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The aims of this study were to describe a new ultrasonographic technique to assess the normal level of the cerebellum and the brainstem in the posterior fossa in normal foetuses and to compare in pathologic cases. We propose a new line cross between the dens cervical and the inferior portion of occipitum (occipitum–dens line—ODL). In a cross-sectional study, a single observer with experience in foetal neurosonography evaluated 54 foetuses (40 normal and 14 with open neural tube defect) between 20 and 28 weeks of gestation. The reference points for the ODL are principally the lower portion of the occipital bone (occipitum) and odontoid process of the second cervical vertebra (dens). The line was considered the level zero (near level of foramen magnum). Structures above it had a positive measurement and below it had a negative measurement. Moreover, in most foetuses with open neural tube defect (93 %), the end portion of cerebellum was below the ODL associated with different degrees of ventriculomegaly. The proposed innovation aims to bring to the ultrasound the most likely anatomical parameters of evaluation in normal foetuses and in foetuses with spinal dysraphism.

Fetal intracranial tumors are rare and their evolution is usually poor. With routine use of antenatal ultrasound imaging, a larger number of such tumors have been diagnosed. During the period from January 1992 to January 2002, 18 cases diagnosed as intracranial tumors in the fetal stage were treated in the Neurosurgery and Obstetrics Departments of the Federal University of Sao Paulo and in the Fetal Medicine Service of the Maternity Hospital Santa Joana. The tumors most frequently found were those of the choroid plexus and teratomas. Out of those 18 cases, 11 patients presented with fetal hydrocephalus, and 5 of them, who were less than 34 weeks old (gestational age), underwent repeated cephalocenteses while awaiting better conditions for delivery. Two fetuses died while in utero before any intervention had taken place and 16 underwent craniotomy after birth. Twelve of those patients are still alive, 9 of whom are considered normal. The 3 others are slightly or moderately retarded.

OBJETIVO: avaliar a influência das alterações ultra-sonográficas pré-natais e das contrações uterinas de trabalho de parto na evolução motora neonatal em fetos portadores de espinha bífida aberta. MÉTODOS: foram analisados fetos portadores de espinha bífida aberta. Estes fetos foram acompanhados nos serviços de Medicina Fetal do Hospital São Paulo (Universidade Federal de São Paulo) e do Hospital e Maternidade Santa Joana. Todos os partos foram realizados nestes serviços e a avaliação neonatal foi realizada pela equipe de Neurocirurgia comum a ambas as instituições Foi observada a influência das alterações ultra-sonográficas (macrocrania, microcrania, nível da falha de fechamento da coluna, pé torto e tipo de apresentação fetal) na força muscular de membros inferiores no período neonatal. Foi analisada, também, a influência das contrações uterinas sobre a movimentação dos membros inferiores. Todos os partos foram realizados por cesárea. Foram utilizados os testes de c² e Fisher para comparações categóricas, com p

Congenital central nervous system tumors diagnosed during pregnancy are rare, and often have a poor prognosis. The most frequent type is the teratoma. Use of ultrasound and magnetic resonance image allows the suspicion of brain tumors during pregnancy. However, the definitive diagnosis is only confirmed after birth by histology. The purpose of this mini-review article is to describe the general clinical aspects of intracranial tumors and describe the main fetal brain tumors.

A case of prenatally diagnosed otocephaly is reported. Otocephaly is an extremely rare malformation characterized by absence or hypoplasia of the mandible and abnormal horizontal position of the ears. 2D ultrasound performed at 25 weeks of gestation revealed agnathia, proboscis and hypotelorism. 3D ultrasound (rendering mode) and magnetic resonance imaging were used to evaluate the facial features, and were essential for characterization of facial malformations in otocephaly and for the demonstration and correct prenatal counseling of the couple.

Objetivo Comparar o desenvolvimento neuromotor de pacientes submetidos à cirurgia fetal intrauterina da mielomeningocele ao de pacientes não submetidos ao procedimento. Métodos Foram avaliados: o desenvolvimento neuromotor (descrevendo o nível anatômico e motor funcional), o tipo de marcha, a necessidade de órteses e o nível cognitivo de crianças com mielomeningocele entre 3,5 e 6 anos de idade, submetidas (Grupo A; n=6) ou não submetidas (Grupo B; n=7) à cirurgia fetal intra-uterina. Resultados A função motora apre-sentou melhora significante, com nível funcional mais elevado em dois ou mais segmentos em relação ao nível anatômico em todas as crianças do Grupo A e em duas crianças do Grupo B, com diferença estatística entre os grupos (p

Present the outcomes of six cases submitted to intrauterine myelomeningocele (MMC) repair. Descriptive observational study of six children submitted to antenatal surgical repair of MMC between 26 and 27 weeks gestation. All deliveries were through cesarean section. The following neonatal variables were assessed: gestational age at delivery, birth weight, Apgar scores, need for intubation, duration of hospital stay and need for postnatal shunt procedures. After 3.5 years, the children were evaluated using the Columbia Mental Maturity Scale or Denver II tests and the Hoffer Ambulation Scale. All deliveries were preterm at a mean gestational age of 32 + 4 weeks and mean birth weight was 1,942 g. Two infants had Apgar scores

Myelomeningocele (MMC) is a nonlethal form of neural tube defect (NTD) that results from failure of the neural tube to fuse during early embryogenesis. The lesion is characterized by protrusion of the meninges through a midline bony defect of the spine, a sac containing cerebrospinal fluid and dysplastic neural tissue not covered by skin. MMC represents an important congenital defect of the brain and spinal cord that affects approximately one in 2,000 live births and about 23% of pregnancies that end in elective abortion [1, 2]. MMC leads to lifelong and significant physical disabilities including paraplegia, hydrocephalus, bladder and fecal incontinence, sexual dysfunction, skeletal deformation and mental impairment [3]. The mortality rate, which can be as high as 47% on long-term followup, is principally attributable to the hindbrain herniation observed in Chiari malformation and to the renal failure observed in neurogenic bladder dysfunction [4].

OBJETIVOS: analisar a contagem dos corpos lamelares em comparação com o teste de Clements na avaliação da maturidade pulmonar fetal em gestantes diabéticas. MÉTODOS: estudo prospectivo envolvendo 62 gestantes submetidas a amniocentese entre a 26ª e a 39ª semana. O líquido amniótico foi imediatamente submetido ao teste de Clements e à contagem de corpos lamelares. Os partos ocorreram até três dias após a amniocentese. A ocorrência de síndrome de angústia respiratória, indicativa de imaturidade pulmonar, foi confrontada com os resultados de imaturidade da amniocentese (ausência de anel completo no 3º tubo e menos de 50.000 corpos lamelares). O teste do chi2 foi utilizado para comparar o desempenho dos dois métodos e p

Objective: Compare the use of a newly designed and reusable metal trocar for initial uterine entry with the disposable Tulipan–Bruner trocar in creation of a hysterotomy for fetal surgery. Methods: Six consecutive patientsundergoing hysterotomy for intrauterine repair of myelomeningocele were randomized to uterine entry either with the Tulipan–Bruner trocar or with the Almodin–Moron trocar. Blood loss was estimated by the primary surgeon. Results: There was no statistically significant difference in the uterine entry times between the trocars. Blood loss was estimated to be approximately the same. The Almodin–Moron trocar was judged to provide easy handling with good safety. Conclusions: The Almodin–Moron trocar provides a uterine entry during creation of a hysterotomy that is as quick and causes as little trauma as the Tulipan–Bruner trocar.

Asymmetrical conjoined twins or heteropagus twins are extremely rare. They are characterized by an incomplete component (parasite) that is normally smaller and dependent on the host (autosite). In cases of an epigastric heteropagus twin, the insertion occurs in the epigastrium. There are few reports of epigastric heteropagus twinning in the English-language literature. The authors report an extremely rare case of epigastric heteropagus twinning in which the parasite presented with head, thorax, and a rudimentary heart.

Objectives: The pituitary gland is critically important in the function of the endocrine axis. So far, antenatal demonstration of the pituitary gland was possible only by using Magnetic Resonance Imaging (MRI) modality. The objective of our study was to describe antenatal visualization of the pituitary gland using two and three dimensional ultrasound modality. Methods: Using a Voluson E-8 (E8 systems, GE Medical Systems, Zipf, Austria) ultrasound machine, equipped with transabdominal multifrequency 4–8-MHz probe, during the third trimester of pregnancy, two dimensional images and three dimensional volume acquisition were taken. Results: We identified the unique shape of the pituitary gland using two and three dimensional ultrasound modality, on axial plane of the skull, parallel to and slightly below the biparietal diameter plane, showing the circle of Willis. Four manipulated steps from the native volume were needed for 3D reconstruction of the gland using transabdominal sonography. The insertion of the stalk to the posterior part of the gland can be seen. The circle of Willis was found to be an excellent marker for the gland location. Conclusions: This is the first report to date indicating that prenatal visualization of the pituitary gland using ultrasound imaging is feasible. In cases with midline anomalies of the brain, face or cranium, the demonstration of the pituitary gland, which is an essential endocrine gland, is recommended.

A prospective cross-sectional study was developed to determine the correlation between the umbilical cord cross-sectional (UCCSA) and fetal anthropometric parameters during normal pregnancies (patients with known dates of LMP and an ultrasound examination before the 20th week, without any pathologic condition). The measurements of the umbilical cord cross-sectional area were obtained in a plane adjacent to the insertion of the cord in the abdomen, as proposed by Raio et al., 1999, and compared to the biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) by the non-parametric correlation of Spearman. The inclusion criteria were: (1) singleton pregnancy; (2) gestational week >20 weeks; (3) intact membranes; (4) normal umbilical Doppler flow velocimetry. The exclusion criteria, in the presence of any of those were: (1) congenital and/or chromosomal abnormalities; (2) pregnancy complications (any type); (3) inadequate size for gestational agent the time the ultrasound examination was performed, i.e. the weight below the 10th or above the 90th percentile; (4) abnormal AFI. The patients were examined and included only once. The statistical analysis was performed by the program called Statistical Package for Social Sciences (SPSS) and we used a Toshiba 140 with a transabdominal transducer of 3.5 MHz. Our results showed a strong correlation (Spearman rank = 0.610, significant at the level of P

A prospective cross-sectional study was developed in order to determine reference ranges for the umbilical cord cross-sectional area (UCCSA) during normal pregnancies (patients with known dates of LMP and an ultrasound examination before the 20th week, without any pathologic condition). The measurements of the UCCSA were obtained in a plane adjacent to the insertion of the cord abdomen, as proposed by Raio et al, 1999. The inclusion criteria were: (1) singleton pregnancy, (2) gestation age >20 weeks, (3) intact membranes, (4) normal umbilical Doppler flow velocimetry. The exclusion criteria, in the presence of any of those, were: (1) congenital and/or chromosomal abnormalities; (2) pregnancy complications (any type); (3) inadequate size for gestational age when the examination was performed, i.e. the weight below the 10th percentile or above the 90th; (4) abnormal AFI for the gestational age. The patients were examined and included only once. During the period of the study (February 2000–May 2001), 545 patients were examined, after meeting the inclusion criteria determined for the present study. The age of the patients ranged from 15 to 42 years (mean = 26.7 ± 4.8), 242 patients (44.4%) had two gestations, 135 patients (28.1%) were at their first gestation, 129 patients (23.7%) were at their third gestation and 39 patients had four or more gestations (3.8%). The ultrasound machine used was the Synergy Multi Sync M 500 and the statistical analysis was performed by the program called Statistical Package for Social Sciences (SPSS). Our data were considered normally by the Kolmogorov–Smirnov test and then we figured the nomogram by linear regression analysis. The analysis of variance obtained through the F-test (value = 356.27) showed that our regression model was significant at the level of P