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Objective: To estimate the frequency of unexpected first-trimester ultrasound findings that would alter prenatal management in pregnant women eligible for cell-free (cf) DNA screening because of advanced maternal age (AMA).Methods: This was a retrospective cohort study of all AMA women at a tertiary care center who had a 10-14-week ultrasound examination between 1 January 2012 and 27 April 2015. Information on pregnancy dating, obstetric ultrasound examination, prenatal screening and genetic testing were collected from a perinatal database. The primary outcome was an unexpected ultrasound finding in the first trimester that would alter the prenatal screening/testing strategy.Results: In total, 2337 women met the inclusion criteria, with a total of 2462 fetuses. Sixty-eight (2.9%) women had an anomalous fetus, of which 44 (64.7%) had diagnostic testing. In the entire cohort, a non-viable pregnancy was identified in 153 (6.5%) women. Multiple gestation was identified in 32 (1.4%) women; five had a cotwin demise. Gestational dating was revised for 126 (5.4%) women. Among those who opted for aneuploidy screening (n = 1806), 68.5% had cfDNA screening and 31.5% had first-trimester screening by analysis of maternal serum biomarkers and nuchal translucency thickness. Among those eligible for cfDNA screening, 16.1% (95% CI, 15.0-18.0%; 377/2337) had an ultrasound finding (anomaly, incorrect dating, multiple gestation, non-viable pregnancy) at the time of testing that would have altered the provider's counseling regarding the prenatal screening/testing strategy.Conclusions: A substantial proportion of AMA women eligible for cfDNA screening have fetal ultrasound findings that could alter genetic testing strategy and clinical management. This study recommends ultrasound examination prior to cfDNA screening in AMA women. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Key Clinical Message Kasabach-Merritt phenomenon can be encountered in the perinatal period. No consensus exists regarding prenatal management. We report one prenatal case leading to therapeutic abortion and one neonatal case, successfully treated by a multimodal therapy. Prenatal counseling should include the possibility of neonatal multimodal treatment that can lead to favorable outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the association of spousal deployment during the antenatal period on maternal and neonatal outcomes and to estimate whether group prenatal care may be beneficial in reducing adverse outcomes when spouses are deployed. METHODS: Primigravid women who delivered at Womack Army Medical Center, Fort Bragg, North Carolina, were prospectively enrolled and selected for participation on a random basis between January 2013 and January 2014. Women whose spouses were deployed to a combat zone during the entire pregnancy (deployed group) were compared with women whose spouses were not deployed during the pregnancy (nondeployed group). Pregnancy and neonatal outcomes were compared between groups. RESULTS: Three hundred ninety-seven women were enrolled with 183 (46.1%) in the deployed group and 214 (53.9%) in the nondeployed group. Spouse deployment was associated with increased risk of preterm delivery (38 [20.8%] compared with 16 [7.5%], P<.001) and postpartum depression (30 [16.4%] compared with 13 [6.1%], P=.001) when compared with women in the nondeployed group. There were no differences in the incidence of preterm delivery and postpartum depression for women in the deployed group who participated in group prenatal care when compared with women participating in traditional care (preterm delivery 6 [14.6%] compared with 32 [22.5%], P=.38; postpartum depression 4 [9.8%] compared with 26 [18.3%], P=.24). CONCLUSION: Women who have a spouse deployed during their pregnancy are at increased risk for preterm birth and postpartum depression. Larger studies are needed to evaluate whether spouse deployment during pregnancy has other perinatal effects and whether group prenatal care may have a positive effect on adverse perinatal outcomes in this population. [ABSTRACT FROM AUTHOR]

Objective. To determine the impact that a 6-year maternal and child health project in rural Honduras had on maternal health services and outcomes, and to test the effect of level of father involvement on maternal health. Methods. This was a program evaluation conducted through representative household surveys administered at baseline in 2007 and endline in 2011 using 30 cluster samples randomly-selected from the 229 participating communities. Within each cluster, 10 households having at least one mother-child pair were randomly selected to complete a questionnaire, for a total of about 300 respondents answering close to 100 questions each. Changes in key outcome variables from baseline to endline were tested using logistic regression, controlling for mother's education and father's involvement. Results. There were improvements in most maternal health indicators, including an increase in women attending prenatal checkups (84% to 92%, P = 0.05) and institutional births (44% to 63%, P = 0.002). However, the involvement of the fathers decreased as reflected by the percentage of fathers accompanying mothers to prenatal checkups (48% to 41%, P = 0.01); the fathers' reported interest in prenatal care (74% to 52%, P = 0.0001); and fathers attending the birth (66% to 54%, P = 0.05). There was an interaction between the fathers' scores and the maternal outcomes, with a larger increase in institutional births among mothers with the least-involved fathers. Conclusions. Rather than the father's involvement being key, changes in the mothers may have led to increased institutional births. The project may have empowered women through early identification of pregnancy and stronger social connections encouraged by home visits and pregnancy clubs. This would have enabled even the women with unsupportive fathers to make healthier choices and achieve higher rates of institutional births. [ABSTRACT FROM AUTHOR]

This article narrates the thrilling story of how the pathogenetic understanding of myelomeningocele was fundamentally revised during the last decades and how these new insights, in particular the "two-hit hypothesis," have prepared the terrain for human fetal surgery. Formerly, the devastating cluster of neurologic and neurogenic problems was mainly attributed to the primary malformation, that is, failure of neurulation. At present, there is solid evidence that in early gestation the nonneurulated spinal cord functions well, but suffers from progressive traumatic and degenerative damage in later gestation because it is openly exposed to the amniotic cavity. There is no doubt that the secondary, in utero acquired spinal cord destruction is mainly responsible for the disastrous and irreversible peripheral neurologic deficit present at birth, and there is no doubt either that timely prenatal protective coverage can potentially arrest these deleterious dynamics and preserve neurologic function. Also, tethering of the cord within and constant outflow of cerebrospinal fluid from the lesion are seen as the driving forces behind the Chiari II malformation and consequent ventriculomegaly. Untethering and watertight sealing of the lesion reverses hindbrain herniation and lowers the risk for a relevant hydrocephalus. This article then details how human fetal surgery started in the late 1990s and follows the evolution from the pioneer case studies via the first case series providing encouraging results to the ground breaking Management of Myelomeningocele Study Trial, published in The New England Journal of Medicine in February 2011 by Adzick et al, that has, for the first time, generated unequivocal evidence that patients with prenatal repair do significantly better than those with postnatal care only. Finally, this review looks at several other critical issues, including the hitherto immature endoscopic approach to fetal repair, some future directions of research and clinical practice, and also utters a plea for concentration of these equally rare and complex cases to a few truly qualified centers worldwide. The conclusion derived from all data existing today is that maternal-fetal surgery, although not a cure and not free of risks, represents a novel standard of care for select mothers and their fetuses suffering from one of the most ruinous nonlethal congenital malformations. [ABSTRACT FROM AUTHOR]

The authors discuss the promotion of opportunities for obstetrician-gynecologists (ob-gyns) and other care providers in the U.S. to help meet the long-term health needs of women with gestational diabetes mellitus (GDM) and their children by the National Diabetes Education Program. They note the proportion of women with GDM or prediabetes postpartum and the level of risks these women are facing. They suggest the need for prenatal care and annual screening to monitor the maternal-fetal health.

The article presents a study which assesses the cost benefit of the Early Start integrated prenatal intervention program to stop substance use during pregnancy. It conducts a retrospective cohort study of women who had prenatal substance abuse screening and shows that the net cost benefit amounted to 5,946,741 dollars per year. It suggests that the Early Start intervention may improve maternal-infant health outcomes and reduce associated costs.

The article presents a study which examines the fetal pulmonary response in lung growth and pulmonary vascularity after fetoscopic tracheal occlusion for severe isolated congenital diaphragmatic hernia in neonatal survival prognosis. It shows that survival rate was higher with 54.3% in patients who had fetal endoscopic tracheal occlusion than in those who did not. It suggests that fetal endoscopic tracheal occlusion may likely improve fetal survival by increasing the lung size and vascularity.

The article presents a cohort study which determines the optimum timing technique for planned delivery of monochorionic and dichorionic twin pregnancies without complications. It shows that perinatal death risk was 1.5% after 34 weeks of gestation for uncomplicated monochorionic pregnancies and no deaths in dichorionic twins after 33 weeks of gestation. It suggests that close fetal monitoring may likely minimize perinatal morbidity by allowing both pregnancies to 37 and 38 weeks, respectively.

Here we report the clinical and cytogenetic results of a family carrying a cryptic translocation involving chromosome 3pter and 21qter detected by single nucleotide polymorphism array and subtelomeric fluorescent in situ hybridisation analysis. The index patient, with mild mental retardation in combination with minor dysmorphic features, inherited the derivative chromosome 21 resulting in a partial trisomy of the short arm of chromosome 3 and a partial monosomy of the long arm of chromosome 21. Her apparently healthy brother inherited the derivative chromosome 3 resulting in a terminal deletion of the short arm of chromosome 3 and a terminal duplication of the long arm of chromosome 21. We discuss the different phenotypes for the 2 genotypes and argue for the importance of reporting these imbalances to achieve accurate genetic counseling in prenatal and postnatal diagnosis. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

In this article the author discusses the relationship between physician and patient particularly for pregnant women declining care during pregnancy which can harm the fetus. He cites the case of a pregnant woman who was charged with criminal homicide after one of her twins died due to her resistance to undergo cesarean despite her physician's advice. He is critical of the women's right to refuse medical aid and the importance of explaining medical guidelines and state law to the patients.

Asymmetry syndrome is one of the forms of delay of neuromotor development, which appears in newborns and infants, and belongs to the group of risk babies (present prenatal, perinatal or postnatal risk factors). Asymmetry syndrome can be manifested with asymmetric head position, trunk asymmetry, and upper and lower extremity asymmetry on the same side. Our study included 64 babies with the asymmetry syndrome who were treated at our Clinic. The most frequent risk factors were intracranial hemorrhages, hypoxicischemic encephalopathy and asphyxia. Clinical expression of asymmetry was correlated with ultrasound of CNS. The most frequent finding was a complete asymmetry of the head, trunk and extremities. [ABSTRACT FROM AUTHOR]