Fetal Ultrasonographic Examination Research Articles

Importance of Aberrant Right Subclavian Artery Detection During Second Trimester Ultrasound Examination in Low-Risk Population

OBJECTIVE: Aberrant right subclavian artery, which is detected in 1-1.5% of the population, is considered an anatomical variant. Aberrant right subclavian artery is usually not symptomatic, but can sometimes lead to dysphagia due to esophageal compression. On the other hand, it has been found that it has accompanied some fetal anomalies in the last two decades. Although aberrant right subclavian artery is seen at a rate of 1-1.5% in normal chromosomal fetuses, it is seen at a rate of 19-36%, especially in fetuses with Down syndrome. STUDY DESIGN: Our study was carried out in the Department of Obstetrics and Gynaecology at Ankara University Faculty of Medicine between the dates of January 2017-January 2020. Pregnant women have had their detailed ultrasonography at our clinic and who were between 18th-24th gestational weeks were included. Amniocentesis was performed on the patients who have accepted, and genetic results were followed up. The patients who did not accept were followed up until after birth, and genetic testing was requested for babies suggestive of anomaly. RESULTS: Our study included 6205 patients who underwent detailed ultrasonography in our clinic between January 2017 and June 2020. Our detailed ultrasonography application week was between 16-24 weeks. During this period, aberrant right subclavian artery was detected in 47 of our patients. The detection rate of ARSA in the normal population in our study was 0.7% (46/6205). While aberrant right subclavian artery was the only ultrasonographic finding in 28 patients, extra anomalies were observed in 18 patients. Down syndrome was detected in four fetuses, CONCLUSION: We did not find any chromosomal anomalies in any of the patients with isolated aberrant right subclavian artery. Therefore, we do not recommend invasive intervention in patients with isolated aberrant right subclavian artery. On the other hand, our study confirmed that aberrant right subclavian artery screening should be a part of a detailed fetal ultrasonographic examination. Further studies with larger patient groups are needed.

Intrauterine Volvulus

Although volvulus is mostly seen in infancy, rare cases of intrauterine volvulus have also been reported. Fetal ultrasonographic (USG) examination of a 32-year-old woman at the 24th gestational week, showed focal dilatation of the intestines with an increased wall echogenity of the dilated segments. At the subsequent visits USG revealed progressive dilatation of the intestines. The patient presented with preterm labor at the 32nd gestational week. Cullen's sign developed on newborn's abdominal skin over time. During the operation, there was a stiff, yellowcolored, fibrinous pouch, jejunal and ileal atretic ends (25 cm of jejunum was remaining). We started total parenteral nutrition (TPN) because of short bowel syndrome. The patient died due to TPN-related sepsis at age 40 days. Timely diagnosis and treatment of intrauterine volvulus cases is very difficult because there are mostly non-specific signs, which have many differential diagnoses. This fact negatively affects mortality and morbidity for intrauterine volvulus cases.

Assessment of normal fetal cortical sulcus development

The aim of our study was to investigate the normal cortical sulcus development in fetuses without central nervous system abnormality with transabdominal ultrasonography. Our study was planned as a cross-sectional study in our clinic between November 2011 and October 2012. The study group was selected among pregnant women who applied to our hospital for routine antenatal follow-up. Singleton pregnancies, between 15th and 32nd gestational weeks, were included in the study. During the routine fetal ultrasonographic examination of these pregnant women, sylvian sulcus, parietooccipital sulcus, calcarine sulcus, and cingulate sulcus length measurements were taken and the correlation of these values with gestational week was evaluated. Three hundred and thirty-two patients were included in the study. Sylvian sulcus length, parietooccipital sulcus length, calcarine sulcus length, and cingulate sulcus length could be first measured respectively, at 15th, 17th, 17th and 25th gestational week. We found a positive correlation between gestational age and sylvian sulcus, parietooccipital sulcus, calcarine sulcus, and cingulate sulcus length measurements (p < 0.001). Sulcal development and cortical maturation can be evaluated prenatally with transabdominal ultrasonography of the central nervous system.

EP12.25: Fetal spontaneous resolution of small bowel volvulus: prenatal ultrasound and MRI diagnosis and neonate issue

The aim of these study was to describe the prenatal spontaneous resolution of small bowel volvulus using ultrasound and MRI examinations and the neonate outcome. A retrospective descriptive study was leaded in our university hospital centre during ten years. Inclusion criteria was fetal intestinal volvulus diagnosed by ultrasound and MRI with complete prenatal resolution. The ultrasound diagnosis was done using 2D and colour Doppler imaging. For each fetus prenatal ultrasound examination was completed by MRI. Ultrasound and MRI semiology were studied and compared. A weekly ultrasound fetal survey was performed. All the neonates had pediatric surgeon examination and an abdominal ultrasound scan was done. 3 fetuses were included. Mean gestational age of mid-gut volvulus diagnosis was 29.8 WG. The ultrasound imaging revealed only the 2D and colour Doppler “whirlpool sign”. The usual indirect ultrasound signs were not found in these three cases. The confirmation by MRI was effective in each case when winding dilated loops was highlighted. In our series no volvulus by intestinal malrotation was revealed. Antenatal outcome was spontaneous resolution with complete disappearance of the ultrasound sign of intestinal volvulus. Neonates outcome was normal with no intestinal complication found in all cases. Fetal ultrasonographic examination can done the diagnosis of small bowel volvulus. MRI is the exam which permit to confirm it. Spontaneous resolution of the fetal volvulus is possible and was described in three cases in our series of 13 prenatal cases of small bowel volvulus. The neonate prognosis was excellent.

Comprehensive Imaging Review of Abnormalities of the Umbilical Cord

A complete fetal ultrasonographic (US) study includes assessment of the umbilical cord for possible abnormalities. Knowledge of the normal appearance of the umbilical cord is necessary for the radiologist to correctly diagnose pathologic conditions. Umbilical cord abnormalities can be related to cord coiling, length, and thickness; the placental insertion site; in utero distortion; vascular abnormalities; and primary tumors or masses. These conditions may be associated with other fetal anomalies and aneuploidies, and their discovery should prompt a thorough fetal US examination. Further workup and planning for a safe fetal delivery may include fetal echocardiography and karyotype analysis. Doppler US is a critical tool for assessment and diagnosis of vascular cord abnormalities. US also can be used for follow-up serial imaging evaluation of conditions that could result in fetal demise. Recent studies suggest that three- or four-dimensional Doppler US of the fetal umbilical cord and abdominal vasculature allows more accurate diagnosis of vascular abnormalities. Doppler US also is invaluable in assessment of fetal growth restriction since hemodynamic changes in the placenta or fetus would appear as a spectral pattern of increased resistance to forward flow in the fetal umbilical artery. Early detection of umbilical cord abnormalities and close follow-up can reduce the risk of morbidity and mortality and assist in decision making.

Prenatal Diagnosis of 4p and 4q Subtelomeric Microdeletion in De Novo Ring Chromosome 4

Ring chromosomes are unusual abnormalities that are observed in prenatal diagnosis. A 23-year-old patient (gravida 1, para 0) referred for amniocentesis due to abnormal maternal serum screening result in the 16th week of second pregnancy. Cytogenetic analysis of cultured amniyotic fluid cells revealed out ring chromosome 4. Both maternal and paternal karyotypes were normal. Terminal deletion was observed in both 4p and 4q arms of ring chromosome 4 by fluorescence in situ hybridization (FISH). However deletion was not observed in the WHS critical region of both normal and ring chromosome 4 by an additional FISH study. These results were confirmed by means of array-CGH showing terminal deletions on 4p16.3 (130 kb) and 4q35.2 (2.449 Mb). In the 21th week of pregnancy, no gross anomalia, except two weeks symmetric growth retardation, was present in the fetal ultrasonographic examination. According to our review of literature, this is the first prenatal case with 4p and 4q subtelomeric deletion of ring chromosome 4 without the involvement of WHS critical region. Our report describes the prenatal case with a ring chromosome 4 abnormality completely characterized by array-CGH which provided complementary data for genetic counseling of prenatal diagnosis.

Prenatal diagnosis of partial trisomy 3q resulting from t(3;14) in a fetus with multiple anomalies including vermian hypoplasia

While genetic origin of Dandy–Walker complex has not yet fully elucidated, the complex has been known to be associated with structural and chromosomal abnormalities. A partial trisomy 3q was also identified in patients with DWC.3q duplication syndrome is defined as duplications of large parts of 3q, especially 3q21-qter. Most cases with 3q duplication are diagnosed postnatally and the patients show typical features including various facial dysmorphisms, congenital heart defects, genitourinary malformations, and mental and growth retardation.Here we report a 28year old nulliparous woman who was referred from the infertility clinic at 21 gestational weeks. Fetal ultrasonographic examination showed various abnormal findings including a ventricular septal defect, hydrocephalus, and hypoplasia of the cerebellar vermis. Fetal chromosome analysis was initially reported as 46,XY,der(14)(?::p11.2→qter). Array CGH followed by FISH allowed precise characterization of the der(14) chromosome and the initial karyotype of the fetus had been changed to 46,XY,add(14)(p11).ish der(14)t(3;14)(q26.1;p11)(tel3q+).arr 3q26.1q29(166249469–199288361)x3.Though further studies are required, gene clusters rather than a single gene might be responsible for the clinical features of the Dandy–Walker complex.

Does normal fetal brain ultrasound predict normal neurodevelopmental outcome in congenital cytomegalovirus infection?

We evaluated the neuropsychological outcome of children with proven congenital cytomegalovirus (CMV) infection and normal consecutive fetal neurosonographic examinations. We retrospectively reviewed laboratory and imaging findings of children with congenital CMV infection. The study group consisted of children with a positive polymerase chain reaction (PCR) in amniotic fluid and virus isolation in urine in the first week of life, and normal fetal ultrasonographic (US) examination findings, including a normal multiplanar neurosonographic evaluation. Patients with abnormal magnetic resonance (MR) findings were not excluded. The study and control groups were evaluated for cognitive, language, and motor development at one follow-up examination conducted at 11-81 months of age. Children with congenital CMV infection and normal fetal brain findings in the US examination did not differ from the control group in terms of cognitive, language, motor, emotional-behavioral, and executive functioning. There were no differences between congenitally infected children who had a normal fetal brain MR examination and children whose fetal brain MR examination raised suspicion of a possible brain insult. Normal neurosonographic examinations during pregnancy appear to predict a normal early neuropsychological outcome in fetuses with congenital CMV infection. Outcome did not correlate with suspected abnormal white matter on fetal MR imaging.

P03.03: A case of isolated congenital ductus arteriosus aneurysm detected by fetal heart sonography at 38 weeks of gestation

Objective: To emphasize the importance of fetal heart sonography in the third trimester by presenting a case of congenital ductus arteriosus aneurysm (DAA) diagnosed by antenatal sonography at 38 weeks of gestation even though level II sonography showed no abnormality in the midtrimester Case: A 30 year-old Korean woman (G1P0), who had normal findings from level II sonography checked at the 23 weeks of gestation, underwent fetal ultrasonographic examination at 38 weeks of gestation. The three-vessel view of heart showed a fusiform dilatation of ductus arteriosus (DA). And the sagital view of ductal arch demonstrated a dilated DA at the distal end. Its diameter was 12 mm. Using color Doppler and pulsed Doppler in DAA, turbulent flow was detected but flow velocity was normal. Any other intracardiac abnormality was not found in subsequent fetal echocardiography. The active male baby was born by spontaneous vaginal delivery at 40 weeks of gestation, weighing 3300 grams. DAA was confirmed by postnatal echocardiography in 24 hours after birth. But, functional closure of the DAA was detected by color Doppler at that time. Finally, the DAA was closed spontaneously without any intervention throughout neonatal period. Conclusion: Congenital DAA is usually developed in the third trimester. The majority of DAA cases shows uncomplicated closure, but it is potentially fatal due to the possible complications such as spontaneous rupture, dissection, and thromboembolism. So, the necessity of fetal heart sonography in the third trimester is considered.

Mother-to-daughter occurrence of biliary atresia: a case report

We herein report a case of mother-to-daughter occurrence of biliary atresia (BA). The mother underwent a Kasai hepatic portoenterostomy at the age of 64 days with a diagnosis of type III BA. Her postoperative course was uneventful, with a good bile discharge, and she became pregnant at the age of 20 years. At 21 weeks of gestational age, fetal ultrasonographic examination of the baby revealed a cystic mass at the hepatic hilum. The baby was born via vaginal delivery at 41 weeks of gestation with a birth weight of 3269 g. Because of an increasing direct bilirubin level and the absence of bile excretion, a laparotomy was performed at the age of 29 days. Intraoperative cholangiography revealed the diagnosis of BA I-cyst, and a hepaticojejunostomy was performed with a good bile discharge. To our knowledge, these patients are the first occurrence of BA in a transmission pattern of mother to daughter.

Associated malformations in patients with anorectal anomalies

Patients with congenital anorectal malformations (ARM) often have other associated congenital defects. The reported incidence and the types of associated malformations vary between different studies. The purpose of this investigation was to assess the prevalences at birth of associated malformations in patients of a geographically defined population with ARM which were collected between 1979 and 2003 in 334, 262 consecutive births. Of the 174 patients with ARM during the study period, 49.4% had associated malformations. Patients with associated malformations were further classified into groups with nonsyndromic multiple congenital anomalies; chromosomal abnormalities; nonchromosomal syndromes including Townes–Brocks, Walker–Warburg, Ivemark, Fetal alcohol, Klippel–Feil, Pallister–Hall, Facio-auriculo-vertebral spectrum, deletion 22q11.2; sequences, including OEIS, Pierre Robin and sirenomelia; and associations including VATER and MURCS. Malformations of the urogenital system (81.1%) and of the skeletal system (45.5%) were the most common other congenital anomalies occurring with ARM in multiply malformed patients without recognized entities, followed by malformations of the cardiovascular system, the digestive system, and the central nervous system. Weight, length, and head circumference of children with ARM and multiple associated malformations were lower than in controls, as was the weight of the placenta. Prenatal detection by fetal ultrasonographic examination was rarely made in isolated ARM. However, even in multiple associated malformations, prenatal detection by fetal ultrasonographic examination had a low sensitivity, 36%. In conclusion the overall prevalence of malformations, which was close to 1 in two infants, emphasizes the need for a thorough investigation of patients with ARM. A routine screening for other malformations may be considered in patients with ARM, and genetic counseling seems warranted in most of these complicated cases.

Prenatal Detection of Congenital Renal Malformations by Fetal Ultrasonographic Examination: An Analysis of 709,030 Births in 12 European Countries

The study was performed to evaluate the prevalence of prenatal ultrasound diagnoses for renal anomalies in 20 registries of 12 European countries, and to compare the different prenatal scanning policies. Standardized data were acquired from 709,030 livebirths, stillbirths, and induced abortions during the study period of 2.5 years and transmitted for central analysis. At least one renal malformation was diagnosed in 1130 infants and fetuses. Prenatal diagnosis (PD) was given in 81.8% of all cases, 29% of these pregnancies were terminated. The highest detection rate was reported for unilateral multicystic dysplastic kidneys with 97% (102/105). An early diagnosis was documented for exstrophy of bladder at a mean gestational age of 18.5 weeks. Dilatations of the upper urinary tract were seen late in pregnancy at 28.3 weeks. Terminations of pregnancies (TOP) were performed in 67% (58/86) of the detected bilateral renal agenesis/dysgenesis, but only 4% of the unilateral multicystic dysplastic renal malformations (4/102). In about 1/3 of the cases, renal malformations are within the category of associated malformations, which include multiple non-syndromal malformations, chromosomal aberrations, and non-chromosomal syndromes. Renal malformations were detected in 2/3 of the associated category by the first prenatal ultrasound scan. Detection rates vary in the different countries of the European community due to diverse policies, ethical, and religious background. Countries with no routine ultrasound show the lowest rates in detection, and termination of pregnancy. Prenatally detected renal malformations should result in a careful examination for further anomalies. Prenatal ultrasound fulfills the needs of screening examinations and is a good tool in detecting lethal and severe renal malformations.

Polysyndactyly, complex heart malformations cardiopathy, and hepatic ductal plate anomalies: an autosomal recessive syndrome diagnosed antenatally.

A distinct syndrome was ascertained in a 3-year-old girl and her brother. The proband was the first child of first cousin parents. She was born after an uneventful pregnancy. At birth, multiple congenital anomalies were noted: ptosis of the left eyelid, hypertelorism, anteverted nares, large fontanel, long philtrum, ungueal hypoplasia, polysyndactyly, single transverse crease, complex cardiopathy, and hepatic cysts. During another pregnancy of the mother, fetal ultrasonographic examination showed an hypertrophy of the right ventricle and atria, a dextroposition of the aorta, a bilateral renal pelvis dilatation, and a club foot. After termination of the pregnancy, necropsy showed facial anomalies, a small penis, a polysyndactyly, a ventricular septum defect, and a malformation of the ductal plate. Bonneau et al. [1983: J Genet Hum 2:93-105] described a family in which three sibs had a complex cardiac malformation, hexadactyly of the first toe, and syndactyly of the third and fourth fingers. Rajab [1997: Clin Dysmorphol 6:85-88] described two sibs with similar features in an Omani family. The sibs described in this report had anomalies of the ductal plate which were not reported in the two other families. These new findings are in favor of autosomal inheritance of this condition which is amenable to antenatal diagnosis.

Evaluation and evolution during time of prenatal diagnosis of congenital heart diseases by routine fetal ultrasonographic examination

The objectives of this study were to evaluate routine prenatal diagnosis of congenital heart diseases (CHD) by fetal ultrasound examination in a well-defined population during the period 1994–1999 and to compare these results with the results from 1979 to 1993. This study included 80 076 consecutive pregnancies of known ouome from 1994 to 1999. CHD were classified as isolated or associated when at least one other major extra-cardiac malformation was present. Only 137 out of 688 malformed fetuses with CHD without chromosomal anomalies were detected (19.9%). The sensitivity of detection varied from 61.9% for malformations such as isolated hypoplastic left heart and single ventricle, to around 7–19% for atrial and ventricular septal defects. Prenatal detection rate of CHD was 11.4% for isolated cases, and 40.2% for multiple malformed with CHD. The gestational age at discovery varied from 16 to 36 weeks. There is no upper limit for termination of pregnancies in our country; 12.3% of all pregnancies were terminated after prenatal diagnosis. However, 62% of the pregnancies with a CHD detected prenatally were terminated. The detection rate of CHD increased during time from 9.2% during the period 1979–1988 to 13.7% during the period 1990–1993 and to 19.1% during the period 1994–1999. Our study shows large variation in the prenatal detection rate of CHD. Prenatal diagnosis of CHD is significantly higher when associated malformations are present. Cardiac defects affecting the size of the ventricles have the highest detection rate. Gestational age at discovery was 20–24 weeks for the majority of associated cardiac defects. The prenatal detection rate of CHD increased during time from 1979 to 1999.

Contribution of ultrasonographic examination to the prenatal detection of chromosomal abnormalities in 19 centres across Europe

The objective of this study was to evaluate the prenatal detection of chromosomal abnormalities by fetal ultrasonographic examination in a large database provided by 19 Registries of Congenital Anomalies from 11 European countries. This study included 1738 cases of chromosomal abnormalities, liveborn, stillborn or termination of pregnancy regardless of maternal age from a population of 664,340 births during the period 1996 – 1998. The most frequent chromosomal anomalies were Down syndrome (n=1050), trisomy 18 (n=191), Turner syndrome (n=125), trisomy 13 (n=86), and triploidy (n=56). Fetal ultrasonographic examination resulted in the prenatal detection of 37.7% of the chromosomal abnormalities, thereby resulting in a reduction of 28.6% in their prevalence at birth due to terminations of pregnancy. The detection rate by ultrasound examination varied according to local policies of prenatal diagnosis : it was lower in countries where routine scan were not performed and higher in countries in which at least one routine anomaly scan during the second trimester of pregnancy was performed. The ultrasound detection varied according to the specific chromosomal anomaly and was lowest for Klinefelter syndrome (5.7%) and highest for triploidy (78.6%). For Down syndrome it was 26.4%. Termination of pregnancy was performed in 75.9% of the cases. Among the 655 cases detected by ultrasound, the most frequent ultrasound signs by category of chromosomal abnormalities were analysed. This study shows that ultrasound screening is an important tool in the prenatal detection of chromosomal abnormalities in Europe, leading to a significant reduction in the prevalence of livebirth children with chromosomal anomalies.

Evaluation of prenatal diagnosis of associated congenital heart diseases by fetal ultrasonographic examination in Europe.

Ultrasound scans in the mid trimester of pregnancy are now a routine part of antenatal care in most European countries. With the assistance of Registries of Congenital Anomalies a study was undertaken in Europe. The objective of the study was to evaluate prenatal detection of congenital heart defects (CHD) by routine ultrasonographic examination of the fetus. All congenital malformations suspected prenatally and all congenital malformations, including chromosome anomalies, confirmed at birth were identified from the Congenital Malformation Registers, including 20 registers from the following European countries: Austria, Croatia, Denmark, France, Germany, Italy, Lithuania, Spain, Switzerland, The Netherlands, UK and Ukrainia. These registries follow the same methodology. The study period was 1996-1998, 709 030 births were covered, and 8126 cases with congenital malformations were registered. If more than one cardiac malformation was present the case was coded as complex cardiac malformation. CHD were subdivided into 'isolated' when only a cardiac malformation was present and 'associated' when at least one other major extra cardiac malformation was present. The associated CHD were subdivided into chromosomal, syndromic non-chromosomal and multiple. The study comprised 761 associated CHD including 282 cases with multiple malformations, 375 cases with chromosomal anomalies and 104 cases with non-chromosomal syndromes. The proportion of prenatal diagnosis of associated CHD varied in relation to the ultrasound screening policies from 17.9% in countries without routine screening (The Netherlands and Denmark) to 46.0% in countries with only one routine fetal scan and 55.6% in countries with two or three routine fetal scans. The prenatal detection rate of chromosomal anomalies was 40.3% (151/375 cases). This rate for recognized syndromes and multiply malformed with CHD was 51.9% (54/104 cases) and 48.6% (137/282 cases), respectively; 150/229 Down syndrome (65.8%) were livebirths. Concerning the syndromic cases, the detection rate of deletion 22q11, situs anomalies and VATER association was 44.4%, 64.7% and 46.6%, respectively. In conclusion, the present study shows large regional variations in the prenatal detection rate of CHD with the highest rates in European regions with three screening scans. Prenatal diagnosis of CHD is significantly higher if associated malformations are present. Cardiac defects affecting the size of the ventricles have the highest detection rate. Mean gestational age at discovery was 20-24 weeks for the majority of associated cardiac defects.

Detection of Congenital Anomalies by Fetal Ultrasonographic Examination across Europe

Objectives: Birth defects are a major health burden. Primary prevention is at present emerging, i.e. folate supplementation. When it is not possible, as is still the case for most birth defects, research is needed to determine how an optimal provision of prenatal diagnosis and use of services can be achieved. Ultrasound scans in the midtrimester of pregnancy are now a routine part of antenatal care in most European countries. The objective of this study was to evaluate the prenatal diagnosis of congenital anomalies by fetal ultrasonographic examination across Europe. Methods: Data from 20 registries of congenital malformations in 12 European countries were included. The prenatal ultrasound screening programs in the countries ranged from no routine screening to 3 fetal scans offered, including 2 for biometric purposes and 1 for search of congenital anomalies, the anomaly scan. Results: There were 8,126 cases with congenital anomalies with an overall prenatal detection rate of 44.3%. Termination of pregnancy was performed in 1,657 cases (21.8%). There was significant variation in the prenatal detection rate between regions with the lowest detection rate in registries of countries without routine fetal screening (Denmark and The Netherlands) and the highest detection rate in registries of countries with at least 1 anomaly scan (France, Germany, Italy, Spain, UK). However, there were large variations among the registries with a high detection rate. There were significant differences in the prenatal detection rate and proportion of induced abortions between isolated anomalies and associated anomalies (chromosomal aberrations, recognized syndromes, and multiple without chromosomal aberrations or recognized syndromes). Conclusions: Prenatal detection rate of congenital anomalies by fetal scan varies significantly between registries of European countries even with the same screening policy. Prenatal detection of congenital anomalies is significantly higher when associated malformations are present. The rate of induced abortions varies between registries of countries even with the same detection rate of congenital anomalies. The variation described may be due to cultural and policy differences.

Sex-related differences in the development of the human fetal corpus callosum:in utero ultrasonographic study

A cross-sectional study of pregnant women presenting for routine fetal ultrasonographic examination was conducted at the Obstetric Ultrasonographic Unit of the Chaim Sheba Medical Center to investigate in utero development of the fetal corpus callosum (CC) in relation to fetal gender. A total of 255 consecutive healthy fetuses of low-risk pregnancies between 16 and 36 weeks' gestation were examined. Thickness and width of the anterior mid-body of the CC were measured in the mid-coronal plane, and length was measured in the mid-sagittal plane. Fetal gender was determined by an independent observer. Female fetuses had statistically significantly thicker CC than males for each gestational age. The mean +/- standard deviation (SD) CC thickness in females was 2.13 +/- 0.8 mm [95% confidence interval (CI) 1.98-2.28] while the mean +/- SD CC thickness in males was 1.8 +/- 0.5 mm (95% CI 1.70-1.89; p < 0.01). The length and width of the CC during gestation did not differ significantly between the sexes. Corpus callosum size as a function of gestational age (GA) in both sexes was expressed by linear regression equations. The correlation coefficients r = 0.93, r = 0.61 and r = 0.62 for length, width and thickness, respectively, in males and r = 0.92, r = 0.71 and r = 0.72 in females were found to be statistically significant (p < 0.01). The present data suggest that female fetuses have a thicker CC than males. These findings support previous studies suggesting sex dimorphism of human CC and raise the possibility that prenatal sex hormones may play a role in determining callosal development.

Fetal cardiovascular function during prolonged magnesium sulfate tocolysis.

The purpose of this study was to evaluate the fetal cardiovascular function during prolonged magnesium sulfate tocolysis. We performed a fetal ultrasonographic examination in 15 patients (Mg group) during magnesium sulfate tocolysis for the treatment of preterm labor. The maternal serum magnesium concentration was 5.7 +/- 0.5 mg/dl at the time of the examination. Sixteen fetuses in normal pregnancies at similar gestational ages were used as the control group. The fetal heart rate and the middle cerebral artery pulsatility index in the Mg group were lower than in the control group (p < 0.01). Fractional shortening (FS) of the right ventricle in the Mg group was lower (p < 0.01), while FS of the left ventricle was higher (p < 0.01) than in the controls. The calculated blood flow through the tricuspid orifice in the Mg group was lower than in the control group (p < 0.01). In contrast, the blood flow through the mitral orifice in the Mg group was higher than in the control group (p < 0.01). In conclusion, in spite of the fact that the right ventricular function is depressed, the fetus maintains its cardiac output during prolonged hypermagnesemia by increasing its left ventricular function. These results indicate the different fetal intracardiac and peripheral circulation, especially in the brain, from normal fetuses.

Associated malformations in cases with oral clefts.

Infants with oral clefts (OCs) often have other associated congenital defects. The reported incidence and the types of associated malformations vary between different studies. The purpose of this investigation was to assess the prevalence of associated malformations in a geographically defined population. The prevalences at birth of associated malformations in infants with OCs were collected between 1979 and 1996 on all infants born in the area covered by the registry of congenital anomalies of Northeastern France in 238,942 consecutive births. Of the 460 cleft infants born during this period, 36.7% had associated malformations. Associated malformations were more frequent in infants who had cleft palate (46.7%) than in infants with cleft lip and palate (36.8%) or infants with isolated cleft lip (13.6%). Malformations in the central nervous system and in the skeletal system were the most common other anomalies, followed by malformations in the urogenital and cardiovascular systems. Weight, length, and head circumference of children with OCs and multiple associated malformations were lower than in controls, as was the weight of the placenta. Prenatal diagnosis was rarely done by fetal ultrasonographic examination in isolated clefts. However, even in multiple associated malformations, prenatal diagnosis by fetal ultrasonographic examination had a low sensitivity, 31.6%. The overall prevalence of malformations, which was one in more than three infants, emphasizes the need for a thorough investigation of infants with clefts. A routine screening for other malformations especially skeletal, central nervous system, and cardiac defects may need to be considered in infants with clefts, and genetic counseling seems warranted in most of these complicated cases.