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COVID-19 is a novel coronavirus with data suggesting a more serious clinical course in pregnancy. We aimed to assess changes in knowledge, behaviors, and intentions of pregnant women regarding COVID-19. This was a cross-sectional survey study of 58 and 77 predominantly African-American and Afro-Caribbean pregnant patients presenting for prenatal care in Brooklyn, NY in 2020 (during the first surge of the pandemic) and 2021, respectively. Descriptive and inferential statistics were performed. Many beliefs and intentions were unchanged between 2020 and 2021 (e.g. believing pregnant women were at higher risk of COVID-19 infection and subsequent ICU admission due to pregnancy, having the desire to breastfeed, among others). Other beliefs and behaviors changed between 2020 and 2021 (fewer women believed they received information from their provider regarding COVID-19 and fewer would miss a prenatal visit for fear of COVID-19 contagion). Patients' behaviors and intended behaviors in both 2020 and 2021 were directly influenced by their beliefs, many of which were based on unsupported data regarding COVID-19 and pregnancy (ie: babies were at increased risk of being born with congenital malformation following a mother's COVID-19 infection). Patients who held these beliefs were more likely to say that they did not attend prenatal visits and did not receive information from their provider regarding COVID-19. Knowledge of patient beliefs is useful for structuring care as the pandemic evolves. This study demonstrates that pregnant patients make decisions regarding behaviors based on beliefs grounded in misinformation. Accordingly, it is the provider's responsibility to ensure that beliefs regarding COVID-19 are based in fact, so patients can make informed decisions.

ObjectivePreeclampsia is more prevalent in African American women than other races. GBS colonization rate in African American women is the highest among different races. We hypothesized there is an association between GBS colonization and preeclampsia among pregnant African American women.Study DesignWe evaluated the relationship between GBS colonization and preeclampsia in 11,766 patients’ records (93% were African Americans patients) between 2010 and 2017.ResultsThe preeclampsia rate of GBS colonized patients (2.6%) was 59% less than that of GBS-negative patients (6.3%). This inverse correlation was independently significant after adjusting for other potential risk factors for preeclampsia: chronic hypertension, gestational diabetes mellitus and diabetes mellitus and other covariates. Further analysis among the patients without these risk factors also confirmed that the preeclampsia rate of GBS colonized patients (2.6%) was 55% less than that of GBS negative patients (5.7%). Similarly, patients with HSV+ or HIV+ had lower incidence of preeclampsia than those with HSV- or HIV-.ConclusionsThe unexpected finding of an inverse relationship between GBS colonization and preeclampsia suggests that the maternal immune response to GBS infection may be beneficial in reducing preeclampsia among African American patients.

David M Sherer, Sara Al-Haddad, Regina Cheng, Mudar Dalloul The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USACorrespondence: David M ShererDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, Box 24, Brooklyn, NY, USATel +1 718 270-2081Fax +1 718 270-4122Email davidmsherer@gmail.comAbstract: The umbilical cord constitutes a continuation of the fetal cardiovascular system anatomically bridging between the placenta and the fetus. This structure, critical in human development, enables mobility of the developing fetus within the gestational sac in contrast to the placenta, which is anchored to the uterine wall. The umbilical cord is protected by unique, robust anatomical features, which include: length of the umbilical cord, Wharton’s jelly, two umbilical arteries, coiling, and suspension in amniotic fluid. These features all contribute to protect and buffer this essential structure from potential detrimental twisting, shearing, torsion, and compression forces throughout gestation, and specifically during labor and delivery. The arterial components of the umbilical cord are further protected by the presence of Hyrtl’s anastomosis between the two respective umbilical arteries. Abnormalities of the umbilical cord are uncommon yet include excessively long or short cords, hyper or hypocoiling, cysts, single umbilical artery, supernumerary vessels, rarely an absent umbilical cord, stricture, furcate and velamentous insertions (including vasa previa), umbilical vein and arterial thrombosis, umbilical artery aneurysm, hematomas, and tumors (including hemangioma angiomyxoma and teratoma). This commentary will address current perspectives of prenatal sonography of the umbilical cord, including structural anomalies and the potential impact of future imaging technologies.Keywords: prenatal ultrasound, umbilical cord, color Doppler imaging

Umbilical cord accidents preceding labor are uncommon. In contrast, nuchal cords are a very common finding at delivery, with reported incidences of a single nuchal cord of approximately between 20% and 35% of all singleton deliveries at term. Multiple loops occur less frequently, with reported incidence rates inverse to the number of nuchal cords involved. Rare cases of up to 10 loops of nuchal cord have been reported. While true knots of the umbilical cord have been associated with a 4-10-fold increased risk of stillbirth, nuchal cord(s) are most often noted at delivery of non-hypoxic non-acidotic newborns, without any evidence of subsequent adverse neonatal outcome. Prior to ultrasound, nuchal cords were suspected clinically following subtle (spontaneous or evoked) electronic fetal heart rate changes. Prenatal sonographic diagnosis, initially limited to real-time gray-scale ultrasound, currently entails additional sonographic modalities, including color Doppler, power Doppler, and three-dimensional sonography, which have enabled increasingly more accurate prenatal sonographic diagnoses of nuchal cord(s). In contrast to true knots of the umbilical cord (which are often missed at sonography, reflecting the inability to visualize the entire umbilical cord, and hence are often incidental findings at delivery), nuchal cord(s), reflecting their well-defined and sonographically accessible anatomical location (the fetal neck), lend themselves with relative ease to prenatal sonographic diagnosis, with increasingly high sensitivity and specificity rates. While current literature supports that single (and possibly double) nuchal cords are not associated with increased adverse perinatal outcome, emerging literature suggests that cases of ≥3 loops of nuchal cords or in the presence of a coexisting true knot of the umbilicus may be associated with an increased risk of stillbirth or compromised neonatal status at delivery. This commentary will address current perspectives of prenatal sonographic diagnosis and clinical management challenges associated with nuchal cord(s) in singleton pregnancies.

Umbilical cord accidents preceding labor are rare. Single and multiple nuchal cords, and true knot(s) of the umbilical cord, are often incidental findings noted at delivery of non-hypoxic non-acidotic newborns without any evidence of subsequent adverse neonatal outcome. In contrast to single nuchal cords, true knots of the umbilical cord, which occur in between 0.04% and 3% of all deliveries, have been associated with a reported 4 to 10 fold increased risk of stillbirth. First reported with real-time ultrasound, current widespread application of color Doppler, power Doppler and three-dimension sonography, has enabled increasingly more accurate prenatal sonographic diagnoses of true knot(s) of the umbilical cord. Reflecting the inability to visualize the entire umbilical cord at prenatal ultrasound assessment, despite detailed second and third-trimester scanning, many occurrences of incidental true knot of the umbilical cord remain undetected and are noted only at delivery. Although prenatal sonographic diagnostic accuracy is increasing, false positive sonographic diagnosis of true knot of the umbilical cord cannot be ruled out with certainty, and must continue to be considered clinically. Notwithstanding the inability to diagnose all true knots, currently there is a clear absence of clinical management guidelines by governing bodies regarding patients in whom prenatal sonographic diagnosis of true knot(s) of the umbilical cord is / are suspected. As a result, in many prenatal ultrasound units, suspected sonographic findings suggestive of or consistent with true knot of the umbilical cord are often disregarded, not documented, and patients are not uniformly informed of this potentially life-threatening condition, which carries an associated considerable risk of stillbirth. This commentary will address current perspectives of prenatal sonographic diagnostic and management challenges associated with true knot(s) of the umbilical cord in singleton pregnancies.

Characteristic phenotypic features of 16p13.3 microduplication include impaired mental development, arthrogryposis-like musculoskeletal anomalies (club-feet, congenital hip dislocation, and camptodactyly of fingers and toes), facial dysmorphology, and at times congenital cardiac disease. Most of the described affected individuals have microduplications involving the CREBBP gene. Findings indicate this gene to be dosage-sensitive and likely involved in the phenotypes of 16p13.3 microduplication syndrome. We describe the incidental finding of 16p13.3 microduplication in a fetus with mid-trimester sonographic examination showing absent nasal bone and transient unilateral hydronephrosis.

Prenatal sonographic depiction of congenital vertical talus (rocker bottom feet), describing a prominent calcaneus and rounded convex appearance of the ventral aspect of the foot, has been reported with fetal Trisomies 18, 13, 9 HOXD10 mutations and recently 2q13 microdeletion. We present a 24 year old in whom mid-trimester sonographic finding of isolated bilateral rocker bottom feet led to diagnosis of 7q11.23 microdeletion-Williams syndrome. This association has not been reported previously. This case emphasizes the critical assessment of detail microarray upon prenatal sonographic notation of abnormal structural fetal features.

Liver herniation commonly associated with omphalocele occurs in only approximately 2.3% to 16% of fetuses with gastroschisis. Liver herniation in such cases is associated with considerably decreased survival rates (43% vs 97% with or without liver herniation, respectively). Rarely, abnormally positioned fetal hepatic vasculature has been reported mainly in association with congenital diaphragmatic hernia. In these rare cases, intrathoracic depiction of hepatic venous vasculature has assisted in confirming intrathoracic displacement of the fetal liver. We present a case of a large gastroschisis with complete herniation of the fetal liver in which prenatal sonography depicted an extracorporeal ductus venosus.

We describe unusual mid-trimester sonography of subtle fetal facial dysmorphic features including; flattened nasofrontal angle with an almost vertically positioned nasal bone, acute nasolabial angle, and convexity of the maxillary areas in a fetus with otherwise normal anatomy. Microarray identified a 64.5 KB interstitial deletion of 2q25.3, which includes one exon of MYT1L. Mutations and deletions in MTY1L have been associated with autosomal dominant intellectual disability, autistic features, and obesity. Association of these features and 2p25.3 microdeletion has not been reported previously. This case emphasizes the importance of detailed microarray analysis following the sonographic recognition of subtle fetal dysmorphic features.

Importance Preeclampsia is a devastating disease of pregnancy associated with increased risk of fetal and maternal complications. African American pregnant women have a high prevalence of preeclampsia, but there is a need of systemic analyses of this high-risk group regarding complications, etiology, and biomarkers. Objective The aim of this study was to provide a synopsis of current research of preeclampsia specifically related to African American women. Evidence acquisition A comprehensive search was performed in the bibliographic database PubMed with keywords "preeclampsia" and "African American." Results African American women with preeclampsia were at an increased risk of preterm birth, which resulted in low-birth-weight infants. Intrauterine fetal death among African American preeclamptic patients occurs at twice the rate as in other races. On the maternal side, African American mothers with preeclampsia have more severe hypertension, antepartum hemorrhage, and increased mortality. Those who survive preeclampsia have a high risk of postpartum cardiometabolic disease. Preexisting conditions (eg, systemic lupus erythematosus) and genetic mutations (eg, sickle cell disease in the mother, FVL or APOL1 mutations in the fetus) may contribute to the higher prevalence and worse outcomes in African American women. Many blood factors, for example, the ratio of proteins sFlt/PlGF, hormones, and inflammatory factors, have been studied as potential biomarkers for preeclampsia, but their specificity needs further investigation. Conclusions Further studies of preeclampsia among African American women addressing underlying risk factors and etiologies, coupled with identification of preeclampsia-specific biomarkers allowing early detection and intervention, will significantly improve the clinical management of this devastating disease.

Background Early in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, before the routine availability and/or use of personal protective equipment, health care workers were understandably concerned. Our aim was to explore health care workers’ attitudes toward patients infected with SARS-CoV-2 at the time of the nation’s first surge in 2 highly affected hospitals in New York. Methods We performed a cross-sectional, self-administered survey study of health care workers. The survey consisted of 17 multiple-choice questions including demographic information, ethics, and willingness to care for patients with SARS-CoV-2 infection. Subgroup analyses were performed using the Fisher exact test. Results Of 340 health care workers approached, 338 (99.4%) consented to the survey; 163 (48.7%) were registered nurses and 160 (48.3%) lived with children. While 326 (97.3%) workers were concerned about putting their family/coworkers at risk of infection after caring for a patient with SARS-CoV-2, only 30 (8.9%) were unwilling to treat a patient with SARS-CoV-2 infection. Registered nurses were more likely than other health care workers to think it was ethical to refuse care for SARS-CoV-2-infected patients, worried more often about contracting infection, and felt that SARS-CoV-2 added to their stress level (P = .009, P = .018, P Conclusions Levels of stress and concern were extremely high. In spite of that, the overwhelming majority of workers were willing to treat patients with SARS-CoV-2 infection. Registered nurses and health care workers who live with children were more likely to think it is ethical to refuse care for SARS-CoV-2-infected patients.

David M Sherer, Crystal Roach, Sarin Soyemi, Mudar Dalloul The Division of Maternal-Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USACorrespondence: David M ShererDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, Box 24, Brooklyn, NY, 11203, USATel +1 718 270-2081Fax +1 718 270-4122Email davidmsherer@gmail.comAbstract: Diagnosis of potential umbilical cord compromise, namely, true knots of the umbilical cord and nuchal cords has been enabled with increasing accuracy with current enhanced prenatal sonography. Often an incidental finding at delivery, the incidence of true knots of the umbilical cord has been estimated at between 0.04% and 3% of deliveries. This condition has been reported to account for a 4 to 10-fold increase of stillbirth and perinatal morbidity of 11% of cases. Nuchal cords, commonly observed at the delivery of uncompromised, non-hypoxic non-acidotic newborns occur more frequently with single nuchal cords noted in between 20% and 35% of all deliveries at term. Multiple nuchal cords are considerably less frequent, with decreasing frequencies inverse to the number of nuchal cord loops. While clearly single (and likely double) nuchal cords are almost uniformly associated with favorable neonatal outcomes, emerging data suggest that cases of ≥ 3 loops of nuchal cords are more likely to be associated with an increased risk of adverse perinatal outcome (either stillbirth or compromised neonatal condition at delivery). We define cases of a true knot of the umbilical cord, cases of ≥ 3 loops of nuchal cords, any combination of a true knot and nuchal cord, or any umbilical cord entanglement (nuchal or true knot) in the presence of a single umbilical artery, in singleton gestations as complex umbilical cord entanglement. Two concurrent developments, the increase in accuracy of prenatal sonographic diagnosis of complex umbilical cord entanglement and recent data confirming fatal compromise of the umbilical circulation in approximately 20% of cases of stillbirth, suggest that establishing governing body guidelines for reporting of potential umbilical cord compromise, and recommendation of consideration for early-term delivery of select cases, may be warranted. This commentary will address current perspectives of prenatal diagnosis and clinical management challenges of complex umbilical cord entanglement.Keywords: prenatal ultrasound, complex umbilical cord entanglement, true knot of the umbilical cord, nuchal cord, clinical management

IntroductionAllostatic load (AL) defines cardiometabolic, inflammatory, and neuroendocrine changes in the body in response to internal and external stressors. It is largely unknown whether gestational diabetes mellitus (GDM) alters maternal and fetal AL, which in turn affects GDM outcomes. Whether dietary intakes and quality can modify AL and thus influence GDM progression is also unknown.Research design and methodsIn this study, we recruited 35 GDM and 30 non-GDM women in gestational week 25–33. Fasting blood samples were collected at enrollment, and cord venous blood samples were collected at delivery for the measurement of a series of AL biomarkers to calculate the composite AL index. Three-day dietary recalls were conducted at enrollment.ResultsResults suggest that GDM women had 60% higher composite AL index scores (p value=0.01). Maternal AL index was associated with shorter duration of gestation (β=−0.33, p value=0.047) and higher fetal AL index (β=0.47, p value=0.006) after adjusting for GDM status. Dietary intake of monounsaturated fatty acids was negatively associated with maternal AL index (β=−0.20, p value=0.006). GDM women had lower total caloric intake and dietary glycemic load, yet their linolenic acid, vitamin C and E intakes were also decreased (all p valueConclusionsIn this study, GDM status and dietary intakes modify AL in this population. AL may serve as an indicator of GDM control. Future research on dietary interventions that can improve maternal AL markers during GDM is warranted.

Placental abruption occurs clinically in approximately 1% of births although placental pathology assessment suggests a higher incidence. Ultrasound rarely plays a role in the diagnosis or clinical management of patients with suspected placental abruption. A patient with an incidental sonographic finding of a large concealed abruption at 36 weeks' gestation, led to induction of labor. This case and the established association of increased stillbirth with placental abruption among patients of advanced maternal age, suggest that at term, following sonographic findings of abruption, consideration should be given to elective delivery of these patients even in the absence of clinical symptomatology.

Umbilical cord accidents preceding labor are rare. Single and multiple nuchal cords, and true knot(s) of the umbilical cord, are often incidental findings noted at delivery of non-hypoxic non-acidotic newborns without any evidence of subsequent adverse neonatal outcome. In contrast to single nuchal cords, true knots of the umbilical cord, which occur in between 0.04% and 3% of all deliveries, have been associated with a reported 4 to 10 fold increased risk of stillbirth. First reported with real-time ultrasound, current widespread application of color Doppler, power Doppler and three-dimension sonography, has enabled increasingly more accurate prenatal sonographic diagnoses of true knot(s) of the umbilical cord. Reflecting the inability to visualize the entire umbilical cord at prenatal ultrasound assessment, despite detailed second and third-trimester scanning, many occurrences of incidental true knot of the umbilical cord remain undetected and are noted only at delivery. Although prenatal sonographic diagnostic accuracy is increasing, false positive sonographic diagnosis of true knot of the umbilical cord cannot be ruled out with certainty, and must continue to be considered clinically. Notwithstanding the inability to diagnose all true knots, currently there is a clear absence of clinical management guidelines by governing bodies regarding patients in whom prenatal sonographic diagnosis of true knot(s) of the umbilical cord is / are suspected. As a result, in many prenatal ultrasound units, suspected sonographic findings suggestive of or consistent with true knot of the umbilical cord are often disregarded, not documented, and patients are not uniformly informed of this potentially life-threatening condition, which carries an associated considerable risk of stillbirth. This commentary will address current perspectives of prenatal sonographic diagnostic and management challenges associated with true knot(s) of the umbilical cord in singleton pregnancies.

Funding for Open Access provided by the UMD Libraries Open Access Publishing Fund., Adverse birth outcomes including preterm birth (PTB

Triclosan (TCS) and triclocarban (TCC) are antimicrobial agents formulated in a wide variety of consumer products (including soaps, toothpaste, medical devices, plastics, and fabrics) that are regulated by the U.S. Food and Drug Administration (FDA) and U.S. Environmental Protection Agency. In late 2014, the FDA will consider regulating the use of both chemicals, which are under scrutiny regarding lack of effectiveness, potential for endocrine disruption, and potential contribution to bacterial resistance to antibiotics. Here, we report on body burdens of TCS and TCC resulting from real-world exposures during pregnancy. Using liquid chromatography tandem mass spectrometry, we determined the concentrations of TCS, TCC, and its human metabolites (2'-hydroxy-TCC and 3'-hydroxy-TCC) as well as the manufacturing byproduct (3'-chloro-TCC) as total concentrations (Σ-) after conjugate hydrolysis in maternal urine and cord blood plasma from a cohort of 181 expecting mother/infant pairs in an urban multiethnic population from Brooklyn, NY recruited in 2007-09. TCS was detected in 100% of urine and 51% of cord blood samples after conjugate hydrolysis. The interquartile range (IQR) of detected TCS concentrations in urine was highly similar to the IQR reported previously for the age-matched population of the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2004, but typically higher than the IQR reported previously for the general population (detection frequency = 74.6%). Urinary levels of TCC are reported here for the first time from real-world exposures during pregnancy, showing a median concentration of 0.21 μg/L. Urinary concentrations of TCC correlated well with its phase-I metabolite ∑-2'-hydroxy-TCC (r = 0.49) and the manufacturing byproduct ∑-3'-chloro-TCC C (r = 0.79), and ∑-2'-hydroxy-TCC correlated strongly with ∑-3'-hydroxy-TCC (r = 0.99). This human biomonitoring study presents the first body burden data for TCC from exposures occurring during pregnancy and provides additional data on composite exposure to TCS (i.e., from both consumer-product use and environmental sources) in the maternal-fetal unit for an urban population in the United States.

In contrast to complete trisomy 8, which occurs in 0.8% of spontaneous pregnancy losses and is usually lethal, trisomy 8 mosaicism (Warkany syndrome 2), occurs in between 1:25,000 and 1:50,000 births and entails a widely variable phenotype including central nervous, ocular, cardiac, gastrointestinal, genitourinary and musculoskeletal abnormalities. Individuals with trisomy 8 mosaicism may exhibit developmental delays and are at increased risk of developing leukemia and myelodysplastic syndrome. We present an unusual case in which midtrimester sonographic diagnosis of fetal truncus arteriosus type I at 18 weeks' gestation, led to amniocentesis with an initial normal karyotype. Microarray analysis detected fetal trisomy 8 mosaicism. Systematic literature search reveals that the association between truncus arteriosus and trisomy 8 mosaicism has not been reported previously.

A cervical pregnancy is an uncommon ectopic pregnancy that accounts for less than 1% of such gestations. This condition is associated with an extremely high risk of massive hemorrhage and previously often required hysterectomy. The current diagnostic modality of this potentially life-threatening condition is transvaginal sonography, supported at times by magnetic resonance imaging. The definitive diagnostic imaging feature of a cervical pregnancy is the location of a gestational sac in the cervix in the presence of a closed internal uterine cervical os. We report the 3-dimensional transvaginal sonographic findings of a cervical pregnancy at 6 weeks' gestation.

Objective The purpose of this study was to create reference range nomograms of the axial fetal neck circumference (FNC) and fetal neck area (FNA) throughout gestation. Methods This prospective cross-sectional study involved pregnant patients between 14 and 40 weeks' gestation. Inclusion criteria consisted of well-established dates (confirmed by early sonography) and nonanomalous singleton fetuses with intact fetal membranes. Sonographic measurements included biparietal diameter, head circumference, abdominal circumference, femur length, humerus length, transcerebellar diameter, and sonographically estimated fetal weight. Axial FNC and FNA values were calculated as means of 3 separate measurements. The 5th, 50th, and 95th percentiles were estimated at each week of gestational age (GA) by least squares regression for the mean and SD of the FNC and FNA as functions of GA. R(2) and associated P values for the relationships between the FNC, FNA, and other sonographic biometric measurements were calculated. Results The study included 720 consecutive patients. The mean maternal age +/- SD was 27.3 +/- 6.6 years; median gravidity, 3 (range, 1-13); and median parity, 1 (range, 0-10). The following equations were devised: mean FNC (centimeters) = -11.85 + 1.687 x GA (weeks) -0.043 x GA(2) + 0.0004951 x GA(3); SD(FNC) = 3.15 - 0.3823 x GA + 0.01733 x GA(2) - 0.0002179 x GA(3); mean FNA (square centimeters) = 37.29 - 7.0 x GA + 0.4717 x GA(2) - 0.01245 x GA(3) + 0.0001222 x GA(4); and SD(FNA) = 7.08 - 0.9413 x GA + 0.04135 x GA(2) - 0.0004829 x GA(3). Both the FNC and FNA correlated significantly and strongly with biparietal diameter, head circumference, abdominal circumference, humerus length, femur length, transcerebellar diameter, and sonographically estimated fetal weight. Conclusions Current nomograms of the axial FNC and FNA throughout gestation have been provided.

Fetal exposure to five parabens was investigated due to their endocrine-disrupting potential and possible impact on fetal development. Body burdens occurring from real-world exposures were determined typically as total concentrations after conjugate hydrolysis in 181 maternal urine and 38 umbilical cord blood plasma samples from a multiethnic cohort of 185 predominantly-black, pregnant women recruited in Brooklyn, New York between 2007/9. For 33 participants, both sample types (maternal urine and cord blood) were available. Methyl- (MePB), ethyl- (EtPB), propyl- (PrPB), butyl- (BuPB), and benzylparaben (BePB) were detected in 100, 73.5, 100, 66.3 and 0.0% of the urine samples at median concentrations of 279, 1.44, 75.3, 0.39, and

Prenatal sonographic diagnoses of subcutaneous soft tissue masses include hemangiomas, malformations (capillary, lymphatic, venous, arterial, or mixed), teratomas, and, rarely, sarcomas. 1-5 Prenatally depicted malformations may be seen in association with more complex fetal conditions, including Klippel-Trenaunay-Weber (angio-osteohypertrophy) and Proteus syndromes.6"9 We present an unusual case in which extensive multiple soft tissue tumors encompassing the fetal upper chest, back, nuchal area, and bilateral axillae, considered consistent with multiple large lymphatic malformations noted at 23 weeks' gestation, decreased in size throughout the remainder of gestation. At delivery, relatively small subcutaneous masses remained. Tissue histopathologic findings obtained at biopsy and the neonate's clinical course during which the subcutaneous masses underwent a marked spontaneous decrease in size, were consistent with low-flow mixed lymphatic and venous malformations.

Objective To assess whether fetal cerebral vascular resistance is affected by the presence of nuchal cord(s) in the third trimester. Methods A set of 115 patients with well-established dates and singleton, appropriate for gestational age (GA), nonanomalous fetuses with nuchal cord(s) diagnosed with prenatalcolorDopplerimaging,between28and41 weeks and 115 controls matched for GA, were studied. Patients with hypertension, diabetes and autoimmune conditions were excluded. Doppler indices were obtained from the umbilical artery (UA) and the fetal middle cerebral artery (MCA) upon initial diagnosis of the nuchal cord. Results Of 115 GA-matched pairs of pregnancies, 103 fetuses had a single nuchal cord and 12 a double nuchal cord. No significant differences were noted in patient age, gravidity, parity, sonographically estimated fetal weight (SEFW), and growth centile at ultrasonographic diagnosis. Mean UA systolic/diastolic ratio (S/D) was 2.28 ± 0.32 and 2.36 ± 0.33 (P = 0.03) and UA resistance index (RI) 0.55 ± 0.06 and 0.57 ± 0.06 (P = 0.02) among study and controls, respectively. Mean fetal MCA S/D and RI did not differ significantly between the two groups (fetal MCA S/D 5.01 ± 1.28 and 5.04 ± 1.71 (P = 0.86), and mean fetal MCA RI 0.78 ± 0.06 and 0.78 ± 0.05 (P = 0.88)). No significant differences were noted in GA at delivery, incidence of meconium-stained amniotic fluid, birth weight, mode of delivery, neonatal gender, 1 and 5 minute Apgar scores, or UA pH and base excess, between study and control patients. Conclusion Fetal cerebral vascular resistance is not affected by the presence of nuchal cord(s) in the third trimester of pregnancy. Copyright  2005 ISUOG. Published by John Wiley & Sons, Ltd.

Objective To assess the feasibility of sonographic depiction of the fetal hard palate and secondarily to create nomograms throughout gestation of its sonographic width, length and area. Methods This was a cross-sectional study of pregnant patients between 15 and 41 weeks' gestation. Inclusion criteria consisted of well-established dates (confirmed by early ultrasound), and singleton, non-anomalous fetuses. Sonographic measurements obtained included biparietal diameter, head circumference, abdominal circumference and femur length. Fetal hard palate measurements included maximum width, maximum length and the calculated area. Tables were prepared depicting the estimated mean ± SD and 5th, 50th and 95th centiles at each gestational week between 15 and 41 weeks. Pearson's correlation coefficient and associated P-values for the relationships between fetal hard palate measurements and other sonographic measurements and coefficients of variation for each of the fetal hard palate measurements were calculated. Results The study included 602 consecutive patients. The mean maternal age was 28.7 ± 6.3 years, with median gravidity of 2 (range, 1–12) and parity 1 (range, 0–8). All attempts at obtaining fetal hard palate ultrasound measurements were successful. Mean fetal hard palate width (cm) = −0.73579345 + 0.11370432 × GA − 0.00083919 × GA2 and SD = −0.017842055 + 0.005142475 × GA, where GA is gestational age in weeks. Mean fetal hard palate length (cm) = −0.82020463 + 0.11767777 × GA − 0.00092801 × GA2 and SD = −0.043064317 + 0.006378869 × GA. Mean fetal hard palate area (cm2) = −2.40090641 + 0.17136556 × GA + 0.00097308 × GA2 and SD = −0.603647741 + 0.040740282 × GA. Sonographic measurements of the fetal hard palate width, length and area correlated significantly and strongly with gestational age (all P < 0.001) and significantly but less strongly with femur length (P = 0.004). Conclusion The fetal hard palate may be depicted sonographically with relative ease between 15 and 41 weeks' gestation and measurements of the fetal hard palate width, length and area correlate well with gestational age, biparietal diameter, abdominal circumference, sonographic estimated fetal weight, and femur length. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

Cervical pregnancy is an uncommon ectopic pregnancy that accounts for approximately