Umberto Bianchi

Width of the fetal lateral ventricular atrium between 10 and 12 mm: a simple variation of the norm?

The prognosis of borderline forms of anomalies that can be detected by ultrasound is one of the most challenging issues in prenatal diagnosis. The aim of this study was to determine the prognosis for fetuses presenting with isolated mild ventriculomegaly (MVM).

Effect of Betamethasone on Computerized Cardiotocographic Parameters in Preterm Growth-Restricted Fetuses with and without Cerebral Vasodilation

Objective: To verify the effects of maternal corticosteroid administration on fetal behavior and heart rate variation using computerized cardiotocography (cCTG) in a selected group of growth retarded fetuses. Study Design: Fifty singleton pregnancies complicated by fetal growth restriction were enrolled in the study before 34 weeks of gestation. All of them received two intramuscular injections of 12 mg of betamethasone 24 h apart. Fetal heart rate was recorded by cCTG before the first injection, and every 24 h for the 3 days following the end of the treatment. After Doppler evaluation of cerebral circulation, fetuses were divided into a group with and a group without signs of cerebral vasodilation. Basal heart rate, short- and long-term variation, percentage of time spent in high variability, fetal movements and percentage of small accelerations were evaluated. Results: Basalfetal heart rate did not show significant changes. Short-term variation and percentage of time spent in high variability significantly decreased in fetuses with but not in fetuses without vasodilation. Long-term variation and fetal movements significantly decreased in both groups. Conclusions: Maternal administration of betamethasone in growth-retarded fetuses with cerebral vasodilation is associated with significant but transitory modifications of fetal heart rate variation.

‘Dual Positivity’ for Neural Tube Defects and Down Syndrome at Maternal Serum Screening: Gestational Outcome

Objective: To evaluate the gestational outcome of pregnancies screen-positive for both neural tube defects (NTD) and Down syndrome (DS) (‘dual positivity’). Methods: Among 10,667 mid-trimester women screened for DS and NTD with α-fetoprotein (AFP), unconjugated estriol (uE3), and human chorionic gonadotropin (hCG), delivered up to July 1996, we have selected cases with both an unexplained AFP value ≥2.5 multiples of median (MoM) and a DS risk ≥1:250. All these pregnant women were managed with amniocentesis and/or CVS, ultrasound scans, and Doppler velocimetry. We have collected all data about the gestations with ‘dual positivity’ and no obvious explanation for these findings (cases with fetal malformations related to raised AFP). Results: Twelve women (1.1:1,000) showed unexplained ‘dual positivity’. Abnormal karyotypes were found in 3 fetuses, and pregnancies were terminated: there were 2 triploidies with partial hydatiform mola, and 1 DS. In 9 cases the fetal karyotype was normal, but a confined placental trisomy 16 was found in 4. Of the 9 continuing gestations, 8 displayed fetal growth retardation (FGR). One gestation ended with fetal death at 27 weeks. All 9 fetuses were morphologically normal, and 8 were small for gestational age. Conclusions: ‘Dual positivity’ at NTD/DS screening may anticipate pregnancy complications. The finding of trisomy 16 confined to the placenta and FGR in 4 cases suggests that at least some fetuses with growth restriction may suffer from a distinct placental disease. Maternal serum screening may have implications different from DS and NTD, as demonstrated by the 2 cases with triploidy and incomplete hydatiform mola, the 4 cases with placental trisomy 16, and the 4 cases of FGR of the 5 fetuses without chromosome abnormalities. As the pathologic outcome of these pregnancies is more important than the mere serum screening results, we feel that these cases need a strict work-up, including CVS, amniocentesis and ultrasound studies to better address the obstetrical management.

Prenatal diagnosis of ventriculocoronary arterial communications combined with pulmonary atresia

We report our findings in a case of pulmonary atresia with intact ventricular septum and ventriculocoronary artery fistula in which power Doppler was used to make the diagnosis. A 30-year-old primiparous woman with no significant medical history presented at the fetal echocardiography service of our prenatal diagnosis center at 21 + 2 weeks of gestation after a routine sonographic examination had demonstrated a slightly enlarged fetal left cardiac ventricle. Sonography was performed using a Siemens Elegra ultrasound machine (Siemens, Erlangen, Germany) with a 3,5C40H transabdominal transducer. This showed fetal biometry to be consistent with gestational age and the extracardiac fetal morphology was normal. Twodimensional imaging of the four-chamber view confirmed that the left ventricle was slightly enlarged. The left outflow tract and the aortic arch were normal. Color Doppler examination demonstrated normal blood flow to the ventricles in diastole and absence of tricuspid valve regurgitation. The right ventricle was slightly hypoplastic with a hypertrophic myocardium and reduced movement. The main pulmonary artery diameter was reduced, the pulmonary arteries were perfused by retrograde flow from the ductus arteriosus and no flow through the pulmonary valve was detected. Power Doppler identified the presence of an anomalous vessel on the external wall of the heart which was confirmed by color Doppler and which demonstrated turbulent flow from the apex along the external wall of the right ventricle (Figures 1 and 2). Pulsed Doppler examination of this vessel demonstrated the presence of bidirectional flow: antegrade flow with a peak velocity of 150 cm/s and retrograde flow with a peak velocity of 110 cm/s (Figure 3). A diagnosis of pulmonary atresia with intact ventricular septum and abnormal communication between the right ventricle and left coronary artery was made. Fetal karyotyping following amniocentesis was normal and excluded the presence of the 22q11.2 deletion. The patient was counseled about the possibility of Figure 1 Power Doppler ultrasound image showing the fistula surrounding the right ventricle (RV) and connecting with the aorta (arrow).

Prophylactic oral nifedipine to reduce preterm delivery: a randomized controlled trial in women at high risk.

To establish the efficacy of prophylactic nifedipine vs. placebo in reducing spontaneous preterm delivery in asymptomatic women at high risk for preterm delivery.

OC200: Uterine artery velocimetry as a screening test in patients with previous preeclampsia

Background: Uterine artery (UA) Doppler measurements are considered to be an index of placental development and trophoblastic invasion of the maternal vascular bed. The purpose of this presentation is to summarise the available published data on UA Doppler screening for pre-eclampsia/IUGR and highlight new data and areas of research in this field. Overview of current literature: The published evidence to date suggests that UA Doppler is the best available screening tool for the prediction of pre-eclampsia and IUGR. The sensitivity for severe preeclampsia requiring pre-term delivery is better than that for pre-eclampsia at term or IUGR. However, the evidence for any effective therapeutic intervention for preventing the onset of these pregnancy complications is far from convincing. New areas of research: Data from an ongoing clinical study on first trimester UA Doppler demonstrates that there is a significant difference in birthweight between fetuses with absent and bilateral diastolic notches (p < 0.001). The role of additional biochemical markers to improve sensitivity of first trimester UA Doppler screening will also be discussed. New data on the relationship of first trimester UA Doppler indices to invitro markers of trophoblast function and development will also be presented.