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Having seen 87 cases we will now attempt to refine the management to be carried out when intra-abdominal hyperechogenic masses are found in the fetus. Before the 20th week of amenorrhoea (47 cases) amniocentesis can be used to study the digestive enzymes to determine the fetal karyotype. The normal results for intestinal enzymes makes it possible to rule out fetal cystic fibrosis. Three karyotype abnormalities were found in this series. After the 20th week (40 cases) intestinal enzymes cannot be interpreted. The diagnosis of cystic fibrosis then must rely on Delta F 508 mutation; but the absence of this mutation does not exclude cystic fibrosis. When ultrasound signs of intra-abdominal hyperechogenicity are found the diagnosis of cystic fibrosis should not be thought of first, because in this series the majority of fetuses who had this sign were born without any malformation. Four cases of cystic fibrosis that were confirmed have been found but equally there were other serious malformations, three chromosome abnormalities, four intestinal atresias, ten unexplained intra-uterine deaths and one case of biliary duct atresia.

A series of 226 antenatal diagnoses of chromosome structural re-arrangements in 181 couples has shown the usefulness of such diagnosis for couples including a genitor carrying a balanced anomaly. Analysis of the data has elicited major variations in the incidence of unbalanced anomalies in foetal cells and has provided information which can usefully be applied to genetic counselling.

The authors' experience of 155 prenatal diagnoses of inborn errors of metabolism shows that such diagnoses cannot be made without an extensive network of laboratories specialized in cell biology and biochemistry. The enzymatic deficiency must also be clearly established in each family at risk, and the value of enzymatic assay techniques must be demonstrated on cultures of skin fibroblasts and amniotic fluid cells. In this series, 126 diagnoses of 25 different autosomal recessive metabolic diseases were made; 23 foetuses were affected. Twenty-nine diagnoses concerned 5 types of X-linked metabolic diseases; since non-obligatory carrier women also had a prenatal diagnosis, the diseases were detected in only 5 foetuses.

Two first cases of prenatal diagnosis of generalized cytochrome b5 reductase deficiency are presented. In each family, there was an index case with a clinical pattern of congenital methemoglobinemia associated with severe mental retardation (type II). The foetal cells were obtained by amniocentesis at 16 weeks of pregnancy at risk. The cells were cultured, and their cytochrome b5 reductase activity was compared to control amniotic cells, and to cultured fibroblasts originating from the index case. In the first family this led to the conclusion that the foetus was normal or heterozygous. The pregnancy was continued, and the mother delivered a normal newborn with normal red-cell cytochrome b5 reductase. In the second family, the foetal cells displayed a profound decrease of cytochrome b5 reductase activity. The pregnancy was terminated and all the tissues of the aborted foetus exhibited the enzyme deficiency. It is concluded that prenatal diagnosis of the severe form of congenital methemoglobinemia can be performed without ambiguity.

We have monitored 3 pregnancies at risk for galactosemia by deficiency in Galactose-1-Phospho uridyl transferase. Galactosemia was diagnosed in the 1st case; heterozygoty in the 2nd, and a "double heterozygoty" in the 3rd. The latter is the first example of such a diagnosis. Post natal confirmation was obtained in the three cases. Arguments are given for the usefulness of this prenatal diagnosis.

The results confirmed the fiability and the accuracy of the different acts and technics leading to these diagnosis. A prospective study of the safety of amniocentesis involved more than 1000 subjects. The analysis of the information on the pregnancy, the delivery, the state at birth and after birth of the infant did not show any significant increase of pathologic findings which may be related to immediate or delayed consequences of amniocentesis.