Obstetrics

Germinal matrix-intraventricular haemorrhage and subsequent post-haemorrhagic ventricular dilatation (PHVD) are frequently encountered complications in preterm neonates. As progressive dilatation of the lateral ventricles may be associated with elevated intracranial pressure, ultrasound measurements of ventricular size play a major role in the evaluation of neonates at risk of ventricular dilatation as well as in assessing the effect of intervention for PHVD. A systematic search was carried out in Medline and Embase to identify neonatal and foetal ultrasound studies on lateral ventricular size. This review presents an overview of the available data concerning neonatal reference values for lateral ventricular size, the influence of gender, ventricular asymmetry and the effect of the mode of delivery on the phenomenon of ventricular reopening following birth.Conclusion:  Serial cranial ultrasound measurements of the lateral ventricles play a key role in the early recognition and therapeutic evaluation of post-haemorrhagic ventricular dilation and can be of prognostic value in neonates with ventricular dilatation.

Chiari’s network is a remnant of the eustachian valve located in the right atrium. Incomplete involution of the fetal sinus venosus valves results in “redundant” Chiari’s network, which may compromise cardiovascular function. This report describes a case with the novel finding of prenatal compromise due to redundant Chiari’s network and an uncommon case with significant postnatal symptoms. In both cases, the symptoms (fetal hydrops and postnatal cyanosis) resolved spontaneously. The variety of cardiovascular pathologies described in the literature is believed to be associated with persistence of a Chiari network. Knowledge about this not always harmless structure is important for perinatologists, pediatricians, and pediatric cardiologists alike. The clinical importance of this rare pathology is that prenatal counseling may anticipate a generally positive outcome and that surgical intervention generally should be avoided.Electronic supplementary materialThe online version of this article (doi:10.1007/s00246-011-0114-6) contains supplementary material, which is available to authorized users.

Abstract A cross sectional study was undertaken to examine the relationship between coeliac disease and bone mineral density. The 135 female coeliac patients registered on the database of the Department of Gastroenterology at Hull Royal Infirmary were approached by letter, advising them of a potential risk of osteoporosis and inviting them to undergo bone densitometry.

Methods. Fetal weight estimation, placental maturity grading, and amniocentesis were performed. The investigators examined the amniotic fluid visually, and performed the tap test and shake test. Laboratory technicians estimated the lecithin-sphingomyelin (L/S) ratio, determined the presence of a phosphatidyl glycerol (PG) band on gel electrophoresis, and the optical density at 650 nm. Neonates delivered within 1 week of amniocentesis were included in the analysis.

Background: Malaria in pregnancy has a negative impact on foetal growth, but it is not known whether this also affects the foetal nervous system. The aim of this study was to examine the effects of malaria on foetal cortex development by three-dimensional ultrasound. Methods: Brain images were acquired using a portable ultrasound machine and a 3D ultrasound transducer. All recordings were analysed, blinded to clinical data, using the 4D view software package. The foetal supra-tentorial brain volume was determined and cortical development was qualitatively followed by scoring the appearance and development of six sulci. Multilevel analysis was used to study brain volume and cortical development in individual foetuses. Results: Cortical grading was possible in 161 out of 223 (72%) serial foetal brain images in pregnant women living in a malaria endemic area. There was no difference between foetal cortical development or brain volumes at any time in pregnancy between women with immediately treated malaria infections and non-infected pregnancies. Conclusion: The percentage of images that could be graded was similar to other neuro-sonographic studies. Maternal malaria does not have a gross effect on foetal brain development, at least in this population, which had access to early detection and effective treatment of malaria.

The past decades have seen enormous progress in the ability to visualize the developing fetal and embryonic central nervous system (CNS) with ultrasound (US) and MRI (magnetic resonance imaging). The purpose of this article is to provide a review of the available literature, and to detail some recent research into the topic.

Objectives To assess the additional value of fetal multiplanar (axial, coronal and sagittal) neurosonography and Magnetic Resonance Imaging (MRI) to axial ultrasound (US) planes to diagnose brain damage (visualized as periventricular echogenicity changes (PVE), intraventricular haemorrhage (IVH) and echogenicities in basal ganglia and/or thalami (BGTE)) and signal intensity changes in the equivalent brain areas on MRI in fetuses at high risk. Methods A prospective, multicenter, observational study. Women eligible for participation were those where the fetus was at risk factor for acquired brain anomalies (congenital infection, fetal growth restriction, trauma during pregnancy, monochorionic twins). Examinations before birth were the following: axial US and advanced neurosonography biweekly; MRI of the brain once. After birth: brain US <24h and at term equivalent age. Brain MRI once at term equivalent age. An expert panel, blinded for medical history, evaluated the presence of PVE, PIVH and BGTE on US and (the equivalent) signal intensity changes on MRI. Scores were generated by consensus. The children were followed with examinations for psychomotor development at one year of age by means of Touwen examination and Alberta Infant Motor Scale and Bayley Scale of Infant Development-III, behavioural, sensory profile and linguistic questionnaires at two years of age; scores <-1 SD were considered suspect. Results 56 fetuses were examined and in 39/56 fetuses all fetal imaging modalities were present. PVE was encountered in 6/39, 18/39 and 2/39 fetuses on axial US planes, neurosonography and MRI examinations, respectively. PIVH was found in 3/39; 10/39 and 1/39; and BGTE in none of 39; 6/39 and none of 39 examinations, respectively. Neurodevelopmental outcome was suspect in 8/50 infants at one year, and 41/41 children had scores >-1 SD on BSID-III, 20 children had scores <-1 SD on the behavioural (5/38), sensory profile (17/37) and/or linguistic (6/39) questionnaires at two years of age.

or lethal complex cardiac or extracardiac anomaly (71 vs. 15%, p <0.001). Conclusion: Parents opted for termination of pregnancy significantly more often in cases with high complex cardiac and extracardiac malformations. It was rare for parents to opt for pregnancy termination in the absence of a severe cardiac or extracardiac malformation.

Objective: The copper sulfate method of screening for anemia was evaluated to determine its accuracy in antenatal patients. Method: In an antenatal clinic in a tertiary referral center, which also serves a local urban black community, 100 antenatal patients were prospectively tested for anemia by Coulter hemoglobin analysis in comparison with the copper sulfate test. The respective accuracy and costs of the tests were evaluated. Results: Once initial technical difftculties had been overcome, the copper sulfate test proved accurate in detecting a hemoglobin level < 10 g% in pregnancy (sensitivity 94%, specificity 95%, positive predictive value 80%, negative predictive value 99%). The cost of the copper sulfate test is estimated to be less than 0.3% that of the Coulter test. Conclusion: The copper sulfate test is accurate and inexpensive, and can be recommended for screening for anemia in pregnancy.

BNP levels after birth in SGA infants, but not in AGA infants (SGA: MCA-PI = r 2 0.23, p < 0.05; UA-PI = r 2 0.46, p < 0.01; DV-PIV = r 2 0.31, p < 0.05). Furthermore, signs of perinatal (chronic) asphyxia coincided with elevated levels of BNP. SGA was related to more postnatal cardiocirculatory complications. No significant relations between postnatal cardiac ultrasound measurements, placenta size and BNP were found. Conclusion: BNP levels were elevated early after birth in SGA infants and corresponded positively with Doppler indices of circulatory compromise. This suggests an increased workload of the myocardium.

Objectives Recent studies have shown the capability of ultrasound to demonstrate fetal cortical development. For practical application, it would be useful to have more insight into the physiological progress of cortical folding. A longitudinal study was undertaken to grade fetal cortical development and to study physiological asymmetry by means of a simple scoring system. The reproducibility of the scoring system and the differences between twodimensional (2D) and three-dimensional (3D) ultrasound were also examined. Methods A cohort of 28 patients was examined by 2D and 3D ultrasound from 20 to 40 weeks of gestation. The development of selected fissures, sulci and cortical areas were graded from 0 to 5. One examination per week of gestation was randomly selected for evaluation of intraobserver and interobserver variation. Results Two-hundred and fifteen ultrasound examinations were performed in 28 patients. The development of the different cortical areas is presented. The intraobserver and interobserver agreement for assessment of grade was good. Asymmetry was common between 24 and 28 weeks, especially in female fetuses. The right parieto-occipital fissure tended to be more advanced and the left calcarine and cingulate sulci tended to be more advanced. No clinically or statistically significant differences were found between 2D and 3D ultrasound. Conclusions Evaluation of cortical development by means of a simple scoring system is feasible and reproducible. Asymmetrical development of sulci, previously only described in vitro, has now also been demonstrated in vivo. 3D ultrasound was equally accurate and repeatable and no more time consuming than 2D ultrasound.

Short oral presentation abstracts Methods: Conventional three dimensional acquisition of volumes permits multiplanar analysis in three orthogonal straight planes. Newer software permits analysis of curved or irregular sections along any plane. This was a prospective study which included second trimester pregnancies referred to a tertiary centre for one of the following indications: a malformation diagnosed elsewhere, a previous history of a malformation, exposure to known teratogens, maternal diabetes mellitus, evidence of an intra-uterine infection, a bad obstetric history, abnormal liquor volume and early onset growth restriction. Each patient was evaluated by a detailed twodimensional anomalies scan, three dimensional volume acquisition of the cranium, face, spine, thorax, abdomen and limbs, biometry, and, an amniotic fluid index. Straight orthogonal and curvilinear non-orthogonal evaluation of all regions was carried out. Ultrasound data was noted and archived. Follow up included detailed gross examination of abortuses/infants, neonatal records and autopsy notes. Results: 1000 pregnancies were included in the study and complete follow up data was possible in 902 patients. The mean gestational age was 19 weeks (13-26 weeks). Conventional three dimensional analysis yielded additional information on anomalies of the cranium and face in 42 cases and curvilinear non-orthogonal plane analysis yielded additional information in another 13 cases. Time taken for analysis was considerably less using the newer technique. There were two false positives in the former group and none in the latter. Conclusions: Non-orthogonal curvilinear three dimensional ultrasound increases the efficiency and accuracy of assessing cranio-facial anomalies in an at-risk population.