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This article discusses the feasibility of using off-line MRI-US fusion imaging in cases of common fetal abnormalities. The study included patients referred for fetal abnormalities and used a standard fetal MRI protocol followed by 3D ultrasound imaging of the same anatomical district. Fusion images were generated using dedicated software. The results showed that fusion imaging was feasible in 70% of cases and significantly enhanced diagnostic confidence in several cases. The authors suggest that MRI-US fusion imaging offers several advantages in clinical practice, including enhanced diagnostic confidence and simultaneous evaluation of ultrasound and MRI findings. The potential for tele-expertise and education using this technique should be further evaluated. [Extracted from the article]

This article discusses a study that aimed to identify non-invasive markers for predicting fetal infection with cytomegalovirus (CMV) following maternal primary infection (MPI) before 14 weeks of gestation. The researchers conducted a retrospective study and found that the maximum trophoblast thickness (MTT) measured using three-dimensional ultrasound was significantly larger in cases where CMV was detected in the trophoblast and amniotic fluid. The study suggests that MTT could be a relevant and reproducible marker for diagnosing fetal CMV infection, but further research is needed to determine the threshold for MTT. The article was written by N. Bourgon, M. Jacquier, J. Fourgeaud, T. Guillerminot, L. Bussières, M. Leruez-Ville, and Y. Ville. [Extracted from the article]

This article, titled "EP04.01: First trimester diagnosis of cytomegalovirus trophoblastic infection using CMV-PCR: prediction of fetal CMV infection and symptoms at birth," discusses the use of CMV-PCR in diagnosing trophoblastic infection in pregnant women. The study aimed to determine the value of CMV-PCR in predicting fetal CMV infection and symptoms at birth. The results showed that CMV-PCR in trophoblast had a high negative predictive value for fetal infection and a high specificity and negative predictive value for symptomatic infection at birth. The study suggests that CMV-PCR on trophoblast can be a useful tool in diagnosing and predicting CMV infection in fetuses. [Extracted from the article]

This article discusses the potential of "black bone" (BB) MRI imaging sequences as an alternative to conventional radiography for examining the skeleton in fetuses during post-mortem MRI examinations. The study involved 60 fetuses, and skeletal abnormalities were found in 31.6% of cases. The overall sensitivity and specificity of BB MRI for skeletal pathology were 89.4% and 97.5% respectively. The main limitation of fetal BB MRI sequences was the diagnosis of craniosynostosis. The authors conclude that BB MRI imaging sequences offer a radiation-free method for imaging the fetal skeleton and could be a potential alternative to radiography for analyzing bone anomalies. [Extracted from the article]

This article discusses the challenges of predicting the postnatal outcomes of congenital cytomegalovirus (CMV) infection during pregnancy. The study evaluated the effectiveness of prenatal assessment, including different machine learning techniques, in predicting symptoms at birth and long-term sequelae. The research involved a large cohort of pregnant women who were referred for fetal infection following maternal infection in early pregnancy. The results suggest that prenatal imaging and early prenatal treatment, particularly in cases with mild prenatal findings, can influence the prognosis of infected fetuses. [Extracted from the article]

This article, titled "Hemispheric asymmetries in the brain microstructure of healthy fetuses detected in utero by diffusion tensor imaging," explores the use of prenatal diffusion tensor imaging (DTI) to detect microstructure asymmetries in the fetal brain. The study involved performing MRI-DTI acquisitions on fetuses without detected abnormalities and comparing DTI metrics between the right and left hemispheres. The results showed significant hemispheric asymmetries in various regions of the brain, suggesting that these asymmetries develop during fetal development and can be detected as early as the mid-trimester. This research provides valuable insights into the early development of cognitive abilities, language processing, and visuo-spatial processing in fetuses. [Extracted from the article]

Unlabelled: A suprasellar arachnoid cyst may cause disorders of growth, puberty and hypothalamic-pituitary function, due to the proximity of the cyst to the hypothalamic-pituitary area. A total of 30 patients (17 boys) with cyst diagnosed at 4.3 +/- 1 years were routinely evaluated at 5.4 +/- 1 years; 24 of them had one or multiple cyst derivations. Some 23 cases had an abnormal height, weight or puberty: short (< -2SD, 5 cases) or tall ( > 2SD, 10 cases) stature, overweight (body mass index, BMI, > 2SD, 6 cases), central precocious puberty (10 cases) and/or no progression of pubertal development (3 cases). The growth hormone (GH) peaks after pharmacological stimulation test were low (< 10 MICROg/L) in 16 patients, confirmed by a second evaluation in 8/11 of them. The plasma free thyroxine was low in five patients, prolactin was high in two and the cortisol and concomitant plasma and urinary osmolalities were normal. BMI was correlated negatively with the GH peaks (r = -0.37, P < 0.01) and positively with the plasma leptin concentrations (r = 0.55, P < 0.01). The plasma fasting insulin concentrations were also correlated negatively with the GH peaks (r = -0.55, P < 0.02) and positively with the plasma insulin-like growth factor I concentrations (r = 0.64, P < 0.002). The adult height (12 cases) was at 4SD in 1 and < -2SD in 4 patients, two of whom had precocious puberty untreated with gonadotropin releasing hormone (GnRH) analogue, and two had untreated GH deficiency. The adult height of those treated was normal. One girl had primary amenorrhoea and two boys had low plasma testosterone, despite a normal gonadotropin response to a GnRH test.Conclusion: Suprasellar arachnoid cysts may cause deficiencies of growth hormone and thyrotropin, stimulation of the hypothalamic-pituitary-gonadal axis, tall stature and/or overweight. These last two disorders may be due to hyperinsulinism, itself due to suprasellar arachnoid cyst. [ABSTRACT FROM AUTHOR]

Abstract: OBJECTIVE: Our purpose was to study the correlation between maternal serum human chorionic gonadotropin levels measured at 15 to 18 weeks of amenorrhea and pregnancy-induced hypertension, preeclampsia, and small-for-gestational-age neonates. STUDY DESIGN: Prospective trisomy 21 human chorionic gonadotropin screening data from 5776 patients were examined in a retrospective investigation of the relationship between human chorionic gonadotropin and pregnancy-induced hypertension (234 cases), preeclampsia (34 cases), and small-for-gestational-age neonates (238 cases). RESULTS: Maternal serum human chorionic gonadotropin (multiples of the median) was higher in the three populations with pathologic disorders. This difference was statistically significant in patients with small-for-gestational-age neonates (p < 0.0163) and preeclampsia (p < 0.0001) but not in those with pregnancy-induced hypertension. In the preeclampsia subgroup, with a cutoff value of 2 multiples of the median, specificity was 32% and sensitivity was 10%; with a cutoff value of 1 multiples of the median, specificity was 100% and sensitivity was 50%. CONCLUSION: High maternal serum human chorionic gonadotropin levels at 15 weeks are related to a risk for preeclampsia. Depending on the human chorionic gonadotropin cutoff value, 32% or 100% of preeclampsia patients would be selected. The usefulness of preventive aspirin treatment from the fifteenth week needs more investigation in a larger multicenter study of preeclampsia. (Am J Obstet Gynecol 1996;175:37-40.) [Copyright &y& Elsevier]

An abstract of the article "In utero treatment of congenital cytomegalovirus infection with Valacyclovir in a multicentre, open-label, phase II study," by M. Leruez-Ville and colleagues is presented.

The neurohumoral events associated with neurocardiogenic syncope remain unclear. The simultaneous assessment of changes in endothelium-dependent and independent hormones and in autonomic balance in patients with tilt-induced syncope has been incompletely studied. Forty-six healthy subjects aged between 21 and 83 years (mean +/- SEM 47 +/- 3) underwent a 30-minute head-up tilt test at 60 degrees. Fourteen subjects (10 females and 4 male subjects) exhibited syncope at 16 +/- 2 minutes into the tilt. Hemodynamics were recorded every 5 minutes and blood samples for the measure of catecholamines, endothelin-1 (ET-1), and angiotensin-II (AT-II), were drawn at baseline, and 5, 10, 15, and 30 minutes into the tilt and immediately before syncope. Heart rate variability was analyzed by 5-minute segments during the test. Both catecholamines and ET-1 levels increased consistently in response to head-up tilt in subjects able to tolerate the test. Epinephrine increased to a greater extent before syncope. In contrast, ET-1 failed to increase at any time during the tilt and just before syncope. AT-II increased at 30 minutes into the tilt only in the control group. Finally, power in high-frequency bands decreased less in the group with syncope. Thus, compared with subjects able to tolerate a head-up tilt test, patients with syncope exhibit a greater increase in adrenomedullary activation, no significant increase in ET-1 levels, and a blunting in the decrease of vagal tone before syncope. The lack of increase in ET-1 during tilt may play a role in the inability to support orthostatic stress. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to clinically validate an operating protocol for early and non-invasive prenatal diagnosis (NI-PND) of Cystic Fibrosis (CF) and Spinal Muscular Atrophy (SMA) avoiding chorionic-villous sampling (CVS) which carries a 2% risk of miscarriage. Methods: We first developed a new approach to rapidly target circulating epithelial cells after their enrichment by ISET (Isolation by Size of Epithelial Tumor/Trophoblastic cells) and then performed a phase III clinical validation study of a protocol for NI-PND of CF and SMA. Circulating epithelial cells enriched from the blood of 63 pregnant women at 1/4 risk of having a child affected by CF or SMA were laser microdissected and tested individually by using short tandem repeat (STR) genotyping to identify circulating fetal trophoblastic cells (CFTCs). Individual CFTCs were subsequently blindly and independently used, in number of 5 or 10 per mother, to perform NI-PND of CF or SMA. In parallel, we tested weekly (4th to 12th week of gestation (WG)), the blood of 14 women after in vitro fertilization (IVF), and counted the number of CFTCs per ml, in order to assess the earlier appearance and kinetics of CFTCs circulation in blood. Results: A total number of 960 CFTCs were identified in the 77 pregnant women. NI-PND was independently performed on 475 individual CFTCs isolated from the 63 pregnant women. Results were demonstrated to be identical to those obtained by the invasive CVS approach. Sensitivity, as computed on the 105 CFTCs with a mutated genome, was 100% (CI 95%: 96.5-100%). Specificity, as computed on the 370 CFTCs without a mutated genome, was also 100% (CI 95% 99.0-100%). Finally, we identified 485 CFTCs in 14 women after IVF. CFTCs were found in all of them from the 5th WG through the 12th WG ranging from 1 to 2 CFTCs per ml. Conclusions: These results show that a reliable NI-PND of genetic diseaeses is feasible and should open the way to implementation of an early and reliable protocol for NI-PND of CF and SMA. P. Paterlini-Brechot and H. Mouawia are joint first authors. [ABSTRACT FROM AUTHOR]

Background: The treatment of congenital cytomegalovirus (CMV) infection is usually administered to neonates after birth; however, it can be anticipated during the prenatal period by treating pregnant women in order to reduce the severity of the congenital disease. The most commonly used treatment for CMV during pregnancy is valaciclovir; however, valganciclovir has a higher potency against CMV and is the first choice for neonates with congenital CMV disease., Objectives: We investigated neonatal and maternal safety of tertiary prevention in infected fetuses showing ultrasound features of infection using valganciclovir., Methods: Retrospective cohort study of pregnant women and their symptomatic infected fetuses taking valganciclovir, 3 × 450 mg per day. All fetuses presented at least one prenatal feature on ultrasound. We assessed fetal/neonatal and maternal safety, as well as neonatal efficacy of treatment. The main outcome was neutropenia. Secondary outcomes included other haematological side effects, symptoms at birth and neonatal CMV-PCR was positive., Results: Seventeen women with singleton pregnancies received valganciclovir from a median (IQR) of 27.1 (26.0-30.3) to 11.6 (6.5-12.9) weeks of gestation. No neonatal neutropenia was reported. One pregnancy was terminated for severe features. Three newborns (18%) were asymptomatic at birth, including one with negative CMV-PCR from blood and saliva. CMV-PCR was positive for 12/13 symptomatic newborns, with a median (IQR) log10 viral load of 3.36 (3.30-4.20), 4.03 (1.75-4.27) and 3.04 (0.00-3.40) log10 copies/mL in blood, urine and saliva, respectively., Conclusions: Tertiary prevention by valganciclovir appears to be well tolerated for both fetus and mother. However, more extensive trials accompanied by long-term follow-up are needed., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Approximately 20% of neonates with congenital cytomegalovirus (cCMV) develop long-term sequelae. The ability to accurately predict long-term outcomes as early as the neonatal period would help to provide for appropriate parental counseling and treatment indications. With this study, we aimed to identify neonatal predictive markers of cCMV long-term outcomes., Methods: As this study's subjects, we chose neonates diagnosed with cCMV in 13 hospitals throughout France recruited from 2013 to 2017 and evaluated for at least 2 years with thorough clinical, audiology, and imaging evaluations and psychomotor development tests., Results: A total of 253 neonates were included, and 3 were later excluded because of the identification of a genetic disorder. A total of 227 were followed up for 2 years: 187/227 (82%) and 34/227 (15%) were infected after a maternal primary or nonprimary infection, respectively, 91/227 (40%) were symptomatic at birth, and 44/227 (19%) had cCMV sequelae. Maternal primary infection in the first trimester was the strongest prognosis factor (odds ratio = 38.34 [95% confidence interval, 5.02-293], P < .001). A predictive model of no risk of sequelae at 2 years of age according to normal hearing loss at birth, normal cerebral ultrasound, and normal platelet count had 98% specificity, 69% sensitivity, and 0.89 area under the curve (95% confidence interval, 0.83-0.96)., Conclusions: In the studied population, children with normal hearing at birth, normal platelet count at birth, and a normal cranial ultrasound had no risk of neurologic sequelae and a low risk of delayed unilateral sensorineural hearing loss. The use of this model based on readily available neonatal markers should help clinicians establish a personalized care pathway for each cCMV neonate., (Copyright © 2024 by the American Academy of Pediatrics.)

Importance: Vacuum aspiration is commonly used to remove retained products of conception in patients with incomplete spontaneous abortion. Scarring of the uterine cavity may occur, potentially impairing future fertility. A procedural alternative, operative hysteroscopy, has gained popularity with a presumption of better future fertility., Objective: To assess the superiority of hysteroscopy to vacuum aspiration for subsequent pregnancy in patients with incomplete spontaneous abortion who intend to have future pregnancy., Design, Setting, and Participants: The HY-PER randomized, controlled, single-blind trial included 574 patients between November 6, 2014, and May 3, 2017, with a 2-year duration of follow-up. This multicenter trial recruited patients in 15 French hospitals. Individuals aged 18 to 44 years and planned for surgery for an incomplete spontaneous abortion with plans to subsequently conceive were randomized in a 1:1 ratio., Interventions: Surgical treatment by hysteroscopy (n = 288) or vacuum aspiration (n = 286)., Main Outcomes and Measures: The primary outcome was a pregnancy of at least 22 weeks' duration during 2-year follow-up., Results: The intention-to-treat analyses included 563 women (mean [SD] age, 32.6 [5.4] years). All aspiration procedures were completed. The hysteroscopic procedure could not be completed for 19 patients (7%), 18 of which were converted to vacuum aspiration (8 with inability to completely resect, 7 with insufficient visualization, 2 with anesthetic complications that required a shortened procedure, 1 with equipment failure). One hysteroscopy failed due to a false passage during cervical dilatation. During the 2-year follow-up, 177 patients (62.8%) in the hysteroscopy group and 190 (67.6%) in the vacuum aspiration (control) group achieved the primary outcome (difference, -4.8% [95% CI, -13% to 3.0%]; P = .23). The time-to-event analyses showed no statistically significant difference between groups for the primary outcome (hazard ratio, 0.87 [95% CI, 0.71 to 1.07]). Duration of surgery and hospitalization were significantly longer for hysteroscopy. Rates of new miscarriages, ectopic pregnancies, Clavien-Dindo surgical complications of grade 3 or above (requiring surgical, endoscopic, or radiological intervention or life-threatening event or death), and reinterventions to remove remaining products of conception did not differ between groups., Conclusions and Relevance: Surgical management by hysteroscopy of incomplete spontaneous abortions in patients intending to conceive again was not associated with more subsequent births or a better safety profile than vacuum aspiration. Moreover, operative hysteroscopy was not feasible in all cases., Trial Registration: ClinicalTrials.gov Identifier: NCT02201732.