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To characterize aspects of the repair process by evaluating the tissue collagen density, metalloproteinases and tissue inhibitor of matrix metalloproteinases in the fetal membranes following open fetal surgery for myelomeningocele (MMC).Experimental.Two Brazilian hospitals in 2013-2014.30 fetal membranes collected after elective cesarean deliveries, in patients who underwent open fetal surgery for MMC intrauterine repair.Regions within and surrounding the scar area and regions distant from the surgical site were evaluated for collagen concentration and expression of MMP-1, MMP-9, TIMP-1 and TIMP-2.Collagen was increased in regions of scar formation (14.4 ± 2.7%) as compared to unaffected regions (8.0 ± 1.9%) (Reparative activity of the fetal membrane after open fetal surgery involves up-regulation of collagen production and differential involvement of MMPs and TIMPs.

Objective In utero fetal surgery to correct incomplete closure of the spinal cord lessens the extent of permanent damage but is associated with preterm prelabour rupture of membranes (PPROM). We determined whether compounds in amniotic fluid collected at the time of surgery predicted subsequent development of PPROM. Design Prospective study. Setting Hospitals in Sao Paulo, Brazil. Population Twenty-four consecutive pregnant women at 24-26 weeks of gestation seen between February and October 2017 with a singleton pregnancy underwent in utero surgery to correct an open spinal defect in their fetus. Methods Amniotic fluid was tested for lactic acid, matrix metalloproteinase 2 (MMP-2), MMP-8, MMP-9 and interleukin-6 (IL-6) by enzyme-linked immunosorbent assay. Clinical data were collected after completion of all laboratory studies. Main outcome measure Amniotic fluid concentration of compounds in women with or without PPROM. Results Preterm prelabour rupture of membranes occurred in seven (29.2%) women. There were no differences in maternal age, gravidity, parity, race, history of caesarean sections or fetal gender between women with or without PPROM. Length of surgery, days of wound healing and length of hospital stay were also indistinguishable. The median concentrations of MMP-8 (1.7 versus 0.6 ng/ml; P = 0.0041) and lactic acid (7.1 versus 5.9 mm; P = 0.0181) were higher in women with PPROM. The amniotic fluid MMP-8 level was also negatively correlated with gestational age at delivery (Spearman r = -0.4217, P = 0.0319). Conclusion Differences in susceptibility to develop PPROM are present before fetal surgery. An increase in anaerobic glycolysis, evidenced by the intra-amniotic lactic acid level, may enhance MMP-8 production and weaken maternal and fetal membranes. Tweetable abstract Matrix metalloproteinase-8 and lactic acid in amniotic fluid predict preterm prelabour rupture of membranes.

An increased understanding of the reparative process in fetal membrane following surgical techniques may be helpful to decrease the risks to mother and fetus and avoid adverse pregnancy outcomes. The present study discusses histological evaluation of the fetal membrane following open fetal surgery. Chorioamniotic membranes (n=10) were obtained following birth from pregnancies that underwent open fetal surgery for myelomeningocele. The collagen distribution was quantified using picrosirius-polarization method comparing the suture site with non-suture site. The differences between the collagen fiber percentages at the two sites was evaluated by the paired t-test with P

OBJECTIVEIn this study, the authors retrospectively reviewed two cohorts of patients with occipital encephalocele (OE) and demonstrate the technical aspects of an innovative and unprecedented method for fetal OE correction.METHODSThis was a cross-sectional retrospective study of 22 patients who underwent surgery from July 2012 to July 2018. The inclusion criteria for participants were a gestational age between 19 weeks and 27 weeks, a maternal age ≥ 18 years, a normal fetal karyotype, the presence of microcephaly, and a cystic hernial sac with the cystic component accounting for more than 80% of the total volume, which was larger than 10 ml. The fetuses with OE and microcephaly underwent intrauterine repair. The exclusion criteria were the presence of a fetal anomaly not associated with OE, chromosomopathy, presence of the brainstem inside the hernial sac or venous sinuses inside the herniated content, the risk of premature birth, placenta previa, and maternal conditions that would constitute an additional risk for fetal and maternal health, as well as refusal for fetal surgery. The authors reviewed the potential for microcephaly reversal and the long-term neurocognitive development.RESULTSThe authors report the cases of 9 fetuses with OE and microcephaly who underwent intrauterine OE repair at gestational ages of less than 27 weeks (fetal group). One case selected for fetal surgery also presented with placental abruption. All patients who underwent the fetal operation had microcephaly reversal, and 3 patients required ventriculoperitoneal shunting in the 1st year of life. The authors reviewed the cases of 12 patients who underwent postnatal repair. In 10 cases, fetal surgery was refused (postnatal group), and in 2 cases, the inclusion criteria for fetal surgery were not met. The authors evaluated the neurocognitive development of the patients with the Bayley Scales of Infant Development II. The median score for the fetal group was 98.7, and that for the postnatal group was 27.8.CONCLUSIONSThe intrauterine repair of OE may stop the progression of encephalocele sac herniation and result in microcephaly reversal. The fetal group had a better cognitive outcome than the postnatal group. The technique required to correct this defect is feasible for those with previous experience in the correction of fetal myelomeningocele. However, more studies are needed to ensure the efficacy of this procedure.

Objectives-The purpose of this study was to establish the reference range for fetal heart volume from 3-dimensional (3D) sonography using the extended imaging virtual organ computer-aided analysis method.Methods-The fetal heart volume was measured in 303 normal singleton pregnancies at gestational ages of 20 to 34 weeks using 3D sonography. The extended imaging virtual organ computer-aided analysis method was used to obtain a sequence of 10 parallel symmetric sections through the heart, according to examiner-determined limits (the apex at one extremity and the connection to the great vessels at the other). Heart contours were drawn manually in all sections to obtain the 3D volume measurement, which was provided automatically by the software. Normal z scores and percentile reference ranges for each gestational age were constructed.Results-The fetal heart volume increased with gestational age. The mean values were 3.09 mL at 20 weeks, 9.18 mL at 26 weeks, and 24.89 mL at 34 weeks, according to the following formulas: fetal heart volume (mL) = 18.0076 - 2.1005 x gestational age + 0.0677 x gestational age(2) (R-2=0.922); and SD (mL) = (4.5038 - 0.4281 x gestational age + 0.0114 x gestational age(2)) x root 1.495808 (R-2=0.922).Conclusions-A reference range for fetal heart volume using the 3D sonographic extended imaging virtual organ computer-aided analysis method at gestational ages of 20 to 34 weeks was established. Univ Fed Sao Paulo, Dept Obstet, BR-05303000 Sao Paulo, SP, Brazil Univ Fed Sao Paulo, Dept Obstet, BR-05303000 Sao Paulo, SP, Brazil Web of Science

obtain the values of EV: XI VOCAL method. Using a sequential section, the contour of each gestational embryo was drawn manually in the fifteen different rotation planes to obtain the 3D volume measurement. To evaluate the relation between EV and gestational age (GA), Person’s correlation coefficient (r) was used. The paired Student’s t-test (P) and ANOVA were used to compare the methods. Results: The study showed there was correlation between EV and GA (r = 0.83 for VOCAL 30 degrees, r = 0.83 for XI VOCAL and r = 0.80 for multiplanar). There was a strong correlation between EV measured by the XI VOCAL e multiplanar methods (RICC = 0,941) and XI VOCAL and VOCAL methods (RICC= 0,965). There weren’t difference statistics between EV measured by the VOCAL, XI VOCAL and the multiplanar by the paired Student’s t-test, but ANOVA showed differences between all methods (p < 0.001). Conclusion: We have demonstrated a strong correlation with the age gestational and embryo volume measurements obtained using the XI VOCAL, VOCAL and multiplanar methods in first trimester gestational. The methods were concordant, but there were differences statistics.

Objectives: Our aim is to describe the technique of fetal intracranial pressure (FIP) assessment developed by using a safe and accurate system of invasive pressure monitoring and registering. Methods: By performing a fetal ultrasound-guided cephalocentesis in the fetal parieto-occipital fissure we may reach the posterior horn of the ventricular cavity. The procedure requires local anesthesia, little or no maternal sedation and no fetal curarization. The technique relies on the use of a sterile disposable pressure transducer that relays pressure information from the intraventricular catheter to a digital monitor in real time. It requires less than 5 seconds for the system to read and plot the pressure values into a graphic describing a straight line with low amplitude oscillations. The pressure transducer has a test port that allows one to verify the accuracy of the system before the fetal punction, minimizing the procedure time. The sensitivity is 5.0 μ V/V/mmHg ±1%, adequate to low pressure ranges. Fetal heart beats should be monitored for bradycardia may occur. Patient should be given uterolythics and has low risk of preterm rupture of membranes after procedure. Discussion: Congenital hydrocephaly has a wide spectrum of presentations and is related to multiple factors. Prognosis depends on the underlying cause, presence of associated malformations, the gestacional age of onset and progression of the ventricle enlargement with brain injury by intracranial hypertension. The FIP assessment may select those who could benefit from intrauterine ventricular derivations, in advanced and progressive cases. The FIP is estimated to be 2mmHg or less in normal fetuses and should be much higher in obstructive hydrocephaly, leading to parenchymal compression and neuronal migration impairment. Conclusions: The technique of FIP measurement is described. Fast, accurate and low-risk assessment may add important information and greatly improve outcome of fetuses with hydrocephaly.

Primary renal agenesis is not a diagnostical challenge as oligohydramnios is almost always present at the time of the anomaly scan. In contrast secondary (or progressive) renal agenesis (e.g. in multicystic dysplastic kidney) is frequently missed as kidneys are present but smaller in size and they tend to vanish with advancing gestational age. We present a case of a 24-year-old woman, gravida 1 para 0, referred to our center at 24+3 weeks’ gestation for suspicion of IUGR and oligohydramnios. Ultrasound showed a small multicystic left kidney. The right kidney could not be visualized. In view of the challenging scan conditions and the fact that normal kidneys were documented on previous exams a fetal MRI was requested. This case stresses the possibility of MCDK and other forms of cystic renal dysplasia in fetuses with oligohydramnios – even if a normal urinary tract was visualized on earlier exams. From our experience MRI as an alternative to amnioninfusion was decisive in confirming the diagnosis.