Isolated single umbilical artery and fetal karyotype.

Objective: To determine the need for fetal karyotyping in cases of an isolated single umbilical artery (SUA) identified during the second-trimester routine anomaly scan.

Methods: All patients booked for antenatal care and delivery in our hospital are offered two ultrasound scans in pregnancy, one at 11-13 weeks' gestation as part of screening for chromosomal defects and another at 20-23 weeks for detailed fetal examination. In addition we examine patients referred from other hospitals because of suspected fetal abnormalities during their routine second-trimester scan.

Isolated single umbilical artery: need for specialist fetal echocardiography?

Objective: To examine the association between single umbilical artery (SUA) and cardiac defects and to determine whether patients with SUA require specialist fetal echocardiography.

Methods: Incidence and type of cardiac defects were determined in fetuses with SUA detected at routine second-trimester ultrasound examination.

Results: A routine second-trimester scan was performed in 46 272 singleton pregnancies at a median gestation of 22 (range, 18-25) weeks and an SUA was diagnosed in 246 (0.

Outcome of pregnancy in sickle cell disease patients attending a combined obstetric and haematology clinic.

This study aims to determine the pregnancy outcomes in women attending the combined obstetric sickle cell clinic at King's College Hospital, London from June 2000 to July 2006. There were 71 pregnancies in 65 women with sickle cell disease. Sickle crisis requiring admission occurred in 47% of the antenatal patients.

Prediction of pre-eclampsia by a combination of maternal history, uterine artery Doppler and mean arterial pressure.

Objectives: To determine the value of combined screening for pre-eclampsia by maternal history, and mid-trimester uterine artery (UtA) Doppler imaging and maternal blood pressure.

Methods: In 3529 singleton pregnancies attending for routine care at 22-24 weeks' gestation we recorded maternal variables, and made UtA Doppler and mean arterial pressure (MAP) measurements. Multiple regression analysis was used to determine the significant predictors of pre-eclampsia, gestational hypertension and small-for-gestational age (SGA) among maternal characteristics, UtA pulsatility index (PI) and MAP.

Prediction of pre-eclampsia by uterine artery Doppler imaging: relationship to gestational age at delivery and small-for-gestational age.

Objectives: To determine the relationship between pre-eclampsia, small-for-gestational age (SGA) and gestational age at delivery, and the effect of this relationship on the prediction of pre-eclampsia by uterine artery Doppler imaging.

Methods: This was a multicenter prospective Doppler study of the uterine artery at 22-24 weeks of gestation in unselected women with singleton pregnancies.

Results: In the 30,639 pregnancies examined, the median uterine artery pulsatility index (PI) was 1.

Choroid plexus cyst, intracardiac echogenic focus, hyperechogenic bowel and hydronephrosis in screening for trisomy 21 at 11 + 0 to 13 + 6 weeks.

Objectives: To investigate the potential value of choroid plexus cyst, intracardiac echogenic focus, hydronephrosis and hyperechogenic bowel as markers of trisomy 21 at 11 + 0 to 13 + 6 weeks.

Methods: We examined three-dimensional volumes from 228 fetuses with trisomy 21 and 797 chromosomally normal fetuses at 11 + 0 to 13 + 6 weeks of gestation. We looked for choroid plexus cysts with a minimum diameter of 1.

The mitral gap at 11 + 0 to 13 + 6 weeks: marker of trisomy 21 or artifact?

Objectives: To investigate the possible association between a particular pulsed Doppler waveform pattern, mitral gap, and trisomy 21 at 11 + 0 to 13 + 6 weeks.

Methods: We performed two studies. The first was a retrospective analysis of pulsed Doppler velocity waveforms of the mitral valve inflow, recorded during specialist fetal echocardiography in 291 chromosomally normal and 144 trisomy 21 fetuses with a nuchal translucency (NT) thickness of 3.

Dose dependency between cigarette consumption and reduced maternal serum PAPP-A levels at 11-13+6 weeks of gestation.

Objective: To examine whether in smokers there is a significant dose dependency between the number of cigarettes per day and levels of free ss-hCG and pregnancy-associated plasma protein A (PAPP-A) at 11-13(+6) weeks of gestation.

Methods: This was a retrospective analysis of the maternal serum free ss-hCG and PAPP-A levels in relation to the maternal smoking status in 109 263 chromosomally normal singleton pregnancies that had undergone first-trimester screening for Down syndrome by a combination of fetal nuchal translucency thickness and maternal serum biochemistry.

Results: There were 95 287 nonsmokers and 13 976 cigarette smokers.

Frontomaxillary facial angle at 11 + 0 to 13 + 6 weeks: effect of plane of acquisition.

Objective: To determine the range of positions of the fetal head in which a three-dimensional (3D) volume is acquired for subsequent successful assessment of the frontomaxillary facial (FMF) angle.

Method: We obtained 3D volumes of the fetal head at 11 + 0 to 13 + 6 weeks. The volumes were acquired with the head in different positions and reconstructed to obtain a mid-sagittal section and demonstrate the maxilla, palate and frontal bone, which constitute the landmarks for the assessment of the FMF angle.

Assessment of the corpus callosum at 20-24 weeks' gestation by three-dimensional ultrasound examination.

Objectives: To determine the range of positions of the fetal head in which a three-dimensional (3D) volume is acquired for subsequent successful imaging of the corpus callosum.

Methods: We used 3D volumes of the fetal head obtained from singleton pregnancies at 20 to 23 + 6 weeks' gestation. The volumes, which had been acquired with the head in different positions, were then reconstructed with the objective of obtaining a mid-sagittal section of the brain to demonstrate the presence of the corpus callosum.

Discordance in nuchal translucency thickness in the prediction of severe twin-to-twin transfusion syndrome.

Objective: To examine in monochorionic pregnancies the possible value of intertwin discordance in nuchal translucency (NT) thickness in the prediction of early fetal death or severe twin-twin transfusion syndrome (TTTS).

Methods: In 512 monochorionic twin pregnancies NT was measured at 11 to 13 + 6 weeks' gestation and regression analysis was used to determine the significance of the association between the intertwin discordance in NT and subsequent early fetal death or development of severe TTTS requiring endoscopic laser surgery.

Results: In 412 (80.

Tetralogy of Fallot in the fetus in the current era.

Objectives: To compare the spectrum of tetralogy of Fallot detected recently in fetal life with that in previous reports of prenatal and postnatal experience.

Methods: All cases of tetralogy of Fallot, including those with pulmonary atresia, diagnosed between 1998 and 2005 inclusive were identified. Additional data for the 129 cases were collected, including associated congenital heart malformations, nuchal translucency measurement, karyotype and outcome.

Preterm birth: the value of sonographic measurement of cervical length.

Transvaginal ultrasound scanning of cervical length at approximately 20 weeks of gestation in women attending for routine antenatal care is useful for predicting the likelihood of spontaneous early preterm birth. The risk of early birth increases exponentially with decreasing cervical length in both singleton and multiple pregnancies. In such women, individualization of risk would lead to rationalisation of antenatal care, including frequency of visits, patient education in recognising and reporting symptoms of spontaneous preterm labour and timely administration of steroids.

Frontomaxillary facial angle at 11+0 to 13+6 weeks' gestation-reproducibility of measurements.

Objective: To assess the intra- and interobserver reproducibility in the measurement of the frontomaxillary facial (FMF) angle at 11+0 to 13+6 weeks' gestation and to investigate the effect of deviations from the exact mid-sagittal view on these measurements.

Methods: Three-dimensional (3D) volumes of the fetal face were used by two operators to measure the FMF angle in 50 chromosomally normal and 50 trisomy 21 fetuses. The measurements were taken in the exact mid-sagittal view and repeated after lateral rotation of the head by 5 degrees, 10 degrees and 15 degrees away from the vertical position of the occipitofrontal diameter axis.

Ultrasound findings before amniocentesis in selecting the method of analysing the sample.

Objective: To determine if the primary method of cytogenetic analysis in pregnant women undergoing amniocentesis should be quantitative fluorescent polymerase chain reaction (qf-PCR), with karyotyping being performed only on those with abnormal ultrasound findings.

Methods: Amniocentesis was performed in 3854 cases. The median maternal age was 36 years and median gestational age was 18 weeks.

Brachycephaly and frontal lobe hypoplasia in fetuses with trisomy 21 at 11 + 0 to 13 + 6 weeks.

Objective: To investigate the incidence of brachycephaly and frontal lobe hypoplasia in fetuses with trisomy 21 at 11 + 0 to 13 + 6 weeks of gestation.

Methods: A three-dimensional (3D) volume of the fetal head was obtained before fetal karyotyping at 11 + 0 to 13 + 6 (median, 12 + 5) weeks of gestation in 100 fetuses that were subsequently found to have trisomy 21 and in 300 fetuses subsequently found to be chromosomally normal. The multiplanar mode was used to obtain a sequence of transverse views of the fetal head and to demonstrate the biparietal and suboccipitobregmatic views.

[Multiple pregnancy at 11+0 - 13+6 weeks].

Chorionicity, rather than zygosity, is the main factor determining pregnancy outcome. In monochorionic twins the rates of miscarriage, perinatal death, preterm delivery, fetal growth restriction and fetal abnormalities are much higher than in dichorionic twins. High mortality confined to monochorionic pregnancies is the consequence of severe early-onset TTTS.

Three-dimensional evaluation of mid-facial hypoplasia in fetuses with trisomy 21 at 11 + 0 to 13 + 6 weeks of gestation.

Objective: To investigate the mid-facial hypoplasia of fetuses with trisomy 21 at 11 + 0 to 13 + 6 weeks of gestation, by three-dimensional (3D) evaluation of the maxilla and the nasal bones.

Methods: A 3D volume of the fetal head was obtained before fetal karyotyping at 11 + 0 to 13 + 6 (median 12) weeks of gestation in 80 fetuses that were subsequently found to have trisomy 21 and in 862 fetuses subsequently found to be chromosomally normal. The multiplanar mode was used to obtain a sequence of transverse views of the fetal face and to demonstrate the maxilla, the adjacent rami of the mandible and the nasal bones.

Dilemmas in the management of twins discordant for anencephaly diagnosed at 11 + 0 to 13 + 6 weeks of gestation.

Objective: To help develop an evidence-based approach to the best management of twin pregnancies discordant for anencephaly.

Methods: We retrospectively examined the management and outcome of 18 pregnancies discordant for anencephaly diagnosed at 11 + 0 to 13 + 6 weeks of gestation in our center. We combined these data with those from other publications.

Placental volume in twin and triplet pregnancies measured by three-dimensional ultrasound at 11 + 0 to 13 + 6 weeks of gestation.

Objective: To compare the placental volume at 11 + 0 to 13 + 6 weeks' gestation between singleton and multiple pregnancies and to examine the possible effect of chorionicity on placental volume.

Methods: The placental volume was measured by three-dimensional (3D) ultrasound using the Virtual Organ Computer-aided AnaLysis (VOCAL) technique in 290 consecutive twin and 37 triplet pregnancies at 11 + 0 to 13 + 6 weeks of gestation. For the comparison of twin, triplet and singleton placental volumes each measurement was expressed as a multiple of the median (MoM) for singletons, previously established from the study of 417 normal fetuses at 11 + 0 to 13 + 6 weeks of gestation.

Maternal characteristics and cervical length in the prediction of spontaneous early preterm delivery in twins.

Objective: The purpose of this study was to examine the value of combining maternal characteristics and measurement of cervical length at 22 to 24 weeks in the prediction of spontaneous early preterm delivery.

Study Design: Cervical length was measured by transvaginal sonography at 22 to 24 weeks in 1163 twin pregnancies attending for routine antenatal care. Logistic regression analysis was used to examine the effect of maternal demographic characteristics and cervical length on the risk of spontaneous early preterm delivery.

Risks of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management: new data and systematic review.

Background: Triplet pregnancies are associated with a high risk of miscarriage and early preterm birth. It is uncertain if the outcome is improved by embryo reduction (ER).

Methods: We examined trichorionic triplet pregnancies with three live fetuses at 10-14 weeks of gestation that were managed expectantly or by ER.

Left and right lung volumes in fetuses with diaphragmatic hernia.

Objective: To compare the volume of the ipsilateral and contralateral lungs in fetuses with congenital diaphragmatic hernia (CDH).

Methods: Left and right lung volumes were measured using three-dimensional (3D) ultrasonography in 42 fetuses with CDH at median 26 (range, 20-32) weeks of gestation. Each value was then expressed as a difference, in standard deviations, from the normal mean for gestation, previously established from the study of 650 normal fetuses at 12-32 weeks (Z-score).

Is vitamin E a safe prophylaxis for preeclampsia?

The prophylactic use of vitamins E and C for the prevention of preeclampsia is currently being evaluated in multiple clinical trials in Canada, Mexico, the United Kingdom, the United States, and other developing countries. In addition to its antioxidant capacity, exogenous vitamin E may prevent an immunologic switch (Th1 to Th2) that is vital for early-to late transition in normal pregnancies. Moreover, vitamin E could be a potential interferon-gamma (IFN-gamma) mimic facilitating persistent proinflammatory reactions at the fetal-maternal interface.

Prediction of patient-specific risk of early preterm delivery using maternal history and sonographic measurement of cervical length: a population-based prospective study.

Objective: To develop a model for calculating the patient-specific risk of spontaneous early preterm delivery by combining maternal factors and the transvaginal sonographic measurement of cervical length at 22 + 0 to 24 + 6 weeks, and to compare the detection rate of this method to that achieved from screening by cervical length or maternal characteristics alone.

Methods: This was a population-based prospective multicenter study involving 40,995 unselected women with singleton pregnancies attending for routine hospital antenatal care in London, UK. Complete follow-up was obtained from 39,284 (95.