Small fetal thymus and adverse obstetrical outcome: a systematic review and a meta-analysis.

INTRODUCTION: To explore the association between small fetal thymus on ultrasound and adverse obstetrical outcome. MATERIAL AND METHODS: Medline, Embase, Cochrane and Web of Science databases were searched. Primary outcome was the risk of preterm birth before 37 and 34 weeks in fetuses with compared to those without a small thymus on ultrasound. SECONDARY OUTCOMES: occurrence of chorioamnionitis, intra-uterine growth restriction, neonatal sepsis, gestational age at birth, birthweight, neonatal morbidity and pre-eclampsia. RESULTS: Twelve studies including 1744 fetuses who had ultrasound assessment of thymus during pregnancy were included. Women with preterm premature rupture of the membranes (PPROM) or with preterm labour with a small fetal thymus were at higher risk of preterm birth <37 (p= 0.01), <34 (12.5 (p<0.001) weeks in fetuses with compared to those without small thymus, and the risk of chorioamnionitis was higher when the thymus was small (p<0.001). Fetuses with small thymus were not at higher risk of intra-uterine growth restriction (p= 0.3). A small thymus increased the risk of neonatal sepsis (p= 0.007) and morbidity (p= 0.003), but not the risk of pre-eclampsia (p= 0.9). CONCLUSIONS: A small fetal thymus is associated with a higher risk of preterm birth, chorioamnionitis, neonatal sepsis and morbidity, but not with intra-uterine growth restriction and pre-eclampsia. This article is protected by copyright. All rights reserved

Placental calcifications: a clue for the identification of high-risk fetuses in the low-risk pregnant population?

Abstract "What does it mean, Doctor?" and "Is it going to affect my baby in some way?". Those are the most typical questions of pregnant women to obstetricians. Answering is sometimes easier but placental calcification is not the case, since placental architecture and disease are two different faces of the same coin and the association between them is not completely clear. Placenta can function properly, even in the presence of architectural alterations, without any fetal consequences. So, remains the question, when does a placental structural anomaly become a sign of increased attention to maternal conditions, fetal development and well-being? The present review will analyze these concepts, with emphasis on placental calcification, its pathogenesis, and the state-of-the-art regarding the influence of this finding on pregnancy outcomes among low-risk pregnant patients