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Objective: To describe the prenatal imaging features enabling diagnosis of developmental venous anomalies (DVA). Methods: Four fetuses with unexplained persistent echogenic parenchymal brain lesions were studied. The evaluation included dedicated neurosonography, fetal MRI, serology for intrauterine infection, screening for coagulation abnormalities, and chromosomal microarray. Postnatal neurodevelopmental follow-up or autopsy results were assessed. Results: DVA presented as very slowly growing echogenic brain lesions without cystic components, calcifications, or structural changes on otherwise normal neurosonographic scans performed at 2- to 3-week intervals. A specific Doppler feature was a collecting vein draining the echogenic parenchyma. Fetal brain MRI depicted normal anatomy on half-Fourier acquisition single-shot turbo spin-echo and diffusion-weighted imaging. The rest of the evaluation was normal. Conclusions: In cases with a persistent, parenchymal echogenic lesion without clastic or structural changes, DVA should be considered. Demonstration of a collecting vein draining the lesion and normal brain anatomy on MRI confirm the diagnosis.

Objective: To examine the influence of epidural analgesia on labor and delivery in nulliparous and multiparous women. Design: Data were collected on 847 consecutive parturients with singleton pregnancy and vertex presentation (384 nulliparous and 463 multiparous). The obstetrical and labor characteristics including maternal age, parity, gestational age, previous cesarean section, instrumental delivery, mode and timing of analgesia, mode of delivery, indications for cesarean section or instrumental delivery were analyzed comparing patients who received epidural analgesia with women who received systemic analgesia. Results: Epidural analgesia was administered in 233 nulliparous and 141 multiparous women. A stepwise logistic regression analysis revealed that epidural analgesia independently affected the rate of non-spontaneous delivery and the duration of the second stage of labor in nulliparous (P=0.0017 and P=0.0036, respectively) and multiparous (P=0.001 and P=0.0081, respectively) women. Epidural analgesia independently affected the duration of labor only in nulliparous women (P=0.0001). Conclusion: Women should be informed that prolongation of labor and increase in nonspontaneous deliveries should be expected when choosing epidural analgesia in labor.

Objective To study the implications of early fetal cardiac scanning immediately following an abnormal nuchal translucency (NT) examination. Methods Fetal cardiac scanning was performed immediately after an increased NT was observed. Scans were performed transvaginally at 11 to 14 weeks. Fetal echocardiography was repeated between 14 and 24 weeks in continuing pregnancies, or when the cardiac scanning appeared normal at 11 to 14 weeks. Results We performed 2513 NT examinations. An abnormal NT was observed in 135 (5.4%) patients. In addition, 65 patients with an abnormal NT were referred to us for fetal cardiac scanning from other offices. Overall, we performed 200 fetal cardiac scans between 11.2 and 13.5 weeks for an abnormal NT examination. Twelve major fetal cardiac anomalies were diagnosed between 12 and 13.5 weeks. Seven patients (58%) terminated pregnancy between 12 and 14 weeks without performing chorionic villous sampling (CVS). Five patients asked for chromosomal analysis before deciding about their pregnancy. Fetal cardiac anomalies were suspected in six additional cases, but only one of them was diagnosed. Another five minor and one major fetal cardiac anomaly were suspected at 11 to 14 weeks but diagnosed later on fetal echocardiography. Conclusion Major fetal cardiac anomalies can be detected immediately following an abnormal NT examination and be useful for the patients' decisions about the management of their pregnancy. Copyright © 2008 John Wiley & Sons, Ltd.