Search

Objective To investigate the value of fetal stomach position in predicting postnatal outcome in left-sided congenital diaphragmatic hernia (CDH) with and without fetoscopic endoluminal tracheal occlusion (FETO). Methods This was a retrospective review of CDH cases that were expectantly managed or treated with FETO, assessed from May 2008 to October 2013, in which we graded, on a scale of 1–4, stomach position on the four-chamber view of the heart with respect to thoracic structures. Logistic regression analysis was used to investigate the effect of management center (Paris, Brussels, Barcelona, Milan), stomach grading, observed-to-expected lung area-to-head circumference ratio (O/E-LHR), gestational age at delivery, birth weight in expectantly managed CDH, gestational ages at FETO and at removal and period of tracheal occlusion, on postnatal survival in CDH cases treated with FETO. Results We identified 67 expectantly managed CDH cases and 47 CDH cases that were treated with FETO. In expectantly managed CDH, stomach position and O/E-LHR predicted postnatal survival independently. In CDH treated with FETO, stomach position and gestational age at delivery predicted postnatal survival independently. Conclusion In left-sided CDH with or without FETO, stomach position is predictive of postnatal survival. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

To evaluate the feasibility of completing in one session a second-trimester ultrasound scan in obese pregnant women, to compare the quality of images obtained with those of non-obese women and to analyze factors that can improve the completion rate.This prospective study, from 2009 to 2011, included all obese pregnant women (prepregnancy body mass index (BMI) 30 kg/m2) who had an ultrasound examination at 20-24 weeks in our department, and a control group of pregnant women with normal BMI (20-24.9 kg/m2) who had the same examination. A single operator reviewed the standardized ultrasound images (three biometric and six to assess key anatomical features) required under French guidelines, to assess their presence, evaluate the quality of all images and score the quality of the six anatomical images. Each image was assessed according to between four and six criteria, each worth one point. We sought excellent quality, defined as the frequency of maximum points for a given image type. The factors associated with completing the scan in one session were evaluated with multivariate logistic regression.The obese group included 223 women and the control group 60; a complete scan in one session was achieved in 70.4% and 81.7% of these, respectively (P = 0.08). The completion rate for each image type was at least 95% in the control group and 90% in the obese group, except for diaphragm and right outflow tract images. Significant factors associated with completing the scan in the multivariate model were: having 10 additional minutes for the scan (P = 0.03), moving the fetus so that the back was in posterior or lateral position (P = 0.01), more experienced sonographer (P = 0.03) and thinner maternal abdominal wall thickness (P = 0.01). Overall, the excellence rate varied from 35% to 92% in the normal BMI group and from 18% to 58% in the obese group, and was significantly lower in the latter for all images except abdominal circumference (P = 0.26) and spine (P = 0.06). Anatomical quality scores were also significantly lower in the obese group (22.3 vs. 27.2; P = 0.001).Although ultrasound scans of obese pregnant women are feasible, image quality and global anatomical scores are significantly lower among obese than normal-weight women. However, certain simple improvements may increase fetal visualization.

The primary aim of this study was to calculate, based on a mathematically modelled decision tree the cost effectiveness of the RM as an intervention for improving fetal medicine specialist’s decisions. Methods: 106 cases of fCNS were prospectively followed up until either termination of pregnancy (TOP) or postnatal follow up (PF). All of them underwent dedicated ultrasonographic (US) assessment and MR, at least once during prenatal evaluation. Neurological postnatal outcome and anatomo-pathology records were registered as gold standards. Positive and negative likelihood ratios (LR) were calculated for four specific regions: posterior fosa (PF), ventricular zone (VZ), cortex and subcortical region (CSC) and middle line (ML). After refinement of univariate analysis, a discriminative likelihood ratio (LR) was calculated for every region and technique, based on direct and indirect cost and calculated post-test probability a Markov’s chain was designed to modelate the real effectiveness of each test. Results: Table 1 summarizes LR results for region and technique, based on post test probabilities and costs, the probability of improving diagnosis with MR before 22 weeks is 15% for PF, 18,5% for VZ, 11% for CSC, 23% for ML, once modified the model for gestational age, the probability at 33 weeks increases to 53%, 78%, 65% and 42% respectively.

genitourinary malformations (7%); 15 gastrointestinal anomalies (6%) and 71 miscellaneous (26%). In 244 (89%) both ultrasound and MRI findings were in agreement with postnatal diagnoses. MRI changed the US diagnosis in 16 (5,8%) cases. Relevant additional information were provided in 7 (2,5%) cases: 3 central nervous system anomalies; 3 thoracic defects; 1 abdominal malformations. Ultrasound was more accurate than MRI in 4 (1,4%) cases: 1 case of placenta previa; 1 exomphalos; 1 CCAM in a twin pregnancy; 1 hypoplasia of corpus callosum. In 9 (3,2%) cases, the diagnoses at both US and MR imaging were not correlated with postnatal outcome. Conclusions: Prenatal US remains the primary fetal imaging modality. Prenatal diagnosis of even complex malformations was accurate in over 90% of cases. In a few selected patients in our experience, particularly in late pregnancy, MRI may however add relevant information.