New Doppler index for prediction of perinatal brain damage in growth-restricted and hypoxic fetuses.

OBJECTIVE: To evaluate the new vascular score, hypoxia index (HI), in the prediction of sonographically detected structural brain lesions in neonates within the first week after delivery of growth-restricted fetuses. METHODS: This prospective study included 29 growth-restricted fetuses delivered between 31 and 40 gestational weeks. Doppler umbilical artery (UA) and middle cerebral artery (MCA) resistance indices (RI) were recorded at 48-h intervals for at least 2 weeks before delivery. The cerebroumbilical ratio (C/U ratio = MCA-RI/UA-RI) and the HI (the sum of the daily reductions in C/U ratio, i.e. percentage below the cut-off value of 1, over the period of observation) were calculated. After delivery, neonatal outcome was evaluated according to obstetric parameters and ultrasound examinations of the brain. Doppler indices, C/U ratio and HI, as well as neonatal clinical and biochemical parameters, were tested as potential predictors of brain lesions using the C4.5 data-mining algorithm. RESULTS: Neonatal brain lesions were detected in 13 growth-restricted fetuses. Of all the parameters tested by the C4.5 data-mining algorithm, only HI was identified as a predictor of neonatal brain lesions. HI also showed better correlation with neonatal biochemical parameters, such as umbilical venous partial pressure of oxygen and umbilical venous pH, compared with the C/U ratio. CONCLUSIONS: HI, which takes into account cumulative oxygen deficit, could significantly improve the prediction of a poor neurological outcome in pregnancies complicated by growth restriction and hypoxia.

The antenatal development of fetal behavioral patterns assessed by four-dimensional sonography.

The investigation of fetal intrauterine activities has been enabled by the development of two-dimensional ultrasound. It has been shown that the earliest signs of fetal motor activity can be in the late embryonic period, and that the characteristics of fetal motor patterns change constantly throughout gestation. During the first trimester of pregnancy, the repertoire and frequency fetal movement patterns constantly expand, whereas the second and third trimesters are characterized by the progressive organization of fetal activities into complex and clearly distinct behavioral patterns. The comparison of real time ultrasonic studies of fetal behavior with the morphological studies of fetal brains has revealed that the appearance of new behavioral patterns or the transition of existing patterns directly reflect the complex neurodevelopment processes. It has been suggested that the assessment of fetal behavioral patterns could give us insight into the integrity of fetal central nervous system and enable the early detection of cerebral dysfunctions. The development of a new ultrasonic technique, four dimensional sonography, could represent a significant improvement in the assessment of fetal behavior. According to the preliminary results, this new technique could open a new perspective for the investigations of fetal behavioral patterns and contribute significantly to our better understanding of complex neurodevelopmental events. The most important neurodevelopmental events, the basic technology of 4D ultrasound and its application in the assessment of functional development of fetal central nervous system will be the subject of this review.

[Case report on the empty sella syndrome]. / Povodom slucaja "empty sella" sindroma.

The patient with "empty sella" syndrome was dealt with in this paper. This syndrome represented a remarkable differential diagnostic problem and was treated surgically.