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Objective: To characterize the natural history of femur length (FL) parameters across gestation in Down syndrome fetuses.Methods: Retrospective review of singletons with fetal Down syndrome deliver...

To determine if sonographic variables, including fetal femur length to abdominal circumference (FL/AC) ratio, are associated with shoulder dystocia in women with gestational diabetes.This was a retrospective cohort study of women with gestational diabetes who delivered singleton infants at Parkland Hospital from 1997 to 2015. Diagnosis and treatment of gestational diabetes were uniform including sonography at 32-36 weeks. Biometric calculations were evaluated for correlation with shoulder dystocia.During the study period, 6952 women with gestational diabetes underwent a sonogram at a mean gestation of 34.8 ± 1.8 weeks. Of 4183 vaginal deliveries, 66 experienced shoulder dystocia (16/1000). The FL/AC was associated with shoulder dystocia (p 0.001) with an AUC of 0.70 (95% CI: 0.64-0.77). This was similar to age-adjusted AC and head circumference to AC ratio (HC/AC) (both with an AUC of 0.72). All other measurements, including estimated fetal weight, were inferior. When examining the 257 women with multiple sonograms after 32 weeks' gestation, FL/AC was stable with advancing gestational age (p = 0.54) whereas age-adjusted AC and HC/AC were not (p 0.001).The FL/AC is associated with shoulder dystocia in women with gestational diabetes. Additionally, it is a simple ratio that is independent of the reference used and remains stable, unlike age-adjusted AC and HC/AC ratio.

To determine the effect of a 6 gram intravenous bolus of magnesium sulfate on maternal cerebral blood flow in women with preeclampsia.Velocity-encoded phase-contrast magnetic resonance imaging studies were performed on twelve preeclamptic women prior to and immediately after infusion of a 6 gram magnesium sulfate loading dose. Cerebral blood flow was determined at the bilateral proximal middle and posterior cerebral arteries. Study participants returned 6 weeks postpartum for a non-pregnant measurement of cerebral blood flow. The Wilcoxon paired-sample test was used with statistical significance defined as p0.05.There was no significant difference in cerebral vessel diameter nor blood flow for any of the examined arteries between the pre- and post magnesium sulfate therapy states.The absence of a significant difference in cerebral blood flow of the middle and posterior cerebral arteries before and after infusion of a 6 gram loading dose of magnesium sulfate in women with preeclampsia could suggest the absence of vasoconstriction of the large cerebral arteries in preeclampsia and question the role of magnesium sulfate as a vasodilator of these arteries.

To determine which non-biometric components of the ultrasound fetal survey can routinely be seen on a single fast acquisition magnetic resonance (MR) sequence aligned axial to the maternal uterus.The non-biometric components of the routine fetal ultrasound examination were applied retrospectively to the initial MR single-shot fast spin-echo acquisition aligned axial to the maternal uterus in the normal fetus to determine whether these parameters could be routinely evaluated. Nineteen women with anatomically normal fetuses had a total of 31 MR studies performed for fetal or maternal indications, either as part of an indicated examination or as part of a study protocol approved by the institutional review board. The images in these 31 MR studies were reviewed by two independent examiners who were blinded to the other's assessment; concordance was necessary for a component to be adequately assessed. The Wilcoxon rank sum test was used to determine the effect of gestational age and fetal lie on the ability to assess non-biometric parameters.Assessment was possible in 85% of the non-biometric parameters. Cord insertion, external genitalia and the four-chamber view of the heart were most problematic. In only two cases was the four-chamber view of the heart identified. Longitudinal lie allowed significantly more parameters (82%) to be evaluated than transverse lie (45%) (p0.003). No difference based on gestational age was found.A single fast acquisition axial MR sequence can evaluate 85% of the non-biometric components of the fetal ultrasound survey. Fetal lie is an important confounder in the ability to resolve fetal anatomy with a single MR axial uterine acquisition.

To carry out a prospective study of Doppler velocimetry of the fetomaternal circulation in women with chronic hypertension, to evaluate whether the subsequent development of superimposed pre-eclampsia can be predicted.Serial Doppler studies of the maternal uterine and renal arteries, and fetal middle cerebral and umbilical arteries, were performed at 16-20 and at 28-32 weeks' gestation in 56 women with chronic hypertension. Pulsatility indices were compared using the Wilcoxon rank sum method. A p value of0.05 was considered significant.Uterine artery impedance was significantly elevated as early as 16-20 and at 28-32 weeks' gestation, while the cerebroplacental ratio was lower at 28-32 weeks' gestation, in the 14 women who developed superimposed pre-eclampsia. The maternal renal artery impedance remained constant throughout gestation, regardless of the development of pre-eclampsia.Uterine artery Doppler velocimetry at 16-20 and at 28-32 weeks' gestation showing increased impedance is predictive for the development of superimposed pre-eclampsia in women with chronic hypertension. The cerebroplacental ratio suggested early fetal brain sparing at 28-32 weeks' gestation in these women.