Prediction of lethal pulmonary hypoplasia among high-risk fetuses via 2D and 3D ultrasonography.

OBJECTIVE: To compare accuracy between 3D and 2D ultrasonography for predicting lethal pulmonary hypoplasia (LPH) among high-risk fetuses. METHODS: In a cross-sectional prospective study at a fetal medicine referral center in Brazil, bilateral fetal lung scans were evaluated for 54 fetuses with suspected LPH between May 2008 and June 2011. Measurements for predicting LPH were ultrasonographic fetal lung volume/estimated fetal weight ratio (US-FLW), observed/expected thoracic circumference (o/e-TC), observed/expected thoracic circumference/abdominal circumference (o/e-TC/AC), observed/expected thoracic area/heart area (o/e-TA/HA), observed/expected amniotic fluid index (o/e-AFI), and observed/expected total fetal lung volume (o/e-Tot-FLV). To evaluate accuracy in predicting LPH, receiver operating characteristic (ROC) curves were calculated, and areas under the curves (AUCs) were compared. The intraclass correlation coefficient (ICC) was used to assess 3D lung volume reproducibility. RESULTS: Data were compared for 47 newborns, of whom 34 had LPH (perinatal mortality 74.5%). The AUCs for predicting LPH were 0.93, 0.69, 0.55, 0.46, 0.71, and 0.86 for US-FLW, o/e-TC, o/e-TC/AC, o/e-TA/HA, o/e-AFI, and o/e-Tot-FLV, respectively. No significant intraobserver difference was observed in measurements of the right (ICC, 0.973; P < 0.0001) or left (ICC, 0.950; P < 0.0001) lung volumes. CONCLUSION: Among high-risk fetuses, US-FLW by 2D/3D and o/e-Tot-FLV by 3D ultrasonography were more accurate than 2D parameters for predicting LPH.

Predictive factors of perinatal mortality in transfused fetuses due to maternal alloimmunization: what really matters?

INTRODUCTION: Alloimmunization is the main cause of fetal anemia. There are not many consistent analyses associating antenatal parameters to perinatal mortality in transfused fetuses due to maternal alloimmunization. The study aimed to determine the prognostic variables related to perinatal death. MATERIAL AND METHODS: A cohort study analyzed 128 fetuses treated with intrauterine transfusion (IUT), until the early neonatal period. Perinatal mortality was associated with prognostic conditions related to prematurity, severity of fetal anemia and IUT procedure by univariated logistic regression. Multiple logistic regression was used to compute the odds ratio (OR) for adjusting the hemoglobin deficit at the last IUT, gestational age at birth, complications of IUT, antenatal corticosteroid and hydrops. RESULTS: Perinatal mortality rate found in this study was 18.1%. The hemoglobin deficit at the last IUT (OR: 1.26, 95% CI: 1.04-1.53), gestational age at birth (OR: 0.53, 95% CI: 0.38-0.74) and the presence of transfusional complications (OR: 5.43, 95% CI: 142-20.76) were significant in predicting fetal death. CONCLUSION: Perinatal mortality prediction in transfused fetuses is not associated only to severity of anemia, but also to the risks of IUT and prematurity.