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Objective: Fetal pleural effusions are uncommon, and treatment options for moderate or severe effusions include drainage and thoracoamniotic shunting. However, relatively few records of effusions treated by thoracoamniotic shunting are available in the literature, so our objective was to study the outcome after thoracoamniotic shunting in our unit., Methods: We searched the database of our tertiary fetal medicine unit for all cases of fetal pleural effusion treated by thoracoamniotic shunting between 1997 and 2003 inclusive, and studied the maternal and neonatal records., Results: Ninety-two cases of fetal pleural effusion were studied, of which 21 had undergone a thoracoamniotic shunt. Sixteen of these 21 fetuses (76%) had associated hydrops, of which seven (44%) survived and, of the five (24%) without associated hydrops, three (60%) survived. There were two procedure-related losses. No shunted cases were associated with abnormal karyotype or proven maternal infection, but it is probable that three cases had been caused by an underlying genetic syndrome., Conclusion: The survival of fetuses with severe pleural effusions after thoracoamniotic shunting in this study was 48%., (Copyright (c) 2005 ISUOG.)

Objectives: To compare different normal reference ranges of fetal blood flow velocity in the middle cerebral artery for predicting fetal anemia., Methods: Eight reference ranges of either middle cerebral artery peak or time-averaged mean velocities were compared using the area under the receiver-operating characteristics (ROC) curve for 113 fetal blood samples from 60 women at risk of fetal red blood cell alloimmunization., Results: The areas under the ROC curves of the different ranges were not significantly different but there were marked differences in sensitivity (range, 7.14-91.78%) and specificity (range, 31.25-96.88%) with the currently used cut-offs. Except for Mari's range, the best theoretical cut-offs, defined as those having the best sensitivity with the best specificity, differed from those in current use, especially when using time-averaged mean velocity., Conclusions: Any of the previously reported reference ranges perform well in the non-invasive prediction of fetal anemia. However, with the exception of Mari's curve, the currently employed cut-offs for predicting fetal anemia should be changed, some of them markedly, in order to provide reliable support for clinical decisions., (Copyright 2005 ISUOG)

Objective: Diabetes could potentially alter fetal nuchal translucency (NT) measurements mainly by increasing microvascular permeability. The aim of this study was to test this hypothesis., Methods: Sixty-five women with pre-pregnancy insulin-dependent diabetes mellitus undergoing NT screening were evaluated. The main outcome measure was the NT measurement, expressed as both absolute measurements and delta values (number of standard deviations by which the observed value differed from the normal mean for the same gestation). The relationships between NT and years of diabetes, insulin dose, glycosylated hemoglobin, and glycemic capillary profiles ('tight' glycemic control) were studied., Results: There was no significant correlation between NT and any of the studied parameters. There were no differences in NT according to the result of either glycosylated hemoglobin or 'tight' control., Conclusions: Metabolic control does not affect the result of ultrasound-determined fetal NT measurement which, when available, seems to be the best option for screening for Down syndrome in women with diabetes mellitus., (Copyright 2003 ISUOG. Published by John Wiley & Sons, Ltd.)

Objectives: To examine the association between fetal talipes and other defects, and outcome in relation to postnatal surgery., Methods: All cases of talipes presenting to the fetal medicine unit between 1993 and 1998 and cases of isolated talipes presenting to the ultrasound department between 1991 and 1998 were examined. The infants were followed-up to determine the number of cases that had structural or positional talipes and the number of cases requiring surgery., Results: There were 76 cases, 59 of which attended the fetal medicine unit and 17 the ultrasound department. Postnatal follow-up details were available in 31 of the 40 live births. There were three neonates with unilateral talipes at birth who were thought to have bilateral talipes on prenatal ultrasound and one neonate had bilateral talipes at birth who had been thought to have unilateral talipes prenatally. In two (6.4%) neonates in whom talipes was not confirmed at birth the abnormality was diagnosed prenatally. Of the 29 neonates with confirmed talipes at birth, the defect was structural in 26 (90%) cases and positional in three. Surgery was necessary in 21 (72%) of the 29 cases and 18 (86%) of those undergoing surgery required only one operation. When live births with associated anomalies were excluded, there were 24 cases with confirmed isolated talipes and 18 (75%) required surgery., Conclusions: This study provides long-term outcome data which can be used to complement current prenatal counseling and shows that in cases of fetal talipes diagnosed prenatally, 90% have a structural rather than a positional deformity. For isolated talipes three quarters of children will require surgery and in the majority of cases only one operation on the foot is necessary. Parents should be made aware of the small possibility of a false-positive diagnosis and discrepancy between the ultrasound and postnatal diagnoses of laterality.

This report of four cases shows that fetal vesicocentesis at 10-14 weeks of gestation is a useful treatment option in some cases with megacystis. Although megacystis at this gestation has been reported, there are few studies examining the role of early vesicocentesis. The natural history of the condition and outcome following treatment is reviewed with reference to the literature.

Objective: To determine the degree of agreement between prenatal ultrasound diagnosis of brain abnormalities and subsequent pathologic findings., Methods: Between August 1993 and August 1999 there were 62 cases where a fetus with a prenatal ultrasound diagnosis of a brain abnormality other than neural tube defects underwent autopsy at the Regional Department of Pediatric Pathology. The cerebral diagnosis at ultrasound was compared with the findings at autopsy in all cases., Results: In 47 of 61 (77%) cases the same defects were seen on ultrasound and at autopsy. The most common disparity was with the Dandy-Walker malformation or variant, where only six of the 14 (43%) cases prenatally diagnosed with this condition showed the same abnormality at autopsy. When fetuses with the Dandy-Walker malformation or variant were excluded, the scan findings correlated with autopsy in 41 of 47 (87%). In the main group with discordant findings, five of the seven cases where termination of pregnancy was undertaken had other fetal anomalies on ultrasound examination which were confirmed at autopsy. In the sixth case there was autolysis of brain tissue which affected detailed autopsy., Conclusions: A very high level of agreement between prenatal ultrasound and autopsy findings was found for all abnormalities of the fetal brain, except for the Dandy-Walker malformation or variant. Potential discrepancy in findings between ultrasound and autopsy should be explained to patients who are considering termination of pregnancy for the Dandy-Walker type of abnormality.

To determine whether there is a relationship between chronic fetal acidemia and subsequent neurodevelopment, a follow-up study was undertaken of 36 children with normal karyotype and morphology, who had prenatal cordocentesis for severe growth retardation. The main outcome measure was the Griffiths neurodevelopmental quotient. The children who had acidemia as fetuses (n = 13) had a significantly lower developmental quotient (mean = 91.8, SD = 6.3) than those with normal (n = 23) fetal blood pH (mean = 100.3, SD = 10.3; t = -2.68, p = 0.011). There was also a significant correlation between developmental quotient and the degree of fetal acidemia (r = 0.41, n = 36, p = 0.012). The pregnancies with acidemic fetuses had similar epidemiological characteristics to those with fetuses with a normal pH, except for a higher incidence of smoking. There was no significant correlation between the degree of growth retardation (birth weight expressed as multiples of SD from the mean for gestational age and sex) and fetal acidemia (r = -0.23, n = 36, NS) or subsequent Griffiths developmental quotient (r = -0.005, n = 36, NS). The results show an association between chronic fetal acidemia and subsequent impaired neurodevelopment. This observation suggests that future preventative interventions may be possible., (Copyright 1992 International Society of Ultrasound in Obstetrics and Gynecology)

The ability of the amniotic fluid index and the single deepest pool to predict perinatal morbidity was compared in 291 high-risk singleton pregnancies without ruptured membranes or fetal renal abnormalities. A poor outcome was defined as a birth weight < -2 standard deviations, emergency Cesarean section for fetal heart rate abnormalities in labor, 5-minute Apgar score < 7, umbilical venous pH at delivery < 7.15 and admission to the special care baby unit. At least one of these parameters occurred in 71 (24%) of the 291 pregnancies. Oligohydramnios (an amniotic fluid index 5 cm (chi(2) = 2.41, p = 0.02). There was a significant correlation between amniotic fluid index and single deepest pool measurements (r = 0.83, n = 291, p < 0.0001). At the recommended cut-off values, the single deepest pool and the amniotic fluid index had sensitivities of 7% and 13%, respectively and specificities of 96% and 95% for predicting perinatal morbidity. Receiver operating characteristic curve analysis showed that these poor results were not the result of the cut-off values chosen and that the performances of the amniotic fluid index and single deepest pool were similar., (Copyright 1991 International Society of Ultrasound in Obstetrics and Gynecology)