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Reviews invasive procedures for fetal diagnosis in multiple pregnancies. Role of ultrasonography as a diagnostic tool and therapeutic procedure in multiple gestations; Comparison of singleton and multiple gestations with respect to prenatal genetic diagnosis; Discussion of chorionic villus sampling and amniocentesis; Consideration of multifetal pregnancy reduction; How feticide must be performed; Fetal blood sampling by cordocentesis.

The objective was to evaluate the associations between arterial, venous and intracardiac parameters and adverse perinatal outcome in growth restricted fetuses. Fetuses beyond the 26th week of gestation with an abdominal circumference below the 5th percentile were included in this prospective study. The last Doppler measurement of the umbilical artery, middle cerebral artery, ductus venosus, outflow tract waveforms, atrioventricular flow and ventricular shortening fraction before delivery and adverse perinatal outcome were used for univariate (Fisher's exact test) and multivariate (stepwise logistic regression) statistical analysis. Adverse perinatal outcome was defined as the following: umbilical artery pH < 7.1, significant neonatal morbidity, need for admission to the neonatal intensive care unit, need for intubation at birth and perinatal mortality. A total of 108 fetuses met the inclusion criteria. The univariate analysis showed that presence of arterial redistribution; the absence or reversion of the umbilical artery end-diastolic flow; an abnormal aortic peak velocity, left shortening fraction, right shortening fraction, right atrioventricular E/A ratio and a pulsatile ductus venosus flow are associated with adverse perinatal outcome. The multivariate analysis showed that apart from arterial redistribution, absent or reversed end-diastolic umbilical artery flow and abnormal ductus venosus waveform, no other tested variable added significantly to the prediction of adverse perinatal outcome. It was concluded that fetal cardiac function indices are associated with adverse perinatal outcome. Nevertheless, no benefit was found from using them, in terms of prediction, when arterial and venous Doppler are used. [ABSTRACT FROM AUTHOR]

Prenatal assessment consists of gathering and analyzing genetic, anatomical, biochemical, and physiological information about the fetus to detect any anomalies that might have repercussions during the fetal period or after birth. The main purpose of prenatal diagnosis is to be able to provide families with information about foreseeable anomalies, genetic counseling, and/or therapeutic alternatives for any anomalies detected. This is a multidisciplinary task involving obstetricians, geneticists, pediatricians, radiologists, and psychologists. Prenatal diagnosis has improved considerably in recent years, thanks to technical and technological advances in chromosomal diagnosis of fetal cells, biochemistry, echography, and molecular genetics. Advances in diagnostic imaging techniques have brought about improvements in image quality and increased sensitivity and specificity, making the detection of anatomical anomalies one aspect of prenatal diagnosis that has come to play a fundamental role. Ultrasound (US) is the standard method in routine screening for fetal anomalies; however, this technique has its limitations, even in expert hands. The use of magnetic resonance imaging (MRI) in pregnant patients was first described in 1983 1 , but its use in fetal studies was, until very recently, very limited due to the degradation in image quality caused by fetal movements. The advent of fast MRI sequences has enabled images to be obtained in a matter of seconds, thus eliminating the problem of motion artifacts 2 – 6 . MRI is fast becoming a non-invasive complementary technique to US in the detection of fetal anomalies. [ABSTRACT FROM AUTHOR]

Objective . The objective was to determine the changes in the prenatal detection rate of congenital heart diseases and the emergency neonatal transfer rate due to conducting a fetal cardiac screening using a checklist. Methods . A checklist with 40 items, including eight items regarding the fetal heart, was used by registered medical sonographers conducting ultrasonic screenings on all pregnant women who were scheduled for delivery. Results . The prenatal detection rate of congenital heart diseases was 13.8% prior to the checklist and increased to 34.2% after its implementation. Regarding major congenital heart diseases, the detection rate is now 89.5%, and most diseases can be detected before birth. For five years prior to implementation of fetal cardiac screening, there were 14 cases of newborns (0.14%) requiring emergency neonatal transfer due to a major congenital heart disease that was not detected before birth. For five years after implementation, the emergency transfer rate decreased by 1/7 to 0.02% (two cases). Conclusion . At obstetric facilities where there is no pediatric cardiologist, the number of emergency neonatal transfer cases after birth can be reduced by the following measures: a registered medical sonographer conducts fetal cardiac screening for congenital heart diseases during pregnancy to detect diseases and refer any cases to a perinatal tertiary center in advance. [ABSTRACT FROM AUTHOR]