Prenatal Ultrasonographic Examination Research Articles

A skeletal dysplasia leading to a perinatal death in 17th–19th century Lisbon, Portugal

AbstractCongenital skeletal disorders are a heterogeneous group of anomalies that become evident during gestation. They are expressed in the shape and growth of the bones during development because of a defective genetic background. With the follow‐up of pregnant women and the advances in prenatal ultrasonographic examination and molecular genetic tests, nowadays, congenital skeletal disorders are identified at an early gestational age. If they are considered lethal, the termination of pregnancy is advised. This work unveils an exceptional instance of a rare pathological condition identified in a perinate (birth ± 2 weeks) from the 17th to 19th centuries, recovered during an excavation at the cloister of the São Domingos Convent in Lisbon, Portugal. The skeleton presents with exuberant modifications that include, among others, severe shortening (micromelia) and bowing of the long bones of the upper and lower limbs. The main skeletal findings indicated a presumptive general diagnosis of skeletal dysplasia, while the differential diagnosis includes hypophosphatasia, campomelic dysplasia, achondrogenesis, thanatophoric dysplasia, and severe achondroplasia with developmental delay and acanthosis nigricans (SADDAN) as the most plausible causes for the observed skeletal changes. Even though an exact diagnosis is unattainable based only on the macroscopic analysis of the bones, the phenotypic features observed in this perinate are more consistent with thanatophoric dysplasia type 1.

Ultrasonographic Imaging of the Fetal Duodenal Tract.

To investigate whether fetal duodenal tract sections can be visualized in the prenatal ultrasonographic examination. This study was designed in cross-section. Healthy singleton pregnant women who applied to the perinatology outpatient clinic for second-level ultrasound scanning between September 2020 and February 2021 were included in the study. Demographic information of the participants was obtained and an ultrasound scan was performed. The fetal duodenal tract was evaluated in three sections, including the pylorus. The fetal duodenal tract was differentiated from adjacent organs by its anatomical location, hyperechoic nature, and presence of fluid in the lumen. A total of 278 eligible participants between 18 and 22 weeks of gestation were evaluated. While the fetal pylorus was closed in 76.6% of the participants, it was open in 23.4%. Duodenum pars superior, pars descendens, and pars inferior imaging rates were 99.3%, 98.2%, and 95.7%, respectively. It was possible to distinguish these parts from neighboring organs by 99.6%, 100%, and 100%, respectively. While the first, second, and third parts of the duodenum were observed as solid in 42.0%, 58.2%, and 52.2%, respectively, 57.9%, 41.7%, and 47.7% had fluid in the lumen. The fetal duodenal tract can be viewed with prenatal ultrasonography in pregnant women who are not in a dorsoanterior position. This may make an additional contribution to the diagnosis of duodenal obstructions, which is the most common cause of intestinal atresia in prenatal screening.

Placental thickness in 2D prenatal ultrasonographic examination.

The placental thickness (PTh) is an ultrasonographic measurement commonly used to assess the placenta. The study aimed to determine selected factors influencing PTh in 2D prenatal ultrasonographic examination. It might have a special value in difficult cases for interpretation when PTh is above or below the reference values. In this retrospective study, we analysed the results of foetal ECHO examination of 2833 foetuses performed between June 2016 and December 2019 in our single unit. 596 healthy foetuses older than 12 weeks of gestation from singleton pregnancies were enrolled in the study. The following parameters were used in the further analysis: placental implantation site, gestational age according to the last menstrual period (LMP) and foetal biometry (FB); maternal weight, height, and body mass index (BMI) at the time of examination; and PTh. PTh was affected by its location: posterior 33 mm vs. anterior 30 mm (p < 0.001). Moreover, its thickness significantly correlated with gestational age according to FB (r = 0.386, p < 0.001), LMP (r = 0.369, p < 0.001), maternal weight (r = 0.192, p < 0.001), height (r = 0.125, p = 0.002), and BMI (r = 0.147, p < 0.001), but not with maternal age (r = 0.050, p = 0.219). A linear regression model based on these data explained the 16.38% variability of the tested subjects (p < 0.001). Our observations suggest that maternal weight correlated more strongly with PTh than maternal BMI. For PTh evaluation, it is important to pay attention to the placental implantation site - the posterior placenta was thicker than the anterior placenta. Moreover, PTh variability remains largely unknown; therefore, further research in this field is needed.

Optic nerve sonography and ophthalmic artery Doppler velocimetry in healthy pregnant women: an Australian cohort study.

Maternal ocular sonography offers a window into cerebrovascular and intracranial pressure changes in pregnancy. This study aimed to determine the Doppler velocimetric variables of the ophthalmic artery, and the mean diameter of the optic nerve sheath (ONSD), in an Australian cohort of healthy pregnant women. A prospective observational cohort study of healthy women with uncomplicated singleton pregnancies in the third trimester was undertaken in a tertiary maternity service. A single prenatal ultrasonographic examination was performed on all participants, with a postnatal examination performed on a subgroup with uncomplicated deliveries. Fifty women were examined at a mean gestation of 35 weeks. The mean ± SD Doppler variables in the ophthalmic artery were peak systolic velocity (PSV) 41.89 ± 13.13 cm/s, second peak velocity 20.63 ± 8.97 cm/s, end diastolic velocity 9.29 ± 5.13 cm/s, pulsatility index 1.97 ± 0.53, resistive index 0.78 ± 0.07, peak ratio (second peak velocity/PSV) 0.49 ± 0.12, while the mean ONSD was 4.34 ± 0.4 mm. None of these variables had a demonstrable relationship with gestation or mean arterial pressure (MAP), nor did the sheath diameter have a relationship with any of the Doppler variables. The ocular sonographic variables observed in this population are similar to those reported in other cohorts. No clear relationship could be identified in this cohort between ophthalmic artery Doppler variables and the ONSD, and between each of these variables and gestation or MAP.

Premaxillary-maxillary suture development in the first trimester : An ultrasound study.

Our study was designed to investigate premaxillary-maxillary suture growth in fetuses from the first trimester of pregnancy using the B‑ultrasound technique in order to determine the suture fusion time. We selected 169 healthy Han singleton pregnancies as subjects. All subjects received routine pregnancy tests and were divided into three groups based on the gestational age of the fetus: group1, the 11th gestational week; group2, the 12th gestational week; and group3, the 13th gestational week. Fetal biometric measurements were recorded during consecutive prenatal ultrasonographic examinations. These measurements included nuchal translucency thickness, crown-rump length, and premaxillary-maxillary length. Intergroup comparisons were performed using analysis of variance (ANOVA). The premaxillary-maxillary suture grows gradually and its measured length at the 11th, 12th and 13th week was 0.54 cm, 0.65 cm, and 0.74 cm, respectively. We observed asignificant linear correlation between the premaxillary-maxillary length and the week of gestation in the first trimester. The growth rate of the maxilla at the 11th, the 12th and the 13th week are significantly different with adescending order of growth rates being week12, week11 and week13, with the 12th week rate being the most rapid. The premaxillary and maxillary growth at 11 and 12 gestational weeks in the first trimester steadily accelerated, peaking at the 12th week. The rate of growth slows down after week 12 which may be associated with the fusion of the premaxillary-maxillary suture.

Association of Prenatal Ultrasonographic Findings With Adverse Neonatal Outcomes Among Pregnant Women With Zika Virus Infection in Brazil

Congenital Zika virus infection causes a spectrum of adverse birth outcomes, including severe birth defects of the central nervous system. The association of prenatal ultrasonographic findings with adverse neonatal outcomes, beyond structural anomalies such as microcephaly, has not been described to date. To determine whether prenatal ultrasonographic examination results are associated with abnormal neonatal outcomes in Zika virus-affected pregnancies. A prospective cohort study conducted at a single regional referral center in Rio de Janeiro, Brazil, from September 1, 2015, to May 31, 2016, among 92 pregnant women diagnosed during pregnancy with Zika virus infection by reverse-transcription polymerase chain reaction, who underwent subsequent prenatal ultrasonographic and neonatal evaluation. Prenatal ultrasonography. The primary outcome measure was composite adverse neonatal outcome (perinatal death, abnormal finding on neonatal examination, or abnormal finding on postnatal neuroimaging). Secondary outcomes include association of specific findings with neonatal outcomes. Of 92 mother-neonate dyads (mean [SD] maternal age, 29.4 [6.3] years), 55 (60%) had normal results and 37 (40%) had abnormal results on prenatal ultrasonographic examinations. The median gestational age at delivery was 38.6 weeks (interquartile range, 37.9-39.3). Of the 45 neonates with composite adverse outcome, 23 (51%) had normal results on prenatal ultrasonography. Eleven pregnant women (12%) had a Zika virus-associated finding that was associated with an abnormal result on neonatal examination (adjusted odds ratio [aOR], 11.6; 95% CI, 1.8-72.8), abnormal result on postnatal neuroimaging (aOR, 6.7; 95% CI, 1.1-38.9), and composite adverse neonatal outcome (aOR, 27.2; 95% CI, 2.5-296.6). Abnormal results on middle cerebral artery Doppler ultrasonography were associated with neonatal examination abnormalities (aOR, 12.8; 95% CI, 2.6-63.2), postnatal neuroimaging abnormalities (aOR, 8.8; 95% CI, 1.7-45.9), and composite adverse neonatal outcome (aOR, 20.5; 95% CI, 3.2-132.6). There were 2 perinatal deaths. Abnormal findings on prenatal ultrasonography had a sensitivity of 48.9% (95% CI, 33.7%-64.2%) and a specificity of 68.1% (95% CI, 52.9%-80.1%) for association with composite adverse neonatal outcomes. For a Zika virus-associated abnormal result on prenatal ultrasonography, the sensitivity was lower (22.2%; 95% CI, 11.2%-37.1%) but the specificity was higher (97.9%; 95% CI, 88.7%-99.9%). Abnormal results on prenatal ultrasonography were associated with adverse outcomes in congenital Zika infection. The absence of abnormal findings on prenatal ultrasonography was not associated with a normal neonatal outcome. Comprehensive evaluation is recommended for all neonates with prenatal Zika virus exposure.

A case of body stalk anomaly: the value of adding fetal magnetic resonance imaging to ultrasonography for perinatal management

Body stalk anomaly (BSA) is a rare congenital anomaly with an abdominal wall defect and is associated limb and spine abnormalities. As BSA is invariably fatal, it is very important to differentiate BSA from potentially treatable abdominal wall defects, such as gastroschisis. The authors report a case of BSA that was diagnosed prenatally using MRI. On prenatal ultrasonographic examination at 30 weeks of gestation, severe gastroschisis was suspected. However, subsequent MRI clearly demonstrated characteristic findings of BSA. The fetus was delivered at 32 weeks of gestation. The parents did not consent to aggressive treatment and the fetus died a few minutes after birth. Fetal MRI is a powerful adjunct to ultrasonography; it provides more comprehensive images of BSA, enabling prudent perinatal management.

The diagnosis value and prognosis analysis of systematic ultrasound examination in fetal lung disease

Objective To explore the clinical significance and diagnosis value of ultrasonography for fetal lung disease. Methods A total of 61 cases of fetal lung disease was diagnosed and the data were retrospectively analyzed. Results In the 61 fetus of lung disease, ⑴ there were 31 fetuses with congenital cystic adenomatoid adenomatoid malforamation (CCAM), the ultrasound found that there were mass in fetus lung , they were mixed echo or large cyst or more little cyst or a hyperechoic in the mass. Among them, there were 2 cases of type Ⅰ, 16 cases of type Ⅱ, and 13 cases of type Ⅲ; 21 cases were labored, who were CCAM-confirmed by pathology, 3 fetus masses were disappeared, 7 cases were CCAM-confirmed with magnetic resonance (MR) after birth. ⑵ There were 19 fetuses with pulmonary sequestration (PS), the sonography was slightly hyperechoic mass in the lung, including 7 cases of induced labor and confirmed by pathology as PS, and 4 cases of mass disappeared, 8 cases confirmed by MR or computed tomography (CT) after birth. ⑶ There were 6 cases of congenital diaphragmatic hernia, the abdomnial viscera was seen in the chest, 5 cases were induced labor, and 1 survived after operation. ⑷ There were 5 cases of pleural effusion (PE), 4 cases were induced labor and 1 case of PE disappeared. Conclusions Systemic prenatal ultrasonographic examination is an reliable method which can be short-term follow-up to observe the progress and the outcome, and to provide valuable information for clinical prognosis. Key words: Fetal diseases/US; Lung diseases/US; Prognosis

Spectrum of prenatally detected central nervous system malformations: Neural tube defects continue to be the leading foetal malformation.

Background & objectives:Prenatal diagnosis of malformations is an important method of prevention and control of congenital anomalies with poor prognosis. Central nervous system (CNS) malformations amongst these are the most common. The information about the prevalence and spectrum of prenatally detected malformations is crucial for genetic counselling and policymaking for population-based preventive programmes. The objective of this study was to study the spectrum of prenatally detected CNS malformations and their association with chromosomal abnormalities and autopsy findings.Methods:This retrospective study was conducted in a tertiary care hospital in north India from January 2007 to December 2013. The details of cases with prenatally detected CNS malformations were collected and were related with the foetal chromosomal analysis and autopsy findings.Results:Amongst 6044 prenatal ultrasonographic examinations performed; 768 (12.7%) had structural malformations and 243 (31.6%) had CNS malformations. Neural tube defects (NTDs) accounted for 52.3 per cent of CNS malformations and 16.5 per cent of all malformations. The other major groups of prenatally detected CNS malformations were ventriculomegaly and midline anomalies. Chromosomal abnormalities were detected in 8.2 per cent of the 73 cases studied. Foetal autopsy findings were available for 48 foetuses. Foetal autopsy identified additional findings in eight foetuses and the aetiological diagnosis changed in two of them (4.2%).Interpretation & conclusions:Amongst prenatally detected malformations, CNS malformations were common. NTD, which largely is a preventable anomaly, continued to be the most common group. Moreover, 60 per cent of malformations were diagnosed after 20 weeks, posing legal issues. Chromosomal analysis and foetal autopsy are essential for genetic counselling based on aetiological diagnosis.

First applications of a targeted exome sequencing approach in fetuses with ultrasound abnormalities reveals an important fraction of cases with associated gene defects.

Background. Fetal malformations and other structural abnormalities are relatively frequent findings in the course of routine prenatal ultrasonographic examination. Due to their considerable genetic and clinical heterogeneity, the underlying genetic cause is often elusive and the resulting inability to provide a precise diagnosis precludes proper reproductive and fetal risk assessment. We report the development and first applications of an expanded exome sequencing-based test, coupled to a bioinformatics-driven prioritization algorithm, targeting gene disorders presenting with abnormal prenatal ultrasound findings.Methods. We applied the testing strategy to14 euploid fetuses, from 11 on-going pregnancies and three products of abortion, all with various abnormalities or malformations detected through prenatal ultrasound examination. Whole exome sequencing (WES) was followed by variant prioritization, utilizing a custom analysis pipeline (Fetalis algorithm), targeting 758 genes associated with genetic disorders which may present with abnormal fetal ultrasound findings.Results. A definitive or highly-likely diagnosis was made in 6 of 14 cases (43%), of which 3 were abortuses (Ellis-van Creveld syndrome, Ehlers-Danlos syndrome and Nemaline myopathy 2) and 3 involved on-going pregnancies (Citrullinemia, Noonan syndrome, PROKR2-related Kallmann syndrome). In the remaining eight on-going pregnancy cases (57%), a ZIC1 variant of unknown clinical significance was detected in one case, while in seven cases testing did not reveal any pathogenic variant(s). Pregnancies were followed-up to birth, resulting in one neonate harboring the PROKR2 mutation, presenting with isolated minor structural cardiac abnormalities, and in seven apparently healthy neonates.Discussion. The expanded targeted exome sequencing-based approach described herein (Fetalis), provides strong evidence suggesting a definite and beneficial increase in our diagnostic capabilities in prenatal diagnosis of otherwise chromosomally balanced fetuses with troubling ultrasound abnormalities. Furthermore, the proposed targeted exome sequencing strategy, designed primarily as a diagnostic rather than a research discovery tool, overcomes many of the problems and limitations associated with clinical wide-scale WES testing in a prenatal setting.

Prenatal diagnosis of congenital syphilis presenting with transient pleural effusion in the fetus: a case report and rising incidence of congenital syphilis in South Korea

Congenital syphilis is preventable and curable if maternal infection is detected early, and pregnant women in Korea are screened routinely for this disease. Nevertheless, the incidence of congenital syphilis is not decreasing. Prenatal diagnosis of congenital syphilis is difficult and treatment is usually based on maternal syphilis serology. Prenatal ultrasonographic examination may sometimes reveal abnormal features suggesting congenital infection. The authors report a case of congenital syphilis that was diagnosed in both fetus and asymptomatic mother following detection on prenatal ultrasonography of transient fetal pleural effusion. The case is noteworthy for its sonographic presentation as fetal pleural effusion rapidly resolved spontaneously.

Measurement of fetal maxillary and mandibular angles for first-trimester prenatal screening among Taiwanese women

BackgroundEarly fetal structure evaluation is crucial. Fetal abnormalities might indicate chromosomal anomalies or abnormal fetal growth. The aim of this study was to establish the appropriate reference range of maxillary and mandibular angles among the Taiwanese population at 11+0–13+6 weeks of gestation in normal singleton pregnancy as reference values for prenatal ultrasonographic examinations. MethodsFetal ultrasonographic data on maxillary angles and mandibular angles at a gestational age ranging from 11+0 weeks to 13+6 weeks were recorded in this study. Maternal background and pregnancy outcome were obtained from hospital records. ResultsA total of 87 patients were included in this study. Maxillary and mandibular angles were successfully recorded in 87 (100%) and 84 (96.6%) patients, respectively. The mean maternal age was 31 (range, 19–41) years, with a corresponding gestational age of 12+4 (range, 11+0–13+6) weeks. The maxillary and mandibular angles were 79.9° ± 15.6° and 71.0° ± 12.8°, respectively. First-degree correlation was not found to exist between gestational age and maxillary and mandibular angles. ConclusionNormative data for ultrasonographic measurements of maxillary and mandibular angles among the Taiwanese population are presented. Our results may serve as reference values in congenital anomaly screening during prenatal examination.

Fetal maxillary and mandibular length in normal pregnancies from 11 weeks' to 13+6 weeks' gestation: A Taiwanese study

ObjectivesThis study aims to establish the normal range of maxillary and mandibular lengths within the Taiwanese population at 11+0 weeks to 13+6 weeks of gestation in normal singleton pregnancy as a reference value for prenatal ultrasonographic examinations. Materials and methodsWe examined nuchal translucency in 269 normal singleton pregnancies, with the gestational age ranging from 11 weeks to 13+6 weeks in this study. Fetal biometric measurements, with an emphasis on maxillary and mandibular lengths, were obtained from the patients during consecutive routine prenatal ultrasonographic examinations. ResultsMaxillary and mandibular lengths were recorded successfully in 191 patients and 179 patients, respectively. The mean maternal age was 31 years (range 19–45 years), with a corresponding gestational age of 12 + 4 weeks (range, 11+0–13+6 weeks). A first-degree correlation was found to exist between the gestational age and maxillary length (r = 0.596; p < 0.0001; y = 1.491 × GA − 10.523) as well as mandibular length (r = 0.465; p < 0.0001; y = 1.050 × GA − 6.50). ConclusionNormative data for ultrasonographic measurements of maxillary and mandibular lengths within the Taiwanese population were presented. Our data can serve as a reference value in congenital anomaly screening during prenatal examination.

Unilateral Isolated Proximal Femoral Focal Deficiency

Objective. To discuss a patient with a prenatal diagnosis of unilateral isolated femoral focal deficiency. Case. Antenatal diagnosis of unilateral isolated femoral focal deficiency was made at 20 weeks of gestation. The length of left femur was shorter than the right, and fetal femur length was below the fifth percentile. Proximal femoral focal deficiency was diagnosed. After delivery, the diagnosis was confirmed with skeletal radiographs and magnetic resonance imaging. In prenatal ultrasonographic examination, the early recognition and exclusion of skeletal dysplasias is important; moreover, treatment plans should be initiated, and valuable information should be provided to the family.

Screening of Fetal Heart for the Congenital Heart Diseases

ABSTRACT Screening of the congenital heart disease (CHD) is one of the most important techniques in prenatal ultrasonographic examination. Step by step screening methods for taking account for the level of screener, especially in the area with poor detection rate, is needed for starting effective fetal CHD screening. In this review, the fetal cardiac screening is divided into two methods accounting for steps for learning screening technique; the basic screening and the advanced screening. Basic screening is a simple method even for the one who is not familiar to the cardiac anatomy. The goal of this basic screening is to detect most of the ductal dependent lesions including transposition of the great arteries. For the basic screening, ‘location’ and ‘size’ of the heart and vessels are checked in standard fourchamber view and three-vessel view. Advanced screening is a screening for detecting all fetal CHDs, including total anomalous pulmonary venous return. For the advanced screening, the side of the heart is defined, and then the ‘detail anatomy’ and the ‘function and blood flow’ are assessed in all standard screening views, including one fetal abdominal transverse view and three fetal chest transverse views, such as four-chamber, three-vessel and three-vessel and trachea view.

Antenatal ultrasound and MRI findings of Pena–Shokeir syndrome

Pena-Shokeir syndrome is an autosomal recessive disorder characterized by arthrogryposis, facial anomalies (micrognathia), camptodactyly, polyhydramnios and lung hypoplasia. We report prenatal ultrasonographic, antenatal MR and postnatal examination findings of a fetus with Pena-Shokeir syndrome. Pena-Shokeir syndrome is a potentially lethal condition and most cases are diagnosed prenatally by ultrasound. Fetal MR can be performed to look associated neurological malformation.

A novel L1CAM mutation in a fetus detected by prenatal diagnosis

X-linked hydrocephalus is due to mutations in the L1 neuronal cell adhesion molecule (L1CAM) gene. L1 protein plays a key role in neurite outgrowth, axonal guidance, and pathfinding during the development of the nervous system. We report on a familial case diagnosed by prenatal ultrasonographic examination, with cerebellar hypoplasia, agenesis of the corpus callosum, and the bilateral overlapping of the second and third fingers of the hand. Sequencing of the L1CAM gene showed a novel missense mutation in exon 14: transition of a guanine to cytosine at position 1777 (c.1777G>C), which led to an amino acid change of alanine to proline at position 593 (Ala593Pro) in the sixth immunoglobulin domain of the L1 protein. The L1CAM mutation testing should be considered in fetuses with ultrasonographic signs of hydrocephalus and a positive family history compatible with X-linked inheritance. We agree with previous reports that suggest also considering limb abnormalities other than adducted thumbs in addition to classical neurological disgenesis, as characteristic for L1-disease.

PRENATAL DIAGNOSTIC ACCURACY IN SOUTH CAROLINA DEMONSTRATED BY AUTOPSY

Fully 150 consecutive fetal/neonatal autopsies were reviewed to determine to what extent they confirmed or altered the impressions gained through prenatal ultrasonographic fetal examination. Distinctions were made between features that may or may not be assessable by prenatal ultrasound. Analyses of weights and measures were based on recently published regressions derived from a worldwide review of normative data. Our analysis indicated a high level of correspondence between prenatal ultrasound findings and later observations of independent persons at autopsy (85% positive predictive value and 44% sensitivity). We concluded that skills of maternal-fetal medicine specialists, located at several geographically divergent centers, are confirmed by a high level of correspondence between prenatal ultrasound and autopsy findings. The low sensitivity was due in large part to the relatively subtle nature of many autopsy findings that had not been predicted by prenatal examination.

Uitrasonographic diagnosis of horseshoe kidney of foetus

Objective To explore the horseshoe kidney of prenatal ultrasonography for detecting birth defects.Methods A total of 3260 women during 22～42 gestational weeks underwent real-time color Doppler ultrasongraphy to find out fetal mati kidney.All the cases were tracked within two month after delivery.Results In all 3260 pregnant women,104 cases were diagnosed on ultrasonography of 100%accordance with clinical diagnosis.Conclusions A systemic prenatal ultrasonographic examination in the second-trimester pregnancy is important for prenatal diagnosis of congenital malformations,which play a very significant role in decreasing fetal birth defects and improving new born population quality. Key words: Ultrasonography,prenatal; Horseshoe kidney

Hypertext atlas of fetal and neonatal pathology

Hypertext atlas of fetal and neonatal pathology is a free resource for pregraduate students of medicine, pathologists and other health professionals dealing with prenatal medicine. The atlas can be found at . The access is restricted to registered users. Concise texts summarize the gross and microscopic pathology, etiology, and clinical signs of both common and rare fetal and neonatal conditions. The texts are illustrated with over 300 images that are accompanied by short comments. The atlas offers histological pictures of high quality. Virtual microscope interface is used to access the high-resolution histological images. Fetal ultrasound video clips are included. Case studies integrate clinical history, prenatal ultrasonographic examination, gross pathology and histological features. The atlas is available in English (and Czech) and equipped with an active index. The atlas is suitable both for medical students and pathologists as a teaching and reference tool. The atlas is going to be further expanded while keeping the high quality of the images.