The role of magnetic resonance imaging in the diagnostic work-up of fetal ventriculomegaly.

The indication for fetal magnetic resonance imaging (MRI) remains a subject of debate, partly because of questions concerning its diagnostic accuracy compared to ultrasound, partly because of practical factors such as accessibility, high costs and available expertise. Most studies advocate an added value for MRI in cases diagnosed with central nervous system pathology. MRI is a good modality to detect small foci of brain hemorrhage, to depict callosal anomalies, to add information about normal and pathological cortical development, and is a more sensitive imaging method to detect white matter pathology.

The fetal respiratory system as target for antenatal therapy.

The widespread use of prenatal ultrasound has made the fetus a patient. A number of conditions diagnosed as such may require therapy prior to birth. Herein we describe past, current and potential future procedures designed to treat pulmonary conditions in the antenatal period.

Prenatal anatomical imaging in fetuses with congenital diaphragmatic hernia.

The role of prenatal ultrasound and magnetic resonance imaging in the diagnosis and management of congenital diaphragmatic hernia (CDH) is reviewed. Topics include morphologic imaging and vascular assessment of the developing lung, the value of imaging parameters as prognostic predictors in CDH and the role of imaging following percutaneous fetoscopic endoluminal tracheal occlusion.

Transplacental transfer of anthracyclines, vinblastine, and 4-hydroxy-cyclophosphamide in a baboon model.

Objective: The paucity of data on the fetal effects of prenatal exposure to chemotherapy prompted us to study transplacental transport of chemotherapeutic agents.

Methods: Fluorouracil-epirubicin-cyclophosphamide (FEC) and doxorubicin-bleomycin-vinblastine-dacarbazine (ABVD) were administered to pregnant baboons. At predefined time points over the first 25 h after drug administration, fetal and maternal blood samples, amniotic fluid (AF), urine, fetal and maternal tissues, and cerebrospinal fluid (CSF) were collected.

The Fetal Heart in Twin-to-Twin Transfusion Syndrome.

Twin-to-twin transfusion syndrome is a severe complication occurring in 10% of monochorionic twin pregnancies. The disease is usually explained as due to an intrauterine imbalance in intertwin blood exchange, which leads to a volume depleted-donor twin and an overfilled recipient twin. The recipient has signs of cardiac dysfunction, which can be measured using echocardiography or blood and amniotic fluid derived biomarkers.

Maternal hyperoxygenation test in fetuses undergoing FETO for severe isolated congenital diaphragmatic hernia.

Objectives: To predict neonatal survival and pulmonary hypertension by measurement of fetal pulmonary artery reactivity to maternal hyperoxygenation in fetuses with severe congenital diaphragmatic hernia treated by fetoscopic endoluminal tracheal occlusion (FETO).

Methods: Thirty-eight fetuses underwent FETO at around 28 weeks' gestation and the balloon was removed at 34 weeks in most cases. We performed a hyperoxygenation test and measured the lung-to-head ratio of each fetus before and after each procedure.

Clinical and ultrasound work-up and follow-up of preeclampsia.

Hypertensive disorders are frequent during pregnancy and are related with an important morbidity and mortality worldwide. In this review we aim to provide the reader with a comprehensive overview of the clinical aspects of and the diagnostic tools used in the primary assessment and the (long term) follow-up of preeclampsia. The focus in this review will lay on the clinical follow-up of both the mother and the fetus aiming at the prevention of severe maternal complications as well as preventing growth restriction and prematurity in the child.

Monochorionic diamniotic twin pregnancies: natural history and risk stratification.

About 30% of monochorionic twin pregnancies are complicated by twin-to-twin transfusion syndrome (TTTS), isolated discordant growth, twin anemia-polycythemia sequence, congenital defects or intrauterine demise. About 15% will be eligible for invasive fetal therapy, either fetoscopic laser treatment for TTTS or fetoscopic or ultrasound-guided umbilical cord coagulation for a severe congenital defect in one twin or severe discordant growth with imminent demise of the growth-restricted twin. Ultrasound examination in the first and early second trimester can differentiate the monochorionic twins at high risk for adverse outcome from those likely to be uneventful, which may be useful for patient counselling and planning of care.

Spontaneous hepatic rupture in a normotensive monoamniotic twin pregnancy: case report and review of the literature.

Background: Spontaneous liver rupture during pregnancy is extremely rare, and often associated with hypertensive disorders. Maternal outcomes are poor and morbidity is high.

Case: A 27-year-old women (G1P0), pregnant with monochorionic-monoamniotic twins, developed extensive abdominal pain while she was electively admitted at 32 weeks for fetal pulmonary maturation.

Randomised experimental comparison of 23G versus 22G needle for ultrasound guided invasive fetal procedures.

Objectives: To experimentally compare the standard 22G spinal needle with a newer 23G needle with specific ultrasound visualisation tip (Cook echotip®, Spencer, Indiana, USA) in the setting of ultrasound-guided invasive intrauterine procedures.

Materials And Methods: We first determined the size of the defects created in human fetal membranes using light microscopy and adapted area calculating software by both needles in an in vitro model performing 20 paired experiments on 4 term membrane specimens. Secondly, we determined the performance of 3 groups of operators, with different levels of experience in invasive intrauterine procedures during cordocentesis on a simulator model, using either a 22G or 23G needle.

Pregnancies complicated by obesity: clinical approach and nutritional management.

This PhD thesis indicated by a literature review and a prospective study that maternal obesity is associated with serious complications for both mother and child. This is a problem since already 9% of the pregnant women at the antenatal department of the University Hospital Leuven was obese during 2006. A prospective study with 142 women showed that maternal obesity is also associated with a lower diet quality during pregnancy compared to normal weight pregnant women.

Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial.

Background: Maternal obesity and excessive gestational weight gain (GWG) are major short- and long-term risk factors for maternal and fetal complications.

Objective: The objective was to study whether a lifestyle intervention based on a brochure or on active education can improve dietary habits, increase physical activity (PA), and reduce GWG in obese pregnant women.

Design: In this randomized controlled trial, 195 white, obese pregnant women [age: 29 + or - 4 y; body mass index (in kg/m(2)); 33.

Fetal surgery is a clinical reality.

An increasing number of fetal anomalies are being diagnosed prior to birth, some of them amenable to fetal surgical intervention. We discuss the current clinical status and recent advances in endoscopic and open surgical interventions. In Europe, fetoscopic interventions are widely embraced, whereas the uptake of open fetal surgery is much less.

Gestational age-dependent repair kinetics of microsurgical defects in monolayers of human amniocytes.

Objectives: There is paucity of data on the capacity of fetal membranes to repair surgical defects following trauma. We aimed at developing an in vitro model using monolayers of human amnion epithelial cells to study fetal membrane healing.

Methods: Term (n = 6) and preterm (n = 3) fetal membranes were collected at caesarean section.

Construction of weight gain charts in a low-risk obstetric Belgian population.

Aim: To generate reference charts for weight gain during pregnancy for the different BMI categories (underweight, normal weight, overweight, obesity), based on recent data in a homogeneous, Caucasian, low-risk obstetric population.

Methods: Weight gain and prepregnancy BMI were retrospectively gathered from 605 pregnant Belgian women with accurately dateable, uncomplicated singleton pregnancies. Percentile curves for the different BMI categories were constructed using the linear mixed model, based on absolute weight gain.

Therapy for foetal pericardial tumours: survival following in utero shunting, and literature review.

We report the first case of foetal pericardial teratoma, treated successfully in utero by pericardio-amniotic shunting, and review the relevant literature. Foetal treatment improves survival in case of hydrops. Foetal pericardio-amniotic shunting could possibly be an alternative to serial pericardiocentesis.

Comparison of transabdominal versus transvaginal ultrasound to measure thickness of the lower uterine segment at term.

Objective: To compare the accuracy of transvaginal (TVS) versus transabdominal (TAS) ultrasound to assess the thickness of the lower uterine segment (LUS).

Methods: Eighty-three pregnant women admitted for an elective cesarean delivery were enrolled. LUS thickness was measured using both TVS and TAS prior to the cesarean.

Sonographic biometrical normograms and estimation of fetal weight in the baboon (Papio anubis).

Background: In order to consider the non-human primate as an adequate model for studying prenatal diagnosis and therapy, comparative data on fetal growth should be available.

Methods: Sixty ultrasound scans were performed in 22 baboons between 14 and 167 days of gestation.

Measurements: included greatest length, head circumference, biparietal diameter (BPD), transcerebellar diameter, abdominal circumference (AC), femur length (FL), and amniotic fluid index.

Maternal bariatric surgery: adverse outcomes in neonates.

Background: The obesity epidemic in developed countries has led to an increased prevalence of obese women of reproductive age. As maternal obesity has far-reaching consequences for both mother and child, the consensus is that weight loss before pregnancy will reduce obesity-related morbidity and mortality. Therefore, an increasing number of women become pregnant after undergoing obesity surgery.

Effects of epidural clonidine and neostigmine following intrathecal labour analgesia: a randomised, double-blind, placebo-controlled trial.

Background: The limited duration of spinal labour analgesia combined with problems associated with maintenance of epidural analgesia, have prompted the search for combinations that could prolong spinal analgesia. A randomised, double-blind trial was carried out to test the hypotheses (a) that initial spinal labour analgesia is prolonged by administering clonidine and neostigmine epidurally whilst (b) the hourly local anaesthetic consumption is reduced.

Methods: Seventy labouring patients received spinal analgesia with ropivacaine and sufentanil.

[Antenatal prediction of pulmonary hypoplasia and intrauterine treatment by endoscopic fetal tracheal occlusion in severe isolated congenital diaphragmatic hernia].

Congenital diaphragmatic hernia (CDH) affects one in 2500 to 5000 births and can be detected in utero by means of ultrasound screening Associated structural problems aggravate the prognosis. The survival rate is 70% or more for cases managed in tertiary care centers. The commonest causes of neonatal death in this setting are pulmonary hypoplasia and pulmonary hypertension.

Premature foetal closure of the arterial duct: clinical presentations and outcome.

Aims: The prevalence of intra-uterine ductal dysfunction is unknown and the clinical consequences are poorly understood. The aim of this study was to investigate the echocardiographic (ECHO) abnormalities and outcomes of this rare phenomenon.

Methods And Results: Retrospective analysis of foetal (n = 602) and neonatal ECHO databases (n = 1477) between 1998 and 2007.

Cefazolin plasma protein binding saturability during pregnancy.

This article aims to document cefazolin (CFZ) plasma binding and its covariates during pregnancy and compare these observations with previously reported observations in nonpregnant adults. Maternal CFZ plasma samples were collected during in utero surgery. The unbound CFZ fraction was reported by median and range.