Does maternal oxygen administration during non-reassuring fetal status affect the umbilical artery gas measures and neonatal outcomes?

PURPOSE: To clarify whether maternal oxygen administration during vaginal delivery improves umbilical artery (UA) gas measurements and neonatal outcomes. METHODS: Singleton pregnancies requiring operative vaginal delivery or emergency cesarean section (CS) due to non-reassuring fetal status (NRFS) during vaginal delivery at our hospital from 2018 to 2021 were retrospectively investigated. Intrapartum fetal wellbeing was evaluated based on the 5-tier fetal heart rate (FHR) pattern which is a delivery management method widely used in Japan. Operative vaginal deliveries or emergency CS was performed under integrated judgment in NRFS. Patients were divided into the oxygen group to whom oxygen (10 L/min) was supplied by a facemask and the room air group. The UA gas measurements and neonatal outcomes were compared. The oxygen administration was classified by conditions before and after the coronavirus disease 2019 pandemic. As a secondary evaluation, stratification of FHR pattern levels and factors associated with UA pH < 7.15 were examined. RESULTS: A total of 250 patients required obstetric surgical delivery due to NRFS, including 140 (56%) and 110 (44%) in the oxygen and room air groups, respectively. No differences in maternal background factors were found between both groups, except for maternal age. UA gas measurements and neonatal outcomes also showed no significant differences. No significant factors were extracted in the multivariate analysis for UA pH < 7.15. CONCLUSIONS: Trans-maternal oxygen administration for intrapartum NRFS did not affect neonatal cord blood gasses or neonatal outcomes. Thus, routine oxygen administration for intrapartum NRFS may not always be necessary.

Does the timing of neuraxial analgesia initiation in elective induction of multiparous women prolong the duration of delivery?

AIM: To investigate whether the early initiation of neuraxial analgesia prolongs the duration of electively induced labor in Japanese multiparous women. METHODS: This retrospective study included multiparous term women who underwent elective induction of labor using combined spinal-epidural analgesia at the Showa University Hospital between October 2018 and March 2021. The participants were divided into two groups: early and late. If neuraxial analgesia was initiated when the cervical dilation was ≤3 cm, the patient was included in the early group. The remaining patients were included in the late group. The obstetric and neonatal outcomes were compared between the two groups. The primary outcome was the duration of delivery. The secondary outcomes were the rates of instrumental and cesarean deliveries. RESULTS: Two hundred and ninety-seven women (early group = 139, late group = 158) were included in the analysis. The duration of the first stage of labor did not differ significantly between the early and late groups (median: 232 vs. 260 min, p = 0.35). Similarly, there was no significant difference in the duration of the second stage (37 vs. 40 min, p = 0.20). Moreover, the rates of instrumental and cesarean deliveries did not differ significantly between the groups, and the neonatal outcomes were comparable. CONCLUSION: Early initiation of neuraxial analgesia in the elective induction of parous Japanese women did not prolong the duration of delivery. Our results suggest that neuraxial analgesia may be initiated whenever a parturient desires it.

The role of first-trimester ultrasound screening for women with positive noninvasive prenatal testing results.

AIM: This study aimed to assess the utility of ultrasound screening for pregnancies with positive noninvasive prenatal testing results for trisomy 21, trisomy 18, and trisomy 13. METHODS: We performed a retrospective analysis of positive noninvasive prenatal testing results and first-trimester ultrasound screening at our department between 2013 and 2019. Invasive genetic testing was performed if the patient had positive noninvasive prenatal testing results. Fetal ultrasound and cytogenetic data were collected. Noninvasive prenatal testing was performed in the women for advanced maternal age, nuchal translucency thickness, or history of abnormality in the previous child or relative. RESULTS: Forty-one pregnant women had positive noninvasive prenatal testing results for trisomy 21, trisomy 18, and trisomy 13. Twenty-three women had positive results for trisomy 21, 13 had positive results for trisomy 18, and 5 had positive results for trisomy 13 at 11 to 14 weeks of gestation. The positive predictive value of noninvasive prenatal testing was 100% for trisomy 21, 84.6% for trisomy 18, and 100% for trisomy 13. The positive predictive value of positive noninvasive prenatal testing results and fetal morphological abnormalities was 100% for trisomy 21, trisomy 18, and trisomy 13. CONCLUSION: Combining an ultrasound examination with noninvasive prenatal testing resulted in a higher positive predictive value for trisomy 18. Normal ultrasound examination results can help alleviate stress caused by false-positive noninvasive prenatal testing results. In contrast, the positive predictive value and negative predictive value for trisomy 21 were not altered by adding an ultrasound examination to noninvasive prenatal testing.

Long-term outcome of cases of fetal pleural effusion: A study at a single perinatal center in Japan.

PURPOSE: To analyze the long-term prognosis of primary and secondary fetal pleural effusion (FPE). METHODS: We investigated all cases of FPE in a single University hospital (2005-2020). Cases were classified as primary (cases with only pleural effusion) and secondary (cases with other abnormalities such as chromosomal abnormalities or fetal cardiac failure). We retrospectively reviewed the medical records from the time of diagnosis, to assess medical procedures performed, chromosomal test results, and clinical outcomes. RESULTS: Among 18 027 deliveries, 17 FPEs were identified (primary FPE: 8, secondary FPE: 9). Most primary FPEs were diagnosed in the second trimester of pregnancy, while all secondary FPEs were diagnosed in the third trimester. Secondary FPE was often associated with chromosomal abnormalities, including trisomy 21. The prognosis of pleural effusion caused by trisomy 21 was relatively good, except for cases with TAM. Cases of secondary FPE without trisomy 21 were of cardiac origin, and the neonatal prognosis was poor. The short-term prognosis was better in the primary FPE group, but long-term follow-up identified conditions such as acute encephalitis with refractory, repetitive partial seizures, developmental delay and attention deficit hyperactivity disorder. CONCLUSION: Fetal pleural effusion without the presence of chromosomal abnormalities or morphologies has a good short-term prognosis, but the long-term prognosis is poor. Thus, long-term follow-up is necessary for all cases of fetal pleural effusion.

Impact of first trimester determination of abnormal cord insertion on twin-to-twin transfusion syndrome and other adverse outcomes in monochorionic diamniotic twins: A retrospective cohort study.

OBJECTIVE: To assess the influence of abnormal cord insertion (CI) detected by first trimester ultrasonography on the development of twin-to-twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twins. METHOD: In this retrospective cohort study, consecutive patients with MCDA twins who underwent fetal ultrasound screening in the first trimester between January 2011 and January 2017 were enrolled. The CI sites were evaluated between 11 + 0 and 13 + 6 weeks' gestation. All twin pairs were assigned to the abnormal CI group (twin pair with velamentous cord insertion (VCI) and/or marginal cord insertion (MCI) in one or both twins) or the normal CI group (twin pair with both normal CI). The relationships of adverse outcomes in two groups were analyzed. RESULTS: A total of 109 MCDA twin pairs were examined; 15 cases were classified into the abnormal CI group and 94 cases into the normal CI group. The incidence of TTTS was significantly higher in the abnormal than in the normal CI group (26.7% vs 7.45%, P = .04). In patients who developed TTTS, all donors had VCI. CONCLUSION: Ultrasound evaluation of abnormal CI at 11 + 0 to 13 + 6 weeks' gestation in MCDA twins is valuable in the assessment of the risk for TTTS.

Prospective evaluation of screening performance of first-trimester prediction models for preterm preeclampsia in an Asian population.

BACKGROUND: The administration of aspirin <16 weeks gestation to women who are at high risk for preeclampsia has been shown to reduce the rate of preterm preeclampsia by 65%. The traditional approach to identify such women who are at risk is based on risk factors from maternal characteristics, obstetrics, and medical history as recommended by the American College of Obstetricians and Gynecologists and the National Institute for Health and Care Excellence. An alternative approach to screening for preeclampsia has been developed by the Fetal Medicine Foundation. This approach allows the estimation of patient-specific risks of preeclampsia that requires delivery before a specified gestational age with the use of Bayes theorem-based model. OBJECTIVE: The purpose of this study was to examine the diagnostic accuracy of the Fetal Medicine Foundation Bayes theorem-based model, the American College of Obstetricians and Gynecologists, and the National Institute for Health and Care Excellence recommendations for the prediction of preterm preeclampsia at 11-13+6 weeks gestation in a large Asian population STUDY DESIGN: This was a prospective, nonintervention, multicenter study in 10,935 singleton pregnancies at 11-13+6 weeks gestation in 11 recruiting centers across 7 regions in Asia between December 2016 and June 2018. Maternal characteristics and medical, obstetric, and drug history were recorded. Mean arterial pressure and uterine artery pulsatility indices were measured according to standardized protocols. Maternal serum placental growth factor concentrations were measured by automated analyzers. The measured values of mean arterial pressure, uterine artery pulsatility index, and placental growth factor were converted into multiples of the median. The Fetal Medicine Foundation Bayes theorem-based model was used for the calculation of patient-specific risk of preeclampsia at <37 weeks gestation (preterm preeclampsia) and at any gestation (all preeclampsia) in each participant. The performance of screening for preterm preeclampsia and all preeclampsia by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index, and placental growth factor (triple test) was evaluated with the adjustment of aspirin use. We examined the predictive performance of the model by the use of receiver operating characteristic curve and calibration by measurements of calibration slope and calibration in the large. The detection rate of screening by the Fetal Medicine Foundation Bayes theorem-based model was compared with the model that was derived from the application of American College of Obstetricians and Gynecologists and National Institute for Health and Care Excellence recommendations. RESULTS: There were 224 women (2.05%) who experienced preeclampsia, which included 73 cases (0.67%) of preterm preeclampsia. In pregnancies with preterm preeclampsia, the mean multiples of the median values of mean arterial pressure and uterine artery pulsatility index were significantly higher (mean arterial pressure, 1.099 vs 1.008 [P<.001]; uterine artery pulsatility index, 1.188 vs 1.063[P=.006]), and the mean placental growth factor multiples of the median was significantly lower (0.760 vs 1.100 [P<.001]) than in women without preeclampsia. The Fetal Medicine Foundation triple test achieved detection rates of 48.2%, 64.0%, 71.8%, and 75.8% at 5%, 10%, 15%, and 20% fixed false-positive rates, respectively, for the prediction of preterm preeclampsia. These were comparable with those of previously published data from the Fetal Medicine Foundation study. Screening that used the American College of Obstetricians and Gynecologists recommendations achieved detection rate of 54.6% at 20.4% false-positive rate. The detection rate with the use of National Institute for Health and Care Excellence guideline was 26.3% at 5.5% false-positive rate. CONCLUSION: Based on a large number of women, this study has demonstrated that the Fetal Medicine Foundation Bayes theorem-based model is effective in the prediction of preterm preeclampsia in an Asian population and that this method of screening is superior to the approach recommended by American College of Obstetricians and Gynecologists and the National Institute for Health and Care Excellence. We have also shown that the Fetal Medicine Foundation prediction model can be implemented as part of routine prenatal care through the use of the existing infrastructure of routine prenatal care.

Differences in perinatal outcomes according to forming period of single umbilical cord in singleton pregnancy.

OBJECTIVES: The aim of this study was to establish the frequency and associations of single umbilical artery (SUA) diagnosed until the first vs second or third trimester. METHODS: A retrospective cohort study was conducted on singleton pregnancies at a tertiary perinatal center. All women underwent both the first and second trimester scans in which the number of arteries in the umbilical cord was routinely documented. SUA was classified as aplastic type when the diagnosis was made in the first trimester and as occlusion type when diagnosed in the second or third trimester. Adverse perinatal outcome was calculated as occurrence of fetal death, birthweight centile < 10th , or Apgar score at 5 minutes < 7. RESULTS: A total of 8675 women underwent ultrasound examinations during the study period. Of the 32 SUA cases, 17 (0.2%) were of the aplastic type and 15 (0.2%) of the occlusion type. Congenital anomalies were more in aplastic than in occlusive SUA (58.8% vs 20%, .043). The occlusive SUA had higher postnatal coiling index (0.3 vs 0.2, .034) and diagnosis of hypercoiled cord (46.7% vs 5.9%, .013) than the aplastic type. CONCLUSIONS: The different gestational age at diagnosis and coiling characteristics suggest two types of SUA, namely, aplastic and occlusion types, which are associated with differences in perinatal outcomes.

Administration of oral and vaginal prebiotic lactoferrin for a woman with a refractory vaginitis recurring preterm delivery: appearance of lactobacillus in vaginal flora followed by term delivery.

Lactoferrin (LF) is one of the prebiotics present in the human body. A 38-year-old multiparous woman with poor obstetrical histories, three consecutive preterm premature rupture of membrane at the 19th, 23rd and 25th week of pregnancy, was referred to our hospital. She was diagnosed as having refractory vaginitis. Although estriol vaginal tablets were used for 4 months, the vaginitis was not cured. We administrated vaginal tablets and oral agents of prebiotic LF, resulting in a Lactobacillus predominant vaginal flora. When she was pregnant, she continued to use the LF, and the Lactobacillus in the vaginal flora was continuously observed during pregnancy. An elective cesarean section was performed at the 38th week of pregnancy. When the administration of LF was discontinued after the delivery, Lactobacillus in the vaginal flora was disappeared.

A case report of umbilical ring constriction with application of amnioinfusion.

This is a case report of a pregnant 38-year-old primigravida woman. Due to severe fetal growth restriction and oligohydramnios, she was referred to our tertiary perinatal center at 24 weeks' gestation. To rule out chromosomal abnormalities and facilitate ultrasound evaluation of fetal morphology, we performed amniocentesis and subsequent amnioinfusion. Thereafter, a precise ultrasound examination revealed no obvious fetal morphological abnormalities except for a hyper-coiled cord and marginal placenta previa. During expectant management, the amount of amniotic fluid was maintained at 20-26 mm for a few days; however, the pregnancy resulted in intrauterine fetal death after 26 weeks + 5 days of gestation. The stillborn infant weighed 530 g (-3.3 SD) and had no obvious external abnormalities apart from umbilical ring constriction. Although a postmortem autopsy was not performed, it is suspected that the fetal growth restriction and the intrauterine fetal death were associated with the hyper-coiled cord and the umbilical ring constriction. It is thought that umbilical ring constriction might therefore be an irreversible fatal condition in cases with a hyper-coiled cord.

Retrospective cohort study: a comparison of two different management strategies in patients with preterm premature rupture of membranes.

PURPOSE: Perinatal outcomes were compared before and after changes in the treatment policy to improve the management for preterm PROM (pPROM). METHODS: This is a retrospective analysis of 99 cases of pPROM diagnosed between 27 and 34 weeks of gestation, which were managed according to the following two different protocols. Group A (47 cases): tocolytic therapy was continued to prevent preterm delivery until clinical chorioamnionitis (CAM) was diagnosed between January 2000 and June 2004. Group B (52 cases): labor was induced or cesarean section performed when oligohydramnios was diagnosed and/or elevation elastase (EL) of amnion was detected by amniocentesis between July 2004 and July 2009. The outcomes of the cases in each group were compared with regard to the extension of pregnancy period, reasons for delivery, perinatal complications, stage of pathological CAM and funisitis (FUN), neonatal serum IgM concentration, mortality, and morbidity. RESULTS: The incidences of pathological CAM and FUN were significantly lower in Group B than in Group A. The concentration of neonatal serum IgM was also significantly lower in Group B than in Group A. CONCLUSIONS: The addition of oligohydramnios and elevation EL of amnion as indicative factors of intrauterine infection might lead to a reduction in the severity of fetal infection in cases of pPROM.

Predictive ability of serum advanced glycation end products at 11 to 13 weeks of gestation for early-onset preeclampsia.

BACKGROUND: Placental hypoxia and resultant oxidative stress have been associated with the development of preeclampsia. Oxidative stress promotes the formation of advanced glycation end products. OBJECTIVE: This study aimed to assess whether serum levels of advanced glycation end products during the early stage of pregnancy are a predictive biomarker of early-onset and late-onset preeclampsia. STUDY DESIGN: This was a nested case-control study that included 6 women with early-onset preeclampsia, 21 women with late-onset preeclampsia, and 50 age- and body mass index-matched healthy female control subjects. All women enrolled in the study had a complete medical history, including mean arterial pressure and uterine artery pulsatility index measurements. Furthermore, the women underwent blood chemistry analysis, including circulating levels of advanced glycation end products, soluble fms-like tyrosine kinase-1, and placental growth factor. Clinical measurements and biochemistry were evaluated at 11 to 13 and 19 to 24 weeks of gestation. RESULTS: The median serum concentrations of advanced glycation end products at 11 to 13 weeks of gestation were significantly higher in patients with early-onset preeclampsia than in those with late-onset preeclampsia and control subjects (6.62 vs 4.10 vs 3.77; P<.05), but no significant difference was found in advanced glycation end products at 19 to 24 weeks of gestation among the 3 groups. The advanced glycation end product-to-placental growth factor ratio in the first trimester of pregnancy was significantly higher in patients with early-onset preeclampsia than in those with late-onset preeclampsia or control subjects (0.78 vs 0.10 vs 0.10; P<.05). The area under the receiver operating characteristic curve values for patients with early-onset preeclampsia were 0.782 (95% confidence interval, 0.522-0.922), 0.855 (95% confidence interval, 0.433-0.978), and 0.925 (95% confidence interval, 0.724-0.983) for the advanced glycation end product and placental growth factor levels and advanced glycation end product-to-placental growth factor ratios, respectively. This population achieved a 100% detection rate for predicting early-onset preeclampsia at a screen-positive rate of 10% by combining the advanced glycation end product-to-placental growth factor ratio and the mean arterial pressure. CONCLUSION: The study results suggested that an elevated advanced glycation end product-to-placental growth factor ratio and mean arterial pressure at 11 to 13 weeks of gestation could be a potential biomarker for predicting the future development of early-onset preeclampsia.

Ultrasonographic study of umbilical cord twist direction during second trimester.

OBJECTIVE: To explore/study/evaluate the relationships among umbilical twist direction, the degree of umbilical twist and differences of umbilical arterial diameters (UAD). METHODS: All obstetric patients presenting for prenatal care of singleton fetuses between 18 and 25 weeks gestation to a single provider (MN) from 2015 to 2018 had detailed umbilical cord Doppler measurements. Data including the cord twist direction, degree of twist and number of twists per cord segment length, and the diameters of each UA (UAD) and the umbilical vein (UVD) were extracted from the records. UAs were described as right or left depending on their position at the fetal cord insertion. Three groups were identified: Group A: right UAD > left UAD and Group B: left UAD > right UAD Group C: equal UAD. The coiling index was calculated as the inverse of the length of cord required for one complete 360 degrees wrap of the UA around the cord. According to the difference of UADs, the variables of right and left UADs, the coiling index, and frequencies of umbilical twist direction were analyzed using non-parametric methods. RESULTS: 485 singleton fetuses and umbilical cords were examined. The value of the antenatal coiling index in cases with left UAD greater than right was 0.43 ± 0.16, which was significantly higher than 0.38 ± 0.16 with right UAD greater than left (p = .001). There were significant differences between the two groups in the values of right and left UAD, value of right minus left UAD, absolute value between right and left UAD, antenatal coiling index, antenatal coiling index due to umbilical twist direction and frequencies of cord twist direction. CONCLUSION: The direction of umbilical twist may be in part dependent on differences in diameters of the umbilical arteries, in addition to other fetal characteristics such as fetal movement, or handedness of fetus or mother, fetal hemodynamic forces and structure of muscles of umbilical vessels.

Perinatal outcomes of cases with umbilical hypocoiled cord: a study at a single perinatal center.

OBJECTIVES: To evaluate the perinatal outcomes of hypocoiled cord. METHODS: This retrospective study was carried out in the Department of Obstetrics and Gynecology at Showa University Hospital between 2011 and 2017. Umbilical cord index (UCI) was calculated by dividing the total number of coils by the total length of umbilical cord. All umbilical cords were measured and calculated coiling index by obstetrician after delivery. Perinatal outcomes like non-reassuring fetal status (NRFS), emergency cesarean sections, and other perinatal complications were compared. RESULTS: From January 2011 to December 2017, a total of 4047 fetuses were born at our hospital after 28 weeks' gestation. After excluding 100 fetuses of hypercoiled cord, a total of 3947 fetuses were included in this study, of which 71 fetuses were hypocoiled cord and 3876 fetuses were normal coiled cord. There were no association between maternal background and both UCI group. NRFS during labor was significantly associated with hypocoiled cord compared with normal cord (p = .02). Additionally, the rates of emergency cesarean section were raised in cases of hypocoiled cord (p = .02). CONCLUSION: In this study, it was found that hypocoiled cord is related to NRFS and emergency cesarean section. In addition, hypocoiled cord was not associated with any maternal factors. However, in previous studies, no opinion has been reported on the timing of diagnosis of hypocoiled cord during pregnancy. It is difficult to evaluate hypocoiled cord correctly in third trimester. It is a task to find the hypocoiled cord correctly before birth.

Accuracy of the FMF Bayes theorem-based model for predicting preeclampsia at 11-13 weeks of gestation in a Japanese population.

This study aimed to investigate the diagnostic accuracy of the Fetal Medicine Foundation (FMF) Bayes theorem-based model for the prediction of preeclampsia (PE) at 11-13 weeks of gestation in the Japanese population. In this prospective cohort study, we invited 2655 Japanese women with singleton pregnancies at 11-13 weeks of gestation to participate, of whom 1036 women provided written consent. Finally, we included 913 women for whom all measurements and perinatal outcomes were available. Data on maternal characteristics and medical history were recorded. Mean arterial pressure (MAP), uterine artery pulsatility index, and maternal serum placental growth factor (PlGF) were measured. The patients delivered their babies at Showa University Hospital between June 2017 and December 2019. Participants were classified into high- and low-risk groups according to the FMF Bayes theorem-based model. Frequencies of PE were compared between groups. The screening performance of the model was validated using the area under receiver operating characteristic (AUROC) curve. A total of 26 patients (2.8%) developed PE, including 11 patients (1.2%) with preterm PE (delivery at <37 weeks). The frequency of preterm PE was significantly higher in the high-risk group than in the low-risk group (3.8% vs. 0.2%, p < 0.05). This population model achieved a 91% detection rate for the prediction of preterm PE at a screen-positive rate of 10% by a combination of maternal characteristics, MAP, and PlGF. The AUROC curve for the prediction of preterm PE was 0.962 (0.927-0.981). In conclusion, the prediction of preterm PE using the FMF Bayes theorem-based model is feasible in the Japanese population.

A case of Ewing's sarcoma identified via noninvasive prenatal testing.

Although noninvasive prenatal testing is not intended to identify maternal genomic information, it can provide other information that may lead to the incidental discovery of coexisting conditions including maternal malignancy.

Usefulness of color Doppler mode for fetal cardiac ultrasound screening in the second trimester: a study at a single perinatal center.

Objectives: To evaluate the usefulness of color Doppler in fetal cardiac ultrasound screening in the second trimester.Methods: Fetuses who underwent ultrasound screening at 18-20 weeks' gestation at Showa University Hospital between 2011 and 2016 were evaluated. After delivery, neonatal congenital heart abnormalities were reviewed and compared with the antenatal ultrasound findings. Since 2014, we have added color Doppler to the routine B mode evaluation of the fetal heart. Congenital heart diseases (CHDs) found antenatally and postnatally were compared before and after protocol alternation. Medical records of all fetuses who underwent ultrasound screening at 18-20 weeks' gestation at Showa University Hospital between 2011 and 2016 were retrospectively reviewed.Results: There were 47 cases of CHDs confirmed postnatally. The detection rates of CHDs were 45.0% (9/20) in 2011-2013 and 55.6% (15/27) in 2014-2016. In 2011-2013, cases with antenatal diagnosis showed obvious abnormal findings of three-vessel view and four-chamber view with the B mode. In 2014-2016, the detection rate of isolated ventricular septal defect (VSD) was elevated from 10 to 42.9% using color Doppler.Conclusions: In this study, color Doppler improved the detection rate of CHDs. Color Doppler could give us additional information on blood flow although the canal or vessel is too small to detect morphological changes in the second trimester. It might be a useful tool for screening of CHDs with stenosis, regurgitation, and shunt that are difficult to detect by only the B mode in the second trimester.

Antenatal ultrasound screening using check list before delivery for predicting a non-reassuring fetal status during labor.

OBJECTIVE: To clarify the effectiveness of ultrasound screening at 36 weeks' gestation for predicting a non-reassuring fetal status during labor (NRFS). METHODS: A prospective cohort study was conducted between 2012 and 2013. Ultrasound evaluations of umbilical cord and placental abnormalities and fetal biometry were performed among pregnant females at 36 weeks' gestation. Patients who underwent ultrasound screening were divided into three risk level groups according to their abnormalities. After delivery, NRFS and emergency Cesarean section (eCS) rate were compared between the risk groups. RESULTS: A total of 790 subjects were analyzed. Elective Cesarean section was performed in 111 cases. Consequently, 34 cases in the high-risk group, 45 cases in the middle-risk group and 600 cases in the low-risk group were analyzed. NRFS was diagnosed in 17.6%* of the patients in the high-risk group, 11.1%* of the patients in the middle-risk group and 5.6% of the patient's in the low-risk group. eCS was performed in 8.8%* of the high-risk subjects, 4.4%* of the middle-risk subjects and 0.8% of the low-risk subjects (*p < 0.05 compared to the low-risk group). CONCLUSIONS: The use of antenatal ultrasound screening and risk classification effectively identifies cases of NRFS during delivery.

Outcomes in the absence of the ductus venosus diagnosed in the first trimester.

PURPOSE: To clarify the outcomes of the absence of the ductus venosus (DV) diagnosed in fetuses suspected to have a structural abnormality during a morphological assessment in the first trimester. METHODS: Infants in whom ultrasound fetal morphological assessments were attempted in the first trimester (11 to 13-6 weeks of gestation) and who were subsequently delivered between 2013 and 2015 at Showa University Hospital were enrolled. In cases in which the absence of the DV was diagnosed in the first trimester, the prognosis was assessed. RESULTS: First-trimester ultrasound screening was performed in a total of 2610 cases between 2013 and 2015. Fetal edema (n = 38), hydrops (n = 16), abnormal four-chamber view findings (n = 2), and tricuspid regurgitation (n = 1) were observed in a total of 52 cases (2.0%). In 4 of the 52 cases with abnormal ultrasound findings, the absence of the DV was detected. CONCLUSION: If fetal edema or hydrops in early pregnancy is found without any other structural abnormalities, not only chromosomal abnormalities should be suspected but also an evaluation for the absence of the DV should be included. In addition, absence of the DV with fetal edema may be associated with the outcomes of cardiac dysfunction, chromosome abnormalities, and intrauterine sudden death. Severe fetal edema is associated with a poor prognosis, and the family must be carefully informed of the potential outcomes.

Usefulness of antenatal ultrasound fetal morphological assessments in the first and second trimester: a study at a single Japanese university hospital.

OBJECTIVE: To assess the usefulness of antenatal ultrasound examinations for detecting fetal morphological abnormalities in the first and second trimesters. METHODS: A prospective cohort study was conducted at a single Japanese university hospital in the period from February 2011 to September 2013. Patients in whom ultrasound was attempted at both 11 to 13 + 6 and 18 to 20 + 6 weeks' gestation and who were delivered at our hospital were enrolled. After delivery, neonatal congenital abnormalities were reviewed and compared with the ultrasound findings in the first and second trimesters. RESULTS: The subjects were 2028 singleton babies. Abnormal fetal morphological findings were found in the first trimester in 28 cases. In these patients, fetal anomalies detected as diagnostic findings were anencephaly (2 cases) and endocardial cushion defect (2 cases). Findings suggestive of fetal anomalies were observed in 24 cases in the first trimester. Twelve cases with ultrasound findings in the first trimester, including fetal edema, anencephaly, endocardial cushion defect, exhibited an abnormal chromosome after amniocentesis. Ultrasound findings in the first trimester disappeared until 18 weeks of gestation in eight cases, and they were preserved in three cases. Fetal anomalies were primarily noted in the second trimester in 10 cases. However, after delivery, morphological abnormalities were primarily observed in 18 cases. CONCLUSION: Major congenital abnormalities were identified in the first trimester morphological assessment. We think the use of a combination of the first trimester ultrasound screening and the second trimester ultrasound scan for detecting fetal anomalies was effective.