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Objective: To assess the natural history and outcome of fetal pulmonary stenosis (PS), particularly that detected at 14-17 weeks' gestation.Methods: In this retrospective study we searched an electronic database of women from the general Israeli population attending a private ultrasound institute (Al-Kol ultrasound institute in Haifa) for routine complete early fetal ultrasound, including all fetal systems and a fetal echocardiogram, between 2004 and 2015. Ninety-seven percent of the women were at low risk of fetal malformations, and 3% had risk factors such as maternal Type-1 diabetes mellitus, exposure during pregnancy to teratogenic drugs, or anomalies in previous pregnancies or in other family members. At presentation at 14-17 weeks of gestation, color and pulsed Doppler imaging were performed across the four cardiac valves. We identified cases in which abnormal flow was detected, leading to suspicion of PS; in these cases, a follow-up examination was carried out at 17-19 weeks and then monthly until delivery or resolution of the finding, and postnatal echocardiography was performed at birth, 4-6 weeks thereafter, and yearly afterwards. Outcome data for suspicious cases, including postnatal diagnosis and general or specific symptoms, were collected by contacting the parents via email or telephone.Results: Among 24 185 early prenatal transvaginal ultrasound screening examinations, 23 cases of suspected PS were identified. They were classified into three groups, according to their ultrasound findings. In Group A (n = 8), the ultrasound screen was normal except for high flow velocity across the pulmonary valve. In six cases, this finding had resolved by 20-21 weeks of gestation and all were found to be normal at postnatal follow-up, one case underwent termination of pregnancy at 19 weeks and PS was confirmed at autopsy and one case was lost to follow-up. In Group B (n = 12), there was aliasing across the pulmonary valve. Two of these cases were normal postnatally and eight had mild-to-moderate PS; the remaining two cases developed hypoplastic right ventricle and pulmonary atresia at 19-20 weeks and the pregnancies were terminated. In Group C (n = 3) PS was associated with other anomalies; all three pregnancies were terminated. There were an additional six cases (Group D) not identified in early gestation, in which PS was late-onset. One had tricuspid regurgitation at the early screen, but was subsequently diagnosed with Ebstein's anomaly and pulmonary atresia, at 22 weeks, and was terminated. The other cases had completely normal early ultrasound screening examinations: one case had Ebstein's anomaly and PS was diagnosed at birth; four had isolated mild PS, of which one was diagnosed at 22 weeks' gestation and the other three were diagnosed postnatally, before 3 months of age. The sensitivity for detection of the ascertained cases of PS was 64% (11/17) and the specificity was > 99%.Conclusion: There is a diverse spectrum of presentation of fetal PS in the early mid-trimester. A possible explanation for this could be different pathophysiological pathways. Further study is needed to explain the different prenatal sonographic presentations in an unselected population. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

We Summarize a three cases of transient fetal hypertrichosis in low risk preganant women. Hypertrichosis has been previously associated with over 140 different syndromes (OMIM); however this finding is rarely described in prenatal ultrasound. In this study we describe the finding of hypertrichosis which resolved later in gestation. CASE N1: A prominent unibrow (synophrys) and elongated eyelashes were noted at 24 weeks of gestation with no other abnormal features. CASE N 2: A prenatal ultrasound scan was performed at 24 weeks and revealed: horseshoe kidney and localized hypertrichosis on the lower back. CASE N 3: Ultrasound exam at 24 weeks of gestation demonstrated localized hypertrichosis on the chin. CONCLUSION: Transient localized hypertrichosis with no other major findings has a favorable prenatal outcome. [ABSTRACT FROM AUTHOR]

Objective To investigate whether uterine contractions at the time of a Cesarean section have an impact on future presence and location of a cervical Cesarean scar. Methods A targeted transvaginal ultrasound examination of the fetus, uterus and cervix was done in 2973 consecutive women at 14–16 weeks' gestation. The sonographer was blinded to the women's previous obstetric histories. The presence and location of a sonographic cervical hypoechogenic line, which probably represented a Cesarean scar, was recorded. Results There were 180 women with a previous Cesarean section performed before the start of uterine contractions and 173 with a Cesarean section performed during contractions in labor. The cervical hypoechogenic line was more common in sections performed during contractions (75.7% vs. 52.7%; P < 0.001) and was more distally located from the internal os (17.9 ± 9.4 vs. 14.6 ± 9.1 mm; P = 0.01). A hypoechogenic line was observed in 21/2620 women without a previous Cesarean section, representing a false-positive rate of 0.8%. Conclusion Cesarean sections, especially those done during uterine contractions, are actually performed through cervical tissue. This finding is in agreement with the physiological process of cervical effacement during contractions. [ABSTRACT FROM AUTHOR]

The article presents a case study of a transient bilateral pedal edema in the fetus of a low-risk pregnancy as an early sign of 22q11.2 deletion syndrome. The 29-year-old nulliparous woman attended for a routine prenatal ultrasound for weeks but had no risk factors for congenital anomalies aside from maternal cleft lip and palate that had been surgically corrected. A transvaginal ultrasound was performed that revealed fetal size compatible in with gestational age and seen bilateral pedal edema.

The article discusses the significance and value of transvaginal sonography (TVS) in pregnancy following cervical cerclage. Particular focus is given to TVS assessments in pregnant women at 14-17 weeks, of which 44 women with 53 pregnancies were inserted with a cervical cerclage. Three cases were emphasized in the observation and recommended assessment of uterine cervix 1 week after placement of a cervical cerclage for prevention of unfortunate outcomes.

Objective The aim of this study was to determine the incidence in an unselected population of a rod-like structure on the fetal upper lip (called a ‘mustache’) which we had previously observed as an incidental finding. A secondary aim was to determine whether this was associated with any abnormalities or abnormal outcomes. Design Prospective non-randomized study. Subjects Three thousand consecutive fetuses from an unselected population were scanned by one sonologist. Method Transvaginal ultrasound examinations were performed at 14–16 weeks' gestation. Repeat sonographic examinations were performed at 20–22 weeks' gestation in cases where a mustache was detected, and these neonates were examined by a pediatrician after delivery. Results Seven of 3000 fetuses had a mustache-like structure on the upper lip. The ‘mustache’ disappeared later in gestation. No anomaly of the upper lip was detected after birth in these fetuses. Conclusion A mustache-like structure on the fetal upper lip in early pregnancy probably represents a normal variant of lip development. It is likely to represent a delay in the normal process of lip fusion during embryonic life. [ABSTRACT FROM AUTHOR]