First trimester examination of fetal anatomy: clinical practice guideline by the World Association of Perinatal Medicine (WAPM) and the Perinatal Medicine Foundation (PMF).

This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for precise standardization to implement the ultrasound evaluation of the fetus in the first trimester of pregnancy and improve the early detection of anomalies and the clinical management of the pregnancy. The aim is to present a document that includes statements and recommendations on the standard evaluation of the fetal anatomy in the first trimester, based on quality evidence in the peer-reviewed literature as well as the experience of perinatal experts around the world.

Application of a Global Multiparameter Scoring System for the Prenatal Prediction of Coarctation of the Aorta.

To assess prospectively the capability of our previously reported global multiparameter scoring system to predict coarctation of the aorta (CoAo) in fetuses with cardiac asymmetry, we applied and analyzed the performance of our scoring system in predicting postnatal CoAo in fetuses undergoing prenatal echocardiographic assessment because of cardiac asymmetry between 2011 and 2021, and we determined the cut-off points of the score with the best balance between specificity and sensitivity, and of maximum sensitivity and specificity. CoAo was confirmed in 39/179 newborns (21.8%). We found a significantly higher probability of CoAo in fetuses with CoAo than in cases without CoAo (84.2 ± 18.2% vs. 26.0 ± 28.6%, p < 0.001). The AUC of the ROC of the score was 0.93 (95% CI 0.89-0.97). The cut-off value with the best balance between specificity and sensitivity was a predicted risk of ≥53% (sensitivity 92.3% and specificity 80.0%). The cut-off point of maximum sensitivity was ≥35% (sensitivity 100% and specificity 72.9%), and that of maximum specificity was ≥96% (sensitivity 43.6% and specificity 96.4%). In none of the fetuses with a probability of CoAo < 35% was this condition confirmed after birth. This occurred in 102 fetuses in the whole study population (57%) and in 84 of the 111 in whom CoAo was suspected beyond 28 weeks (75.7%). This multiparameter score allows an adequate discrimination between fetuses without CoAo and those with CoAo, reducing the false positive diagnoses in cardiac asymmetry.

A Randomized Trial of a Cervical Pessary to Prevent Preterm Singleton Birth.

BACKGROUND: Preterm birth is the leading cause of neonatal and infant death and of disability among survivors. It is unclear whether a pessary inserted around the cervix reduces the risk of preterm singleton birth. METHODS: We conducted a multicenter, randomized, controlled trial comparing pessary placement with expectant management (control) in girls and women who were pregnant with singletons (singleton pregnancies) and who had a cervical length of 25 mm or less at 20 weeks 0 days to 24 weeks 6 days of gestation. Participants in either group who had a cervical length of 15 mm or less, at randomization or at subsequent visits, received treatment with vaginal progesterone. The primary outcome was spontaneous delivery before 34 weeks of gestation. RESULTS: In an intention-to-treat analysis, there was no significant difference between the pessary group (465 participants) and the control group (467 participants) in the rate of spontaneous delivery before 34 weeks (12.0% and 10.8%, respectively; odds ratio in the pessary group, 1.12; 95% confidence interval, 0.75 to 1.69; P=0.57). There were no significant differences in the rates of perinatal death (3.2% in the pessary group and 2.4% in the control group, P=0.42), adverse neonatal outcome (6.7% and 5.7%, respectively; P=0.55), or neonatal special care (11.6% and 12.9%, respectively; P=0.59). The incidence of new or increased vaginal discharge was significantly higher in the pessary group than in the control group. CONCLUSIONS: Among girls and women with singleton pregnancies who had a short cervix, a cervical pessary did not result in a lower rate of spontaneous early preterm delivery than the rate with expectant management. (Funded by the Fetal Medicine Foundation; Current Controlled Trials number, ISRCTN01096902.).

Maternal serum α-fetoprotein at 11-13 weeks' gestation in spontaneous early preterm delivery.

OBJECTIVE: To examine the potential value of maternal serum level of α-fetoprotein (AFP) in the first trimester of pregnancy in the prediction of spontaneous early preterm delivery. METHODS: Maternal serum concentration of AFP at 11-13 weeks' gestation was measured in a case-control study of singleton pregnancies delivering phenotypically normal neonates, including 33 cases with spontaneous delivery before 34 weeks and 99 matched controls delivering after 37 weeks. The median multiple of the median (MoM) serum AFP in the two outcome groups was compared and the bivariate gaussian distributions were simulated in a previously described screened population of 33,370 pregnancies to estimate the performance of screening for early delivery by a combination of maternal characteristics and obstetric history with serum AFP. RESULTS: In the preterm delivery group compared to the term delivery group, the median serum AFP MoM was higher (1.33 vs. 0.97, p = 0.006). The estimated detection rate of preterm delivery, at a false-positive rate of 10%, from maternal characteristics and obstetric history was 27.5% and this increased to 36.0% with the addition of serum AFP. CONCLUSIONS: Measurement of serum AFP at 11-13 weeks improves the prediction of early preterm delivery provided by maternal characteristics and obstetric history.

Hemopatías malignas en el embarazo / Malignant blood diseases in pregnancy

Objetivo. Analizar la incidencia, el manejo obstétrico y médico de la patología revisada, y los resultados maternos y perinatales en gestantes afectadas de tumores hematológicos malignos. Sujetos y métodos. Se analizaron, mediante revisión de historias clínicas, todos los casos de mujeres con tumores hematológicos diagnosticados durante la gestación, comprendidos entre los años 2000 y 2005. Resultados. Se hallaron 5 casos (2 leucemias agudas y 3 linfomas, 2 de ellos enfermedad de Hodgkin), en diferentes trimestres de la gestación, que consultaron principalmente por síntomas B, con datos analíticos y anatomopatológicos muy variables. En todos los casos, tras una adecuada estadificación y tratamiento, se obtuvo una remisión completa de la afección. Conclusiones. El curso de la enfermedad no se altera con el embarazo. La supervivencia libre de enfermedad a largo plazo es equiparable a la de mujeres no gestantes con la misma patología (AU)

Objective. To analyze the incidence of hematological malignancies, their obstetric and medical management, and maternal and perinatal outcomes in pregnant women. Subjects and methods. Medical histories were reviewed, and all cases of women diagnosed with hematologic malignancies during pregnancy from 2000 to 2005 were analyzed. Results. We found five cases (two leukemias and three lymphomas, two of which were Hodgkin's disease), in distinct trimesters of pregnancy. The women consulted mainly because of B symptoms. Blood tests and histological data were highly variable. In all patients, complete remission was achieved after proper staging and treatment. Conclusions. Pregnancy does not alter the development of hematological malignancies. Long-term disease-free survival is similar in both pregnant and non-pregnant women with the same disease (AU)

Maternal serum placental protein 13 at eleven to thirteen weeks in chromosomally abnormal pregnancies.

OBJECTIVE: To investigate whether the maternal serum concentration of placental protein 13 (PP13) is altered in chromosomally abnormal pregnancies and to examine the potential value of this placental protein in screening for aneuploidies at 11-13 weeks. METHODS: The maternal serum concentration of PP13 at 11-13 weeks was compared in 536 euploid and 134 aneuploid pregnancies (trisomy 21: n = 49; trisomy 18: n = 28; trisomy 13: n = 19; Turner syndrome: n = 28; triploidy: n = 10). RESULTS: Serum PP13, expressed as multiples of the median (MoM) of the euploid group, was not significantly different in trisomy 21 (1.12 MoM) pregnancies, but the levels were decreased in trisomy 18 (0.75 MoM), trisomy 13 (0.65 MoM), Turner syndrome (0.61 MoM) and triploidy (0.19 MoM). In both euploid and aneuploid pregnancies there was a significant association of serum PP13 with both serum pregnancy-associated plasma protein A (PAPP-A) and free beta-human chorionic gonadotropin (beta-hCG; p < 0.0001 for both). Logistic regression analysis demonstrated that the addition of serum PP13 did not improve the prediction of trisomy 13 and 18 provided by a combination of maternal age, nuchal translucency, and serum free beta-hCG and PAPP-A. CONCLUSION: The measurement of maternal serum PP13 at 11-13 weeks does not improve the performance of screening for aneuploidies achieved by current algorithms.