In Brief OBJECTIVE To study the outcome of 50 pregnancies with documented vertical transmission of cytomegalovirus infection. METHODS We recruited 50 pregnant women (51 fetuses) with primary cytomegalovirus infection and confirmed in utero transmission. Prenatal evaluation included diagnostic amniocentesis and repeated ultrasound examinations. Fetal diagnosis was made after 21 weeks' gestation by amniocentesis and based on virus isolation by culture, shell vial, and polymerase chain reaction (PCR). Cytomegalovirus infection in neonates was determined by urinary viral isolation after birth or histologic examination of tissue from aborted fetuses. Cerebral ultrasound, hearing assessment, and psychomotor development were investigated for all 18 live-born neonates. RESULTS Thirty-three of the 50 women (66%) elected termination of pregnancy. Ultrasonographic abnormalities associated with in utero fetal infection were observed in 11 (21.5%) fetuses. Two of them continued to term; both were congenitally infected, and one had neurologic abnormalities. The positive predictive values of the PCR and virus isolation assessments performed in all 50 pregnancies (51 gestational sacs) were 92% and 93.7%, respectively. Seventeen pregnancies (18 fetuses) continued to term: four fetuses had neurologic abnormalities, of which three had normal prenatal ultrasound findings. The remaining 14 had normal neonatal assessments. CONCLUSION Positive isolation of cytomegalovirus accompanied by positive PCR values in amniotic fluid provided approximately 94% certainty of in utero cytomegalovirus infection. The risk of postnatal neurologic abnormalities was 19% (three of 16) when there were no prenatal ultrasonographic abnormalities. We present prenatal and neonatal outcomes of 50 pregnancies with proven primary maternal infection and vertical transmission of cytomegalovirus.
Bilateral failure of the kidney to ascend during embryonic life may lead to fusion of the two renal masses resulting in a round mass known as pancake kidney. Prenatal diagnosis of pancake kidney was not reported in the literature. The objective of this study is to investigate prenatal diagnosis and postnatal outcome of fetuses with pancake kidney. Cases referred for bilateral empty renal fossa and diagnosed with pancake kidney confirmed postnatally were analysed retrospectively over a period of 5 years at two tertiary centres. Prenatal diagnosis was established following the detection of a single renal mass located in the fetal pelvis and drained by two ureters. Between 2013-2018, pancake kidney was diagnosed in 5 cases. In two case, multiple family members had renal malformations (2 uncles, father, sibling – double collecting system, previous pregnancy terminated due to potter sequence, sibling with horseshoe kidney). No associated renal anomalies were diagnosed pre- or post-nataly. Extra renal associated anomalies included aberrant right subclavian artery and non-visualisation of the uterus consistent with Mayer-Rokitansky-Küster-Hauser syndrome. Amniocentesis for chromosomal microarray was normal in 4/5 case. In one case a deletion in 15q11.2 was found in the fetus and his father, considered a VUS. On post-natal follow up, one female child has mildly elevated blood level creatinine and a GFR = 50ml/min/1.73m2. All other childern have normal renal function. Pancake kidney malformation should be considered in cases presenting with bilateral renal fossa. This malformation is not necessarily associated with renal dysfunction but does require exclusion of concomitant anomalies including the fetal uterus as well as close post-natal renal follow-up. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
A severe form of TOF has pathological vessels arising from the aorta or its branches and caring the blood flow to the lungs, instead of the pulmonary arteries. Those arteries call Major Aortopulmonary Collateral Arteries (MAPCAs). This anomaly usually is diagnosed only postpartum and has poor prognosis. We present here for the first time prenatal detection of MAPCAs. The diagnosis was done in four cases in two Medical Centres: First case: TOF with pulmonary atresia was diagnosed in one twin of monoamniotic pregnancy at 27 weeks. The pulmonary arteries could not be detected, and total diversion of blood from both ventricles into the aorta was demonstrated. Careful examination reviled MAPCAs arising from the descending aorta to the right lung. Selective termination of pregnancy using Radiofrequency Ablation was done at 31 week gestation and Caesarean delivery for the second twin. Second case: A 37 week fetus diagnosed with TOF and Pulmonic Atresia. The pulmonary arteries could not be detected. At the age of 3 days CT scan demonstrate two MAPCAs arising from the subclavian artery from each side. The child was operated (unifocalisation) and died at the age of 5 month from lung complication. Third case: The diagnosis of TOF with pulmonary atresia and MAPCAs was made at 28 week gestation. The MAPCAs arise from the descending aorta to both lungs. This pregnancy was terminated. Forth case: A 19 week fetus was diagnosed with TOF, absent pulmonary valve, small right PA, hypoplastic left PA, absent ductus arteriosus and MAPCAs arising from the descending aorta. The pregnancy was terminated. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
The study objective was to evaluate the added-value of fetal brain MRI to ultrasound examination in detecting and specifying callosal anomalies, and its impact on clinical decision making. Fetuses with a sonographic diagnosis of an anomalous corpus callosum (CC) who underwent a subsequent fetal brain MRI between 2010 and 2015 were retrospectively evaluated and classified according to their findings' severity. Comparison of the findings detected on ultrasound to those detected on MRI was performed. An analysis was made to assess whether the addition of fetal MRI altered the group classification, and thus the management of these pregnancies. 78 women were recruited following sonographic diagnosis of either complete or partial callosal agenesis, short, thin or thick CC. Normal MRI studies were obtained in 19 cases (24%). Analysis of the concordance between US and MRI demonstrated a good level of agreement for complete callosal agenesis (kappa: 0.742), moderate agreement for thin CC (kappa: 0.418) and fair agreement for all other callosal anomalies. Comparison between US and MRI based mild/severe findings classifications revealed that for 28 fetuses (35.9%) MRI altered the initial ultrasound based classification. Following MRI, the classification of 25 fetuses (32.1%) changed from severe to mild findings while the classification of 3 fetuses (3.8%) changed from mild to severe findings. Fetal MRI effectively detects callosal anomalies and enables satisfactory validation of the occurrence or absence of callosal anomalies identified by ultrasound and adds valuable data that improves clinical decision making.
The four-chamber view (4CV) detects about 30% of major cardiac anomalies. Adding the outflow tract and the three-vessel trachea view (3VT) improve the detection of cardiac anomalies. 3-Dimensional ultrasound (3DUS) is more available than 4-Dimensional ultrasound for cardiac examinations. The aim of this study is to investigate the ability to demonstration of the 3VT of the fetal heart with 3DUS, and to test the reliability of the measurements of the arches. Prospective study of normal fetal heart volumes, acquired at the second trimester of gestation by 3DUS with color Doppler. Post processing off line manipulation of the volumes to demonstrate the 3VT view by two expert sonologists. The ‘V’ shape of the arches, the color of flow and the place of the trachea and superior vena cava were evaluated. Measurements of the aortic- and ductal-arch diameter were calculated and compared to the value from literature of 2-Dimension ultrasound. Intra- and inter-observer variability was calculated. 31 healthy patients with normal fetuses by anomaly scan were evaluated prospectively. Mean gestational age was 22w6d (range 19w4d–25w0d). Navigation in the cephalic direction revealed the 3VT view in 87–90% by the two reviewers. Mean and 95CI diameter of the aortic and pulmonary arteries are presented in Table 1. The estimated time for volume acquisition and manipulation in the A plane is about 60 seconds. Combination of basic knowledge of 3DUS and demonstration of 4CV allows extension of the cardiac examination to the 3VT view in about 90% of cases. Information of the number of vessels, shape, diameter, flow direction and the relation of the two arches is collected with simple sonographic method.
The purpose of this study was to evaluate a novel sonographic scoring system for risk assessment of complications in patients suspected of having morbidly adherent placenta.This retrospective study evaluated the association between maternal complications and a grayscale sonographic scoring system for adherent placenta before surgery. Criteria for adherent placenta included uteroplacental and uterobladder demarcation lines and the presence of lacunae. Placentas were classified into 4 stages: stage 0, normal placentation; stage 1, low probability of adherence; stage 2, moderate possibility of adherence; and stage 3, high suspicion of adherence. Placental adherence as assessed by a surgical team, estimated blood loss, and postoperative hospitalization days were determined for each group, as well as the rates of the need for packed blood cells, cryoprecipitate units, and hysterectomy.One hundred nine women were included in the study. Twenty-six (23.8%) women were given a score of stage 0, 22 (20.2%) stage 1, 28 (25.7%) stage 2, and 33 (30.3%) stage 3. Linear regression analysis demonstrated that the sonographic staging was the only variable significantly associated with the number of packed cells or cryoprecipitate units transfused (P< .001) and a clinical diagnosis of adherent placenta (P< .001). In addition, both sonographic staging and a history of cesarean delivery were significantly associated with hysterectomy (P = .01; P = .03, respectively), treatment with any blood products (P< .001; P= .01), and the duration of postoperative hospitalization (P< .001; P = .006).A scoring system based on simple grayscale parameters may be effective for antenatal risk assessment of maternal complications in cases of suspected morbidly adherent placenta.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
