Search

Objective: To determine the short‐ and long‐term outcome of pregnancies with proven first‐trimester fetal cytomegalovirus (CMV) infection in a large prospective cohort. Methods: This was a prospective cohort study of pregnancies with documented primary maternal CMV infection in the first trimester and evidence of fetal infection, referred for further evaluation between January 2011 and January 2018. Maternal serological diagnosis of primary CMV infection was documented by seroconversion. Vertical CMV transmission was identified by amniocentesis with polymerase chain reaction (PCR) for the CMV genome. After birth, fetal infection was re‐tested by PCR in neonatal urine or saliva samples. All patients underwent serial prenatal ultrasound scans and fetal magnetic resonance imaging (MRI) at 32–33 weeks' gestation. All neonates underwent ocular fundus examination, an ultrasound brain scan and hearing evaluation, and were followed periodically for a median of 2 years (range, 6 months to 10 years). Follow‐up information was obtained from hospital charts and by telephone interviews with parents. The CMV‐associated outcomes assessed were sensorineural hearing loss (SNHL), neurodevelopmental abnormality, composite clinical outcome (including SNHL and neurodevelopmental abnormality) and composite outcome (additionally including termination of pregnancy (TOP)). The association between prenatal ultrasound or MRI findings and abnormal outcome was assessed. Results: Primary CMV infection in the first trimester occurred in 123 patients. The rate of an abnormal ultrasound finding was 30.9%, and the rate of an abnormal MRI finding was 30.1% overall and 14.1% in the subgroup of patients with normal ultrasound. Of the 85 patients with normal ultrasound, 12 had an abnormal MRI finding, of whom five (5.9%) had true anatomical findings. Fifteen patients decided to terminate the pregnancy owing to abnormal prenatal findings on either ultrasound or MRI. Overall, the rate of CMV‐associated postnatal and childhood sequelae was 27.8%, with a rate of 16.7% for SNHL and 11.1% for neurodevelopmental abnormalities, mostly slight motor or verbal delay. Approximately half of the cases with CMV‐associated sequelae did not have any abnormal prenatal imaging findings. Abnormal prenatal findings on ultrasound were not associated significantly with SNHL, neurodevelopmental delay or composite clinical outcome (P = 0.084, 0.109 and 0.176, respectively), but they were associated with the composite outcome including TOP (P < 0.001). We identified a non‐significant trend for a higher rate of SNHL in the group with abnormal ultrasound than in those with normal ultrasound. For abnormal MRI findings, we found a correlation only with neurodevelopmental abnormality and composite outcome (P = 0.014 and P < 0.001, respectively). Conclusions: The risk of childhood sequelae after first‐trimester fetal CMV infection is most often associated with abnormal prenatal imaging findings. However, normal imaging does not rule out the development of SNHL and minor neurodevelopmental abnormalities. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. Linked article: There is a comment on this article by Picone and Mandelbrot. Click here to view the Correspondence. [ABSTRACT FROM AUTHOR]

Objective: Fetal isolated ventricular asymmetry (IVA) is a relatively common finding in pregnancy, but data regarding its effect on neurodevelopmental outcome are scarce and founded principally on ultrasound-based studies. The purpose of this study was to assess the neurodevelopmental outcome of IVA cases in a magnetic resonance imaging (MRI)-based study.Methods: Cases referred for fetal brain MRI as part of the assessment of IVA without ventriculomegaly (lateral ventricular atrial diameter ≤ 10 mm), identified during routine ultrasound examination, were assessed for possible inclusion. Asymmetry was defined as a difference in width of ≥ 2 mm between the two lateral ventricles. Forty-three cases were included in the study group and compared with a control group of 94 normal cases without IVA. Children were assessed at ages 13-74 months using the Vineland-II Adaptive Behavior Scales (VABS-II).Results: VABS-II scores were within normal range. There was no significant difference in composite VABS-II score between the study and control groups (106.5 vs 108.0; P = 0.454). VABS-II scores did not differ between the groups when matched for gender and age at VABS-II interview (109.6 in study group vs 107.8 in control group; P = 0.690).Conclusion: In cases of IVA without ventriculomegaly on MRI, neurodevelopmental test scores were normal and did not differ from cases without IVA. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Conclusions Our small sample size study did not show that further investigation using fetal body MRI has an added value in cases of sonographic idiopathic polyhydramnios and perhaps puts in doubt its utilisation in cases of idiopathic polyhydramnios. Additional studies of large sample size are needed to further assess the value of MRI in idiopathic polyhydramnios investigation. [Extracted from the article]

For dose assessment of workers at Nuclear Research Center Negev exposed to natural uranium, spot urine samples are analysed and the results are normalised to 24-h urine excretion based on 'standard' man urine volume of 1.61 d-1. In the present work, the urine volume, uranium level and creatinine concentration were determined in two or three 24-h urine collections from 133 male workers (319 samples) and 33 female workers (88 samples). Three volunteers provided urine spot samples from each voiding during a 24-h period and a good correlation was found between the relative level of creatinine and uranium in spot samples collected from the same individual. The results show that normalisation of uranium concentration to creatinine in a spot sample represents the 24-h content of uranium better than normalisation to the standard volume and may be used to reduce the uncertainty of dose assessment based on spot samples. [ABSTRACT FROM AUTHOR]

The Organic Bound Tritium (OBT) amount in the body may induce changes in the evaluation of the internal exposure to tritium, due to its different retention time relative to HTO. OBT measurements for urine are not performed routinely, mainly because of the lengthy work needed in preparation of the samples, when using the standard oxygen combustion method. A simpler and more rapid method based on liquid scintillation counting (LSC) was employed, and an evaluation was performed to check its suitability for urine samples. The principle of the proposed method is based on subtracting the LSC counts of the water phase sample (HTO) from the total activity of the urine sample (OBT + HTO). A good correlation was found between the results obtained when applying the proposed direct method and the Gold standard method. The minimum detectable activity when using this method was determined. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to clarify whether increased aggregation of red blood cells (RBCs) of multiple myeloma (MM) patients is caused by changes in plasma chemical composition or is associated with alterations in RBC properties and in addition, to suggest an approach to revert the enhanced aggregation in MM toward normal. Materials and methods: 40 blood samples of MM patients and suspensions of control RBCs in MM plasma were examined. In addition, RBC aggregation in MM blood was studied in the presence of dextrans with mean molecular weights of 9.6 and 40 kDa (D9.6 and D40). A method based on electrical and dielectric properties of cellular suspensions was used to study RBC aggregation. In this method, a lower aggregation index demonstrates a higher aggregability. Results: The mean values of aggregation index for whole blood of healthy individuals, control cells in MM plasma and MM blood sample are 19.0, 7.2 and 3.2%, respectively. The kinetics of RBC aggregation slow down with the decrease in the fraction of MM plasma. No correlation was found between RBC aggregation and the immunoglobulin plasma level. Addition of D9.6 to MM blood reverts the enhanced aggregation toward normal. Discussion: The findings that RBC aggregation changes in the following order: MM blood > normal RBCs in MM plasma > control blood sample, suggest that surface-active plasma molecules play a role in enhanced aggregation in MM. The surface concentration of these molecules and hence RBC aggregability is reduced in the presence of dextrans due to their competitive adsorption onto RBC membrane. Because the end-to-end distance of D40 is quite comparable with the Debye length, the effect of this particular dextran on RBC aggregation is negligible. [ABSTRACT FROM AUTHOR]

OC08.09: Functional magnetic resonance imaging of the placenta in monochorionic twin pregnancies complicated by Twin-twin transfusion syndrome Conclusions In this pilot study, we have illustrated that placental perfusion discrepancy can be demonstrated by means of functional MRI, identifying a decrease in T2* in the donor placental area. To evaluate placental functional imaging markers in monochorionic twin pregnancies with or without Twin-twin transfusion syndrome (TTTS), using diffusion-weighted magnetic resonance imaging (MRI) and relaxometry. [Extracted from the article]

Methods In this retrospective study we examined normal fetuses from uncomplicated pregnancies. The aim of this study was to evaluate the level of the fetal conus medullaris (CM) throughout the pregnancy, by a simple 3D rendering technique. The assessment of the conus level was feasible in 96% of the fetuses scanned, in the remaining 4% high maternal body mass index or inappropriate fetal position prevented the clear visualisation of the CM. [Extracted from the article]

Fetal brain MRI (fbMRI) has been increasing in use in recent years as means of tracking normal and pathological fetal brain maturation. Only the CMV positive group had increased ADC values in the temporal and parietal lobes. T2 hyper-intense signal in fbMRI associated with positive for CMV infection has increased ADC values in the temporal and parietal lobes, suggestive of brain edema in these areas. [Extracted from the article]

In this study, we aimed to compare brain volumes of fetuses with CMV infection and non-infected controls. A retrospective cohort study examined MRI brain scans of 42 fetuses (at 30-34 weeks gestational age) that were diagnosed with intrauterine CMV infection. [Extracted from the article]

Outcome variables included termination of pregnancy (TOP), hearing abnormalities (SNHL), neurological disabilities (NDI) or composite outcome (all three). When sonographic abnormalities were excluded, MRI findings were not associated with NDI (9.1% vs. 5.1%, p = 0.48), SNHL (8.4% vs. 7.3%, p = 0.91) or composite outcome (13.6% vs. 11.1%, p = 0.86). [Extracted from the article]

A letter to the editor is presented which demonstrates an early diagnosis of congenital high-airway obstruction syndrome (CHAOS) in the fetus of a 35-year-old primigravida through using high-resolution transvaginal sonography.

Invasive placentation poses a significant challenge in obstetrics. In this study we examined the individual and combined ability of multiple sonographic and MRI signs to diagnose invasive placentation in suspected cases in the third trimester. [Extracted from the article]

The article presents a case study of 24-year old primigravida who underwent fetal anatomy scan in her gestation. Topics include the images of the soft-tissue mass in the fetal scalp, changes in the dural sinuses, and diagnosis of either sinus pericranii (SP)or atretic cephalocele (AC) with falcine sinus.

The purpose of this study was to assess whether the finding is related to neurodevelopmental delay, and to examine reclassification to normal fetal CC length using CC length/EFW ratio. In addition, there was no statistically significant difference between fetuses reclassified as normal callosal length according to CC length/EFW ratio in comparison to the control group. The neurodevelopmental outcome of fetuses with diagnosed short CC did not differ from the neurodevelopment of normal fetuses in the control group. [Extracted from the article]

The aim of our study was to explore the contribution of fetal brain MRI to the detection of CNS anomalies in cases of polyhydramnios. Brain anomalies were detected in ultrasound in 12 (26%) cases while MRI detected brain anomalies in 23 (50%) cases. [Extracted from the article]

To assess the level of agreement and correlation between the two cardinal imaging methods of fetal neuroimaging: ultrasonography (US) and magnetic resonance imaging (MRI), by measuring the corpus callosum (CC) and transverse cerebellar diameter (TCD), in terms of length and percentile. In comparison to the agreement of TCD and CC length (mm), TCD and CC percentile (%) had a lower level of agreement, moderate agreement for TCD percentile (ICC = 0.44) and fair agreement for CC percentile (ICC = 0.36). [Extracted from the article]

P18.05: Neurodevelopmental outcome of fetal intracranial hemorrhage: MRI-based cohort study The purpose of this study is to assess the risk factors and neurodevelopmental outcome of fetal ICH in a magnetic resonance imaging (MRI)-based study. 22 patients with diagnosis of ICH by fetal MRI were included. [Extracted from the article]

The primary outcome was assessed by Adaptive Behavior Composite Score that is summarised from four long-term neurodevelopment domains: communication, daily living skills, socialisation and motor skills. We proved that exposure to 1.5T MRI during pregnancy had no harmful effects on communication, daily living or motor skills. Moreover, we found favorable socialisation scores in exposed fetuses; The effect of first trimester exposure on motor development remains unclear. [Extracted from the article]

Arachnoid cysts (AC) are congenital lesions comprising 1% of all intracranial mass lesions. This is a retrospective cohort study of arachnoid cysts detected prenatally by fetal MRI in 29 fetuses compared to a control group of 59 fetuses without arachnoid cyst who were examined by MRI. [Extracted from the article]

Thus SNHL, NDI and composite outcome were more likely after first trimester infection compared to second trimester (p < 0.05). It should be noted that the hearing impairment was more severe in first trimester infection with 4 cases of complete deafness (3 of them with normal US and normal MRI) requiring implants while in second trimester infection there was only partial or unilateral SNHL. Our data shows that SNHL and NDI can occur after second trimester infection, however it is significantly less common and all cases of SNHL after second trimester infection were partial or unilateral. [Extracted from the article]

Comparison of MRI results was made between the different classification of the CHD and to a control group of 113 fetal MRI examinations, performed on fetuses with normal heart and brain ultrasound. Significant higher rates of overall brain-pathologies, ventricle-pathologies, cortex-pathologies were found in the simple-group compared to in the complex-group and the controls, along with significance in the biometrical-parameters. Fetuses with CHD demonstrate findings in brain MRI, suggestion in-utero pathogenesis of the neurological and cognitive anomalies found later on. [Extracted from the article]

Fetal isolated ventricular asymmetry (IVA) is a relatively common finding in pregnancy, but data regarding its effect on neurodevelopmental outcome are scarce and based on studies using the ultrasound modality. The purpose of this study was to assess the outcomes of IVAs in a magnetic resonance imaging (MRI) based study. When comparing cases of IVA to controls matched for gender and children's age during VABS there was no significant difference in the composite VABS score (109.6 in study group vs 107.8 in control group; I p i = 0.690), or any of its components. [Extracted from the article]

To evaluate the accuracy of prenatal and post-natal parameters to predict neonatal outcome in isolated congenital diaphragmatic hernia (CDH) by a single centre with recurrent prenatal evaluations. In all cases, evaluation included either LHR measurement, O/E LHR. In cases with multiple evaluations, the minimal O/E LHR was most accurate to predict survival (vs. maximal, first or last evaluation, figure 1). [Extracted from the article]

The aim of this study is to assess the additional benefit of fetal MRI in cases with proven fetal primary CMV infection. Abnormal postnatal US was associated with first trimester infection (OR 2.4, p=0.044), abnormal fetal US (OR=6.8, p=0.009), fetal sonographic cerebral findings (OR=17, p<0.001) and abnormal fetal MRI (OR=15, p<0.001). Hearing loss was associated only with first trimester infection (OR=1.9, p=0.039) while other neurological impairment was associated with first trimester infection (OR=3.9, p=0.04) and abnormal MRI (OR=4.28, p=0.005). [Extracted from the article]