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Objective To assess the role of early mid-trimester cervical length measurement as a predictor of spontaneous preterm birth in an unselected population. Methods In this prospective study, unselected, asymptomatic, Caucasian women with singleton pregnancies underwent standardized transvaginal ultrasonographic (TVS) cervical length measurement at 13–15 weeks' gestation as a screening test for preterm delivery (PTD). Women with multiple gestations, iatrogenic PTD, and previous cervical conization were excluded. The primary outcome measures were spontaneous PTD at < 37 and < 34 weeks. The correlation between cervical length and previous obstetric history was evaluated. Results A total of 2469 patients met the inclusion criteria. The mean gestational age at cervical assessment was 14 + 2 weeks. The mean gestational age at delivery was 40 + 0 weeks. The rate of spontaneous deliveries before 37 weeks' gestation was 1.7%. In 0.2% the delivery occurred before 34 weeks' gestation. The mean ± standard deviation cervical length for the entire population was 44.2 ± 5.4 mm. No difference was observed between cervical length in women that delivered at term and those that delivered either before 37 or before 34 weeks' gestation. Previous obstetric history (prior preterm birth, previous miscarriages and terminations, and parity) did not affect cervical length at 14 weeks of gestation. Conclusions Performed at 14 weeks' gestation, TVS measurement of the cervical canal length to predict spontaneous PTD is not a reliable screening procedure. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.

A prospective study of screening for fetal abnormalities and chromosomal defects was carried out by ultrasound examination at 13–l5 weeks of gestation and 20–22 weeks; the first scan was performed transvaginally and the second transabdominally. During a 4-year period (1991–95), 3490 unselected consecutive pregnancies with a total of 3514 fetuses were examined. There were 21 chromosomally abnormal fetuses, including ten with trisomy 21, and, in 19 (90.5%), fetal defects were detected at the first and/or second ultrasound examination. The most effective marker for chromosomal defects was increased nuchal translucency thickness (≥ 4 mm) at the 13–15-week scan, which was present in seven of the ten fetuses with trisomy 21 and in six of the 11 with other chromosomal abnormalities. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology

The aim of this study was to assess whether a screening program for fetal cardiac malformations is justified in a low-risk population, and which factors influence its accuracy. The fetal heart was evaluated in 7024 pregnant women at 20–22 weeks, and evaluation was repeated at a more advanced gestational age in 9% of cases. Cardiological follow-up was continued postnatally until 2 years of age. The overall prevalence of cardiac anomaly was 0.93% The incidences of major and minor defects were 0.44% and 0.48%, respectively. There were 23 true positives (0.33%). in 20 cases, the diagnosis was made in the second trimester, and 13 women (6.5%) chose termination of pregnancy. Seventeen of the 20 cases identified in the second trimester were serious malformations. There were 42 false negatives (0.60%). Of these, 12 had signs of cardiac dysfunction at birth or within the 1st month of life, and three of them died as a result of their cardiac anomaly. There were eight false positives (0.11%), all of a minor type. Six abnormal karyotypes, out of a total of 21 performed in the true-positive group (28.5%) were found. In addition five of 42 newborns in the false-negative group had trisomy 21. The overall sensitivity was 35.4% and 61.3% for major defects. The accuracy in two distinct periods was estimated because the level of experience of the operators was different: sensitivity was 45.2% in period 1 (1986–88) (77.8% for major defects) and 26.5% in period 2 (1989–92) (52.9% for major defects). We conclude that a fetal heart screening program in the obstetrics population is justified. It defines a high-risk group for karyotyping, allows planning of delivery in a tertiary center or the choice of terminating the pregnancy for the parents and appears to have a positive cost-benefit ratio. A crucial factor is the level of training and experience of the operators, who need specific teaching support. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology

Two thousand and ninety-seven unselected pregnant women bearing 2114 fetuses were examined by transvaginal sonography at 14 weeks of gestational age and rescreened via transabdominal sonography at 21 weeks (excluding those who chose termination of pregnancy). Twenty-five of 47 anomalies were correctly identified at the first scan, 15 malformations were missed and detected only during the scan, two were identified later in pregnancy, and five were identified after birth. Ten of 12 abnormalities were detected correctly on the basis of ultrasonographic findings. Transvaginal sonographic screening for fetal malformation, in our experience, permits the detection of more than 50% of all fetal structural defects and 75% of all aneuploidies early in pregnancy.

A total of 149 women with postmenopausal bleeding underwent transvaginal sonography, hysteroscopy and dilatation and curettage in order to study the diagnostic accuracy of several ultrasound parameters in assessing endometrial pathology and to determine the most sensitive cut-off value of endometrial thickness for the exclusion of endometrial lesions. In distinguishing pathological from normal endometrium, transvaginal sonography showed a sensitivity of 69.3%, specificity of 82.7%, positive predictive value of 74.1% and negative predictive value of 72.1%. In detecting premalignant and malignant endometrial pathology, transvaginal sonography showed a sensitivity, specificity, positive predictive value and negative predictive value of 55%, 96.1%, 68.7% and 93.2%, respectively. Considering endometrial thickness as a single parameter, the most sensitive cut-off for defining normality was 4 mm; nevertheless, in the group of patients that had an endometrial thickness less than 4 mm, there was one case of malignancy (sensitivity, 95.2%; specificity, 49.4%; positive predictive value, 57.3%; and negative predictive value, 93.5%). Transvaginal sonography combined evaluation (morphology, thickness and color Doppler) showed a poor diagnostic accuracy in detecting endometrial pathology and in differentiating between endometrial benign lesions, endometrial polyps and adenocarcinoma in women with postmenopausal bleeding. Endometrial thickness evaluated with transvaginal sonography was preferable but not sensitive enough to exclude endometrial pathology.

Antenatal detection of an isolated abdominal cyst was found to be a pancreatoblastoma in a female fetus with Beckwith-Wiedemann syndrome. Prenatal and post-natal features and management of this very rare tumour are discussed. Molecular investigation disclosed a mosaic paternal 11p15 uniparental disomy in the tumoral cells. The prognosis of a congenital pancreatoblastoma is good if complete surgical excision is achieved. However, the association with Beckwith-Wiedemann syndrome requires a prolonged follow-up because of the increased risk of developing malignant tumours.

In order to assess the usefulness of amniotic fluid α-fetoprotein (AFP) levels at the time of midtrimester genetic amniocentesis, 4,430 cases were retrospectively studied to compare the high, normal or low AFP values with the karyotype characteristics and fetal anatomy using ultrasound (US) scanning and confirmed by postnatal evaluation or necroscopy in the case of termination of pregnancy. All the cases presenting malformations were correctly diagnosed by US examinations. AFP levels over the 2nd standard deviation (SD) were found in 112 cases (2.52%) and below the 2nd SD in 11 cases (0.24%). The characteristics of these cases are presented and discussed. According to our results, it is concluded that routine assessment of AFP at the time of midtrimester genetic amniocentesis, if coupled with optimal US scanning, is no longer justified.

Background The aim of this study is to review all the cases of FCV diagnosed in the Obstetric and Gynecology Unit of our Institution from 1990 to 1999 and to evaluate the neonatal outcome. Method This is a retrospective study. The diagnosis of ventriculomegaly is according to Cardoza criteria and to atrial width ≥ 10 mm between 15 and 40 weeks gestational. For all cases we consider: progression and/or resolution; association with other fetal ultrasound signs of malformations and with chromosomal abnormalities; fetal infections (TORCH); pregnancy termination and follow-up by pediatric report. In cases of interruption of pregnancy we evaluate postmortem examination. Results Among 165 cases of FCV, n 84 (50.9%) are associated with malformation of SNC, n 59 (35.76%) are isolated, n 22 (13.33%) are associated with other fetal malformations. In the group of isolated: 32 case are borderline (≤ 15 mm), chromosomal abnormalities are 4 among 40 evaluated (10%), favourable neonatal outcome is present in 22 cases of 29 born (75.86%). Conclusions In this study the percentage of chromosomal abnormalities in the FCV isolated is higher than other series in the literature. The reproducibility of measurement of atria rather permits comparisons than other qualitative and quantitative signs.