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Abstract: Objective: To evaluate the caregivers’ opinions regarding decision-making in termination of pregnancy (TOP) for fetal anomaly. Material and methods: Questionnaire survey using a semi-structured survey based on visual analogue scales, sent to all multidisciplinary centres for prenatal diagnosis in France. Answers were received from 26 centres nation-wide. Results: Response rate was 39% (213 responses received over 550 questionnaires sent). Fifty-five percent of respondents were women, 90% physicians, 7,5% midwives. A vast majority (69.8%) believes that their own convictions play a bigger role in decision in real practice than in their ideal. The major decisional factors in decision-making for TOP are: the long-term prognosis of the anomaly, a specialized opinion on its curability, the quality of the information given to the future parents, their expressed opinion, the existence of a multidisciplinary decision, the ability of the future parents to understand the medical data, the obtention of a medical consensus, the proof level of the medical information. For only 55% of the respondents, the current legal framework is adequate to manage the situations that result from prenatal diagnostic practices today. The question of late third-trimester TOP raises ethical debate: over a third (37%) see no ethical difference between TOP and withdrawal of care during the neonatal period; the majority (48% versus 43%) feel that ethically speaking a neonate and a foetus at 39weeks gestational age (GA) should not be treated differently; 37% of the respondents feel that current practice is likely to lead to eugenism. Discussion and conclusion: As far as TOP is concerned, the huge discrepancies in responses from the professionals highlight the ongoing ethical debate, especially concerning the concept of informed choice in TOP, which we believe should be entirely revisited. [Copyright &y& Elsevier]

Abstract: Dysmorphology is the study of congenital malformations and anatomic variations of the individuals. Up to 2500 dysmorphic or malformative syndromes are described, most of them being characterized by mental retardation. Craniofacial dysmorphology may be the keystone of syndrome identification, although limb anomalies are sometimes important diagnostic clues. The advances of fetal imaging, particularly the development of 3D ultrasound techniques, allow a detailed analysis of the fetal face. Dysmorphology requires experience of rare syndromes and a perfect knowledge of normal facial appearance and variations. In utero, this approach must combine the skills of both a practitioner with expertise in fetal ultrasound and a pediatric dysmorphologist. Furthermore, facial changes have to be analyzed according to the context of the pregnancy and family history. Identification of patent facial anomalies may be a clue for the diagnosis of severe fetal syndromes and diseases. Conversely, when fetal malformations or abnomalities of the fetal growth are identified, a careful facial analysis can be proposed in order to rule out well-known syndromes with a poor prognosis. However, from an ethical point of view, parents should not be aware of a possible facial dysmorphism unless there is a precise diagnosis and options concerning the pregnancy. [ABSTRACT FROM AUTHOR]

Exponential improvements in imaging techniques over the last ten years, through patients’ and physicians’ wishes for less invasive fetal work-up, now allow us to better explore and understand fetal lung physiology during pregnancy. Diagnostic and prognostic consequences at stake are huge, especially for fetuses at risk of pulmonary hypoplasia. We will decline in three parts (normal lung, malformative lung and pulmonary hypoplasia), through a review of the literature and enlightened by our experience, the potentialities and limitations of all imaging modalities (Ultrasound, Doppler, 3D, MRI). Then, we will dwell on future leads and the need for large-scale collaborative studies. [Copyright &y& Elsevier]

Résumé Cette revue iconographique se propose dans un premier temps de faire le point sur les grands principes de l’approche segmentaire des cardiopathies congénitales, son origine, ses définitions et ses objectifs en particulier. Dans un second temps, au travers d’illustrations échographiques nous envisagerons son application pratique en dépistage prénatal. Enfin, par des exemples iconographiques en échographie et en IRM, nous discuterons son utilisation potentielle en évaluation diagnostique fœtale. This pictorial essay will initially present the origin, definitions, objectives and main principles of the segmental approach to congenital heart diseases. Then, through ultrasound scans iconography we will consider its practical applications to prenatal screening. Eventually, through both ultrasound and MRI cases, we will discuss its potential use in fetal diagnostic evaluation. [ABSTRACT FROM AUTHOR]

Résumé Les champs d’application de l’imagerie post-mortem sont en croissance exponentielle depuis 10 ans. Son potentiel pour identifier la cause du décès dans des situations traumatiques et balistiques est maintenant correctement documenté. Dans la pratique pédiatrique et périnatale, des grandes séries sont moins nombreuses, sauf pour l’IRM et en particulier l’analyse du système nerveux central où les preuves scientifiques sont maintenant robustes. Après un bref rappel historique et l’analyse de l’état de l’art, nous allons essayer de décrire les défis actuels et la façon dont nous voyons l’avenir de cette sur-spécialité de l’imagerie en coupe post-mortem, en particulier dans les situations spécifiques à la périnatalité. The fields of application of post-mortem imaging have been exponentially growing for 10 years. Its potential to identify the cause of death in trauma and ballistic cases is now properly documented. In pediatric and perinatal practice, large significant series are less available, except for MRI and central nervous system analysis where scientific evidence is now robust. After a short historical and state-of-the-art review, we will try to depict the way we see the future of this sub-specialty of post-mortem imaging, especially in specific perinatal situations. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Évaluer les caractéristiques tissulaires du placenta par élastographie ShearWave transabdominale chez la babouine gestante. Matériels et méthode Pendant 9 mois (03/2013–12/2013) deux opérateurs (EQ, GG) ont réalisé des échographies du placenta pendant la grossesse des babouines gestantes de la station de primatologie partenaire du projet. Le repérage du placenta était réalisé au préalable en échographie 2D. Le mode élastographie était ensuite activé. Trois mesures ont été réalisées par opérateur pour chaque placenta. Les coefficients de corrélation intra-classe intra- et inter-observateur ont été calculés pour l’appréciation objective (élastographie) de la maturité placentaire. Résultats Pendant la période de l’étude, 21 babouines gestantes ont été incluses et ont été échographiées entre 1 et 3 fois chacune. Les mesures ont pu être effectuées par les deux opérateurs dans 100 % des cas. Les CCI intra- et inter-observateur des valeurs uniques sont respectivement 0,657 – IC 95 % (0,548–0,752) et 0,458 – IC 95 % (0,167–0,675). Les CCI intra- et inter-observateur des valeurs moyennes sont respectivement 0,852 – IC 95 % (0,784–0,901) et 0,628 – IC 95 % (0,286–0,806). Conclusion L’étude par élastographie ShearWave du placenta de babouines gestantes par voie transabdominale est possible. Les reproductibilités intra- et inter-opérateur de cette méthode sont bonnes en utilisant la moyenne de trois mesures. L’étude objective via l’élastographie ShearWave du degré de maturité placentaire ne semble pas pour l’instant être utilisable en pratique clinique. Des études de plus larges cohortes sont nécessaires. Objectives To evaluate tissue characteristics of the placenta by transabdominal ShearWave Elastography in pregnant baboon. Materials and method For 9 months (03/2013–12/2013) two operators (EQ, GG) performed ultrasound of the placenta during pregnancy pregnant baboons station partner primatology project. The identification of the placenta was performed previously in 2D ultrasound. The elastography method was then activated. Three measurements were carried out by operator for each placenta. The intraclass correlation coefficients within and between observers were calculated for the objective assessment (elastography) of placental maturity. Results During the study period, 21 pregnant baboons were included and ultrasounds were performed between 1 and 3 times each. The measurements have been carried out by two operators in 100% of cases. The intra- and inter-observer ICC for single values are respectively 0.657 – 95% CI (0.548 to 0.752) and 0.458 – 95% CI (0.167 to 0.675). The intra- and inter-observer ICC for average values are respectively 0.852 – 95% CI (0.784 to 0.901) and 0.628 – 95% CI (0.286 to 0.806). Conclusion The study by transabdominal ShearWave Elastography of placenta's pregnant baboons is possible. The intra- and inter-operator reproducibility of this method is good using the average of three measurements. The objective study via elastography ShearWave of the degree of placental maturity seems not yet be used in clinical practice. Studies of larger cohorts are needed. [ABSTRACT FROM AUTHOR]