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Fetal Diagnosis and Therapy

Mateusz Zamłyński, Jacek Zamłyński, Ewa Horzelska, Iwona Maruniak-Chudek, Rafał Bablok, Dariusz Szukiewicz, Izabela Herman-Sucharska, Ewa Kluczewska, Anita Olejek
OBJECTIVE: This study presented outcomes of classical hysterotomy with modified antiprostaglandin therapy for intrauterine repair of foetal myelomeningocele (fMMC) performed in a single perinatal centre. STUDY DESIGN: Forty-nine pregnant women diagnosed with fMMC underwent classic hysterotomy with anti-prostaglandin management, complete amniotic fluid replacement and high dose indomethacin application. RESULTS: The average gestational age (GA) at delivery was 34...
May 14, 2019: Fetal Diagnosis and Therapy
Petr Janku, Marian Kacerovsky, Barbora Zednikova, Ctirad Andrys, Martina Kolackova, Marcela Drahosova, Lenka Pliskova, Helena Zemlickova, Romana Gerychova, Ondrej Simetka, Petr Matlak, Bo Jacobsson, Ivana Musilova
PROBLEM: To determine the changes of pentraxin 3 (PTX3) level in noninvasively obtained cervical fluid samples from women with preterm prelabor rupture of membranes (PPROM) based on the presence of microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation (IAI), and intra-amniotic infection (the presence of both MIAC and IAI). METHODS OF STUDY: A total of 160 women with PPROM were included. Cervical fluid samples were obtained using a Dacron polyester swab and amniotic fluid samples were obtained by transabdominal amniocentesis...
May 9, 2019: Fetal Diagnosis and Therapy
Manouk L E Hendrix, Judith A P Bons, Roy R G Snellings, Otto Bekers, Sander M J van Kuijk, Marc E A Spaanderman, Salwan Al-Nasiry
BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the value of adding fetal growth velocity and first trimester maternal biomarkers to baseline screening, for the prediction of small-for-gestational age (SGA) and adverse neonatal outcomes. METHOD: A retrospective cohort study was conducted of singleton pregnancies in the Maastricht University Medical Centre between 2012 and 2016. The biomarkers PAPP-A, β-hCG, PlGF, and sFlt-1 were measured at 11-13 weeks of gestational age (GA) and two fetal growth scans were performed (18-22 and 30-34 weeks of GA)...
May 8, 2019: Fetal Diagnosis and Therapy
Sarah A Hilton, Maggie M Hodges, Lindel C Dewberry, Michael Handler, Henry L Galan, Michael V Zaretsky, Nicholas Behrendt, Ahmed I Marwan, Kenneth W Liechty
BACKGROUND: In utero repair has become an accepted therapy to decrease the rate of ventriculoperitoneal shunting and improve neurologic function in select cases of myelomeningocele. The Management of Myelomeningocele Study (MOMS) trial excluded patients with a BMI >35 due to concerns for increased maternal complications and preterm delivery, limiting the population that may benefit from this intervention. OBJECTIVES: The aim of this study was to evaluate outcomes associated with extending the maternal BMI criteria to 40 in open fetal repair of myelomeningocele...
May 2, 2019: Fetal Diagnosis and Therapy
Sonia Soo Yee Teoh, Yao Wang, Ying Li, Shalem Yiner-Lee Leemaqz, Gus A Dekker, Claire T Roberts, Guiying Nie
OBJECTIVE: The aim of this study was to investigate the potential utility of serum HtrA1 and HtrA3, serine proteases that are highly expressed in the developing placenta, at 15 and 20 weeks of gestation for predicting later development of adverse pregnancy outcomes of preeclampsia (PE), gestational hypertension (GHT), preterm birth (PTB), and small for gestational age (SGA) birth. METHODS: This is a nested case control study of 665 samples (330 controls, 335 cases) from the Adelaide SCOPE cohort...
April 23, 2019: Fetal Diagnosis and Therapy
José Morales-Roselló, Antonio José Cañada Martínez, Elisa Scarinci, Alfredo Perales Marín
OBJECTIVE: The aim of this work was to compare the accuracy of the cerebroplacental ratio (CPR), Intergrowth 21st standards (IG21), customized growth (CG), and local population references (LPR) in the prediction of intrapartum fetal compromise (IFC). METHODS: This was a prospective study of 714 fetuses that underwent an ultrasound examination at 34-41 weeks and were delivered within a 2-week interval. The CPR was converted into multiples of the median and the estimated fetal weight (EFW) transformed into CG, IG21, and LPR centiles...
April 23, 2019: Fetal Diagnosis and Therapy
Carmen Mesas Burgos, Henrik Ehrén, Peter Conner, Björn Frenckner
BACKGROUND: The etiology of congenital diaphragmatic hernia (CDH) remains poorly understood. We hypothesize that environmental factors play an important role in the development of CDH. AIM: The objective of this study was to investigate associated maternal risk factors in pregnancies with CDH. MATERIAL AND METHODS: The study was a nationwide, population-based prospective case-control study consisting of a cohort of newborn children entered into the records of pregnant women receiving antenatal care in Sweden, registered in the Medical Birth Registry during the period from January 1, 1982 to December 31, 2015...
April 12, 2019: Fetal Diagnosis and Therapy
Stephen P Emery, Stephanie Greene, Geoffrey Murdoch, Clayton A Wiley
INTRODUCTION: Documentation of histologic findings associated with congenital hydrocephalus in the fetal lamb model is a critical step in evaluating the efficacy of ventriculoamniotic shunting in the human fetus. METHODS: Four fetal sheep had hydrocephalus induced at approximately 95 days' gestation. Two co-twins remained as controls. The ewes were euthanized at term. The lamb brains were fixed in formalin, paraffin-embedded, stained, and analyzed for markers of neuropathology...
April 11, 2019: Fetal Diagnosis and Therapy
Susan C Shelmerdine, Kimberly L Chung, John C Hutchinson, Claire Elliott, Neil J Sebire, Owen J Arthurs
INTRODUCTION: Organ volumes at postmortem magnetic resonance imaging (PMMR) should reflect autopsy organ weights, and thus brain:liver volume ratios on imaging could be a surrogate for weight volume ratios at autopsy to indicate fetal growth restriction (FGR). This study aims to determine whether imaging-based organ volume ratios can replace autopsy organ weight ratios. Materials and Meth ods: An unselected cohort of perinatal deaths underwent PMMR prior to autopsy. Semiautomated brain and liver volumes were compared to autopsy organ weights and ratios...
April 10, 2019: Fetal Diagnosis and Therapy
Melissa Vanover, Christopher Pivetti, Laura Galganski, Priyadarsini Kumar, Lee Lankford, Douglas Rowland, Zachary Paxton, Bailey Deal, Aijun Wang, Diana Farmer
INTRODUCTION: The surgically induced fetal lamb model is the most commonly used large animal model of myelomeningocele (MMC) but is subject to variation due to surgical technique during defect creation. MATERIAL AND METHODS: Thirty-one fetal lambs underwent creation of the MMC defect, followed by defect repair with either an extracellular matrix (ECM) patch (n = 10) or ECM seeded with placental mesenchymal stromal cells (n = 21). Postnatal hindlimb function was assessed using the Sheep Locomotor Rating (SLR) scale...
April 10, 2019: Fetal Diagnosis and Therapy
Ibrahim Halil Kalelioglu, Selen Gursoy Erzincan, Emircan Erturk, Recep Has
OBJECTIVES: We aimed to determine the incidence of the absence of the (last) 12th ribs in a population in a setting of detailed 2nd-trimester sonography using three-dimensional (3D) ultrasound and to assess whether or not this may be related to chromosomal aneuploidies. METHODS: Prospectively, we counted fetal ribs for the absence of the (last) 12th ribs in singleton pregnancies of women who presented to our clinic for detailed 2nd-trimester sonography. The assessment was carried out using 3D ultrasound...
April 10, 2019: Fetal Diagnosis and Therapy
Kathleen Sondern, Kiana Kreitz, Kerstin Hammer, Mareike Möllers, Kathrin Oelmeier de Murcia, Helen Ann Köster, Janina Braun, Walter Klockenbusch, Ralf Schmitz
BACKGROUND: The examination of the fetal ear is a promising but still challenging approach in prenatal diagnosis. OBJECTIVES: This study investigated a novel ear length/width ratio based on anatomical landmarks. Additionally, we compared different 3D ultrasound surface rendering modes regarding their potential to depict detailed structures of the outer ear. METHOD: We measured both the ear length and width of 118 fetal ears from 20 to 40 weeks of gestation to establish a length/width ratio...
March 29, 2019: Fetal Diagnosis and Therapy
Elizabeth M O'Hare, Angie C Jelin, Jena L Miller, Rodrigo Ruano, Meredith A Atkinson, Ahmet A Baschat, Eric B Jelin
Anhydramnios caused by early anuria is thought to be universally fatal due to pulmonary hypoplasia. Bilateral renal agenesis and early fetal renal failure leading to anhydramnios constitute early pregnancy renal anhydramnios (EPRA). There have been successful reports of amnioinfusions to promote lung growth in the setting of EPRA. Some of these successfully treated EPRA fetuses have survived the neonatal period, undergone successful dialysis, and subsequently received a kidney transplant. Conversely, there are no reports of untreated EPRA survivors...
March 21, 2019: Fetal Diagnosis and Therapy
Christoph Wohlmuth, Eric Bergh, Cynthia Bell, Anthony Johnson, Kenneth J Moise, Martin J C van Gemert, Jeroen P H M van den Wijngaard, Iris Wohlmuth-Wieser, Ian Averiss, Helena M Gardiner
BACKGROUND: Sacrococcygeal teratomas (SCT) are often highly vascularized and may result in high-output cardiac failure, polyhydramnios, fetal hydrops, and demise. Delivery is guided by the SCT to fetus volume ratio (SCTratio), SCT growth rate, and cardiac output indexed for weight (CCOi). METHODS: We compared measurements and outcome in 12 consecutive fetuses referred with SCT. Adverse outcomes were: fetal surgery, delivery < 32 gestational weeks or neonatal demise...
March 20, 2019: Fetal Diagnosis and Therapy
Ivana Musilova, Richard Spacek, Jaroslav Stranik, Bo Jacobsson, Marian Kacerovsky
OBJECTIVES: To determine the pulsatility index (PI) in the fetal splenic vein, the main portal vein, the left portal vein, and the ductus venosus with respect to the presence or absence of intra-amniotic inflammation (IAI) in preterm prelabor rupture of membranes (PPROM). METHOD: Women with singleton pregnancies and PPROM, ranging in gestational age from 22+0 to 36+6 weeks, were included. Amniotic fluid samples were obtained by transabdominal amniocentesis and the amniotic fluid level of interleukin-6 (IL-6) was assessed by a point-of-care test...
March 19, 2019: Fetal Diagnosis and Therapy
Antonio Macedo, Sérgio Cavalheiro, Antonio Moron, Tássia Lobountchenko, Felipe Silveira Dini, Sergio Leite Ottoni, Gilmar Garrone, Riberto Ligori, Marcela Leal da Cruz
INTRODUCTION: After the successful results of in utero myelomeningocele (MMC) repair presented by the Management of Myelomeningocele Study, the concept of fetal surgery was introduced in our institution in 2011. Since then, we have been able to follow prospectively a group of patients with attention to urological care. In the present study, we were interested in estimating urinary and fecal continence in this new subset of patients. MATERIAL AND METHODS: We selected from our database patients aged 5 years or older for evaluation of urinary and fecal continence...
March 18, 2019: Fetal Diagnosis and Therapy
Michael R Mallmann, Heiko Reutter, Ingo Gottschalk, Annegret Geipel, Christoph Berg, Ulrich Gembruch
BACKGROUND: Enterolithiasis is a sonographic sign defined by hyperechogenic foci within the - often distended - fetal bowel. OBJECTIVES: We report on a series of 20 cases with enterolithiasis diagnosed prenatally and illustrate the spectrum of associated malformations. METHOD: This was a retrospective study involving 20 fetuses with enterolithiasis at two large tertiary referral centers in Germany over a 17-year period (2000-2017). RESULTS: Median diagnosis was made with ultrasound at 18+2 weeks of gestation (IQR25,75: 14+5, 26+5)...
March 15, 2019: Fetal Diagnosis and Therapy
Noriyuki Nakamura, Katsusuke Ozawa, Seiji Wada, Kentaro Matsuoka, Takako Yoshioka, Rika Sugibayashi, Haruhiko Sago
OBJECTIVE: To examine the incidence of umbilical cord ulcer (UCU) that causes intrauterine fetal death (IUFD) in fetal duodenal or jejunoileal atresia and the association between UCU and bile acid concentrations in amniotic fluid. METHODS: Perinatal outcomes were evaluated in cases of fetal intestinal atresia between 2003 and 2017. A pathological examination of the umbilical cord was performed, and bile acid concentrations in the amniotic fluid were measured. RESULTS: Among the 46 cases included in this study, there were 27 with duodenal atresia and 19 with jejunoileal atresia...
March 14, 2019: Fetal Diagnosis and Therapy
Avery C Rossidis, Alessia Angelin, Kendall M Lawrence, Heron D Baumgarten, Aimee G Kim, Ali Y Mejaddam, Barbara E Coons, Heather A Hartman, Grace Hwang, Stylianos Monos, William H Peranteau, Marcus G Davey, Deborah Murdock, Douglas C Wallace, Alan W Flake
BACKGROUND: In an effort to mitigate the major morbidities and mortality associated with extreme prematurity, we have developed an EXTrauterine Environment for Neonatal Development (EXTEND) designed to provide physiologic support of extremely premature infants. OBJECTIVES: We have previously shown that long-term, physiologic support of premature fetal lambs is possible with EXTEND, but in this study, we sought to demonstrate bioenergetic equipoise at the tissue level...
March 12, 2019: Fetal Diagnosis and Therapy
Ka Wang Cheung, Lee Na Tan, Mimi Tin Yan Seto, Shruti Moholkar, Geraldine Masson, Mark D Kilby
BACKGROUND: Fetal subdural haematoma (SDH) is associated with poor prognosis. OBJECTIVE: The conflicting evidence from the literature presents a challenge in prenatal counselling. We present a case study and systematic review of the literature for the management and outcome of fetal SDH. METHODS: Systematic search of electronic database. RESULTS: A total 45 cases were extracted from 39 papers. Prenatal ultrasonographic features were intracranial echogenicity (42%), lateral ventriculomegaly (38%), presence of an intracranial mass (31%), macrocephaly (24%), midline deviation of cerebral falx (20%), and intracranial fluid collection (11%)...
March 12, 2019: Fetal Diagnosis and Therapy
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