Preventing preterm birth with progesterone: costs and effects of screening low risk women with a singleton pregnancy for short cervical length, the Triple P study.

Background: Women with a short cervical length in mid-trimester pregnancy have a higher risk of preterm birth and therefore a higher rate of neonatal mortality and morbidity. Progesterone can potentially decrease the number of preterm births and lower neonatal mortality and morbidity. Previous studies showed good results of progesterone in women with either a history of preterm birth or a short cervix.

Erroneous production of PAPP-A kits: the impact of a downward shift in PAPP-A concentration on the test performance of first-trimester combined screening for Down syndrome.

Objective: To evaluate a 20% downward shift in the pregnancy-associated plasma protein A (PAPP-A) concentration on the test performance of first-trimester combined screening (FTS) for Down syndrome (DS) following a flaw in the production of PAPP-A kits on FTS for DS.

Methods: A retrospective re-evaluation of PAPP-A in stored sera. Inclusion criteria were a maternal weight-corrected PAPP-A multiple of the median value ≥ 0.

Ethnic differences in participation in prenatal screening for Down syndrome: a register-based study.

Objective: To assess ethnic differences in participation in prenatal screening for Down syndrome in the Netherlands.

Methods: Participation in prenatal screening was assessed for the period 1 January 2009 to 1 July 2009 in a defined postal code area in the southwest of the Netherlands. Data on ethnic origin, socio-economic background and age of participants in prenatal screening were obtained from the Medical Diagnostic Centre and the Department of Clinical Genetics.

Anaphylactic shock to fresh-frozen plasma inactivated with methylene blue.

Background: Methylene blue allergy is a well-known entity associated with food or lymph node location. Inactivation of viruses by methylene blue in fresh-frozen plasma (FFP-MB) has been recently introduced in France after many years of use in other parts of Europe.

Case Report: We describe here two anaphylactic shock reactions occurring during FFP-MB infusion in patients after cardiac surgery.

Estimating the effect of gestational age on test performance of combined first-trimester screening for Down syndrome: a preliminary study.

Objective: To establish how different methods of estimating gestational age (GA) affect reliability of first-trimester screening for Down syndrome.

Methods: Retrospective single-center study of 100 women with a viable singleton pregnancy, who had first-trimester screening. We calculated multiples of the median (MoM) for maternal-serum free beta human chorionic gonadotropin (free beta-hCG) and pregnancy associated plasma protein-A (PAPP-A), derived from either last menstrual period (LMP) or ultrasound-dating scans.

Congenital diaphragmatic hernia associated with duplication of 11q23-qter.

Congenital diaphragmatic hernia (CDH) is a relatively common birth defect with a high mortality. Although little is known about its etiology, there is increasing evidence for a strong genetic contribution. Both numerical and structural chromosomal abnormalities have been described in patients with CDH.

Prenatal prediction of survival in isolated left-sided diaphragmatic hernia.

Objective: To investigate the potential value of antenatally determined intrathoracic herniation of the liver and the ratio of fetal lung area to head circumference (LHR) in the prediction of postnatal survival in isolated, left-sided congenital diaphragmatic hernia (CDH).

Methods: In this multicenter study, we searched the antenatal-CDH-Registry for fetuses with isolated left-sided CDH that were liveborn after 30 weeks of gestation and were followed up postnatally for at least 3 months after discharge from hospital. The patients were subdivided into those with and those without intrathoracic herniation of the liver and into subgroups according to the LHR that had been measured between 22 + 0 and 28 + 0 weeks of gestation.

T cell-mediated reactions to iodinated contrast media: evaluation by skin and lymphocyte activation tests.

Background: In addition to immediate reactions, late adverse reactions to iodinated contrast media (ICM) were reported in 2% to 5% of patients exposed to ICM and, as a consequence, have recently gained more attention. A few well-documented case reports postulate a hypersensitivity mechanism.

Objective: The aim of this study is to demonstrate a T cell-mediated mechanism to the ICM by using in vitro and ex vivo tests.

[Prenatal investigations for Down's syndrome: medical-technical considerations and dilemmas arising from current screening methods].

Prenatal investigations can be divided into specific diagnostic investigations i.e. chorionic villus sampling, amniocentesis and selective ultrasonography for the detection of fetal abnormality, and screening tests which estimate the chances of the condition being present.

Congenital diaphragmatic hernia: an evaluation of the prognostic value of the lung-to-head ratio and other prenatal parameters.

Objectives: A retrospective analysis of the prognostic significance of the lung-to-head ratio (LHR) and other prenatal parameters on the outcome of fetuses with left-sided congenital diaphragmatic hernia (CDH).

Methods: A total of 26 fetuses with isolated left CDH without chromosomal abnormalities were included. Twenty-one LHR measurements could retrospectively be calculated from the last available ultrasonographic recordings before birth.

Three-dimensional US assessment of hepatic volume, head circumference, and abdominal circumference in healthy and growth-restricted fetuses.

Purpose: To establish reproducibility and normal values for fetal hepatic volume and its significance in identification of fetal growth restriction relative to head and upper abdominal circumferences according to a cross-sectional study design.

Materials And Methods: Pregnant women (n = 135) underwent ultrasonography. The coefficient of variation (CV) for hepatic volume scans obtained at 0 and 20 minutes and hepatic area tracings, performed twice for each scan, was determined (n = 20; range, 23-36 weeks).

Prenatal prediction of pulmonary hypoplasia: clinical, biometric, and Doppler velocity correlates.

Objectives: To determine the value of pulmonary artery Doppler velocimetry relative to fetal biometric indices and clinical correlates in the prenatal prediction of lethal lung hypoplasia (LH) in prolonged (>1 week) oligohydramnios.

Methods: Forty-two singleton pregnancies with oligohydramnios associated with premature rupture of membranes ([PROM]; n = 31) or bilateral renal pathology (n = 11) were examined using color-coded Doppler ultrasound in a cross-sectional study design. Mean gestational age was 28.

The fetal lung. 2: Pulmonary hypoplasia.

This review describes the pathogenesis of pulmonary hypoplasia and highlights its clinical, radiological and pathologic features, with emphasis on oligohydramnios-related pulmonary hypoplasia. Since pulmonary hypoplasia may lead to severe respiratory distress immediately after birth and even to neonatal death, an accurate and patient-friendly prenatal test for early detection and distinction between lethal and non-lethal pulmonary hypoplasia is still highly desirable. An extended overview of the proposed methods for the prenatal prediction of pulmonary hypoplasia is presented.

The fetal lung. 1: Developmental aspects.

A literature survey is presented on normal fetal development during the embryonic, pseudoglandular, canalicular, saccular and alveolar stages in the human fetus. Normal anatomical and physiological aspects of fetal lung development including the fetal pulmonary circulation are described. Factors which may influence fetal lung growth and consequently may play a role in the development of pulmonary hypoplasia are discussed, such as intrauterine and intrathoracic space, lung fluid, fetal breathing movements, normal balance of volume and pressure in the lung and interference with the blood supply.

Human fetal pulmonary artery velocimetry: repeatability and normal values with emphasis on middle and distal pulmonary vessels.

Objectives: To establish the nature and gestational age dependency of flow velocity waveforms from fetal middle and distal arterial pulmonary branches in the second half of normal pregnancy and to determine repeatability and inter-relationship of flow velocity waveform recordings from proximal, middle and distal arterial pulmonary branches.

Design: Cross-sectional study.

Subjects/methods: A total of 111 singleton normal pregnancies between 20 and 40 weeks of gestation were studied using a color-coded Doppler ultrasound system.

Doppler velocimetry of normal human fetal venous intrapulmonary branches.

Objectives: To describe the nature of flow velocity waveforms from fetal middle and distal venous pulmonary branches in the second half of normal pregnancy in relation to gestation, and to test repeatability and interrelationships of flow velocity waveform recordings from proximal, middle and distal venous pulmonary branches.

Design: Cross-sectional study.

Subjects/methods: A total of 111 normal singleton pregnancies between 20 and 40 weeks' gestation were studied using a color-coded Doppler ultrasound system.

Periconceptional use of folic acid amongst women of advanced maternal age.

Between February 1994 and February 1997 a group of 881 women completed a questionnaire on the use of folic acid. During the study period the percentage of women who had been informed about the benefits of folic acid rose from 41 per cent to 90 per cent and the percentage taking supplementation rose from 18 per cent to 60 per cent. Nevertheless, few women used folic acid at the right time and dose and although 90 per cent would have been willing to follow recommendations, correct use did not exceed 25 per cent.

Fetal pulmonary venous flow into the left atrium relative to diastolic and systolic cardiac time intervals.

Objective: To establish the nature and gestational age dependency of the pulmonary venous flow velocity pattern into the left atrium relative to systolic and diastolic phases of the cardiac cycle.

Design: This was a cross-sectional study of Doppler measurements of fetal pulmonary venous inflow velocities, which were correlated with simultaneous recordings of transmitral and aortic flow velocity waveforms based on an equal cardiac cycle length (+/- 5%).

Results: Successful recordings were obtained in 28 out of 60 (47%) normal singleton pregnancies at 20-36 weeks of gestation.

Behavior-state-dependent changes in human fetal pulmonary blood flow velocity waveforms.

Objective: To establish the influence of fetal behavior states on venous and arterial pulmonary blood flow velocity waveforms in the normally developing term fetus.

Methods: The relation between venous and arterial pulmonary blood flow velocity waveforms and fetal behavior states was investigated in 18 normal term fetuses. Recordings of the venous pulmonary blood flow velocity waveforms were obtained just proximal to the entrance in the left atrium, and the arterial pulmonary blood flow velocity waveforms were taken from the most proximal branch of the pulmonary artery in the same lung using color Doppler imaging.

Fetal liver volume measurement by three-dimensional ultrasonography: a preliminary study.

Objective: To establish the application of three-dimensional ultrasonography in measuring fetal liver volume during the second half of normal pregnancy.

Design: A prospective cross-sectional study of normal fetal liver volume at 19-39 weeks of gestation (median 29 weeks).

Subjects: Thirty-four non-smoking women with a singleton pregnancy resulting in the delivery of a healthy infant with a birth weight between the 5th and 95th centiles according to the Kloosterman tables adjusted for maternal parity and fetal sex.

Early transvaginal ultrasonographic diagnosis of Beemer-Langer dysplasia: a report of two cases.

The early second-trimester sonographic diagnosis of two infants with short rib (polydactyly) dysplasia type IV (Beemer-Langer dysplasia) is presented. In addition to short ribs, this syndrome is characterized by short limbs with or without polydactyly. There are often associated defects, particularly neural-tube anomalies.

Three-dimensional ultrasonography of normal fetal lung volume: a preliminary study.

The objective of this preliminary study was to evaluate three-dimensional ultrasonographic lung volume measurement in the normally developing fetus in the second half of pregnancy. Total fetal lung volume was determined by subtraction of fetal heart volume from thoracic volume, using the perpendicular transverse, sagittal and frontal planes of the fetus. Technically acceptable lung volume measurements were obtained in 29 out of 34 women with an uncomplicated pregnancy.

Doppler velocimetry in branch pulmonary arteries of normal human fetuses during the second half of gestation.

The objective of the present study was to determine the characteristics of Doppler flow velocity wave forms in branch pulmonary arteries in relation to gestational age. A total of 111 singleton normal pregnancies were studied during the second half of pregnancy using a combined color-coded Doppler and two-dimensional real-time ultrasound system. Pulsed Doppler measurements of the most proximal branch of the right or left pulmonary artery were attempted during fetal apnea from a transverse cross-section of the fetal chest at the level of the cardiac four-chamber view after visualization with color Doppler.