Ratio of fetal choroid plexus to head size: simple sonographic marker of open spina bifida at 11-13 weeks' gestation.

OBJECTIVES: To measure the ratio of choroid plexus (CP) size to head size in normal fetuses and to compare it to that in fetuses with open spina bifida (OSB) and quantify the subjective sign of a 'dry brain'. METHODS: This was a retrospective study of ultrasound images, obtained during first-trimester screening between 11 and 13 weeks of gestation, from 34 fetuses with OSB and 160 normal fetuses. From the hospital databases, we retrieved images of the fetal head in the transventricular axial plane. We measured the areas of both CPs and the head and calculated the ratio between them. We also measured the longest diameter of each CP and calculated their mean (CP length), and measured the occipitofrontal diameter (OFD) and calculated the ratio of CP length to OFD. Measurements from the OSB fetuses were plotted on crown-rump length (CRL) reference ranges constructed using data from the normal fetuses, and Z-scores were calculated. RESULTS: In the normal fetuses, the CP area increased, while the ratios of CP area to head area and CP length to OFD decreased, with increasing CRL. In 30 of the 34 (88%) fetuses with OSB, both ratios were increased significantly and the CPs filled the entirety of the head, giving the impression of a dry brain. In these cases, the borders of the lateral ventricles could not be identified. CONCLUSIONS: At 11-13 weeks, the majority of fetuses with OSB have reduced fluid in the lateral ventricles such that the CPs fill the head. The dry brain sign is easily visualized during routine first-trimester ultrasound examination while measuring the biparietal diameter, and can be quantified by comparing the size of the CPs to the head size. Until prospective data confirm the usefulness of this sign in screening for OSB, it should be considered as a hint to prompt the examiner to assess thoroughly the posterior fossa and spine. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Prospective detection of open spina bifida at 11-13 weeks by assessing intracranial translucency and posterior brain.

We describe a case series of six fetuses with open spina bifida (OSB) from four different prenatal units, where the anomaly was detected at the routine 11-13-week ultrasound examination. Crown-rump length ranged from 49 to 78 mm. All cases were first suspected during nuchal translucency thickness measurement in the mid-sagittal plane of the face. OSB was lumbosacral in five fetuses and cervical in one. The intracranial translucency (IT) was obliterated in two cases, but some fluid was found in the other four cases. However, in all cases the typical landmarks of a normal posterior brain and normal IT were absent. In all six cases the ratio of brainstem diameter to brainstem-occipital bone distance was increased (≥ 1). This detection of an abnormal posterior brain led to a targeted examination and detection of the spinal lesion during the same examination in five cases, whereas in one suspicious case the patient was recalled at 17 weeks, when the abnormality was detected. Two fetuses had both multiple anomalies and trisomy 18. These prospective cases demonstrate the feasibility of using the standard mid-sagittal plane commonly used for NT measurement to assess the IT and the posterior brain and to determine the presence of OSB during NT screening.

[Contraception with cyclic administration of buserelin and gestagens: increase in testosterone and free testosterone serum concentration]. / Kontrazeption durch zyklische Gabe von Buserelin und Gestagenen: Zunahme der Serumkonzentrationen von Testosteron und freiem Testosteron.

During contraception with the LH-RH analogue buserelin, some women developed mild androgenic symptoms. Therefore, we investigated in 10 women various hormonal serum parameters during one cycle of treatment with daily 300 micrograms buserelin intranasally (day 1-22) and 5 mg medroxyprogesterone acetate (MPA) orally (day 16-22), and, after a washout cycle, during another cycle of treatment with daily 300 micrograms buserelin intranasally (day 1-15) and 5 mg norethisterone acetate (NETA) orally (day 16-22). The serum parameters were investigated on day 1, 15 and 21 during the 4 hours after administration of the drugs. During the treatment, LH release was significantly reduced, whereby additional MPA had no effect whatsoever, while NETA profoundly suppressed LH. During treatment with buserelin and MPA, the average oestradiol levels remained unaltered, but were significantly suppressed by 65% during intake of NETA. Contrary to 17 alpha-hydroxyprogesterone, which did not change, serum testosterone was significantly increased by 30% when buserelin was given with or without MPA, while NETA had no effect. During both regimens, the serum concentrations of SHBG were reduced by 15 to 25%, and those of free testosterone were increased by 30 to 50%. These alterations in hormonal parameters may have contributed to the development of seborrhoeic symptoms and acne of the facial skin which were observed in 6 of the 10 women treated with intranasal buserelin for contraception.