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The pathologic findings in placentas from ten multiple gestations complicated by the so-called vanishing twin phenomenon were studied to confirm the ultrasonographic evidence. Five pregnancies resulted from in vitro fertilization and embryo transfer, and five conceptions were spontaneous. The pregnancies were studied by repeat ultrasound examinations between five and 12 weeks' gestation. First-trimester bleeding was the only clinical sign of this phenomenon. Postpartum evidence of the vanishing twin phenomenon was found in five cases. Morphologically, the lesions were characterized by well-delineated plaques of perivillous fibrin deposition, associated in one case with embryonic remnants. This focal degenerative change of the placental mass, which also exists in about 25% of placentas from uncomplicated term pregnancies, may be the only clue to the disappearance of one conceptus.

Based on the experience of 63 antenatal diagnosis of fetal uropathies, the authors discuss the diagnostic problems, practical implications of antenatal diagnosis and potential indications of in utero interventions. A correct diagnosis was established in 43 out of the 63 cases (70%). Diagnostic problems were encountered in differentiating between multicystic dysplastic kidneys and uretero-pelvic junction obstruction, dilatation due to reflux or from obstruction and from the lack of visualisation of small hypoplastic kidneys. Transitory urinary tract dilatations were found in 14 cases (22%) and can be responsible for additional false positive findings. Evaluation of the thoracic development and amniotic fluid must be part of the examination since they are related to severe obstructive uropathy. Repeated examinations are necessary in these cases. In evaluating the eventual benefit of an in utero decompression one should keep in mind the diagnostic difficulties but mainly the time of diagnosis of most uropathies when related to the time of its onset during morphogenesis and the absence of any reliable method of evaluation of fetal renal function. This leads the authors to consider that at the present time there are no real indication for in utero intervention. The major benefit of prenatal echography is to allow early recognition of major uropathies before postnatal infection worsens it prognosis.

24 cases of non-immune feto-placental hydrops which were diagnosed by ultrasonography are presented. The precise etiology was possible in 21 of the cases using chromosome analyses, radiological assessments and carefully conducted post mortem examinations. The cause was maternal in 3 cases and due to fetal pathology in 18 cases, of which 5 were due to chromosome abnormalities. Three recessive autosomal syndrome, 9 malformations and in particular cardiac malformations and one twin pregnancy with transfusion from one fetus to the other were diagnosed. These features, which can be compared with those already in the literature, show that most of these cases of hydrops are due to genetic fetal defects and demonstrate how important it is to carry out chromosome analyses and systematic anatomo-pathological investigations. The results of these tests will indicate the way the doctors should look after the mother during pregnancy and how to deliver these mothers in subsequent pregnancies.

This work illustrates the major contributions of ultrasound to the monitoring of the human fetus and to our understanding of its normal and abnormal development. Examples of in-utero diagnosis of uropathies, ovarian cysts, hemorrhage or biliary sludge with post natal follow-up help to understand the occurrence and disappearance of several "pathological" entities. More experience is needed and improvements should occur in the sonographic detection of intra uterine growth retardation and in uncomplicated genetic anomalies.

Amniofetography is a valuable tool for the diagnosis of fetal malformations. We have studied the effect of radiopaques dyes, containing large amounts of iodide, on fetal thyroid function. We have performed serial determinations of serum thyrotropin and thyroxine in seven newborn infants submitted to amniofetography. This work demonstrates that amniofetography induces a transient impairment of fetal thyroid function.

The first diagnostic cordocentesis was performed in our unit in October 1985, our 2-year experience is reported. 144 samplings were performed in 137 patients (139 fetuses - 2 patients had twin pregnancies) during gestational weeks 14 to 42. The first attempt was successful in 80% of the procedures, 4 samplings failed. There were no fetal deaths within 3 days after diagnostic cordocentesis, a transient fetal bradycardia was observed in 12.2% of the cases, bleeding occurred in 13.6% of the cases. The indications for cordocentesis were: risk of fetal infection, karyotyping, hemophilia A, alloimmunisation, search for paternity, assessment of fetal acid-base status. Our data confirm that cordocentesis is a safe and reliable diagnostic procedure providing guidelines for management of the pregnancy.

Percutaneous umbilical blood sampling (cordocentesis) appears to be a valuable new procedure for prenatal diagnosis. In order to evaluate whether focal injury of the umbilical vessels caused by the needle puncture is potentially harmful, we completely examined 50 umbilical cords collected between 1 hour and 20 weeks after cordocentesis. Macroscopic evidence of the needle entry was found in 37 cases, including one giant hematoma of the cord. Within 48 hours after the procedure, microscopic examination of transverse sections taken at the puncture site revealed distinct perforation of the vessel wall, associated in four cases with a small hematoma encircling the vessel. One week after cordocentesis, the vessel wall was partially reformed. There were no histologic differences between needle entry in a vein or in an artery. No thromboses of the umbilical vessels were found.

The adenosine-3',5'-monophosphate (cAMP) level in human amnion has been measured in vitro during short-term incubations, with or without prostaglandin E1 (PGE1) or isoproterenol. Concentration-response and kinetic curves were obtained. Isoproterenol and PGE1 stimulated cAMP production by amnion in a time-dependent manner. The stimulating effect of isoproterenol and noradrenalin on cAMP level was abolished by the addition of propranolol. Our study, demonstrating cAMP production by amniotic membranes and its stimulation by PGE1 and beta-agonists, suggests that hormones could modulate the amniotic cell metabolism through the cAMP system.

Three cases of pregnancies complicated by feto-maternal anti-Kell iso-immunisation are presented, as well as a review of the literature. The evolution of new techniques for antenatal diagnosis has made it possible to have a new approach to this fetal pathology. Chorionic villus biopsy can be carried out in the first trimester of pregnancy when there has previously been a serious incidence of anti-Kell immunisation with a couple where the husband is heterozygous for the Kell antigen. In the second and third trimesters the surveillance of the patient is essentially dependent on ultrasound examination of the fetus and placenta, which makes it possible to detect hydropic changes, and also depends on blood sampling from the cord which makes it possible to assess by direct measurement the degree of fetal anaemia. Now pulsed Doppler must be added to these classical diagnostic techniques because it allows a gross estimation of fetal haematocrit levels.

This investigation was undertaken to determine whether examination of the placenta contributed to a better understanding of the causes of fetal malformations. Specific histological abnormalities were found in triploidy and lysosomal storage disorders. Placentas from trisomies only showed a marked a specific retardation of villous maturation. The most frequent placental abnormalities detailed in cases presenting major fetal malformations with normal karyotype were: velamentous insertion of the umbilical cord, placental hypotrophy, single umbilical artery, marginal retroplacental hematoma and generalized perivillous fibrin deposition. Examination of the placenta after fetal malformation can provide helpful informations in counseling the parents and the perinatal team in the follow-up of any future child bearing.

Since the very start of using ultrasound to monitor pregnancy the information that the obstetrician has obtained from it has been great. Measuring the fetus (biparietal diameters, rump-crown length etc.) makes it possible to check development of the fetus in the uterus, as well as seeing the various organs and their placing and internal structure. Real time pictures make it possible to visualise the organs precisely from the point of view of their positioning and their internal structures. We report 12 cases of malformations of the central nervous system which were diagnosed in utero and we point out the value of early diagnosis in pregnancy. The 12 cases we found included four of hydrocephaly, one cyst of the choroid plexus, one hydrencephaly , two cases of holoprocencephaly and four cases of anencephaly. Since these malformations may be part of generalised malformations it is important to search for these others by ultrasound as well as by caryotyping and estimation of alpha-fetoprotein levels.

The authors report on 80 cases of the syndrome of a single umbilical artery (SUA) and compare the anatomo-clinical features with the abnormalities found on ultrasound. The clinical results confirm the information given in the literature which is that there is a higher incidence of poor intra-uterine fetal growth (36.4%), of prematurity (16.3%), of associated congenital abnormalities (42%) and of perinatal mortality (21.3%). Ultrasound examination makes it possible to screen for associated major fetal malformations (26.6%) and of most cases of intra-uterine growth retardation (28.3%). The ultrasound detection of the absence of one of the umbilical arteries and of the associated fetal abnormalities together with the techniques for sampling fetal cells now causes change in the approach to these high risk pregnancies on the cytogenetic level as on the perinatal handling of this syndrome.