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Purpose: To evaluate whether patients with isolated elevation of umbilical artery (UA) systolic/diastolic (S/D) ratio are at increased risk for adverse perinatal outcome., Methods: This is a retrospective cohort study of 330 patients who underwent routine evaluation at our maternal fetal medicine center. We regularly perform UA S/D ratio analysis with every third trimester sonogram. All identified patients were included and divided into four groups based on estimated fetal weight (EFW) and UA S/D ratio. Perinatal outcome was compared between the groups., Results: Regardless of the EFW, fetuses with persistent elevated UA S/D ratio showed significantly more preterm deliveries (p < .001), neonatal intensive care unit (NICU) admissions (p < .001), longer stay in the NICU (p < .001) and lower birth weight (p < .001) relative to controls. Stepwise logistic regression analysis demonstrated that being a member in any study group significantly and independently predicted birth weight less than the 10th percentile and preterm delivery. Patients with persistently elevated S/D ratio were significantly and independently from other factors, more likely to have a newborn admitted to the NICU., Conclusion: Our results indicate a suboptimal perinatal outcome in all pregnancies with an elevated UA S/D ratio. These fetuses may benefit from intensive monitoring.

Objectives: To evaluate the impact of maternal body mass index (BMI) as well as maternal ethnicity on the detection of either echogenic intra-cardiac focus (EIF) or echogenic bowel (EB)., Methods: This prospective study identified 74 uncomplicated singleton fetuses in which EIF and/or EB were detected between 18 and 21 weeks of gestation (i.e. study group). Seventy four consecutively scanned fetuses without EIF or EB, at the same gestational age, were selected as controls. The differences in maternal BMI and maternal ethnicity were compared between the two groups using the chi(2) test, Fisher's exact test, and the Student t-test. A multivariable logistic regression model was constructed to control for confounders. Odds ratios (OR) and their 95% confidence interval (CI) were computed., Results: The mean maternal BMI was significantly lower in the study group as compared to controls (22.9 +/- 3.1 vs. 28.0 +/- 7.5 kg/m(2), respectively; p < 0.0001). Patients with fetal EIF and/or EB were significantly more likely to be Asians (20.3% vs. 5.4%, OR = 4.5; 95% CI 1.3-16.9). Using a multivariable analysis, controlling for ethnicity, the association between maternal BMI and fetal EIF or EB remained significant (OR = 0.83; 95% CI 0.76-0.91). However, based on this model Asian ethnicity was not an independent risk factor for the detection of EIF and/or EB (OR = 2.6; 95% CI 0.8-8.9)., Conclusions: Our data suggests an inverse relationship between the maternal BMI and the detection of fetal EIF and/or EB. Moreover, it appears that low maternal BMI, and not Asian ethnicity, is an independent risk factor for the detection of these echogenic fetal findings.

Aims: Recent advances in prenatal screening, including first and second trimester genetic screening as well as targeted sonography, have significantly improved the detection of trisomy 21. Therefore, several investigators have questioned the validity of recommending genetic amniocentesis to all women who are 35 years or older at delivery. Thus, we sought to investigate the risks and benefits associated with performing genetic amniocentesis in women whose sole indication for testing was advanced maternal age (AMA)., Methods: A retrospective review of a Genzyme Genetics amniocentesis database (January 2006-December 2006) was performed. All specimens obtained from women of AMA as the sole indication were eligible for analysis. The amniocentesis-related potential fetal loss was calculated based on the traditional fetal loss rate of 1/200 as well as the recently published loss rate of 1/1600 procedures. Risk-benefit analysis was performed by comparing the number of trisomy 21 fetuses identified within the AMA group to the potential number of amniocentesis-related fetal losses within this group., Results: A total of 87,241 amniocentesis specimens were processed during the study period. AMA was the sole indication for genetic amniocentesis in 43,303 cases which formed the study group. In 399 (0.92%) of these cases, a trisomy 21 was identified. Assuming an amniocentesis related fetal loss rates of 1/200 or 1/1600; 217 or 27 fetal losses would have been expected, respectively., Conclusions: Our analysis suggests that the benefit of genetic amniocentesis for the sole indication of AMA far outweighs the potential amniocentesis-related fetal loss rate, regardless of the actual rate one considers.

Objective: This study was undertaken to evaluate the contribution of either an abnormal second-trimester maternal serum screen or the presence of additional sonographic markers of aneuploidy to the risk of a major trisomy (13, 18, and 21) in fetuses with pyelectasis., Study Design: A retrospective review of a large amniocentesis database was performed. Specimens obtained after the sonographic detection of fetal pyelectasis were eligible for analysis. Age-matched women who underwent amniocentesis solely for maternal anxiety or advanced maternal age served as controls., Results: 760,495 amniocentesis specimens were analyzed. Fetal pyelectasis was detected in 671 cases. Pyelectasis, with either a single or multiple additional sonographic markers, was associated with an 8-fold and 62-fold increase in the prevalence of major trisomies (odds ratio = 7.7, 95% CI = 1.2-32.6, P = 0.02) and (odds ratio = 61.9, 95% CI = 13.2-144.6, P < .001), respectively. Pyelectasis with an abnormal maternal serum screen, with or without additional sonographic markers, was associated with a 32-fold and a 205-fold increase in major trisomies (odds ratio = 32.2, 95% CI = 5.3-94.8, P < .001) and (odds ratio = 205.8, 95% CI = 37.9-427.6, P < .001), respectively., Conclusion: In fetuses with pyelectasis, the presence of additional sonographic markers or an abnormal maternal serum screen significantly increases the risk of trisomy 13, 18, and 21.

Objective: The aim of this study was to determine whether maternal age, prepregnancy and mid-trimester body mass index (BMI), or excessive mid-pregnancy weight gain predict abnormal glucose challenge test (GCT) results., Methods: A retrospective chart review of 75 consecutive singleton pregnancies was performed. Patients were screened at 24-28 weeks of gestation with a 50-g oral GCT. Prepregnancy BMI and pregnancy weight gain up to the time of GCT testing, as well as other demographic data, were recorded. Statistical analysis included regression analysis and Student's t-test, receiver-operator characteristic curve and multivariate logistic regression., Results: Maternal age and prepregnancy and mid-trimester BMI were significantly higher in women with an abnormal GCT (p<0.05). A direct correlation was found between these parameters and GCT results (R(2)=0.08, R(2)=0.102 and R(2)=0.116, respectively; p<0.05). Mid-trimester maternal BMI of >or=30 kg/m(2) and maternal age >or=32 years are the optimal predictors of abnormal GCT results., Conclusions: Mid-trimester maternal BMI of >or=30 kg/m(2) and maternal age >or=32 years are useful predictors of abnormal GCT results. We suggest that these factors should also be considered when selective screening for gestational diabetes mellitus is practiced.

Postoperative ultrasonographic assessment as a result of unremitting fever after cesarean section depicted a large pedunculated thrombus within the inferior vena cava at the level of the right renal vein. Subsequent imaging studies revealed that this thrombus was the distal extension of right ovarian vein thrombosis into the inferior vena cava.

Objectives: (1) to evaluate the incidence of preterm delivery in patients with gestational diabetes mellitus; (2) to determine the association between glycaemic control and preterm delivery in these patients., Study Design: (1) The incidence of spontaneous preterm singleton deliveries was determined in 550 intensively-treated patients with gestational diabetes mellitus. A total of 14 552 consecutive patients without gestational diabetes mellitus who delivered during the same interval served as a control population; (2) Glycaemic profiles (i.e., mean blood glucose, percent of hypoglycaemic [ < 60 mg/dl] and hyperglycaemic [ > 120 mg/dl] episodes) were compared in 34 patients with gestational diabetes mellitus who delivered preterm, and 68 matched controls with gestational diabetes mellitus who delivered at term., Results: (1) The incidence of preterm delivery in gestational diabetics was similar to that found in the non-diabetic population (6.2% vs. 6.5%, respectively, P = 0.82; confidence limits: 0.65, 1.36); (2) women with gestational diabetes mellitus who delivered at term, or preterm had similar glycaemic profiles for both the entire treatment period and the week preceding delivery., Conclusions: (1) There is no increased risk for preterm delivery in intensively-treated gestational diabetes mellitus patients; (2) In a population such as this women with gestational diabetes mellitus who deliver preterm cannot be characterised by their glycaemic profile.

Numerous methods of identifying fetal-pelvic disproportion to its clinical presentation have been tested, but none has been consistently accurate or economically feasible. The objective of this study was to prospectively evaluate the utility of the maternal-fetal ratio (MFR) with clinical and sonographic estimates of fetal weight (FEW) for predicting active phase arrest disorders and the need for a subsequent cesarean section (C/S). Upon admission, maternal height (MH), symphyseal-fundal height (SFH), and clinical and sonographic FEW were obtained on 140 laboring women at term. The MFR was defined as MH (cm) divided by SFH (cm). A modified MFR was calculated by adjusting the SFH according to the station of the presenting part. Women delivered by C/S had a modified MFR of 3.75 +/- 0.35 compared with 4.0 +/- 0.36 for women delivering vaginally, P = 0.02. An abnormal modified MFR showed a relative risk of 7.3 (95% CI = 1.45-33.2) for predicting a C/S, while a sonographic EFW > 4,000 g had a relative risk of 3.8. The MFR of women delivered by C/S due to arrest disorders is significantly lower than that measured for women delivering vaginally. Women with an abnormal modified MFR have a sevenfold increased likelihood of having an arrest disorder. The modified MFR (which can be measured antenatally) is superior to the birth weight (which can be approximated by sonography) in predicting arrest disorders.

Objective: To compare the fetal heart rate (FHR) pattern between fetuses of well controlled diabetic and non diabetic mothers using a computerized analysis of FHR., Study Design: Weekly fetal surveillance was performed in 99 fetuses of mothers with diabetes class A, 21 fetuses of mothers with diabetes class B-R, and 55 fetuses of non-diabetic women, starting at 30 weeks' gestation. All diabetic patients were well controlled. Fetal surveillance included a computerized analysis of the FHR, umbilical and uterine Doppler velocimetry, and a biophysical profile. Changes of FHR variation, frequency of FHR accelerations, and umbilical and uterine Doppler velocimetry were calculated using a regression analysis for each patient. The average slopes and the intercept at 30, 34, and 38 weeks' gestation of these variables were compared among the three groups., Results: The slope of FHR variation and the frequency of accelerations had a lower rate of increase during the third trimester in fetuses of mothers with diabetes class A (0.84 +/- 0.25 ms/week and 0.06 +/- 0.02/20 min/week, respectively) compared with fetuses of non-diabetic mothers (1.34 +/- 0.55 ms/week and 0.5 +/- 0.1/20 min/week, respectively). In fetuses of mothers with diabetes class B-R, FHR variation did not change with gestation (-0.011 +/- 0.2 ms/week) with a small increase in the frequency of accelerations (0.02 +/- 0.004/20 min/week). While no differences were observed at 30 weeks' gestation, FHR variation and the frequency of accelerations were significantly reduced at 34 weeks' gestation in fetuses of mothers with diabetes class B-R compared with fetuses of non-diabetic mothers (P < 0.01). At 38 weeks' gestation, fetuses of mothers with diabetes class B-R and diabetes class A had both significantly reduced FHR variation as well as frequency of accelerations compared with fetuses of non-diabetic mothers (P < 0.01). The rate of decrease of the umbilical and uterine artery S/D ratios were similar among the three groups., Conclusions: The FHR pattern appears to be different in fetuses of well controlled diabetic mothers when related to fetuses of non-diabetic mothers. Disease specific standards should be considered for interpretation of FHR patterns in diabetic pregnancies.

Objective: To study the effect of oligohydramnios on the accuracy of intrapartum clinical and sonographic estimates of fetal weight (EFWs)., Study Design: Intrapartum clinical and sonographic EFWs and an amniotic fluid index (AFI) were obtained on 124 term patients. Oligohydramnios was defined as an AFI < or = 5 cm., Results: Clinical and sonographic EFWs in women with oligohydramnios were significantly less accurate than estimates derived in patients with normal amniotic fluid: P = .03 and .02, respectively. The incidence of clinical and sonographic EFWs within +/-10% of the actual birth weight were 70.1% and 68.4%, respectively (P = NS)., Conclusion: In term patients, intrapartum sonographic prediction of birth weight offers no advantage over estimated fetal weight obtained by abdominal palpation. The presence of oligohydramnios significantly reduces the accuracy of intrapartum clinical as well as sonographic EFWs. Therefore, we suggest that intrapartum EFWs be obtained prior to artificial rupture of the membranes.

Purpose: The diagnosis of multicystic kidney in utero can be made with reasonable reliability with real-time sonography. However, a cystic hydronephrotic kidney may be difficult to distinguish from a multicystic kidney, necessitating postnatal renography. We report our preliminary observations of Doppler waveform variation in normal and cystic fetal kidneys., Materials and Methods: Five consecutive fetuses with a unilateral cystic kidney, and one with a unilateral hydronephrotic duplex kidney and cystic upper moiety were evaluated in utero with color Doppler renal sonography., Results: Doppler signal on serial ultrasound was consistently absent in the ipsilateral cystic kidney, while normal renal artery Doppler waveforms with a systolic and diastolic component were obtained from the contralateral and unaffected moieties. Postnatal renography confirmed nonfunction in all cystic moieties. The hydronephrotic noncystic moiety of the duplex kidney showed a normal Doppler waveform and good function., Conclusions: Absence of renal artery Doppler waveforms in fetal cystic kidneys correlates with renal nonfunction. If this observation can be further confirmed by additional cases, fetal Doppler sonography would become an additional tool to diagnose confidently a multicystic kidney in utero, which may allow us to dispense with postnatal renography.

Objective: Our purpose was to determine the frequency of fetal chromosomal anomalies in pregnancies complicated by polyhydramnios., Study Design: Between Jan. 1, 1992, and July 31, 1993, an amniotic fluid index was measured prospectively in 2730 third-trimester pregnant women. Polyhydramnios was defined as an amniotic fluid index > or = 24 cm. A computer search identified all infants born with structural or chromosomal anomalies., Results: Polyhydramnios was detected in 49 of 2730 women (1.7%). The incidence of chromosomal anomalies was two in 49 (4.1%) compared with three in 2681 (0.12%) among women with normal fluid (p < 0.05). Six of the 49 newborns had structural anomalies (12.2%), whereas 48 of 2681 (1.8%) structural anomalies occurred in the control group (p < 0.05). Among study patients both fetuses with chromosomal anomalies were growth retarded; four of the six structural anomalies were associated with an amniotic fluid index > 30 cm., Conclusions: (1) Polyhydramnios is associated with an increased incidence of congenital fetal anomalies. (2) Growth-retarded fetuses with polyhydramnios warrant genetic evaluation. (3) A genetic study is not absolutely indicated for patients with polyhydramnios and a sonographically normal fetus.

We present the first transvaginal first-trimester diagnosis of achondrogenesis type I confirmed by radiographic and histologic studies. The ultrasonographic signs included severe short limb mesomelic dwarfism, large head with decreased ossification, and lack of vertebral ossification.

Objective: Our purpose was to determine the association between amniotic fluid volume and recent glucose status in gestational diabetes., Study Design: Serial amniotic fluid index values, mean blood glucose levels, and percent hyperglycemia (> or = 120 mg/dl) 1 day and 1 week before the ultrasonographic examinations were prospectively collected in 399 gestational diabetics. Patients demonstrating at least one amniotic fluid index measurement within the normal range (i.e., 5 cm < amniotic fluid index < or = 20 cm) and at least one elevated measurement (i.e., amniotic fluid index > 20 cm) formed the study group. With each patient serving as her own control, glucose index values preceding normal and elevated amniotic fluid index values were compared., Results: Significantly higher mean blood glucose values 1 day (114.7 mg/dl vs 102.8 mg/dl, p < 0.01) and 1 week before (111.0 mg/dl vs. 102.0 mg/dl, p < 0.05) were calculated for examinations resulting in elevated amniotic fluid index values compared with normal amniotic fluid index values, respectively. Similarly, significantly higher percents of hyperglycemia 1 day (32% vs 16.5%, p < 0.05) but not 1 week (30.8% vs 21.7%, p > 0.05) before the elevated amniotic fluid index were documented., Conclusion: Amniotic fluid volume reflects recent glycemic status in gestational diabetes mellitus.

The primary objective of fetal surveillance is to prevent antenatal fetal deaths, which still account for greater than one half of perinatal mortality. Several techniques for assessing fetal well-being are available to the practicing obstetrician, including fetal movement counting, nonstress testing, contraction stress testing, fetal biophysical assessment with real-time sonography, and Doppler ultrasonography for measuring umbilical and fetal blood flow. Despite several unanswered questions regarding fetal surveillance, identification of high-risk pregnancies allows appropriate fetal evaluation that can reduce intrauterine fetal death rates.