Mirko Prodan

Prevalence of anencephaly in the region of Rijeka, Croatia

This retrospective study determines the prevalence of anencephaly in the region of Rijeka, Croatia. Records of all spontaneous and therapeutic abortions terminated in medical institutions, all fetuses weighing more than 500 g or more than 22 weeks gestation (whether the product of abortion, therapeutic termination, stillborn or liveborn) and infants who died in the first year of life in the region of Rijeka, Croatia, during the 1963–2000 period were reviewed. There were 135,451 births; 22 of them were anencephalics (19 stillborn), which comprises 0.2% of all births and 2.1% of stillbirths. Annual prevalence of anencephaly varied in range from 0.00 to 7.42 per 10,000 births. In two cases pregnancy was electively terminated after ultrasonographic diagnosis of anencephaly. Fifteen anencephalics were female, six were male, and in one case sex was undetermined due to aplasia of genital organs. Associated congenital malformations were detected in 18 anencephalics. The importance of establishing national and international registers of congenital malformations in all countries is stressed. The authors suggested that the setting of obligatory reporting of all congenital malformations would be the first step toward this practice in Croatia, as well as in other developing countries.

Combination of vibroacoustic stimulation and acute variables of mFBP as a simple assessment method of low-risk fetuses

Objectives. To observe a rate of fetal breathing and gross body movement appearance as physiologic reactions to the external vibroacoustic stimulation (VAS) and to establish a rapid and reliable antepartal method for accurate selecting of non-compromised fetuses in the low-risk population. Methods. Actual condition of 742-term and near-term structurally normal and otherwise healthy singleton fetuses with favourable outcome was assessed by previously established combination of the modified fetal biophysical profile and VAS. Only inactive fetuses at the beginning of the testing were included in the study. The combined biophysical testing has been started by a transabdominal real-time ultrasound examination, followed by vibroacoustic stimulus applied over the fetal head for 5 s during fetal quiescence. Fetal breathing and gross body movements were observed with particular attention in each case at measured time intervals from the application of external VAS until the moment at which either the first 60-s episode of breathing movements or all three fetal gross body movements were detected. Obtained results have been presented numerically in 5-min periods and cumulative percentages. Results. After the external VAS, 84.5% of studied fetuses successfully manifested their normal breathing or gross body movements in the first 5 min of the modified biophysical testing. Furthermore, approximately 96% of them were able to demonstrate at least one of these two biophysical activities after 6–7 min. Discussion. Because of its simplicity, non-invasiveness, independence of precise gestational dating, reproducibility and immediate individual results, ultrasonographic observation of normal fetal breathing and/or gross body movements after the external VAS stands a real chance to become a nearly optimal antenatal test for accurate and rapid information of actual non-compromised fetal condition. Authors strongly believe that the described antenatal method should represent a rather efficient assessment procedure of fetal well-being in late pregnancy, performed during regular antenatal visits.

Lamellar body count as a diagnostic test in predicting neonatal respiratory distress syndrome

Aim To determine the lamellar body count (LBC) cutoff value for fetal lung maturity and to evaluate the clinical usefulness of LBC in predicting the severity of neonatal respiratory distress syndrome (RDS). Methods A prospective study was conducted from 2002 until 2010. LBC was estimated in uncentrifugated amniotic fluid samples using Cell-Dyn 1800 analyzer. Amniotic fluid samples were obtained by amniocentesis or by puncturing embryonic membranes during cesarean section. The presence of mild, moderate, and severe RDS was assessed by neonatologist. Results A total of 313 patients with singleton pregnancies (24-41 weeks) were included in the study and 294 met the inclusion criteria. RDS was diagnosed in 28 neonates – mild in 8, moderate in 10, and severe in 10. In premature neonates (<37 gestational weeks), significant differences in LBC were only found between the subgroup without RDS and the group with moderate and the group with severe RDS (P < 0.001). In all neonates, significant differences were found between neonates without RDS and neonates with RDS. Using LBC cutoff value of ≥20,000/µL, sensitivity, specificity, and positive and negative predictive values of LBC in determining mature fetal lungs were 96%, 88%, 45.6%, and 99.5%, respectively. Conclusion This study suggests that LBC cutoff value of ≥20,000/µL can predict pulmonary maturity and reduce the risk of neonatal respiratory distress syndrome.