Precise mid-trimester placenta localisation: does it predict adverse outcomes?

Background: A low-lying placenta detected at the mid-pregnancy ultrasound is commonly reported to warn against potential morbidity associated with placenta praevia. There is no information on what distance away from the internal cervical os is safe.

Aims: We examined whether a low-lying placenta not overlapping the cervical os in the second trimester increases the risk of obstetric complications and whether there is a cut-off point at which that increase occurs.

Biliary infections: spectrum of imaging findings and management.

Infectious cholangitides encompass a wide spectrum of infectious processes affecting the biliary tree. They can have protean clinical and imaging appearances. Some manifest as an acute medical emergency with high mortality if not properly and emergently managed.

Trends in state/population-based Down syndrome screening and invasive prenatal testing with the introduction of first-trimester combined Down syndrome screening, South Australia, 1995-2005.

Objective: The purpose of this study was to review trends in the us of maternal serum Down syndrome screening and invasive prenatal testing before and after the introduction of a state-based first-trimester combined Down syndrome screening program.

Study Design: A retrospective population-based study was performed on first- and second-trimester Down syndrome screening, invasive prenatal testing, and prenatal detection of Down syndrome from 1995 to 2005 in South Australia with data from state-based registers. Chi-square tests were used to evaluate trends.

Circulating angiogenic factors and abnormal uterine artery Doppler velocimetry in the second trimester.

Objective: Circulating angiogenic growth factors (such as vascular endothelial growth factor [VEGF] and placental growth factor [PlGF]) and their interaction may be associated with vascular remodeling of spiral arteries in normal pregnancy. Soluble Flt-1, an antagonist of both VEGF and PlGF, has been shown to be increased, while PlGF is decreased in women prior to the onset of preeclampsia. The purpose of this study was to compare maternal soluble Flt-1 and PlGF levels in the second trimester with a marker of abnormal placentation, abnormal uterine artery Doppler (UAD).

Utility of fetal echocardiogram in high-risk patients.

Aim: Patients at high risk of fetal congenital heart disease are commonly referred for second trimester fetal echocardiogram. The objective of this study was to evaluate the utility of routine fetal echocardiogram in high-risk patients after the evaluation of the four-chamber/left ventricular outflow tract (LVOT) views during comprehensive second trimester anatomy ultrasound.

Methods: Second trimester comprehensive anatomy ultrasounds, which included a four-chamber/LVOT view, and subsequent fetal echocardiograms carried out at the Duke University Medical Center from January 1995 and July 2002 were reviewed.

Pregnancy with prolonged fetal exposure to an angiotensin-converting enzyme inhibitor.

Maternal exposure to angiotensin-converting enzyme (ACE) inhibitors has consistently been associated with significant fetal toxicity. We report the case of a 24-year-old woman, gravida 3, para 1-0-1-1 who presented at 24 2/7 weeks' gestation with initial abnormal fetal sonographic findings, including severe oligohydramnios, misshapen cranium, pericardial effusion, small bladder, and echogenic bowel, all after prolonged exposure to multiple medications including an ACE inhibitor. Eighteen days after discontinuation of the ACE inhibitor, repeat fetal sonography revealed normal amniotic fluid and normal cranial and fetal anatomy.