 7% (≧4,500 g). Discussion: Some formulae showed advantages as far as mean and absolute percentage errors were concerned, but none reached a detection rate and false positive rate for fetuses ≧4,500 g that could lead to clinical recommendation.

Intra- and interoperator reliability of manual and semi-automated measurement of fetal nuchal translucency by sonographers with different levels of experience

To compare the intra‐ and interoperator reliability of manual and semi‐automated nuchal translucency thickness (NT) measurement by sonographers with different levels of experience.

First trimester ultrasound screening for Down syndrome based on maternal age, fetal nuchal translucency and different combinations of the additional markers nasal bone, tricuspid and ductus venosus flow

To examine the performance of screening for Down syndrome based on maternal age, fetal nuchal translucency (NT) and different combinations of the additional ultrasound parameters: nasal bone (NB), tricuspid flow (TF) and ductus venosus (DV).

Prenatal evaluation of the position of the fetal conus medullaris

To determine the position of the fetal conus medullaris during pregnancy in relation to the last vertebral body and to examine its use in detecting skin‐covered spinal dysraphism.

Prefrontal space ratio in second- and third-trimester screening for trisomy 21.

To evaluate the prefrontal space ratio (PFSR) in second‐ and third‐trimester euploid fetuses and fetuses with trisomy 21.

Bronchopulmonary sequestration with massive pleural effusion: pleuroamniotic shunting vs intrafetal vascular laser ablation

To assess the incidence of complications among a relatively large cohort of fetuses with bronchopulmonary sequestration (BPS) and the success of two different intrauterine treatment modalities.

Screening for chromosomal abnormalities by first trimester combined screening and noninvasive prenatal testing.

PURPOSE To examine combined first trimester screening (FTS), noninvasive prenatal testing (NIPT) and a two-step policy that combines FTS and NIPT in screening for aneuploidy. MATERIALS AND METHODS Retrospective study involving 21,052 pregnancies where FTS was performed at the Praxis Praenatal.de in Duesseldorf, Germany. In each case, the sum risk of trisomy 21, 18 and 13 was computed. We assumed that NIPT detects 99 %, 98 %, 90 % and 99 % of cases with trisomy 21, 18, 13 and sex chromosomal abnormalities and that the false-positive rate is 0.5 %. The following screening policies were examined: NIPT or FTS with sum risk cut-offs of 1 in 50 and 1 in 250 in all patients or a two-step-policy with FTS in all patients followed by NIPT in the intermediate sum risk group. For the intermediate risk group, sum risk cut-offs of 1 in 50 and 1 in 1000 and 1 in 150 and 1 in 500 were used. RESULTS There were 127, 34, 13 and 15 pregnancies with trisomy 21, 18, 13 and sex chromosomal abnormalities. 23 fetuses had other chromosomal abnormalities with an increased risk for adverse outcome that are not detectable by NIPT. 20,840 pregnancies were classified as normal as ante- and postnatal examinations did not show any signs of clinically significant chromosomal abnormalities. FTS with a sum risk cut-off of 1 in 50 and 1 in 250 detects 81 % and 91 % for all aneuploidies. NIPT detects 88 % of the respective pregnancies. The 2-step approach with sum risk cut-offs of 1 in 50 and 1 in 1000 detects 94 % of all aneuploidies. With sum risk cut-offs of 1 in 150 and 1 in 500, the detection rate is 93 %. CONCLUSION A 2-step policy with FTS for all patients and NIPT in the intermediate risk group results in the highest detection rate of all aneuploidies.

Impact of bias in crown–rump length measurement at first‐trimester screening for trisomy 21

To assess the repeatability of crown–rump length (CRL) measurement and examine the effect of its over‐ and underestimation on first‐trimester combined screening.

Factors influencing the duration of late first and second-trimester termination of pregnancy with prostaglandin derivates.

OBJECTIVE To examine the time interval between first induction and fetal expulsion in fetal defect-related termination of pregnancy and to determine the relevant factors that influence this time interval. STUDY DESIGN Retrospective study involving singleton pregnancies that were terminated due to fetal abnormalities between 2005 and 2009. Induction was done by either 200 μg misoprostol, 1 mg gemeprost or in case of a previous caesarean section by 0.5 mg dinoprostone gel or 1mg gemeprost. The length of the induction interval between first induction and fetal expulsion was examined according to different maternal and fetal characteristics. Univariate and multivariate logistic regression analyses were used to determine the significant contributors for a delivery within 24 h. RESULTS One hundred and eighty-four singleton pregnancies fulfilled the inclusion criteria. The median gestational age at first induction was 19.2 weeks of gestation. The median time interval between first induction and expulsion was 18 h (25-75th centile, 11-30 h) and in 59 (32.1%) cases, the induction interval was longer than 24 h. Multivariate logistic regression analysis in the prediction of fetal expulsion within 24 h after first induction indicated significant contribution from gestational age and history of spontaneous delivery without previous caesarean section. CONCLUSIONS The only relevant contributors to an estimation of the time interval were gestational age and previous history of spontaneous delivery. By combining this information it was possible to correctly anticipate fetal expulsion within 24h after first induction in 90% of the cases.