Matthias Scheier

Fetal middle cerebral artery peak systolic velocity in the investigation of non-immune hydrops

In some cases of non‐immune hydrops there is congenital or acquired fetal anemia. The aim of this study was to investigate the potential value of fetal middle cerebral artery peak systolic velocity (MCA‐PSV) in the assessment and management of non‐immune hydrops due to anemia.

Prediction of fetal anemia in rhesus disease by measurement of fetal middle cerebral artery peak systolic velocity

In red blood cell (RBC) isoimmunized pregnancies fetal anemia is associated with a hyperdynamic circulation. The aim of the present study was to examine further the possible value of fetal middle cerebral artery peak systolic velocity (MCA‐PSV) in the management of affected pregnancies.

Three-dimensional sonography of the posterior fossa in fetuses with open spina bifida at 11-13 weeks' gestation.

To investigate the posterior fossa of normal fetuses and fetuses with open spina bifida in stored three‐dimensional (3D) volumes and to describe signs that might allow early detection of this defect.

Appearance of the fetal posterior fossa at 11 + 3 to 13 + 6 gestational weeks on transabdominal ultrasound examination

To describe the sonographic appearance of the structures of the posterior cranial fossa in fetuses at 11 + 3 to 13 + 6 weeks of pregnancy and to determine whether abnormal findings of the brain and spine can be detected by sonography at this time.

Three‐dimensional sonographic calculation of the volume of intracranial structures in growth‐restricted and appropriate‐for‐gestational age fetuses

To evaluate the feasibility and reproducibility of volume segmentation of fetal intracranial structures using three‐dimensional (3D) ultrasound imaging, and to estimate differences in the volume of intracranial structures between intrauterine growth‐restricted (IUGR) and appropriate‐for‐gestational age (AGA) fetuses.

Changes in Central and Peripheral Circulation in Intrauterine Growth-Restricted Fetuses at Different Stages of Umbilical Artery Flow Deterioration: New Fetal Cardiac and Brain Parameters

Objective: To evaluate changes in central and peripheral circulation, including new and standard parameters of the fetal brain and heart in fetuses with intrauterine growth restriction (IUGR) in relation to progressive deterioration of the umbilical artery (UA). Methods: Seventy-two IUGR fetuses were studied longitudinally. IUGR was defined as an estimated fetal weight <10th centile for gestational age. Fetuses were classified according the UA pulsatility index (PI) as: group 1, normal UA-PI (<95th centile; <1.645 z-scores), group 2, UA-PI (≧95th centile and <99th centile; ≧1.645 and <3 z-scores), group 3, UA absent end-diastolic flow, and group 4, UA reversed end-diastolic flow. Middle cerebral artery (MCA), anterior cerebral artery segments 1 (ACA1) and 2 (ACA2), aortic isthmus blood flow index (IFI), modified myocardial performance index (Mod-MPI), ductus venosus (DV), renal artery (RA), femoral artery (FA) and amniotic fluid index (AFI) were weekly evaluated until delivery. Results: A total of 263 scans were performed (median, 3 (range: 1–23) per patient). There were 6 intrauterine and 2 neonatal deaths. Although all cerebral arteries showed a reduction in the PI, ACA1 showed the earliest vasodilatation. From group 2 onwards, all cerebral vessels had a similar pattern of vasodilatation. Mod-MPI became abnormal at group 1 with no further changes. IFI and DV became constantly abnormal starting from group 2. No changes in the RA-PI or FA-PI were documented. Conclusion: The process of hemodynamic deterioration in IUGR fetuses seems to be earlier represented by the ACA1 and the Mod-MPI. Signs of further deterioration were observed in the DV, IFI and MCA. The peripheral blood in the RA and FA did not show any change. AFI showed a late deterioration process.

Left ventricular function many years after recovery from pre-eclampsia.

Please cite this paper as: Strobl I, Windbichler G, Strasak A, Weiskopf‐Schwendinger V, Schweigmann U, Ramoni A, Scheier M. Left ventricular function many years after recovery from pre‐eclampsia. BJOG 2011;118:76–83.

Outcome of twin reversed arterial perfusion sequence following treatment with interstitial laser: a retrospective study.

Objectives: To determine the outcome of twin reversed arterial perfusion (TRAP) sequence treated with or scheduled for treatment with interstitial laser therapy. Methods: This is a retrospective study on ten pregnancies diagnosed with TRAP sequence. Seven of the ten pregnancies were treated with interstitial laser therapy, and two pregnancies were scheduled for later treatment. One pregnancy was treated with fetoscopic laser ablation and excluded from analysis. The delivery reports of all pregnancies were collected, the neonatal health status recorded and the median time of delivery and the treatment to delivery interval calculated. Results: Six of seven pump fetuses in TRAP pregnancies treated with interstitial laser therapy at a median of 16+2 (range 13+1 to 20+3) gestational weeks were born healthy at a median of 38+0 (range 34+3 to 40+6) gestational weeks. One fetus treated with interstitial laser died after the procedure at 20+3 weeks. Two pump twins scheduled for later treatment died before the gestational age of 16 weeks. The median treatment to delivery interval for the surviving fetuses was 153 days (range 128-194). Conclusion: Treatment of TRAP sequence by interstitial laser therapy is feasible from the 13th week of gestation and has a good outcome.

Reference Values for Doppler Parameters of the Fetal Anterior Cerebral Artery throughout Gestation

Aim: To construct normal reference values for Doppler parameters in 2 anatomical segments of the fetal anterior cerebral artery (ACA) throughout pregnancy. Methods: The ACA was evaluated in 373 normally growing fetuses from 20 to 40 weeks of gestation. The first segment of the ACA (ACA-S1) was recorded just after its origin from the internal carotid artery in the same plane as the middle cerebral artery (MCA). The second segment (ACA-S2) was recorded distal to the outlet of the anterior communicating artery. Results: The ACA pulsatility index (PI) behaved similarly in both segments, with a constant increase until 28 weeks followed by a decrease until the end of pregnancy [ACA-S1 PI = 3.49 – 0.37 × gestational age (GA) – (0.0063 × GA2), SD = 0.6 – 0.061 × GA – (0.001 × GA2); ACA-S2 PI = 1.54 – 0.22 × GA – (0.0037 × GA2), SD = 0.206 + (0.0037 × GA)]. Peak systolic velocities in both segments showed a constant increase from 20 to 40 weeks of gestation. No significant differences were found between the 2 segments with regard to any Doppler parameter. However, the angle of insonation and the time spent on examination were significantly lower and reproducibility was better for ACA-S1. Conclusion: Despite showing similar Doppler values, ACA-S1 has a higher reliability than ACA-S2 and can be recorded in the same anatomical projection as the MCA.

Congenital Fibrosarcoma as Cause for Fetal Anemia: Prenatal Diagnosis and in utero Treatment

Objectives: To discuss diagnosis and management of a case of a rare fetal tumor complicated by fetal anemia due to intratumoral hemorrhage. Case Report: We report on a 29-week-old fetus with a tumor in the posterior left shoulder region. The morphologic aspect of the tumor, lack of fetal movements and an increased middle cerebral artery (MCA) peak systolic velocity (PSV) were indicative of fetal anemia caused by intratumoral bleeding. Following intravascular blood transfusion the pregnancy was safely prolonged for 15 days, during which lung maturity was induced. After delivery the neonate underwent surgical excision. Histological examination revealed an infantile congenital fibrosarcoma. Conclusion: Anemia must be ruled out in cases with fetal tumors. MCA PSV is useful in diagnosis and surveillance in these fetuses.