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Background: Preeclampsia (PE) and intrauterine growth restriction (IUGR) are major causes of maternal and perinatal morbidity and mortality. Previous studies have shown that intervention with low-dose aspirin resulted in a reduction in the occurrence of preterm PE. However, no data are currently available on the effect of low-molecular-weight heparin (LMWH) for the prevention of pregnancy complications in women enrolled at first trimester screening. Objective: We aimed to assess the effectiveness of LMWH in the prevention of PE, IUGR, fetal death, and abruptio placentae in women classified as high risk based on their medical history and in women selected by first trimester screening of PE. Study ­Design: This was a multicenter, randomized, open-label, parallel controlled trial in women without thrombophilia between 6.0 and 15.6 weeks of gestation. Inclusion criteria were severe PE or IUGR before 34 weeks of gestation and/or abruptio placentae or unexplained intrauterine death in a previous pregnancy; uterine artery mean pulsatility index Doppler >95th percentile and/or positive first trimester screening for PE. Pregnant women were randomly assigned to receive no intervention or LMWH until the 36th week of gestation. The primary composite outcome consisted of 1 or more of the following: development of PE, IUGR, abruptio placentae, and intrauterine fetal death. Results: A total of 278 pregnant women were randomly allocated to receive LMWH (n = 134) or no intervention (n = 144). Overall, 115 (41%) women experienced placental insufficiency complications, with no significant differences between the 2 arms: 50/144 (34.7%) in the LMWH arm and 43/134 (32%) in the control arm (p = 0.64, OR: 1.13, 95% CI: 0.68–1.85). Conclusion: LMWH did not reduce the incidence of placenta-mediated complications either in women with previous adverse obstetric history without thrombophilia or in women selected by first trimester screening for PE. Based on these results, we cannot recommend the use of LMWH alone in women at risk of placental complications.

Introduction: Forty percent of Down syndrome (DS) fetuses have congenital heart defects (CHD). An abnormal angiogenic environment has been described in euploid fetuses with CHD. However, the underlying pathophysiologic pathway that contributes to CHD in DS remains unknown. The objective was to compare the expression of angiogenic factors and chronic hypoxia genes in heart tissue from DS and euploid fetuses with and without CHD. Methods: The gene expression profile was determined by real-time PCR quantification in heart tissue from 33 fetuses with DS, 23 euploid fetuses with CHD and 23 control fetuses. Results: Angiogenic factors mRNA expression was significantly increased in the DS group compared to the controls (soluble fms-like tyrosine kinase-1, 81%, p = 0.007; vascular endothelial growth factor A, 57%, p = 0.006, and placental growth factor, 32%, p = 0.0227). Significant increases in the transcript level of hypoxia-inducible factor-2α and heme oxygenase 1 were also observed in the DS group compared to the controls. The expression of angiogenic factors was similar in DS fetuses and CHD euploid fetuses with CHD. Conclusion: Abnormal angiogenesis was detected in the hearts of DS fetuses with and without CHD. Our results suggest that DS determines an intrinsically angiogenic impairment that may be present in the fetal heart.

6 páginas Objective. Fetal goitrous hypothyroidism is a rare and potentially lethal condition. Consequently, itsearly diagnosis and treatment improve prognosis. Thyroid hormone measurement in either fetal serumor amniotic fluid implies important risks. Here we present a fetal goiter and the follow-up procedure,both done by the traditional method and by using 3-dimensional power Doppler (3DPD) imaging andvirtual organ computer-aided analysis (VOCAL). Methods.A single well-documented case of fetal goi-ter was followed weekly from 22 weeks until delivery. Amniocentesis for thyrotropin (TSH) and freethyroxine (T4) measurement as well as levothyroxine injections were performed at every control. Inaddition to amniocentesis, every control involved a sonographic evaluation, which included standardmeasurements of the gland and the capture of volume image sets in gray scale and 3DPD. Volume cal-culation of the gland was done using VOCAL software. Vascularization of the gland was evaluated bythe vascularization index (VI) included in the software. Results. With treatment, TSH levels decreasedprogressively until normalization. Free T4levels increased toward the end of gestation. Sonographicmeasurements of the gland volume to estimated fetal weight ratio decreased across treatment as lev-els of TSH did. The VI clearly depicted the vascular regression of the goiter, decreasing throughouttreatment in a consistent way until 24 hours before delivery. Conclusions.Gray scale and 3DPD eval-uations of the thyroid gland have been validated under similar circumstances and might be reliablecomplements to the invasive methods used in the management of this fetal condition. Key words:fetal hypothyroidism; goiter; 3-dimensional power Doppler sonography; 3-dimensional sonography;virtual organ computer-aided analysis.

Objectives: To compare the accuracy and repeatability of the volume perfusion index (VPI), -a mathematical model for calculation of flow developed by our team-, with the current available indexes for threedimensional power Doppler quantification (VI,FI and VFI) in an experimental in-vitro study. Methods: A phantom of flow was designed by using a mechanical pump generating a pulsatile flow with known values and by using elastic artificial vessels and blood mimicking fluid. A set of three and four-dimensional power Doppler volumes was obtained at different flow settings. Three dimensional volumes were quantified by using the VOCAL software included in the machine’s software. Fourdimensional flow measurement was evaluated by using a previously validated algorithm. Repeatability was evaluated through the intraclass correlation coefficient (ICC)for single unpaired tests and the Bland-Altmann (B-A) plot. Accuracy was tested by comparing the actual values against the obtained indexes with a polynomial regression model. Results: Phantom design was successful in generating a pulsatilelike flow and volumes could be taken in 92% of cases. ICC (95% CI) was 0.34 (0.23–0.51) for VI; 0.41 (0.3–0.51) for FI and 0.56 (0.43–0.69) for VFI. For VPI, it was 0.69 (0.48–0.79). B-A plot showed an inter-observer variability (%) (95% CI) of 48 (23–76) for VI; 62 (33–68) for FI; 29 (21–48) for VFI and 22 (15–29) for VPI. r-value (95% CI) was 0.45 (0.33–0.49) for VI; 0.53 (0.38–0.6) for FI; 0.62 (0.51–0.79) and 0.83 (0.65–0.9) for VPI (P < 0.01). Conclusions: Volume Perfusion Index exhibits a more robust internal validity than the traditional three-dimensional power Doppler indexes and might reflect more accurately actual changes in flow.

magna were assessed. The diagnostic value and image quality was evaluated. In all cases brain anatomy was verified by postnatal neurosonography, fetal/postnatal MRI or by autopsy. Results: Abnormal appearance of the posterior fossa was consistent with complete absence of the cerebellar vermis (Dandy-Walker malformation) in 8 fetuses, vermian hypoplasia in 3 fetuses and Blake’s pouch cyst (BPC) in 5 fetuses. Axial transcerebellar view in all fetuses with posterior brain anomalies at 11+0–13+6 weeks’ showed non-specific enlargement of the posterior fossa. Mid-sagittal view in fetuses with Dandy-Walker malformation demonstrated the absence of border between 4th ventricle and cisterna magna. In contrast in fetuses with BPC normal size of cisterna magna, enlargement of the 4th ventricle with an intact border between these two structures was noted in mid-sagittal view. Conclusions: Assessment of the fetal posterior fossa is possible in 1st trimester of pregnancy by 3-D sonography. A mid-sagittal view retrieved from 3D volume data set of the fetal head demonstrates a good display of the diagnostic landmarks of fetal posterior fossa with appropriate quality of images. By standardizing the approach to image acquisition and display 3D-sonography may potentially improve our understanding of normal fetal brain development and help to increase the detection rate of fetal posterior brain abnormalities in early pregnancy.

Objectives: Non-invasive and accurate measurement of fetal flow remains an elusive matter. Precision of current tools is very limited and relies mainly in operator skills. The aim of this study was to test a tool for indirect flow measurement, by using power Doppler signal and four-dimensional ultrasound (4DPD) and image data simulation and adjustment tools based on mathematical modelling of particles’ vectorial velocities. Methods: Six near term pregnant sheep were surgically instrumented to access fetal aorta by transventricular catheterization. Actual flow through aortic isthmus was measured directly by a PICCO monitor, as well as by pulsed Doppler. Several sets of 4DPD volumes were taken during the procedure. Measurements were stored in an electronic datasheet. A mathematical algorithm for signal normalization was developed for the project by using Mathematica. A differencial equation matrix was generated and obtained data was evaluated through an error adjustment process. Mean velocity at every time was calculated and compared to actual data. The obtained values were plotted against the calculated values. Repeatability was evaluated by using a Bland Altmann test. Results: A total of 30 sets of measurements were collected. A mean of six measurements by cardiac cycle were digitally obtained from the velocity curve. An n by m matrix of data was designed for every set. A mathematically generated flow curve was plotted with the data built through a multi-layer algorithm. Bland Altmann test showed an inter observer variability (95% CI) of 22.3% (11.5–34.3). The r-value for calculated flow was 0.78 (0.73–0.91) (P < 0.05). Conclusions: 4DPD with mathematical modeling overcomes the limitations of two and three-dimensional moving particles measurement and might be an accurate tool for fetal flow measurement.

ng/ml, 49.4 (7-264) pg/ml, 6.8 (3.0–11.9) IU/L and 165 (42373) pmol/L respectively. The median (range) total AFC was 12 (2–39). The total AFC was significantly correlated with serum AMH (r=0.43; P 6.0 mm. Conclusions: The total AFC is significantly correlated with serum AMH levels but not with inhibin-B, FSH or oestradiol. The number of antral follicles measuring 2–6 mm is most closely related to AMH levels and this follicular cohort is most reflective of the quantitative status of ovarian reserve.

Objective The aim of the study was to know what fetal hemodynamic response to therapeutical fetoscopic laser was, specially in the donor. Material and methods Patients with severe TTS undergoing laser coagulation of placental anastomoses (n = 25) were included. Doppler measurements (Accuson Aspen) were performed in the Umbilical artery, Middle cerebral artery, ductus venosus and Umbilical vein of both fetuses preoperatively and on days 1, 3 and 5 postlaser. Results Venous pulsatility indices tend to decrease in the recipient while they increase in the donor. Increased PI and/or appearance of pulsations in the UV was observed in 75% of donors, which was accompanied but one or more signs of hydrops in 20% of cases. These did not constitute signs of poor prognosis. Conclusions We hypothesize that venous return in the donor fetus increases after laser coagulation, which could explain a transient overload phase, which in any case does not imply a poorer prognosis.