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An editorial is presented on Professor Joachim Dudenhausen being one of the most prominent German obstetricians, and an ambassador of German medicine and science. Topics include pioneering work in perinatal medicine being instrumental in unifying the fields of obstetrics and gynecology in Germany; and observing the work at the clinic where Professor Dudenhausen inspired for committing to a career in medicine, specifically obstetrics and gynecology.

Ventriculomegaly (VM) is defined as an enlargement of the lateral ventricles of the developing fetal brain. The diagnosis is easily made by measuring the lateral ventricle width at the level of the atrium, which is normally <10 mm. VM is defined as mild when the atrial width is 10–12 mm, moderate 12–15 mm, severe >15 mm. VM is a non-specific sonographic sign which is common to different pathological entities and genetic conditions. When no associated anomaly can be found VM is defined as isolated. Since the prognosis of fetal VM mainly depends on the presence of associated anomalies, a careful diagnostic approach is necessary to rule out CNS and extra- CNS fetal anomalies. Magnetic Resonance Imaging can be a useful diagnostic tool complementary to ultrasound in order to recognize subtle brain anomalies, particularly cortical disorders. In this review the diagnostic approach to fetal VM will be discussed starting from ultrasound screening, moving to neurosonographic and MRI examination and genetic evaluation, in order to recognize the cause of VM and offer the appropriate counselling to the parents. [ABSTRACT FROM AUTHOR]

The article focuses on ventriculomegaly (VM) or the enlargement of the lateral ventricles of a developing fetal brain. Topics discussed include the fetal scan to screen for fetal anomalies, recognizing unilateral and bilateral mild VM, the steps for a diagnostic work-up such as ruling out for associated anomalies, ruling out for feto-neonatal/alloimmune thrombocytopenia, and ruling out for chromosomal abnormalities, and the neurological results of fetuses with prenatal diagnosis of mild VM.

Objective To review literature about treatment of twin-twin transfusion syndrome (TTTS) stage I. Materials A search in PubMed, EMBASE, Medline, and reference lists was performed. Inclusion criteria were TTTS diagnosed with standard criteria and classified with Quintero staging and survival rates (SR) stratified for stage and first-choice treatment. Outcomes were SR and progression to advanced stages. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. Results Seven articles pooled 262 twin sets treated with amnioreduction (16%), conservative management (22%), and laser therapy (62%). The overall SR was 77% after amnioreduction, 86% in the conservative management group, and 85% in the laser therapy group. Progression rate occurred in 30%, 15%, and 0%, respectively. Outcomes were similar between laser therapy as first- versus second-choice treatment. Because most studies were observational and not comparative, a meta-analysis was not performed. Conclusion Conservative management of TTTS stage I is a reasonable option until randomized clinical trials are presented. [ABSTRACT FROM AUTHOR]

Objective To review literature about treatment of twin-twin transfusion syndrome (TTTS) stage I. Materials A search in PubMed, EMBASE, Medline, and reference lists was performed. Inclusion criteria were TTTS diagnosed with standard criteria and classified with Quintero staging and survival rates (SR) stratified for stage and first-choice treatment. Outcomes were SR and progression to advanced stages. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. Results Seven articles pooled 262 twin sets treated with amnioreduction (16%), conservative management (22%), and laser therapy (62%). The overall SR was 77% after amnioreduction, 86% in the conservative management group, and 85% in the laser therapy group. Progression rate occurred in 30%, 15%, and 0%, respectively. Outcomes were similar between laser therapy as first- versus second-choice treatment. Because most studies were observational and not comparative, a meta-analysis was not performed. Conclusion Conservative management of TTTS stage I is a reasonable option until randomized clinical trials are presented. [ABSTRACT FROM AUTHOR]

Objective: To review the neonatal outcomes of assisted reproductive technique (ART) vs. naturally conceived (NC) twins. Methods: A search in PubMed, Medline, EMBASE, and Cochrane library was performed (January 2000-September 2010). Articles reporting outcomes of ART vs. NC twins were classified in controlled and non-controlled studies. A sub-group was limited to unlike sex twins (UST). The MOOSE guidelines were followed. A randomized model was generated if inter-studies heterogeneity was >25%. Inter-group comparison was significant if P<0.05. Results: Thirteen articles were reviewed. In non-controlled studies, outcomes were equal between groups, except for cesarean section rates (ART: 71.8%; NC: 49.6%; P<0.0001; OR: 2.34; 95% CI: 1.55-3.54). Similar results were obtained in controlled studies, except for higher rates of preterm delivery in ART (55%) than in NC (53%) twins (P=0.03; OR: 1.30; 95% CI: 1.03-1.65). UST differed with regard to preterm delivery (ART: 58.6%; NC: 49.5%; P<0.0001; OR: 1.51; 95% CI: 1.25-1.83), and perinatal death (ART: 3.6%; NC: 1.8%; P<0.0001; OR: 1.95; 95% CI: 1.41-2.71). Birth weight differed between groups. Conclusion: ART twins carry increased risk of adverse outcomes. UST are at higher risk of perinatal death, although further studies are needed to assess whether chorionicity impacts on neonatal outcomes after ART. [ABSTRACT FROM AUTHOR]

Aims: To compare the diagnostic accuracy of sonographic signs that may be looked for in fetuses with spina bifida. Methods: Forty-nine fetuses affected by spina bifida were enrolled, at a gestational age of 18–28 weeks. The following sonographic signs were looked for: “lemon” sign, small cerebellum, effaced cisterna magna, small posterior fossa, ventriculomegaly and direct visualization of a spinal defect. Results: The “lemon” sign was present in 53%, a small cerebellum in 96%, an effaced cisterna magna in 93%, a small posterior fossa in 96%. Ventriculomegaly was present in 40/49 (81%) cases and was severe in 20 fetuses and borderline in the remaining 20. The spinal defect was missed in one fetus presenting the cerebellar and posterior fossa signs. In two fetusus, the myelomeningocele was present without cranial signs of Chiari II malformation and in both cases the defect was covered by intact skin. Conclusions: Our results confirm the usefulness of evaluation of the posterior fossa in the diagnosis of spina bifida, particularly in cases of small spinal defects that may be missed at ultrasound. Conversely, myelomeningocele covered by intact skin was not associated with the cranial signs of Chiari II malformation. [ABSTRACT FROM AUTHOR]

Dilatation of the fetal cerebral ventricles (ventriculomegaly) is a generic sonographic sign that is common to several pathological entities carrying different prognoses. The main causes of fetal ventriculomegaly are aqueductal stenosis, Chiari II malformation, Dandy-Walker complex, and agenesis of the corpus callosum. Ventriculomegaly is easily recognized by ultrasound by measuring the atrial width. This simple measure allows the recognition of mild forms of ventricular dilatation and is used in screening for ventriculomegaly. However, although the diagnosis of ventriculomegaly is easy, the prenatal identification of the cause of ventricular dilatation is a more difficult task. For this purpose the evaluation of the posterior fossa in association with the visualization of the corpus callosum is useful. Research into the causes of ventriculomegaly is clinically useful, since the prognosis mainly depends on the etiology and on the presence of associated abnormalities. In this article the role of prenatal sonography in determining the cause of the ventriculomegaly is reviewed, as well as the prognostic value of the prenatal sonographic findings. [ABSTRACT FROM AUTHOR]

Dilatation of the fetal cerebral ventricles (ventriculomegaly) is a generic sonographic sign common to several pathological entities carrying different prognoses. The main causes of fetal ventriculomegaly are aqueductal stenosis, Chiari II malformation, Dandy-Walker complex and agenesis of the corpus callosum. Ventriculomegaly is easily recognized by ultrasound by measuring the atrial width. This simple measure allows the recognition of mild forms of ventricular dilatation and is used as a screening method for ventriculomegaly. However, although the diagnosis of ventriculomegaly is easy, the prenatal identification of the cause of ventricular dilatation is a more difficult task. To this end, the evaluation of the posterior fossa in association with the visualization of the corpus callosum is a useful landmark. Research into the cause of ventriculomegaly is clinically useful, since the prognosis mainly depends on the etiology and on the presence of associated anomalies. In this article the role of prenatal sonography in recognizing the cause of ventriculomegaly and the prognostic value of the prenatal sonographic findings are discussed. [ABSTRACT FROM AUTHOR]

The authors report the prenatal sonographic diagnosis of subependymal cysts, confirmed by in utero MRI, in an apparently uneventful pregnancy. The sonographic appearance of the lesions, the obstetric management and the postnatal follow-up to one year are described. Special attention is paid to prenatal factors of neurological morbidity, rather than intrapartum and postnatal, thus emphasizing the importance of early and sequential evaluation of the developing fetal brain. Diagnosis, clinical significance and outcome of prenatal subependymal cysts are necessary for parental counselling and obstetric management. Furthermore, the detection of a prenatal brain injury may have remarkable medico-legal implications. [ABSTRACT FROM AUTHOR]

Objective. To explore whether the umbilical vein blood flow of growth-retarded fetuses with normal Doppler parameters changes over time differently to that of normally grown fetuses. Methods. Fifteen consecutive women whose fetus was diagnosed to be growth restricted were compared with 30 women whose fetus was normally grown. Two ultrasonographic evaluations were conducted at 2-weekly intervals (± 2 days) in all cases. At each sonographic evaluation, umbilical vein blood flow parameters were obtained by digital color Doppler velocity profile integration. To allow comparisons among fetuses, the umbilical vein blood flow per minute was normalized for abdominal circumference. Results. The absolute vein blood flow was lower in growth-retarded than in normally grown fetuses (209 ml/min ± 73 vs. 313 ml/min ± 72, p < 0.01). The median (range) umbilical vein blood flow normalized for abdominal circumference was significantly lower in growth-retarded than in normally grown fetuses at the first [0.70 (0.32; 1.15) vs. 1.11 (0.65; 2.07), p < 0.05] and at the second [0.71(0.30; 1.09) vs. 1.14 (0.69; 2.05), p < 0.05] sonographic evaluation. The difference in umbilical vein blood flow normalized for abdominal circumference between the second and the first examination was significantly lower in growth-retarded than in appropriate for gestational age fetuses [-0.005 (- 0.08; 0.06) vs. 0.02 (- 0.08; 0.1), p < 0.05]. Conclusion. This study demonstrates that umbilical vein blood flow normalized for biometric parameters is lower in growth-retarded fetuses than in healthy fetuses even in the absence of umbilical artery Doppler abnormalities. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses reports within the issue including an update of prenatal screening for microcephaly, consideration of racial variability in human development in fetal ultrasound, and guide to management of prenatally diagnosed fetal head and neck tumors.

A letter to the editor is submitted in response to the article "Antibiotic Prophylaxis in Obstetric and Gynaecological Procedures: A Review" by V. Clifford et al.

Presents a study that investigated the thymus size at birth as a function of gestational age and chorioamnionitis (CA). Number of newborns investigated; Assessment of the gestational age; Relation between thymus size and gestational age in the CA-positive newborns.

No oocytes were obtained at ovum retrieval in a 33-year-old patient with secondary tubal infertility, whereas in a previous cycle nine oocytes were obtained under the same ovarian stimulation protocol as used in the studied cycle. Oocyte retrieval failed in spite of the correct administration of human chorionic gonadotrophin (HCG) as demonstrated by serum β-HCG concentration (58.6 mIU/ml) on day HCG+1. However, it was shown that progesterone failed to rise even after the administration of exogenous HCG as the luteinizing hormone signal. Therefore, when ovum retrieval fails, the serum progesterone as well as β-HCG concentrations may be useful to help identify the cause of this unusual event. [ABSTRACT FROM PUBLISHER]