Nicola Rizzo

Ultrasound prediction of symptomatic congenital cytomegalovirus infection

OBJECTIVE The objective of the study was to assess the effectiveness of ultrasound in the antenatal prediction of symptomatic congenital cytomegalovirus (CMV) infection. STUDY DESIGN The sonograms of 650 fetuses from mothers with primary CMV infection were correlated to fetal or neonatal outcome. Infection status was disclosed by viral urine isolation at birth or CMV tissue inclusions at autopsy. Classification of symptomatic disease was based on postnatal clinical or laboratory findings or macroscopic evidence of tissue damage at autopsy. RESULTS Ultrasound abnormalities were found in 51 of 600 mothers with primary infection (8.5%) and 23 of 154 congenitally infected fetuses (14.9%). Symptomatic congenital infection resulted in 1 of 23 and 68 of 131 cases with or without abnormal sonographic findings, respectively. Positive predictive values of ultrasound vs symptomatic congenital infection was 35.3% relating to all fetuses or infants from mothers with primary infection and 78.3% relating to fetuses or infants with congenital infection. CONCLUSION When fetal infection status is unknown, ultrasound abnormalities predict symptomatic congenital infection in only a third of cases.

Diagnosis of station and rotation of the fetal head in the second stage of labor with intrapartum translabial ultrasound

To investigate the ability of intrapartum translabial sonography to diagnose fetal station in the second stage of labor.

Diagnosis of midline anomalies of the fetal brain with the three‐dimensional median view

To investigate the effectiveness of a simplified approach to the evaluation of the midline structures of the fetal brain using three‐dimensional (3D) ultrasound.

Prenatal diagnosis of open and closed spina bifida

To identify criteria useful for differentiating closed from open spina bifida antenatally.

Three‐dimensional ultrasound examination of the fetal central nervous system

The technique used to obtain an ultrasound volume is adequately described by three elements: (1) the section that is used to start the acquisition of the volume (referred to in the following as the ‘start’ scan); (2) the angle of rotation of the mechanical sweep of the motorized probe; and (3) the quality of the acquisition that can be varied by the operator and depends on the number of sections obtained during the acquisition. Both the angle of rotation and the quality of the volume influence the acquisition time and, when this is too long, the probability of movement artifacts increases. Tailoring the size and quality of the volumes to the specific diagnostic requirements is important because it increases the efficiency of the scan. In the following we provide information for each of the applications discussed. The modalities for the analysis of ultrasound volumes have been described in depth previously4,16,17. The multiplanar mode is most frequently used for assessment of the fetal CNS6,10,13,14. With this mode of display, the plane parallel to the acquisition plane or ‘start’ appears in the upper left corner of the screen and is identified with the letter A; the plane perpendicular to A but parallel to the ultrasound beam is identified with the letter B and appears in the upper right corner. The plane that is both perpendicular to the ‘start’ scan and the ultrasound beam is defined as C, and is frequently referred to as the coronal plane17 (Figure 1). The terminology may sound confusing at times. As discussed later, when dealing with the fetal brain, the coronal plane of the volume typically demonstrates a sagittal or axial section of the fetal head13. Although 3D ultrasound imaging can be used in many ways to evaluate the fetal (CNS), we have found that in practice there are mainly two useful applications: the multiplanar analysis of volumes obtained with an axial approach6,13 and the multiplanar analysis of volumes obtained from a sagittal or coronal approach12,14. 3D ultrasound examination can assist in evaluation of the spine18 and is particularly helpful in early neurosonographic studies1–3,5,19. It may also be used to improve the quality of two-dimensional (2D) images. These aspects are described separately below.

The clinical significance of prenatally diagnosed choroid plexus cysts

The choroid plexus cyst is one of many malformations of the central nervous system that can be detected in utero by ultrasonography. Choroid plexus cysts occur in 2.3% of fetuses. Because previous reports have shown an association between choroid plexus cysts and chromosomal anomalies, we analyzed 82 prenatally diagnosed cases, 65 of whom had chromosome analysis performed. Of the group, 6.2% had chromosomal anomalies of the trisomy 18 type. The remaining 17 cases were clinically normal at birth. These cases of trisomy 18 were also associated with multiple structural anomalies. Therefore, we suggest that after the diagnosis of choroid plexus cysts is made, a complete ultrasonographic survey of the fetal anatomy be performed. Fetal karyotype determination may be offered to patients, especially in the presence of structural anomalies.

PP13 mRNA Expression in Trophoblasts From Preeclamptic Placentas

To assess the role of placental protein 13 (PP13) in the pathogenesis of preeclampsia, the messenger RNA expression of PP13 was investigated in the trophoblasts from first and third trimester placenta. First, syncytiotrophoblasts and extravillous trophoblasts were separated from frozen section of third trimester placenta obtained from pregnant women with and without preeclampsia by laser microdissection. The PP13 levels of syncytiotrophoblasts were significantly higher than those of extravillous trophoblasts. The expression levels in syncytiotrophoblasts from the preeclampsia were significantly lower than those from normal. Next, the PP13 expression was assessed in trophoblasts from residual samples of chorionic villus sampling at 11 weeks of gestation, who subsequently developed preeclampsia. The levels in the preeclampsia group were significantly lower than those of normal cases. These findings indicate that an alteration in the PP13-messenger RNA expression in the trophoblasts may be associated with the pathogenesis of preeclampsia.

Relationship between Severity of Hyperemesis Gravidarum and Fetal DNA Concentration in Maternal Plasma

Cell-free fetal DNA is present in maternal plasma (1), where its concentration increases during some abnormal conditions that can occur during pregnancy, including preterm delivery (2), preeclampsia (3)(4)(5), invasive placenta (6), and fetal trisomy 21 (7)(8). The origin of fetal DNA is not clear, but a body of evidence in the literature suggests that it comes mainly from the destruction of villous trophoblasts that border the intervillous space filled with maternal blood (5)(9). Although the pathogenesis of hyperemesis gravidarum (HG) is obscure, activation of natural killer and cytotoxic T cells is higher in the blood and uterine decidua of women with HG with respect to healthy pregnant women (10). Thus, if HG and DNA concentrations were correlated, one possible common pathway that could explain these conditions might be an overactivated maternal immune system that destroys trophoblasts, causing both HG and higher concentrations of cell-free fetal DNA. The aim of this study was to investigate a possible correlation between HG and fetal DNA concentrations. We also evaluated the relationship between the cell-free fetal DNA concentration and the severity of HG. A total of 202 pregnant women (gestational age, 6–16 weeks) bearing a single male fetus, who presented at Showa University Hospital between July 2000 and July 2002 were enrolled in this study. Forty-five consecutive pregnant women with HG were classified into three groups based on the severity of the condition and matched for gestational age with 157 controls. All samples were analyzed blindly without knowledge of case-control status. The three HG groups were generated according to the following criteria: mild HG (nausea and vomiting but no need for admission), moderate HG (admission for HG with dehydration that needed infusion therapy but lacking all of the criteria that define severe HG), and severe HG …

Down syndrome biochemical markers and screening for preeclampsia at first and second trimester: correlation with the week of onset and the severity

To estimate the combined screening performance of first and early second trimester prenatal serum markers for Down syndrome, in screening for the development of preeclampsia, and analyze the correlation among marker levels, week of onset, and severity of the disease.

Prenatal diagnosis and outcome of partial agenesis and hypoplasia of the corpus callosum

To present antenatal sonographic findings and outcome of fetuses with hypoplasia or partial agenesis of the corpus callosum.