O. Picone

Detailed in utero ultrasound description of 30 cases of congenital cytomegalovirus infection.

The aim of this research was to describe precisely prenatal ultrasound (US) features in congenital cytomegalovirus (CMV) infection.

Technique de cerclage cervico-isthmique par voie vaginale avec bandelette de polypropylène: technique de Fernandez: Description et résultats

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 5 - p. 465-471OBJECTIVEnTo assess the efficacy of performing transvaginal cervico-isthmic cerclage using synthetic tape in prevention of preterm labor in high-risk women.nnnPATIENTS AND METHODSnA retrospective analysis of 24 transvaginal cerclages using polypropylene tape performed in women presenting with high risk of preterm delivery: prior histories of pregnancy losses in the second trimester, prior failure of Mac Donalds cerclage and/or absent portio vaginalis of the cervix. Cerclage was performed between 12 and 16 weeks of gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route.nnnRESULTSnThe median age of the patients in this series was 32.1 years (range 22-39 years). No intra-operative complication occurred. The median operating time was 34.9 minutes (+/-5.1) (range 30-45 min). Cesarean delivery was systematically performed in all patients since the cerclage was considered to be definitive. Mean gestational age and birth weight at delivery were respectively 37.1 weeks (+/-1.8) and 2850 g (+/-745). Preterm birth rate was 19% (4/21). Birth at less than 32 weeks occurred in only one patient (4%). In one case, the tape has been removed later because symptomatic vaginal erosion was noted. One neonatal death occurred following amniotic fluid infection at 34 weeks. At the present time, 3 women are at 22, 26 and 26 weeks of gestation with no preterm labor.nnnCONCLUSIONnTransvaginal cerclage using polypropylene tape may be considered as an effective and minimally invasive alternative to transabdominal cervico-isthmic cerclage in women presenting with high risk of preterm delivery.

Intravenous fetal exchange transfusion before 22 weeks of gestation in early and severe red-cell fetomaternal alloimmunization.

Objectives: To determine the perinatal outcome in severe red-cell fetomaternal alloimmunization. Methods: Retrospective series of 32 affected fetuses treated with intravenous fetal exchange transfusion (IFET) before 22 weeks of gestation. The main outcome measures were the degree of fetal anemia, fetal transfusions and perinatal outcome. Results: The first IFET was performed at 19.8 ± 1.8 weeks of gestation. All fetuses were severely anemic and hemoglobin levels were not different between 20 hydropic and 12 nonhydropic fetuses (4.1 ± 2.5 vs. 5.6 ± 2.8 g/dl, p = 0.33). The initial maternal anti-D level ranged from 4 to 76 µg/l and was not correlated to fetal anemia (r = –0.07). Conclusion: The overall perinatal survival rate was 78% compared to a previous perinatal loss rate excluding first pregnancies of 55.5%.

Prenatal diagnosis of a patent urachus cyst with the use of 2D, 3D, 4D ultrasound and fetal magnetic resonance imaging.

Patent urachus cyst is a rare umbilical anomaly, which is poorly detected prenatally and frequently confounded with pseudo bladder exstrophy or omphalocele. A 27-year-old woman was referred to our prenatal diagnosis centre at 18 weeks of gestation after diagnosis of a megabladder and 2 umbilical cord cysts. Subsequent 2D, 3D and 4D ultrasound examinations and fetal magnetic resonance imaging (MRI) revealed a typical umbilical cyst and an extra-abdominal cyst, communicating with the vertex of the fetal bladder through a small channel that increased in size when the fetus voided urine. Termination of pregnancy occured at 31 weeks because of associated cerebral septal agenesis, and autopsy confirmed the prenatal diagnosis of urachus cyst. Few cases of urachus cyst diagnosed prenatally are reported in literature, but none were associated with other extra-abdominal disorders and none used 3D, 4D and fetal MRI. Our case illustrated the efficiency in prenatal diagnosis of 3D and 4D ultrasound examinations. This could help pediatrician surgeons to explain to a couple about neonatal surgical repair and plastic reconstruction in the prenatal period.

The association of gastroschisis with other congenital anomalies: how important is it?

To report the prevalence of the association between gastroschisis and other anomalies, their prenatal characteristics and the postnatal follow‐up.

Prenatal diagnosis of a possible new middle interhemispheric variant of holoprosencephaly using sonographic and magnetic resonance imaging.

A peculiar subtype of holoprosencephaly, middle interhemispheric variant (MIH), which is characterized by a partial posterior interhemispheric fusion of the brain, has been described in children. We describe the features of a case of a possible new MIH at 26 weeks of gestation, diagnosed using prenatal sonography and magnetic resonance imaging and confirmed by postmortem examination. This malformation of the brain was associated with an unusual appearance of the corpus callosum and rare chromosomal abnormality: a 45X/46,XX/47,XX,+ 18 mosaicism. Copyright

Three-dimensional ultrasonographic diagnosis of a cervical pregnancy

Cervical pregnancy is a rare condition characterized by implantation of a fertilized ovum in the endocervical canal below the internal os level; its incidence is less than 0.1% of all ectopic pregnancies. Although predisposing factors have been described, the cause of cervical pregnancy remains unknown. Cervical pregnancy has a high morbidity potential due to massive hemorrhage that can be associated with it, but mortality is low due to early ultrasonographic diagnosis, using transvaginal examination. Making a differential diagnosis between cervical [...]

Pitfalls in the diagnosis of congenital rubella syndrome in the first trimester of pregnancy

A 29-year-old woman, gravida 3 para 0, was referred at19weeks of gestation because of a maternal rubella infectionduring the first trimester of pregnancy. She consulted at5weeks for a rash, which, at that time, was considered tobe urticaria. Her serological status for rubella was unknownat that time, and as rubella infection was not considered,serological investigations were not conducted. At 6weeks,toxoplasma and rubella testings were performed asrecommended by the French High Health Authority [HauteAutorite de Sante (HAS)]. HAS only recommends IgGtesting for routine Rubella screening and both IgG and IgMtestings for toxoplasma.

Evaluation of the third trimester amniocentesis for fetal karyotyping in women with fear of pregnancy loss

OBJECTIVESnThe aim of this study is to determine the complications of third trimester amniocentesis for fetal karyotyping among women unwilling to accept the fetal loss risks of second trimester amniocentesis.nnnMATERIALS AND METHODSnA retrospective study was carried out from January 1998 to December 2006 of 182 singleton pregnancies that underwent a late amniocentesis (after 32 weeks) for fetal karyotyping. The indications were integrated risk (maternal age, first trimester nuchal translucency, second trimester maternal serum markers) over 1/250 (n=68), isolated maternal age over 38 years (n=51), isolated abnormal second trimester biochemical markers (n=34), history of personal or familial a chromosomal abnormality (n=21) or maternal choice (n=8). Presence of fetal abnormalities at ultrasound or context of viral or parasitologic seroconversion as well as multiple pregnancies were considered as non-inclusion criteria.nnnRESULTSnMedian maternal age and gestational age at sampling were 39 years (range 23-48) and 32.4 weeks (29.5-37.6). Median interval between amniocentesis and definitive results of amniocentesis on the one hand, and delivery on the on the hand were 15 days (7-42) and 47 days (8-69), respectively. There were no chromosomal abnormality and non-termination of pregnancy. Nine patients out of 182(5%) had a spontaneous labour followed by premature delivery before 37 weeks and six women (3.3%) among those nine displayed preterm premature rupture of membranes (PPROM). Four patients out of 182 (2%) gave birth before definitive karyotyping result but all of them had a direct fluorescence in situ hybridisation analysis with a normal karyotyping result known well before delivery.nnnCONCLUSIONSnThe risk of preterm premature rupture of membrane is 3.3%, with a 5% risk of premature delivery before 37 weeks. This late procedure provides a safe reassurance to women who are unwilling to accept the risks of earlier amniocentesis. However, it should only be used in particular situation and in countries were legislation allows late termination of pregnancy.

OP09.15: Prenatal features of a fetal frontal hemangioma assessed by 3D ultrasound and color Doppler imaging

Methods: A total of 124 women attending the prenatal diagnostic clinic of a teaching hospital were randomized into the intervention (2DUS followed by 3D/4DUS) or control (2DUS alone) group. One operator performed all the ultrasound examinations. The primary outcome was maternal anxiety levels which were assessed by the Spielberger State-Trait Anxiety Inventory. The secondary outcome was breastfeeding rate. We measured the anxiety levels in all women at the first visit, around 18 weeks’ (immediately after ultrasound examinations) and finally at 28 weeks’ gestation. Results: A short-term reduction of stateanxiety score (by around two) from the first visit to after ultrasound examinations was similarly observed in both the intervention group and control group. Repeated measures ANOVA showed that there was no significant interaction effect between groups and time of assessment on the stateanxiety scores (F value = 1.072 and P value = 0.344). There was also no significant difference in the breastfeeding rate on discharge from the hospital after delivery between the control group (33.3%) and the intervention group (43.6%). About 80% of women reported a better understanding that their baby was normal after viewing 3D than 2D images. Conclusion: This randomized study indicates that the addition of 3D/4DUS does not cause a significant reduction on maternal anxiety or increase in breastfeeding rate in pregnancies at risk of fetal abnormalities compared with conventional 2DUS alone.