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Fetal thymus size in uncomplicated twin and singleton pregnancies

The main objective of this study was to determine whether fetal thymic measurements could be obtained in twins, with a secondary goal to determine whether thymic measurements from uncomplicated singleton and twin pregnancies are comparable.

Sonographic thymic measurements in Down syndrome fetuses.

Children with Down syndrome (DS) can have hypoplastic thymuses with an impaired capacity to liberate newly generated T cells. We sought to determine if the size of the thymus in DS fetuses is different from control fetuses.

Comparison of measurements of the transverse diameter and perimeter of the fetal thymus obtained by magnetic resonance and ultrasound imaging

To compare measurements of the fetal thymus obtained by magnetic resonance imaging (MRI) and ultrasound (US).

Maternal and perinatal outcomes in pregnancy-associated melanoma. Report of two cases and a systematic literature review

OBJETIVES Melanoma is one of the most frequent malignancies during gestation. However, oncological and perinatal management is still challenging. Our first objective is to describe the cases of pregnancy-associated melanoma (PAM) diagnosed in our centre between January-2004 and May-2015. Secondly, to perform a systematic review of the published articles analysing the maternal-perinatal outcomes of patients diagnosed with PAM. DESIGN, POPULATION AND METHODS Obstetrical, oncological and perinatal variables were recorded in the case series. For the systematic review we include all published articles assessing the obstetric and neonatal outcomes in PAM cases in Pubmed, Web of Knowledge and Cochrane Library. The search was restricted to articles published in English, between January-2004 and May-2015. Study characteristics, oncological and maternal-perinatal variables were recorded in the systematic review. RESULTS Two patients were found: the first case presents a newly diagnosed metastatic melanoma at 26-weeks of gestation with fatal maternal and neonatal outcome. The second case presents a patient with metastatic melanoma who got pregnant during her treatment. For the systematic review we found 25 articles, providing data from 489 patients. Maternal-perinatal outcomes, including termination of pregnancy rates, vary depending on the country, gestational age and tumour stage at diagnosis. PAM is usually detected at advanced stages, even with metastasis affecting the placenta and the foetus. CONCLUSIONS When diagnosed at early stages, melanoma does not seem to alter the evolution of gestation, whereas patients with advanced stages of melanoma frequently deliver prematurely, by caesarean section, with lower neonatal weight, higher neonatal morbidity and mortality rates.

Breast cancer during pregnancy: results of maternal and perinatal outcomes in a single institution and systematic review of the literature

Abstract To compare the maternal and the perinatal variables of the patients with pregnancy associated breast cancer (PABC) and the pregnant patients without breast cancer (PNABC), we retrospectively included 13 PABC cases and 66.265 PNABC patients. The PABC patients presented a lower mean gestational age at their delivery and had higher induction of labour and prematurity rates. A diagnosis was performed before stage III in 77% of the cases. The overall survival was 90%; moreover, we collected 16 manuscripts when gathering data from 1581 patients with PABC. The mean follow-up time was 70 ± 8 months. The mean maternal age at diagnosis was 34 years old. Most of the patients were at their second trimester of pregnancy. The gestational age at delivery was 35 weeks. A mastectomy was the most frequently used surgical approach. PABC should be managed by a multidisciplinary team, ensuring there is a rigorous oncological treatment, with foetal well-being. IMPACT STATEMENT What is already known on this subject? The malignant breast tumours diagnosed during pregnancy, or 1 year after a delivery are increasing, there is evidence supporting the treatment during a pregnancy with maternal and foetal safety. A PABC should be managed by a multidisciplinary team in a referral centre, ensuring that there is a rigorous oncological treatment with foetal well-being. What do the results of this study add? Our results show that the PABC patients in our centre had a mean maternal age older than the PNABC women, as well as a higher percentage of the induction of labour and prematurity. 48 Cancer was usually diagnosed in early stages, and the most common type was ductal infiltrating, with positive hormonal receptors. For those patients continuing their pregnancies, a mastectomy plus a lymphadenectomy was the most frequent chemotherapy, and was usually administered in the third trimester of pregnancy. What are the implications of these findings for future clinical practice and/or further research? Moreover, the number of publications concerning PABC has grown, series are still scarce. We understand the limitations of the low number of the cases on our population, but this study is the first which compare the PABC with the PNABC patients, allowing to describe and compare the obstetrical and perinatal variables. Finally, we consider it is of a paramount importance to create an international database to register in a prospective way all of the cases of PABC to increase our knowledge in this field.

Reference ranges for the pulsatility index of the fetal aortic isthmus in singleton and twin pregnancies.

The purpose of this study was to estimate reference ranges for the pulsatility index (PI) of the fetal aortic isthmus in uncomplicated singleton and twin pregnancies during the second half of pregnancy.

Prenatal diagnosis of Type II single umbilical artery (persistent vitelline artery) in a normal fetus

Figure 1 (a) Schematic image showing contents of umbilical cord (UC) at 8 weeks’ gestation in a fetus with a normal trivascular umbilical cord. Initially, the UC is formed by the ductus omphaloentericus (DOE), which contains the yolk sac (YS) and four vitelline vessels (two arteries and two veins). The DOE also contains the body stalk (BS), which in turn contains the umbilical vesicle of the allantois (Al) and four umbilical vessels (two arteries and two veins). The BS is connected to the placenta and the DOE, and is enveloped by the spreading amnion. Until 12 weeks, numerous elements degenerate, namely, the DOE, Al, YS and its circulation system, and the right umbilical vein (RUV). Finally, the UC remains with its umbilical vessels (two arteries, one vein). (b) Clinical characteristics associated with the different types of single umbilical artery (SUA) suggested by Blackburn and Cooley2. AO, aorta; LUA, left umbilical artery; LUV, left umbilical vein; LVA, left vitelline artery; LVV, left vitelline vein; PRUV, persistent right umbilical vein; RUA, right umbilical artery; RVA, right vitelline artery; RVV, right vitelline vein; SMA, superior mesenteric artery; UA, umbilical artery; UV, umbilical vein; VA, vitelline artery; VV, vitelline vein. one umbilical artery is either obliterated or simply does not form, giving rise to single umbilical artery (SUA) syndrome1–3. Although several mechanisms have been proposed to explain the pathogenesis of SUA, in most cases it is due to secondary atresia or atrophy of one or both previously normal umbilical arteries1. Blackburn and Cooley2 suggested four plausible types of SUA (Figure 1). Type II SUA is the second most frequent and is thought to occur secondary to fusion of the two umbilical arteries. It is normally reported in malformed fetuses with sirenomelia, or after interruption in the development of both umbilical arteries accompanied by persistent vitelline artery, which compensates for this defect2,3. We report a favorable outcome after prenatal diagnosis of Type II SUA in a normal fetus. A 31-year-old primigravida was referred to our center at 22 weeks’ gestation after a routine ultrasound scan revealed SUA and abnormal abdominal vasculature without other malformations. Umbilical arteries could not be seen in their normal position adjacent to the bladder, and a large artery was observed continuing in an anterior direction towards the umbilical cord, inferior to the celiac trunk at the position of the superior mesenteric artery (SMA) with normal blood flow indices (Figure 2). The umbilical vein appeared normal and blood flow in the abdominal aorta, renal and femoral arteries was also normal. The

Fetal MRI as a complementary technique after prenatal diagnosis of persistent vitelline artery in an otherwise normal fetus.

Prenatal ultrasound is the standard for the diagnosis of fetal anomalies. However, fetal MRI has emerged as a valuable diagnosis tool to complete the study of fetal malformations. Type II single umbilical artery results from the absence of both umbilical arteries and persistence of the vitelline artery. It has been described only in fetuses with sirenomelia or caudal regression syndrome. We report a favorable outcome in a normal fetus in which prenatal ultrasound and MRI showed a single umbilical artery arising from the aorta. The etiology of such a finding and its possible consequences are discussed.J. Magn. Reson. Imaging 2013;38:951–954.