Interventricular septal thickness as a diagnostic marker of fetal macrosomia

Introduction: Serious complications in both mother and child arising as a result of fetal macrosomia indicate the need for early diagnosis and prevention. Unfortunately, current predictors such as fetal biometry, fundal height and amniotic fluid index appear to be insufficient

An investigation of the optimal inter-pregnancy interval following pregnancy with a fetus with congenital heart disease

INTRODUCTION: Congenital heart defects (CHD) are one of the most commonly diagnosed congenital malformations in fetuses and newborns. The aim of the study was to determine whether inter-pregnancy interval (IPI), maternal age or number of pregnancies had any influence on the recurrence of congenital heart disease in subsequent pregnancies. MATERIAL AND METHODS: We found in our database 144 women with subsequent pregnancies after CHD in a previous pregnancy. Each woman was selected according to the eligibility and exclusion criteria. Medical history as well as obstetrics history were recorded. Comparisons of groups with and without a recurrence of CHD were performed. We calculated hazard ratios for recurrence of CHD. We also performed analysis of the impact of confounding variables: maternal age and parity. Missing data were excluded from the analysis. Smoking habits as well as socio-demographic characteristics were not evaluated in this study. RESULTS: A higher risk of recurrence of CHD correlated with a shorter IPI, with a median of 11 months compared with 24 months for the group of healthy fetuses in subsequent pregnancy. The results were statistically significant. Parity was proven to be an important confounder of the study. Multivariable analysis including parity and maternal age did not affect the confidence intervals of hazard ratios for IPI. CONCLUSIONS: The optimal IPI to reduce the risk of recurrence of CHD is 24 months. Shorter intervals are related to a higher risk of recurrence of CHD in the next pregnancy and are independent on the age of the woman and parity

Measurement of the Great Vessels in the Mediastinum Could Help Distinguish True From False-Positive Coarctation of the Aorta in the Third Trimester

Objective. We investigated the utility of analyzing prenatal mediastinal measures of the great arteries in distinguishing true coarctation of the aorta (CoA) from false-positive CoA. Methods. All fetuses in this study had suspicion of CoA based on the presence of right-left heart disproportion. We defined 3 study groups: group 1, true fetal CoA; group 2, false-positive fetal CoA with a narrow aortic arch; and group 3, false-positive fetal CoA without a narrow aortic arch. Results. In group 1, the mean mediastinal pulmonary artery (PA) to ascending aorta (Ao) diameter ratio ± SD was 2.03 ± 0.48, and in group 2, the ratio was 1.60 ± 0.23. The difference was statistically significant (P = .0018, t test). In group 3, the mean PA:Ao ratio was 1.35 ± 0.14. The difference between groups 1 and 3 was statistically significant (P = .0002, t test). In our study group, for a PA:Ao ratio of 1.60, sensitivity was 83.0%; specificity, 85.0%; positive predictive value, 62.5%; and negative predictive value, 94.0%. Conclusions. In the third trimester, the main PA:Ao ratio as measured in the fetal mediastinum can be a helpful tool in distinguishing true CoA requiring neonatal cardiac surgery from false-positive CoA and simple disproportion requiring medical attention but no surgery in the first month of postnatal life. Key words: coarctation of the aorta; great vessels; mediastinum; third trimester. ntenatal diagnosis of coarctation of the aorta (CoA) is a challenge, although it is critically important for early treatment of the neonate. 1-3 Echocardiography allows for identification of groups at high risk but does not predict with certainty the presence of a CoA after birth. Echocardiographic markers suggestive of CoA in the fetus are many and include a visual disproportion in size between the ventricles, with the right heart larger than the left, visualization of a narrow aortic isthmus or aortic shelf, the presence of a left superior vena cava, and a bicuspid aortic valve. In the third trimester of pregnancy in an otherwise structurally normal heart, substantial right-left heart size disproportion raises the possibility of the diagnosis of CoA with the need for delivery at an appropriately equipped center for performance of a cardiovascular evaluation and postnatal echocardiography. However