Prenatal Ultrasound Scan Research Articles

Association between rare, genetic variants linked to autism and ultrasonography fetal anomalies in children with autism spectrum disorder

BackgroundRecent evidence suggests that certain fetal anomalies detected upon prenatal ultrasound screenings are associated with autism spectrum disorder (ASD). In this cross-sectional study, we aimed to identify genetic variants associated with fetal ultrasound anomalies (UFAs) in children with ASD.MethodsThe study included all children with ASD who are registered in the database of the Azrieli National Center of Autism and Neurodevelopment and for whom both prenatal ultrasound and whole exome sequencing (WES) data were available. We applied our in-house integrative bioinformatics pipeline, AutScore, to these WES data to prioritize rare, gene-disrupting variants (GDVs) probably contributing to ASD susceptibily. Univariate statistics and multivariable regression were used to assess the associations between UFAs and GDVs identified in these children.ResultsThe study sample comprised 126 children, of whom 43 (34.1%) had at least one UFA detected in the prenatal ultrasound scan. A total of 87 candidate ASD genetic variants were detected in 60 children, with 24 (40%) children carrying multiple variants. Children with UFAs were more likely to have loss-of-function (LoF) mutations (aOR = 2.55, 95%CI: 1.13–5.80). This association was particularly noticeable when children with structural anomalies or children with UFAs in their head and brain scans were compared to children without UFAs (any mutation: aOR = 8.28, 95%CI: 2.29–30.01; LoF: aOR = 5.72, 95%CI: 2.08–15.71 and any mutation: aOR = 6.39, 95%CI: 1.34–30.47; LoF: aOR = 4.50, 95%CI: 1.32–15.35, respectively). GDVs associated with UFAs were enriched in genes highly expressed across all tissues (aOR = 2.76, 95%CI: 1.14–6.68). There was a weak, but significant, correlation between the number of mutations and the number of abnormalities detected in the same children (r = 0.21, P = 0.016).ConclusionsThe results provide valuable insights into the potential genetic basis of prenatal organogenesis abnormalities associated with ASD and shed light on the complex interplay between genetic factors and fetal development.

Aortic isthmus flow reversal in fetal coarctation of the aorta and the associated factors.

The aim of this study was to investigate the presence of aortic isthmus flow reversal and its associated factors in fetuses with positive and false-positive coarctation of the aorta (CoA) compared with normal controls. Pregnant women with fetuses suspected of CoA and normal control were enrolled, and these women experienced prenatal ultrasound scan and followed up for 6 months after birth to confirm the presence of CoA. All the ultrasound parameters were analyzed. A total of 134 pregnant women were enrolled, with 43 CoA-positive fetuses and 91 CoA false-positive fetuses, and 334 matched pregnant women were enrolled in the control group. Aortic isthmus flow reversal occurred in 28 (65.1%) fetuses in the CoA-positive group, significantly (p < 0.05) more than in the false-positive (37 or 40.7%) or control group (64 or 19.2%). Aortic isthmus flow reversal was mostly in the full systole (n = 17 or 60.7%) or late systole and early-middle diastole (n = 10 or 35.7%) in the CoA-positive fetuses (n = 27 or 96.4%), significantly (p < 0.001) different from that in the false-positive or control group. The aortic isthmus flow reversal peak systolic velocity (PSV), flow volume, and ratio of reversed flow/forward flow were significantly (p < 0.05) increased in the CoA-positive and false-positive groups than in the control group. The aortic isthmus flow reversal incidence was significantly (p < 0.05) correlated with the middle cerebral artery (MCA) PSV in the total three groups or in the false-positive group but was significantly (p < 0001) negatively correlated with the MCA resistance index (RI) in the CoA-positive group. The incidence of the aortic isthmus flow reversal was significantly (p < 0.05) positively correlated with the umbilical artery (UA) RI in the false-positive group and with the UA RI in the total three groups. Independently associated factors for aortic isthmus flow reversal were isthmic flow volume/CCO (combined cardiac output) in the CoA-positive group. Reversal of flow in the aortic isthmus is much more common in true-positive cases of CoA as compared to controls, and isthmic flow reversal in the full systolic phase only suggests presence of CoA. The aortic isthmic reversed flow volume accounts for over half of the isthmic forward flow volume in the CoA-positive fetuses than in the normal controls.

Genetic analysis of a Chinese pedigree affected with Branchio-oculo-facial syndrome and a literature review

To explore the genetic etiology of a Chinese pedigree affected with Branchio-oculo-facial syndrome (BOFS) and summarize the prenatal phenotype of BOFS patients. A pedigree with BOFS which had presented at the Genetics and Prenatal Diagnosis Center of the First Affiliated Hospital of Zhengzhou University in December 2021 was selected as the study subject. Clinical data of the pedigree was collected. The fetus was subjected to routine prenatal ultrasound scan. Trio-whole exome sequencing (trio-WES) was carried out for the fetus and its parents, and candidate variant was verified by Sanger sequencing. Relevant literature was searched from the database to summarize the prenatal phenotype of BOFS patients. Ultrasound exam suggested the fetus had cleft lip and palate. Its father had presented with high palatal arch, prematurely grayed hair, occult cleft lip, congenital preauricular fistula, red-green color blindness and unilateral renal agenesis. Its grandfather also had high palatal arch, prematurely gray hair, protruding ears, congenital preauricular fistula and hearing disorders. Trio-WES revealed that the fetus and its father had both harbored a heterozygous c.890-1G>A variant of the TFAP2A gene. The same variant was not found in its mother. Sanger sequencing confirmed that its grandfather had also harbored the same variant. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was rated as likely pathogenic (PVS1+PM2_Supporting). Combined with 36 similar cases retrieved from the literature, the prenatal phenotypes of BOFS patients had included growth restriction (25/37), renal abnormalities (10/37), cleft lip and palate (5/37) and oligohydramnios (5/37). The c.890-1G>A variant of the TFAP2A gene probably underlay the pathogenesis of BOFS in this pedigree. Discovery of the novel variant has enriched the mutational spectrum of the TFAP2A gene. The common prenatal phenotypes of BOFS have included growth restriction, renal abnormalities, cleft lip and palate and oligohydramnios. Delineation of the intrauterine phenotype of BOFS may facilitate its prenatal diagnosis, clinical diagnosis, treatment and genetic counseling.

Implications of right aortic arch prenatal diagnosis: the multicentric nationwide ARCADE cohort

ObjectivesThis study aims to describe the various presentations of the prenatally diagnosed isolated right aortic arch (RAA), that is, without associated congenital heart defect and to evaluate the impact of...

Accuracy and repeatability of fetal facial measurements in 3D ultrasound: A longitudinal study

ObjectiveFetal face measurements in prenatal ultrasound can aid in identifying craniofacial abnormalities in the developing fetus. However, the accuracy and reliability of ultrasound measurements can be affected by factors such as fetal position, image quality, and the sonographer's expertise. This study assesses the accuracy and reliability of fetal facial measurements in prenatal ultrasound. Additionally, the temporal evolution of measurements is studied, comparing prenatal and postnatal measurements. MethodsThree different experts located up to 23 facial landmarks in 49 prenatal 3D ultrasound scans from normal Caucasian fetuses at weeks 20, 26, and 35 of gestation. Intra- and inter-observer variability was obtained. Postnatal facial measurements were also obtained at 15 days and 1 month postpartum. ResultsMost facial landmarks exhibited low errors, with overall intra- and inter-observer errors of 1.01 mm and 1.60 mm, respectively. Landmarks on the nose were found to be the most reliable, while the most challenging ones were those located on the ears and eyes. Overall, scans obtained at 26 weeks of gestation presented the best trade-off between observer variability and landmark visibility. The temporal evolution of the measurements revealed that the lower face area had the highest rate of growth throughout the latest stages of pregnancy. ConclusionsCraniofacial landmarks can be evaluated using 3D fetal ultrasound, especially those located on the nose, mouth, and chin. Despite its limitations, this study provides valuable insights into prenatal and postnatal biometric changes over time, which could aid in developing predictive models for postnatal measurements based on prenatal data.

Preference and Disclosure of Fetal Gender to Pregnant Women during Prenatal Ultrasonography in South South Nigeria.

Ultrasound scan (USS) in pregnancy has become a common diagnostic tool used in the assessment of pregnancy in recent time. In the course of routine pregnancy assessment using USS, some pregnant women will request to know the sex of their unborn babies. Their reasons for wanting to know the gender of their baby could be either for social reason like planning for an unborn child or their desire for a preferred gender. The aim of the study was to evaluate gender preferences and disclosure of foetal sex at prenatal USS. This was a cross-sectional study conducted at the antenatal clinic of Central Hospital Agbor, Delta State, Nigeria. A total of 235 consecutive consenting women who came for antenatal care (ANC) registration were recruited for the study after obtaining their informed written consent. Questionnaire was used to seek for their sociodemographic characteristics, preference and desires for foetal gender disclosure, reasons for gender disclosure, and awareness of USS accuracy for gender determination. The desire to know the sex of baby was high (99.6%). The major reason for wanting to know the sex of baby was to plan for the unborn child (47.7%) and maternal curiosity (37.0%). Majority of the women (57.4%) had no gender preference. Sixty percent (60%) were not aware that USS sex diagnosis could be wrong. There is a strong desire by pregnant women to know the sex of their babies at routine USS. Considering the fact that many of the women were not aware that there could be wrong diagnosis at prenatal ultrasound, it is suggested that adequate counselling be given before fetal sex disclosure.

The routine prenatal ultrasound scan should be more comprehensive.

The routine prenatal ultrasound scan should be more comprehensive.

ABDOMINAL WALL DEFECTS: GASTROSCHISIS, DEFINITION, EPIDEMIOLOGY, PATHOGENESIS, TYPES, DIAGNOSIS AND MANAGEMENT

Introduction: Abdominal wall defects are common congenital anomalies, both gastroschisis and omphalocele conform to fetal developmental anomalies that favor multidisciplinary support before and after birth. Outcomes for newborns with gastroschisis usually depend on the distinctive features of the abdominal wall defect and underlying intestinal viability, whereas omphalocele outcomes are determined by the size of the defect and the presence of other related anomalies. Objective: to detail current information related to the two fetal abdominal wall defects, especially gastroschisis definition, epidemiology, pathogenesis, types, diagnosis and management. Methodology: a total of 48 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 36 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: fetal abdominal wall defects, gastroschisis, prenatal anomalies, surgery and prosthetic silo. Results: The incidence of gastroschisis ranges from 0.4 to 3 per 10,000 births and shows an upward pattern, the incidence of omphalocele ranges from 1.5 to 3 per 10,000 births. About 10% of infants with gastroschisis have intestinal stenosis or atresia because of vascular insufficiency due to volvulus or compression of the vascular pedicle by a narrowing abdominal ring. Periconceptional genitourinary tract infections were significantly associated with gastroschisis (OR, 1.5; 95 % CI, 1.3 to 1.9). Other significant associations presented in various studies with gastroschisis pregnancies include smoking (odds ratio (OR), 2.86; 95 % CI, 2.22-3.66), history of pregestational or gestational diabetes (OR, 2.81; 95 % CI, 1.42-5.5), and use of antidepressant medications (OR, 4.4; 95 % CI, 1.38-11.8). Conclusions: Abdominal wall defects are common congenital anomalies, both gastroschisis and omphalocele represent different embryological outcomes, which depend on accurate prenatal diagnosis and referral to a multidisciplinary fetal center. Gastroschisis is a congenital anomaly of the rudimentary umbilical ring, in which there is herniation of a variable portion of viscera through the defect, with no membrane or covering sac, and its prevalence has been steadily increasing. Gastroschisis is classified into simple and complex types. Prenatal ultrasound scans can diagnose gastroschisis as early as 12 weeks of gestation. Routine preterm delivery or elective cesarean section has not been shown to improve outcome. Surgical management after birth is aimed at reduction of the herniated viscera and closure of the abdominal wall. Survival rates are usually high; however, the prognosis depends on the state of the bowel at birth. Those affected with significant intestinal alteration at birth are at higher risk of premature death or later complications. Future fetal surgery could improve the outlook and management of the condition. KEY WORDS: gastroschisis, abdominal wall defect, congenital.

Prenatal diagnosis of a case with Schuurs-Hoeijmakers syndrome

To explore the genetic basis for a fetus with multiple malformations. Clinical data of the fetus was collected, Amniotic fluid sample of the fetus was subjected to conventional G-banded karyotyping, low-depth whole genome copy number variants detection and whole exome sequencing (WES). Candidate variant was verified by Sanger sequencing of the fetus and its parents. Prenatal ultrasound scan at 21+5 gestational weeks had revealed increased nuchal thickness (9.0 mm), enhanced echos of bilateral renal parenchyma, seroperitoneum, left pleural effusion and right displacement of the heart. The mother had a previous history of terminated pregnancy for multiple fetal anomalies. No abnormality was found by conventional karyotyping and CNV analysis, though WES revealed that the fetus has harbored a de novo heterozygous c.607C>T (p.Arg203Trp) variant of the ACS1 gene (NM_018026.3), and the result was validated by Sanger sequencing. Through WES and prenatal ultrasonography, the fetus was diagnosed with Schuurs-Hoeijmakers syndrome due to the heterozygous c.607C>T (p.Arg203Trp) variant of the PACS1 gene (NM_018026.3). For fetuses with multiple malformations, WES can help to reveal the genetic etiology when CNV result is negative.

Intrauterine death in vasa previa without hemorrhage: case reports

Antepartum and intrapartum hemorrhage from vasa previa (VP) is one of the main causes of intrauterine fetal death (IUFD). Here, we present two cases with type I VP in which velamentous cord insertion below the fetal head and overlying the cervix were reported by prenatal ultrasound scanning, and IUFD occoured after 35 weeks with no signs of prenatal bleeding but with engaged fetal head at presentation. We hypothesized that the IUFD may attributed to the compression of the unprotected umbilical vessels by the engaged fetal head. Thus we suggest that VP with a velamentous cord insertion should be considered for earlier termination of the pregnancy to avoid the risk of non-hemorrhagic adverse fetal outcomes.

Two- and three-dimensional sonographic findings of harlequin ichthyosis: case report and literature review

BackgroundHarlequin ichthyosis (HI) is a rare skin disorder with extremely high lethality due to a mutation of the ABCA12 gene. Because of its rarity and the often-late onset, prenatal screening for HI is extremely difficult, and most pregnant women might easily miss the period for optimal examinations. ObjectiveTo summarize the sonographic features of HI for prenatal diagnostic purposes. MethodsThe authors describe a case of HI with no family history who was diagnosed by using prenatal ultrasound scanning. The sonographic features of HI and the clinical characteristics of pregnant women were summarized by searching relevant literature over nearly two decades. ResultsThe unique sonographic presentations including peeling skin, clenched hands and clubfeet, ectropion, flat nose, fetal growth impairment, polyhydramnios and echogenic amniotic fluid may be primarily related to skin disorders in HI fetuses. The authors also identified a novel pathogenic ABCA12 gene mutation and explained the possible pathogenic mechanisms. Study limitationsCaution should be exercised in summarizing disease characteristics because of the small number of cases, and the authors are faced with the possibility of incomplete case searching. ConclusionsHI has relatively unique sonographic features. Therefore, 2D-ultrasound combined with 3D-ultrasound may be an effective method for the prenatal diagnosis of HI. Moreover, a novel pathogenic ABCA12 gene mutation may provide important clues for future research on the etiology of HI. However, the authors consider that additional studies are needed to provide more evidence for prenatal diagnosis.

Prenatal ultrasound monitoring and diagnostic accuracy rates of fetal congenital heart disease: A meta-analysis.

Congenital heart disease (CHD) is the most common birth defect that is caused by genetic and acquired factors. Accurate prenatal diagnosis of congenital heart disease (CHD) can ensure proper delivery and in-time postpartum management, but the diagnostic rate is not clear. PubMed, CNKI, Web of Science, Wanfang, and VIP databases were searched for publications investigating CHD during prenatal ultrasound scans. Original studies with strict screening and diagnostic criteria were included. Fixed effect model or random effect model was used according to homogeneity statistical test. A total of 859 CHD cases were diagnosed by ultrasound, and 1394 cases were confirmed by induced labor autopsy or at birth. The heterogeneity of the analysis was 100% and the accuracy of CHD diagnosis using prenatal ultrasound was 76% (95%CI: 50.00%-102%). The diagnostic yield of fetal CHD screening using ultrasound alone is still not very high, which lower than the combined diagnostic yield of other studies. This suggests the need to combine other monitoring methods that do not harm fetal development. When economic conditions permit, the diagnosis of CHD can be recommended to use no less than two monitoring methods.

The role of routine first-trimester ultrasound screening for central nervous system abnormalities: a longitudinal single-center study using an unselected cohort with 3-year experience

BackgroundTo evaluate the role of a standardized first-trimester scan in screening different kinds of central nervous system malformations and to report a 3-year experience from a tertiary center using an unselected cohort.MethodsThis was a retrospective analysis of prospectively collected data from a single center evaluating first-trimester scans with predesigned standardized protocols performed between 1 May 2017 and 1 May 2020, involving 39,526 pregnancies. All pregnant women underwent a series of prenatal ultrasound scans at 11–14, 20–24, 28–34 and 34–38 weeks of gestation. Abnormalities were confirmed by magnetic resonance imaging, postmortem examination or trained ultrasound professionals. Pregnancy outcomes and some postnatal follow-up were obtained from maternity medical records and telephone calls.ResultsA total of 38,586 pregnancies included in the study. The detection rates of CNS anomalies by ultrasound in the first, second, third and late third trimester were 32%, 22%, 25%, and 16%, respectively. And there were 5% of CNS anomalies missed by prenatal ultrasound. In the first-trimester scan, we diagnosed all cases of exencephaly, anencephaly, alobar holoprosencephaly and meningoencephalocele, and some cases of posterior cranial fossa anomalies (20%), open spina bifida (67%), semilobar holoprosencephaly (75%) and severe ventriculomegaly (8%). Vein of Galen aneurysmal malformation, closed spina bifida, lobar holoprosencephaly, intracranial infection, arachnoid cyst, agenesis of the corpus callosum, cysts of the septum pellucidum and isolated absence of the septum pellucidum were never detected during the first trimester. The abortion rates of fetal CNS anomalies detected by first-trimester scan, second-trimester scan, and third- trimester scan were 96%, 84% and 14%, respectively.ConclusionsThe study showed that almost 1/3 of central nervous system anomalies were detected by the standard first-trimester scan and these cases were associated with a high rate of abortion. Early screening for fetal abnormalities gives parents more time for medical advice and safer abortion if needed. It is therefore recommended that some major CNS anomalies should be screened in the first trimester. The standardized anatomical protocol, consisting of four fetal brain planes, were recommended for routine first trimester ultrasound screening.

Amniotic band syndrome leading to severe malformations of the newborn: a case report at Tu Du Hospital, Vietnam, and literature review

In the present case report, the authors describe a case of ABS that was diagnosed at the time of delivery at full term. Although the male newborn was alive, the infant underwent the distal deformity of amputated limbs and clubfoot. He has currently been followed up for the reconstruction treatment. ABS remains a challenging diagnosis for obstetricians following the onset timepoint. A prenatal ultrasound scan is carefully required to detect the morphologic abnormalities of the fetus. Postnatal management should be integrated by a multidisciplinary team in order to improve the infant's outcome. ABS is an extremely dangerous entity during pregnancy, which leads to poor outcomes for the infant. An early detection on ultrasound helps in preparing better for the acceptance of the mother and the family as well as the prognosis afterwards.

Fetal intestinal loop dilatation: Follow-up and outcome of a series of 133 consecutive cases (the DILDIG study).

To define the prognostic markers of fetal dilated bowel loops. National non-interventional study of 133 consecutive prenatal observations of dilated loops including ultrasound examinations, complementary laboratory tests, magnetic resonance imaging (MRI), outcomes, and postnatal diagnosis. One hundred twenty seven cases were classified according to outcome: Group 1, very severe (n=43), Group 2, children needing specific care (n=39), and Group 3, healthy children (n=45). Prenatal ultrasound scan suggested duodenal obstruction in 30 cases, small bowel obstruction in 81, colonic obstruction in 11, and diffuse dilatation in 5. Diameter of dilated loops did not significantly differ between the groups. A poor prognosis was significantly associated with duodenal obstruction, genetic anomalies (53% vs. 21.8%), including aneuploidies or CFTR gene mutations and abnormal amniotic fluid biochemistry (86.4% vs. 38.7%). A good prognosis was associated with regression of dilatation and normal MRI. In this study, postnatal outcomes for fetuses with intestinal dilatation were best predicted by assessing the level of obstruction with prenatal ultrasound and MRI, determining the presence of associated malformations, amniotic fluid biochemical and genetic testing, and monitoring for regression of bowel dilatation. These results should help inform future guidelines on the prenatal and neonatal management of congenital intestinal obstruction.

PD42 Diagnosis Of Chronic Diseases During The COVID-19 Pandemic Through Telemedicine

IntroductionThe diagnosis and management of chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic was one of the biggest challenges facing healthcare systems globally, especially in low-income countries. Since basic health care for chronic diseases can overwhelm the capacity of conventional face-to-face healthcare services, there is growing interest in using information and communication technology and telemedicine to improve access to medical services that are often not consistently available in rural communities. In this context, telemedicine tools should be directed toward maintaining basic health services for patients with chronic conditions in rural and underserved hospitals. This study evaluated a telemedicine system in remote public hospitals in Paraguay to demonstrate how telemedicine improved access to tertiary level diagnostic services for patients with chronic conditions.MethodsThis descriptive study evaluated the use of telemedicine for diagnosing patients in remote public hospitals to improve provision of basic health services to patients with chronic disease during the COVID-19 pandemic. The type and frequency of diagnostic studies performed were determined.ResultsDuring the study 677,023 telediagnoses were performed in 67 hospitals. The 435,568 electrocardiograms performed in 61 hospitals indicated normal physiology (60.1%), unspecified arrhythmias (10.5%), and sinus bradycardia (8.4%). The 227,360 teletomography tests performed in 12 hospitals were undertaken on the head (52.4%) because of trauma (motorcycle accidents) and cerebrovascular diseases, chest (15.8 %), and other anatomical regions. The 14,076 electroencephalograms performed in 19 hospitals were undertaken for antecedents of seizure (53.3%), disease progression controls (14.0%), and headache (12.5%). Nineteen prenatal ultrasound scans were conducted.ConclusionsAlthough the results are promising for using telemedicine to bridge gaps and improve equity in the provision of basic health services for patients with chronic diseases in remote locations during the COVID-19 pandemic, a widespread use assessment should be undertaken before this tool is adopted.

Congenital cystic adenomatoid malformations of the lung: a retrospective study of diagnosis, treatment strategy and postoperative morbidity in surgically treated patients.

The purpose of this study was to evaluate the diagnosis of, clinical signs of and strategy for congenital cystic adenomatoid malformations (CCAM). In this retrospective study, patients who had thoracic surgery for CCAM lesions at the University Hospitals of Leuven from July 1993 to July 2016 were identified. Data on diagnosis, prenatal ultrasound findings, clinical signs, lesion site, CCAM type, associated anomalies, imaging, surgical approach and postoperative morbidity were reviewed. The Fisher exact and Mann-Whitney tests were used as appropriate. A total of 55 patients were identified with CCAM. In 65% (n = 36/55), CCAM was detected on prenatal ultrasound scans. Prenatal symptoms due to hydrops or mass effect were present in 22% (n = 8/36), 6 of whom eventually needed prenatal intervention (thoracoamniotic shunting or intrauterine puncture). Elective surgery was performed in 40% of patients (n = 22/55); others developed clinical signs that indicated the need for semi-urgent surgery, with clinical signs of pulmonary infection and respiratory distress being the most common. Most patients had a single lobectomy via a minithoracotomy. Postoperative complications and length of stay were significantly higher in patients with CCAM with preoperative clinical signs. Surgery in asymptomatic patients with CCAM can be performed safely with few postoperative complications and can be planned at a young age in patients with a high risk of developing clinical signs later in life.

Male partners’ experiences of early pregnancy ultrasound scans in Soweto, South Africa: The Healthy Pregnancy, Healthy Baby randomised trial

Background. Despite international evidence highlighting the benefits of male partners attending antenatal visits, including pregnancy ultrasound scans, it is unusual for South African (SA) men to attend such visits, and little is known about their experiences if they do.&#x0D; Objectives. To explore the experiences and antenatal attachment among male partners who attend early pregnancy ultrasound examinations in Soweto, SA.&#x0D; Methods. Pregnant women attending ultrasound examinations were invited to bring their partners with them. Both completed individual questionnaires, including the antenatal attachment scale. The results are based on a descriptive analysis of 102 mother-partner pairs.&#x0D; Results. The mean age of partners was 35 years. Only 32% of men were living with their pregnant partner. Before the ultrasound scan, 64% of men reported feeling very anxious, while 54% also felt anxious after the procedure. The ultrasound examination had a positive effect on men and their thoughts regarding their developing baby, with 30% stating that they were ready or excited to be a father. Twenty-eight percent believed their relationship with the mother was stronger as a result of participating in antenatal care.&#x0D; Conclusions. We found that prenatal ultrasound scans had a positive effect on male partners and their thoughts about the pregnancy, their forthcoming child and their relationship with and support for their partner. Health services in SA should accommodate partners/ fathers and encourage them to attend antenatal care, including pregnancy ultrasound scans. Interventions are needed to encourage more men to be involved – from conception – potentially addressing individual, familial, societal and structural barriers to involvement of the father in long-term maternal and child care.

The role of preserved bowel and mesentery fixation in apple-peel intestinal atresia

ObjectiveThis study explored the feasibility of mesoplasty with end-to-side anastomosis in the treatment of different apple-peel mesenteric defects with high jejunal atresia.MethodsA retrospective analysis was performed on 42 premature infants admitted to the hospital between 2014 and 2021. Prenatal ultrasound scans revealed bowel dilatation. The patients experienced vomiting after birth and produced white or no meconium. Plain radiography showed double or triple bubble signs and the patients underwent emergency laparotomy. High jejunal atresia with different apple-peel atresia appearance was discovered intraoperatively, involving mobilization of the ileocecal region. Patients received end-to-side anastomosis between the enlarged blind pouch and atretic bowel, as well as mesoplasty. A jejunal feeding tube was placed trans-nasally. Patients were discharged after achieving full enteral feeding. We also reviewed the literature on the subject.ResultsThree patients died and 39 survived. The discharged patients were followed up for 12 months, and none showed post-operative complications such as intestinal obstruction, malnutrition, or chronic diarrhea. All surviving patients reached the expected height and weight for children of the same age.ConclusionFor cases of high jejunal atresia with apple-peel intestinal atresia, mesoplasty may be a good option to avoid postoperative volvulus.

A case series on abnormal placenta accreta spectrum in a rural tertiary care centre

Placenta accreta spectrum (PAS) is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The main complication of PAS is due to it’s massive obstetric haemorrhage which leads to maternal morbidity and mortality. The incidence of placenta accreta spectrum increases day by day due to an alarming increase in caesarean section rates. Depending on the range of invasiveness, The Placenta accreta spectrum is classified as placenta accreta, placenta increta and placenta percreta. The etiology of placenta accreta spectrum is that a defect of the endometrial–myometrial interface leading to failure of normal decidualization in the area of a uterine scar, which allows abnormally deep placental anchoring villi and trophoblast infiltration. In recent times, prenatal ultrasound scanning with gray scale imaging and color Doppler imaging seems to be an excellent tool for screening of PAS.We report here a series of 5 cases of Placenta Accreta who reported to hospital as Bleeding P/v or USG scan report showing Abnormal Placental invasion or Placental Position. Patients reported were posted for Emergency LSCS under definitive indications but underwent Peripartum hysterectomy. The Ultrasound findings were subsequently confirmed at surgery and proven on histopathological examination. Peripartum hysterectomy remains the life saving procedure over conservative methods for PPH secondary to Abnormal Placental invasion.