Prediction of lung maturity through quantitative ultrasound analysis of fetal lung texture in women with diabetes during pregnancy.

OBJECTIVES: The present study aimed to evaluate the performance of QuantusFLM® software, which performs quantitative ultrasound analysis of fetal lung texture, in predicting lung maturity in fetuses of diabetic mothers. METHODS: The patients included in this study were between 34 and 38 weeks and 6 days gestation and were divided into two groups: (1) patients with diabetes on medication and (2) control. The ultrasound images were performed up to 48 h prior to delivery and analyzed using QuantusFLM® software, which classified each fetus as high or low risk for neonatal respiratory morbidity based on lung maturity or immaturity. RESULTS: A total of 111 patients were included in the study, being 55 in diabetes and 56 in control group. The pregnant women with diabetes had significantly higher body mass index (27.8 kg/m2 vs. 25.9 kg/m2, respectively, p=0.02), increased birth weight (3,135 g vs. 2,887 g, respectively, p=0.002), and a higher rate of labor induction (63.6 vs. 30.4 %, respectively, p<0.001) compared to the control group. QuantusFLM® software was able to predict lung maturity in diabetes group with 96.4 % accuracy, 96.4 % sensitivity and 100 % positive predictive value. Considering the total number of patients, the software demonstrated accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 95.5 , 97.2, 33.3, 98.1 and 25 %, respectively. CONCLUSIONS: QuantusFLM® was an accurate method for predicting lung maturity in normal and DM singleton pregnancies and has the potential to aid in deciding the timing of delivery for pregnant women with DM.

Phenotype to genotype characterization by array-comparative genomic hydridization (a-CGH) in case of fetal malformations: A systematic review.

The aim of the current review is to report a-CGH abnormalities identified in fetuses with prenatally diagnosed fetal malformations in whom a normal karyotype was diagnosed with conventional cytogenetic analysis. A systematic electronic search of databases (PubMed/Medline, EMBASE/SCOPUS) has been conducted from inception to May, 2017. Bibliographic analysis has been performed according to PRISMA statement for review. The following keywords were used: 'array-CGH' and 'fetal malformations" and "prenatal diagnosis"; alternatively, "microarray", "oligonucleotide array", "molecular biology", "antenatal diagnostics", "fetal diagnostics", "congenital malformations" and "ultrasound" were used to capture both "a-CGH" and "prenatal". One-hundred and twelve fetuses with prenatally diagnosed fetal malformations with normal karyotyping and a-CGH abnormalities detected are described. Single or multiple microarray abnormalities diagnosed have been classified in relation to different organ/system affected. The most frequent a-CGH abnormalities were detected in cases of congenital heart diseases (CDHs), multiple malformations and central nervous system (CNS) malformations. Maternal or paternal carrier-state was seen in 19.64% (22/112), of cases while the number of reported de novo mutations accounted for 46.42% (52/112) of all CNVs microarray abnormalities. Array-comparative genomic hydridization (a-CGH) may become an integral and complemantary genetic testing when fetal malformations are detected prenatally in fetuses with normal cytogenetic karyotype. In addition, a-CGH enables the identification of CNVs and VOUS and improves the calculation of recurrent risk and the genetic counseling.

Reference ranges of fetal adrenal gland and fetal zone volumes between 24 and 37 + 6 weeks of gestation by three-dimensional ultrasound.

OBJECTIVE: To establish reference ranges of the fetal adrenal gland (AG) and fetal zone (FZ) volumes using three-dimensional ultrasound (3DUS). METHODS: We performed a prospective cross-sectional study with 204 normal singleton pregnancies between 24 and 37 + 6 weeks of gestation. The fetal AG and FZ volumes were obtained using the virtual organ computer-aided analysis method with a 30° rotation. To establish reference ranges as the function of gestational age (GA), quantile regression was performed with the adjusted coefficient of determination (R2). Intra- and inter-observer repeatability was performed using the intraclass correlation coefficient (ICC). RESULTS: The mean results of fetal AG and FZ values were 0.42 cm3 (0.04-1.22) and 0.10 cm3 (0.02-0.47), respectively. The best-fit quantile regression models for fetal AG and FZ volumes as the function of GA were in first-degree models: AG = -0.937 + 0.041 × GA (R2 = 0.124) and FZ = -0.201 + 0.009 × GA (R2 = 0.127), respectively. We observed good intra-observer repeatability of fetal AG and FZ volumes, with an ICC of 0.996 and 0.989, respectively. We also observed good inter-observer repeatability, with an ICC of 0.972 and 0.966 for AG and FZ, respectively. CONCLUSION: The reference ranges of AG and FZ volumes using 3DUS between 24 and 37 + 6 weeks of gestation were established and exhibited good repeatability.

Assessment of modified myocardial performance index in foetuses with growth restriction.

AIM: To evaluate the modified myocardial performance index (Mod-MPI) in foetuses with growth restriction and compare this index with appropriate for gestational age foetuses. MATERIAL AND METHODS: A prospective cross-sectional case-control study was conducted involving 76 singleton foetuses between 24 and 34 weeks of gestation divided into three groups (24 appropriate growth foetuses, 30 foetuses with estimated weight between the 3rd and 10th percentiles and 22 foetuses with estimated weight < 3rd percentile, according to the Hadlock table). The Mod-MPI was obtained in the plane of the four chamber view, and the spectral Doppler sample volume was placed in the lateral wall of the aorta, close to the mitral valve. Doppler of umbilical artery was normal in all cases. Analysis of variance (ANOVA) was used to compare the groups and the intra-class correlation coefficient (ICC) was used to assess intra- and inter-observer reproducibility. RESULTS: The mean Mod-MPI in the groups of appropriate for gestational age, estimated weight between the 3rd and 10th percentiles, and estimated weight < 3rd percentile was 0.32 +/- 0.05, 0.35 +/- 0.05 and 0.36 +/- 0.06, respectively; there was no statistical difference between the groups (p = 0.072). There was good intra- and inter-observer reproducibility (ICC = 0.726 and 0.760, respectively). CONCLUSION: Mod-MPI was not significantly different between foetuses appropriate for gestational age and those with growth restriction. Mod-MPI proved to be a feasible and reproducible technique.