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Objective: Monochorionic (MC) triplet pregnancies are extremely rare and information on these pregnancies and their complications is limited. We aimed to investigate the risk of early and late pregnancy complications, perinatal outcome and the timing and methods of fetal intervention in these pregnancies. Methods: This was a multicenter retrospective cohort study of MC triamniotic (TA) triplet pregnancies managed in 21 participating centers around the world from 2007 onwards. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anomalies, twin‐to‐twin transfusion syndrome (TTTS), twin anemia–polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence and or selective fetal growth restriction (sFGR) were retrieved from patient records. Data on antenatal interventions were collected, including data on selective fetal reduction (three to two or three to one), laser surgery and any other active fetal intervention (including amniodrainage). Data on perinatal outcome were collected, including numbers of live birth, intrauterine demise, neonatal death, perinatal death and termination of fetus or pregnancy (TOP). Neonatal data such as GA at birth, birth weight, admission to neonatal intensive care unit and neonatal morbidity were also collected. Perinatal outcomes were assessed according to whether the pregnancy was managed expectantly or underwent fetal intervention. Results: Of an initial cohort of 174 MCTA triplet pregnancies, 11 underwent early TOP, three had an early miscarriage, six were lost to follow‐up and one was ongoing at the time of writing. Thus, the study cohort included 153 pregnancies, of which the majority (92.8%) were managed expectantly. The incidence of pregnancy affected by one or more fetal structural abnormality was 13.7% (21/153) and that of TRAP sequence was 5.2% (8/153). The most common antenatal complication related to chorionicity was TTTS, which affected just over one quarter (27.6%; 42/152, after removing a pregnancy with TOP < 24 weeks for fetal anomalies) of the pregnancies, followed by sFGR (16.4%; 25/152), while TAPS (spontaneous or post TTTS with or without laser treatment) occurred in only 4.6% (7/152) of pregnancies. No monochorionicity‐related antenatal complication was recorded in 49.3% (75/152) of pregnancies. Survival was apparently associated largely with the development of these complications: there was at least one survivor beyond the neonatal period in 85.1% (57/67) of pregnancies without antenatal complications, in 100% (25/25) of those complicated by sFGR and in 47.6% (20/42) of those complicated by TTTS. The overall rate of preterm birth prior to 28 weeks was 14.5% (18/124) and that prior to 32 weeks' gestation was 49.2% (61/124). Conclusion: Monochorionicity‐related complications, which can impact adversely perinatal outcome, occur in almost half of MCTA triplet pregnancies, creating a challenge with regard to counseling, surveillance and management. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To determine the quality of Doppler images of the fetal middle cerebral artery (MCA) and umbilical artery (UA) using an objective scale, and to determine the reliability of this scale, within a multicenter randomized controlled trial (Revealed versus concealed criteria for placental insufficiency in unselected obstetric population in late pregnancy (Ratio37)).Methods: The Ratio37 trial is an ongoing randomized, open-label, multicenter controlled study of women with a low-risk pregnancy recruited at 20 weeks. Doppler measurements of the fetal MCA and UA were performed at 37 weeks. Twenty patients from each of the six participating centers were selected randomly, with two images evaluated per patient (one each for the MCA and UA). The quality of a total of 240 images was evaluated by six experts, scored on an objective scale of six items. Inter- and intrarater reliability was assessed using the Fleiss-modified kappa statistic for ordinal scales.Results: On average, 89.2% of MCA images and 85.0% of UA images were rated as being of perfect (score of 6) or almost perfect (score of 5) quality. Kappa values for intrarater reliability of quality assessment were 0.90 (95% CI, 0.88-0.92) and 0.90 (95% CI, 0.88-0.93) for the MCA and UA, respectively. The corresponding inter-rater reliability values were 0.85 (95% CI, 0.81-0.89) and 0.84 (95% CI, 0.80-0.89), respectively.Conclusion: The quality of MCA and UA Doppler ultrasound images can be evaluated reliably using an objective scale. Over 85% of images, which were obtained by operators from a broad range of clinical practices within a multicenter study, were rated as being of perfect or almost perfect quality. Intra- and inter-rater reliability of quality assessment was very good. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Summary: Phase‐mode electrostatic force microscopy (EFM‐Phase) is a viable technique to image surface electrostatic potential of silicon oxide stripes fabricated by oxidation scanning probe lithography, exhibiting an inhomogeneous distribution of localized charges trapped within the stripes during the electrochemical reaction. We show here that these nanopatterns are useful benchmark samples for assessing the spatial/voltage resolution of EFM‐phase. To quantitatively extract the relevant observables, we developed and applied an analytical model of the electrostatic interactions in which the tip and the surface are modelled in a prolate spheroidal coordinates system, fitting accurately experimental data. A lateral resolution of ∼60 nm, which is comparable to the lateral resolution of EFM experiments reported in the literature, and a charge resolution of ∼20 electrons are achieved. This electrostatic analysis evidences the presence of a bimodal population of trapped charges in the nanopatterned stripes. [ABSTRACT FROM AUTHOR]

Caleta el Cobre (CeC) 022 is a Martian meteorite of the nakhlite group, showing an unbrecciated cumulate texture, composed mainly of clinopyroxene and olivine. Augite shows irregular core zoning, euhedral rims, and thin overgrowths enriched in Fe relative to the core. Low‐Ca pyroxene is found adjacent to olivine. Phenocrysts of Fe‐Ti oxides are titanomagnetite with exsolutions of ilmenite/ulvöspinel. Intercumulus material consists of both coarse plagioclase and fine‐grained mesostasis, comprising K‐feldspars, pyroxene, apatite, ilmenite, Fe‐Ti oxides, and silica. CeC 022 shows a high proportion of Martian aqueous alteration products (iddingsite) in olivine (45.1 vol% of olivine) and mesostasis. This meteorite is the youngest nakhlite with a distinct Sm/Nd crystallization age of 1.215 ± 0.067 Ga. Its ejection age of 11.8 ± 1.8 Ma is similar to other nakhlites. CeC 022 reveals contrasted cooling rates with similarities with faster cooled nakhlites, such as Northwest Africa (NWA) 817, NWA 5790, or Miller Range 03346 nakhlites: augite irregular cores, Fe‐rich overgrowths, fine‐grained K‐feldspars, quenched oxides, and high rare earth element content. CeC 022 also shares similarities with slower cooled nakhlites, including Nakhla and NWA 10153: pyroxene modal abundance, pyroxenes crystal size distribution, average pyroxene size, phenocryst mineral compositions, unzoned olivine, and abundant coarse plagioclase. Moreover, CeC 022 is the most magnetic nakhlite and represents an analog source lithology for the strong magnetization of the Martian crust. With its particular features, CeC 022 must originate from a previously unsampled sill or flow in the same volcanic system as the other nakhlites, increasing Martian sample diversity and our knowledge of nakhlites. [ABSTRACT FROM AUTHOR]

Cosmetic treatments aim at improving skin appearance through vehicles of good sensory properties. Those vehicles are mainly emulsions and gels designed to deliver safe and effective compounds to skin. Creams and serums are widely used to achieve these goals, but recently a new type of formulation known as organogels triggered scientific attention, particularly in the design of both topical and cosmetic formulations. It has been established that the lipophilic nature of organogels makes it an excellent candidate for the delivery of cosmetic molecules through skin. In this review, we discuss the properties and characteristics of organogels and present the advantages of the application of these systems in cosmetics. [ABSTRACT FROM AUTHOR]

Summary: Background: Few studies have been published about cryopreservation and embryo assessment in horses and donkeys. Objectives: To evaluate the viability of embryos collected from mares and jennies that were cryopreserved by slow freezing or by vitrification. Study design: Randomised controlled experiment. Methods: Horse (n=19) and donkey (n=16) embryos (≤300 μm) were recovered on days 6.5–7.5 post‐ovulation and assigned to control or cryopreservation protocols of slow freezing or vitrification. For slow freezing, 1.5 mol/L ethylene glycol (EG) was used. For vitrification, horse embryos were exposed to 1.4 mol/L glycerol, 1.4 mol/L glycerol + 3.6 mol/L EG and 3.4 mol/L glycerol + 4.6 mol/L EG, using Fibreplug or a 0.25 mL straw; donkey embryos were vitrified using Fibreplug with similar EG–glycerol solutions to above or 7.0 mol/L EG. Dead cells, apoptotic and fragmented nuclei, and cytoskeleton quality were assessed on thawed/warmed embryos. Results: A significant decrease in embryo quality was observed after cryopreservation (P<0.05). Although the percentage of dead cells was lower (P<0.05) in control than in cryopreserved embryos, no differences were observed between freezing protocols used for horse or donkey embryos. While no differences were detected in the number of apoptotic cells in warmed horse embryos, in donkey embryos a higher incidence of apoptosis was measured after vitrification with EG–glycerol in Fibreplug (P<0.05). Vitrified horse embryos had a significantly (P<0.05) higher percentage of nonviable cells than donkey embryo. Actin cytoskeleton quality did not differ between treatments. Main limitations: Difficulties in obtaining a large number of embryos meant that the number of embryos per group was low. Conclusions: Vitrified horse and donkey embryos did not show higher susceptibility to cell damage than those preserved by slow freezing, whether using straws or Fibreplug. However, Fibreplug with EG 7 mol/L resulted in fewer nonviable and apoptotic cells in donkey embryos. Donkey embryos showed lower susceptibility to vitrification than horse embryos. The Summary is available in Spanish ‐ See Supporting Information: [ABSTRACT FROM AUTHOR]

Models beyond the Standard Model with extra scalars have been highly motivated by the recent discovery of a Higgs boson. The Two Higgs Doublet Model Type III considers the most general case for the scalar potential, allowing mixing between neutral CP-even and CP-odd scalar fields. This paper presents the results of the study on the t → cγ, t → ch, and t → cg decays at one-loop level if neutral flavor changing is generated by top-charm-Higgs coupling given by the Yukawa matrix. [ABSTRACT FROM AUTHOR]

The primary outcome was survival and secondary outcome was gestational age at birth. To describe the incidence and survival rate of monochorionic-diamniotic twin pregnancies complicated with Twin-twin transfusion syndrome (TTTS) between patients who underwent treatment by fetoscopic laser therapy versus delivery by Caesarean section after 26 weeks of gestation. EP21.02: Survival outcomes between Caesarean delivery and fetoscopic laser therapy for late Twin-twin transfusion syndrome after 26 weeks of gestation. [Extracted from the article]

There was a weak positive correlation between the anterior and posterior vaginal azygos arteries PIs ( I r i = 0.23; I P i = 0.04) and no correlation between the posterior vaginal azygos artery PI and the mean uterine artery PI (Figure 2c,d). We describe here the characteristics of the Doppler waveform of the vaginal azygos arteries1 during pregnancy and their association with the uterine arteries. [Extracted from the article]

ABSTRACT Objective To assess the effectiveness of laser surgery in fetuses with a cystic lung lesion with systemic arterial blood supply (hybrid lung lesion) at risk of perinatal death. Methods A cohort of five consecutive fetuses with a large hybrid lung lesion associated with hydrops and/or pleural effusion with severe lung compression was selected for percutaneous ultrasound-guided fetal laser ablation of the feeding artery ( FLAFA) before 32 weeks' gestation in a single tertiary national referral center in Queretaro, Mexico. The primary outcomes were survival and need for postnatal surgery. Results FLAFA was performed successfully in all cases at a median gestational age of 24.9 (range, 24.4-31.7) weeks. After fetal intervention, dimensions in both lungs increased and fluid effusions resolved in all cases. All cases were delivered liveborn at term at a median gestational age of 39.6 (range, 38.0-39.7) weeks, without respiratory morbidity or need for oxygen support, resulting in perinatal survival of 100%. During follow-up, three (60%) cases showed progressive regression of the entire lung mass and did not require postnatal surgery, whereas in two (40%) cases a progressive decrease in size of the mass was observed but a cystic portion of the lung mass persisted and postnatal lobectomy was required. Conclusion In fetuses with large hybrid lung lesions at risk of perinatal death, FLAFA is feasible and could improve survival and decrease the need for postnatal surgery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT [ABSTRACT FROM AUTHOR]

The article presents a study which analyzes the effectiveness of fetal laser surgery in preventing in cases with bronchopulmonary sequestration. In this study, eight fetuses which underwent fetal surgery with full laser ablation of the feeding artery (FLAFA) were studied. The study concludes that FLAFA prevents fetal death and avoids the need for neonatal sequestrectomy. [ABSTRACT FROM AUTHOR]

OC13.05: Flexible video fetoscopy for laser therapy in Twin-twin transfusion syndrome presenting with inaccessible anterior placenta Conclusions Flexible video fetoscopy for completion of laser coagulation of placental anastomosis is feasible and represents a good option for TTTS cases presenting after 20 weeks with inaccessible anterior placenta. To describe the technique, feasibility and outcomes of flexible video fetoscopy for laser coagulation in monochorionic (MC) twin pregnancies with Twin-twin transfusion syndrome (TTTS) presenting with inaccessible anterior placenta. [Extracted from the article]

To compare maternal and perinatal outcomes of late open fetal repair for open spina bifida (OSB) between 26 SP +0 sp - 27 SP +6 sp weeks with those intervened before 25 SP +6 sp weeks. Two groups were defined based on the gestational age (GA) at intervention (weeks+days): MOMS time window group: GA 19 SP +0 sp -25 SP +6 sp , and late intervention group: GA 26 SP +0 sp -27 SP +6 sp . OC09.05: Outcomes of late open fetal surgery for intrauterine spina bifida repair after 26 weeks: should we extend the MOMS time window?. [Extracted from the article]

Conclusions In Latin American centres, FETO was associated with a significant increase in survival among CDH fetuses with severe lung hypoplasia. To evaluate survival outcomes of fetuses with left-sided congenital diaphragmatic hernia (CDH) treated with fetal endoscopic tracheal occlusion (FETO) in Latin American centres. Methods A retrospective cohort including isolated left sided CDH fetuses with severe pulmonary hypoplasia (observed/expected lung area to head ratio < 35% with liver herniation) treated with FETO in five Latin American countries. [Extracted from the article]

The cervical defect was first repaired through a 2.0 cm hysterotomy and then, the fetus was positioned by internal version to allow access to the lumbosacral defect by the same hysterotomy. A 32-year-old, gravida 1, was referred to our fetal surgery centre, due to double open spina bifida (OSB) defect (C4-T1 and L2-S1) with ultrasound findings of Chiari II malformation, and mild bilateral ventriculomegaly. [Extracted from the article]

An abstract of the article "Impact of maternal obesity on operative times and perinatal outcome at laser therapy for Twin-twin transfusion syndrome" by R. Cruz-Martinez and others is presented.

An abstract of the article "Outcome and longitudinal changes in pulmonary growth, lung mass volume and intrafetal fluid effusions after percutaneous laser ablation of the feeding artery in fetuses with bronchopulmonary sequestration" by R. Cruz-Martinez and colleagues is presented.

An abstract of the article "The independent effect of maternal height and weight on cervical length" by M. Cruz-Martinez is presented.

An abstract of the article "Outcomes and chromosomal abnormalities in fetuses prenatally diagnosed with isolated persistent left superior vena cava" by M. Cruz Lemini and others is presented.

ABSTRACT Objective To assess the clinical value of third-trimester uterine artery ( UtA) Doppler ultrasound in the prediction of hemodynamic deterioration and adverse perinatal outcome in term small-for-gestational-age ( SGA) fetuses. Methods UtA Doppler parameters, cerebroplacental ratio ( CPR) and fetal middle cerebral artery ( MCA) pulsatility index ( PI) were evaluated weekly, starting from the time of SGA diagnosis until 24 h before induction of labor, in a cohort of 327 SGA fetuses with normal umbilical artery PI (< 95th centile), delivered at > 37 weeks' gestation. Differences in the sequence of CPR and MCA-PI changes < 5th centile, between the group with normal UtA Doppler indices at diagnosis and those with abnormal UtA indices, were analyzed by survival analysis. In addition, the use of UtA Doppler value, alone or in combination with a brain Doppler scan before delivery, to predict the risk of Cesarean section, Cesarean section for non-reassuring fetal status ( NRFS), neonatal acidosis and neonatal hospitalization was evaluated by logistic regression analysis, adjusted for gestational age at birth and birth-weight percentile. Results Abnormal UtA Doppler at diagnosis of SGA was associated with a higher risk of developing abnormal brain Doppler indices before induction of labor than in those with a normal UtA at diagnosis (62.7% vs 34.6%, respectively; P < 0.01). Compared to those with normal UtA Doppler indices, those with abnormal UtA Doppler findings were associated with a higher risk of intrapartum Cesarean section (52.2% vs 37.3%, respectively; P = 0.03), Cesarean section for NRFS (35.8% vs 23.1%, respectively; P = 0.03), neonatal acidosis (10.4% vs 7.7%, respectively; P = 0.47) and neonatal hospitalization (23.9% vs 16.5%, respectively; P = 0.16). Logistic regression analysis indicated that UtA Doppler findings were not significantly associated with adverse perinatal outcome independent of brain Doppler findings. Conclusion UtA Doppler indices predict adverse perinatal outcome, but do not help to improve the predictive value of brain Doppler indices. However, at the time of SGA diagnosis they identify the subgroup of fetuses at highest risk of progression to abnormal brain Doppler findings. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Mutations in the ATP6 gene are reported to be associated with Leber hereditary optic neuropathy, bilateral striatal necrosis, coronary atherosclerosis risk and neuropathy, ataxia and retinitis pigmentosa ( NARP)/maternally inherited Leigh syndromes. Here, we present a patient with NARP syndrome, in whom a previously undescribed mutation was detected in the ATP6 gene: m. 8839G>C. Several observations support the concept that m. 8839G>C is pathogenically involved in the clinical phenotype of this patient: (1) the mutation was heteroplasmic in muscle; (2) mutation load was higher in the symptomatic patient than in the asymptomatic carriers; (3) cybrids carrying this mutation presented lower cell proliferation, increased mitochondrial DNA ( mtDNA) copy number, increased steady-state OxPhos protein levels and decreased mitochondrial membrane potential with respect to isogenic wild-type cybrids; (4) this change was not observed in 2959 human mtDNAs from different mitochondrial haplogroups; (5) the affected amino acid was conserved in all the ATP6 sequences analyzed; and (6) using in silico prediction, the mutation was classified as 'probably damaging'. However, measurement of ATP synthesis showed no differences between wild-type and mutated cybrids. Thus, we suggest that m. 8839G>C may lower the efficiency between proton translocation within F0 and F1 rotation, required for ATP synthesis. Further experiments are needed to fully characterize the molecular mechanisms involved in m. 8839G>C pathogenicity. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To evaluate the 2-year neurodevelopmental outcome of full-term, small-for-gestational-age ( SGA) newborns with normal placental function, according to current criteria based on umbilical artery Doppler findings. Methods A cohort of consecutive full-term, SGA newborns with normal prenatal umbilical artery Doppler was compared with a group of full-term, appropriate-for-gestational-age ( AGA) infants sampled from our general neonatal population. Neurodevelopmental outcome was evaluated at 24 months' corrected age using the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley- III), which evaluates cognitive, language, motor, social-emotional and adaptive competencies. The effect of the study group on each domain was adjusted with MANCOVA and logistic regression for gestational age at delivery, socioeconomic status, gender, tobacco smoking and breastfeeding. Results A total of 223 infants (112 SGA and 111 AGA) were included. The groups differed significantly with respect to socioeconomic status and gestational age at delivery. All studied neurodevelopmental domains were poorer in the SGA group, reaching significance for the cognitive (92.9 vs 100.2, adjusted P = 0.027), language (94.7 vs 101, adjusted P = 0.025), motor (94.2 vs 100, adjusted P = 0.027) and adaptive (89.2 vs 96.5, adjusted P = 0.012) scores. Likewise, the SGA group had a higher risk of low scores in language (odds ratio ( OR) = 2.63; adjusted P = 0.045) and adaptive ( OR = 2.72; adjusted P = 0.009) domains. Conclusions Compared with normal-sized babies, full-term SGA infants, without placental insufficiency defined according to currently used criteria, have lower 2-year neurodevelopmental scores. These data challenge the concept that SGA fetuses with normal umbilical artery Doppler are 'constitutionally small' but otherwise completely normal. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To explore the potential value of intrapulmonary artery Doppler velocimetry in predicting neonatal morbidity in fetuses with left-sided congenital diaphragmatic hernia ( CDH) treated with fetoscopic tracheal occlusion ( FETO). Methods Observed/expected lung-to-head ratio (O/E- LHR), and intrapulmonary Doppler pulsatility index and peak early-diastolic reversed flow were evaluated within 24 h before FETO in a consecutive cohort of 51 fetuses with left-sided CDH at between 24 and 33 weeks' gestation. Lung Doppler parameters were converted into Z-scores and defined as abnormal if the pulsatility index had a Z-score of > 1.0 or the peak early-diastolic reversed flow had a Z-score of > 3.5. The association of O/E- LHR and Doppler velocimetry with neonatal outcome was assessed using multiple linear or logistic regression analysis adjusted for gestational age at birth. Results Among the 26 fetuses that survived, 18 (69.2%) had normal and eight (30.8%) had abnormal Doppler values. O/E- LHR was not associated with neonatal morbidity in surviving fetuses. Compared with the group with normal Doppler parameters, cases with abnormal intrapulmonary Doppler were associated with a significant increase in the duration of mechanical ventilation (average increase of 21.2 (95% CI, 9.99-32.5) days; P < 0.01), conventional ventilation (15.2 (95% CI, 7.43-23.0) days; P < 0.01), high-frequency ventilation (6.34 (95% CI, 0.69-11.99) days; P < 0.05), nitric oxide therapy (5.73 (95% CI, 0.60-10.9) days; P < 0.05), oxygen support (36.5 (95% CI, 16.3-56.7) days; P < 0.01), parenteral nutrition (19.1 (95% CI, 7.53-30.7) days; P < 0.01) and stay in neonatal intensive care unit (42.7 (95% CI, 22.9-62.6) days; P < 0.001), and with significantly higher rates of high-frequency ventilation (87.5 vs 44.4%; P < 0.05), oxygen requirement at 28 days of age (75.0 vs 11.1%; P < 0.01), gastroesophageal reflux (62.5 vs 22.2%; P < 0.05) and tube feeding at discharge (37.5 vs 5.56%; P < 0.05). Conclusion As previously reported, O/E- LHR did not predict neonatal morbidity. In contrast, intrapulmonary artery Doppler evaluation was predictive of neonatal morbidity in CDH fetuses treated with FETO.Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To evaluate the risk of adverse perinatal outcome according to estimated fetal weight (EFW) in a cohort of term small-for-gestational-age (SGA) pregnancies with normal umbilical, fetal middle cerebral and maternal uterine artery Doppler indices. Methods A cohort of 132 term SGA fetuses with normal umbilical artery pulsatility index (PI), mean uterine artery PI and cerebroplacental ratio was compared to a control group of 132 appropriate-for-gestational-age babies, matched by gestational age at delivery. The capacity of the EFW percentile to predict Cesarean delivery, Cesarean delivery for non-reassuring fetal status (NRFS), neonatal acidosis and days of neonatal hospitalization was analyzed. Results As a whole, SGA fetuses with normal Doppler findings did not show a statistically significant difference for intrapartum Cesarean delivery (22.0 vs. 15.9%; P = 0.21) and neonatal acidosis (3.3 vs. 1.5%; P = 0.30), but had significantly higher risk for Cesarean delivery for NRFS (15.9 vs. 5.3%; P < 0.01) and longer neonatal hospitalization (1.39 vs. 0.87 days; P < 0.05) than did controls. SGA fetuses with EFW < 3 rd centile had a significantly higher incidence of intrapartum Cesarean delivery (30.0 vs. 15.3%; P = 0.04), Cesarean delivery for NRFS (25.0 vs. 8.3%; P < 0.01) and longer neonatal hospitalization (2.0 vs. 0.9 days; P < 0.01) than those with EFW ≥ 3 rd centile. SGA cases with EFW ≥ 3 rd centile had perinatal outcomes similar to those of controls with normal EFW. Conclusion Among SGA fetuses with normal placental and cerebral Doppler ultrasound findings, EFW < 3 rd centile discriminates between those with a higher risk for adverse perinatal outcome and those with outcomes similar to those of normally grown fetuses. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective Fetuses with congenital diaphragmatic hernia (CDH) and for whom additional ultrasound findings are abnormal typically are considered to have a dismal prognosis. Our aim was to assess the outcome of fetuses with CDH and associated intrafetal fluid effusions. Methods This was a retrospective bicentric cohort study on the perinatal management of fetuses with CDH and intrafetal fluid effusions. Results The incidence of effusions was 5.2% ( n = 14) in 269 consecutive cases of left-sided CDH and 29.2% ( n = 14) in 48 cases of right-sided CDH. Hydrothorax ( n = 19 (68%)) and ascites ( n = 16 (57%)) were the most common effusions. A combination of both was present in 11 (39%) fetuses. Of 20 ongoing pregnancies with CDH and fluid effusions, without other anomalies, five with moderate or mild pulmonary hypoplasia were managed without fetoscopic endoluminal tracheal occlusion (FETO). The 15 other cases underwent FETO because of severe pulmonary hypoplasia. Neonatal survival rate was similar in both groups ( n = 2/5 and n = 6/15, respectively ( P = 1.0)). Survival among those who underwent FETO was similar to previously published results concerning isolated cases undergoing FETO. Conclusions Our observations do not support the view that intrafetal effusions are an adverse prognostic factor in fetuses with CDH. In CDH fetuses with effusions and severe pulmonary hypoplasia treated with FETO, neonatal survival is similar to that in isolated cases undergoing the intervention. Whether pleural effusions should be addressed by thoracic drainage procedures remains unproven. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To evaluate the changes in myocardial performance index (MPI) and aortic isthmus (AoI) and ductus venosus (DV) Doppler in term, small-for-gestational age (SGA) fetuses with normal umbilical artery (UA) Doppler. Methods MPI, AoI and DV pulsatility indices (PI) were measured within 1 week prior to delivery in a cohort of 178 term singleton consecutive SGA fetuses with normal UA-PI (< 95 th percentile) and 178 controls matched by gestational age. Cardiovascular parameters were converted into Z-scores and values above the 95 th centile defined as abnormal. Results Median gestational age at inclusion and at delivery was 35.7 and 38.6 weeks, respectively. Compared to controls, SGA fetuses showed significantly higher values in MPI and AoI-PI and similar values in DV-PI. SGA fetuses showed a significantly higher proportion of increased MPI (28.1 vs. 6.7%; P < 0.01) and abnormal AoI-PI (14.6 vs. 5.1%; P < 0.01) than controls. The proportion of cases with abnormal DV-PI was similar between SGA cases and controls. Retrograde net blood flow in the AoI was observed in 7.3% of the SGA cases and in none of the controls. Conclusion A proportion of SGA fetuses show cardiovascular Doppler abnormalities. This information might be of clinical relevance in improving the detection and management of late-onset intrauterine growth restriction. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To evaluate the neurobehavioral outcomes of preterm infants with intrauterine growth restriction (IUGR), with and without prenatal advanced brain-sparing. Methods A cohort of IUGR infants (birth weight < 10th percentile with abnormal umbilical artery Doppler) born before 34 weeks of gestation was compared with a control group of appropriate-for-gestational age infants matched for gestational age at delivery. MCA pulsatility index was determined in all cases within 72 hours before delivery. Neonatal neurobehavior was evaluated at 40 weeks' ( ± 1) corrected age using the Neonatal Behavioral Assessment Scale. The effect of abnormal MCA pulsatility index (< 5th percentile) on each neurobehavioral area was adjusted for maternal smoking status and socioeconomic level, mode of delivery, gestational age at delivery, pre-eclampsia, newborn illness severity score and infant sex by multiple linear and logistic regression. Results A total of 126 preterm newborns (64 controls and 62 IUGR) were included. Among IUGR fetuses, the proportion of abnormal MCA Doppler parameters was 53%. Compared with appropriate-for-gestational age infants, newborns in the IUGR subgroup with abnormal MCA Doppler had significantly lower neurobehavioral scores in the areas of habituation, motor system, social-interactive and attention. Similarly, the proportion of infants with abnormal neurobehavioral scores was significantly higher in the IUGR subgroup with abnormal MCA Doppler parameters in the areas of habituation, social-interactive, motor system and attention. Conclusion Abnormal MCA Doppler findings are predictive of neurobehavioral impairment among preterm newborns with IUGR, which suggests that this reflects an advanced stage of brain injury with a higher risk of abnormal neurological maturation. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To explore the sequence of changes in myocardial performance index (MPI) and aortic isthmus (AoI) and ductus venosus (DV) flow in fetuses with early-onset intrauterine growth restriction (IUGR). Methods MPI and AoI and DV pulsatility indices (PI) were evaluated every 1-7 days in a cohort of IUGR fetuses with abnormal umbilical artery Doppler PI (> 95 th percentile) delivered before 34 weeks' gestation. The longitudinal changes were analyzed in the last 30 days before delivery by multilevel and survival analysis. Results A total of 430 scans were performed on 115 IUGR fetuses. MPI, AoI-PI and DV-PI showed increases with the progression of fetal deterioration throughout the follow-up study period, but the rates of progression were different. On average, MPI, AoI-PI and DV-PI crossed the 95 th percentile at 26 days, 12 days and 5 days before delivery, respectively. At the last examination before delivery, the proportion of increased MPI (70.4%) was significantly higher than that of abnormal AoI-PI (55.7%; P < 0.01) and DV-PI (47.8%; P < 0.01). Conclusion In early-onset IUGR, MPI and AoI and DV Doppler indices all increase but at different rates, which could provide the basis for further research on their use for improving in-utero monitoring and prediction of long-term outcome. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To evaluate the incidence and clinical outcome of inadvertent septostomy after fetoscopic laser therapy for twin-twin transfusion syndrome (TTTS) and, particularly, to explore its association with the risk of developing pseudoamniotic band syndrome (PABS). Methods In a cohort of 414 consecutive monochorionic twin pregnancies with confirmed TTTS treated with laser, the incidence of postoperative septostomy within 1 week of the procedure was recorded prospectively. Rates of preterm delivery, preterm premature rupture of membranes (PPROM), intrauterine fetal demise (IUFD) and PABS were compared among cases with and without septostomy. Results The mean gestational age at laser therapy was 20.4 (range, 15.3-27.6) weeks. Postoperative septostomy occurred in 30 (7.2%) cases. Pregnancies complicated with septostomy had a significantly higher proportion of preterm delivery before 32 weeks (76.7% vs. 30.2%, P < 0.001), PPROM before 32 weeks (46.7% vs. 19.0%, P < 0.001), IUFD (43.3% vs. 25.8%, P < 0.05) and PABS (13.3% vs. 1.0%, P < 0.001), compared with pregnancies without septostomy. Conclusions Inadvertent septostomy occurred in 7% of cases after fetoscopic laser therapy and was associated with a substantially increased risk of adverse perinatal outcome and PABS. [ABSTRACT FROM AUTHOR]

Objective To assess the learning curve for measurement of the fetal modified myocardial performance index (MPI). Methods Three trainees with the theoretical knowledge of but without prior experience in performing MPI measurement were selected. Each trainee and one experienced examiner measured MPI in a cohort of 90 consecutive fetuses. The average difference between the three trainees and the expert in the MPI measurements was calculated; a difference below 10% was considered to indicate an accurate measurement. Individual and averaged learning curveswere delineated using cumulative sum analysis (CUSUM). Results The gestational age at evaluation ranged from 20+ 4 to 41+ 4 (mean, 33+3) weeks. The CUSUM plots demonstrated that, on average, competence in performing fetal MPI measurement was achieved by 65 cases. The average number of attempts to achieve competence were 42, 77 and 83 for the ejection time, isovolumetric contraction time and isovolumetric relaxation time, respectively. Conclusions Evaluation of fetalMPI by an inexperienced trainee requires on average 65 measurements to achieve competence. [ABSTRACT FROM AUTHOR]

Objectives To establish normal reference intervals of fetal regional brain blood perfusion using power Doppler ultrasound as measured by fractional moving blood volume (FMBV). Methods A cohort of consecutive singleton normally grown fetuses was selected including at least 12 fetuses for each completed week of gestation between 24 and 41 weeks. Cerebral blood perfusion was estimated using conventional power Doppler ultrasound in the following brain regions: frontal area, basal ganglia and posterior brain. Five consecutive good-quality imageswere recorded in each area and the region of interest was delineated offline. The FMBV was quantified as the average of all images and expressed as a percentage. Normal reference ranges were constructed by means of the LMS (lambdamu- sigma) method. Results A total of 230 fetuses were included. The median gestational age at evaluation and at delivery was 33.1 (range, 24.0-41.0) and 39.7 (range, 34.9-42.3) weeks, respectively. From 24 to 41 weeks' gestation, the mean FMBV increased from 13.21 to 14.97% in the frontal area, 11.17 to 14.86% in the basal ganglia and 4.83 to 6.70% in the posterior brain. Conclusions Normal data of fetal cerebral blood perfusion in the frontal area, basal ganglia and posterior brain are provided, which could be of clinical use in the assessment of fetal brain circulation. [ABSTRACT FROM AUTHOR]

Objectives To determine the longitudinal trends and rates of conversion of normal to abnormal uterine (UtA), umbilical (UA) andmiddle cerebral artery (MCA) Doppler velocimetry throughout the third trimester in late-onset small-for-gestational-age (SGA) fetuses. Methods UtA, UA and MCA Doppler velocimetry was serially performed in a cohort of singleton consecutive late-onset SGA fetuses with normal Doppler values at diagnosis. The rate of conversion of normal to abnormal Doppler values was evaluated by survival analysis. Longitudinal trends were modeled by means of multilevel analysis. Results A total of 616 scans were performed on 171 SGA fetuses. Mean gestational age at inclusion and at delivery was 34.1 (SD 1.6) and 38.7 (SD 1.7) weeks, respectively. The proportions of abnormal UtA (2.3 vs. 4.1%) and UA (2.3 vs. 2.9%) pulsatility index (PI) were not significantly different between 37 weeks and before delivery. On the other hand, the proportions of abnormal MCA-PI (4.1 vs. 13.5%) and cerebroplacental ratio (CPR) (7 vs. 22.8%) were significantly different between these two examinations. The remaining proportion of cases with normal UtA-, UA- and MCA-PIs and CPR at 40 weeks were 98.6, 94.5, 85 and 49.6%, respectively. Whereas a slight increasing trend was observed for the UtA-PI (β = 0.002) and UA-PI (β = 0.01), MCA-PI (β = 0.044) and CPR (β = 0.124) showed a progressive decrease until delivery. Conclusions Late-onset SGA fetuses with normal Doppler velocimetry upon diagnosis show progression from 37 weeks' gestation with worsening CPR followed by a decrease in MCA-PI. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Congenital diaphragmatic hernia (CDH) is a congenital birth defect affecting around 1/3000 births. We propose that a significant number of isolated CDH cases have an underlying genetic cause, and that a subset of these result from copy number variations (CNVs) identifiable by array CGH. METHODOLOGY: We have designed a custom array targeted at genes and genomic loci associated with CDH. A total of 79 isolated CDH patients were screened using this targeted array. RESULTS: In three patients, we detected genomic imbalances associated with the observed diaphragmatic hernia; a deletion of 8p22-p23.3, 14.2 Mb in size, a 340 kb duplication of Xq13.1 including the ephrin-B1 gene (EFNB1), and mosaicism for trisomy 2. CONCLUSION: Using this approach, we detected genomic imbalances associated with CDH in 3/79 (4%) isolated CDH patients. Our findings further implicate 8p deletions as being associated with CDH. The duplication of EFNB1 further highlights this gene as a potential candidate involved in diaphragm development. Mosaicism for trisomy 2 is a rare event and unlikely to be a common cause of CDH. Further investigations of isolated CDH patients by array CGH will continue to identify novel submicroscopic loci and refine genomic regions associated with CDH. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article presents a study that examines learning curve for inexperienced sonographer to be competent in lung area to head circumference ratio (LHR) calculations in fetuses with congenital diaphragmatic hernia (CDH). The study compares observed to expected (O/E)-LHR measured by experts and trainee in CDH fetuses. Result of the cumulative sum analysis (CUSUM) reveals learning curved between 77 and 72 times examinations, suggesting that competence can be gain after 70 times execution of tests.

The article presents a study which evaluates the perfusion of lung tissue on human fetuses who have congenital diaphragmatic hernia (CDH) and its relationship with pulsed Doppler and the lung area to head circumference ratio (LHR). The study compares fetuses that were identified with isolated left CDH and fetuses group without CDH and uses fractional moving blood volume (FMBV) to measure the lung tissue perfusion. Results show the decrease in the lung tissue perfusion of the fetuses with CDH.

The article presents a study on the determination of the existence of fetuses with congenital diaphragmatic hernia. Forty-one fetuses with a gestational age of 24-28 weeks underwent fetoscopic tracheal occlusion treatment using decision-tree and multiple logistic regression analysis following the Doppler measurement of the peak systolic velocity, peak early diastolic reversed flow, and pulmonary artery pulsating index. It shows that the Doppler assessment aids in predicting the fetal survival.

Objective To evaluate whether anterior cerebral artery (ACA) Doppler ultrasonography is superior to middle cerebral artery (MCA) Doppler in the prediction of perinatal outcome and neonatal neurobehavior in term small-for-gestational-age (SGA) fetuses with normal umbilical artery (UA) Doppler. Methods MCA and ACA Doppler ultrasonography was performed in a cohort of SGA term fetuses with normal UA Doppler. Perinatal outcome and neonatal neurobehavioral performance were compared with a group of term appropriate-for-gestational age (AGA) infants. Neurobehavior was evaluated at 40 ( ± 1) weeks of corrected age with the Neonatal Behavioral Assessment Scale. Differences between the study groups were adjusted for potential confounding variables by multiple linear or logistic regression analyis. Results A total of 199 newborns (98 SGA and 101 AGA) were included. Among the SGA fetuses, 28.6 and 17% had MCA and ACA redistribution, respectively. Cases with either type of redistribution had an increased risk for adverse outcome, with no differences in predictive performance between the two parameters. SGA fetuses with MCA redistribution compared with controls had an increased risk for abnormal neurobehavioral performance in motor (36 vs. 20%; adjusted P = 0.02) and state organization (25 vs. 17.5%; adjusted P = 0.03) areas. SGA fetuses with ACA redistribution had only an increased risk for abnormal neurobehavioral performance area in state organization compared with controls (30 vs. 17.5%; adjusted P = 0.021). Conclusion In term SGA newborns with no signs of brain-sparing, ACA Doppler investigation does not provide any benefit over MCA in terms of the prediction of adverse perinatal outcome. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]