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(Abstracted from Eur J Obstet Gynecol Reprod Biol2019;234:63–70)Uteroplacental insufficiency is the most common cause of fetal growth restriction (FGR), with potentially critical consequences for both the mother and fetus. Definitions of uteroplacental insufficiency vary between an antenatal diagnosis reflecting the placental dysfunction and a postnatal diagnosis based on birth weight.

(Abstracted from Ultrasound Obstet Gynecol2018;51:596–603)In this study, the authors sought to evaluate the cost-effectiveness of combining cervical length (CL) measurement and fetal fibronectin (fFN) testing in women with symptoms of preterm labor between 24 and 34 weeks' gestation.

During pregnancy, twins and higher-order multiples are exposed to the same intrauterine and external environment, although there might be differences in amniotic fluid, position and placental supply. Nevertheless, placental nutritional supply and hemodynamics may vary within the set of multiples ('nurture'). There are also variations in the intrinsic development and susceptibility, which mainly depend on their gender and genetic disposition ('nature'). Ultrasound allows one to observe the origin and development of prenatal activity, to compare intertwin variations and to assess the possible impact of internal and external determinants. Contacts between human beings contribute to neuropsychological development and to quality of life. Multiple pregnancies are natural models to study first initiatives and reactions to touch.Methods of documenting early twin behavior and the influences of physiological and pathological variables are described.

Transvaginal sonography (TVS) of the cervix has been shown to be superior to the digital examination in detecting patients at risk for sponatenous preterm birth. The cervical length, width, length or area of the internal os (funneling) and, to some extent, the position and structure of the cervix, can be determined from ultrasound images. We have established longitudinal sonographic criteria separate for twin and singleton pregnancies in a vertical and horizontal position of the patient. Shortening of the cervical length and funneling occur earlier in an upright compared to a supine maternal position and in twin compared to singleton pregnancies. For dividing high-risk and low-risk groups, we considered the cut-off values specific for gestational age, position and singleton or twin pregnancy. Multiple logistic regression revealed that, between 20 and 24 + 6 weeks and between 25 and 29 + 6 weeks, funnel width in an upright position and the detection of fibronectin were the most significant independent variables to diagnose subsequent preterm birth. Receiver-operator curve analysis demonstrated that measurements of the cervical length and funnel width in an upright position had higher detection rates of patients at risk for spontaneous preterm birth than examinations in a supine position. There seems to be some evidence from the use of historic controls that the rate of spontaneous preterm birth may decrease with the application of early longitudinal TVS, indicating lifestyle changes, and the use of a vaginal pessary designed to support the incompetent cervix. Although TVS has its place in the follow-up of twin pregnancies with advanced dilatation and prolonged interval between deliveries, it is recommended to perform TVS early enough to recognize symptoms in a reversible instead of an irreversible phase. In the future, TVS may help to indicate and control interventions aimed at prevention or therapy of cervical incompetence.

Cervical shortening, as seen by transvaginal sonography increased concentrations of maternal salivary estriol, inflammatory cytokines in amniotic fluid, and fetal fibronectin expression in cervicovaginal mucus are all detected weeks to months before a preterm birth, providing evidence that spontaneous preterm birth is the result of a long-term process, with varying clinical manifestations and dynamics and a dilated cervix as the common terminal pathway.Routine pelvic examination has not been shown to be predictive of preterm labor. The examination of the cervix by transvaginal sonography is more objective and has been shown to be superior to the digital examination in estimating the risk of premature birth. Thereby, the sonographic structure of the cervix (length, funneling) determines, more than any other clinical findings, the interval to the delivery.During normal pregnancy, the pregnant woman spends part of her time in an upright position. Therefore, we have established longitudinal sonographic criteria, separate for twin and singleton pregnancies, in supine and upright positions. Up to now, we have found that the funneling in an upright position -in combination with cervicovaginal fibronectin -is the most significant sonographic parameter to predict prematurity.In risk populations, we emphasize longitudinal examinations by transvaginal sonography to increase the chance to recognize symptoms in a reversible instead of an irreversible phase and to evaluate whether maternal postural challenge assists in predicting patients at risk for premature delivery. Transvaginal sonography is of assistance to indicate and follow any management to prevent preterm birth. Clinical trials of interventions (e.g. lifestyle changes, tocolytic treatment, different types of cerclage or vaginal pessaries), based on transvaginal sonographic findings combined with biochemical examinations (cultures, interleukins, fibronectin), are urgently needed.

LH-releasing hormone (25 μg, iv.) was administered to 37 women with functional amenorrhea. In addition to the clinical classification, these patients were divided into three groups according to the basal level of serum LH. A significant correlation was found between the base-line levels of LH and the serum concentration of oestradiol plus oestrone. The absolute increment of LH after the injection of LH-RH was found to be dependent only on the base-line level of LH. Except for the patients with anorexia nervosa, the base-line levels and the response pattern of FSH were almost the same for all three groups.From the results of this study, it was concluded that:The circulating levels of oestradiol and oestrone, where derived from ovarian secretion, actually depend on the gonadotrophic stimulus. In patients with functional amenorrhea, the oestrogens do not make an independent contribution to the pituitary response to LH-RH.Dysregulation of releasing hormones, whether located at the hypothalamic or suprahypothalamic level, necessarily influences the secretory capacity of the pituitary gland; long-standing deficiency of LH-RH may finally lead to a state of pituitary "functional" unresponsiveness to releasing hormones.In view of the excellent correlation between the base-line levels of LH and the absolute increment of LH following stimulation with LH-RH, this test only accentuates the existing pituitary secretory capacity, which can be roughly estimated from the circulating levels of LH and FSH.This test may be useful in distinguishing the milder cases of psychogenic amenorrhea from extreme gonadotrophic dysfunction in patients with anorexia nervosa.

Doppler flow velocity waveforms in the fetal internal carotid artery were recorded in 21 normal pregnancies during fetal behavioural state IF (quiet sleep) and 2F (active sleep) according to Nijhuis and co-workers, from the 36th week of gestation onwards. The present study confirms the earlier finding of a significant reduction of the pulsatility index (PI) in state 2F as compared to state IF at 37–38 weeks of gestation and demonstrates that this difference in PI exists throughout the entire period, in which fetal behavioural states have been described. Furthermore, it is demonstrated that there is a significant reduction in PI of this vessel during the last 4 weeks of gestation, suggesting a haemodynamic redistribution, favouring blood supply to the brain during the latter weeks of gestation.

Restrictive dermopathy is a lethal autosomal recessive skin disease. Prenatal diagnosis has not yet been reported. We present a case of restrictive dermopathy and describe the associated prenatal sonographic findings. A continuously open mouth was the most striking feature and this sonographic finding may be a marker of a skin disease. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology