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To evaluate the timing of antenatal corticosteroids (ACS) administration in relation to the delivery timing based on indications and risk factors for preterm delivery. We conducted a retrospective cohort study to understand what factors predict the optimal timing of ACS administration (ACS administration within seven days). We reviewed consecutive charts of adult pregnant women receiving ACS from January 1, 2011, to December 31, 2019. We excluded pregnancies under 23 weeks, incomplete and duplicate records, and patients delivered outside our health system. The timing of ACS administration was categorized as optimal or suboptimal. These groups were analyzed regarding demographics, indications for ACS administration, risk factors for preterm delivery, and signs and symptoms of preterm labor. We identified 25,776 deliveries. ACS were administered to 531 pregnancies, of which 478 met the inclusion criteria. Of the 478 pregnancies included in the study, 266 (55.6 %) were delivered in the optimal timeframe. There was a higher proportion of patients receiving ACS for the indication of threatened preterm labor in the suboptimal group as compared to the optimal group (85.4 % vs. 63.5 %, p<0.001). In addition, patients who delivered in the suboptimal timeframe had a higher proportion of short cervix (33 % vs. 6.4 %, p<0.001) and positive fetal fibronectin (19.8 % vs. 1.1 %, p<0.001) compared to those who delivered in the optimal timeframe. More emphasis should be placed on the judicious use of ACS. Emphasis should be placed on clinical assessment rather than relying solely on imaging and laboratory tests. Re-appraisal of institutional practices and thoughtful ACS administration based on the risk-benefit ratio is warranted. [ABSTRACT FROM AUTHOR]

Aim: In this study, we aimed to investigate the role of systemic immune‐inflammation index (SII) and other inflammatory parameters in the diagnosis of placenta accreta spectrum (PAS) and its histological subtypes. Methods: This retrospective case–control study included patients who underwent surgery for placenta previa (PP). Case group (patients with PAS) included pregnant women diagnosed with histologically confirmed PAS, whereas control group (patients with PP) included pregnant women who underwent cesarean section with a PP diagnosis, required no additional intervention during the operation. Both groups were compared with respect to their demographic data, clinical characteristics, SII, and other laboratory parameters. Cut‐off values that can predict PAS were calculated. The PAS group was separated into subgroups based on histology findings, and inflammatory parameters were compared between subgroups. Results: In this study, data of 273 patients were analyzed. Of these, 68 (24.9%) were included in the PAS group and 205 (75.1%) patients were included in the PP group. Significant differences were observed in SII, platelet distribution width, mean platelet volume, neutrophil‐to‐lymphocyte ratio, and platelet‐to‐lymphocyte ratio (p = 0.000, p = 0.006, p = 0.002, p = 0.000, and p = 0.000, respectively). The best SII cut‐off value was 985.02109/L (57.4% sensitivity and 72.2% specificity). There was no significant association between the histologic subtypes of PAS and inflammatory parameters. Conclusion: SII can be used to predict PAS in pregnant women with PP. The relationship between the histologic subtypes of PAS and inflammatory parameters should be investigated in more comprehensive studies. [ABSTRACT FROM AUTHOR]

Prenatal trisomy 21 (T21) screening commonly involves testing a maternal blood sample for fetal DNA aneuploidy. It is reliable but poses a cost barrier to universal screening. We hypothesized maternal plasma RNA screening might provide similar reliability but at a lower cost. Discovery experiments used plasma cell-free RNA from 20 women 11–13 weeks tested by RNA and miRNA microarrays followed by qRT-PCR. Thirty-six mRNAs and 18 small RNAs of the discovery cDNA were identified by qPCR as potential markers of embryonic T21. The second objective was validation of the RNA predictors in 998 independent pregnancies at 11–13 weeks including 50 T21. Initial analyses identified 9–15 differentially expressed RNA with modest predictive power (AUC < 0.70). The 54 RNAs were then subjected to machine learning. Eleven algorithms were trained on one partition and tested on an independent partition. The three best algorithms were identified by Kappa score and the effects of training/testing partition size and dataset class imbalance on prediction were evaluated. Six to ten RNAs predicted T21 with AUCs up to 1.00. The findings suggest that maternal plasma collected at 11–13 weeks, tested by qRT-PCR, and classified by machine learning, may accurately predict T21 for a lower cost than plasma DNA, thus opening the door to universal screening. [ABSTRACT FROM AUTHOR]

Background: Although the Oral Glucose Tolerance Test (OGTT) is routinely recommended during pregnancy, the number of people who have the test is decreasing. Failure to perform the OGTT poses a risk for both mother and baby health. Objective: This study was conducted to investigate the effects of the education given on the Oral Glucose Tolerance Test in the first antenatal follow-up of pregnant women on having the test. Methodology: In this study, 385 pregnant women (192 in the control group and 193 in the education group) were included. The present study was designed as a quasi-experimental study. The education group was provided with comprehensive education on the oral glucose tolerance test by the researcher after the questionnaire and then an education brochure on the oral glucose tolerance test. The pregnant women in both groups were contacted by phone between the 30th and 37th weeks of pregnancy and were asked whether they had the test or not. In data analysis, descriptive statistics, Chi-square independence test and Binary regression analysis were conducted. Results: Before the education, most pregnant women in both groups would not have OGTT in their current pregnancy (p>0.05). In the second interview after the education, 79.3% of the participants in the education group had oral glucose tolerance test, whereas only 38.5% of the participants in the control group had oral glucose tolerance test (p<0.05). The binary regression analysis results showed that the rate of having oral glucose tolerance test was higher in those with high school and university education (p<0.05). Conclusion: The findings indicated that the education provided using written, verbal, and visual methods based on scientific evidence in the first antenatal follow-ups increased the rate of having oral glucose tolerance test during pregnancy. [ABSTRACT FROM AUTHOR]

Prenatal trisomy 21 (T21) screening commonly involves testing a maternal blood sample for fetal DNA aneuploidy. It is reliable but poses a cost barrier to universal screening. We hypothesized maternal plasma RNA screening might provide similar reliability but at a lower cost. Discovery experiments used plasma cell-free RNA from 20 women 11–13 weeks tested by RNA and miRNA microarrays followed by qRT-PCR. Thirty-six mRNAs and 18 small RNAs of the discovery cDNA were identified by qPCR as potential markers of embryonic T21. The second objective was validation of the RNA predictors in 998 independent pregnancies at 11–13 weeks including 50 T21. Initial analyses identified 9–15 differentially expressed RNA with modest predictive power (AUC < 0.70). The 54 RNAs were then subjected to machine learning. Eleven algorithms were trained on one partition and tested on an independent partition. The three best algorithms were identified by Kappa score and the effects of training/testing partition size and dataset class imbalance on prediction were evaluated. Six to ten RNAs predicted T21 with AUCs up to 1.00. The findings suggest that maternal plasma collected at 11–13 weeks, tested by qRT-PCR, and classified by machine learning, may accurately predict T21 for a lower cost than plasma DNA, thus opening the door to universal screening.

Purpose: To assess the gestational course and postnatal outcome of antenatally diagnosed choroid plexus cysts.Methods: From January 2015 to October 2017, mothers carrying foetuses with choroid plexus cysts (CPCs) were followed up prospectively till delivery, and subsequent postnatal assessment of all the babies was done. Progress of the lesions was monitored during pregnancy with ultrasound (USG) scans and postnatally analysed with clinical assessment and USG examination of the cranium.Results: A total of 67 mothers of antenatally diagnosed CPCs were referred to the Paediatric Surgery Unit for opinion. Mean gestational age at the time of diagnosis was 19 ± 2.1 weeks (17-28 weeks) while mean age of the mothers at the time of referral was 26 ± 3.3 years (19-35 years). Sixty four mothers have undergone repeat antenatal scans after the diagnosis, and the CPCs disappeared completely in 60 (93.8%) of them. The CPCs persisted but reduced in size in 2 (4.1%), and the other 2 have been lost to follow-up. Thirty eight patients (56.7%) have unilateral CPCs. Mean size of cysts is 6.08 ± 3.0 mm (2.4‑14.8 mm). One foetus, in which the CPC disappeared antenatally, developed it again on the postnatal scans, but is doing well on follow-up. Thirteen babies (19.4%) have other associated congenital malformations as well.Conclusions: CPCs may involve one or both ventricles and disappear in approximately 95% of the cases, mostly within 2 months from the diagnosis. The size of the cyst has no relation to its rate of disappearance. Postnatal persistence of CPCs is uncommon and the neurological sequel is unlikely; hence, prospective parents should be reassured accordingly. [ABSTRACT FROM AUTHOR]

INTRODUCTION The consequences of de novo balanced structural chromosome aberrations diagnosed antenatally are unpredictable, and, as a result, they introduce uncertainty into genetic counseling decisions. OBJECTIVE Describe de novo balanced structural aberrations present at antenatal diagnosis in samples from pregnant women in five Latin American countries and determine their effect on carrier individuals. METHODS This was a retrospective observational study based on analysis of 109,011 antenatal tests conducted from January 1981 to December 2016 in Cuba, Uruguay, Costa Rica, Mexico, and Colombia. Thirteen cytogenetic laboratories provided information that included the cases analyzed during the study period; number of de novo balanced structural aberrations diagnosed antenatally; number of diagnoses with de novo balanced structural aberrations that resulted in termination of pregnancy; detailed descriptions of the karyotypes of de novo balanced structural aberration carriers, and descriptions of the form of diagnosis, including types of samples used (amniotic fluid, chorionic villus or fetal blood). Each laboratory also provided pathology reports and genetic counseling at time of diagnosis. Postnatal followup for pregnancies carried to term continued for at least two years. RESULTS Of the 109,011 antenatal tests studied, 72 (0.07%) showed de novo balanced structural aberrations. These events primarily involved chromosomes 1, 2, 7, 14, 18, and 20. Of the 79 breakpoints identified, the most common were 5p15.3, 7q11.2, 7q22, and 14q24. We identified three breakpoints corresponding to 3.8% (3q13.1, 3q13.2, and 9p12) that were not reported in other studies of de novo balanced structural aberrations diagnosed antenatally in patients from other geographic regions or in studies of chromosomal fragile sites. Two of these breakpoints (3q13.1 and 3q13.2) were associated with high risk of phenotypic abnormalities. Information on antenatal or postnatal followup was available for 62 (86%) of de novo balanced structural aberration carriers; of the 44 carriers with postnatal followup, 10 had phenotypic abnormalities. CONCLUSIONS Three new de novo breakpoints were identified, presumably related to genetic admixture characteristics in Latin America. Since some diseases associated with de novo balanced structural aberrations detected antenatally have a late onset, followup for at least two years is recommended for carriers of these aberrations. The information in this study is useful in genetic counseling for pregnant women in Latin America. [ABSTRACT FROM AUTHOR]

Background Pregnancy can be a stressful time for many women. There is ample evidence of numerous physical and mental health inequities for Indigenous Australians. For those Indigenous women who are pregnant, it is established that there is a higher incidence of poor physical perinatal outcomes when compared with non-Indigenous Australians. However, little evidence exists that examines stressful events and post-traumatic stress disorder ( PTSD) symptoms in pregnant women who are members of this community. Aims To quantify the rates of stressful events and PTSD symptoms in pregnant Indigenous women. Methods One hundred and fifty rural and remote Indigenous women were invited to complete a survey during each trimester of their pregnancy. The survey measures were the stressful life events and the Impact of Events Scale. Results Extremely high rates of PTSD symptoms were reported by participants. Approximately 40% of this group exhibited PTSD symptoms during their pregnancy with mean score 33.38 (SD = 14.37) significantly higher than a study of European victims of crisis, including terrorism attacks (20.6, SD = 18.5). Conclusions The extreme levels of PTSD symptoms found in the women participating in this study are likely to result in negative implications for both mother and infant. An urgent response must be mounted at government, health, community development and research levels to address these findings. Immediate attention needs to focus on the development of interventions to address the high levels of PTSD symptoms that pregnant Australian Indigenous women experience. [ABSTRACT FROM AUTHOR]

Objective: in the UK, midwives are facing a policy-drive to include men in antenatal care, and men will soon receive paternity leave to enable their involvement. As a result, more men will be able to attend screening, support women and participate in decision-making. We therefore conducted a timely exploration of what being involved means for men and what they want from antenatal screening and midwives. Design and setting: in-depth, semi-structured interviews with 12 men were carried out, mostly by telephone. Data were analysed using grounded theory. Findings: we constructed three themes and showed that (1) in normal pregnancies, men knew little about screening, and were happy for midwives to take control during appointments, (2) in complicated pregnancies, men wanted to be more actively involved but some perceived that they faced suspicions of being coercive if voicing opinions, and (3) over time, men became more adept at communicating with midwives, but some disengaged from screening because of poor communication with midwives and/or a lack of faith in the benefits of screening. Conclusion: findings build on other studies to highlight the multiplicity of roles men play during screening. For men and women to reap the benefits of men's involvement in antenatal screening, good communication is required between midwives and couples. Communication training could help to improve care delivery and the relationships between men, women and midwives. [ABSTRACT FROM AUTHOR]

Cavernous hemangioma of the uterus may be either localized presenting as an endometrial polyp or a uterine mass mimicking myoma, or as a diffuse mass in which most of the uterine wall is composed of enlarged vascular spaces replacing the normal myometrium. It is usually asymptomatic, but can present with menometrorrhagia and infertility in gynecological practice, and intra or postpartum bleeding or thromboembolism in obstetric patients. Diffuse cavernous hemangioma can be seldom, identified during routine antenatal ultrasonographic examination as the thickened uterine wall composed of cavernous fluid-filled spaces with turbulent flow. We present an antenatally diagnosed case of diffuse cavernous hemangioma in which the fetus was severely growth-restricted. Caesarean section was performed successfully without any intra or postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

Aim: To identify the significance of associated antenatal ultrasound findings on long-term prognosis following the antenatal diagnosis of cleft lip/palate [CL(P)]. Patients and methods: Retrospective case note analysis of patients seen at a single tertiary referral centre with a diagnosis of CL(P). The patients were classified as those with unilateral or bilateral clefts and then further subdivided according to the presence of associated anomalies, and these were related to pregnancy and neonatal outcome. Results: A total of 125 singleton pregnancies were seen at the antenatal diagnostic unit, 14 of which were subsequently lost to follow-up. Eighty-two (65.6%) had a diagnosis of unilateral CL(P) and 43 (34.4%) a bilateral CL(P). Seventy-five foetuses (67.5%) had no other anomalies detected on antenatal ultrasound. Seventeen patients (15%) underwent a termination of pregnancy. A normal postnatal outcome was seen in 79% of liveborn infants overall. Only 50% of foetuses diagnosed with a single minor anomaly and 4% of the foetuses in whom more than two minor anomalies or one major anomaly had been detected on ultrasound had a normal postnatal outcome. Infants with bilateral CL(P) had a significantly reduced incidence of a normal postnatal course (60% vs. 87.5%, P<0.01). Conclusion: In cases of CL(P), there is a high incidence of associated anomalies detected on antenatal ultrasound and these significantly increase the risk of poor neonatal outcome. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate brief communication skills training for healthcare professionals (HCPs) in offering antenatal sickle cell and thalassaemia (SCT) screening in primary care. Design: Descriptive study within a cluster randomised controlled trial in 17 inner city practices. Methods: 126 HCPs were invited to attend a training session. Outcome measures were: attendance; perceived usefulness of training; comfort and confidence in offering screening; offering screening at pregnancy confirmation consultations; gestational age at test uptake. Results: 62% (78/126) HCPs attended training and 61 completed both pre- and post-training questionnaires. There were 49 new joiners and locums not in post at the start of the trial. After training, HCPs reported greater comfort [4.8 vs 5.4, p =0.05] and confidence [4.6 vs 5.6, p <0.001] in offering screening. Pregnant women consulting trained HCPs were offered screening more frequently and at an earlier gestational age than those consulting untrained HCPs (75% vs 44%, χ 2 =122, p <0.001; 91.5 days (attending training) vs 98.5 days (did not attend training) vs 101.8 days (new joiners and locums), F =8.49, df 1069,2 p =0.001). Conclusion: Brief communication skills training for HCPs in offering antenatal SCT screening in primary care is feasible and can be effective. Practice implications: Ways of maximising HCP attendance in training sessions requires consideration. [Copyright &y& Elsevier]

Purpose: Congenital cystic adenomatoid malformations (CCAMs) are increasingly diagnosed in recent years due to the routine usage of antenatal ultrasound. The aim of this study was to present the natural course and outcome of antenatally diagnosed cystic lung diseases, which were prospectively studied.Methods: Between the period June 2004 and June 2010, 25 fetuses with suspected CCAMs were seen in a single tertiary maternal fetal unit. One child was excluded as the fetal MRI suggested congenital diaphragmatic hernia. Data were prospectively entered into a database including antenatal and postnatal findings which were then analyzed.Results: Mean gestational age at the time of diagnosis was 20.8 weeks (range 17-29). Fetal interventions included amnioreduction (n = 2) and fetal thoracocentesis (n = 3) in one child. The mean gestational age at delivery was 38.5 weeks (range 31.6-40.6). None of the mothers underwent termination of pregnancy or spontaneous abortion. All patients underwent postnatal radiological assessment. Of the 24 cases, 5 children were symptomatic in the immediate neonatal period and 19 were asymptomatic. Anatomical surgical resection was undertaken in all symptomatic cases. There was one death in this group due to severe pre-existing pulmonary hypoplasia. Among the 19 asymptomatic cases, 5 children were managed conservatively as the lesions were not significant and the remaining 14 (73%) underwent surgical resection. The mean age at surgery was 11.1 months (range 3.3-34 months). Postnatal pathology confirmed CCAM in all operated cases, except one who had pulmonary sequestration.Conclusion: Antenatally diagnosed CCAMs have an excellent prognosis except in children with a large lesion and associated with lung hypoplasia. Postnatal investigations are required in all cases to confirm the diagnosis. Symptomatic CCAMs require immediate surgery in the neonatal period with a good outcome. Asymptomatic CCAMs can be safely operated between 9 and 12 months of age. [ABSTRACT FROM AUTHOR]

This review explores what is already understood about antenatal diagnosis of a variety of conditions, including Down syndrome, what progress has been made in this field, the role that imaging plays in the diagnostic pathway and the impact on management of pregnancies and the parental decision process. An overview of future potential developments is also made. [ABSTRACT FROM AUTHOR]

Abstract: Pregnancy is an important stage in processes of the woman''s identity structuring. During this so particular period of her life the woman shows an important “psychic transparency”, that also signs a psychic vulnerability. The arising of a suspicion on her child''s integrity to come reaches her representation''s models and trouble her interactions with the child descended of this pregnancy and by this slant this child''s development. Objectives, population and methods: In order to put in evidence these disruptions, we followed two groups of women: a presenting a “pregnancy supervised” following a suspected scan, the other without echographic anomaly, during the last quarter of pregnancy, to the childbirth and the child''s two months. Results: We present the first results of this survey. During pregnancy, mother described a suspension of infant investment, with perturbation of foetus'' representation. At the birth, the infant-mother meeting is tense. The dyad is not well dynamic. Mother is anxious and this anxiety increase across the time. Conclusion: Nevertheless, it seems that a preventive taking in charge during of the pregnancy associated with a medical follow up of that suspected anomaly could help to avoid that “diversion” of the maternal psychic mechanism, all the more so since maternity makes women more psychically approachable. [Copyright &y& Elsevier]

Summary: Laryngeal mucous cysts are rare congenital malformations of the upper aero-digestive tract. We report one case of a ductal cyst developed in the supraglottic area. The diagnosis of an antenatal malformation was suspected on the basis of a hydramnios development during pregnancy. Ultrasound scan showed a cervical anechogen mass. This led to a fetal MRI which showed the cyst extension. A management of delivery had to be prepared due to the risk of air obstruction at the birth. The treatment consisted of a marsupialization of the cyst under laryngo-endoscopic surgery. Six months follow-up showed no recurrence. [Copyright &y& Elsevier]

Objective: To compare antenatal diagnoses with autopsy findings in pregnancies terminated after ultrasound detection of fetal anomalies. A second aim was to study the quality of antenatal fetal diagnosis over time. Design: Retrospective, multicenter study over two consecutive six-year periods in Uppsala and Stockholm. Setting: Cases were identified through fetal autopsy reports. Subjects: Three hundred and twenty-eight fetuses from pregnancies terminated between 1992 and 2003 because of ultrasonographically diagnosed anomalies. Main Outcome Measures: The findings at the last ultrasound examination were compared with the autopsy reports. Results: In 299 cases (91.2%) ultrasound findings either exactly matched or were essentially similar to the autopsy findings. In 23 cases (7%) ultrasound findings were not confirmed at autopsy, but the postnatal findings were at least as severe as the antenatal ones. In six cases (1.8%) termination was performed for an anomaly which proved to be less severe than was predicted by ultrasound. The number of such cases was the same in both six-year periods, while the total number of cases increased from 113 in the first to 215 in the second period. Fetal examination provided further diagnostic information in 47% of the cases. In 10% a syndrome was disclosed. Conclusion: Termination of pregnancy was not always based on a correct antenatal diagnosis. All fetuses but one from terminated pregnancies had evident anomalies. In six cases (1.8%) the decision to terminate was based on suboptimal prognostic and diagnostic information. Fetal autopsy by an experienced perinatal pathologist is essential to provide a definitive diagnosis. [ABSTRACT FROM AUTHOR]

Objectives To assess the feasibility of detecting the cord insertion site during the late first trimester, and to investigate the possible association between perinatal complications and a cord insertion in the lower third of the uterus in the first trimester. Methods This was a prospective cohort study in which the positional relationship between the uterus and the cord insertion site was examined using gray-scale transvaginal sonography at 9-11 weeks of gestation. The distance between the internal os and the fundus was divided equally into three parts. Cord insertions located in the upper or middle thirds were defined as normal (controls), and those located in the lower third were defined as cases, regardless of their relationship to the chorion villosum. Third-trimester sonography and pathological examination of the placenta and cord at delivery were performed to check for placental/cord abnormalities. The univariate association between the location of the cord insertion in the first trimester and placental and umbilical cord abnormalities and perinatal complications was assessed. Results The cord insertion site was identified in 318/340 (93.5%) cases at 9-11 weeks of gestation and it was in the lower third of the uterus in 35 (11.0%) cases. Of these 35, the cord insertion was found at delivery to be low in nine cases (26%) and the placenta was low-lying at delivery in eight (23%). None of the 283 cases with a normal cord insertion in the first trimester was found to have a low-lying placenta at delivery (P < 0.0001). Ten (29%) of the cases with a low cord insertion and four (1.4%) with a normal cord insertion in the first trimester had a velamentous or marginal cord insertion at delivery (P < 0.0001). At delivery, five (14%) of the low cord insertion cases and four (1.4%) of the normal cord insertion cases (P < 0.0001) had some form of placental malformation, including accessory placenta and infarction of the placenta. An emergency Cesarean section was performed in four (11%) and six (2.1%) of the low and normal cord insertion cases, respectively (P = 0.003). Conclusion Developmental abnormalities of the placenta and umbilical cord occur frequently in cases in which the cord insertion is in the lower third of the uterus in the first trimester. We suggest that screening for the cord insertion site at 9-11 weeks of gestation may have clinical significance for predicting abnormalities of the cord and the placenta at delivery. [ABSTRACT FROM AUTHOR]

Objective:Although prenatal ultrasound (US) is a common clinical undertaking today, little information is available about women's experience of the procedure from the perspective of women themselves. The objective of this study was to explore women's experience of undergoing a routine prenatal US examination associated with an unexpected fetal diagnosis.Study Design:Qualitative methods were used to explore the prenatal US experience of 13 women. Five women were given unexpected news of multiple pregnancy and eight women were given unexpected news of congenital fetal abnormality. One in-depth audio-taped interview was conducted with each woman. Content analysis of interview data identified themes common to women's experience of US.Results:Identified themes of women's experience of routine prenatal US examination associated with an unexpected fetal diagnosis are: experiencing the setting, sensing information, feeling connected/disconnected, the power of the image, and communication rules.Conclusions:Women's experience of prenatal US examination is influenced by physical and environmental factors and by the behaviors of the US examiner. Behaviors of the examiner contribute to a woman's labeling of the US experience as positive or negative. Women identify being objectified by the examination and experience poor communication patterns after a fetal US diagnosis. Women's description of the US screen image as a baby suggests it is a powerful influence on subsequent clinical and ethical decision-making about the pregnancy.Journal of Perinatology (2006) 26, 403–408. doi:10.1038/sj.jp.7211540 [ABSTRACT FROM AUTHOR]

Abstract: Fetal teratomas are commonly found in the sacrococcygeal area. More rarely, these tumors may be found in cervicofacial forms. Rhinopharyngeal teratoma represent an extremely rare congenital tumor, often resulting in intracranial extension, obstruction of the respiratory or the digestive pathways and rapid asphyxia following birth. We report a case of rhinopharyngeal teratoma identified in a foetus at 18 weeks of gestation. The diagnosis was made by antenatal ultrasound and IRM. Tumor invaded the cavum and the right infratemporal region with no intracranial extension. The pregnancy was interrupted at 27 weeks of gestation. Authors discuss the difficulties to establish antenatal diagnosis by ultrasound, and those to decide what treatment to carry out. [Copyright &y& Elsevier]

Objectives To evaluate the accuracy of sonographic identification of the site of umbilical cord insertion (CI) at 18–20 weeks of gestation, to compare the sensitivities for detection of a velamentous cord insertion (VCI) secondary to a CI into the anterior, posterior or fundal wall, and to compare the intrapartum complications secondary to VCI into the upper, middle or lower third of the uterus. Methods As part of the routine ultrasound scan at 18–20 weeks' gestation we evaluated abnormal CI (VCI and marginal CI) and the location of the CI in the uterus in 3446 pregnancies. In cases of abnormal CI, the location of the CI was further classified as being in the upper, middle or lower third of the uterus. After delivery, the placenta and the umbilical cord were examined and intrapartum complications were compared with the location of the CI. Results The values for antenatal detection of VCI were: sensitivity, 25 of 40 (62.5%); positive predictive value, 25 of 25 (100%); and negative predictive value, 3406 of 3421 (99.6%). The sensitivity for cases in which the CI was located on the anterior wall was 12 of 13 (92.3%); when it was located on the posterior wall, the sensitivity was 11 of 22 (50.0%); and when it was fundal the sensitivity was 2 of 5 (40.0%). Variable decelerations were frequently observed with a VCI. In lower VCI cases, non-reassuring fetal heart rate patterns and emergency Cesarean sections occurred with a higher frequency than in cases with upper or middle VCI (P < 0.01). After delivery, the length of the aberrant vessels in cases of VCI by pathologic examination was 3.9 ± 3.3 cm in the upper third, 4.7 ± 4.6 cm in the middle third, and 10.6 ± 6.8 cm in the lower third; thus, the aberrant vessel length was significantly greater when the CI was in the lower third of the uterus (P = 0.024). Conclusion We have demonstrated that VCI with a lower CI site and with longer aberrant vessels is associated with various intrapartum complications. This finding has the potential for improving perinatal outcome. [ABSTRACT FROM AUTHOR]

This retrospective study reviews the medical records of 77 fetuses and babies with congenital diaphragmatic hernia (CDH) referred to two hospitals in Detroit from 1986 through 2000. The aims were to examine the effects on outcome of multiple variables, especially the type of CDH, associated anomalies, and ultrasound prognostic parameters. Ultrasound measurements of head (HC), chest (CC), and abdominal circumferences (AC) were obtained from videotapes. ANOVA and chi-square analysis were used to determine statistical significance between groups and proportions. Eighty-nine percent (65/73) of pregnancies resulted in live births, and 54% (35/65) of patients survived past 30 days. Liveborn patients with low APGAR scores were less likely to survive. Forty-three percent (30/70) had major associated anomalies, with cardiac anomalies constituting about 52% (33/64) of the major associated anomalies. Seventy percent of patients with isolated CDH survived versus 36% of patients with both CDH and cardiac anomalies. Sixty-seven percent (8/12) of fetuses antenatally diagnosed before 25 weeks of gestation survived past 30 days of birth. The survival rate of right-sided CDH with liver herniation was 80% (8/10), compared with 29% (4/14) for left-sided CDH with liver herniation (p=0.088). There was a significant linear relationship (r=0.603, p =0.029) between CC/AC and CC/HC among patients with CDH; survivors had higher CC/AC and CC/HC values than nonsurvivors. These results support the utility of CC/AC and CC/HC measurements and the presence of liver herniation as important prognostic factors that can be used in antenatal counseling and in planning clinical trials. [ABSTRACT FROM AUTHOR]

Authors report a case of abdominal pregnancy diagnosed by MRI at 17 SA with prospective follow-up and planned delivery at 37 SA. The diagnosis is clinically suspected when extra-uterine pregnancy risk factors or history of uterine trauma are present. This is confirmed by MRI, which may be considered as the gold standard. A conservative management may be proposed when the diagnosis is made after 20 weeks and under the following conditions: absence of fetal growth malformation, placental implantation remote from the upper abdomen, good maternal condition, close management in a hospital setting of the patient previously informed of the risks and outcomes. Placental location on the uterus seems to be a major positive factor of outcome for these pregnancies. Materno-fetal follow-up is based on physical examination, repeated ultrasonic investigations with Doppler imaging and daily fetal heart rate monitoring. In the absence of complications, a laparotomy should be planned at 34 weeks. The placenta may not be removed when a serious risk of hemorrhage is feared. [Copyright &y& Elsevier]

Fœtal and neonatalogical services recognize now that the elder''s psychological problems came first and must be charge taken by a pluridisciplinary team. The practice of a medical interruption of pregnancy puts the mother in a situation of great guilt. The fœtus represents the child''s promise with all of it''s investissments. The psychologist cannot reduce the sadness, the effraction is unavaidable. The accompanying should reduce the effects of the effraction on the psychic life of these families. [Copyright &y& Elsevier]

Aim: Talipes is a congenital anomaly that can be corrected conservatively or surgically. Despite advances in management, a proportion of pregnancies still result in termination. We therefore aimed to establish the birth prevalence, interventions and outcome of talipes in our population. Methods: Cases with foetal talipes were identified from the ultrasound register at the James Cook University Hospital between 1990 and 2006. Infants with congenital talipes between 1998 and 2006 were identified from the physiotherapy database. Management details were obtained from case records. Results: A total of 46 cases with foetal talipes were identified among 75 933 pregnancies. Of the 34 live-born infants, 24 (70.5%) required surgery to correct the talipes. Congenital talipes was found in 69 infants, giving a birth prevalence of 2 per 1000 live births. Sixteen (72.7%) infants with an antenatal diagnosis required surgical correction. Infants with an antenatal diagnosis were at an increased risk of requiring surgery (relative risk [RR]= 1.6). Conclusion: Surgical management was required in more than two-thirds of babies with foetal talipes. Conservative management was successful in the majority of the babies without an antenatal diagnosis. Infants with an antenatal diagnosis are 1.6 times as likely to need surgical correction as infants without an antenatal diagnosis. [ABSTRACT FROM AUTHOR]

Introduction. Fetal abdominal masses represent a wide spectrum of pathological entities, which may represent important causes of morbidity or may develop asymptomatically until they disappear, without significant sequelae. Methodology. We present a series of seven cases followed in the Clinic of Obstetrics-Gynecology of the “Dr. I. Cantacuzino” Clinical Hospital during the period 1.03.2015 – 1.02.2020, when intraabdominal cystic formations during pregnancy were detected ultrasonographically. The patients were followed-up antenatally through serial ultrasound, and all cases benefited from multidisciplinary counseling (neonatologist, pediatrician and obstetrician). In cases where the formation persisted post-natally, the newborns benefited from postnatal follow-up. Results. During the period 1.03.2015 – 1.02.2020, seven pregnant women, aged between 20 and 35 years old, were followed-up, during which fetal intraabdominal cystic formations were detected during pregnancy. In all seven cases, the diagnosis was made during the second or third trimester. Out of the seven cases, six fetuses presented ovarian cysts out of which: four cases with cystic formation of over 5 cm – two benefited from surgical intervention; two cases with cystic formations below 5 cm with spontaneous antenatal regression; one case presented a cystic formation <5 cm, located on the median line – urachal cyst, in dimensional regression up to 7 mm at 37 weeks. Two of the four cases that had ovarian cyst >5 cm associated other ultrasound anomalies – one of the two fetuses presented unilateral renal agenesis and the other one associated a renal cyst formation (simple renal cyst) in dimensional regression during pregnancy. Conclusions. The intraabdominal cystic lesions revealed antenatally in the fetus represent a vast pathology, with different embryological origin and evolution. In the experience of our clinic, most asymptomatic cases develop favorably, without significant sequelae, only the fetuses with large, complicated cystic formations, benefiting from postnatal surgical treatment. [ABSTRACT FROM AUTHOR]

Fetal cardiac defects leading to intrauterine cardiac failure and subsequent fetal hydrops are rare. We report an unusual case of a double-chamber right ventricle leading to progressive fetal cardiac insufficiency and hydrops. The patient was first managed conservatively. Delivery by Cesarean section was performed for a pathological fetal heart-rate tracing at 28 weeks of gestation. The newborn died 4 h postpartum due to generalized cardiac insufficiency. [ABSTRACT FROM AUTHOR]

The article focuses on the genetic counseling of parents of children with cystic fibrosis (CF) and the antenatal diagnosis of the condition. It still appears to be pregnancy which concentrates the pediatrician's and parents' minds to request urgent genetic counseling. This type of counseling might include a reminder of the recurrence risk and the potential variability of CF. The technique of chorionic biopsy is described to couples who are considering antenatal diagnosis.