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Congenital pulmonary vascular anomalies are rare. Antenatal diagnosis of these vascular anomalies requires a good knowledge of fetal cardiac anatomy because clinical presentations are variable. In fact, screening of pulmonary arteries anomalies can be not complex in some cases because of important associated consequences easily detected on ultrasound, but some other anomalies have more discrete features. The severity depends on the underlying lesion and whether or not it is isolated. Moreover, they may be associated with genetic syndromes as well. The aim of this review is to define and review all unusual and abnormal situations of the main pulmonary artery and its branches and to propose, through the identification of "red flags" during routine antenatal heart examination, an optimal screening around the pulmonary pathway. Fourteen different antenatally diagnosed entities of pulmonary artery anomalies were defined. Those entities belonging to the four following family of disorder: 4 anomalies of the pulmonary valvular region with stenosis or atresia of the valve; 4 anomalies related to conotruncal abnormalities; 4 anomalies associated with the abnormal origin or pathway of the pulmonary artery; and finally, 2 anomalies belonging to primitive abnormal development of the pulmonary artery and its branches. We highlight the need to differentiate three-vessel and three-vessel and trachea views when assessing a fetus with an abnormality belonging the CPA family spectrum. This article is protected by copyright. All rights reserved.

International audience; Antenatal ear examination is an integral part of the thorough examination of the fetal face. The discovery of an anomaly, whether it is made by chance or during a complementary in-depth examination, leads the practitioner to determine its isolated or associated character, in order to characterise its possible belonging to a syndromic entity. In this context, the realization of genetic analysis more precise and wider allowing a return of the results in a time compatible with an evolutive pregnancy, gives to the geneticist a central role in the management of these couples. The main challenge lies in obtaining a set of concordant clinical and biological clues, enabling the genetic results identified to be interpreted correctly, the optimised functioning of the ultrasound practitioner - geneticist duo is therefore fundamental. This results in a complex information to deliver, in the fact that the clinical translation of an ear anomaly in antenatal can go from an isolated aesthetic anomaly to a genetic syndrome with neurodevelopmental disorder. The objective of this work is to describe, from a methodological analysis of antenatal ears, the accessible malformative entities, isolated or associated, and to discuss the problems in the need or not to propose their screening.

The demand for remote advice has expanded since the advent of information and communication technology. This study aims to evaluate the use of asynchronous tele-expertise (ASTE) in providing a quality expert opinion in the field of obstetric ultrasound.Requests for expert opinions on pregnant patients were considered retrospectively over a 24-month period (01/09/2018 to 01/21/2020). All patients were initially seen in consultation with a midwife sonographer, located in Hyères, 82km from the expert's centre. In the event of unusual images, including one or more malformations on ultrasound screening, a second opinion was necessary. Responses were characterized as follows : possible or impossible to analyse images; ASTE alone or combined with a face-to-face consultation; and absence or presence of unusual images. Unusual images were classified as normal variants or recognised malformations. We analysed the outcomes of these pregnancies and assessed concordance between prenatal advice and postnatal outcome.During the study period, we identified 174 referrals from 141 patients. Requests for advice were made by 3/174 (1.7%), 69/174 (39.7%), and 102/174 (58.6%) in the first, second, and third trimester of pregnancy, respectively. Overall, 115/141 (81.6%), 21/141 (14.9%), 4/141 (2.8%), and 1/141 (0.7%) patients were provided with one, two, three, and five opinions, respectively. In total, 37/141 (26.2%) patients required a face-to-face consultation, resulting in 38/174 (21.8%) opinions (one patient was seen twice). At least one unusual image was found for 27/141 (19.2%) patients and no unusual images were reported for 114/141 (80.8%) patients. Analysis of the pregnancy outcomes revealed a perfect correlation between prenatal advice and postnatal data, both for cases with unusual images and those without.The preliminary results of our study reveal that ASTE is safe in terms of enabling an expert to answer a precise question formulated by a screener when confronted with images deemed to be unusual. Using this mode of communication, a tailored healthcare pathway may be defined for the mother and her foetus. This new type of practice cannot exist without establishing a genuine relationship of trust between the person requesting the opinion and the person who is asked to provide the opinion.

Facial cleft are the most frequent craniofacial anomalies with an incidence of one for 1000 births, all births combined, and require specialized multidisciplinary care. Since 2005, the systematic realization of two ultrasound views (nose-lip and profile) is recommended for the exploration of the fetal face in the 2nd trimester of pregnancy. Application of these recommendations should allow screening of the majority of cleft lip and palate. However, cleft palates, without labiomaxillary involvement, are currently largely underdiagnosed at prenatal ultrasound, although they can be associated with a syndromic diagnosis in up to 30% of cases. The aim of this work is to describe, from embryology to surgical consultation, the complete ultrasound examination of a fetus with a classic facial cleft.

The good knowledge of the characteristics of the left outflow tract allows us to detect but also to identify anomalies such as conal VSD and conotruncal anomalies. The analysis of this specific area of the heart must always be performed as part of a global analysis of the outflow tracts, combining the analysis of the right outflow tract with the assessment of the three vessel and trachea view.

Introduction L’objectif de notre etude est d’evaluer l’impact medico-economique de la tele-expertise en echographie obstetricale. Elle s’appuie une modelisation de minimisation des couts. L’analyse de reference est basee sur la pratique du Dr Quarello qui depuis plus de deux ans effectue des tele-expertises asynchrones pour collegues medecins et sages-femmes de la region PACA. Methodes Une etude de minimisation des couts par arbre de decision a ete realisee sous l’hypothese d’une efficacite equivalente de la tele-expertise et de la prise en charge en face-a-face. Les couts sont mesures du point de vue collectif. Les donnees de l’analyse de reference reposent sur l’analyse retrospective d’une cohorte de 260 patientes pour 322 demandes d’avis. L’analyse des donnees mobilise les methodes statistiques usuelles et la modelisation economique est realisee sur logiciel TreeAge. Resultats L’analyse de la cohorte montre que l’expertise synchrone a permis au medecin requis de poser un diagnostic precis et d’identifier 69 grossesses associees a des anomalies congenitales. Cette expertise a evite le deplacement de 73 % des patientes, soit 189 patientes pour 225 avis. Pour 71 patientes, un deplacement a ete necessaire apres la tele-expertise (impossibilite de conclure a distance, demande des patientes et/ou conseil prenatal). La modelisation des couts respectifs des interventions a distance et des couts modelises pour cette meme expertise en face a face montre une reduction du cout total moyen de 123,40 € par patiente. Conclusion Les resultats de l’etude soulignent l’efficience de la pratique de tele-expertise et revelent des avantages economiques et cliniques qui pourront eclairer les politiques de sante publique sur l’impact des actes de teleexpertises dans le domaine de l’echographie obstetricale.

Congenital heart disease remains an important cause of perinatal morbidity and mortality. Screening for these is based on a good knowledge of normal fetal heart anatomy and ultrasound views to be performed. After recommending the use of the four chambers and the right outflow tract views in 2005, CNEOF proposes recently adding the left outflow tract assessment. The use of this one should sensitize the operator to the notion of sweeping essential to obtain all these views and make it possible to improve the detection of the conal VSD and conotruncal pathologies.

The prenatal finding of a head circumference (HC) below the 3rd percentile (p) remains, in the same way as short femur or increased nuchal translucency with normal karyotype, one the most difficult situations for the praticionner in the setting of prenatal diagnosis. Microcephaly is a gateway to possible cerebral pathologies, but the main objective is to identify serious prenatal situations. A standardized HC measurement, the use of adapted reference tools and charts, longitudinal following of cephalic biometrics in high-risk situations, and systematic central nervous system analysis can increase the diagnostic performance of ultrasound which is often disappointing for microcephaly. The early distinction between associated or isolated microcephaly makes it possible to quickly orient the prenatal management and counseling. Fetal MRI and genetic counseling are fundamental in this context, making it possible to specify at best the etiological diagnosis and to provide assistance to the neuropediatrician in the establishment of an often uncertain prognosis. The recent increase in cases of microcephaly concomitant with the epidemic of the ZIKA virus is an additional argument to improve our practices and the daily apprehension of HC3rd p.

The detection of abnormalities of the fetal urinary system in the first trimester of pregnancy is constantly improving, namely owing to the improved resolution of the image, the use of the endovaginal approach and thanks to sonographers' constant training. The pathological aspects, usually detected in the second trimester of pregnancy, can be suspected early in the first trimester and range from kidneys' cavity dilation to bilateral renal agenesis, polycystic kidney disease, multi-cystic dysplasia and bladder megavessia or bladder exstrophy. A poly-malformative syndrome is to be found out. The detection of an abnormality of the urinary tract requires a close ultrasound check. Very often, the pathological aspects tend to disappear spontaneously. In particular, the non-visualization of the bladder requires repeated examinations during the same session or even a little later in the pregnancy. We will carry out a review of the literature by pointing out the usual and unusual aspects of the fetal urinary system visible in the first trimester and we will as well propose an algorithm describing how to deal with abnormalities of the urinary tract that can be found out at first trimester ultrasound.

Good knowledge of normal characteristics of prenatal three vessels and trachea view allows not only to detect, but also to identify abnormalities such as normal variants and malformations of interest to main vessels (trunk of the pulmonary artery and its branches, the aorta and the superior vena cava) and various vascular structures in the anterior-superior mediastinum. These abnormalities may be isolated or associated with other anomalies of cardiac architecture.

STUDY QUESTION: Can independent predictors of pregnancy-associated plasma protein-A (PAPP-A) levels be identified in a group of women who conceived following IVF/ICSI? SUMMARY ANSWER: The significantly decreased PAPP-A level in IVF and ICSI pregnancies compared with non-IVF/ICSI pregnancies was correlated strongly with the serum estradiol (E2) level at ovulation triggering. WHAT IS KNOWN ALREADY: The first trimester prenatal combined screening test for fetal aneuploidies in pregnancies conceived following assisted reproduction techniques (ART) is complicated by an alteration of the maternal biomarkers free β-hCG and PAPP-A, causing a higher false-positive rate compared with pregnancies which are conceived naturally. The use of controlled ovarian stimulation prior to IVF/ICSI is suggested to be the principle reason for these alterations of biomarkers in ART pregnancies. STUDY DESIGN, SIZE, DURATION: Between January 2010 and December 2011, 1474 women who conceived naturally and 374 women who conceived following IVF (n = 89), ICSI (n = 204) or intrauterine insemination (IUI, n = 81) were included in this retrospective study. Only singleton pregnancies were eligible for this study. For all women, serum analysis was performed in the same clinical laboratory. Measurement of nuchal translucency (NT) thickness was performed by four physicians belonging to the same infertility centre. PARTICIPANTS/MATERIALS, SETTING, METHODS: First-trimester combined screening test of aneuploidy parameters (maternal age, PAPP-A and free β-hCG, NT thickness) were compared between non-ART and ART (IVF, ICSI and IUI) singleton pregnancies. Next, a minimal threshold E2 level at ovulation triggering was suggested for IVF/ICSI pregnancies above which the PAPP-A levels were significantly decreased compared with non-ART pregnancies. Finally, a multivariate analysis was performed to reveal independent predictors of PAPP-A level in IVF/ICSI pregnancies. MAIN RESULTS AND THE ROLE OF CHANCE: We showed a decrease of the multiple of the median (MoM) PAPP-A level in IVF and ICSI singleton pregnancies compared with non-ART singleton pregnancies (P < 0.001), with MoM values of 0.74 (0.16-3.16) and 0.81 (0.12-4.61) versus 0.98 (0.14-5.76), respectively. Analysis of variance of the overall model was highly significant (Fisher test 3.76, P = 0.01), indicating that the model explains a significant portion of the variation in the data. No difference in PAPP-A level was found between non-ART and IUI pregnancies. The free β-hCG level and NT thickness did not differ between ART and non-ART pregnancies. PAPP-A levels in IVF and ICSI pregnancies were strongly correlated with the E2 level at ovulation triggering. We showed by multivariate analysis that an E2 cut-off level of 1300 pg/ml at the time of ovulation could predict a significantly lower PAPP-A level at first trimester combined screening (β -0.239 ± 0.088, P < 0.005). LIMITATION, REASONS FOR CAUTION: The measures of biochemical markers can differ between laboratories and with the used equipment; therefore, extrapolation of the E2 cut-off level to other infertility centres should be undertaken with caution. WIDER IMPLICATIONS OF THE FINDINGS: One should be careful when using correction factors for ART patients undergoing the first trimester combined screening test. The proposed E2 cut-off level may help to identify a subgroup of women within the population of ART patients for whom use of a correction factor is justified. STUDY FUNDING/COMPETING INTEREST(S): None.

Coarctations of the aorta can be associated with severe neonatal consequences. Screening for and diagnosis of this prenatal malformation remain difficult. We review the various tools currently available to us, and their respective limits, to minimize the rate of false negatives and false positives associated with prenatal screening for this situation.

Resume L’objectif de cet article est de savoir mener un examen echographique de depistage du thorax fœtal, de connaitre l’approche diagnostique en cas de deviation mediastinale fœtale, et de savoir quels signes de gravite rechercher. L’examen du thorax fœtal commence par la verification du situs. Secondairement, tracer une ligne sagittale mediane sur la coupe de quatre cavites permet de se reperer, puis l’analyse de l’echostructure de l’hemithorax compressif permet de poser le diagnostic. Nous proposons une approche systematique, principalement basee sur le sens de la deviation et l’echogenicite de l’hemithorax compressif. En cas de grand hemithorax controlateral a la deviation, situation la plus frequente, hernie diaphragmatique et malformation adenomatoide macrokystique sont les deux causes les plus probables, si son echostructure est heterogene. Une malformation adenomatoide microkystique, eventuellement associee a une sequestration, est la cause principale si l’echostructure est homogene. La situation beaucoup plus exceptionnelle de petit hemithorax homolateral a la deviation, avec hemithorax controlateral isoechogene homogene, devra faire envisager le diagnostic d’hypoplasie-agenesie-aplasie pulmonaire.

OBJECTIVES To determine the most efficient and tailored screening method for aneuploidies in twins for the French population. MATERIAL AND METHODS Articles were searched using the PubMed and the Cochrane libraries. RESULTS In cases of twin pregnancies, the aneuploidy's risk related to maternal age as well as gestational age must be considered as being the same as in singletons. In bichorionic twins, we have to consider individually the nuchal translucency thickness of each twin. In monochorionic twins, we have to consider a range of risks related to the nuchal translucency measurements of each twins. The additional benefit of maternal serum biochemistry screening in twins is not as established as in singletons. CONCLUSION The most appropriate method of screening for aneuploidies in twin pregnancies is based during the first trimester of pregnancy on the risk related to maternal age combined with those related to the nuchal translucency measurement. In the absence of first-trimester screening, it is possible to offer a screening method based on the second trimester maternal serum biochemistry and/or by a targeted ultrasound.

The incidence of twins has dramatically increased in the last two decades. The theorical risk of aneuploidy is higher than in singletons. Screening for aneuploidies should be offered in all twin pregnancies. This review examines the current methods and evidence regarding screening for fetal aneuploidies in twin pregnancies.

Intra uterine growth retardation is a major cause of perinatal morbidity and mortality. These are due to prolonged intra uterine hypoxia and complications from subsequent induced prematurity. Fetal arterial doppler measurements, and more recently venous Doppler measurements, help choosing the ideal moment for delivering these fragile fetuses. Nevertheless, venous doppler measurements should be combined to other monitoring tools, used longitudinally and only when very preterm birth is expected.

The placenta percreta is a rare form of anomaly of placental insertion threatening the maternal and foetal lives. The incidence of abnormal placental adhesion is correlated to frequency of caesarean sections and advanced maternal age. Patients who are at high risk should be identified during pregnancy by ultrasound examination with Color Doppler looking for characteristic features. The practice of MRI in case of echographic suspicion may be useful, particularly in posterior placentas. A late diagnosis, in an emergency context, leads generally to hysterectomy and even to partial resection of neighbour organs. Thus, we report the case of a conservative management associating uterine embolisation following an elective caesarean delivery at 36 weeks gestation. In postpartum, the placental involution was followed clinically and by imagery. In our case, a total abdominal hysterectomy was performed on the fifth postoperative week because of a severe antibiotics resistant infection. No blood transfusion was required and the postoperative period was uneventful. This clinical case aims to show, through an analysis of the recent data of the literature, the interest of modern imagery to select patients with suspected placenta percreta that would be suitable candidates for conservative management.

The diagnosis of an abnormal fetal posterior fossa is usually done during the second trimester scan. However, some forms of open spina bifida with Arnold-Chiari malformation can be detected from the first trimester ultrasound with a precise examination of the posterior fossa and intracranial translucency. Furthermore, other abnormalities of the posterior fossa such as cystic malformations also seem to be accessible to early detection. This work detailed the possible usual and unusual aspects of the posterior fossa individualized during the first trimester ultrasound scan. Identifying an unusual appearance may identify high-risk fetus to present an abnormality of the posterior fossa. Then, thorough analysis of the fetal brain from 18 weeks will often differentiate a normal variant of a real brain malformation.

Los fetos procedentes de embarazos gemelares monocoriales estan expuestos a un riesgo elevado de desarrollar complicaciones inespecificas (retraso del crecimiento intrauterino, muerte fetal in utero y prematuridad) y especificas de este tipo de placentacion. El sindrome de transfusion fetofetal (STFF) complica hasta el 15% de estos embarazos con la transfusion de uno de los gemelos (receptor) a partir de su cogemelo (donante) a traves de las anastomosis vasculares placentarias. El diagnostico de STFF se basa en un conjunto de argumentos ecograficos. El tratamiento de esta complicacion se encuentra condicionado por la edad gestacional de ocurrencia y por la tolerabilidad hemodinamica de los dos fetos. La coagulacion con laser de las anastomosis placentarias es la mejor manera de tratar las formas graves y precoces (

To evaluate tissue characteristics of the placenta by transabdominal ShearWave Elastography in pregnant baboon.For 9 months (03/2013-12/2013) two operators (EQ, GG) performed ultrasound of the placenta during pregnancy pregnant baboons station partner primatology project. The identification of the placenta was performed previously in 2D ultrasound. The elastography method was then activated. Three measurements were carried out by operator for each placenta. The intraclass correlation coefficients within and between observers were calculated for the objective assessment (elastography) of placental maturity.During the study period, 21 pregnant baboons were included and ultrasounds were performed between 1 and 3 times each. The measurements have been carried out by two operators in 100% of cases. The intra- and inter-observer ICC for single values are respectively 0.657 - 95% CI (0.548 to 0.752) and 0.458 - 95% CI (0.167 to 0.675). The intra- and inter-observer ICC for average values are respectively 0.852 - 95% CI (0.784 to 0.901) and 0.628 - 95% CI (0.286 to 0.806).The study by transabdominal ShearWave Elastography of placenta's pregnant baboons is possible. The intra- and inter-operator reproducibility of this method is good using the average of three measurements. The objective study via elastography ShearWave of the degree of placental maturity seems not yet be used in clinical practice. Studies of larger cohorts are needed.

Good knowledge of normal characteristics of prenatal three vessels and trachea view allows not only to detect, but also to identify abnormalities such as normal variants and malformations of interest to main vessels (trunk of the pulmonary artery and its branches, the aorta and the superior vena cava) and various vascular structures in the anterior-superior mediastinum. These abnormalities may be isolated or associated with other anomalies of cardiac architecture.

Congenital heart disease (CG) are mostly from a low-risk population. Their screening should be based on reproducible and easy to use methods. Prenatal echocardiographic analysis is based primarily on the analysis of the four chambers and great vessels. The study of general admission pathways generalized since the 1980s is performed on an axial section while that of great vessels is performed in most countries more recently using several views and remains difficult. We review the features, under normal circumstances, of the three-vessel and tracheal view that allows via an axial section of the fetal thorax to assess at the same time the trunk of the main pulmonary artery and its branches, the convergence of the ductus arteriosus and the aortic arches, the superior vena cava, and the trachea. Furthermore, the use of color Doppler mode optimizes the information obtained by this view.

In order to illustrate the significance of a new anatomical finding, distortion of the interhemispheric fissure (DIHF) associated with impacted medial borders of the frontal lobes, we report a retrospective observational study of 13 fetuses in which DIHF was identified on prenatal imaging. In 10 cases there were associated anatomical anomalies, including mainly midline anomalies (syntelencephaly (n=2), lobar holoprosencephaly (n=1), Aicardi syndrome (n=2)), but also schizencephaly (n=1), cortical dysplasia (n=1) and more complex cerebral malformations (n=3), including neural tube defect in two cases. Chromosomal anomaly was identified in two cases, including 6p deletion in a case without associated central nervous system anomalies and a complex mosaicism in one of the cases with syntelencephaly. In two cases, the finding was apparently isolated on both pre- and postnatal imaging, and the children were doing well at follow-up, aged 4 and 5 years. The presence of DIHF on prenatal imaging may help in the diagnosis of cerebral anomalies, especially those involving the midline. If DIHF is apparently isolated on prenatal ultrasound, magnetic resonance imaging is recommended for careful analysis of gyration and midline, especially optic and olfactory structures. Karyotyping is also recommended.