Prenatally diagnosed foramen ovale restriction in fetuses with hypoplastic left heart syndrome may be a predictor of longer hospitalization, but not of a need for an urgent rashkind procedure.

OBJECTIVES: This prospective study aimed to assess the effectiveness of foramen ovale examination in classifying prenatal hypoplastic left heart syndrome (HLHS) in accordance with the new classification groupings for congenital heart defects. MATERIAL AND METHODS: The analysis included 145 fetuses with HLHS, diagnosed and monitored between 2008 and 2015 in Prenatal Cardiology Department at Polish Mother's Memorial Hospital Research Institute in Lodz. The main criteria for classifying our study population into three sub-groups was was the presence of a foramen ovale restriction, which we diagnosed by evaluating the diameter and blood flow through the foramen ovale. Of the total group, 73.8% (n = 107) were classified as severe planned, 24.1% (n = 35) as severe urgent, and 2.1% (n = 3) as the severest group. RESULTS: Comparing the severe planned and the severe urgent HLHS groups showed: gestational age of delivery 38 vs 38 weeks respectively (p = 0.45); cesarean delivery 62% vs 79.2% (p = 0.15); neonatal birth weight 3110 g vs 2985 g (p = 0.2); Apgar score 9 vs 9 points; survival rate 65.8% vs 61.9% (p = 0.8); and hospitalization 38 vs 46.5 days (p = 0.059). Prenatal qualification for the group of severe urgent HLHS was characterized by 100% sensitivity, 80.6% specificity and a low posi- tive predictive value of 9.5%. CONCLUSIONS: 1. Prenatal qualification into the group of severe urgent CHD based on the features of foramen ovale was characterized by high sensitivity, a satisfying specificity and a low positive predictive value. 2. Prenatally diagnosed foramen ovale restriction may be a predictor of longer hospitalization, but not of a need for an urgent Rashkind procedure. 3. New classifications of CHDs allowed clinicians to determine prognoses and to plan optimal multi-specialized care which resulted in similar outcomes between the severe planned and severe urgent HLHS groups.

The role of visfatin in pathogenesis of gestational diabetes (GDM).

Gestational diabetes (GDM) is defined as a glucose intolerance of varying severity with onset or first recognition during pregnancy. Two major metabolic disorders: insulin resistance and ß-cells dysfunction, play currently major role in pathogenesis of GDM. Adipose tissue is an organ involved in production of adipokines, which have various influence on metabolism of glucose and lipids. Visfatin is an adipokine mainly produced and secreted by the fat tissue. It exerts an insulin-like effect by binding to the insulin receptor-1 and have hypoglycemic effect. Visfatin appears to be an important factor in the pathophysiology of GDM. The aim of this article is to review the literature concerning the relationship between the adipokine mentioned above and GDM, and to clarify its role in the pathophysiology of GDM.

Chorionic thickness and PlGF concentrations as early predictors of small-for-gestational age birth weight in a low risk population.

OBJECTIVES: SGA is associated with higher incidence of postnatal complications, including suboptimal neurodevelopment and increased cardiovascular risk. Screening for SGA, carried out at 11-13 (+ 6d) gestational weeks enables to reduce or completely eliminate the above mentioned complications. The aim of this study was to assess the correlation between chorionic thickness, concentration of PIGF protein and foetal birth weight in a single low-risk pregnancy. MATERIAL AND METHODS: The study included 76 patients at 11-13 (+ 6d) gestational weeks, monitored throughout preg-nancy. Ultrasound examinations identified the location and thickness of the chorion by measuring it in its central part at its widest point in a sagittal section. Additionally, at each visit venous blood was collected to determine the level of PlGF, PAPP-A, and BhCG. RESULTS: A significant positive correlation (r = 0.37) was found between the foetal weight and chorionic thickness. This correlation was affected by the location of the chorion and a significant negative correlation was observed between the level of PLGF, FHR, weight and length of the newborn. Maternal early-pregnancy BMI did not affect neonatal weight and body length, FHR, chorionic thickness, and the levels of PlGF, PAPP-A, and BhCG. CONCLUSIONS: The preliminary analysis indicates an association between chorionic thickness assessed during ultrasound at 11-13 (+ 6d) gestational weeks, PIGF levels assayed at the same time and birth weight. Increasing chorion thickness was accompanied by increasing foetal birth weight. PlGF level showed an inversely proportional effect on the foetal weight. This correlation was significant for the posterior location of the chorion.

Effect of morphological and functional changes in the secundines on biometric parameters of newborns from dichorionic twin pregnancies.

OBJECTIVES: The aim of the study was to determine if, and to what extent, structural and functional changes of the secundines influence biometric parameters of neonates from dichorionic twin pregnancies. MATERIAL AND METHODS: The study included neonates from dichorionic, diamniotic twin pregnancies, along with their secundines. Based on histopathological examination of the secundines, the mass and dimensions of the placenta, length and condition of the umbilical cord, chorionicity, focal lesions, and microscopic placental abnormalities were determined for 445 pairs of twins. Morphological development of examined twins was characterized on the basis of their six somatic traits, while birth status of the newborns was assessed based on their Apgar scores. Statistical analysis included Student t-tests, Snedecor's F-tests, post-hoc tests, non-parametric chi-squared Pearson's tests, and determination of Spearman coefficients of rank correlation. RESULTS: The lowest values of analyzed somatic traits were observed in twins who had placentas with velamentous or marginal cord insertion. Inflammatory lesions in the placenta and placental abruption turned out to have the greatest impact of all analyzed abnormalities of the secundines. Inflammatory lesions in the placenta were associated with lower values of biometric parameters and a greater likelihood of preterm birth. Neonates with a history of placental abruption were characterized by significantly lower birth weight and smaller chest circumference. CONCLUSIONS: Morphological changes in the secundines have a limited impact on biometric parameters of neonates from dichorionic twin pregnancies. In turn, functional changes exert a significant effect and more often contribute to impaired fetal development.

Ballantyne Syndrome (Mirror Syndrome) associated with severe non-immune fetal hydrops--a case report.

OBJECTIVES: The aim of the study was to present a case of rapidly progressing non-immune fetal hydrops (NIHF) of unknown etiology in a normal-karyotype fetus, accompanied by severe maternal edema, anemia, and hypoproteinemia. After the differential diagnosis, Ballantyne Syndrome (BS, Mirror Syndrome) was diagnosed. MATERIAL AND METHODS: We present a case of a 31-year-old multipara at 22/24 weeks of pregnancy presenting severe symptoms of non-immune fetal hydrops: subcutaneous edema, hydrothorax, ascites and placental edema associated with maternal edema, anemia and hypoproteinemia. After cardiovascular infectious, immune and morphological causes were excluded, amniocentesis was performed and confirmed normal female 46, XX karyotype. Since 22 weeks of pregnancy increasing maternal edema and anemia were observed. No hematological, cardiac or nephrological causes of this condition were found. RESULTS: At 24 weeks of pregnancy intrauterine fetal demise was diagnosed and surgical evacuation (cesarean section) of the fetus was performed. Resolution of maternal edema, anemia, and hypoproteinemia was observed shortly after the delivery. CONCLUSIONS: Based on our findings, it seems safe to conclude that BS may develop in pregnancy complicated by NIHF of unknown origin.

[The impact of metabolic control on uteroplacental circulation parameters in pregnancies complicated by gestational hypertension and/or preeclampsia in pregnant women with pregestational diabetes]. / Wplyw wyrównania metabolicznego na parametry krazenia maciczno-lozyskowego w ciazy powiklanej nadcisnieniem ciazowym i stanem przedrzucawkowym u ciezarnych z cukrzyca przedciazowa.

OBJECTIVES: The aim of the study was to evaluated the impact of metabolic control in pregnant women with PGDM on uteroplacental circulation parameters during pregnancy. MATERIAL AND METHODS: The study group included 141 pregnant women divided into 3 subgroups: PE + GH group (n = 16)--woman suffering from PGDM, with superimposed PE or GH, the PGDM group (n = 84)--women suffering from PGDM without hypertension, and the control group--41 healthy women in uncomplicated pregnancy. All participants were monitored for metabolic control and uteroplacental circulation parameters during pregnancy. The survey was completed after the data from the perinatal period were collected. RESULTS: The differences between the uterine artery pulsatility index (Pi UtA) in the first trimester of pregnancy expressed as a multiple of the median (MoM), were not statistically significant between the groups (p ≥ 0.42). Also, no statistically significant differences were observed between the groups Pi UtA in the second (p ≥ 0.33) and third trimester of pregnancy (p = 1.0). The rate of fetal growth was comparable in all groups. Infant birth weight percentile in the study groups did not differ statistically (p ≥ 0.15). CONCLUSIONS: Tight metabolic control during pregnancy in women suffering from PGDM allows to obtain blood flow in the uteroplacental circulation which is comparable to their healthy pregnant peers.

Maternal serum placental growth factor and fetal SGA in pregnancy complicated by type 1 diabetes mellitus.

AIM: To analyze the role of maternal placental growth factor (PlGF) in the prediction of small for gestational age (SGA) birth weight in pregnancy complicated by type 1 diabetes mellitus (T1DM). METHODS: A prospective observational study on 59 normotensive T1DM pregnant women, assessing maternal PlGF concentrations between the 10th-14th and 22nd-25th weeks of gestation. RESULTS: Number of SGA vs. non-SGA newborns was 11 (18.6%) vs. 48 (81.4%), respectively. First trimester PlGF serum concentrations (pg/mL) were similar between SGA vs. non-SGA groups [data given as median (interquartile range)]: 65.5 (35.58-159.20) vs. 68.23 (11.59-150.03), respectively; P=0.44. A trend for lower PlGF concentrations was observed in the second trimester in the SGA vs. non-SGA group: 63.34 (12.79-119.16) vs. 116.75 (33.93-235.82); P=0.07. In the SGA group, PlGF concentrations did not differ between the first and the second trimester: 65.5 (35.58-159.20) vs. 63.34 (12.79-119.16), respectively; P=0.36. In the non-SGA group, PlGF concentrations were significantly higher at the gestational age of 22-25 weeks compared to 10-14 weeks [116.75 (33.93-235.82) vs. 68.23 (11.59-150.03); P=0.03). CONCLUSIONS: Decreased PlGF serum concentration in mid-pregnancy, as well as a lack of physiological increase in PlGF levels between early and mid-gestation, may precede development of SGA in women with T1DM.

Fetal pulmonary and cerebral artery Doppler velocumetry in normal and high risk pregnancy.

UNLABELLED: Studies on fetal lung/brain circulation by means of power Doppler technique have suggested a marked reduction in lung perfusion in high-risk pregnancies as a sign of circulation redistribution. The ratio between lung/brain perfusion might therefore give a new method to predict fetal circulation centralization. OBJECTIVE: The aim of the present study was to obtain fetal lung and cerebral artery ratio in normal and high-risk pregnancies. STUDY DESIGN: Doppler samples from proximal right pulmonary artery blood velocities and middle cerebral artery (MCA) were recorded cross-sectionally in 228 normal singleton pregnancies at gestational age 22 to 40 weeks. MCA/right pulmonary artery pulsatility index (PI) ratio was calculated. Doppler samples from proximal right pulmonary artery and MCA were also recorded in 89 high-risk singleton pregnancies and the results related to perinatal outcome. RESULTS: In the normal controls, right pulmonary artery PI remained stable until 30 weeks of gestation with slight increase thereafter until term. The MCA to right pulmonary artery PI ratio increased between 22 and 28 weeks of gestation with the rapid fall towards term. In the high-risk pregnancies group, right pulmonary artery PI showed no significant correlation to perinatal outcome, but signs of brain-sparing in the MCA were correlated to all adverse outcome parameters. CONCLUSION: Velocimetry of the middle cerebral artery is better than velocimetry of right pulmonary artery in predicting adverse outcome of pregnancy The brain/lung PI ratio does not improve the prediction of adverse outcome of pregnancy.

Can redox imbalance predict abnormal foetal development?

OBJECTIVES: Based on the current state of knowledge, elevated levels of oxidative stress markers may be considered as risk factors for pregnancy complications. The aim of the research was to assess the correlation between selected oxidative stress biomarkers with the occurrence of foetal chromosomal aberration and congenital malformations. MATERIAL AND METHODS: This retrospective research lasted for two years. The purpose was to determine serum levels of selected oxidative stress markers, including total protein (TP), glutathione (GSH), S-nitrosothiols (RSNO), nitric oxide (NO), trolox equivalent antioxidant capacity (TEAC) and glutathione S-transferase (GST) at 11-13 + 6 gestational weeks in 38 women with confirmed foetal developmental abnormalities and in 34 healthy pregnancies in order to assess their utility as predictors of abnormal foetal development. RESULTS: Serum concentrations of TP (56.90 ± 5.30 vs 69.1 ± 15.30 mg/mL), TEAC (4.93 ± 0.82 vs 5.64 ± 0.74 µM/mL) and GST (15.94 ± 4.52 vs 21.72 ± 6.81 nM/min/mg) were statistically significantly (p < 0.05) lower in the group of patients with developmental abnormalities in the fetus, whereas GSH levels (6.43 ± 1.24 vs 4.98 ± 1.88 nM/mg) were significantly higher, compared to the group of healthy fetuses. There were no differences in the concentration of these markers between chromosomal aberrations and fetal dysmorphia in subjects. A significant difference in odds ratio obtained for GSH (OR = 0.57, 95% CL: 0.40-0.80) indicates that its higher concentration can relate to reduced risk of developmental abnormalities, whereas odds ratio for TP (OR=1.11, 95% CL: 1.04-1.17), TEAC (OR = 3.54, 95% CL: 1.56-8.05) and GST (OR = 1.18, 95% CL: 1.03-1.17) indicate that their elevation may increase the risk of developmental abnormalities CONCLUSIONS: Elevated levels of TP, GST, TEAC and low GSH level may be relevant to predict congenital defects.

The role of individual blood flow parameters through ductus venosus in the first and second trimesters of pregnancy in predicting the condition of the fetus and newborn.

OBJECTIVES: To predict fetal and neonatal outcome during pregnancy based on detailed analysis of ductus venosus blood flow velocities in first and second-trimester fetuses. MATERIAL AND METHODS: A retrospective analysis was made in 680 patients with single pregnancies in years 2015 and 2016. The following ductus venosus blood flow velocities in first and second-trimester were analyzed: S-wave velocity, D-wave velocity, a-wave velocity, Tmax velocity, PIV. Results were divided into sub-groups with reduced value, normal value and increased value and compared with fetal and neonatal condition. RESULTS: The relationship between the increased PIV value in the first trimester of pregnancy and an increased risk of chromosomal aberrations was observed, whereas the increased DV PI value in the second trimester of pregnancy with reduced A -wave were associated with a higher incidence of FGR. No correlation between the remaining DV blood flow velocities in the first and second trimester of pregnancy and the more frequent occurrence of fetal and neonatal complications has been confirmed. CONCLUSIONS: The increased DV PIV is a good prognostic tool for the detection of chromosomal aberrations in first trimester of pregnancy. In the second trimester, the increased DV PIV and the reduced A- wave velocity correlate with the fetal growth restriction. Ductus venosus seems to be an indirect indicator of intrauterine hypoxia with moderate prognostic value for adverse obstetric outcomes.

An Assessment of Selected Molecular and Biochemical Markers of the Folate Pathway as Potential Risk Factors for Fetal Trisomy 21 during the First Trimester of Pregnancy in the Polish Population.

Are the maternal gene variants MTHFR: c.665C>T, MTHFR: c.1286A>C, MTR: c.2756A>G, MTRR: c.66A>G, RFC1: c.80C>T and TCN2: c.776G>C and blood markers of the folate pathway important factors in assessing the risk of fetal trisomy 21 (fetal-T21)? Twenty pregnant women with a high risk and twenty with a low risk of fetal-T21 underwent prenatal examination. Selected gene variants and folate pathway markers and pregnancy-associated plasma protein A (PAPP-A) and free ß-subunit of human chorionic gonadotropin ß (free-ß-hCG) multiple of the medians (MoMs) were determined. The distributions of the alternative alleles and genotypes of the gene variants did not differ between the studied groups. There was no relationship between PAPP-A and ß-hCG MoM values and the presence of allele alternative genotype variants. The occurrence of alternative variants of the selected genes and concentrations of most of the studied folate pathway markers may not play a crucial role in the risk of fetal-T21 in pregnant women. However, the relationships between erythrocyte folate concentrations and the occurrence of alternative variants: c.665C>T MTHFR and c.776G>C TCN2, as well as the methylmalonic acid concentration and the occurrence of alternative variant c.776G>C TCN2 in pregnant women with fetal-T21, encourage further research. So far, of the biochemical markers, maternal PAPP-A and ß-hCG MoM values remain independent risk factors for fetal-T21.

Spontaneous Resolution of Congenital Dural Venous Sinus Ectasia Associated With Polymicrogyria-Case Report.

Dural venous sinus ectasia belongs to a rare group of venous sinus malformations of unknown origin and uncertain prognosis. We report the first patient with idiopathic congenital ectasia of the confluence of sinuses with thrombosis associated with bilateral polymicrogyria. It may highlight the causative relation between ischemia within the central nervous system due to torcular herophili ectasia with thrombosis in early pregnancy and the development of cortical malformations in neonates. We also highlight the role of MR neuroimaging in the diagnosis of these entities.

[Ultrasound macrosomic fetal weight estimation formula using maternal weight measurements]. / Ultrasonograficzne prognozowanie makrosomii plodu z zastosowamniem oceny masy ciala ciezarnej.

INTRODUCTION: Methods of macrosomic fetal weight estimation are associated with large deviations and statistically significant errors. Fetal macrosomia might be better predicted by using fetal ultrasound measurements and maternal characteristics. MATERIAL AND METHODS: Ultrasound evaluation of fetal weight was performed in 113 singleton fetuses one week (max. 7 days) before delivery. Retrospectively all newborns with birth weight o A new logarithmic estimation formula proposed by Hart and co. was compared with commonly used formulas of Shepard, Campbell, Hadlock I, Hadlock II, Hadlock Ill. Exclusion criteria were: multiple pregnancies, intrauterine deaths, structural or chromosomal abnormalities. The new formula established by Hart (loge EFW = 7.6377445039 + 0.0002951035 x maternal weight + 0.0003949464 x HC + 0.0005241529 x AC + 0,0048698624 x FL) uses fetal biometric measurements and maternal weight as two different parameters: EFW- estimated fetal weight, maternal weight--weight measured at one week (max. 7 days) before delivery HC--fetal head circumference, AC--abdominal circumference, FL--femur length. RESULTS: The new Hart formula gives the lowest mean percentage error (MPE) : -0.74% and mean absolute percentage error (MAPE) : 3.38%, as compared to other routinely used formulas which presented statistically significantly higher MPE and AMPE With the new formula 84 of estimated fetal weights fell within +5% of the actual weight at birth, 111 within +/- 10% and 112 within +/- 15% and +/- 20%. CONCLUSIONS: The presented ultrasound formula demonstrated a more precise macrosomic fetuses weight estimation with the lowest MPE and MAPE as compared to the others and might be introduced when fetal macrosomia is suspected.

[Nonimmune hydrops fetalis associated with congenital small bowel atresia--a case study]. / Nieimmunologiczny obrzqk plodu w przebiegu wrodzonej niedroznosci jelit--analiza przypadku klinicznego.

Nonimmune hydrops fetalis is observed with the frequency of 1:3000 cases diagnosed pre- and postnatally. In the following paper the authors analyzed the course of pregnancy complicated by fetal ascites and polyhydramnios with the appearance of colonic ileus and they presented the postnatal condition of the baby The preliminary diagnosis was confirmed after birth and the newborn was operated in the second day of his life. The congenital small bowel atresia was qualified as a III B type (Grossfeld qualification), which is called the "pagoda" syndrome [3]. The colonic atresia is located then around the superior mesenteric vessels, which leads to colonic necrosis (Figure 1).

[Obstetric consequences of uncontrolled gestational diabetes--a case study]. / Konsekwencje poloznicze niewyrównanej metabolicznie cukrzycy ciazowej--analiza przypadku klinicznego.

This paper presents a case of a pregnant woman who was admitted to the obstetrics and gynecology department because of a new onset of uncontrolled diabetes in 27 weeks gestation. The maternal and fetal diabetic complications suggested a chronic character of the disease which must have been undiagnosed before pregnancy. Many of the co-existing infections caused a life-threatening ketoacidosis. Fortunately with the adequate treatment it was possible to ensure appropriate birth weight of the newborn baby despite the ultrasound markers for LGA (Large For Gestational Age) observed during pregnancy. Intensive insulin therapy was obligatorily continued by the mother after the delivery.

Serum visfatin as a metabolic biomarker in obese patients with gestational diabetes mellitus.

BACKGROUND: Visfatin is an adipokine produced and secreted by the adipose tissue. It exerts an insulin-like effect by the insulin receptor-1 and has a hypoglycemic effect. We aimed to investigate how serum visfatin changes in women with gestational diabetes mellitus (GDM), and whether it is predictive of neonatal outcomes. METHODS: Visfatin levels were prospectively measured in peripheral blood serum by enzyme immunoassay in 210 pregnant women, 156 of which were diagnosed with GDM, 18 of which suffered from pregnancy-induced hypertension (PIH) and 36 healthy controls. RESULTS: Patients with obesity class II (median=2.562 ng/mL) and class III (median=6.2940 ng/mL) had higher serum visfatin than overweight patients (median=0.735 ng/mL); (Mann-Whitney U test, P=0.037 and P=0.023, respectively). In GDM patients with BMI above 30, serum visfatin was associated to glycosylated hemoglobin (Spearman correlation test, R=0.26, P=0.045). Women with BMI above 25 treated with insulin had lower serum visfatin levels than those treated with diet only (Mann-Whitney U test, P=0.045). No correlation was found between visfatin and parameters of lipid profile such as HDL, LDL, or triglycerides (Spearman correlation tests, R=-0.051, -0.1, 0.0019; P=0.54, 0.29, 0.98, respectively). We observed that visfatin was not associated with birth weight (Spearman correlation test, R=-0.014, P=0.86) or adverse neonatal outcome as measured by umbilical artery pH below 7.25 (Mann-Whitney U test, P=0.55) or Apgar score below 10 (Mann-Whitney U test, P=0.21). CONCLUSIONS: In GDM patients with higher BMI, serum visfatin was elevated, correlated positively with glycosylated hemoglobin, and decreased upon treatment with insulin therapy.

[Thanatoforic dysplasia--case report]. / Dysplazja tanatoforyczna u plodu--opis przypadku.

The case report presents a prenatal diagnosis of a fetus with thanatophoric dysplasia. Characteristic features in this syndrome are: extremely short limbs with curved thigh bones, narrow chest, enlarged abdomen, prominent forehead, dysmorphic face, macrocephaly polihydramnion. The malformation results from the mutation in fibroblast growth factor receptor gene (FGFR-3) which is located in chromosome 4. TD is considered to be an autosomal dominant but most cases are caused by new mutations in the FGFR-3 gene. The prognosis in this malformation is extremely poor. The article presents ultrasound and additional investigations which might be useful in differential diagnosis.

How mother's obesity may affect the pregnancy and offspring.

One of the main reasons for the epidemic of obesity, which has already influenced the economic condition of health system worldwide, is our modern lifestyle having an unbalanced calorie intake and insufficient physical activity. Maternal-fetal nourishment and metabolism are the mechanisms of fetal programming of obesity-adiposity and non-communicable diseases that have been most extensively investigated. A mother's obesity is related to adverse outcomes for both mother and baby. Maternal overnutrition is also associated with a higher risk of gestational diabetes, preterm birth, large-for-gestational-age babies, fetal defects, congenital anomalies, and perinatal death. Women with obesity should be encouraged to reduce their body mass index (BMI) prior to pregnancy, and to limit weight gain during pregnancy. Obstetric ultrasound imaging in pregnant women is negatively affected by abdominal adipose tissue, having an adverse influence on congenital anomaly detection rates and the estimation of fetal weight.

The significance of maternal blood pregnancy-associated plasma protein A (PAPP-A) and free beta-subunit of human chorionic gonadotropin (ß-hCG) levels for the risk assessment of fetal trisomy 18 during the first prenatal testing between 11 and 13+6 weeks of pregnancy.

OBJECTIVE: The aim of the study was to evaluate the significance of the maternal blood level of pregnancy-associated plasma protein A (PAPP-A) and free beta-subunit of human chorionic gonadotropin (ß-hCG), to estimate the risk of fetal trisomy 18 and their correlation with the assessment of nuchal translucency (NT) during the first prenatal testing. MATERIAL AND METHODS: Examinations of 93 pregnant women between 11 and 13+6 weeks of pregnancy were conducted, which included determination of ß-hCG and PAPP-A concentrations in the maternal serum and ultrasound assessment of fetal nuchal translucency. Concentrations of biochemical parameters were expressed as multiples of median (MoM) for the appropriate gestational age. The risk assessment of trisomy 18 was analyzed using Astraia software. Pregnant women with a high (≥ 1:300) risk of trisomy 18 were offered a genetic amniocentesis with an examination of fetal karyotype. Twenty cases were healthy and 23 with trisomy 18. RESULTS: PAPP-A and ß-hCG MoM values < 0.3 were found in 61% cases of fetal trisomy 18. In 26% of cases, PAPP-A and ß-hCG MoM values < 0.2 were NT-independent risk factors for trisomy 18. There were no significant differences between groups with normal fetal karyotype (40%) and trisomy 18 (35%) in PAPP-A and ß-hCG MoM 0.2-0.5 range. CONCLUSIONS: Maternal free ß-hCG MoM was found to change parallelly to fetal NT widening in case of trisomy 18 diagnosis. Maternal ß-hCG and PAPP-A MoM results presented less then 0.2 might be used independently of NT widening in fetus for trisomy 18 risk evaluation. Above 0.2 for PAPP-A and ß-hCG MoMs, fetal NT measurement was an requirment.