Maternal outcomes and risk factors for COVID-19 severity among pregnant women.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease

Hemifacial Microsomia with Spinal and Rib Anomalies: Prenatal Diagnosis and Postmortem Confirmation Using 3-D Computed Tomography Reconstruction

Hemifacial microsomia (OMIM164210) is a condition featuring unilateral ear anomalies and ocular epibulbar dermoids associated with unilateral underdevelopment of the craniofacial bony structures. Other associated anomalies have also been described, especially spinal malformations, and the term oculoauriculovertebral dysplasia spectrum (OVAS) was suggested to include the three predominant systems involved. Both genetic and environmental causes are implied in the pathogenesis of the syndrome, with a 3% recurrence rate according to reports of both vertical transmission and affected siblings. No specific gene was identified, albeit mutations in chromosome 10 and deficiencies of genes in the endothelin pathway in mice exhibited the same clinical features. We hereby describe the first case of prenatal diagnosis of spinal and rib malformations associated to hemifacial microsomia by means of 2-D and 3-D ultrasound in a 23-week fetus. the sonographic study depicted fetal scoliosis due to the presence of hemivertebrae, Sprengel's deformity of the left shoulder, ribs fusion, asymmetric ears with unilateral microtia, mandible unilateral hypoplasia as well as single umbilical artery and a 'golf ball' sign in the left ventricle of the heart. the diagnosis of OVAS was suggested and the family received proper genetic consultation. After termination of the pregnancy, the syndrome was confirmed by postmortem 3-D computed tomography study. in view of the grim outcome, prenatal death rate and high mortality and morbidity when three or more systems are involved, prenatal diagnosis and appropriate counseling are warranted. Copyright (C) 2011 S. Karger AG, BaselEdith Wolfson Med Ctr, Fetal Neurol Clin, Prenatal Diag Unit, Dept Obstet & Gynecol, IL-58100 Holon, IsraelEdith Wolfson Med Ctr, Dept Obstet & Gynecol, IL-58100 Holon, IsraelEdith Wolfson Med Ctr, Genet Inst, IL-58100 Holon, IsraelEdith Wolfson Med Ctr, Dept Pathol, IL-58100 Holon, IsraelTel Aviv Univ, Sackler Sch Med, IL-69978 Tel Aviv, IsraelUniversidade Federal de São Paulo, Dept Obstet, Fetal Med Discipline, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Obstet, Fetal Med Discipline, São Paulo, BrazilWeb of Scienc

Fetal optic nerve sheath measurement as a non-invasive tool for assessment of increased intracranial pressure

Objectives To describe the sonographic technique for assessment of the fetal optic nerve sheath and to report on three fetuses with intracranial lesions and enlarged optic nerve sheath diameter (ONSD) compared with normal controls matched for gestational age (GA).Methods in this cross-sectional study ONSD was measured sonographically in three fetuses (aged 23, 24 and 35 gestational weeks) with intracranial findings associated with increased intracranial pressure (ICP; dural thrombosis and intracranial tumors) as well as 42 healthy controls matched for GA +/- 1 week (aged 22-25 and 34-36 weeks). for fetal eye assessment, transabdominal and transvaginal routes and high-resolution transducers were used for optimal visualization depending on fetal position. Measurements were made using an axial view at the level of the orbits, with the fetal face positioned towards the transducer. the ONSD was measured 1.5 or 2 mm behind the papilla (depending on GA) in all fetuses. Mean +/- 2 SD ONSD of controls were calculated for each GA and compared with data from the three fetuses with intracranial pathology.Results in the 42 normal fetuses, ONSD increased from 1.2 mm at 23 weeks to 2.6 mm at 36 weeks. the measurements at 36 weeks correlated well with those observed in newborns. ONSD measurements of the three cases were above mean + 2 SD of values obtained from healthy controls at the same GA and also exceeded values of fetuses that were 1 week older.Conclusions Fetal ONSD measurement is feasible using a technique similar to that used in adults and children. ONSD enlargement was observed in all three fetuses with intracranial lesions and may be an early tool with which to diagnose increased ICP. Copyright (C) 2011 ISUOG. Published by John Wiley & Sons, Ltd.Wolfson Med Ctr, Fetal Neurol Clin, Holon, IsraelWolfson Med Ctr, Dept Obstet & Gynecol, Holon, IsraelUniversidade Federal de São Paulo, Fetal Med Discipline, Dept Obstet, São Paulo, BrazilCtr AGB Ultrasonog & Clin Sanatorio Aleman, Concepcion, ChileWolfson Med Ctr, Genet Inst, Holon, IsraelTel Aviv Med Ctr & Sch Med, Dept Pediat Radiol, Tel Aviv, IsraelTel Aviv Univ, Sackler Sch Med, IL-69978 Tel Aviv, IsraelWolfson Med Ctr, Pediat Neurol Unit, Holon, IsraelUniversidade Federal de São Paulo, Fetal Med Discipline, Dept Obstet, São Paulo, BrazilWeb of Scienc

The 'brain shadowing sign': a novel marker of fetal craniosynostosis

Introduction: The prenatal diagnosis of fetal craniosynostosis is challenging, especially in single-suture cases. When sutures are obliterated, sound waves fail to penetrate the cortical bone, creating an evident acoustic shadow on the underlying brain. The objective of this study was to evaluate the yield of the 'brain shadowing sign' (BSS) as a novel sono-graphic marker for craniosynostosis. Subjects and Methods: Patients with an antenatal diagnosis of fetal craniosynostosis (cases) and healthy controls paired for gestational age were enrolled in this retrospective case-control study. Two-dimensional scans were assessed by three examiners for the presence of the BSS and additional fetal findings. Results: The BSS was clearly depicted in all 24 cases on the first anal- ysis and in 22 cases on the second analysis. No fetus from the control group (n = 48) presented the BSS in any of the analyses. Fifteen cases had isolated craniosynostosis and 9 were syndromic (Apert, Saethre-Chotzen and craniofrontonasal syndromes), which were diagnosed significantly earlier due to additional malformations. Discussion: The BSS is a novel sonographic marker of craniosynostosis which can be used to increase the diagnostic rate of this rare condition and does not require the use of high-definition three-dimensional transducers to be depicted. (C) 2016 S. Karger AG, BaselDivision of Prenatal Diagnosis, Department of Obstetrics and Gynecology, Wolfson Medical Center, HolonGenetics Institute, Wolfson Medical Center, HolonPediatric Neurology Unit, Wolfson Medical Center, HolonDepartment of Obstetrics and Gynecology, Bnai Zion Medical Center, HaifaObstetric-Gynecologic Ultrasound Unit, Department of Obstetrics and Gynecology, AsaHarofeh Medical Center, Beer YaakovGenetics Institute, Tel Aviv Sourasky Medical CenterObstetric-Gynecologic Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, IsraelDepartment of Gynecology and Obstetrics, Fetal Medicine Unit, Hospital Israelita Albert EinsteinDepartment of Obstetrics, Fetal Medicine Division, Federal University of São PauloCentro Paulista de Medicina Fetal, São Paulo, BrazilDepartment of Obstetrics, Fetal Medicine Division, Federal University of São Paulo, and jCentro Paulista de Medicina Fetal, São Paulo, BrazilWeb of Scienc

Reference Intervals for Fetal Heart Volume From 3-Dimensional Sonography Using the Extended Imaging Virtual Organ Computer-Aided Analysis Method at Gestational Ages of 20 to 34 Weeks

Objectives-The purpose of this study was to establish the reference range for fetal heart volume from 3-dimensional (3D) sonography using the extended imaging virtual organ computer-aided analysis method.Methods-The fetal heart volume was measured in 303 normal singleton pregnancies at gestational ages of 20 to 34 weeks using 3D sonography. The extended imaging virtual organ computer-aided analysis method was used to obtain a sequence of 10 parallel symmetric sections through the heart, according to examiner-determined limits (the apex at one extremity and the connection to the great vessels at the other). Heart contours were drawn manually in all sections to obtain the 3D volume measurement, which was provided automatically by the software. Normal z scores and percentile reference ranges for each gestational age were constructed.Results-The fetal heart volume increased with gestational age. The mean values were 3.09 mL at 20 weeks, 9.18 mL at 26 weeks, and 24.89 mL at 34 weeks, according to the following formulas: fetal heart volume (mL) = 18.0076 - 2.1005 x gestational age + 0.0677 x gestational age(2) (R-2=0.922); and SD (mL) = (4.5038 - 0.4281 x gestational age + 0.0114 x gestational age(2)) x root 1.495808 (R-2=0.922).Conclusions-A reference range for fetal heart volume using the 3D sonographic extended imaging virtual organ computer-aided analysis method at gestational ages of 20 to 34 weeks was established.Univ Fed Sao Paulo, Dept Obstet, BR-05303000 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Obstet, BR-05303000 Sao Paulo, SP, BrazilWeb of Scienc