Włoch A

Doppler study of the embryonic heart in normal pregnant women

Objective. To describe normal fetal cardiac and hemodynamic development in normal early first trimester pregnancies. Materials and methods. Eighty-eight women with singleton, uncomplicated pregnancies were prospectively studied with transvaginal ultrasound, pulsed and color Doppler. Heart diameter, heart rate, and inflow and outflow waveforms with valve signals were documented. The proportion of the cardiac cycle of isovolumetric relaxation time (IRT%) and isovolumetric contraction time (ICT%) as well as Tei index were calculated. Results. Ninety-one percent of studies were successful. Heart diameter and the fetal heart rate showed a positive correlation with increasing gestational age: R = 0.80 (p < 0.000001), R = 0.76 (p < 0.000001), respectively. Mean heart diameter at 6 weeks was 1.28 ± 0.26 mm and mean fetal heart rate was 117 ± 6 bpm compared to 3.88 ± 0.54 mm and 171 ± 6 bpm at 10 weeks. The inflow waveform was monophasic (atrial contraction) in all cases from 6 to 9 weeks. Eight pregnancies (9%) miscarried between 6 and 12 weeks of gestation and the heart exams were characterized by increased IRT% compared with the survivors. In survivors, IRT% decreased between 7 and 8 weeks, from 32.9 ± 10.7% to 20.8 ± 5.7% (p < 0.0001). ICT% decreased from 18.6 ± 4.4% of the cardiac cycle at 8 weeks to 12.6 ± 4.4% at 9 weeks (p < 0.0008) (after heart development period). Conclusions. Doppler examination of the fetal cardiac function is possible after 5 weeks of gestation. After 8 weeks of gestation, the fetal heart is morphologically mature but has not yet achieved effective myocardial compliance. The embryonic human heart is dependent on the atrial contraction for ventricular filling throughout the period of cardiac development. Non-survivors manifest myocardial dysfunction.

The evolution of fetal presentation during pregnancy: a retrospective, descriptive cross-sectional study

We investigated changes in the frequencies of four primary types of singleton fetal lie/presentation for each gestational week from 18 to 39 weeks in a retrospective, cross‐sectional study which analyzed ultrasound examination records of fetal positions, in the outpatient prenatal diagnosis clinics in two cities in Poland. We calculated the prevalence and 95% confidence intervals for each type of lie/presentation. We then identified the gestational age after which no statistically significant changes in terms of prevalence were observed, by comparing the results at each week with the prevalence of cephalic presentation at 39+0 weeks, used as reference. A total of 18 019 ultrasound examinations were used. From 22 to 36 weeks of gestation, the prevalence of cephalic presentation increased from 47% (45–50%) to 94% (91–96%), before and after which times plateaus were noted. Spontaneous change from breech to cephalic is unlikely to occur after 36 weeks of gestation.

Human embryonic cardiovascular function

This review presents an overview of descriptive knowledge on human embryonic cardiovascular physiology mostly based on noninvasive assessment by Doppler ultrasonography. Our objective was to identify and analyze published studies on embryonic cardiovascular function, and summarize available knowledge in this field.

Atrial dominance in the human embryonic heart: a study of cardiac function at 6-10 weeks of gestation.

To investigate the difference in forces developed by atrial and ventricular myocardium during contraction in human embryos using a novel method.

Frontomaxillary facial angle measurement in screening for trisomy 18 at 11 + 0 to 13 + 6 weeks of pregnancy: a double-centre study.

Objective. The aim of this study was to evaluate the effectiveness of prenatal screening for trisomy 18 with the use of the frontomaxillary facial angle (FMF angle) measurement. Material and Methods. The study involved 1751 singleton pregnancies at 11–13 + 6 weeks, examined between 2007 and 2011. Serum PAPP-A and free beta-hCG levels were assessed, and crown-rump length, nuchal translucency, and FMF angle were measured in all patients. 1350 fetuses with known follow-up were included in the final analysis. Results. Highly significant (P < 0.01) negative correlation between the CRL and the FMF angle was found. There were 30 fetuses with trisomy 18. FMF angle was highly significantly larger (P < 0.0001) in fetuses with trisomy 18 as compared to chromosomally normal fetuses. Two models of first trimester screening were compared: Model 1 based on maternal age, NT, and first trimester biochemistry test (DR 80–85% and FPR 0.3–0.6%), and Model 2 = Model 1 + FMF angle measurement (DR 87.3–93.3% and FPR 0.8–1.3%). Conclusions. The use of FMF angle measurement increases the effectiveness of the screening for trisomy 18. Introduction of the FMF angle as an independent marker for fetal trisomy 18 risk requires further prospective research in large populations.

A Retrospective Study on the Risk of Respiratory Distress Syndrome in Singleton Pregnancies with Preterm Premature Rupture of Membranes between 24

Aim This study aimed to investigate the cause of respiratory distress syndrome (RDS) in neonates from singleton pregnancies with preterm premature rupture of membranes (pPROM) between 24+0 and 36+6 weeks by using regression analysis for various factors. Methods In 175 singleton pregnancies with pPROM, 95 cases of RDS (54,29%) were diagnosed. In all cases the following information was collected: latency period of PROM, gestational age at birth, Umbilical Artery Pulsatility Index (UA PI), Middle Cerebral Artery Pulsatility Index (MCA PI), fetal distress, antenatal steroids use, delivery type, pregnancy hypertension disease, gestational glucose intolerance or diabetes, neonatal laboratory parameters, gender, weight, Apgar score, and other neonatal complications. Logistic regression analysis was used to investigate the effect of variables on RDS. Results The results of logistic regression analysis showed that the following variables are closely correlated with RDS: female gender (OR=0.52; 95%CI:0.28-0,97), antenatal steroids use (OR=0,46; 95%CI:0,34-0,64), abnormal UA PI and MCA PI (OR=2.96; 95%CI:1,43-6,12) (OR=2.05; 95%CI:1,07-3,95), fetal distress (OR=2.33; 95%CI:1,16-4,71), maternal HGB (OR=0.69; 95%CI:0,5-0,96), and neonatal RBC, HGB (OR=0.32; 95%CI:0,19-0,55) (OR=0.75; 95%CI:0,65-0,88). Conclusions The main RDS risk factors in premature neonates are gender, abnormal fetoplacental circulation, and fetal distress. The laboratory parameters such as lower RBC and HGB count are observed in infants with RDS.

P05.25: A cardiovascular profile score assessment of cardiac dysfunction in the recipient and donor twins in severe twin–twin transfusion syndrome

our centre, at between 26 to 33 weeks of gestation in order to screen for subtle fetal cerebral lesions. Gestational age was established according to crown-rump length. Fetal cerebral maturation was characterized according to gyration for gestational age in both twins. One donor presented a delay in fetal cerebral maturation at 28 weeks of gestation. This fetus had growth retardation < 3th percentile. Delayed gyration consisted of a 2 week-delay as compared to that of its co-twin. Neurological development was normal in both twins at 3, 6 and 12 months of age. In conclusion, delay in fetal brain maturation may occur in TTTS even in cases with two survivors and a normal outcome. This should be accounted for in the follow-up of these cases.

OP05.09: Preliminary experience in Poland with fetoscopic laser surgery for severe TTTS

Objective: To compare the transfer of technetium-99m labelled red blood cells (99mTc RBCs) in monochorionic (MC) placentas, MC placentas after laser coagulation of the vascular anastomoses for TTTS and fused dichorionic (DC) placentas. Methods: Placental perfusion study with 99mTc O Rh – RBCs in 5 MC, 5 lasered MC and 5 fused DC placentas. The arteries of twin 1 were injected with 20–30.10 × 9 99mTc RBCs diluted in 100 mL NaCl, whereas the vessels of twin 2 were rinsed with 200 mL NaCl. The % of transferred 99mTc RBCs was calculated by dividing the radioactivity measured in the rinsing solution of twin 2 by the initial radioactivity injected in twin 1. Afterwards, each placenta was injected with dyed barium sulphate to document the angioarchitecture. Results: GA at birth was similar in the 3 groups. None of the lasered MC and fused DC placentas had visible anastomoses, whereas all 5 MC placentas had visible anastomoses-1 had only small arteriovenous (AV)-venoarterial anastomoses (VA) without an arterioarterial (AA) anastomosis, 4 had an AA with AV/VA. The % of transferred 99mTc RBCs in lasered MC placentas (0, range: 0–000012) was similar to fused DC placentas (0, range: 0–001760) (NS), but significantly lower than in MC placentas (8.5, range: 1–66) (p < 0.01). In MC placentas, the larger the AA, the higher the % of transferred 99mTc RBCs. Conclusion: In MC placentas successfully separated by laser coagulation of the vascular anastomoses, the transfer of 99mTc RBCs was not significant and similar to fused DC twin placentas. Therefore, laser seems to functionally separate the 2 fetal circulations.

P05.02: National database for fetal cardiac anomalies in 2004

Objectives: To determine if the Nuchal Index (NIx) is increased in euploid fetuses diagnosed with an isolated structural congenital heart defect (CHD) on fetal echocardiogram. Methods: A prospective case-control study was conducted from March 2002 to July 2003. All patients between 18 and 24 weeks’ gestation referred for fetal echocardiography were approached for participation. Patients were excluded if other major anomalies or an abnormal karyotype were present. The NIx was calculated as the mean nuchal thickness/mean biparietal diameter ×100. Fetal cardiac axis was calculated from hard copy images in a blinded fashion. Analysis was by standard descriptive tests, 2-tailed t-test, receiver operating characteristic (ROC) curve, univariate analysis and discriminant analysis. Cases were classified as normal or abnormal as per the co-authors diagnosis at the time of the fetal echocardiogram. Results: Of the 607 echocardiograms performed, 314 were eligible. Two hundred and seven (22 abnormals and 185 normals) were recruited for a capture rate of 65.9%. The mean NIx in the abnormal and normal group was 9.3 and 7.8 respectively. This was statistically significant (p = 0.003). Using a cut-off of 10.4 at a 5% false positive rate, the sensitivity was 29% with an ROC of 0.699 [95%CI 0.582, 0.816]. Eleven of the 22 abnormal hearts and 7/185 normals had an abnormal cardiac axis. (OR 0.04 [95%CI 0.01, 0.12, p < 0.00001]). Although NIx and Nth were different between the study groups, discriminant analysis was unable to identify an adequate cut-off to allow adequate prediction of CHD. Conclusions: The NIx and CA were significantly different in fetuses with CHD in a high-risk population. However, an appropriate cutoff value could not be found in our study. Further studies in a low-risk population are warranted.

P01.19: Prenatal diagnosis of Down's syndrome in II and III trimester of pregnancy using ultrasound and echocardiography examination

Objective: To determine whether isolated choroid plexus cysts are a risk factor for trisomy 18 Methods: The cases with isolated choroid plexus cyst(s) were retrieved from our database from January 2001 to December 2004. Detailed ultrasonographic examination, maternal serum screening or genetic karyotyping was provided at the discretion of obstetricians who care for the pregnant women. All women were followed up through delivery. A retrospective chart review of the prenatal sonograms in the cases of trisomy 18 during the same period was also conducted. Results: One hundred fifty-six women had fetuses with isolated choroid plexus cyst(s). All fetuses with isolated choroid plexus cyst(s) either the normal karyotypes or the normal postnatal pediatric examination. There are 8 fetuses with trisomy 18 during the same period. Thirty-three percent of fetuses with trisomy 18 had choroid plexus cyst(s). All fetuses with trisomy 18 had structural anomalies. Conclusion: Isolated choroid plexus cyst was not associated with trisomy 18 in this study. All fetuses with trisomy 18 had structural anomalies which are obvious in antenatal scanning. These results indicate that the karyotyping of fetuses with isolated choroid plexus cyst(s) is not warranted.