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Congenital aortic vascular ring may present after birth with variable degrees of respiratory distress due to tracheal compression. The aim of this study was to prospectively evaluate in utero tracheal patency in correlation with postnatal outcome. During an eight-year period, fetuses with aortic arch abnormality encircling the trachea and forming a complete ring were recruited for the study. Tracheal patency was classified as: no compression, partial compression, or complete compression. Postnatal MRI/CTangio studies were performed and outcome data was retrospectively analyzed from the medical records. Among the 46 fetuses recruited to the study, 38 had right aortic arch (RAA), and 8 presented with double aortic arch (DAA). In the RAA group 35 (92.1 %) of the fetuses presented no compression and 34 (97.1 %) of them were asymptomatic in the long-term follow-up. Three fetuses (7.9 %) in this group presented in utero compression: one was terminated at 16 weeks of gestation due to associated ominous findings, and the other two had mild respiratory symptoms around 12 months of age and underwent surgery with a good outcome. In the DAA group, all fetuses presented in utero with tracheal compression. Seven showed partial and one complete compression. Among the seven with partial compression, six were symptomatic and underwent surgery. The case with severe airway occlusion had emergency tube insertion in the delivery room and underwent surgery at 7 days but died from severe respiratory complications. This is the first study to evaluate in utero tracheal patency in cases with vascular ring. It allows better prenatal and postnatal workup and follow-up including potentially life-threatening respiratory failure.ZIEL: Nach der Geburt kann ein kongenitaler Aorten-Gefäßring mit unterschiedlich starker Atemnot aufgrund einer Trachealkompression auftreten. Das Ziel dieser Studie war die prospektive Bewertung der Durchgängigkeit der Trachea in utero in Korrelation mit dem postnatalen Outcome. Über einen Zeitraum von 8 Jahren wurden Föten mit einer Anomalie des Aortenbogens, der die Trachea umschloss und einen vollständigen Ring bildete, für die Studie rekrutiert. Die tracheale Durchgängigkeit wurde wie folgt klassifiziert: keine Kompression, partielle Kompression oder vollständige Kompression. Postnatale MRT-/CT-Angio-Studien wurden durchgeführt und Daten zum Outcome wurden aus den medizinischen Unterlagen retrospektiv analysiert. Von den 46 für die Studie rekrutierten Föten hatten 38 einen rechten Aortenbogen (RAA) und 8 einen doppelten Aortenbogen (DAA). In der RAA-Gruppe zeigten 35 (92,1 %) Föten keine Kompression und 34 (97,1 %) dieser Föten waren im Langzeit-Follow-up asymptomatisch. Drei Föten (7,9 %) in dieser Gruppe zeigten eine Kompression in utero: eine Schwangerschaft wurde in SSW 16 aufgrund assoziierter verdächtiger Befunde beendet, die anderen beiden Kinder hatten im Alter von etwa 12 Monaten leichte respiratorische Symptome und wurden mit gutem Ergebnis operiert. In der DAA-Gruppe zeigten alle Föten eine intrauterine Trachealkompression. Sieben zeigten eine partielle und 1 Fetus eine vollständige Kompression. Von den 7 Kindern mit partieller Kompression waren 6 symptomatisch und wurden operiert. Im Fall des schweren Atemwegsverschlusses wurde das Kind im Kreißsaal notfallmäßig intubiert und nach 7 Tagen operiert, verstarb jedoch an schweren respiratorischen Komplikationen. Dies ist die erste Studie, die die Durchgängigkeit der Trachea in utero bei Föten mit Gefäßring untersucht. Sie ermöglicht eine bessere prä- und postnatale Versorgung und Nachbetreuung einschließlich eines potenziell lebensbedrohlichen Atemversagens.

Purpose To describe in utero and postnatal imaging and clinical characteristics of primary fetal lung hypoplasia (PFLH). Methods A retrospective review of fetuses and neonates diagnosed in one academic tertiary center during an eleven-year period. Results 12 cases of PFLH were identified. 4 were bilateral and 8 had unilateral involvement. Prenatal sonographic characteristics, postnatal magnetic resonance imaging (MRI), computerized tomographic angiography (CTA), and histologic findings are described. 3 of the 4 bilateral cases were evaluated during fetal live. 2 were terminated and 2 died shortly after delivery. Among the 8 cases with unilateral PFLH, 7 involved the right lung and 1 the left lung. In fetuses with right hypoplasia, 5 showed characteristic features of Scimitar syndrome, while associated gastrointestinal tract (GIT) anomalies were presented in 2 cases. In this group 3 were born alive and the other 5 were terminated. Conclusion Primary PFLH is a rare anomaly that lethal in its bilateral form and with variable prognosis in its unilateral variant. Targeted evaluation of lung vascularity and exclusion of associated anomalies, especially of the GIT, are important prognostic factors.

Purpose: Talipes equinovarus (TEV) is a common birth defect. Differentiation between isolated and complex TEV is fundamental due to its effect on prognosis. Association between TEV and poor neurological outcome is more prominent in complex cases and highlights the significance of brain evaluation. The aim of the current study was to evaluate the contribution of fetal brain MRI to sonographic evaluation. Materials and Methods: In this retrospective study we evaluated charts of all pregnant patients referred for fetal brain MRI due to fetal TEV between 1/1/2011 and 12/31/14 in a single tertiary referral center. Isolated and complex TEV were differentiated according to associated anomalies. Brain US and MRI results were compared. Results: 28 pregnant patients were included with an average gestation and parity of 2.5 and 1.5, respectively. Both isolated and complicated TEV groups included 14 fetuses after initial TEV diagnosis on anatomical survey. Brain sonography and MRI were normal among 12/14 patients with isolated TEV while two patients were later diagnosed with mild ventriculomegaly. US brain evaluation has revealed pathologic findings in 4 (28.6 %) cases in the complicated TEV group, while MRI demonstrated abnormal findings in 8 (57.1 %) fetuses with notable severity diversity. In 6 cases, MRI diagnosed additional pathologies which were not demonstrated by US. Conclusion: Brain fetal MRI is an efficient tool during antenatal evaluation of complicated TEV with a high percentage of additional findings not demonstrated songraphically while its efficacy in isolated cases is in doubt. The current study expands the relevance of fetal brain MRI in cases of non-CNS anomalies.

To evaluate different sonographic methods for the prediction of the difficulty and the success of operative vaginal delivery (OPD).A prospective study was performed on 45 term singleton uncomplicated pregnancies with prolonged 2nd stage of delivery with cephalic presentation. Measurements of the fetal head, relations between the fetal head and maternal pelvic parameters during rest and during maternal pushing were taken using translabial ultrasound.29 cases of OPD were successful and 4 cases failed ending in cesarean section. The passage of the biparietal diameter (BPD) of the infrapubic line (IPL) was statistically correlated with the success of OPD. Head station, passage of the BPD of the IPL, percentage of head after the IPL, circumference of head after IPL were all correlated with the difficulty of OPD. When the distance between the widest diameter of the head and the IPL is 1.2 cm, there is a 90 % probability of success of OPD. When that distance is 3.3 cm, there is 90 % probability of cesarean section. When the percentage of head beyond the IPL was 54 %, there was 90 % probability of successful OPD.Translabial ultrasound is useful in the prediction of the difficulty and the success of OPD. The higher the extent of head that passed the IPL, the less difficult the OPD and the greater the success rate of the OPD.