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Maternal stress and malnutrition modify intrauterine fetal development with impact on postnatal blood pressure, nutrient, water, and electrolyte metabolism. The present study explored the possible involvement of maternal serumand glucocorticoid-inducible kinase (SGK)-1 in fetal programming of blood pressure. To this end, wild-type ([sgk1.sup.+/+]) male mice were mated with SGK1 knockout ([sgk1.sup.-/-]) female mice, and [sgk1.sup.-/-] males with [sgk1.sup.+/+] females, resulting in both cases in heterozygotic ([sgk1.sup.-/+]) offspring. Following prenatal protein restriction, the offspring of [sgk1.sup.+/+] mothers gained weight significantly slower and had significantly higher blood pressure after birth. Moreover, a sexual dimorphism was apparent in fasting blood glucose and plasma corticosterone concentrations, with higher levels in female offspring. In contrast, prenatal protein restriction of [sgk1.sup.-/-] mothers had no significant effect on postnatal weight gain, blood pressure, plasma glucose concentration, or corticosterone levels, irrespective of offspring sex. Plasma aldosterone concentration, urinary flow rates, and urinary excretions of [Na.sup.+] and [K.sup.+] were not significantly modified by either maternal genotype or nutritional manipulation. In conclusion, maternal signals mediated by SGK1 may play a decisive role in fetal programming of hypertension induced by prenatal protein restriction. dietary protein; body weight; plasma glucose

A patent urachus, which is typically diagnosed as leakage from the umbilicus postnatally, can present as an allantoic cyst in the umbilical cord antenatally. We report a case of a patent urachus with an allantoic cyst diagnosed via fetal MR imaging at 24 weeks' gestation. Early detection allowed for appropriate counseling and prompt corrective surgery after birth. Keywords Allantoic cyst * Fetal MRI * Patent urachus

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2006.00025.x Byline: Peter Widdess-Walsh (1), Beate Diehl (1), Imad Najm (1) Keywords: Focal cortical dysplasia; MRI; MRS; PET; SPECT; diffusion imaging; functional HRI Abstract: ABSTRACT Focal cortical dysplasia (FCD) is a common cause of pharmacoresistant epilepsy that is amenable to surgical resective treatment. The identification of structural FCD by magnetic resonance imaging (MRI) can contribute to the detection of the epileptogenic zone and improve the outcome of epilepsy surgery. MR epilepsy protocols that include specific T1 and T2 weighted, and fluid-attenuated inversion recovery (FLAIR) sequences give complementary information about the characteristic imaging features of FCD; focal cortical thickening, blurring of the gray-white junction, high FLAIR signal, and gyral anatomical abnormalities. Novel imaging techniques such as magnetic resonance spectroscopy (MRS), magnetization transfer imaging (MTI), and diffusion tensor imaging (DTI) can improve the sensitivity of MR to localize the anatomical lesion. Functional/metabolic techniques such as positron emission tomography (PET), ictal subtraction single photon emission computed tomography (SPECT), functional MRI (fMRI), and magnetic source imaging (MSI) have the potential to visualize the metabolic, vascular, and epileptogenic properties of the FCD lesion, respectively. Identification of eloquent areas of cortex, to assist in the surgical resection plan, can be obtained non-invasively through the use of fMRI and MSI. Although a significant number of FCD lesions remain unidentified using current neuroimaging techniques, future advances should result in the identification of an increasing number of these cortical malformations. Author Affiliation: (1)From the Section of Adult Epilepsy and Clinical Neurophysiology, The Cleveland Clinic Epilepsy Center, Cleveland, Ohio. Article History: Received May 15, 2005, and in revised form October 14, 2005. Accepted for publication October 26, 2005. Article note: Address correspondence to Dr Imad Najm, Section of Adult Epilepsy, The Cleveland Clinic Foundation, 9500 Euclid Avenue, S51, Cleveland, Ohio 44195. E-mail: najmi@ccf.org.

We report two cases of fetal inner ear abnormalities diagnosed by MRI. Cerebral MRI was performed on two fetuses, at 32 and 30 weeks gestation, following US that demonstrated multiple malformations suggestive of CHARGE syndrome in one fetus and ventriculomegaly and poor visibility of the posterior fossa in the other. MRI revealed vestibular hypoplasia and agenesis of the semicircular canals in one fetus and cystic cochleas, partial vermian agenesis and an occipital meningocele in the second fetus. Both pregnancies were terminated and there was good correlation between fetal MRI, ex utero CT and fetopathological findings. The inner ears should be carefully examined when performing fetal cerebral MRI because abnormalities of the inner ear may be associated with cerebral anomalies. Keywords Fetus * Inner ear * Congenital * MRI

A study examines whether a fetus feels pain and if so, whether safe and effective techniques exist for providing direct fetal anesthesia or analgesia in the context of therapeutic procedures or abortion. The results indicate that the evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester.

This paper addresses the problem of fetal electrocardiogram extraction using blind source separation (BSS) in the wavelet domain. A new approach is proposed, which is particularly advantageous when the mixing environment is noisy and time-varying, and that is shown, analytically and in simulation, to improve the convergence rate of the natural gradient algorithm. The distribution of the wavelet coefficients of the source signals is then modeled by a generalized Gaussian probability density, whereby in the time-scale domain the problem of selecting appropriate nonlinearities when separating mixtures of both sub- and super-Gaussian signals is mitigated, as shown by experimental results. Index Terms--Blind source separation, fetal electrocardiogram extraction, independent component analysis, wavelet transform.

Byline: Eli Armando S. Rabelo (1), Eduardo A. Oliveira (1,4), Jose Silverio S. Diniz (1), Jose Maria P. Silva (1), Maria Tereza Freire Filgueiras (2), Isabela Leite Pezzuti (1), Edson Samesina Tatsuo (3) Keywords: Multicystic kidney; Prenatal diagnosis; Management; Ultrasonography; Hypertension Abstract: We report the long-term clinical results of conservative management of children with unilateral multicystic dysplastic kidneys (MCDK). Between 1989 and 2002, 43 children with MCDK detected by prenatal ultrasonography were prospectively followed. At birth, ultrasonography confirmed the prenatal findings in all cases. Patients underwent a radioisotope scan and micturating cystogram in order to confirm the diagnosis and to exclude other uropathies. Follow-up ultrasound (US) examinations were performed at 6-month intervals during the first 2 years of life and yearly thereafter. The mean follow-up time was 42 months (range 12--156 months). Two children developed hypertension during follow-up. In total 257 US scans were performed. The mean number of US scans per patient was 6 (range 3--10). US scans demonstrated partial involution of the MCDK in 30 (70%) cases and complete involution in 8 (19%). The absolute MCDK length remained almost unchanged in 5 children (11%). The estimated median time of complete involution of the MCDK was 122 months [95% confidence interval (CI)=86--158 months]. A total of 33 (76.7%) contralateral kidneys underwent compensatory hypertrophy, reaching a renal length above the 95th percentile during follow-up. The estimated median time for the occurrence of compensatory hypertrophy was 30 months (95% CI=15--45 months). In conclusion, the natural history of MCDK is usually benign but patients must have long-term follow-up with US scans and blood pressure measurements. Author Affiliation: (1) Pediatric Nephrourology Unit, Department of Pediatrics, Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (2) Radiology Unit, Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (3) Pediatric Surgery Unit, Department of Surgery, Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (4) Rua Patagonia 515/701, Belo Horizonte, 30.320.080, Minas Gerais, Brazil Article History: Registration Date: 19/05/2004 Received Date: 25/11/2003 Accepted Date: 05/05/2004 Online Date: 16/07/2004

Byline: L. Allan (1) Keywords: Fetal heart; Fetal echocardiography; Congenital heart disease; Prenatal diagnosis Abstract: The fetal heart is examined by a series of sequential ultrasound views, which image the cardiac connections and intracardiac structure. The imformation obtained by cross-sectional imaging can be augmented by the use of cardiac measurements, and evaluation with pulsed or color flow Doppler. A thorough familiarity with the normal appearance and systematic evaluation of standard views can exclude or diagnose major heart malformations. With training, cardiac evaluation can be performed during routine obstetric scanning, in a matter of minutes. An accurate description of any abnormal findings and a knowledge of the types of cardiac malformation which are possible, will help the examiner to reach a correct diagnosis. Author Affiliation: (1) King's College Hospital, London, United Kingdom Article History: Registration Date: 01/01/2003 Online Date: 02/04/2004

Byline: J. P. Kovalchin (1,2), N. H. Silverman (3) Keywords: Fetal echocardiography; Congenital heart disease Abstract: Fetal echocardiography has impacted the fetus with congenital heart disease in many important ways. Advances in fetal echocardiography have allowed for more accurate and earlier detection of cardiac abnormalities. In turn, the prenatal diagnosis of cardiac abnormalities has improved the care and outcome of selected fetuses with severe cardiac malformations or arrhythmias. Fetal echocardiography has improved the understanding of the development and evolution of congenital heart disease in utero, and it may serve a role in identifying candidates for prenatal intervention. The prenatal diagnosis of congenital heart disease has allowed for better counseling and preparation of families regarding the anticipated prenatal development of the fetus as well as the expected postnatal management plans and prognosis. This article reviews the impact of fetal echocardiography in these and other areas. Author Affiliation: (1) Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA (2) Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA (3) Division of Pediatric Cardiology, Lucile Packard Chldren's Hospital, Stanford University Medical Center, 750 Welch Road, Suite 305, Palo Alto, CA 94304, USA Article History: Registration Date: 01/01/2003 Online Date: 19/04/2004

Byline: J. C. Huhta (1) Keywords: Fetal; Congestive heart failure; Congenital heart disease; Hydrops fetalis; Doppler echocardiography Abstract: Fetal echocardiography has progressed to be able to diagnose many forms of congenital heart disease and to assess the prognosis of cardiac lesions based on their anatomy and presentation in utero. However, the presence of signs of fetal heart failure, such as hydrops or valvular regurgitation, makes the assessment of prognosis difficult. This article outlines a straightforward method for the rapid evaluation of the fetus who may have congestive heart failure. The differentiation of the prehydropic state from normal is illustrated. Author Affiliation: (1) University of South Florida College of Medicine, Department of Pediatrics, 140 7th Ave. South, Children's Research Institute, St. Petersburg, FL 33701, USA Article History: Registration Date: 01/01/2003 Online Date: 19/04/2004

Byline: M. Small (1), J. A. Copel (1) Keywords: Fetal echocardiography; Prenatal diagnosis; Congenital heart defects; Diabetes mellitus; Congenital anomalies; Nuchal translucency Abstract: Congenital heart disease is one of the most common congenital malformations diagnosed in liveborns. As more women undergo prenatal diagnosis, the need for screening fetal echocadiography increases. The fetal, maternal, and familial indications for fetal echocadiography are outlined in order to improve the identification of women in greatest need for this screening modality. Author Affiliation: (1) Section on Maternal--Fetal Medicine, Department of Obstetrics &amp Gynecology, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208063, New Haven, CT 06520-8063, USA Article History: Registration Date: 01/01/2003 Online Date: 02/04/2004

Byline: Mahtab Tehrani (1), Ivana M. Vettraino (2), Chung-ho Chang (1) Keywords: cardiac mass; fetal heart; fetal sonogram; localized nodular hypertrophy; rhabdomyoma; tuberous sclerosis Abstract: Multiple intracardiac masses (ICM) are considered to be diagnostic of rhabdomyoma often associated with tuberous sclerosis. We describe a fetus with multiple ICM detected by fetal sonography at 18.7 wk gestation. The appearance and number were consistent with leading diagnosis of rhabdomyoma. Due to complications of pregnancy and extreme prematurity, the fetus did not survive. Autopsy showed the cardiac masses to be localized nodular hypertrophy (LNH) of the myocardium. No features of rhabdomyoma or tuberous sclerosis were present. In a review of the literature, similar lesions were reported in a child and two adults, perhaps as localized variants of hypertrophic cardiomyopathy. Our case does not, however, show the histopathologic features of hypertrophic cardiomyopathy. Isolated developmental abnormalities, such as in this case, can have a mass effect mimicking cardiac tumors. At the time of autopsy, the largest mass in the anterior wall of the right ventricle extended to and obstructed the right ventricular outflow tract. Author Affiliation: (1) Department of Anatomic Pathology, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI, 48073, USA (2) Department of Obstetrics and Gynecology, Division of Fetal Imaging, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI, 48073, USA Article History: Registration Date: 01/01/2003 Received Date: 06/12/2002 Accepted Date: 18/10/2003 Online Date: 17/03/2004 Article note: The abstract was presented at the Fall Meeting of the Society for Pediatric Pathology, Dallas, Texas, USA, September 27--28, 2002.

Byline: Daisuke Nonaka (1), Chen-Chih J. Sun (1,2) Keywords: congenital fibrosarcoma; ETV6-NTRK3; infantile fibrosarcoma; metastasis; t(12 15) Abstract: It is well known that congenital or infantile fibrosarcoma has a much less aggressive behavior than fibrosarcoma in adults, and it rarely metastasizes. We report a case of congenital fibrosarcoma in a 26-wk-old fetus, the diagnosis of which was made by an in utero needle core biopsy. Metastatic tumors were identified at autopsy when the pregnancy was terminated 3 wk later. English literature of metastatic congenital fibrosarcoma was also reviewed. Author Affiliation: (1) Department of Pathology, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA (2) Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA Article History: Registration Date: 01/01/2003 Received Date: 18/10/2003 Accepted Date: 04/12/2003 Online Date: 17/03/2004

Prenatal diagnosis is useful for managing a pregnancy with identified fetal abnormalities and for planning and coordinating care during delivery. Studies show that addition of formaldehyde to maternal blood samples, coupled with careful processing protocols, increases the relative percentage of free fetal DNA.

Byline: Amy E. Heerema (1), Joseph T. Rabban (1), Roman M. Sydorak (2), Micheal R. Harrison (2), Kirk D. Jones (1) Keywords: congenital diaphragmatic hernia; fetal surgery; lung morphometry; lung pathology; tracheal occlusion Abstract: Fetal intervention for congenital diaphragmatic hernia was developed to lessen the high morbidity and mortality of pulmonary hypoplasia. Lung pathology and morphometry in patients treated with fetal intervention have not been described. We report clinical and autopsy findings, as well as basic lung morphometry in 16 cases of congenital diaphragmatic hernia with fetal intervention (12 cases tracheal occlusion 4 cases hernia repair), and 19 cases of congenital diaphragmatic hernia without fetal intervention. All patients who underwent fetal intervention were born premature. Lung enlargement with increased lung-to-body weight ratio was observed with fetal tracheal occlusion, accompanied by lower than normal radial alveolar counts and increased alveolar size. Patients treated with tracheal occlusion also had early alveolar development (at 29.8, 30.6, and 30.9 wk postconceptual age) as well as mucous fluid pooling in airways and alveoli. All cases showed severe alveolar septal widening, more extensive in patients without fetal intervention. When grouped by postconceptual age, no statistically significant difference was found between patients with and without fetal intervention with respect to lung-to-body weight ratio, radial alveolar count, mean alveolar length, and relative arteriolar media thickness. Lung enlargement has been observed with fetal tracheal occlusion sonographically our studies suggest that this is due in part to emphysema and mucous fluid pooling. The lung remains abnormal with low radial alveolar counts and increased alveolar size. Tracheal occlusion did not prevent development of lung pathology associated with pulmonary hypoplasia. Author Affiliation: (1) Department of Pathology, University of California, San Francisco, 300 Parnassus Avenue, Box 0506, San Francisco, CA 94143-0506, USA (2) The Fetal Treatment Center, Department of Surgery, Division of Pediatric Surgery, University of California, San Francisco, 513 Parnassus Avenue, HSW-1601, San Francisco, CA 94143-0570, USA Article History: Registration Date: 01/01/2003 Received Date: 12/05/2003 Accepted Date: 10/07/2003 Online Date: 05/11/2003

Because ultrasound does not use ionizing radiation and is considered relatively safe, it is the technique of choice for imaging the fetus. This article focuses on the fetal skeletal survey and its role in diagnosing skeletal dysplasias. After completing this article, the reader will be able to: * Understand the embryology of bone. * Explain why prenatal evaluation of the fetal skeletal system is important. * Describe ultrasound evaluation of the fetal skeletal system. * Identify normal fetal skeletal anatomy. * Describe ultrasound findings in some of the more common fetal skeletal dysplasias, such as achondrogenesis, achondroplastic dysplasia, osteogenesis imperfecta and thanatophoric dysplasia. This article is a Directed Reading. See the quiz at conclusion., Fortunately, in the majority of cases, fetal ultrasound examinations bring joy to ultrasound practitioners and expectant parents alike. The ability to 'see' the moving fetus inside the womb, count fingers [...]

Byline: Phillip M. Cox (), Louise A. Brueton (), Predrag Bjelogrlic (), Penelope Pomroy (), Caroline A. Sewry () Abstract: Lethal multiple pterygium syndrome (LMPS) is an uncommon fetal-onset disorder of unknown etiology. The pathogenesis of LMPS has been suggested to be early-onset fetal akinesia, fragile collagen, or generalized edema. Information on the neuromuscular pathology of LMPS in the literature is generally scanty. We present the findings from a review of 14 fetuses with features of LMPS from the archives of the Hammersmith Hospital Perinatal Pathology Department. Autopsy reports, photographs, fetograms, and histological sections were examined, and additional special stains and immunostaining were performed on muscle sections. In five cases, there was evidence of autosomal recessive inheritance. One case was later shown to be due to glycogen storage disease type IV. The skeletal muscle bulk was reduced in all fetuses and the remaining muscle showed a range of histological appearances including vacuolar degeneration, dystrophy, a generalized or patchy myotubular appearance, and generalized hypotrophy. In one, the histological appearance was essentially normal. Two cases had abnormalities in the brain. Large motor neurons were present in the anterior spinal horns of all fetuses in whom the spinal cord could be examined. There was no evidence of cartilaginous joint fusion. We conclude that LMPS is the phenotype resulting from fetal akinesia commencing in the first or early second trimester. In the majority of cases, the precise underlying cause will not be identified, however, occasionally a metabolic or neurodevelopmental disorder or a specific primary myopathy may be demonstrated, providing adequate autopsy investigations are undertaken. Author Affiliation: () Department of Histopathology, Birmingham Women's Hospital, Metchley Park Road, Birmingham B15 2TG, UK, GB () Department of Clinical Genetics, Birmingham Women's Hospital, Metchley Park Road, Birmingham B15 2TG, UK, GB () School of Biology, University of St. Andrews, Bute Medical Building, St. Andrews KY16 9TS, UK, GB () Division of Paediatrics, Obstetrics and Gynaecology, Imperial College School of Medicine, Hammersmith Campus, 150 Du Cane Road, London W12 0NN, UK, GB () Department of Histopathology, Robert Jones &amp Agnes Hunt Orthopaedic and District Hospital, Oswestry SY16 7AG, UK, GB Article History: Received Date: 02/04/2002 Accepted Date: 13/09/2002

Byline: T. Hasegawa (1), T. Sasaki (1), T. Kimura (1), T. Sawai (1), K. Nose (1), S. Kamata (1), A. Okada (1), K. Wada (2), T. Kanzaki (3) Keywords: Biliary atresia Fetal ultrasonography Neonatal jaundice Prenatal diagnosis Uncorrectable type biliary atresia Abstract: Although prenatal ultrasonographic (US) diagnosis has been reported in biliary atresia (BA), most cases are type I (correctable with cystic dilatation). We report three prenatal cases of type IIId BA (uncorrectable with cystic dilatation). Routine fetal US at 22 to 24 weeks of gestation showed two communicating cystic lesions 12 to 16 mm in diameter. On color Doppler US, the lesions were separate from the portal vein or hepatic artery. The size did not change during the prenatal period in any case. Choledochal cyst (CC) was considered the most likely diagnosis, although BA with cystic lesions was also considered. After birth, the patients developed acholic stools and prolonged neonatal jaundice. Hepatobiliary scintigraphy showed negative passage. Duodenal fluid showed a negative or slightly positive Gmelin test. The neonates underwent laparotomy at the age of 36, 46, and 32 days, respectively. Intraoperative cholangiography showed the gallbladder and slightly-dilated common-bile duct without entering the proximal or distal bile ducts in all cases. They were classified as type IIId BA and underwent excision of the cystic lesions and dissection of the portal bile-duct remnants, followed by hepatic portoenterostomy. Case 1 showed persistent jaundice and finally underwent liver transplantation (LTx), case 2 became anicteric. Case 3 remained jaundiced and is to undergo LTx. In conclusion, type IIId BA may be one of the differential diagnoses when a cystic lesion is detected under the hepatic hilum by fetal US. However, prenatal diagnosis of BA is still difficult with respect to differentiation from a CC or type I BA. Early postnatal diagnosis followed by immediate treatment is important, especially in type IIId BA. Author Affiliation: (1) Department of Pediatric Surgery, Osaka University Medical School, 2-2 Yamadaoka, Suita City, Osaka 565-0871, Japan (2) Department of Pediatrics, Osaka University Medical School, 2-2 Yamadaoka, Suita City, Osaka 565-0871, Japan (3) Department of Obstetrics and Gynecology, Osaka University Medical School, 2-2 Yamadaoka, Suita City, Osaka 565-0871, Japan Article History: Accepted Date: 23/11/2001 Article note: Electronic Publication

Byline: F. Daikha-Dahmane (1), M. Dommergues (2), F. Narcy (3), M.C. Gubler (4), Y. Dumez (2), E. Gauthier (5), Y. Nordmann (6), C. Nessmann (1), G. Terrasse (3), F. Muller (7) Keywords: Key words: congenital erythropoietic porphyria, fetuses sibs, prenatal diagnosis, hydrops fetalis Abstract: Congenital erythropoietic porphyria is an autosomal recessive disease characterized by a deficiency of uroporphyrinogen III cosynthetase activity, with diffuse tissue accumulation of specific type I porphyrins. The diagnosis of this disease was made in two fetuses, who were siblings, and from a Caucasian nonconsanguinous family. The first fetus died in utero with hydrops fetalis and anemia, but without an etiopathogenic diagnosis. In the second case, the diagnosis was based on pink fluorescence of the amniotic fluid examined fortuitously in sunlight. DNA analysis showed that the fetus was heteroallelic for the mutation C73R. The autopsy showed brown skin, and at histological examination, porphyrin pigment was deposited in many tissues. Retrospectively, similar deposits were found in the tissues of the first fetus. Author Affiliation: (1) Service de Biologie du Developpement, Hopital Robert Debre, Faculte de Medecine Xavier Bichat, 48 Boulevard Serurier, 75019 Paris, France, FR (2) Service de Medecine Foetale, Hopital Necker Enfants-Malades, Faculte de Medecine Paris V, Paris, France, FR (3) Service d'Anatomie Pathologique, Hopital Cochin, Faculte de Medecine Cochin-Port Royal, Paris, France, FR (4) INSERM U 423, Hopital Necker Enfants-Malades, Faculte de Medecine Paris V, Paris, France, FR (5) Hopital Americain, Paris, France, FR (6) Departement de Biochimie, Hopital Louis Mourier, Faculte de Medecine Xavier Bichat, Paris, France, FR (7) Service de Biochimie, Universite Rene Descartes, Hopital Ambroise Pare, Paris, France, FR Article note: Received October 14, 1999 accepted July 12, 2000.

Byline: Joseph R. Siebert (1), David A. Nyberg (2), Raj P. Kapur (3) Keywords: Key words: cerebral cortex, cerebral ventricles, fetal diseases, hydrocephalus, ultrasonography, ventriculomegaly Abstract: The ultrasonographic diagnosis of cerebral ventriculomegaly carries grave implications, in that affected fetuses may suffer abnormal postnatal development or therapeutic abortion. It is important for pathologists to corroborate the clinical diagnosis, but because diagnostic methodologies and criteria differ so radically, this can be problematic. The clinical diagnosis is made primarily by serial ultrasound examinations of the cerebral ventricles, spaces that can be altered postmortem, particularly when the brain is autolysed or deformed artifactually. We therefore sought to learn if examination of tissue, rather than spaces, can identify accurately those fetuses diagnosed with cerebral ventriculomegaly by prenatal ultrasound. The thickness of the cerebral mantle was obtained in 100 control fetuses aged 14 to 26 postmenstrual weeks. Statistical analysis revealed significant correlation of cerebral mantle thickness with crown--rump length, foot length, and head circumference. Twenty fetuses diagnosed with ventriculomegaly showed mantle thicknesses that were less than the control mean. In a few cases, mantle thickness fell between the mean and -1 SD in several others, thickness was diminished by -1 SD to -2 SD in one-half of cases, mantle thickness was 2 SDs or more below the expected mean. Head circumference was within 2 SDs of the control mean in most cases, and increased beyond 2 SDs in only two cases. Head circumference is an unreliable indicator of ventriculomegaly in the midgestational fetus. By contrast, cerebral mantle thickness is a simple and useful way of corroborating ultrasonographic diagnoses at autopsy and may also prove useful in clinical settings. Author Affiliation: (1) Department of Laboratories (CH-37), Children's Hospital and Regional Medical Center, P.O. Box 5371, and Department of Pathology, University of Washington, Seattle, WA 98105, USA , US (2) Seattle Nuclear Medicine and Ultrasound Associates, 1229 Madison--Suite 1150, Seattle, WA 98104, USA , US (3) Department of Pathology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA , US Article note: Received February 13, 1998 accepted July 20, 1998.

Byline: Chen-Chih J. Sun (1), Kathryn Grumbach (2), Donna T. DeCosta (2), Carol M. Meyers (3), Jeffrey S. Dungan (3) Keywords: Key words: fetal autopsy, prenatal ultrasound, neural tube defect, chromosomal abnormality, multiple congenital anomalies, dilatation and evacuation Abstract: This retrospective study compared the prenatal ultrasound (US) diagnosis with autopsy findings in 61 intact fetuses following induced abortion and 36 fragmented fetuses from dilatation and evacuation (D&amp E). In intact fetuses, complete agreement between US diagnosis and autopsy findings was achieved in 65.6% of cases in the central nervous system (CNS) and 47.5% in other somatic organ systems (SOS). There were major differences between US and autopsy findings involving the CNS in 6.5% of cases and SOS in 27.9%. Correlation was better for evaluation of renal anomalies (complete agreement in 63.6% of 11 suspected cases, 2 false-positive and no false-negative cases) than congenital heart disease (complete agreement in 27.3% of 11 suspected cases, 5 false-positive and 3 false-negative cases). In D&amp E specimens, a prenatal diagnosis of neural tube defect (NTD) was confirmed in 90% of cases. However, due to fragmentation of fetal parts, the US diagnosis in the CNS could not be confirmed totally (69.4%) or partially (2.8%) in fetuses with chromosomal abnormalities (ChA) or multiple congenital anomalies (MCA). Nonetheless, the US diagnosis of SOS was confirmed in six cases on D&amp E, including Meckel-Gruber syndrome, cystic hygroma, renal agenesis with contralateral renal dysplasia, cardiac defect, fetal hydrops, and tracheal atresia. Our results show that a thorough autopsy of an intact fetus after abortion is necessary to confirm prenatal diagnosis and allow proper management and counseling. The pathologic examination of D&amp E specimens can reliably confirm the US diagnosis of NTD, but it is very limited in identifying other fetal anomalies. Author Affiliation: (1) Department of Pathology and Pediatrics, School of Medicine, University of Maryland, 655 W. Baltimore Street, Baltimore, MD 21201, USA , US (2) Department of Diagnostic Radiology, School of Medicine, University of Maryland, 655 W. Baltimore Street, Baltimore, MD 21201, USA , US (3) Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Maryland, 655 W. Baltimore Street, Baltimore, MD 21201, USA , US Article note: Received January 6, 1998 accepted May 25, 1998.

Fetal alloimmune thrombocytopenia can occur early in pregnancy. This disease is caused by an immune incompatibility between the mother and fetus that causes a drop in levels of blood cells called platelets. Researchers took blood samples from 107 fetuses at an average gestational age of 25 weeks. All the fetuses were being monitored because an older sibling had been diagnosed with this condition at birth. Half the fetuses had extremely low levels of platelets. Blood platelet counts continued to drop in many fetuses until they were treated. All fetuses recovered after birth.