Abstract: Congenital Heart Disease (CHD) is the most common severe congenital abnormality in the newborn and the cause of over half the deaths from congenital anomalies in childhood. Prenatal diagnosis, possible as early as 15 weeks of gestation, allows physicians and families the greatest number of therapeutic options, and can improve the postnatal outcome. There are several potential indications for performing such examination. Evaluation of the heart in the setting of restricted fetal growth or fetal distress is often recommended. Whenever extracardiac anomalies are detected during fetal ultrasound examination or in presence of chromosomal abnormalities detected with amniocentesis, cardiac assessment is mandatory. The test should also be performed as part of the assessment of fetal arrhythmias. Finally, whenever congenital heart disease is suspected for other reasons, such as maternal exposure to teratogenic substances or a parental history of previous children with congenital lesions, the examination should be considered.
The performance of a fetal echocardiogram requires experience and a systematic approach. Guidelines for training have been formulated, and only qualified individuals should perform this highly specialized examination.
A description of the techniques of heart examination is presented below.
Abstract: Objective
To compare procedure-related pregnancy loss after second-trimester genetic amniocentesis in women given an antibiotic prophylaxis and controls.
Methods
Prospective, open randomised controlled single-centre study between January 1999 and December 2005 at Artemisia Fetal Maternal Medical Centre. A follow-up within 4 weeks after the procedure was done.
Of 36 347 eligible women, 1424 refused to participate and 34 923 were enrolled and randomised with unequal chance of selection, 21 991 were assigned to treatment group and 12 932 were assigned to the control group, and did not receive any placebo. Oral azithromycin, 500 mg per day, was administered 3 days before amniocentesis. The primary endpoint was the procedure-related pregnancy loss. The secondary endpoint was the rate of preterm premature rupture of membranes.
Results
The rate of abortion related to the amniocentesis was 7/21 219 women (0.03%, 95% CI 0.009-0.057) in the intervention group, and 36/12 529 (0.28%, 0.28-0.30) in controls (p = 0.0019). The rate of preterm premature rupture of membranes was 14/21 219 (0.06%, 0.031-0.101) in the intervention group, and 140/12 529 (1.12%, 0.94-1.30) in the control group (p = 0.001).
Conclusions
Antibiotic prophylaxis before second-trimester amniocentesis reduced the risk of abortion and of rupture of the membranes
Abstract: The SCA-TEST, Prenatal Aneuploidies Screening, is an innovating program with very articulated and differentiated calculation potentials. It is a software which allows executing a sequence-like rational screening involving the ultrasound study of the first and second trimester. The program enables to execute a complete and different-levels combined screening, through very sophisticated mathematic analysis methods. In particular, it enables to make: a first trimester screening combining it with nuchal translucency, and biochemical parameters of free beta-hCG and PAPP-A; a second trimester screening by the evaluation of up to 6 biometric parameters (biparietal diameter, cranial circumferentia, femur, humerus, pyelectasis and plica nucalis), and up to 7 associated morphologic parameters (hyperechogenic bowel, cardiac foci, interventricular defect, pericardial effusion, tricuspid valve regurgitation, right/left heart disproportion, and structural abnormalities).The purpose of the study was to present the performance of the SCA TEST in the second trimester of pregnancy through the evaluation of a prospective study performed in the period between April 2007 and December 2007 on 1000 women who underwent the SCA TEST followed by amniocentesis. Studying all the cardiovascular and non-cardiovascular markers, SCA TEST made it possible to identify 62.5% fetuses affected by Trisomy 21 with a specificity of 94.6%, and a 5.4% of false positive.
Considering only women older than 35 years the detection rate reaches 80% with a 7.8% of false positive. The statistical analysis confirmed that the second trimester screening gives essential information regarding the aneuploidia risks in particular in high risk
women, and in those who did not perform first trimester screening.
KEY WORDS: second trimester, sonography, ultrasound, Down syndrome, trisomy 21, fetus, SCA TEST.
Abstract: The SCA-TEST, Prenatal Aneuploidies Screening, is an innovating program with very articulated and differentiated calculation potentials. It is a software which allows executing a sequence-like rational screening involving the ultrasound study of the first and second trimester. The program enables to execute a complete and different- levels combined screening, through very sophisticated mathematic analysis methods. In particular, it enables to make: a first trimester screening combining it with nuchal translucency, and biochemical parameters
of free beta-hCG and PAPP-A; a second trimester screening by the evaluation of up to 6 biometric parameters
(biparietal diameter, cranial circumferentia, femur, humerus, pyelectasis and plica nucalis), and up to 7 associated morphologic parameters (hyperechogenic bowel, cardiac foci, interventricular defect, pericardial
effusion, tricuspid valve regurgitation, right/left heart disproportion, and structural abnormalities).The purpose
of the study was to present the performance of the SCA TEST in the second trimester of pregnancy
through the evaluation of a prospective study performed in the period between April 2007 and December
2007 on 1000 women who underwent the SCA TEST followed by amniocentesis. Studying all the cardiovascular
and non-cardiovascular markers, SCA TEST made it possible to identify 62.5% fetuses affected by Trisomy
21 with a specificity of 94.6%, and a 5.4% of false positive. Considering only women older than 35 years the
detection rate reaches 80% with a 7.8% of false positive. The statistical analysis confirmed that the second
trimester screening gives essential information regarding the aneuploidia risks in particular in high risk
women, and in those who did not perform first trimester screening.
Abstract: PURPOSE: Evaluate the most effective fetal treatment for male fetal obstructive uropathy. This study compares the different approaches of several authors for this pathology and presents our experience in cases of fetal obstructive uropathy to demonstrate which option is the easiest and the best for male obstructive uropathy.
ABSTRACT: Posterior urethral valves are the leading cause of antenatally dia-gnosed lower-urinary tract obstruction and are the structural genitourinary anomaly
amenable to fetal therapy. PUV are found only in the male population and have an incidence of 1 in 5000 births. The mortality rate in these patients has been reported to be as high as 63%, especially when it is associated with severe oligo-hydramnios due to pulmonary hypoplasia. This association is known as Prune Belly
Syndrome (PBS), an uncommon anomaly consisting of genito-urinary abnorm-alities and a partial or complete absence of the abdominal wall musculature.
Although many theories have been proposed to explain the pathogenesis of this anomaly (abnormal mesodermal development, genetic defect, and urethral obstruction
malformation complex), many authors suggest that the fetal prune belly is not a syndrome but a sequence when the âprimum movensâ is the obstruction of the outflow of the urine.
Urinary tract decompression in the early second trimester is recommended to reduce the potential for ongoing damage to the developing kidneys and pulmonary
hypoplasia due to the oligohydramnios. The percutaneous placement of an indwelling catheter for urinary diversion is a possible therapy.
Vesicoamniotic shunt for complete urinary tract obstruction is partially effective. Although the main purpose of VASP is to prevent pulmonary hypoplasia and dysfunctional
kidneys, Vesicoamniotic shunt has not always been effective, as the outcomes were poor in most patients.
According to a previous work (Zaccara, 2005), we use the amniotic fluid index to evaluate the bladder outlet obstruction and to decide whether to perform the bladder drainage or not. All cases of bilateral obstructive uropathy were seen prenatally at the Artemisia Medical Center. They were initially reviewed at 17 to 20 weeks of gestation, when a distended fetal bladder with thickened wall and enlarged kidneys were displayed. At the same time, ultrasonographic assessment of the amniotic fluid was performed by calculating the amniotic fluid index. An amniotic fluid index less than 25th percentile was considered below average and an index less than 5th percentile was considered oligohydramnios, whereas an index ranging between 50th and 75th percentiles was considered normal. In our simple technique, we empty the bladder with a percutaneous needle. Our result demonstrates that this easiest procedure is the most effective fetal treatment for male obstructive uropathy.
