Doppler Impedance Changes at the Fetal Brain Vessels in a Pregnancy Affected with a Multiple Combination of Uteroplacental Anomalies

A fetus with a very rare five-fold combination of uteroplacental anomalies, bicornuate uterus, short cervix with cervical incompetence, multilobed placenta succenturiata, accessory cotyledon within the cervical funneling, and umbilical cord insertion into the anomalous cervical cotyledon, presented an early and marked decrease at the vertebral and middle cerebral arteries Doppler resistances. This cerebral low-impedance state, usually found before labor, and considered an adaptive mechanism developed to protect the fetus at term from labor asphyxia, was present for an unknown reason at 20 weeks. After the patient was treated with vaginal progesterone, the cervix shortening improved and markedly, at the same time, the cerebral vascular resistances increased and maintained an adequate for gestational age impedance until delivery at 34 weeks. As the described uteroplacental anomalies determined a high risk of preterm delivery, due to cervical dilation, cord compresion, and placental haemorrhage, these fluctuating brain vascular changes might be the result of the fetal adaptation to the changes preceding an imminent delivery

Outcome of Fetuses with Diagnosis of Isolated Short Femur in the Second Half of Pregnancy

Objectives. To assess the outcome of fetuses with isolated short femur detected at 19–41 weeks and determine to what extent this incidental finding should be a cause of concern in fetuses with a normal previous follow-up. Methods. 156 fetuses with isolated short femur were compared with a control group of 637 fetuses with normal femur length. FL values were converted into Z-scores and classified into 4 groups: control group: Z-score over −2, group 1: Z-score between −2 and −3, group 2: Z-score between −3 and −4, and group 3: Z-score below −4. FL values were plotted with the curves representing Z-scores −2, −3, and −4. To assess fetal outcome, the frequency of SGA, IUGR, abnormal umbilical Doppler (AUD), Down's syndrome, and skeletal dysplasia was determined for each group after delivery, and the relative risk in comparison with the control group was obtained. Finally, ROC curves were drawn in order to evaluate the FL diagnostic ability for the conditions appearing with increased frequency. Results. SGA, IUGR, and AUD were more frequent in the fetuses with short femur. Conversely, none of them presented Down's syndrome or skeletal dysplasia. According to ROC analysis, FL measurement behaved as a good diagnostic test for SGA and IUGR. Conclusions. A short femur diagnosis in a fetus with an otherwise normal follow-up determines just a higher risk of being small (SGA or IUGR)

Bicervical Normal Uterus with Normal Vagina and Anteroposterior Disposition of the Double Cervix

We report a very uncommon uterine anomaly consisting on a normal uterus, a double cervix with an anteroposterior disposition, and absence of vaginal septum. A 36-years-old woman with one child and absence of past reproductive disorders was examined for a routine checkup. Clinical and transvaginal ultrasound examinations showed a normal uterus with a double cervix disposed in an anteroposterior fashion with the absence of vaginal septum. A review of the theories concerning müllerian fusion is done, and implications of this case in relation with these theories are discussed. This is the first case of a normal uterus with a double cervix situated in an anteroposterior fashion and absence of vaginal septum. This case is in concordance with theories that consider the fusion of the caudal part of Müllerian ducts to be the result of a complex process. It proves that at least in some cases the most caudal part of müllerian ducts is fused in an anteroposterior disposition