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To evaluate the agreement and disagreement between prenatal ultrasound and fetal autopsy findings in pregnancy terminations due to urogenital anomalies.Of 453 pregnancy terminations performed due to fetal anomalies, 82 cases with urogenital anomalies on either prenatal ultrasound or fetal autopsy were included in this retrospective study. The discrepancy between prenatal ultrasound and fetal autopsy findings on urogenital anomaly findings was evaluated.Complete agreement between prenatal ultrasound and fetal autopsy findings was noted in 33 (40.2%) cases (particularly for megacystis, bilateral renal agenesis, and infantile polycystic kidney), whereas partial agreement (anal atresia and horseshoe kidney as additional minor findings) and altered diagnosis were noted in 12 (14.6%) and 8 (9.8%) cases, respectively. Disagreement was noted in 29 (35.4%) cases including anomaly only on autopsy in 20 (24.3%) cases (renal agenesis, horseshoe kidney and multicystic dysplastic kidney in particular) and anomaly only on ultrasound in 9 (10.9%) cases.Accordingly, our findings indicate fetal autopsy to be a method of vital importance in complementing prenatal diagnosis; it may add valuable information that may improve future pregnancy management and counseling of parents, and hence prenatal ultrasound and fetal autopsy should be regarded as complementary techniques.

Objectives In this study, we aimed to compare prenatal ultrasound (USG) and postmortem examination findings of central nervous system (CNS) abnormalities in fetuses following termination of pregnancy (TOP). Methods A total of 190 fetuses with USG-confirmed fetal CNS abnormalities of terminated pregnancies between January 2001 and January 2017 were retrospectively analyzed and USG and postmortem examination findings were compared. Results The most frequent CNS abnormalities were acrania/anencephaly (n=45, 24%), spina bifida (n=43, 23%), and ventriculomegaly (n=35, 18%). In 144 of the 190 (76%) cases, there was total agreement between USG and postmortem examination diagnosis. Postmortem examination provided minor findings which did not change the major clinical diagnosis in two (1%) cases with spina bifida and ventriculomegaly. In six (3%) cases, the diagnosis changed after postmortem examination. In 25 of the 190 (13%) cases with multiple abnormalities as evidenced by USG, CNS abnormality was unable to be confirmed at postmortem examination. Conclusions Our study results show an overall high agreement (76%) between USG and postmortem examination findings for CNS malformations. Due to autolysis and fluid structure, USG-confirmed CNS diagnosis cannot be always confirmed by postmortem examination. This potential discrepancy should be explained to patients before considering TOP. Postmortem examination is the gold standard to confirm prenatal diagnosis.

The World Health Organization in May 2022 declared the monkeypox virus (MPXV) a health emergency. Since then, over 45,355 cases have been reported, mostly from countries where the disease is not endemic. At the moment, most confirmed cases with travel history are reported to countries in Europe and North America, rather than West or Central Africa where the monkeypox virus is endemic. Its transmission depends on large respiratory droplets and skin-to-skin or skin-to-lesion close physical contact, including oral, anal, and vaginal intercourse therefore, women are also at risk of acquiring it. Given few data available, women’s and clinicians’ concerns about the uncertainty of the clinical course and management are more than understandable, especially so after the SARS-CoV-2 pandemic. Lessons must be learnt from our prior mistakes and pregnant individuals should be included in international registries as well as any studies evaluating new treatments or vaccines. The following recommendation aims to provide the latest evidence about the effect of MPXV in pregnancy as well as recommendations for clinical management. ispartof: Perinatal Journal vol:30 issue:3 pages:231-239 status: published

Objectives The present study was performed to examine the utility of a new first trimester marker called the “brain angle” (BA) in screening for trisomy 21. We postulate that differences in the midbrain anatomy between euploid fetuses and those that are affected by trisomy 21 are reflected in changes in BA measurements. Methods In fetuses at 11+0–13+6 weeks of gestations, which were at high risk for trisomy 21, the angle was measured between the line crossing the thalamus and mesencephalon cranial border tangentially and the line crossing the brainstem lower limit. This angle was compared between fetuses with trisomy 21 (based on karyotyping) and those with a normal karyotype. Results Trisomy 21 was detected in 45 (8%) of 560 fetuses. Receiver operating characteristic analysis showed that, at BA≥94°, the sensitivity and specificity for determining trisomy 21 were 97.8% (95% CI=88.2–99.9%) and 100% (95% CI=99.2–100%), respectively. Conclusions Fetal BA appears to be a promising new first trimester marker in screening for trisomy 21.

These practice guidelines follow the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation, bringing together groups and individuals throughout the world, with the goal of improving the ultrasound assessment of the fetal Central Nervous System (CNS) anatomy. In fact, this document provides further guidance for healthcare practitioners for the evaluation of the fetal CNS during the mid-trimester ultrasound scan with the aim to increase the ability in evaluating normal fetal anatomy. Therefore, it is not intended to establish a legal standard of care. This document is based on consensus among perinatal experts throughout the world, and serves as a guideline for use in clinical practice.

Objective To elucidate the role of advanced maternal age (AMA) in determining the outcome of pregnancies complicated by SARS-CoV-2 infection. Methods Multinational cohort study included women with laboratory-confirmed SARS-CoV-2 infection from 76 centers in 27 different countries in Europe, United States, South America, Asia and Australia from 04 April 2020 till 28 October 2020. The primary outcome was a composite measure of maternal mortality and morbidity including admission to intensive care unit (ICU), use of mechanical ventilation (defined as intubation, need for continuous positive airway pressure, extra-corporeal membrane oxygenation), severe respiratory symptoms (including dyspnea and shortness of breath) or death. Results Eight hundred and eighty seven pregnant women were included in the study who were positive SARS-CoV-2 results by RT-PCR (reverse transcriptase-polymerase chain reaction) on their nasal and pharyngeal swab specimens (352 with and 652 with no AMA). The risk of composite adverse maternal outcome was higher in AMA group compared to that of under 35 years of age group, with an OR of 1.99 (95% CI 1.4–2.9; p=0.002). Likewise, women >35 years were also at higher risk of hospital admission (OR: 1.88, 95% CI 1.4–2.5; p

This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for standardization to implement the ultrasound evaluation in labor ward and improve the clinical management of labor. Ultrasound in labor can be performed using a transabdominal or a transperineal approach depending upon which parameters are being assessed. During transabdominal imaging, fetal anatomy, presentation, liquor volume, and placental localization can be determined. The transperineal images depict images of the fetal head in which calculations to determine a proposed fetal head station can be made.

n this review, we reviewed current literature on COVID-19 infection during pregnancy and provided up-to-date information and community/society recommendations. Although it has previous examples such as SARS and MERS and the infection findings appeared at an earlier period and have become known in China, the infection could not be limited and spread worldwide. Until June 8, 2020, a total of 6.8 million cases were reported and 397,000 cases died. As of the same date, the total case number in Turkey is 171,000 and total number of death is 4711. COVID-19 virus spread by droplets and its incubation period varies between 2 and 14 days. The rate of asymptomatic cases is 42% in non-pregnant patients while it is 44–89% in pregnant women. The disease progresses with mild-medium severity in about 80% of the patients, and it recovers by itself. A total of 17 maternal death cases has been reported. Although vertical transmission risk is very low according to a study investigating 265 pregnant women, there are cases showing fetal vertical transmission and we reviewed such cases in detail in this review.

Objectives To evaluate the relationship between prenatal ultrasonography (USG) and fetal autopsy findings. Methods Among 453 pregnancy terminations performed because of fetal anomalies on prenatal USG, 54 with skeletal dysplasia on fetal autopsy were included in this retrospective study. Results The most common diagnoses among the 54 fetal autopsies were osteogenesis imperfecta (n=12), dysostosis (n=10), achondroplasia (n=9), arthrogryposis (n=6), and thanatophoric dysplasia (n=6). The prenatal USG and fetal autopsy findings showed complete agreement in 35 cases (64.8%), partial agreement in nine cases (16.6%), and disagreement in 10 cases (18.5%). Conclusions Fetal autopsy via perinatal pathology is essential for precise identification of the type of skeletal dysplasia; it should be routinely performed to confirm the diagnosis of prenatally detected fetal anomalies. Autopsy is vital for accurate prenatal diagnosis and the ‘gold standard’ technique for the identification of clinically important abnormalities.

This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for precise standardization to implement the ultrasound evaluation of the fetus in the first trimester of pregnancy and improve the early detection of anomalies and the clinical management of the pregnancy. The aim is to present a document that includes statements and recommendations on the standard evaluation of the fetal anatomy in the first trimester, based on quality evidence in the peer-reviewed literature as well as the experience of perinatal experts around the world.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8–0.9 per week increase; p Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.

WOS:000613461600006 PubMed ID: 32926494 Objectives To evaluate the maternal and perinatal outcomes of pregnancies affected by SARS-CoV-2 infection. Methods This was a multinational retrospective cohort study including women with a singleton pregnancy and laboratory-confirmed SARS-CoV-2 infection, conducted in 72 centers in 22 different countries in Europe, the USA, South America, Asia and Australia, between 1 February 2020 and 30 April 2020. Confirmed SARS-CoV-2 infection was defined as a positive result on real-time reverse-transcription polymerase chain reaction (RT-PCR) assay of nasopharyngeal swab specimens. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit (ICU), use of mechanical ventilation and death. Results In total, 388 women with a singleton pregnancy tested positive for SARS-CoV-2 on RT-PCR of a nasopharyngeal swab and were included in the study. Composite adverse maternal outcome was observed in 47/388 (12.1%) women; 43 (11.1%) women were admitted to the ICU, 36 (9.3%) required mechanical ventilation and three (0.8%) died. Of the 388 women included in the study, 122 (31.4%) were still pregnant at the time of data analysis. Among the other 266 women, six (19.4% of the 31 women with first-trimester infection) had miscarriage, three (1.1%) had termination of pregnancy, six (2.3%) had stillbirth and 251 (94.4%) delivered a liveborn infant. The rate of preterm birth before 37 weeks' gestation was 26.3% (70/266). Of the 251 liveborn infants, 69/251(27.5%) were admitted to the neonatal ICU, and there were five (2.0%) neonatal deaths. The overall rate of perinatal death was 4.1% (11/266). Only one (1/251, 0.4%) infant, born to a mother who tested positive during the third trimester, was found to be positive for SARS-CoV-2 on RT-PCR. Conclusions SARS-CoV-2 infection in pregnant women is associated with a 0.8% rate of maternal mortality, but an 11.1% rate of admission to the ICU. The risk of vertical transmission seems to be negligible. (C) 2020 International Society of Ultrasound in Obstetrics and Gynecology.

The goal of perinatal medicine is to provide professionally responsible clinical management of the conditions and diagnoses of pregnant, fetal, and neonatal patients. The New York Declaration of the International Academy of Perinatal Medicine, “Women and children First – or Last?” was directed toward the ethical challenges of perinatal medicine in middle-income and low-income countries. The global COVID-19 pandemic presents common ethical challenges in all countries, independent of their national wealth. In this paper the World Association of Perinatal Medicine provides ethics-based guidance for professionally responsible advocacy for women and children first during the COVID-19 pandemic. We first present an ethical framework that explains ethical reasoning, clinically relevant ethical principles and professional virtues, and decision making with pregnant patients and parents. We then apply this ethical framework to evidence-based treatment and its improvement, planned home birth, ring-fencing obstetric services, attendance of spouse or partner at birth, and the responsible management of organizational resources. Perinatal physicians should focus on the mission of perinatal medicine to put women and children first and frame-shifting when necessary to put the lives and health of the population of patients served by a hospital first.

Objective: To evaluate the ultrasonographic features and pregnancy outcomes in women with ductus venosus-systemic shunt and systematic review of the literature.Method: A computerized search was con...

Indomethacin is a commonly used medication against preterm delivery. Several reports of fetal ductal constriction have been described after indomethacin use in the literature; however, there are no previously documented reports describing an association between Twin-Twin Transfusion syndrome and a constrictor effect of indomethacin on the ductus arteriosus. Two patients were referred to our department for Twin-Twin Transfusion syndrome and each underwent placental laser surgery. Constriction of the ductus arteriosus occurred as early as 20 and 24 weeks’ gestation following maternal use of indomethacin after laser surgery. Spontaneous amelioration was observed after discontinuation of the drug. The constrictor effect of indomethacin on the ductus arteriosus can be observed even after a single dose and as early as 20 weeks of gestation in complicated monochorionic twin pregnancies. We emphasize meticulous use of indomethacin in complicated monochorionic twin pregnancies because the constrictive effect seems to be independent of gestational age.

Yil: 2017Cilt: 25Sayi: 3ISSN: 1300-5251 / 1305-3132Sayfa Araligi: 139 - 144Metin Dili:Turkce

These guidelines follow the mission of the World Association of Perinatal Medicine, which brings together groups and individuals throughout the world with the goal of improving outcomes of maternal, fetal and neonatal (perinatal) patients. Guidelines for auditing, evaluation, and clinical care in perinatal medicine enable physicians diagnose, treat and follow-up of COVID-19-exposed pregnant women. These guidelines are based on quality evidence in the peer review literature as well as the experience of perinatal expert throughout the world. Physicians are advised to apply these guidelines to the local realities which they face. We plan to update these guidelines as new evidence become available.

Advances in technology and wide used of obstetric ultrasound have allowed an increase in the antenatal identification of fetal problems, such as fetal lung lesions. Technological advances in transducer and software technology have remarkably improved visualization of structures in the fetus. Additionally, newer understanding of the natural course of several malformations and new methods of in utero treatment, the evolution of fetal surgical techniques and anesthesia have made fetal surgery possible and have changed the course of evolution of lung defects before and after birth. Therefore, there is now an increasing demand for an accurate and timely diagnosis, counseling, and planning of appropriate management of the cases whether expectant management or in utero therapy at perinatal care centers with timely perinatal transfer. How to cite this article Sen C, Yayla M, Api O, Goynumer G. Fetal Lung Surgery. Donald School J Ultrasound Obstet Gynecol 2016;10(3):271-296.

Prenatal screening for fetal aneuploidies has been focused on mainly Down syndrome in the last 40 years. The method of screening has changed from maternal age in the 1970s, with a detection rate of 30 and 5% false positive rate (FPR), to a combination of maternal age and second-trimester serum biochemical markers (triple test and quadruple test) in the 1980s and 1990s, with 60 to 75% detection rate and 5% false positive rate (FPR). Following this, the era of first trimester screening for Down syndrome has started with the clinical implementation of fetal nuchal translucency screening. The combination of maternal age, NT thickness and serum free beta-human chorionic gonadotropin (â-hCG) and pregnancy-associated plasma protein A (PAPP-A) in the first trimester has yielded a 90% detection rate with a 5% FPR. Starting from the year 2008, studies have shown that the performance of screening may be improved by analysis of cell-free deoxyribonucleic acid (DNA) (cfDNA) in maternal blood. Several studies in the last few years have reported the clinical validation of cell free fetal DNA test in the maternal serum in screening for trisomies 21, 18, and 13 and sex chromosome aneuploidies.Its widespread use is limited by the relatively high cost of the test and the lack of consensus about the optimal way for its clinical implementation. Until the optimal way of incorporating cfDNA into the clinical practice gets identified, it would be wise not to substitute cfDNA testing in place of first-trimester screening for fetal defects and other major complications of pregnancy. Furthermore, it would be preferable for clinicians managing individual patients not to counsel them for their result as positive or negative, rather the clinicians should use the risk estimate from the first-line method of screening as the prior risk and modify this by the appropriate positive or negative likelihood ratio from the cfDNA test.How to cite this articleSen C, Api O, Yayla M, Goynumer G. Cell-free DNA Testing: Where are We now? Donald School J Ultrasound Obstet Gynecol 2016;10(2):172-177.

Hospital births, when compared to out-of-hospital births, have generally led to not only a significantly reduced maternal and perinatal mortality and morbidity but also an increase in certain interventions. A trend seems to be emerging, especially in the US where some women are requesting home births, which creates ethical challenges for obstetricians and the health care organizations and policy makers. In the developing world, a completely different reality exists. Home births constitute the majority of deliveries in the developing world. There are severe limitations in terms of facilities, health personnel and deeply entrenched cultural and socio-economic conditions militating against hospital births. As a consequence, maternal and perinatal mortality and morbidity remain the highest, especially in Sub-Saharan Africa (SSA). Midwife-assisted planned home birth therefore has a major role to play in increasing the safety of childbirth in SSA. The objective of this paper is to propose a model that can be used to improve the safety of childbirth in low resource countries and to outline why midwife assisted planned home birth with coordination of hospitals is the preferred alternative to unassisted or inadequately assisted planned home birth in SSA.

Fetal arrhythmias are one of the most feared clinical problems encountered during the pregnancy that require prompt recognition and effective management by a multidisciplinary team involving fetal medicine specialist, fetal cardiologist, midwife, radiologist, sonographer, neonatologist and the patient herself. This review is aimed at providing a concise guide to medical practitioners involved in the care of pregnant women and the fetus on the diagnosis and management of fetal arrhythmias, follow-up principles and delivery recommendations. How to cite this article Uzun O, Goynumer G, Sen C, Beattie B. Systematic Appraisal of Diagnosis and Management of Arrhythmias in the Fetus. Donald School J Ultrasound Obstet Gynecol 2015;9(3):314-326.

Monochorionic (MC) twin pregnancy is a distinct entity and has certain differences from dichorionic twins due to the unique placental angioarchitecture. It is characterized by twin-to-twin transfusion syndromes (twin oligohydramnios-polyhydramnios sequence and twin anemia-polycythemia sequence), acardiac twinning, selective fetal growth restriction and congenital anomalies. Selective termination is an option in MC twins complicated by selective fetal growth restriction and discordant fetal anomaly. Fetal demise of the co-twin can occur even after uncomplicated surgery. A selective fetal termination using an intrafetal laser was performed in the case of an MC twin pregnancy complicated by twin oligohydramnios-polyhydramnios sequence and hydrocephalus in the donor twin. Fetal demise of the co-twin was observed after surgery. The placenta was examined with dye injections after abortion and showed vascular anastomoses causing unexpected fetal demise.

To establish a reference range for the intracranial translucency (IT). In this prospective study, we examined 596 singleton fetuses at 11–14 weeks of gestation using transabdominal ultrasonography. The distribution curves of the anterior–posterior diameter of the IT were established according to the gestational weeks, and the percentiles for 11–14 weeks of gestation were calculated. Regression analysis was performed to estimate the relationship between the anterior–posterior diameter of the IT and other fetal biometric parameters. The mean anterior–posterior diameter of the IT was 1.8 ± 0.4 mm. From 11 to 14 weeks of gestation, the IT diameter increased linearly with advancing gestation. The linear regression equation for the IT × crown–rump length (CRL) was IT = CRL × 0.0184 + 0.575 (R = 0.385, p

Aim. To evaluate the relationship between uterine artery Doppler indices and placental bed histopathology independent of clinical outcome. Materials and Methods. Uterine artery measurements were performed to 510 pregnant women who had come for routine antenatal care in 11–14th and 20–24th weeks. Placental bed biopsies from 141 cases were taken during cesarean section. Physiological changes and abnormal placental histology findings were investigated and compared with Doppler findings. Results. 116 biopsies were accepted as adequate biopsy and included in the study. Physiological changes were seen in 100 biopsies. Statistically significant higher PI and RI values in second trimester and higher notch rate in both trimesters were detected in the abnormal placental histology group (P<0,001). Conclusion. Strong relationship between uterine artery Doppler indices and preeclampsia or intrauterine growth retardation has been shown in previous studies. In our study, we concluded that there is significant relationship between Doppler findings and placental bed histopathology independent of clinical course.

Background: Considerable controversy continues to surround the management of severe preeclampsia and HELLP syndrome. Experts, researchers, and those published in the field were surveyed about their specific practices. Materials and methods: An extensive literature search was undertaken to identify the cohort of authors with recent publications on the subjects of preeclampsia (2009–2012) and HELLP syndrome (2005–2012). Online surveys were sent to all authors using the email addresses found in their publications. Results: Surveys were delivered by email to 363 authors of preeclampsia publications and 91 authors of HELLP syndrome publications. Completed surveys were received from 61 (13.4%) of the group. Except for consensus about the indication of corticosteroids for the enhancement of fetal lung maturation, there was considerable variation in corticosteroid practice and anesthesia techniques. Conclusions: A marked diversity in practice characterized the clinical care rendered by experts in the field of preeclampsia and HELLP syndrome. Thus, there is an urgent need for well-designed and executed prospective clinical trials to improve the evidence for best consensus practice in this area of obstetrical medicine.

Cytomegalovirus (CMV) can be a cause of fetal morbidity and mortality among approximately 1% of pregnancies. With an aim to detect CMV antigenemia among 51 pregnant women with/without clinically diagnosed abnormalities and intrauterine growth retardation (IUGR) maternal and fetal samples either prenatal (n:22) or postpartum (n:29) were obtained between 17-42 weeks of gestation to analyze anti-CMV IgG, IgM antibodies and cytoplasmic or nuclear CMV antigens. Cytoplasmic and nuclear CMV antigenemia was detected among 19.6% and 11.8% of maternal samples. These values were 29.4% and 17.6% for fetal samples. Among both maternal and fetal samples, there was a 100% correlation when IgG and IgM were negative. The correlation for IgG and IgM positivity was not present among maternal samples since cytoplasmic (37.5%) and nuclear (25%) antigens could not be demonstrated in spite of immunity. Cytoplasmic and nuclear CMV antigens were detected within fetal samples from subjects presenting maternal immunoglobulin positivity, clinical abnormality and clinically normal findings (50, 32, 16.7% and 50, 16, 5.6%) respectively. In conclusion, immunocytochemical detection of CMV antigenemia improves CMV infection diagnosis which may be associated with clinical abnormalities/IUGR.

Maternal corticosteroid administration has been reported to improve the blood pressure, urine output, laboratory values of liver enzymes and platelets in HELLP syndrome. In this controversial subject, recently, Cochrane Database had updated its systematic review and in the subgroup analysis they indicated that dexamethasone was superior to betamethasone for the improvement of platelet counts and liver enzymes. However, there are several issues which need to be clarified about the subgroup analysis and the consequent conclusion.Systematic review and re-analysis of the indicated studies.In the subgroup analysis two studies were included, which had used non-parametric methods for statistical analysis and yielded insignificant p-values that showed indifference between betamethasone and dexamethasone. However, the Cochrane meta-analysis had used parametric methods in contradistinction to the included studies and indicated significant difference between two steroids. Accordingly, results and conclusions of the Cochrane meta-analysis in this subgroup analysis cannot be justified with the indicated two studies.Here we can only urge further studies to provide frank evidence about the comparison of dexamethasone and betamethasone in HELLP syndrome. Until shown to be true, we doubt the credibility of the subgroup analysis results of the Cochrane review and the application of these subgroup results into clinical practice.

A case of cranioraschischisis including incomplete pentalogy of Cantrell (PC) is described. The female fetus had a large omphalocele with evisceration of the heart, left lung, liver, stomach, and intestines accompanying anencephaly, cervical, thoracal lumbar, spina bifida. The fetus had ectopia cordis and diaphragmatic agenesia with an intact sternum. We present a case of a neonate with the stigmata for PC with the exception of a sternal defect. A literature review is also included. Sonographers should check for ventral and dorsal anomalies with PC because they may occur simultaneously.

Dear Editor, With great interest I read the recently published guidelines for the management of spontaneous preterm labor [1]. I was delighted to see that unlike the previous guidelines published in 2006 [2], these new ones also take into consideration the diagnostic marker insulin-like growth factor binding protein-1 (IGFBP-1) that I have worked with since the early 80s. However, I would like to bring the readers’ attention to some errors and points that may be misleading regarding evaluation of IGFBP-1 as a marker of ruptured fetal membranes (ROM) and in comparing it with placental α microglobulin-1 (PAMG-1). Firstly, human IGFBP-1 is a well characterized protein since more than 20 years [3,4]. Its synthesis by the liver and decidua, and levels in amniotic fluid and other body fluids have been thoroughly examined in all stages of pregnancy [5,6] and the data have been published in peer-reviewed journals. Meanwhile, the data available on PAMG-1 is more limited and partly confusing. In the most often cited papers regarding the PAMG-1 levels in amniotic fluid, blood and other body fluids [7–9], the values are quite different from those reported in the guidelines. This makes comparison between IGFBP-1 and PAMG-1 difficult. IGFBP-1 has been used as a marker of ROM since the mid 90s (Actim PROM test). Since then, several studies have consistently shown that this test identifies membrane rupture with high accuracy. Unfortunately, many of these studies were omitted in the analysis presented in Table I of the guidelines comparing the performance of the different tests [10–12]. As a consequence, the sensitivity and specificity of the IGFBP-1 test remain underestimated. For example, the lowest sensitivity (74%) is from a study by Lockwood 1994 using a quantitative radioimmunoassay with frozen samples in the laboratory with a different detection limit and assay conditions from the current IGFBP-1 based bed-side PROM test [13]. Secondly, the guidelines state that the detection limit of PAMG-1 with Amnisure ROM test (5 ng/ml) is lower than the detection limit of IGFBP-1 with Actim PROM test (25 ng/ml). This comparison is irrelevant, since the quoted levels of PAMG-1 protein in amniotic fluid (2000−25,000 ng/ml) are clearly lower than the known levels of IGFBP-1 (10,500−350,000 ng/ml [14]), which naturally calls for a need of a lower detection limit. In the guidelines the lowest level of IGFBP-1 is quoted to be 27 ng/ml in early pregnancy. Such low levels have not been reported at pregnancy weeks clinically relevant for diagnosis of ROM [15]. Thirdly, the sensitivity and specificity of any test has to be interpreted in the clinical context. The methods used for estimation of the accuracy and reliability of the PAMG-1 test compared to the IGFBP-1 test are questionable for several reasons. For example, samples of pure blood-free amniotic fluid obtained during intra-operative amniocentesis at cesarean section were diluted with 0.9% saline and serial dilutions were tested using both tests [16,17]. The study design does not correspond to the bed-side situation where amniotic fluid is contaminated by vaginal discharge or other possible fluids like urine, semen or blood that may affect the test result causing false positives, if the test is too sensitive. A high rate of positive PAMG-1 test results has been found among patients with intact membranes and labor at term [18] and in patients with a short cervix [19]. This data has not been considered when analyzing the specificity of PAMG-1 test. Also, the publication on the intra-amniotic dye test and its comparison with the PAMG-1 test is a congress abstract only, with no information on the numbers of patients or the study design [20]. Finally, IGFBP-1 test results have repeatedly been shown to be unaffected by the presence of blood [10,21,22]. Indeed, the monoclonal antibody used in the Actim PROM test does not recognize the highly phosphorylated IGFBP-1 which is the predominant isoform in maternal and fetal blood and decidua [4]. Since blood may be present in approximately 25% of cases with suspected PROM, this information is critical in order to estimate the accuracy and clinical usefulness of the marker. Suspected rupture of membranes in the presence of bleeding is the most challenging situation in the clinic, since the therapeutic measures differ depending on whether the membranes in such a case are intact or not. Yet, no information is available on the accuracy of the PAMG-1 test in patients with suspected membrane rupture and bleeding since patients with bleeding have systematically been excluded in PAMG-1 clinical studies, suggesting that PAMG-1 test cannot be used in such challenging cases. The statement that presence of blood up to 50% does not interfere with the PAMG-1 test result is only based on a conference poster, reporting serial dilutions of peripheral blood in 0.9% saline in vitro [23]. Again, the study design is not equivalent to the clinical situation where amniotic fluid in cervicovaginal swab sample is mixed with vaginal secretion and other possible contaminants. Also, this high rate of positive Amnisure results in the presence of blood raises a question on the validity of the reported range in the maternal blood (0.5–2 ng/ml) that should not react in a test with a detection limit of 5 ng/ml. Considering all the points above, the currently available data does not unequivocally support the superiority of the PAMG-1 test as compared with the IGFBP-1 test.

Magnetic resonance imaging (MRI) has been increasingly adopted in obstetrics practice in the past three decades. MRI aids prenatal ultrasound and improves diagnostic accuracy for selected maternal and fetal conditions. However, it should be considered only when high-quality ultrasound cannot provide certain information that affects the counseling, prenatal intervention, pregnancy course, and delivery plan. Major indications of fetal MRI include, but are not restricted to, morbidly adherent placenta, selected cases of fetal brain anomalies, thoracic lesions (especially in severe congenital diaphragmatic hernia), and soft tissue tumors at head and neck regions of the fetus. For fetal anatomy assessment, a 1.5-Tesla machine with a fast T2-weighted single-shot technique is recommended for image requisition of common fetal abnormalities. Individual judgment needs to be applied when considering usage of a 3-Tesla machine. Gadolinium MRI contrast is not recommended during pregnancy. MRI should be avoided in the first half of pregnancy due to small fetal structures and motion artifacts. Assessment of fetal cerebral cortex can be achieved with MRI in the third trimester. MRI is a viable research tool for noninvasive interrogation of the fetus and the placenta.

Gray-scale image data are processed in 3D ultrasound by repeated scans of multiple planes within a few seconds to achieve one surface rendering image and three perpendicular plane images. The 4D image is achieved by repeating 3D images in short intervals, i.e. 3D and 4D ultrasound are based on simple B-mode images. During 3D/4D acquisition, a fetus in utero is exposed by ultrasound beam for only a few seconds, and it is as short as real-time B-mode scanning. Therefore, simple 3D imaging is as safe as a simple B-mode scan. The 4D ultrasound is also as safe as a simple B-mode scan, but the ultrasound exposure should be shorter than 30 min. The thermal index (TI) and mechanical index (MI) should both be lower than 1.0, and the ultrasound study is regulated by the Doppler ultrasound if it is combined with simple 3D or 4D ultrasound. Recently, some articles have reported the functional changes of animal fetal brain neuronal cells and liver cell apoptosis with Doppler ultrasound. We discuss cell apoptosis by ultrasound in this report. Diagnostic ultrasound safety is achieved by controlling the output pulse and continuous ultrasound waves using thermal and mechanical indices, which should be

Today we are living in a globalized world in which information on what is happening in one part of the world is easily communicated to other parts of the world. This happens thanks to advancement in science and technology. One area where technology has made the greatest impact is heath care provision. Ultrasound technology is now playing a critical role in health care provision particularly in Obstetrics and Gynaecology. This has significantly assisted in provision of quality health care to pregnant women and their unborn infants and in reducing maternal and neonatal morbidity and mortality in the developed world. Africa the continent with greatest health care challenges and with the highest maternal and neonatal mortalities is yet to fully utilize this important technology. The need for this technology is great as the conditions requiring its application abound. The effective application of Ultrasound however faces serious challenges in Africa. To successfully entrench Ultrasound in quality Obstetrics and Gynaecology care various approaches must be adopted to overcome the challenges. The aim of this paper is to identify the benefits and the challenges inimical to the application Ultrasound in Obstetrics and Gynecology in Africa. It also examines what needs to be done to achieve better application of Ultrasound in Obstetrics and Gynecology.

Fetal surgery involves a large number of heterogeneous interventions that vary from simple and settled procedures to very sophisticated or still-in-development approaches. The overarching goal of fetal interventions is clear: to improve the health of children by intervening before birth to correct or treat prenatally diagnosed abnormalities. This article provides an overview of fetal interventions, ethical approaches in fetal surgery, and benefits obtained from antenatal surgeries.