Fetal age estimation using MSCT scans of deciduous tooth germs.

Evaluation of fetal age is an essential element in many fields such as anthropology, odontology, paleopathology, and forensic sciences. This study examines the correlation between fetal age, femoral diaphyseal length (considered as the gold standard), and deciduous tooth germs of fetuses aged 22 to 40 weeks amenorrhea (WA) based on computed tomography (MSCT) reconstructions. Qualitative and quantitative studies of femoral and deciduous tooth germ lengths were performed on 81 fetuses (39 females and 42 males). R software was used for statistical analyses. Intra-observer and inter-observer variabilities and the interclass correlation coefficient (ICC) were calculated. Correlation coefficients (R (2)) and linear regression equations were calculated. Intra- and inter-observer variabilities were very satisfactory (intra-observer ICC ≥ 0.96, inter-observer ICC ≥ 0.95). Femoral length was significantly correlated with age (R (2) = 0.9). The correlation coefficient between age and height, width, and dental volume was R (2) ≥ 0.73. Tooth germs were good indicators of fetal age. Our method appears to be reliable and reproducible, and the results of this study agreed with those of the literature. The dental formula provided a precise estimation of fetal age between 25 and 32 WA. Tooth germs were reliable indicators of fetal age, and multislice computed tomography was shown to be an innovative and reliable technology for this purpose.

First-trimester sonographic prediction of obstetric and neonatal outcomes in monochorionic diamniotic twin pregnancies.

OBJECTIVES: The purpose of this study was to investigate whether discordant nuchal translucency and crown-rump length measurements in monochorionic diamniotic twins are predictive of adverse obstetric and neonatal outcomes. METHODS: We conducted a multicenter retrospective cohort study including all monochorionic diamniotic twin pregnancies with two live fetuses at the 11-week to 13-week 6-day sonographic examination who had serial follow-up sonography until delivery. Isolated nuchal translucency, crown-rump length, and combined discordances were correlated with adverse obstetric outcomes, individually and in composite, including the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction (IUGR), twin-twin transfusion syndrome (TTTS), intrauterine fetal death (IUFD), growth discordance (≥ 20%), and preterm birth before 28 weeks' gestation. Correlations with adverse composite neonatal outcomes were also studied. A receiver operating characteristic curve analysis and a logistic regression analysis with a generalized estimating equation were conducted. RESULTS: Fifty-four of the 177 pregnancies included (31%) had an adverse composite obstetric outcome, with TTTS in 19 (11%), IUGR in 21 (12%), discordant growth in 14 (8%), IUFD in 14 (8%), and preterm birth before 28 weeks in 10 (6%). Of the 254 neonates included in the study, 69 (27%) were complicated by adverse composite neonatal outcomes, with respiratory distress syndrome being the most common (n = 59 [23%]). The areas under the curve for the combined discordances to predict composite obstetric and neonatal outcomes were 0.62 (95% confidence interval, 0.52-0.72), and 0.54 (95% confidence interval, 0.46-0.61), respectively. CONCLUSIONS: In our population, nuchal translucency, crown-rump length, and combined discordances in monochorionic diamniotic twin pregnancies were not predictive of adverse composite obstetric and neonatal outcomes.

Embryonic growth discordance and early fetal loss: the STORK multiple pregnancy cohort and systematic review.

STUDY QUESTION: Is there an association between discordance in embryonic growth and fetal loss at the time of the 11-14-week scan in twin pregnancies? SUMMARY ANSWER: Regardless of the chorionicity, crown rump length (CRL) discordance at 7(+0)-9(+6) weeks is predictive of subsequent single fetal demise in the first trimester. WHAT IS KNOWN ALREADY: Previous small studies have reported a variable association between discordance in embryonic growth and subsequent fetal loss. STUDY DESIGN, SIZE, DURATION: Retrospective study of all twin pregnancies of known chorionicity from a large regional cohort over a 10-year period. A total of 1356 twin pregnancies (288 monochorionic and 1068 dichorionic) were included in the study. PARTICIPANTS, SETTING, METHODS: Women presenting to the early pregnancy unit were included in the study. Logistic regression, ROC curve and Kaplan-Meier analyses were performed to evaluate the association between CRL discordance at 7(+0)-9(+6) weeks and spontaneous single fetal loss diagnosed at the 11-14-week scan. A systematic review was also performed using MEDLINE, EMBASE, Cinahl and the Cochrane Library in order to explore the relationship between early growth discordance and single fetal loss in twin pregnancies. MAIN RESULTS AND THE ROLE OF CHANCE: There were 111 (8.2%) single fetal losses diagnosed at 11-14 weeks in this cohort. At multivariate analysis, CRL discordance percentile [odds ratio (OR) 1.20; 95% confidence interval (CI), 1.12-1.63, P < 0.0001] and CRL <5th centile of at least one twin (OR, 2.21; 95% CI 1.23-4.24, P = 0.023), but not chorionicity (P = 0.486) or maternal age (P = 0.283) was independently associated with the loss of one fetus at the 11-14-week scan. The predictive accuracy of CRL discordance for single fetal loss was high (AUC = 0.93; 95% CI = 0.91-0.94). A significant association was found between the increase in the degree of embryonic discordance and the likelihood of early fetal loss (P < 0.0001). LIMITATIONS, REASONS FOR CAUTION: Only a high-risk population was analysed. Therefore, the patients studied were not a representative sample from the population of women pregnant with twins. WIDER IMPLICATION OF THE FINDINGS: Twin pregnancies, in particular those resulting from assisted conception, are scanned frequently, particularly during the early stages of pregnancy. The findings of this study are likely to prove important in counselling parents about the short-term outcome of the pregnancy when an embryonic discordance is present. STUDY FUNDING/COMPETING INTEREST(S): No external funding was sought for this study. None of the authors has any conflicts of interest to declare.

Systematic review of sonographic findings of placental mesenchymal dysplasia and subsequent pregnancy outcome.

OBJECTIVE: To describe the sonographic features and pregnancy outcomes of placental mesenchymal dysplasia (PMD), an entity often misdiagnosed as molar pregnancy. METHODS: We reviewed PMD cases from our institution and performed a systematic review of the existing literature. Inclusion criteria for the review were diagnosis of PMD as defined by placental pathology, description of placental morphology on antenatal ultrasound and reporting of pregnancy outcomes. RESULTS: We found three cases of PMD at our institution. Patient 1 had elevated human chorionic gonadotropin (hCG) and an enlarged, hydropic placenta at 13 weeks, suggestive of a molar pregnancy. Patient 2 also had elevated hCG with large, vascular placental lakes on ultrasound suggesting placenta accreta or molar pregnancy. Case 3 involved placentomegaly and fetal anomalies suggestive of Beckwith-Wiedemann syndrome. From the literature review, 61 cases met the inclusion criteria. The most common sonographic features included enlarged (50%) and cystic (80%) placenta with dilated chorionic vessels. Biochemical aneuploidy screening abnormalities were relatively common as were fetal anomalies, Beckwith-Wiedemann syndrome and other genetic abnormalities. Pregnancy complications included intrauterine growth restriction (IUGR; 33%), intrauterine fetal death (IUFD; 13%), and preterm labor (33%). Pregnancies without fetal anomalies, IUGR, IUFD or preterm labor had normal neonatal outcomes despite PMD (9%). CONCLUSIONS: The differential diagnosis of PMD includes molar pregnancy and other placental vascular anomalies. PMD is associated with adverse pregnancy outcome, so heightened surveillance with genetic evaluation, serial growth scans and third-trimester assessment of wellbeing should be considered. PMD must be differentiated from gestational trophoblastic disease because management and outcomes differ.

Prediction of intrauterine fetal death in small-for-gestational-age fetuses: impact of including ultrasound biometry in customized models.

OBJECTIVE: Customized growth charts derived from maternal demographic characteristics alone have been shown to improve the prediction of pregnancy complications compared to population growth curves. We sought to estimate the impact of adding ultrasound biometric parameters to the customized chart for the prediction of intrauterine fetal death (IUFD). METHODS: A retrospective cohort study was undertaken using an ultrasound database including singleton pregnancies followed between 16 and 20 weeks' gestation. After exclusion of preterm births, congenital anomalies, multifetal pregnancies and stillbirths (excluded only from derivation samples), we identified 59 016 births, divided into derivation (34 832) and validation (24 184) samples. Coefficients for significant physiological and pathological variables affecting fetal growth were derived using backward stepwise multiple regression (Cust-chart). The same process was repeated including second-trimester biometric parameters: biparietal diameter, head circumference, femur length and abdominal circumference in the regression models (Cust-plus-USS-chart). The association between small-for-gestational age < 10(th) centile (SGA) pregnancies, defined using the two customized charts or our population-based growth chart (Pop-chart) and IUFD, were compared. Statistical analyses including OR, 95% CI and screening accuracy using each chart were performed. RESULTS: The derived coefficients for fetal growth are comparable to those of previously published series. Of 24 184 pregnancies in the validation sample, IUFD was seen in 169 (0.7%). The pregnancies identified as SGA were: 2482 (10.26%), 2499 (10.33%) and 2634 (10.89%) using the Cust-chart, Cust-plus-USS-chart and Pop-chart, respectively. The OR (95% CI) for the association between SGA defined by the three charts and IUFD was: 7.0 (4.5-11), 6.5 (4.2-10.2) and 2.4 (1.6-3.6) according to the Cust-chart, Cust-plus-USS-chart and Pop-chart, respectively. Screening efficiency for IUFD using both customized charts was similar, with both demonstrating a higher sensitivity compared with the Pop-chart. CONCLUSIONS: Customized charts are more efficient in identifying pregnancies at risk for IUFD compared with population-based charts. However, adding second-trimester ultrasound biometric parameters to the customized model does not improve the prediction of IUFD compared with using maternal characteristics only.

Influence of chorionicity on perinatal outcome in a large cohort of Danish twin pregnancies.

OBJECTIVE: To assess outcome in twin pregnancies according to chorionicity. METHODS: A cohort was retrieved from local ultrasound databases at 14 obstetric departments in Denmark, comprising all twin pregnancies with two live fetuses scanned between weeks 11 and 14 in the period 1 January 2004 to 31 December 2006. Outcome data were retrieved from the National Board of Health. RESULTS: Among 2038 twin pregnancies, 1757 (86.2%) were dichorionic (DC) and 281 (13.8%) were monochorionic diamniotic (MC). In MC pregnancies, the rate of spontaneous fetal loss in both second and third trimesters was more than threefold higher than the comparable rate in DC pregnancies: 6.0% vs. 1.9% for at least one fetus in the second trimester (P < 0.001) and 2.1% vs. 0.7% in the third trimester (P = 0.03). In 98.4% of DC pregnancies and in 91.1% of MC pregnancies, at least one infant was liveborn. Amongst pregnancies with two live fetuses at 24 weeks, the proportion with two live infants at 28 days after delivery was 97.5% and 95.1%, respectively. CONCLUSIONS: The increased incidence of fetal loss in MC pregnancies compared with DC pregnancies predominantly occurs before 24 weeks' gestation. After this stage, although the risk of intrauterine fetal death is still higher in MC than in DC pregnancies, if both fetuses are alive at 24 weeks, the chance of a woman having two live infants 1 month after delivery is similar in MC and DC pregnancies.

Virtual autopsy by computed tomographic angiography of the fetal heart: a feasibility study.

OBJECTIVE: To determine the feasibility of postmortem computed tomographic (pm-CT) angiography for fetal heart evaluation. METHODS: Following termination of pregnancy (TOP) or intrauterine fetal death (IUFD) beyond 18 weeks' gestation, 33 fetuses were examined by pm-CT; in eight contrast medium was injected through the umbilical cord and in 25 contrast medium was injected directly into the heart. Logistic regression analysis was used to investigate the effect on the ability to visualize cardiac structures on pm-CT angiography of gestational age at TOP or delivery following IUFD, the time delay between fetal death and examination, the technique used for contrast-medium injection, the presence of cardiac abnormalities and whether or not there was IUFD. The diagnostic accuracy of pm-CT angiography for the evaluation of fetal cardiac structures was also evaluated. RESULTS: Cardiac anatomy including heart situs, the four-chamber view and great vessels could be visualized on pm-CT angiography in 29 out of 33 fetuses (87.9%). Logistic regression analysis showed that the ability to visualize cardiac structures on pm-CT angiography was positively correlated only with contrast medium injected directly into the heart. Twenty-five out of the 33 fetuses underwent conventional autopsy. There were five cases with suspected major cardiac abnormality at prenatal ultrasound and one with a minor cardiac abnormality. In one of these cases, severe leakage into the pleural cavity did not allow for visualization of any heart structure on pm-CT angiography and in another invasive autopsy was declined. In two of the remaining four cases, the findings on pm-CT angiography and invasive autopsy were in agreement, while in two a ventricular septal defect was found on invasive autopsy but not on pm-CT. None of the 27 cases with normal hearts was falsely classified as abnormal using pm-CT angiography. CONCLUSION: Pm-CT angiography by direct injection into the heart seems to be a feasible method for its evaluation. The extent to which such a technique could be used for the evaluation of congenital heart disease as an alternative to classical postmortem autopsy remains to be determined.

Prospective risk of intrauterine fetal death in monoamniotic twin pregnancies.

This study was conducted to review the overall short-term outcome of monoamniotic twins in Japan and to determine the prospective risk of fetal death so as to adequately counsel parents with monoamniotic twins. Study subjects were 101 women with monoamniotic twins who were registered with the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System and who had given birth at ≥22 weeks of gestation during 2002-2009. The gestational week at delivery (mean±SD) was 31.8±3.7. Fourteen women experienced intrauterine fetal death (IUFD). Short-term outcomes of co-twins born to the 14 women included 8 IUFDs, one early neonatal death within 7 days of life (END), and 5 survivors. Four other women experienced 5 ENDs. Thus, 13.9% (28/202) of infants died perinatally (22 IUFDs and 6 ENDs), 13.9% (14/101) of women experienced IUFD, and 82.2% (83/101) of women experienced neither IUFD nor END. Structural anomalies and twin-to-twin transfusion syndrome explained 17.9% (five infants) and 10.7% (three infants) of the 28 perinatal deaths, respectively. The prospective risk of IUFD was 13.9% (14/101) for women who reached gestational week 22(-0/7), gradually decreasing thereafter but remaining at between 4.5% and 8.0% between gestational week 30(-0/7) and 36(-0/7).

Decreased echogenicity of the embryo is correlated with absence of cardiac activity.

PURPOSE: The purpose of this study was to investigate whether the sonographic echogenicity of embryos is associated with cardiac activity in utero. METHODS: The present study reviewed a total of 164 embryos having a gestational age between 6 and 8 weeks. These embryos were examined by transvaginal ultrasonography and a comparison of their echogenicity was made with respect to those of the placenta and the myometrium. Grade II embryos were less echogenic than the placenta or had similar echogenicity with the myometrium, whereas grade I embryos shared the same echogenicity as the placenta. In contrast, grade III embryos were less echogenic than the myometrium. RESULTS: Most of the embryos with cardiac activity were detected to have grade II echogenicity (78/130, 60.0%), whereas the remaining embryos had grade I echogenicity (52/130, 40.0%). In contrast, most of the embryos without cardiac activity had grade III echogenicity (20/34, 58.8%), whereas the remaining embryos had either grade II (8/34, 23.5%) or grade I (6/34, 17.7%) echogenicity. CONCLUSIONS: Decreased echogenicity of embryos on grayscale ultrasound in the early first trimester is correlated with an absence of cardiac activity.

Fetus papyraceus in dichorionic diamniotic twin pregnancy: a case report.

INTRODUCTION: The actual rate of multiple pregnancies is significantly larger than that observed during labor due to the fact that in the course of pregnancy intrauterine death of one or more fetuses may occur. CASE PRESENTATION: A twenty-six old woman (GII, PII) reported to hospital in 26 weeks of DC/DA twin gestation complicated by intrauterine death of one fetus in the second trimester of a spontaneous pregnancy. Pregnancy ended at term with vaginal birth of a single live fetus. After birth, entanglement of the fetal umbilical cord around the leg of the dead fetus was discovered. It was the most probable cause of death. CONCLUSIONS: Conservative management is preferred in case of intrauterine demise of one of the fetuses in DC/DA twin pregnancy. One of the reasons of fetal death may be entanglement of the umbilical cord around fetal small parts. The time of fetal death can be determined on the basis of the length of the thigh bone (Femur Length - FL).

Accuracy of first-trimester ultrasound in the diagnosis of early embryonic demise: a systematic review.

OBJECTIVES: To evaluate, by systematic review of the literature, the accuracy of first-trimester ultrasound in diagnosing early embryonic demise. METHODS: We searched MEDLINE (1951-2011), Embase (1980-2011) and the Cochrane Library (2010) for relevant citations. The reference lists of all known primary and review articles were examined. Language restrictions were not applied. Studies which evaluated the accuracy of first-trimester ultrasonography in pregnant women for the diagnosis of early embryonic demise were selected in a two-stage process and their data extracted by two reviewers. Accuracy measures including sensitivity, specificity and likelihood ratios (LRs) for abnormal and normal test results were calculated for each study and for each test threshold. RESULTS: Eight primary articles with four test categories (18 2 × 2 tables), involving 872 women, evaluated the accuracy of ultrasound in diagnosing early embryonic demise. The lower limit of the 95% CI for specificity was > 0.95 in only two tests. These were an empty gestational sac with mean diameter of ≥ 25 mm and absent yolk sac with a mean gestational sac diameter of ≥ 20 mm (specificity, 1.00; 95% CI, 0.96-1.00 for both). CONCLUSIONS: There is a paucity of high-quality, prospective data on which to base guidelines for the accurate diagnosis of early pregnancy demise. The findings are limited by the small number of studies and patients, the age of the studies, inclusion of symptomatic and asymptomatic women and variable reference standards for diagnosis of early pregnancy demise. Before guidelines for the safe management of threatened miscarriage can be formulated, there is an urgent need for an appropriately powered, prospective study using current ultrasound technology and an agreed reference standard for pregnancy success or loss.

Ultrasound predictors of mortality in monochorionic twins with selective intrauterine growth restriction.

OBJECTIVES: The aim of this study was to evaluate the use of ultrasound assessment to predict risk of mortality in expectantly managed monochorionic twin fetuses with selective intrauterine growth restriction (sIUGR). METHODS: This was a retrospective study of 101 monochorionic twin pregnancies diagnosed with sIUGR before 26 weeks of gestation. All patients were under expectant management during the observation period. At the initial evaluation, the presence or absence of each of the following abnormalities was documented: oligohydramnios; stuck twin phenomenon; severe IUGR < 3(rd) centile of estimated fetal weight; abnormal Doppler in the umbilical artery; and polyhydramnios in the larger twin. The relationships between these ultrasound findings and mortality of sIUGR fetuses were evaluated using multiple logistic regression analysis. RESULTS: Of 101 sIUGR twins, 22 (21.8%) fetuses suffered intrauterine demise and nine (8.9%) suffered neonatal death; 70 (69.3%) survived the neonatal period. Multiple logistic regression analysis revealed that the stuck twin phenomenon (odds ratio (OR): 14.5; 95% CI: 2.2-93.2; P = 0.006) and constantly absent diastolic flow in the umbilical artery (OR: 29.4; 95% CI: 3.3-264.0; P = 0.003) were significant risk factors for mortality. CONCLUSIONS: Not only abnormal Doppler flow in the umbilical artery but also severe oligohydramnios should be recognized as important indicators for mortality in monochorionic twins with sIUGR.

Absent pulmonary valve syndrome: prenatal cardiac ultrasound diagnosis with autopsy correlation.

Absent pulmonary valve syndrome (APVS) is a rare conotruncal anomaly consisting of a severely hypoplastic pulmonary valve with annular stenosis, aneurysmal dilatation of main pulmonary artery with dilatation of one or both pulmonary artery branches, and a ventricular septal defect. Here, we report a prenatal echo diagnosis of APVS in a 27-year-old primi gravida at 20 weeks of gestation confirmed on fetal autopsy. A 'bow tie'-like hypoechoic shadow in fetal cardiac ultrasound observed by us in a modified four-chamber view was suggestive of aneurysmal dilatation of branch pulmonary arteries. The consequences of continuation of pregnancy including immediate neonatal complications and possible medical and multistaged surgical interventions were well explained. Parents opted for medical termination of pregnancy. Autopsy findings of the fetus were consistent with the prenatal echo diagnosis of APVS. The presence of patent ductus arteriosus seen in the autopsy may be the cause of severe heart failure evidenced by the abnormally large congested liver, dilated right heart chambers, and tricuspid valve annulus. We infer that the prenatal diagnosis of APVS may be possible with a high degree of accuracy with characteristic fetal echocradiographic findings such as 'bow tie'-like or 'ballooning'-like shadows observed in this case. The presence of ductus confirms definite fetal loss and the parents can be counselled accordingly. However, when the ductus is absent, decision-making is difficult as the fetus is going to survive.

Fetal death in twins.

OBJECTIVE: To examine the pattern and prospective risk of intrauterine fetal death (IUFD) in twin pregnancy by chorionicity. DESIGN: Retrospective cohort analysis. SETTING: Large national tertiary referral center. POPULATION: All consecutive twin deliveries (1997-2006) ≥24 weeks. METHODS: Retrospective review of all consecutive twin deliveries over 10 years to identify patterns of IUFD in twins and calculate gestation-specific prospective risks of IUFD. Fetal death was defined as intrauterine demise of a fetus ≥24weeks, intertwin birthweight discordance as ≥20% difference and growth restriction as birthweight <5(th) centile. Chorionicity was confirmed by postnatal placental examination. MAIN OUTCOME MEASURES: Fetal death. RESULTS: 1094 twin pairs including 276 monochorionic-diamniotic (MCDA) (25.3%) and 818 dichorionic-diamniotic (DCDA) twin pregnancies (74.7%) were studied. Twenty-nine fetal deaths occurred affecting 22 twin pregnancies. The incidence of IUFD (death of one or both fetuses) in MCDA twin pregnancies was three times that in DCDA pregnancies [11/276 (3.9)% vs. 11/818 (1.3%) p<0.001]. The majority of deaths in MCDA twins were associated with twin-twin transfusion syndrome (TTTS) prior to 30 weeks. In normally grown twins the prospective risk of IUFD was similarly low in MCDA and DCDA pregnancies after 34 weeks but in pregnancies complicated by abnormal growth, the prospective risk of IUFD was 3.4 in MCDA and 2.0 in DCDA pregnancies. CONCLUSION: Twin pregnancies complicated by growth restriction or growth discordance were associated with a high risk of IUFD, particularly in affected MCDA twins. Conversely, in normally grown twins the risk was similarly low in MCDA and DCDA pregnancies after 34 weeks.

Value of "minimum menstrual age" in determining early pregnancy failure.

OBJECTIVES: The purposes of this study were to assess a discriminatory "minimum menstrual age" (28 days + number of days elapsed between the first positive pregnancy test result and sonogram) for the diagnosis of early pregnancy failure when no embryonic/fetal heartbeat is seen and to compare minimum menstrual age dating with last menstrual period and sonographic dating. METHODS: We conducted a retrospective study of 338 initial first-trimester sonographic examinations among women with suspected early pregnancy failure. A minimum menstrual age for each was calculated, and pregnancy outcomes were assessed. The predictive value of the minimum menstrual age for the pregnancy outcome was assessed at both 42 and 49 days and compared to that of dating by the last menstrual period and sonography. RESULTS: Among a study cohort of 338 patients, the average gestational age calculated by the last menstrual period was 53 days; by sonography, it was 50 days; and by the minimum menstrual age, it was 35 days (P < .01). All cases in which there was no sonographically detectable embryonic heartbeat above a minimum menstrual age of 42 days resulted in pregnancy failure. CONCLUSIONS: The minimum menstrual age is a conservative estimate of the gestational age, with an estimated positive predictive value of 100% for early pregnancy failure when no embryonic heartbeat is seen after 42 days. The minimum menstrual age can be combined with other existing diagnostic clues to predict early pregnancy failure with greater accuracy.

Conjoined twins in a spontaneous trichorionic quadruplet pregnancy: a case report.

BACKGROUND: Multifetal pregnancies are high-risk pregnancies. Coexistence of conjoint twins with multifetal pregnancies further increases the risk factor, which is already considerably high with multiple births. Assisted reproductive techniques lead to an increase in multifetal pregnancies, especially monozygotic pregnancies, which in turn lead to an increase in the rate of conjoined twins. CASE: A spontaneously achieved quadruplet pregnancy with coexisting conjoint twins has not been reported previously. We report one such case of spontaneously achieved quadruplet pregnancy with coexisting conjoined twins. CONCLUSION: Early (preferably first trimester) recognition of multifetal pregnancy, chorionicity, amnionicity and fetal malformation help in proper pregnancy management and optimizing outcome.

Doppler assessment between pathological examination of the placenta and late fetal intrauterine demise.

AIM: The relation between placental histopathological examination, umbilical cord pathology and abnormal umbilical and cerebral Doppler as a predictor of stillbirth at later gestations was evaluated. MATERIALS AND METHODS: A retrospective study of 55 monofetal pregnancies complicated with late fetal death from 2005-2008 was conducted at the Institute of Gynecology and Obstetrics, Bel-grade. STATISTICAL ANALYSIS: chi-square likelihood ratio test and Spearman's coefficient correlation. RESULTS: Intrauterine fetal demise occurred most frequently at term -32.7% of the time. Changes in the umbilical artery resistance index were not significantly different from placental histopathology findings, p = 0.363. There was a significant correlation between neonatal birth weight and weeks of gestation at delivery, r = 0.796; p = 0.001. CONCLUSION: Umbilical artery Doppler is a relatively poor predictor of stillbirths due to placental dysfunction. It seems that neonatal birth weight is the best predictor of late stillbirth in high-risk pregnancies.

Assessment of fetal well-being in cattle by ultrasonography in normal, high-risk, and cloned pregnancies.

This study determined ultrasonographic parameters of fetuses and uterine adnexa in late pregnancy in normal, cloned, and high-risk pregnancies in relation to perinatal and neonatal outcome. Ten cows with normal pregnancies (CONTROL, mean pregnancy length 273 d), 10 sick cows with potentially compromised pregnancies (HIGH-RISK, mean pregnancy length 267 d), and 10 heifers with cloned pregnancies (CLONED, mean pregnancy length 274 d) were examined at more than 260 d of gestation. There was no difference in mean fetal heart rates among the groups. The cloned calves were heavier (57 ± 8 kg) than calves from CONTROL group (36 ± 7 kg), and calves from HIGH-RISK group (37 ± 13 kg) (P = 0.003). The diameter of the thoracic aorta was positively correlated (R = 0.62) with fetal birth weight in the CONTROL group (P = 0.01). Fetal activity was not associated with survival. The results suggest that transabdominal ultrasonographic assessment of the fetal well-being may serve as a potential tool for evaluation of the fetoplacental unit.

[Fetal acardia in a twin pregnancy achieved by in vitro fertilization]. / Acardia fetal en embarazo gemelar logrado por fertilización in vitro.

The frequency of fetal arcadia in the world is 1:35,000 to 1:48,000 pregnancies; is currently estimated that 1% of newborns in developed countries are the result of assisted reproduction techniques and the frequency of twin pregnancies is close to 18%, of these, an estimated relative risk for cardiac defect is 1.6. However, the association of acardiac fetus, twin pregnancy and assisted reproductive techniques is not fully established. In this paper, we describe a case of fetal acardia, in a pregnancy resulting from assisted reproduction and its obstetric care.

[Fetus compressus and fetus papyraceous. Clinical differences (report of three cases)]. / Feto compreso y feto papiráceo. Diferencias clínicas, tres casos.

The items papyraceus fetus and fetus compressus are used like synonymous. The low incidence and the lack of reporting of these cases leads to confusion. Clinical evidence shows significant differences between them and sustain a proper diagnosis. We report 3 cases of patients with multiple pregnancy (2 twins and 1 triplets) observed in the death of one of the products of each patient, obtaining 2 fetus compressus and 1 fetus papyraceous, respectively.