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Objective To elucidate the characteristic morphological features that may help in the prenatal differential diagnosis of absent septum pellucidum as demonstrated by ultrasound. Methods Twenty-six fetuses were referred to the fetal neurology clinic due to mild to severe ventriculomegaly and a connection between the lateral ventricles. The following ultrasonographic features were evaluated: place and extent of the ventricular communication, non-cleavage of the hemispheres and deep gray nuclei, callosal anomalies, position of the choroid plexus, and other central nervous system and facial or body anomalies. A flowchart was created in order to facilitate the final diagnosis. Results The presence of non-cleavage and/or characteristic facial anomalies prompted the diagnosis of holoprosencephaly (HPE) in 14 fetuses, including two fetuses with the middle interhemispheric variant. Ten fetuses were diagnosed as having hydrocephalus based on the lack of the same features and the observation that the communication between the lateral ventricles was at the level of the third ventricle with almost normal anterior and posterior segments. In two fetuses the diagnosis of septo-optic dysplasia vs. isolated agenesis of the cavum septi pellucidi was contemplated. Conclusions The use of the proposed flowchart enabled differentiation between hydrocephalus and HPE. The communication between the ventricles in hydrocephalic fetuses may be due to a disruption of the septum pellucidum or to a pathological enlargement of the foramen of Monro. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

Objective To evaluate the role of middle cerebral artery Doppler in small fetuses during the late third trimester. Design Prospective observational study of structurally normal fetuses with an estimated fetal weight , 5th percentile for gestation. Perinatal outcome was determined using a structured datasheet sent to each referring obstetrician. Subjects Structurally normal fetuses at 35 or more weeks of gestation referred during a 2-year period to the fetal growth clinic of a regional fetal medicine unit in North London. Fetuses with aneuploidy and/or major structural abnormalities were excluded. Methods Umbilical artery and middle cerebral artery (MCA) Doppler waveforms were recorded and considered abnormal if above 95th or below 5th percentiles, respectively. Amniotic fluid was considered reduced if the maximum vertical cord-free pool was , 2 cm. The placenta was considered mature if the Grannum grade was II or III. The head circumference (HC)/abdominal circumference (AC) ratio was considered abnormal if . 95th percentile for gestation. Fetal growth, amniotic fluid, biophysical profile score and umbilical artery Doppler were used to advise the referring obstetrician about fetal well-being and he/she independently decided both the timing and mode of delivery. Results Forty-seven fetuses fulfilled the entry criteria. Thirty-four (72%) demonstrated normal umbilical artery Doppler waveforms. Sixteen (34%) demonstrated middle cerebral artery redistribution, of which nine (56%) had normal umbilical artery Doppler waveforms. MCA blood flow redistribution was associated with an increased incidence of cesarean delivery and need for neonatal admission. Of all gray-scale parameters, an elevated HC/ AC ratio has the strongest association with MCA blood flow redistribution (15/16 vs. 1/31; P , 0.01). Conclusions MCA Doppler may be a useful tool to assess the health of small fetuses in the late third trimester. Redistribution may occur in the presence of normal umbilical artery Doppler and should be suspected when the HC/AC ratio is elevated.

Fetal seizures are an unusual phenomenon. When diagnosed by ultrasonography, they are frequently associated with malformations and carry a poor prognosis. We describe first trimester seizures in two siblings with arthrogryposis multiplex congenita. In both cases, convulsions appeared before other sonographic signs of the disease. Review of the literature revealed 11 other cases of fetal seizures diagnosed by ultrasound, all later in gestation. Fetal seizures may be the first manifestation of defective neural and motor development. Therefore, in pregnancies at high risk for neuromuscular disease, early sonographic evaluation of fetal motility, in addition to the anatomical survey, is advised.

We report two cases of prenatal ultrasound diagnosis of the lethal form of multiple pterygium syndrome in successive pregnancies in the same woman. This extremely rare entity is characterized by multiple pterygia, flexion contractures, facial anomalies and hypoplasia of heart and lungs. The appearance of the congenital cataract is unique and this finding was present in both abortuses. Prenatal detection of this syndrome is feasible, and an ultrasound survey should be offered during genetic counselling to previously affected couples. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology

Background Elevated midtrimester human chorionic gonadotropin (hCG) is associated with adverse maternal and perinatal outcome. The aims of the study were to evaluate the association between elevated hCG and fetal arterial circulation and to determine the relationship between maternal and perinatal complications and elevated hCG. Methods Pulsatility indices (PI) of middle cerebral artery (MCA) and umbilical artery (UA) were determined prospectively in 72 consecutive patients with abnormal maternal serum hCG (> 2.5 MoM). Each patient had between two to four US scans during pregnancy. Patients with known structural or chromosomal anomalies were excluded from the study. Results Out of 72 women with hCG > 2.5 MoM, 48% (35/72) had hCG > 3.5 and 24% (17/72) had. hCG levels > 4.5 MoM. MCA PI was lower in women with hCG > 4.5 MoM between 28 and 36 wks' gestation, but not between 18 and 27 wks' gestation (fig). No differences of MCA PI were found when the cutoff point of hCG was 3.5. PI of the UA was not different between the groups. Women with hCG levels > 4.5 MoM had a higher prevalence of PIH and preeclampsia, preterm deliveries and cesarean sections in comparison to women with hCG 4.5 mom is associated with cerebral blood flow redistribution and with higher rates of maternal and perinatal complications in comparison to maternal hCG of 2.5–4.5 MoM.

Objectives: 1) To determine the incidence of cord entanglement during early gestation using three dimensional (3D US) sonography. 2) To establish relationship between fetal and umbilical cord lengths, as a suggested pathophysiology for the cord entanglement incidence throughout pregnancy. Material and Methods: A prospective consecutive study was designed and 3D US was performed. Two hundred and thirty seven singleton pregnancies between 13–16 weeks were included. Cord entanglement was defined when one or more of the following was detected: cord around neck, hand, leg, thorax, abdomen shoulder, pelvis. Floating free cord through all its length in the amniotic fluid was defined as normal position cord. Results: Abnormal cord position was observed in 149 (62.9%) patients. Of those: 42.9.0% around neck, 15.4% legs, 12.7% hands, 4.8% -abdomen, 24.2% -other body parts (thorax, shoulder and pelvis). Incidence of total cord entanglement was similar between 13–16 weeks gestation. A decreasing ratio between cord length and CRL (according to literature) was calculated throughout pregnancy. Conclusions: A high incidence of early second trimester cord entanglement was found. This may be explained by the high calculated ratio between cord and fetal lengths during early pregnancy. Cord entanglement should be considered a part of normal early fetal movements and development.

ROI direction on the lateral aspect; then, the inversion visualization mode was activated and the threshold increased until the voxels started to bleed into the vermis, highlighting the fissures, paying no attention to the surrounding structures. Finally, it was analysed if the primary and/or additional fissures could be confidently detected. Results: The primary fissure was consistently detected at 20 weeks of gestation on 3DUS vs 28 weeks on 2DUS. The earliest recognition of the primary fissure was by transvaginal approach with 6–12 MHz probe at 16 weeks. By 26 weeks, both the primary and the secondary fissures were recognisable at least in part in all cases of normalcy, MCM and BPC. At 32 weeks of gestation, fissures were recognisable in all volumes, if of good quality. Abnormal or absent fissures were seen in case of DW and DWv. Conclusions: 3DUS can identify vermian fissures more reliably and earlier than 2DUS in normal and abnormal PF conditions. This technique may contribute to the differential diagnosis of vermian abnormalities.

artery PI, had increased risk for Cesarean section and lower birth weight, lower gestational age at delivery, lower apgar scores and higher need for neonatal intensive care. Uterine Doppler test have a positive prediction value of 58% to predict adverse perinatal outcome and therefore it could be useful to assess SGA fetus with normal umbilical Doppler. CPR at diagnosis of SGA was not useful to assess the subsequent adverse outcome.