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Objectives Screening studies for trisomy 21 demonstrate that low maternal serum pregnancy-associated plasma protein-A (PAPP-A) at 11–13 weeks’ gestation is associated with stillbirth, intrauterine growth restriction (IUGR) and pre-eclampsia in chromosomally normal fetuses. However, the strength of these associations is too weak to justify screening for these placental insufficiency syndromes. Our objective was to evaluate placental size and uterine artery (UtA) Doppler imaging as second-stage screening tests for women with low PAPP-A. Methods We prospectively studied 90 normal singleton pregnancies with first-trimester PAPP-A ≤ 0.30 multiples of the median. Maternal serum α-fetoprotein (AFP) at 15–18 weeks’ gestation, and second-trimester placental size and UtA Doppler indices were assessed as predictors of pregnancy outcome. Results The risks of IUGR, preterm delivery before 32 weeks’ gestation and stillbirth were significantly associated with small placental size (relative risk (RR), 3.96; 95% CI, 2.21–5.98; RR, 3.96; 95% CI, 2.21–5.98; and RR, 6.44, 95% CI, 2.74–14.54, respectively) and elevated AFP (RR, 3.67; 95% CI, 1.78–7.71; RR, 2.48; 95% CI, 1.23–4.94; and RR, 5.14; 95% CI, 1.66–16.85, respectively), but not with abnormal UtA Doppler indices. The combination of elevated AFP and small placental size further increased the risk of IUGR (RR, 4.88; 95% CI, 2.88–5.31), delivery before 32 weeks’ gestation (RR, 4.25; 95% CI, 2.38–4.98) and stillbirth (RR, 7.44; 95% CI, 3.04–3.75). Conclusions Small placental size and elevated AFP, but not UtA Doppler indices, identify women with low PAPPA at high risk of IUGR, extreme preterm delivery and stillbirth. These additional screening tests may directly improve perinatal outcomes in women with low PAPP-A. Copyright  2009 ISUOG. Published by John Wiley & Sons, Ltd.

diagnosis. The registers provided information about the timing and method of diagnosis. Results: 37 cases of schizencephaly were identified in an estimated 2,568,556 live and stillbirths, giving an overall incidence of 1.48/100,000 births (95% confidence intervals 1.01–1.95/100,000 births). Seventeen of the 37 cases (46%, 95% Confidence Interval 30–62%) were identified antenatally. No affected fetus had abnormal chromosomes identified. There was a high proportion of younger mothers. The average age of mothers was 22.34 years (95% confidence interval 20.4–24.3). 22 of the mothers were aged 24 or less (59%: 95% confidence interval 44–75%). In England and Wales between 1998 and 2008 the average age of mothers of live births was 29.3 years, and 26% occurred to mothers aged 24 or less (P < 0.0001). Only three cases were identified before 21 weeks gestation. Additional anomalies associated with vascular disruption sequences were found in nine cases, one of which had gastroschisis and eight had septo-optic dysplasia or absent septum pellucidum. Conclusions: Schizencephaly occurs more frequently in younger mothers. It is often associated with septo-optic dysplasia, which also occurs more commonly in younger mothers, and the two conditions may share a common origin, arising as a result of vascular disruption affecting the tributaries of the circle of Willis that causes changes which only become apparent on ultrasound in the second half of pregnancy.