Developmental Process and Symmetry of Fetal Sulci in the Mesial Area Assessed by Ultrasound: A Cohort Study in Chinese Population.

OBJECTIVE: We aimed to investigate the progression of cortical development in Chinese population and to determine the rate of isolated asymmetric cortical development. We also explored the outcomes of these fetuses and determined whether cortical asymmetry represents normal individual physiological variation. METHODS: Our observational cohort study included 456 healthy singleton pregnant women who visited Peking University First Hospital between September 2020 and December 2021. We evaluated the progression and symmetry of the parieto-occipital sulcus, calcarine sulcus, and cingulate sulcus using a scoring system during routine fetal ultrasound examinations. The outcomes of the included fetuses after birth were assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3). RESULTS: The median gestational ages at which the parieto-occipital, calcarine, and cingulate sulci reached grade 1 were 22, 22, and 26 weeks, respectively. Among 456 included fetuses, 426 showed symmetric cortical development and 30 showed asymmetric cortical development during ultrasound examination. Fetuses with asymmetric cortical development underwent 'catch-up growth' and developed to the same grade in 2-6 weeks. All fetuses with symmetric or asymmetric cortical development had normal neurodevelopment after birth according to ASQ-3 assessment. CONCLUSION: The gestational age at which the parieto-occipital, calcarine, and cingulate sulci can be detected using ultrasound varies in different studies. Racial differences may be present in cortical development. Normal fetuses may physiologically have mildly asymmetric cortical development in the mesial area.

Prenatal assessment and pregnancy outcomes of foetal low-lying conus medullaris using 3D ultrasound.

OBJECTIVES: This study aims to follow up on low-lying conus medullaris (CM) cases and explore the correlation between the CM location and the final prognosis.  METHODS: We retrospectively collected 37 cases diagnosed with low-lying CM during pregnancy in the Peking University First Hospital from January 2019 to December 2020. The location of CM was confirmed by 3D ultrasonography, and clinical data, including postnatal outcomes, were recorded. When the conus medullaris was below L3 (excluding L3), it was diagnosed as low-lying conus medullaris, regardless of gestational age. The short-term postnatal outcome included assessment of symptoms and signs of motor and sensory neuron dysfunction. RESULTS: The average gestational weeks of low-lying diagnosis was between 23 and 24 weeks. Among 37 cases, nine (24.3%) were complicated with spine dysraphism (3 cases of open spina bifida, 6 cases of tethered cord syndrome). Apart from 7 cases of pregnancy termination, the remaining 30 live births had a good prognosis in the short term, though 5 out of 6 cases of tethered cord syndrome underwent surgical release. The mean location of cases of open spinal dysraphism (n = 3) and those of closed dysraphism/tethered cord syndrome (n = 6) was at Lumber vertebra 5 (L5) and between L5 and Sacral vertebra 1 (S1), respectively, which showed statistical significance compared with the postnatally normal group. When we set Lumber 4.25 as the cut-off value to predict the diagnosis of spine dysraphism (mainly involving open spinal dysraphism and closed spinal dysraphism/tethered cord syndrome), the sensitivity was 66.7. At the same time, the specificity was 96%, along with the area under the curve (AUC) at 0.877. CONCLUSION: The second trimester finding of low CM is associated with spinal defects, mainly open spinal dysraphism and closed spinal dysraphism/tethered cord syndrome. Careful assessment of the fetal spine should be considered especially when the location of CM is lower than L4.

Influence of smoking cessation on carotid artery wall elasticity evaluated by echo-tracking.

OBJECTIVE: Exploring the use of echo-tracking (ET) for evaluating changes in carotid artery wall elasticity after smoking cessation. METHODS: Carotid artery ultrasound examination was performed in 67 male patients before and after smoking cessation treatment, for measurement of intimal media thickness (IMT), and ET measurement of wall elasticity variables, ie, wall stiffness index (ß), pressure-strain elastic modulus (Ep), compliance (AC), augmentation index (AI), and local pulse wave velocity (PWVß). We also measured heart rate (HR), systolic pressure (Ps), diastolic pressure (Pd), total cholesterol (TC), triglyceride level (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). RESULTS: Hyperlipemia and/or arterial hypertension and/or hyperglycemia were absent in 22 (group A1) and 12 (group B1) and present in 19 (group A2) and 14 (group B2) of the patients with successful (group A, n = 41) and unsuccessful (group B, n = 26) treatment, respectively. In the A1 group, there was no significant difference in AI before and after smoking cessation, whereas ß, Ep, and PWVß decreased, and AC increased (p < 0.05). None of these variables changed after smoking cessation in groups A2, B1, and B2. There was no change in IMT in either group. HR decreased and HDL increased in the A1 group, without change in Ps, Pd, TC, TG, and LDL. There was no change in HR, Ps, Pd, TC, TG, LDL, and HDL in groups A2, B1, and B2. CONCLUSIONS: ET can be used to evaluate quantitatively the impact of smoking cessation on common carotid artery wall elasticity.

Neurodevelopmental outcomes in mild and moderate isolated ventriculomegaly originating in utero.

OBJECTIVE: To determine the differences in outcomes between mild and moderate isolated ventriculomegaly (IVM). METHODS: We conducted a prospective cohort study on 94 fetuses with IVM and evaluated the neurodevelopmental outcomes at 12 months of age using the ASQ-3 and BSID-I neurodevelopmental assessment tools. Progression of VM was defined as an increase in the width of the ventricular by at least 3 mm during sequential ultrasound monitoring. The population was divided into two groups according to ventricular width: mild (10-12 mm) and moderate (12.1-15 mm), which were further evaluated for VM progression in utero separately. RESULTS: Neurodevelopmental assessments at 12 months were the main form of evaluations. Neurodevelopmental impairment (NDI) was defined as a mental development index (MDI) or psychomotor development index (PDI) < 85. There were no significant differences in NDI values between the mild and moderate groups (p = .155). Compared with the non-in utero progression group (7.6%), the rate of NDI was significantly higher (p = .004) in the group with progression (33.3%). Using linear regression and correlation, no negative correlation was found between the maximum value of atrial diameter (AD) in utero and the PDI (r = -0.021, p = .914) or MDI (r = -0.073, p = .703) score. However, the maximum change in the AD in utero was negatively correlated with both PDI (r = -0.460, p = .011) and MDI (r=-0.422, p = .020) scores. CONCLUSION: There were likely no differences in neurodevelopmental outcomes between mild and moderate IVM. In fetuses with mild to moderate VM, intrauterine progression may be a poor prognostic factor for neurodevelopmental outcomes.