S. Gabrielli

Ultrasonographic criteria for the prenatal diagnosis of placental chorionicity in twin gestations

Thirty-two patients with uncomplicated twin pregnancies had ultrasonographic examinations for genetic amniocentesis, confirmation of twinning, or assessment of fetal growth. The dividing membranes between the fetuses were visualized, and the thickness of the membranes was measured. With a thickness of 2 mm used as a cutoff point, the accuracy in predicting monochorionic or dichorionic twinning was 82% and 95%, respectively. Prenatal assessment of these dividing membranes may be helpful in the management of twin gestations.

Transvaginal ultrasonographic detection of congenital anomalies in the first trimester

Transvaginal ultrasonography enables detailed visualization of the first-trimester pregnancy. Thirty-three structural anomalies have been diagnosed in the first trimester of pregnancy during a 2-year study period. An understanding of normal embryonic development is essential before attempting diagnosis in this gestational period.

Recurrent adverse pregnancy outcome and antiphospholipid antibodies

Antiphospholipid antibodies, which include lupus-like anticoagulant and anticardiolipin antibody, have been linked to a number of adverse pregnancy outcomes, although their exact pathogenic mechanisms remain poorly defined. The relative risk of complications such as intrauterine growth retardation, spontaneous abortions, and stillbirth in patients with antiphospholipid antibodies also remains undetermined. Heightened attention has been focused on the association, leading to investigations into the pathogenesis. Uncontrolled studies have also explored therapeutic regimens such as aspirin, steroids, and heparin, and clinical trials have used various treatment protocols. Although knowledge into the association of antiphospholipid antibodies and recurrent adverse pregnancy outcome is limited and continues to evolve, this association provides new insights into the disease and offers promise for pharmacologic prophylaxis. In this article, current concepts on pathogenesis, diagnosis, and therapy are reviewed and recommendations are made for clinical care of these patients.

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.

Accuracy of the umbilical arteries Doppler flow velocity waveforms in detecting adverse perinatal outcomes in a high-risk population

Objective. To define the accuracy of the umbilical artery Doppler flow velocity waveforms, according to different cut‐off values, in predicting adverse perinatal outcomes among fetuses at high risk of hypoxic complications.

Sonography of pregnancies with first-trimester bleeding and a small intrauterine gestational sac without a demonstrable embryo

This was a prospective observational cohort study to evaluate the outcome and prognostic criteria of pregnancies with first‐trimester bleeding and a gestational sac ≤16 mm without a demonstrable embryo.

Ultrasound of the fetal central nervous system.

Current ultrasound equipment allows the antenatal identification of many central nervous system anomalies from early gestation. In selected cases, special techniques (transvaginal sonography, three-dimensional ultrasound, colour Doppler) may enhance the diagnostic potential. Diagnostic accuracy, however, remains heavily dependent upon the expertise of the sonologist. Fetal ultrasound is effective in identifying neural tube defects, although alpha-fetoprotein screening seems to yield a greater sensitivity. The sensitivity in the diagnosis of central nervous system malformations other than neural tube defects remains unclear because of the ascertainment biases of the few large prospective studies that have been carried out so far. Magnetic resonance imaging may play a major role in the evaluation of cases with suboptimal ultrasound visualization, or when specific anomalies are suspected, such as intracranial haemorrhage or migrational disorders.

The prognostic role of uterine artery Doppler studies in patients with late-onset preeclampsia

OBJECTIVE To evaluate the usefulness of uterine artery Doppler in the prediction of outcome in patients with late-onset preeclampsia. STUDY DESIGN Patients with late-onset preeclampsia underwent Doppler interrogation of the uterine arteries. Patients with abnormal uterine artery Doppler were compared with those who had a normal uterine artery Doppler. RESULTS Ninety-nine patients were included in the study group. Abnormal uterine artery Doppler group presented significantly lower gestational age at admission (36.1 +/- 2.1 weeks vs 37.2 +/- 1.9 weeks; P < .005), lower gestational age at delivery (36.5 +/- 1.9 weeks vs 37.7 +/- 1.7 weeks; P < .005), lower birthweight (2429 +/- 590 g vs 3013 +/- 597 g; P < .0001), and a higher admission rate to neonatal intensive care unit (17/51 vs 6/48; odds ratio, 3.5; 95% confidence interval, 1.2-9.5). No significant difference in the occurrence of maternal complications (10/51 vs 6/48; odds ratio, 1.7; 95% confidence interval, 0.5-4.9) was registered. CONCLUSION Women with late-onset preeclampsia show a higher risk of perinatal complications if uterine resistance is increased although maternal outcome does not seem to be related to Doppler findings.

Dating through Pregnancy: A Measure of Growing Up

The accurate estimation of gestational age is an essential part of pregnancy management, since the consequences of erroneous dating carry increased risks of perinatal morbidity and mortality. Ultrasonography offers a unique opportunity to objectively measure quantitative changes in growth increments of various fetal structures, as well as qualitative changes occurring near term which are indicative of fetal maturity. Therefore, dating through pregnancy is possible by the use of various parameters such as the crown-rump length, the trunk circumference, and the biparietal diameter in the first trimester; the biparietal diameter, the cerebellum, orbital distance, clavicular length, lengths of the long bones of the upper and lower extremities, and the foot length in the second and third trimesters; and the indices of maturity in the late third trimester such as colonic grading and epiphyseal ossification centers of the long bones of the upper and lower extremities. Using a combination of fetal biometry and maturity indices permit dating through pregnancy as a measure of growing up.

Bilateral cleft lip and palate without premaxillary protrusion is associated with lethal aneuploidies.

To investigate the clinical implications of two categories of fetal bilateral cleft lip and palate (BCLP): with premaxillary protrusion and with a flattened profile.