Prenatal ultrasound diagnosis in 51 cases of holoprosencephaly: craniofacial anatomy, associated malformations, and genetics.

Contains fulltext : 89666.pdf (publisher's version ) (Closed access)OBJECTIVE: To analyze the prenatal ultrasound findings of the craniofacial and extracephalic anatomy, the postnatal pathological findings, and the genetic anomalies in 51 cases of holoprosencephaly (HPE). MATERIALS AND METHODS: Between 1990 and 2005, a collective of 51 fetuses with tentative ultrasound diagnosis of HPE was recruited at two tertiary referral centers for prenatal ultrasound diagnostics via the Pia Fetal Database (GEMedical Systems, Webling, Germany). Cephalic as well as extracephalic anomalies were investigated, and all cases were subdivided into the subgroups lobar, a lobar, and semilobar HPE. In addition to the ultrasound investigation, 45 fetuses were analyzed for genetic anomalies and 21 fetuses underwent an autopsy. RESULTS: The average age at diagnosis was 21.9 weeks of gestation. There was a greater number of female fetuses, with an overall ratio of 2.67:1. In 61% of all cases, there was a reduction of growth in comparison with healthy fetuses of the same age. Within the second trimenon, the cephalic anomalies became evident when investigating the diameter of the fetal head (second trimenon: 71%below the fifth percentile; third trimenon: 92% below the fifth percentile). In 82%of the cases, extracephalic anomalies were diagnosed additionally. In 63%, the diagnosis of holoprosencephaly led to a termination of pregnancy. Ten percent of the fetuses were born alive. In 81% of the cases, the diagnosis of HPE was confirmed postnatally. The remaining 19% showed other severe cephalic and extracephalic anomalies. Chromosomal anomalies were detected in 79% of the fetuses, most frequently trisomy 13 (59%). DISCUSSION: Because of recent advances in the development and improvement of high-resolution ultrasound, early diagnosis of congenital anomalies such as HPE is now possible. In this study, which represents the largest collection of prenatally diagnosed HPE reported in the literature to date, the average age at diagnosis was earlier than in other studies. The ultrasound devices of today provide excellent images of the fetus that allow an exact diagnosis of craniomaxillofacial anomalies as well as extracephalic anomalies. Apart from a very few cases, the diagnosis of HPE is incompatible with life.1 januari 201

Prenatal management of monoamniotic twin pregnancies.

OBJECTIVE: To evaluate antenatal surveillance strategies and the optimal timing of delivery for monoamniotic twin pregnancies. METHODS: Obstetric and perinatal outcomes were retrospectively retrieved for 193 monoamniotic twin pregnancies. Fetal and neonatal outcomes were compared between fetuses followed in an inpatient setting and those undergoing intensive outpatient follow-up from 26 to 28 weeks of gestation until planned cesarean delivery between 32 and 35 weeks of gestation. The risk of fetal death was compared with the risk of neonatal complications. RESULTS: Fetal deaths occurred in 18.1% of fetuses (70/386). Two hundred ninety-five neonates from 153 pregnancies were born alive after 23 weeks of gestation. There were 17 neonatal deaths (5.8%), five of whom had major congenital anomalies. The prospective risk of a nonrespiratory neonatal complication was lower than the prospective risk of fetal death after 32 4/7 weeks of gestation (95% confidence interval 32 0/7-33 4/7). The incidence of death or a nonrespiratory neonatal complication was not significantly different between fetuses managed as outpatients (14/106 [13.2%]) or inpatients (15/142 [10.5%]; P=.55). Our statistical power to detect a difference in outcomes between these groups was low. CONCLUSIONS: The in utero risk of a monoamniotic twin fetus exceeds the risk of a postnatal nonrespiratory complication at 32 4/7 weeks of gestation. If close fetal surveillance is instituted after 26-28 weeks of gestation and delivery takes place at approximately 33 weeks of gestation, the risk of fetal or neonatal death is low, no matter the surveillance setting. LEVEL OF EVIDENCE: : II

Alimentação de bezerros ruminantes com dieta líquida, via goteira esofageana: parâmetros ruminais Ruminant calves feeding with liquid diet, through esophageal groove: ruminal parameters

Efeitos de fornecer proteína texturizada de soja (PTS) na forma líquida, via goteira esofágica, ou na forma sólida, via concentrados, foram estudados em um delineamento quadrado latino 4 x 4, empregando quatro novilhos Holandeses providos de cânulas ruminais, pesando cerca de 100 kg cada, no início do experimento. Os tratamentos consistiram de níveis crescentes de PTS na forma líquida (0, 33, 66 e 100%), oferecidos em mamadeiras, e níveis decrescentes de misturas concentradas, mantendo-se a mesma quantidade de nitrogênio em todas as dietas. Os subperíodos experimentais foram de 21 dias, sendo os primeiros 16 de adaptação às rações (feno de Cynodon dactilon, mistura concentrada e alimento líquido). Ensaio de digestibilidade in situ foi executado do dia 17 ao 20, sendo os tempos de incubação de 0, 1,5, 3, 6, 12, 24 e 48 horas, para o farelo de soja e PTS, e 0, 6, 12, 24, 48h, 72 e 96 horas para o feno. Foram tomadas amostras de conteúdo ruminal para análise de volume e taxa de passagem de líquidos, e pH, no dia 21 às 0, 1, 3, 6, 12 e 24 horas. No dia 20, conteúdos ruminais foram coletados para análise de ácidos graxos voláteis (AGV) e N amoniacal às 0, 2, 4, 5 e 6h após a primeira alimentação do dia. Foi observado aumento na taxa de passagem e turnover líquido com a diminuição do suplemento protéico na forma líquida. Não ocorreram efeitos da forma de alimentação nas concentrações dos totais de AGV ou nas suas porcentagens molares individuais, do mesmo modo que o pH não foi afetado. Não houve efeitos da forma de alimentação sobre a degradabilidade in situ da proteína e da matéria seca do farelo de soja e PTS, tampouco efeitos sobre a degradabilidade da matéria seca e fibra em detergente neutro do feno.<br>Effects of feeding textured soy protein (TSP), in liquid form throught esophageal groove, or solid form throught concentrate meal, were studied in a 4 x 4 Latin-square change-over design, using four Holstein steers fitted with ruminal cannulas, averaging 100 kg live weight at the beginning of trial. Treatments consisted of increasing TSP levels in liquid form (0, 33, 66 and 100%) offered through nipple-pail, and decreasing levels in concentrate meal to keep the same amout of nitrogen in all diets. Twenty-one days sub periods were used, the first sexteen for diet adaptation (Cynodon dactilon hay, concentrate mixture and liquid feed). In situ degradability assay was runned from day 17 to 20, and incubation times were 0, 1.5, 3, 6, 12, 24 and 48hours for soybean meal and TSP, and 0, 6, 12, 24, 48, 72 and 96 hours for coastcross hay. Ruminal contents colections to analize liquid volume, passage rate, and pH were made at twentieth first day at 0h, 1h, 3h, 6h, 12h, and 24h. On twentieth day ruminal contents were colected to analyze volatile fatty acids (VFA) and ammonia nitrogen at 0, 2h, 3h, 4h, 5h and 6h after first feed. An increase in passage rate and ruminal turnover was observed as the liquid suplement protein amount decreased. There were no effects of feeding form in the total VFA concentrations or its individual molar percentages; also ruminal pH was not affected. There were no effects of feeding form upon in situ degradability of soybean meal and TSP dry matter (DM) and crude protein (CP), as well as there were no effects in the degradability of Coast-Cross hay DM and neutral detergent fiber (NDF)