P. Stoutenbeek

Atrial flutter in the perinatal age group: diagnosis, management and outcome

OBJECTIVESnThe aim of this retrospective study was to evaluate perinatal atrial flutter (AF) and the efficacy of maternally administered antiarrhythmic agents, postpartum management and outcome.nnnBACKGROUNDnPerinatal AF is a potentially lethal arrhythmia, and management of this disorder is difficult and controversial.nnnMETHODSnForty-five patients with documented AF were studied retrospectively.nnnRESULTSnAtrial flutter was diagnosed prenatally in 44 fetuses and immediately postnatally in 1 neonate. Fetal hydrops was seen in 20 patients; 17 received maternal therapy, 2 were delivered and 1 was not treated because it had a severe nontreatable cardiac malformation. In the nonhydropic group of 24 patients, 18 were treated and the remaining 6 were delivered immediately. In the hydropic group, 10 received single-drug therapy (digoxin or sotalol) and 7 received multidrug therapy. In the nonhydropic group, 13 received a single drug (digoxin or sotalol) and 5 received multiple drugs. One patient with rapid 1:1 atrioventricular conduction (heart rate 480 beats/min) died in utero and another died due to a combination of severe hydrops because of the AF, sotalol medication, stenosis of the venous duct and hypoplastic placenta. Of the 43 live-born infants, 12 were in AF at birth. Electrical cardioversion was successful in eight of nine patients. No recurrences in AF have occurred beyond the neonatal period. Four patients with fetal flutter and hydrops showed significant neurological pathology immediately after birth.nnnCONCLUSIONSnFetal AF is a serious and threatening rhythm disorder, particularly when it causes hydrops, it may be associated with fetal death or neurological damage. Treatment is required and primarily aimed at reaching an adequate ventricular rate and preferably conversion to sinus rhythm. Digoxin failed in prevention of recurrence at time of delivery in a quarter of our patients, whereas with sotalol no recurrence of AF has been reported, suggesting that class III agents may be the future therapy. Once fetuses with AF survive without neurological pathology, their future is good and prophylaxis beyond the neonatal period is unnecessary.

Treatment of fetal heart block with maternal steroid therapy: case report and review of the literature

The presence of maternal autoantibodies to SS‐A/Ro and/or SS‐B/La is associated with the development of fetal heart block. There are data suggesting that maternal treatment with steroids might reverse heart block. We report on a pregnancy in a mother with secondary Sjögren syndrome and systemic lupus erythematosus with presence of autoantibodies to SS‐A/Ro and SS‐B/La, which was complicated by the development of incomplete fetal heart block. Oral dexamethasone treatment could not prevent progression to complete heart block and was associated with a number of complications.

First-trimester placental protein 13 and placental growth factor: markers for identification of women destined to develop early-onset pre-eclampsia.

Please cite this paper as: Wortelboer E, Koster M, Cuckle H, Stoutenbeek P, Schielen P, Visser G. First‐trimester placental protein 13 and placental growth factor: markers for identification of women destined to develop early‐onset pre‐eclampsia. BJOG 2010;117:1384–1389.

Neurological outcome of children who were treated for fetal tachycardia complicated by hydrops.

Fetal tachycardia is a condition associated with congestive heart failure and development of fetal hydrops, which may result in neurological morbidity and mortality. The aim of this study was to investigate the long‐term outcome of hydropic fetuses.

Grade and symmetry of normal fetal cortical development: a longitudinal two‐ and three‐dimensional ultrasound study

Recent studies have shown the capability of ultrasound to demonstrate fetal cortical development. For practical application, it would be useful to have more insight into the physiological progress of cortical folding. A longitudinal study was undertaken to grade fetal cortical development and to study physiological asymmetry by means of a simple scoring system. The reproducibility of the scoring system and the differences between two‐dimensional (2D) and three‐dimensional (3D) ultrasound were also examined.

Transvaginal ultrasound measurement of cervical length in the supine and upright positions versus Bishop score in predicting successful induction of labor at term

To examine the predictive value of cervical length as measured by transvaginal sonography (TVS) in supine and upright maternal positions for the mode of delivery and induction‐to‐delivery interval after induction of labor at term, and to compare these measurements with the Bishop score and its predictive value.

Transperineal versus transvaginal sonographic cervical length measurement in second‐ and third‐trimester pregnancies

To investigate the reliability of, and patient satisfaction with, transperineal cervical length measurement during the third trimester of pregnancy and to compare these with measurement during the mid‐trimester, using transvaginal sonographic imaging of the cervix as a reference.

Lack of standardization in determining gestational age for prenatal screening.

To determine whether estimation of gestational age (GA) in the context of first‐trimester Down syndrome screening is standardized in the Netherlands.

Sonographic longitudinal cervical length measurements in nulliparous women at term: prediction of spontaneous onset of labor

The aim of this study was to predict spontaneous onset of labor by serial transvaginal ultrasound measurement of cervical length (CL) in a homogeneous population of nulliparous women at term.

Trisomy 18 and 13 screening: consequences for the Dutch Down syndrome screening programme

Edwards syndrome (trisomy 18) and Patau syndrome (trisomy 13) are the second and third most common autosomal trisomies after Down syndrome (trisomy 21). Most infants with a trisomy 18 or 13 die in utero and the others within the first year of life. Especially, in case of trisomy 13, there is an increased risk of severe and early onset pre-eclampsia (Boyd et al., 1987). To enable an early termination of trisomy 18 and 13 pregnancies, and to avoid maternal complications, screening for trisomy 18 and 13 seems a sensible option, especially since modelling has shown that current first trimester screening can detect both chromosomal anomalies with a high detection rate (DR) and low false positive rate (FPR) (Tul et al., 1999; Spencer et al., 2000). From January 2007 a governmentally approved national screening programme for Down syndrome has been implemented in the Netherlands, using the first trimester combined test [pregnancy-associated plasma protein A (PAPP-A), the free beta subunit of human choriongonadotrophin (fβ-hCG) and nuchal translucency (NT)]. The government license for this screening programme is strictly confined to screening for trisomy 21. Under the current license, it is not allowed to report on the risks for trisomy 18 and 13. However, since an increasing number of health care providers know the potential role of serum screening for trisomy 18 and 13, including some who already counsel their patient regarding these anomalies and since these trisomies are associated with early maternal complications it was recently decided to file a request to extend the government license to Edwards and Patau’s syndrome. This request is currently under review. The aim of this article is to predict the consequences for the Dutch screening programme in terms of DR and FPR if trisomy 18 and 13 screening is introduced, using an accepted algorithm and retrospective data of the Dutch programme.