Placental and Umbilical Cord Anomalies Diagnosed by Two- and Three-Dimensional Ultrasound

The aim of this review is to present a wide spectrum of placental and umbilical cord pathologies affecting the pregnancy. Placental and umbilical cord anomalies are highly associated with high-risk pregnancies and may jeopardize fetal well-being in utero as well as causing a predisposition towards poor perinatal outcome with increased fetal and neonatal mortality and morbidity. The permanent, computerized perinatology databases of different international centers have been searched and investigated to fulfil the aim of this manuscript. An extended gallery of prenatal imaging with autopsy correlation in specific cases will help to provide readers with a useful iconographic tool and will assist with the understanding and definition of this critical obstetrical and perinatological issue

Skeletal dysplasia with bowing long bones: Proposed flowchart for prenatal diagnosis with case demonstration

Abstract Objective Skeletal dysplasia with bowing long bones is a rare group of multiple characterized congenital anomalies. Materials and Methods We introduce a simple, practical diagnostic flowchart that may be helpful in identifying the appropriate pathway of obstetrical management. Results Herein, we describe four fetal cases of bent bony dysplasia that focus on ultrasound findings, phenotype, molecular tests, distinctive X-ray features, and chondral growth plate histology. The first case was a typical campomelic dysplasia resulting from a de novo mutation in the SOX9 gene. The second fetus was affected by osteogenesis imperfecta Type II carrying a mutation in the COLA1 gene. The third case was a rare presentation of campomelic dysplasia, Cumming type, in which SOX9 examination was normal. Subsequently, a femoral hypoplasia unusual facies syndrome is also discussed. Conclusion Targeted molecular tests and genetic counseling are required for supplementing ultrasound imaging in order to diagnose the correct skeletal disorders

The preoperative treatment of patients with heart valve prostheses undergoing oral and maxillofacial surgical interventions. Our protocol

The paper examines the prevention of hemorrhagic and bacterial endocarditis in patients with a prosthetic heart value and treated with oral anticoagulant therapy, undergoing oral and maxillo-facial surgery. The authors present a protocol personally adopted in hospital activity underlining the excellent results

Convalescent Plasma for Pregnant Women with COVID-19: A Systematic Literature Review

The treatment of COVID-19 is particularly critical in pregnant women, considering the potential teratogenic effects of antiviral agents and the immune-depression related with pregnancy. The aim of this review is to systematically examine the current evidence on the clinical use of convalescent plasma during pregnancy. The electronic databases Medline PubMed Advanced Search Builder, Scopus, Web Of Science and Google Scholar were searched (until 1 January 2021). Inclusion criteria were pregnant women with COVID-19 (or SARS-CoV-2 infection), in whom convalescent plasma (or hyperimmune plasma) was used as treatment. We searched clinical trial registries (censored 5 January 2021) for eligible studies under way. After elimination of duplications, the initial search yielded 79 potentially relevant records, of which 67 were subsequently excluded. The 12 remaining records were case reports involving 12 pregnancies. Six of the mothers were reported to be well, two were reported to have preeclampsia, and in one case each the maternal outcome was described as survival, clinical improvement, discharged with oxygen and rehabilitation. With regard to the neonates, two were declared to be well, four had transient morbidity, two were critically ill and one died; normal ongoing pregnancies, but no post-delivery information, were reported for the remaining three cases. Clinical trials under way or planned to investigate the use of convalescent plasma for COVID-19 during pregnancy are lacking. This is the first systematic review of the literature regarding the treatment of COVID-19 in pregnancy. The published literature data seem to indicate that convalescent plasma administered to pregnant women with severe COVID-19 provides benefits for both the mother and the fetus. The quality of the available studies is, however, very limited since they are all case reports and thus suffer from relevant reporting bias

Sonographic demonstration of the fetal esophagus using three-dimensional ultrasound imaging

INTRODUCTION: There is limited data on the antenatal examination of the fetal esophagus. The objective of this study was to evaluate the feasibility of the direct antenatal visualization of the normal and abnormal fetal esophagus using three-dimensional (3D) ultrasound (US) and Crystal Vue rendering technology. METHODS: From February to April 2018 we collected 3D volumes from a non-consecutive series of fetuses referred to the laboratory of ultrasound of two Fetal Medicine Units and submitted to prenatal ultrasound upon clinical indication at gestational age comprised between 19 and 28 weeks. 3D volumes were acquired from a midsagittal section of the fetal thorax and upper abdomen with the fetus lying in supine position. Post-processing with multiplanar mode was applied to orientate the volume and identify the esophagus. The Region Of Interest was angled by approximately 30° to the spine and its thickness was adjusted in order to optimize the visualization of the intra-thoracic and intra-abdominal course of the esophagus. Crystal Vue software was used for image rendering of the fetal trunk on the coronal plane. Postnatal follow up was collected in all cases. RESULTS: During the study period 91 cases were recruited for the study purposes including two with suspected esophageal atresia due to suboptimal visualization of the stomach. Among the cases with normal stomach at 2D imaging Crystal Vue rendering technology allowed the direct evaluation of the whole course of the esophagus in 74 (83.1%). In the two cases with small or absent stomach bubble at 2D imaging an esophageal atresia could be demonstrated at 3D Crystal Vue imaging. The mean time required for offline postprocessing and visualization of the esophageal anatomy was 4 minutes. CONCLUSIONS: It is possible to visualize the normal fetal esophagus or to demonstrate its atresia using 3D US and Crystal Vue. This represents a major advance in the prenatal counselling and management in those cases where esophageal atresia is suspected

Congenital Syphilis Presenting with Brain Abnormalities at Neuroscan: A Case Report and a Brief Literature Review

A case of vertical transmission in a 35-year-old pregnant woman, gravida 4, para 2 with an unknown medical history of carrying primary syphilis is described. A routine 3rd trimester scan was performed at 30 + 5 weeks of pregnancy, which revealed fetal growth restriction (FGR) associated with absent fetal movement, a pathologic neuroscan characterized by cortical calcifications and ominous Doppler waveform analysis of the umbilical artery and ductus venosus. Computerized electronic fetal monitoring (EFM) showed a Class III tracing, according to the American College of Obstetricians and Gynecologists (ACOG) guidelines. An emergency C-section was performed and a female newborn weighing 1470 g was delivered. The Apgar scores were 5 and 8 at the first and fifth min, respectively. Besides the prompted obstetrical and neonatal interventions, the neonate died after 7 days. A histologic examination of the placenta revealed a chorioamnionitis at stage 1/2 and grade 2/3. The parenchyma showed diffuse delayed villous maturation, focal infarcts, and intraparenchymal hemorrhages. The decidua presented with chronic deciduitis with plasma cells. The parents declined the autopsy. Congenital syphilis is an emerging worldwide phenomenon and the multidisciplinary management of the mother and the fetus should be mandatory

Prediction of outcome in 255 fetuses with absent ductus venosus - a multicenter experience and literature review

Baylor Coll Med, Dept Obstet & Gynecol, Houston, TX 77030 USATexas Childrens Hosp, Fetal Ctr, Houston, TX 77030 USAAUSL, Dept Obstet & Gynecol, Prenatal Diagnost Serv, Reggio Emilia, ItalyCarlo Poma Hosp, Dept Obstet & Gynecol, Prenatal Diagnost Serv, Mantua, ItalyUniv Fed Sao Paulo, Dept Obstet, Sao Paulo, BrazilUniv Brescia, Dept Obstet & Gynecol, Brescia, ItalyClin Las Condes, Dept Obstet & Gynecol, Santiago, ChileBaylor Coll Med, Dept Pediat Cardiol, Houston, TX 77030 USAUniv Fed Sao Paulo, Dept Obstet, Sao Paulo, BrazilWeb of Scienc

Clinical Presentations and Diagnostic Imaging of VACTERL Association

: Background: VACTERL association consists of Vertebral, Anorectal, Cardiac, Tracheo-Esophageal, Renal, and Limb defects. The diagnosis depends on the presence of at least three of these structural abnormalities. Methods: The clinical presentation and diagnostic prenatal imaging of VACTERL association are comprehensively reviewed. Results: The most common feature is a vertebral anomaly, found in 60-80% of cases. Tracheo-esophageal fistula is seen in 50-80% of cases and renal malformations in 30% of patients. Limb defects including thumb aplasia/hypoplasia, polydactyly, and radial agenesis/hypoplasia are present in 40-50% of cases. Anorectal defects, like imperforate anus/anal atresia, are challenging to detect prenatally. Conclusion: The diagnosis of VACTERL association mostly relies on imaging techniques such as ultrasound, computed tomography, and magnetic resonance. Differential diagnosis should exclude similar diseases such as CHARGE and Townes-Brocks syndromes and Fanconi anemia. New insights into genetic etiology have led to recommendations of chromosomal breakage investigation for optimal diagnosis and counseling