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Objective: To investigate the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and infection-to-delivery interval with maternal and cord serum concentrations of anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies and transplacental transfer ratio in pregnant women with active or recovered SARS-CoV-2 infection., Methods: This was a prospective case series of consecutive pregnant women with laboratory-confirmed SARS-CoV-2 infection between 27 March 2020 and 24 January 2021. We collected information regarding deep throat saliva or nasopharyngeal swab (NPS) reverse transcription polymerase chain reaction (RT-PCR) test results, serial cycle threshold (Ct) values at and after diagnosis, demographic, clinical and outcome data, and neonatal NPS RT-PCR results. Qualitative and quantitative analysis of IgG and immunoglobulin M (IgM) antibodies against SARS-CoV-2 was performed in maternal and cord blood serum samples obtained at delivery. Correlation of maternal Ct values, infection-to-delivery interval, infection duration and viral load area under the curve (AUC) with gestational age (GA) at diagnosis, maternal and cord serum IgG concentrations and transplacental transfer ratio of IgG were evaluated using Pearson's correlation., Results: Twenty pregnant women who consented to participate and who had delivered their babies by 31 January 2021 were included in the study, comprising 14 who had recovered from coronavirus disease 2019 (COVID-19) and six with active infection at delivery. The median GA at clinical manifestation was 32.7 (range, 11.9-39.4) weeks. The median infection-to-delivery interval and infection duration were 41.5 (range, 2-187) days and 10.0 (range, 1-48) days, respectively. The median GA at delivery was 39.1 (range, 32.4-40.7) weeks and the median seroconversion interval was 14 (range, 1-19) days. Of 13 neonates born to seropositive mothers with recovered infection at delivery, 12 tested positive for anti-SARS-CoV-2 IgG. All neonatal NPS samples were negative for SARS-CoV-2 and all cord sera tested negative for IgM. The median transplacental transfer ratio of IgG was 1.3 (interquartile range, 0.9-1.6). There was a negative correlation between infection-to-delivery interval and anti-SARS-CoV-2 IgG concentrations in maternal (r = -0.6693, P = 0.0087) and cord (r = -0.6554, P = 0.0068) serum and a positive correlation between IgG concentration in maternal serum and viral load AUC (r = 0.5109, P = 0.0310). A negative correlation was observed between transfer ratio and viral load AUC (r = -0.4757, P = 0.0409)., Conclusions: In pregnant women who have recovered from COVID-19, anti-SARS-CoV-2 IgG concentrations at delivery increased with increasing viral load during infection and decreased with increasing infection-to-delivery interval. The median transplacental transfer ratio of IgG was 1.3 and it decreased with increasing viral load during infection. © 2021 International Society of Ultrasound in Obstetrics and Gynecology., (© 2021 International Society of Ultrasound in Obstetrics and Gynecology.)

Increased uterine artery pulsatility and resistance indices with or without notching of the waveform have been associated with an increased risk of pre-eclampsia and fetal growth restriction. However, reversed diastolic flow in the uterine artery has not previously been reported. We present two high-risk obstetric cases complicated by severe placental insufficiency: pre-eclampsia followed by eclampsia in one case and intrauterine growth restriction with abnormal cardiotocography in the other. Doppler studies of the uterine arteries revealed reversed diastolic flow in both cases. The pathophysiology and potential implications are discussed., (Copyright 2007 ISUOG. Published by John Wiley & Sons, Ltd.)

Objective: To test the hypothesis that the use of two-dimensional (2D) ultrasonography with three-dimensional/four-dimensional (3D/4D) ultrasonography can reduce anxiety to a greater extent in women at risk of having a fetus with congenital abnormalities than the use of 2D ultrasonography alone., Methods: A total of 124 women attending the prenatal diagnostic clinic of a teaching hospital were randomized into the intervention group (2D ultrasonography followed by 3D/4D ultrasonography) or control group (2D ultrasonography alone). The primary outcome was maternal anxiety levels, which were assessed by the Spielberger state-trait anxiety inventory. We measured the anxiety levels in all women at the first visit, at around 18 weeks' gestation (immediately after ultrasound examinations) and at 28 weeks' gestation., Results: A short-term reduction of the state-anxiety score (by around 2 points) from the first visit to after ultrasound examinations was observed in both the intervention group and the control group. Unexpectedly, a small increase in the state-anxiety score from the first visit to 28 weeks' gestation was observed in the intervention group but not in the control group, though there was no significant difference in the changes between the two groups. Repeated measures ANOVA (analysis of variance) also showed that there was no significant interaction effect between groups and time of assessment on the state-anxiety scores (F = 1.072 and P = 0.344). About 80% of women reported a better understanding that their baby was normal after viewing 3D rather than 2D images., Conclusion: This randomized study indicates that the addition of 3D/4D ultrasound does not cause a significant reduction in maternal anxiety in pregnancies at risk of fetal abnormalities compared with conventional 2D ultrasound alone., (Copyright 2006 ISUOG. Published by John Wiley & Sons, Ltd.)

Objective: To describe Three-Dimensional eXtended Imaging (3DXI) as a new display modality for three-dimensional (3D) ultrasound examination of the fetus., Methods: The spine, palate, heart and brain were evaluated using 3D ultrasound examination at a mean gestational age of 22 weeks in 35, 31, 32 and 31 fetuses, respectively. The volume data captured were analyzed using the conventional orthogonal display mode (ODM), as well as the 3DXI, which includes the Multi-Slice View (MSV) mode and the Oblique View (OBV) mode. The MSV mode allows simultaneous display of multiple sequential parallel planes while the OBV mode allows examination of a non-standard straight or curved plane., Results: The MSV mode allowed a simultaneous display of multiple sequential parallel planes of the fetal structures, but we found some uncertainty if an isolated image in one of the multi-slice images represented the exact level of a fetal structure. The MSV mode was advantageous in one of the six cases of facial cleft by allowing the simultaneous display of bilateral clefts that were located in two different axial planes. The multi-slice images were helpful in making the diagnosis in one case of holoprosencephaly. The OBV mode allowed examination of the coronal plane across the curvature of the spine, and the 'in-plane' view of the interventricular septum in a non-gated study., Conclusion: The 3DXI can display the volume data in a different manner from that which usually results from the use of more conventional ODM, and provide additional information over conventional two-dimensional sonography.

Without intervention, the development of hydrops fetalis secondary to cystic adenomatoid malformation of the lung (CAML) implies a 100% mortality rate. Conversely, four CAML cases with in-utero resolution of hydrops fetalis after prenatal betamethasone therapy with good clinical outcome have been reported in the literature. The mechanism is speculated to be the effect of corticosteroid in improving lung maturation. Here we present another CAML case with resolution of hydrops fetalis after prenatal betamethasone therapy but which was followed by later intrauterine death. We speculate that the resolution of the CAML lesion itself may be more important in determining the clinical outcome than the resolution of hydrops. The association between prenatal betamethasone therapy and resolution of hydrops may be related to a different mechanism other than improvement of lung maturation., (Copyright 2005 ISUOG)

Objectives: To explore the relationship between cerebroplacental Doppler impedance index and birth weight in postdates pregnancies, and to evaluate the use of a combination of Doppler parameters and ultrasound biometry in the prediction of large-for-gestational age (LGA) fetuses at 41 weeks of gestation., Methods: The pulsatility indices of the umbilical (UA-PI) and middle cerebral (MCA-PI) arteries, the cerebroplacental pulsatility index ratio (CPR) and the estimated fetal weight (EFW) were obtained in a cohort of 181 ultrasound-dated pregnancies at 41 weeks' gestation, 2 days before induction of delivery. A regression equation was established and the correlation between umbilical artery impedance and different birth-weight centile groups was determined. A receiver-operating characteristics (ROC) curve was used to compare prediction of LGA fetuses using biometry alone with that using biometry and UA-PI., Results: UA-PI was inversely related to EFW (Spearson's correlation coefficient rho = -0.28, P < 0.001). Logistic regression showed an independent contribution of UA-PI to the birth-weight estimation (birth weight = 1356.8 - 232.0 x UA-PI + 0.65 x EFW). On ROC curve analysis, the prediction of LGA with the regression equation was comparable to that using ultrasound biometry alone., Conclusion: UA-PI was inversely correlated to EFW, but the combination of ultrasound biometry and UA-PI compared with biometry alone showed similar prediction of LGA fetuses in postdates pregnancies. Further prospective trials on larger populations or groups with a higher prevalence of LGA fetuses would be needed to validate the use of the new formula.

Objective: To investigate the correlation between Doppler parameters in the umbilical and fetal middle cerebral arteries and pregnancy outcome in women with gestational diabetes mellitus (GDM)., Methods: A prospective study was performed on 169 singleton GDM pregnancies in a university teaching hospital from January to December 2002. Umbilical artery (UA) pulsatility index (PI) and middle cerebral artery (MCA) PI and peak systolic velocity (Vmax) were measured every 4 weeks until delivery from the time of diagnosis of GDM. The pregnancy outcome was obtained from the hospital database. Using linear or quadratic regression, lines of best fit were drawn to compare the Doppler measurements between the two groups with normal and abnormal pregnancy outcomes., Results: One hundred and thirty-eight women with known pregnancy outcome completed the study. A total of 305 Doppler examinations were performed with one to four examinations for each woman. Thirty-eight women (27.5%) had one or more abnormal pregnancy outcomes: placental abruption, pre-eclampsia, preterm delivery, small-for-gestational age (SGA) infants, low Apgar scores, neonatal jaundice requiring treatment, sepsis, birth trauma, meconium aspiration syndrome, respiratory and neurological complications. There was extensive overlap of the UA-PI, MCA-PI and MCA-Vmax measurements between the two groups., Conclusion: A Doppler study of the UA-PI, MCA-PI and MCA-Vmax was not useful in the prediction of abnormal pregnancy outcome in GDM.

Objective: To investigate the procedure-related complications of rapid amniodrainage in the treatment of polyhydramnios., Methods: We followed prospectively all patients with polyhydramnios treated with rapid amniodrainage under continuous ultrasound guidance using a vacuum wound-drainage system from 1995 to 2002 in the fetal medicine unit of a university teaching hospital. We recorded: maternal age, type of pregnancy (singleton/twin), cause of polyhydramnios, gestational age at amniocentesis, volume of amniotic fluid drained, duration of the procedure, other intrauterine procedures in addition to the amniodrainage, and procedure-related complications including placental abruption, premature rupture of membranes (PROM), chorioamnionitis, fetal bradycardia and preterm delivery within 48 h of amniodrainage., Results: Seventy-four consecutive women had 134 rapid amniodrainage procedures during the study period. Four procedures were excluded because the women were already in labor at the time of amniodrainage and they delivered within 48 h of the procedure. The final database therefore consisted of 70 patients with 130 procedures. Sixty-two percent (80/130) of the procedures were performed for the treatment of twin-twin transfusion syndrome (TTTS). There were altogether four procedure-related complications (3.1%; 95% CI, 1.0-8.0%). Three of them occurred in the TTTS group (3/80 procedures, 3.8%; 95% CI, 1.0-11.0%): one case each of placental abruption, PROM and fetal bradycardia. One PROM occurred in the non-TTTS group (1/50 procedures, 2.0%; 95% CI, 0-11.0%). In both cases of PROM the women presented in labor., Conclusions: Rapid amniodrainage using a vacuum wound-drainage system is safe and efficient to treat severe polyhydramnios, with a 3.1% complication rate., (Copyright 2003 ISUOG. Published by John Wiley & Sons, Ltd.)

Objectives: To evaluate the potential usefulness of noninvasive ultrasound assessment of fetal anemia in the diagnosis and management of fetuses with homozygous alpha-thalassemia-1., Methods: We describe four pregnancies complicated by fetal homozygous alpha-thalassemia-1. They presented with ultrasound abnormalities before the development of hydrops. As part of evaluating the fetal condition, we performed ultrasound and Doppler studies aimed at identifying fetal anemia. These studies included evaluation of intrahepatic umbilical venous maximum flow velocity, middle cerebral artery peak flow velocity, fetal liver length and spleen perimeter., Results: In all four fetuses, ultrasound and Doppler studies suggested the presence of fetal anemia. Homozygous alpha-thalassemia-1 was diagnosed in all cases, with fetal blood sampling confirming anemia in three fetuses. The majority of the intrahepatic umbilical venous maximum flow velocity and middle cerebral artery peak flow velocity measurements were above the 95th centile. Two fetuses underwent intrauterine transfusion and fetal blood flow velocities returned to normal after correction of the fetal anemia. The fetal liver length and spleen perimeter measurements showed a similar trend, although they were less consistent before 28 weeks., Conclusion: Non-invasive ultrasound parameters, in particular quantification of intrahepatic umbilical venous maximum flow velocity and middle cerebral artery peak flow velocity, were found to be useful in the diagnosis and management of fetal anemia in pregnancies with fetal homozygous alpha-thalassemia-1.