Orna Levinsohn-Tavor

Bedside estimation of Down syndrome risk from second‐trimester ultrasound prenasal thickness

To construct tables for ‘bedside’ estimation of Down syndrome risk based on maternal age and ultrasound prenasal thickness (PT) measurements.

First‐ and second‐trimester maternal serum markers of pre‐eclampsia in twin pregnancy

To evaluate the distribution of first‐ and second‐trimester maternal serum markers in twin pregnancy with and without pre‐eclampsia.

Early pregnancy maternal serum markers of pre‐eclampsia in twins

To evaluate the distribution of first‐ and second‐trimester maternal serum markers in twin pregnancy with and without pre‐eclampsia.

Fetal abnormalities leading to termination of twin pregnancies: the 17-year experience of a single medical center.

Abstract Objective: To assess fetal abnormalities leading to termination of pregnancy (TOP) performed in twin pregnancies. Method: The current study consisted of all women with dichorionic twin pregnancies (study group) who underwent TOP due to fetal abnormalities in our institute from 1999 to 2015. The data were compared to our registry of all parturient women with a singleton pregnancy (control group) that underwent TOP due to fetal anomalies at the same period. Results: There were 2495 cases of TOP because of fetal indications during the study period. Of them, 86 (3.4%) and 2409 (96.6%) were from the study and control group, respectively. Structural anomalies were the leading indication for TOP in twins compared with singleton pregnancies (81.4% versus 50.9%, respectively, p < 0.0001). For twins, the leading indication for TOP was central nervous system (CNS) abnormalities and it was more common compared with singleton pregnancies (26.1% versus 12.2%, respectively, p < 0.0001). This was followed by chromosomal/genetic abnormalities (16.3% versus 40.4%, respectively, p < 0.0001). Conclusions: We found a different distribution for fetal anomalies leading to TOP in twins versus singleton pregnancies. The main indication for TOP in the study group was structural malformations, with a predominance of CNS abnormalities.

The "honeycomb" appearance of fetal myofibromatosis

Infantile myofibromatosis (IM) is a benign neoplasm of infancy with an incidence of 1:150,000, presenting in 90% of the cases before two years of age and is rarely encountered in newborns. The mortality rate is 15%, most being with generalized visceral multicentric disease1-4 . Prenatal diagnosis may lead to termination of pregnancy being an option for the parents and the communities who accept such a choice. This article is protected by copyright. All rights reserved.

Termination of pregnancy due to fetal abnormalities performed after 32 weeks’ gestation: survey of 57 fetuses from a single medical center

Abstract Objective: To assess fetal abnormalities leading to very late termination of pregnancy (VLTOP) performed after 32 weeks’ gestation. Method: The study population included all pregnant women with singleton pregnancy that underwent VLTOP in our institute because of fetal indications between the years 1998 and 2015. Results: Fifty-seven cases (2.0%) were at ≥32 weeks’ gestation and are the subjects of the current study. Our VLTOP cases were subdivided into four categories according to the sequence of events that led to the decision for VLTOP: (1) No routine prenatal screening with an incidental fetal finding discovered after 32 weeks’ gestation (9 fetuses ∼16%); (2) Routine early prenatal care raised suspicion of abnormalities, and the final diagnosis was established by additional tests (8 fetuses, ∼14%); (3) Developmental findings detected during the third trimester (21 fetuses; ∼37%), and (4) fetal abnormalities that could have been detected earlier during pregnancy (19 fetuses; ∼33%). Conclusions: The two categories in which the pregnant women did not underwent any fetal evaluation (i.e. group 1) or those that could have been detected earlier (i.e. group 4) consists ∼49% from our cohort in which VLTOP could have been avoided.

Hysteroscopic removal of retained products of conception following first trimester medical abortion

Study Objective: To investigate the use of operative hysteroscopy instead of traditional curettage in women with retained products of conception (RPOC) following first trimester medical abortion, with the aim of reducing post-operative intrauterine adhesions. Design: Retrospective study. Setting: Gynecology department in a University affiliated hospital. Patients: All women treated by hysteroscopy for RPOC following first trimester medical abortion using the mifepristone-misoprostol protocol for pregnancy termination or the misoprostol protocol for early missed abortion from January 2013 to August 2016. Intervention: Operative hysteroscopy for removal of RPOC. Post-operative intrauterine adhesions were assessed by diagnostic office hysteroscopy after 6–8 weeks. Measurements and Main Results: 50 cases were identified. The mean time from medication administration to the operative hysteroscopy was 1.7 ± 0.7 months. Operative hysteroscopy with blunt use of the resectoscopic loop was used to remove all specimens, and all procedures were completed without intra-operative complications. Two patients (4.0%) were readmitted for fever. Pathology confirmed the presence of RPOC in 45 (90.0%) cases. On follow-up office hysteroscopy, a normal uterine cavity without evidence of intrauterine adhesions was seen in 29/29 (100%) women. Conclusion: Hysteroscopy for removal of RPOC following medical abortion is associated with low rates of complications and post-operative intrauterine adhesions.

Evaluation of the impact of vasa previa on feto-placental hormonal synthesis and fetal growth

INTRODUCTION A vasa previa (VP) refers to aberrant chorionic vessels which can either connect the chorionic plate to a velamentous cord (type I) or a succenturiate or accessory lobe to the main placental mass (type II). METHODS We performed retrospective cohort study of 32 singleton pregnancies diagnosed with VP. The levels of maternal serum alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG) and unconjugated estriol (uE3) were measured at 15-18 weeks as part of the triple test screening for Trisomy 21. The data were subdivided according to the type of VP and compared with those of a control group with central cord insertion and no succenturiate or accessory placental lobe. RESULTS Twenty one (65.6%) parturient women presented with VP type I and 11 (34.4%) with VP type II. The mean birthweight and placental weight was significantly higher in pregnancies with VP type II than in pregnancies with VP with VP type I (3037.3±400.9 gr vs 2493.5±491.6 gr; p=0.004 and 511.0±47.2 gr vs 367.1±64.3 gr; p<0.0001; respectively). The mean hCG level in VP type II was significantly (p<0.001) higher than those with type I (2.38MoM vs 1.17MoM) and compared to controls (2.38MoM vs 0.99MoM). CONCLUSIONS There is no obvious impact on both placental and fetal growth in VP type II. By contrast, VP type I is associated with slower feto-placental growth secondary to impaired development and biological functions of the placenta during the first half of pregnancy.

Prenatal ultrasound charts of orbital total axial length measurement (TAL): a valuable data for correct fetal eye malformation assessment.

To construct prenatal age‐specific reference intervals using ultrasound measurement of total axial length (TAL) in normal fetuses for assessing microphthalmia.

The Triple Test Markers Profile Among Fetuses and Children Diagnosed With Umbilical Vein Varix

Umbilical vein varix (UVV) is defined as a focal enlargement of the umbilical vein and represents approximately 4% of fetal umbilical cord malformations. The reported neonatal outcome of fetuses with UVV varies widely due to its rarity, hence the small sample sizes of the case series in the literature. Earlier studies reported high fetal mortality, but more recent reports have demonstrated no association between UVV and intrauterine fetal death. A recent study has described a possible association between UVV diagnosed prenatally and child developmental delay. The present study of fetuses with UVV was done to evaluate and compare the levels of triple test serum biomarkers used for Down syndrome screening (human chorionic gonadotropin, α-fetoprotein, and unconjugated estriol) between a group of fetuses with uneventful obstetric outcome versus a subgroup of children with developmental delay.