Reference charts for fetal cerebellar vermis height: A prospective cross-sectional study of 10605 fetuses

A prospective cross-sectional study between September 2009 and December 2014 was carried out at ALTAMEDICA Fetal–Maternal Medical Centre, Rome, Italy. Of 25203 fetal biometric measurements, 12167 (48%) measurements of the cerebellar vermis were available. After excluding 1562 (12.8%) measurements, a total of 10605 (87.2%) fetuses were considered and analyzed once only. Parametric and nonparametric quantile regression models were used for the statistical analysis. In order to evaluate the robustness of the proposed reference charts regarding various distributional assumptions on the ultrasound measurements at hand, we compared the gestational age-specific reference curves we produced through the statistical methods used. Normal mean height based on parametric and nonparametric methods were defined for each week of gestation and the regression equation expressing the height of the cerebellar vermis as a function of gestational age was calculated. Finally the correlation between dimension/gestation was measured

Placental mesenchymal dysplasia, a case of intrauterine sudden death in a normal-sized fetus

Introduction: placental mesenchymal dysplasia (PMD) is a rare placental anomaly characterized by placentomegaly and grapelike vesicles which resemble molar pregnancy. Case: we report the case of 33-year-old woman (1-gravid) who visited our clinic at 11 weeks of gestation due to a suspected molar pregnancy. Ultrasound examination showed an enlarged placenta with multiple vesicular lesions. Maternal human chorionic gonadotropin level was normal and chorionic villus sampling showed a normal male karyotype (46 XY). The fetus exhibited no specific anomalies and fetal growth was normal during pregnancy with no signs of fetal suffering. At 31 weeks, the pregnancy ended owing to intrauterine fetal death (IUFD). The patient delivered a normal-sized male fetus (1800g) with no definite anomalies. A pathological examination led to a diagnosis of placental mesenchymal dysplasia. Conclusion: in the presence of placental ultrasound anomalies with no other sign of fetal suffering, the pregnancy should be considered at risk and, therefore, should be monitored carefully including the option of hospitalization

Prenatal Aneuploidies Computerized Screening (SCA TEST): a pilot study on 1000 women

The SCA-TEST, Prenatal Aneuploidies Screening, is an innovating program with very articulated and differentiated calculation potentials. It is a software which allows executing a sequence-like rational screening involving the ultrasound study of the first and second trimester. The program enables to execute a complete and different- levels combined screening, through very sophisticated mathematic analysis methods. In particular, it enables to make: a first trimester screening combining it with nuchal translucency, and biochemical parameters of free beta-hCG and PAPP-A; a second trimester screening by the evaluation of up to 6 biometric parameters (biparietal diameter, cranial circumferentia, femur, humerus, pyelectasis and plica nucalis), and up to 7 associated morphologic parameters (hyperechogenic bowel, cardiac foci, interventricular defect, pericardial effusion, tricuspid valve regurgitation, right/left heart disproportion, and structural abnormalities). The purpose of the study was to present the performance of the SCA TEST in the second trimester of pregnancy through the evaluation of a prospective study performed in the period between April 2007 and December 2007 on 1000 women who underwent the SCA TEST followed by amniocentesis. Studying all the cardiovascular and non-cardiovascular markers, SCA TEST made it possible to identify 62.5% fetuses affected by Trisomy 21 with a specificity of 94.6%, and a 5.4% of false positive. Considering only women older than 35 years the detection rate reaches 80% with a 7.8% of false positive. The statistical analysis confirmed that the second trimester screening gives essential information regarding the aneuploidia risks in particular in high risk women, and in those who did not perform first trimester screening

Two-dimensional fetal echocardiography: where we are

Congenital Heart Disease (CHD) is the most common severe congenital abnormality in the newborn and the cause of over half the deaths from congenital anomalies in childhood. Prenatal diagnosis, possible as early as 15 weeks of gestation, allows physicians and families the greatest number of therapeutic options, and can improve the postnatal outcome. There are several potential indications for performing such examination. Evaluation of the heart in the setting of restricted fetal growth or fetal distress is often recommended. Whenever extracardiac anomalies are detected during fetal ultrasound examination or in presence of chromosomal abnormalities detected with amniocentesis, cardiac assessment is mandatory. The test should also be performed as part of the assessment of fetal arrhythmias. Finally, whenever congenital heart disease is suspected for other reasons, such as maternal exposure to teratogenic substances or a parental history of previous children with congenital lesions, the examination should be considered

Predictive value of pregnancy-associated plasma protein-A (PAPP-A) and free beta-hCG on fetal growth restriction: results of a prospective study

Purpose Low levels of plasmatic pregnancy-associated plasma protein-A (PAPP-A) and high levels of free-beta human chorionic gonadotropin (beta-hCG) could influence the outcome of pregnancy. The objective of this study is to assess the correlation between PAPP-A and free beta-hCG and birth weight. Materials and methods Prospective follow-up study performed on 3332 patients in the first trimester of pregnancy who were subjected to a screening test focused on evaluation of fetal aneuploidy (SCA-TEST). The values of PAPP-A and free beta-hCG were both analyzed as raw values and subsequently converted to a multiple of the median (MoM). Statistical analysis was performed using SPSS version 17.0.1 (SPSS Inc., Chicago, USA). Results The incidence of ‘‘small for gestational age’’ in patients with PAPP-A MoMst andth ‰ was statistically significant (12 and 9.8 %; p<0.0001). Also statistically significant data have been highlighted about free beta MoM [95th ‰ (7 %; p = 0.03). The values of PAPP-A MoM [99th ‰ are significantly correlated with an increased risk of ‘‘large for gestational age’’ (16.7 %; p<0.0001). Conclusion Our study demonstrates that specific values of PAPP-A and free beta-hCG could identify the risk of low or high birth weight since the first trimester of pregnancy

GAMLSS diagnostic plots.

<p>GAMLSS diagnostic plots.</p

Measurement of the cerebellar vermis height.

<p>Measurement of the cerebellar vermis height.</p

Normal-based mean curve.

<p>95^th and 5^th centile curves across gestational age.</p

Shape-constrained quantile regression (QR).

<p>Estimates for a range of levels of interest and approximate confidence bands (point-wise bands in dark gray, uniform bands in light gray) compared with the standard normal-based fit.</p

Anderson-Darling tests and the associated diagnostic plots.

<p><i>Top left</i>, Box plot of the original measurements. <i>Bottom left</i>, Raw p-values associated with the Anderson-Darling test of normality for the original measurements. <i>Top right</i>, Box plot of the log-transformed data. <i>Bottom right</i>, Raw p-values associated with the Anderson-Darling test of normality for the log-transformed data. The sizes of the circles in the bubble plot are proportional to the numbers of samples (n) available during that week.</p