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A wide range of fetal interventions are being performed worldwide to save the fetus's life, prevent permanent fetal organ damage, and allow a successful transition to extrauterine life. However, these are invasive procedures and can be associated with serious complications. This article focuses on promoting a culture of safety by highlighting five common error traps while anesthetizing patients for fetal interventions. They include failure to preserve uteroplacental perfusion and gas exchange, failure to achieve adequate uterine relaxation prior to hysterotomy, failure to monitor the fetus and prepare for fetal/neonatal resuscitation, failure to prepare for maternal hemorrhage, and failure to promptly treat uterine atony. Practical tips for avoiding these serious complications will also be discussed.

Background: Maternal malnutrition can lead to fetal growth restriction. This is often associated with organ sparing and long-lasting physiological dysfunctions during adulthood, although the underlying mechanisms are not yet well understood. Methods: Low protein (LP) dietary models in C57BL/6J mice were used to investigate the proximal effects of maternal malnutrition on fetal organ weights and organ sparing at embryonic day 18.5 (E18.5). Results: Maternal 8% LP diet induced strikingly different degrees of fetal growth restriction in different animal facilities, but adjustment of dietary protein content allowed similar fetal body masses to be obtained. A maternal LP diet that restricted fetal body mass by 40% did not decrease fetal brain mass to the same extent, reflecting positive growth sparing of this organ. Under these conditions, fetal pancreas and liver mass decreased by 60-70%, indicative of negative organ sparing. A series of dietary swaps between LP and standard diets showed that the liver is capable of efficient catch-up growth from as late as E14.5 whereas, after E10.5, the pancreas is not. Conclusions: This study highlights that the reproducibility of LP fetal growth restriction studies between laboratories can be improved by careful calibration of maternal dietary protein content. LP diets that induce 30-40% restriction of prenatal growth provide a good model for fetal organ sparing. For the liver, recovery of growth following protein restriction is efficient throughout fetal development but, for the pancreas, transient LP exposures spanning the progenitor expansion phase lead to an irreversible fetal growth deficit.

The placenta is a fetal organ, composed of fetal DNA and as such reflects the fetal phenotype. The placenta consists of an umbilical cord, fetal membranes (amnion and chorion), and the placental disc which in turn is comprised of villous tissue. Both maternal and fetal disorders have placental sequelae and placental abnormalities can affect both maternal and fetal well-being. As such, placentas are often helpful in future maternal and neonatal healthcare. Thus, examination of the placenta is important for both mother and infant. On this basis, a list of indications for placental examinations has been created by a multidisciplinary group of pathologists, maternal-fetal-medicine specialists, and neonatologists that, if followed, will ensure that the vast majority of placentas that ultimately show any significant pathology will be examined (Arch Pathol Lab Med, 121, 1997, 449-76). This list include fetal, maternal, and placental indications. This chapter will discuss those indications as well as give a brief overview of macroscopic placental examination and procedure.

The present manuscript reviews the main three-dimensional ultrasound (3DUS) methods that are clinically available to measure fetal organ volumes. Nowadays, it is possible to measure the volume of different organs (lungs, heart, liver, kidneys, adrenal glands and brain) using 3DUS. Those measurements are clinically useful to predict pulmonary hypoplasia, cardiac dysfunction and anomalies, fetal growth, renal function and prematurity as well as to predict adequate and normal neurodevelopment. How to cite this article Ruano R. Fetal Organ Volume Measurements by Three-dimensional Ultrasonography in Clinical Practice. Donald School J Ultrasound Obstet Gynecol 2015;9(4):397-407.

Placentation consists of the establishment of a physical contact between the fetus and the mother inside the mother's body for the transfer of nutrients and hormones, as well as the removal of waste products from the fetus. Placentation is a phenomenon that is found in many animals, including insects and velvet worms, but is mostly studied in vertebrates. This brief overview covers the different types of placentation and their evolution in mammals. Three systems for the classification of placentae are explained: based on the structure of the fetal-maternal interface, the fetal organ forming the placenta, and the morphology of the term placenta.

The use of x-ray computed tomography (CT) has increased drastically worldwide during the last two decades and is nowadays playing a pivotal role in clinical diagnosis and radiation therapy planning. The radiation dose delivered to the fetus during CT imaging procedures of pregnant patients raised fhealth concerns because of the high radiosensitivity of the developing embryo/fetus. To assess the diagnostic benefits considering the radiation risks, the radiologist needs reasonably accurate and detailed estimates of the fetal dose from diagnostic CT imaging protocols. To produce realistic biological and physical representations of pregnant patients and embedded fetus, we developed a methodology for construction of patient-specific voxel-based computational phantoms based on existing standardized hybrid computational pregnant female phantoms. We estimated the maternal absorbed dose and fetal organ dose for pregnant patients referred to the emergency unit of Geneva University Hospital for abdominal CT scans. The N-Particle extended (MCNPX) general purpose Monte Carlo code was used for radiation transport simulation. The obtained results were compared to those reported by Radimetrics™ (Bayer Healthcare) dose tracking software. The estimated effective dose to the mother varied from 1.1 mSv to 2.0 mSv with an average of 1.6 mSv while Radimetrics™ commercial dose tracking software reported an average effective dose of 1.9 mSv. The normalized fetal dose is about 9.2 mGy/100mAs. The fetus brain and bone marrow receive an average dose of 3.11 ± 1.09 mGy and 1.44 ± 0.45 mGy, respectively. The methodology developed for construction of personalized computational models can be exploited to estimate patient-specific radiation dose from CT imaging procedures. The generated dosimetric data can be used for accurate assessment of the radiation risks to the pregnant patient and fetus from various CT scanning protocols, thus guiding the decision making process.

Background Micro Computed Tomography (Micro CT) allows high resolution imaging using a multi-detector X-ray source to give 3D imaging reconstruction of tiny objects at micron resolution. Through a strong industrial collaboration between Great Ormond Street Hospital Children’s Charity and Nikon Metrology Ltd, we installed the world’s first micro CT scanner in a children’s hospital worldwide in 2016. We have recently published detailed micro CT imaging in a variety of different settings, including craniopharyngioma phenotyping (Apps JR et al., 2016) and fetal organ imaging. (Hutchinson et al., 2016, 2017). Methods In order to image human surgical specimens or fetal organs as part of a post mortem assessment, the addition of iodine is necessary to enhance soft tissue contrast for diagnostic purposes. This study empirically assessed the iodination optimisation protocol to allow high tissue contrast in feline cardiac samples, which would allow the protocol to be transferred to human samples. Results We present the preliminary results from feline cardiac tissue preparation optimisation where signal to noise, contrast to noise, and depth of tissue penetration were quantitatively assessed. Conclusion This is a sub-study as part of a larger trial in collaboration with the Royal Veterinary College into an animal model of hypertrophic cardiomyopathy, and has implications for the study of this disease in humans.

The European Union's SOLO (Epidemiological Studies of Exposed Southern Urals Populations) project aims to improve understanding of cancer risks associated with chronic in utero radiation exposure. A comprehensive series of hybrid computational fetal phantoms was previously developed at the University of Florida in order to provide the SOLO project with the capability of computationally simulating and quantifying radiation exposures to individual fetal bones and soft tissue organs. To improve harmonization between the SOLO fetal biokinetic models and the computational phantoms, a subset of those phantoms was systematically modified to create a novel series of phantoms matching anatomical data representing Russian fetal biometry in the Southern Urals. Using previously established modeling techniques, eight computational Urals-based phantoms aged 8, 12, 18, 22, 26, 30, 34, and 38 weeks post-conception were constructed to match appropriate age-dependent femur lengths, biparietal diameters, individual bone masses and whole-body masses. Bone and soft tissue organ mass differences between the common ages of the subset of UF phantom series and the Urals-based phantom series illustrated the need for improved understanding of fetal bone densities as a critical parameter of computational phantom development. In anticipation for SOLO radiation dosimetry studies involving the developing fetus and pregnant female, the completed phantom series was successfully converted to a cuboidal voxel format easily interpreted by radiation transport software.

Custom bismuth-antimony shields were previously shown to reduce fetal dose by 53% on an 8DR (detector row) CT scanner without dynamic adaptive section collimation (DASC), automatic tube current modulation (ATCM) or adaptive statistical iterative reconstruction (ASiR). The purpose of this study is to compare the effective maternal and average fetal organ dose reduction both with and without bismuth-antimony shields on a 64DR CT scanner using DASC, ATCM and ASiR during maternal CTPA.A phantom with gravid prosthesis and a bismuth-antimony shield were used. Thermoluminescent dosimeters (TLDs) measured fetal radiation dose. The average fetal organ dose and effective maternal dose were determined using 100 kVp, scanning from the lung apices to the diaphragm utilizing DASC, ATCM and ASiR on a 64DR CT scanner with and without shielding in the first and third trimester. Isolated assessment of DASC was done via comparing a new 8DR scan without DASC to a similar scan on the 64DR with DASC.Average third trimester unshielded fetal dose was reduced from 0.22 mGy ± 0.02 on the 8DR to 0.13 mGy ± 0.03 with the conservative 64DR protocol that included 30% ASiR, DASC and ATCM (42% reduction, P0.01). Use of a shield further reduced average third trimester fetal dose to 0.04 mGy ± 0.01 (69% reduction, P0.01). The average fetal organ dose reduction attributable to DASC alone was modest (6% reduction from 0.17 mGy ± 0.02 to 0.16 mGy ± 0.02, P=0.014). First trimester fetal organ dose on the 8DR protocol was 0.07 mGy ± 0.03. This was reduced to 0.05 mGy ± 0.03 on the 64DR protocol without shielding (30% reduction, P=0.009). Shields further reduced this dose to below accurately detectable levels. Effective maternal dose was reduced from 4.0 mSv on the 8DR to 2.5 mSv on the 64DR scanner using the conservative protocol (38% dose reduction).ASiR, ATCM and DASC combined significantly reduce effective maternal and fetal organ dose during CTPA. Shields continue to be an effective means of fetal dose reduction.

As a consequence of fetal radiosensitivity, the estimation of internal dose received by a fetus from radiopharmaceuticals applied to the mother is often important in nuclear medicine. A new 9-months pregnant phantom based on magnetic resonance (MR) images tied to the International Commission on Radiological Protection (ICRP) reference voxel phantom has been developed. Maternal and fetal organs were segmented from a set of pelvic MR images of a 9-months pregnant subject using 3D-DOCTOR(TM) and then imported into the 3D modeling software package Rhinoceros(TM) for combining with the adult female ICRP voxel phantom and further modeling. Next, the phantom organs were rescaled to match with reference masses described in ICRP Publications. The internal anatomy of previous pregnant phantom models had been limited to the fetal brain and skeleton only, but the fetus model developed in this study incorporates 20 different organs. The current reference phantom has been developed for application in comprehensive dosimetric study in nuclear medicine. The internal dosimetry calculations were performed for thyroid agents using the Monte Carlo transport method. Biokinetic data for these radiopharmaceuticals were used to estimate cumulated activity during pregnancy and maternal and fetal organ doses at seven different maximum thyroid uptake levels. Calculating the dose distribution was also presented in a sagittal view of the pregnant model utilizing the mesh tally function. The comparisons showed, in general, an overestimation of the absorbed dose to the fetus and an underestimation of the fetal thyroid dose in previous studies compared with the values based on the current hybrid phantom.

The placenta, one of the most important transient organs, forms by the apposition of fetal membranes and maternal tissues. Its role is to mediate physiological exchanges between mother and fetus. The word "apposition" covers a wide range of structural variations. It includes approximation, adhesion, interdigitation, or actual fusion between fetal and maternal tissues.1 Formation of the placenta establishes hemotropic nutrition for the fetus: essential metabolites must be provided to maintain the growing fetus, and these must come to it via the maternal circulatory system.2,3 Equally important, the placenta also provides oxygen and removes metabolic waste products from fetal blood. Nutritive and excretory roles of the placenta are not its only functions: it also has immune and endocrine activities.4 Nutrient and gas transport, waste removal, immunological protection of the fetus, and hormonal secretion influencing the maternal metabolism are all complex functions. They may also to some extent be conflicting purposes; hence, the placenta is a complex fetal organ. It is structurally adapted to perform its roles somewhat differently in different species, but the set of functions remain the same. Understandably, the placenta has been the subject of extensive research, and it will continue be an important topic thanks to its complexity. The intent of this chapter is to provide a simple description of placental anatomy using classic categories and to describe anatomical species variations in humans, important domestic animals, and the major laboratory species.

Colossal industrial developments, excessive use of pesticides, and chemicals in various uses on humans and animals have severely polluted our environment. The adverse effects of chemical pollutants including drugs and pathogens on the reproductive systems are the major causes of infertility in humans. Reproductive toxicity can result in fetal organ deformities in pregnant women and have a detrimental impact on male fertility. Histopathological examination of reproductive organs in repeated dose toxicity studies in rodents and nonrodents is the only assessment of male and female reproductive organs performed prior to the first administration of a novel pharmaceutical to humans. An overview of potential mechanisms, toxicity end points evaluation, and histopathological lesions of reproductive tracts in laboratory animals along with toxicokinetics are given in this chapter. The regulatory and nonregulatory studies that need to be carried out during drug development are described. Some examples of toxicants affecting the reproductive systems are also provided. Current concepts that underlie mechanisms of teratogenesis with thalidomide as an example are discussed. In summary, meticulous use of different methods of pathology can generate sufficient information to evaluate the reproductive system during repeated dose toxicity studies and help to develop safer drugs, agrochemicals, and cosmetics for human use.

Screening-(«Routine-») Untersuchungen in der Schwangerschaft haben einen genau beschriebenen Umfang. Die Anforderungen daran sind in den letzten Jahren gestiegen. Neue Ultraschallgräte ermöglichen zudem in der weiterführenden Diagnostik detaillierte Darstellungen verschiedener fetaler Körperregionen. Dies kann zu einer besseren Planung der Geburt führen, was vor allem bei angeborenen Herzfehlern offensichtlich ist.

Different sonographic criteria have been developed to estimate canine fetal age, including fetal mensuration and assessment of fetal organ development. This retrospective study assessed the accuracy of gestational age and litter size predictions in 76 bitches using one of two techniques. The first method used the differential features of fetal organ development that occur in early and mid pregnancy, based on published tables for beagles. The second method used biparietal head and trunk diameters to predict gestational age based on tables published for late gestational Labrador Retrievers. The accuracy of the two methods was compared and the effect of maternal body weight and litter size evaluated. Litter size and maternal body weight did not affect the accuracy of gestational age prediction. Using a combination of both methods, the overall accuracy of predicting parturition date within 65 +/- 1 day and +/- 2 days was 70.8% and 86.1%, respectively. The correct litter size was predicted in 65% of cases, and in 89.5% of cases for +/- 1 pup. Pearson's correlation between actual litter size and predicted litter size was high (R = 0.957, P < 0.001). The organ development method of predicting gestational age was more accurate than late gestational fetal mensuration (P = 0.019). The optimum time for sonographic estimation of fetal age and litter size is early and mid pregnancy.

Pre-eclampsia leads to disturbed fetal organ development, including metabolic syndrome, attributed to altered pituitary-adrenal feedback loop. We measured cortisol metabolites in infants born from pre-eclamptic and normotensive women and hypothesised that glucocorticoid exposure would be exaggerated in the former. Twenty-four hour urine was collected from infants at months 3 and 12. Cortisol metabolites and apparent enzyme activities were analysed by gas chromatography-mass spectrometry. From 3 to 12 months, excretion of THS, THF and pregnandiol had risen in both groups; THF also rose in the pre-eclamptic group. No difference was observed with respect to timing of the visit or to hypertensive status for THE or total F metabolites (P>0.05). All apparent enzymes activities, except 17α-hydroxylase, were lower in infants at 12 compared to 3 months in the normotensive group. In the pre-eclamptic group, only 11β-HSD activities were lower at 12 months.17α-hydroxylase and 11β-HSD activities of tetrahydro metabolites were higher in the pre-eclamptic group at 3 months (P

OBJECTIVES To determine how often fetal organ systems are imaged completely and whether this rate varies by hospital. METHODS All initial sonographic anatomic examinations between 16 and 24 weeks from 3 hospitals (perinatal designation levels I-III) from January 2012 through December 2013 were identified in their obstetric and gynecologic anatomic survey report databases, focusing on 36 anatomic fields. Structures were grouped into regions: brain, face, spine, heart, abdomen, and extremities. Rates of complete visualization of each structure, structure grouping, and the total were calculated and compared by χ2 testing. RESULTS From 7211 examinations (2578 from level I, 986 from level II, and 3647 from level III), the completion rate was 16.8% (I, 20.6%; II, 20.0%; and III, 13.2%; P < .00001). Brain and extremity imaging was complete 85% of the time or more but spine only 62.4% (sacrum consistently lowest). Completeness rates varied significantly (P< .00001) for the face (28.1%-64.4%, due to low rates of clearing lips at level III, and level I not clearing profiles), heart (37.3%-56.1%, level I < II < III), and abdomen (65.2%-85.7%, due to lower rates of clearing kidneys at level I). Completion of both the heart and spine was 32.0% (I, 23.0%; II, 25.4%; and III, 40.2%; P < .00001). CONCLUSIONS With a comprehensive reporting system, completion rates for full anatomic sonograms are low. Facial, cardiac, and spinal structures are least complete, and follow-up examinations often remain incomplete. Completion benchmarks would be helpful because "incomplete" studies lead to repeated examinations that increase health care costs.

Three-dimensional ultrasound has become an essential tool for visualization of fetal structures in the past few years. The recent improvements in transducers and signal processing provide new information, particularly in obstetrics and gynecology sonography. The present paper will present the most recent advances in volume acquisition and presentation modes followed by results of fetal organ visualization in normal and abnormal cases as well as applications in gynecology.

Our purpose was to evaluate the capability of ultrafast single-shot fast spin-echo MR imaging to assess normal fetal anatomy and abnormalities of different fetal organ systems. Fetal MR imaging was performed prospectively in consecutive 40 pregnant women because of abnormal findings or suspected fetal abnormalities on prenatal US. No statistically significant difference between US and MR imaging was found for the detection of abnormality in any organ system. MR imaging was slightly superior to US with regard to cerebral abnormalities only. In four (10%) of 40 fetuses, additional information provided by MR imaging altered counseling. However, MR imaging of the extremities-face and soft tissues was limited because of the lack of real-time information.

Accurate assessment of the fetal organ volumes is very important in the evaluation of fetal well-being and maturation. Previous investigators have pointed out that fetal thigh volume (ThiV) may be a useful predictive factor of intrauterine growth retardation. Yet, 2-D ultrasound (US) is limited in assessing fetal ThiV accurately. With the recent advance of 3-D US, the limitation in assessing fetal ThiV by 2-D US can be overcome. To establish a normal reference chart of fetal ThiV for clinical use, a prospective and cross-sectional study using 3-D US was undertaken to assess the fetal ThiV in normal pregnancy. In total, 204 singleton fetuses ranging between 20 and 40 weeks of gestation and fitting the criteria of normal pregnancies were enrolled in this study. Our results showed that fetal ThiV is highly correlated with the gestational age (GA). Furthermore, using GA as the independent variable and ThiV as the dependent variable, the best-fit regression equation was ThiV (mL) = 35.494 − 4.985 × GA + 0.183 × GA2 (r = 0.91, n = 204, p < 0.0001). For further clinical use, a chart of normal growth centiles of fetal ThiV was then calculated based on this equation. Furthermore, common indexes of fetal biometry, such as biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW), were all highly correlated with ThiV (all p < 0.0001). In conclusion, our data of fetal ThiV assessed by 3-D US can serve as a useful reference in evaluating fetal growth and nutrition status during normal gestation.

A variety of neoplasms can develop in each fetal organ. Most fetal neoplasms can be detected by careful prenatal ultrasonographic examination. Some neoplasms show specific ultrasonographic findings suggesting the differential diagnosis, but others do not. Knowledge of the presence of a neoplasm in the fetus may alter the prenatal management of a pregnancy and the mode of delivery, and facilitates immediate postnatal treatment. During the last five years, we experienced 32 cases of fetal neoplasms in a variety of organs. We describe their typical ultrasonographic findings with correlating postnatal CT, MRI, and pathologic findings.

The needed of Iron Tablet in pregnancy was increase than mother who not pregnant. That cause of high metabolism at the pregnancy for formed of fetal organ and energy. One of effort for prevent anemia in mother pregnant with giving the Iron tablet and vitamin c. The reason of this research in 4 June – 11 July 2014 is for compare the effect of iron tablet suplementation with and without vitamin C toward Hemoglobin level in mother pregnant With Gestational Age Of 16-32 Weeks In Desa Keniten Kecamatan Mojo Kabupaten Kediri. This research method using comparative analytical. Research design type of Quasy Eksperiment that have treatment group and control group. Treatment group will giving by Iron tablet and 100 mg vitamin C, and control group just giving by iron tablet during 21 days. Population in this research are all of mother pregnant with Gestational Age Of 16-32 Weeks with Sampling technique is cluster random sampling is 29 mother pregnant. Comparison analysis of iron tablet suplementation effect with and without vitamin C toward Hemoglobin level in mother pregnant With Gestational Age Of 16-32 Weeks, data analysis using Mann Whitney U-test and the calculated U value (44,5) less than U-table (51). So there was difference of iron tablet suplementation effect with and without vitamin C toward Hemoglobin level in mother pregnant With Gestational Age Of 16-32 Weeks Therefore, the addition of vitamin C on iron intake is needed to increase the uptake of iron tablets. When the amount of iron uptake increases, the reserves of iron in the body will also increase, so as to prevent anemia in pregnant women; Keywords : Iron Tablet (Fe), Vitamin C, Hemoglobin level, Mother Pregnant

Objectives: We aimed to find answers to the following questions: What are the technical and biological prerequisites for easily obtainable three-dimensional (3D) images? What are the visualization rates for various fetal organ systems? What is the potential for assessing fetal malformations? What are the psychological effects of 3D imaging on the expectant mothers? Methods: Between January and June 1998, 433 pregnant women were prospectively examined with two-dimensional (2D) and 3D sonography. Results: 3D visualization in healthy fetuses was inferior in quality to 2D visualization, which also accounted for the comparison of 3D imaging versus 2 D imaging among fetuses affected with malformations. In only 1 case did 3D imaging yield a slightly better description of the given malformation. This did not result in a different therapeutical approach. Concerning the psychological effect of 3D imaging, a marked approval of the 3D method was recorded. Conclusions: These results show that the image information acquired by 3D ultrasound technology is nearly always inferior to the image information obtained by conventional 2D imaging. 3D imaging can be useful for specific malformations under the condition that these examinations be performed in specific ultrasound departments. Thus, a clearly defined range of indications can be assigned to 3D imaging.

Three-dimensional ultrasound was introduced in clinical use more than a decade ago. Early attempts in obstetrics were directed at surface rendering of the fetal anatomy, mostly of the face, to detect or exclude fetal anomalies. Recently, several papers have discussed fetal volumetry calculated by three-dimensional ultrasound, which has helped greatly to construct the normal ranges for fetal organ volumes, and which improves fetal weight prediction. According to recent literature, more and more fetal anomalies are diagnosed based only on the findings of three-dimensional ultrasound. However, the role of three-dimensional ultrasound in genetic screening and counselling is still undetermined. In this review, we try to address the capability of three-dimensional ultrasound in a number of anatomic areas, to catalog possible markers in the second-trimester genetic sonogram, and finally to introduce the merits of three-dimensional ultrasound in genetic counselling.

Chorioamnionitis is commonly associated with preterm labor and delivery. The infection in chorioamnionitis is mainly in the amniotic compartment. Chorioamnionitis is however a risk factor for adverse outcomes after preterm birth such as bronchopulmonary dysplasia, necrotizing enterocolitis, and injury to the brain’s white matter. In this chapter, we discuss the contribution of oxidative stress from chorioamnionitis to fetal organ injury.

Growth of the fetal cerebellum was monitored by transverse cerebellar diameter (CD) from 14 to 39 weeks menstrual age in 125 normal Japanese fetuses. The growth curve for this parameter was determined using a Rossavik growth model [p = c(t) k+s(t) ]. An R 2 value of 95.5% was obtained for CD. Variability analysis indicated a progressive increase in variability with fetal age for this parameter. Variability data were used with the growth curve model to determine a standard curve for this parameter. This standard curve provides a superior means to evaluate normal fetal cerebellar growth in the fetus and to identify cerebellar abnormalities in utero.

Part I The ideas behind this book.- Part II Basic Science and the unique aspect of fetal growth and maturation.- Part III Fetal Cell transplant experiments in animal and human systems.- Part IV Fetal tissue transplant experiments in animal and human systems.- Part V Fetal Organ transplant experiments in animal and human systems.- Part VI Biobanking.- Ethics of fetal tissue transplant.

Growth of the fetal cardiac ventricle has been monitored by total cardiac diameter (TCD), left ventricular systolic (LVSD) and diastolic diameter (LVDD), right ventricular systolic (RVSD) and diastolic diameter (RVDD), left ventricular width (LVW), interventricular septal width (IVSW), and right ventricular width (RVW) from 19 to 39 weeks, menstrual age, in 114 normal Japanese fetuses. Growth curves for these parameters have been determined using a Rossavik growth model [P = c(t)k+s(t)]. R2 values of 89.7, 58.0, 65.3, 77.9, 80.3, 31.1, 30.1, and 26.9 were obtained for TCD, LVSD, LVDD, RVSD, RVDD, LVW, IVSW, and RVW, respectively. Variability analysis indicated a progressive increase in variability with fetal age for these eight parameters. Variability data were used with the growth curve models to determine standard curves for these parameters. These standard curves provide a superior means for evaluating the normal fetal cardiac growth in the fetus and for identifying congenital heart anomalies in utero.

Pediatric malignancies are a spectrum of biologically diverse cancers different from those seen in adults. Malignant solid tumors diagnosed in children are often, and at least partly the result of developmental pathways dysregulation, and may recapitulate stages of organogenesis. Significant insight into their pathogenesis came from studying normal embryonal and fetal organ development, as well as mechanisms responsible for developmental disorders and congenital syndromes associated with these tumors. Systematic integration of pathology, genetic and molecular analyses of pediatric solid tumors is allowing the recognition of distinct clinical tumor subtypes, as well as potential therapeutic targets for some of these neoplasms. From the diagnostic point of view, some pediatric solid tumors represent examples of clinical translation, as genetic and molecular markers are being incorporated into clinical algorithms, and used for tumor classification, risk stratification, theragnostics or disease monitoring. The on-going comprehensive analysis of some pediatric tumor types using genomic, expression and epigenetic profiling tech- nologies, and the development of experimental tumor model systems, are fastly improving our understanding of their biology. However, further and comprehensive characterization of other pediatric solid tumors, particularly aggressive or chemoresistant cancer types, is still necessary, and should result in the development of new integrated clinical testing, improved therapeutic strategies and better outcomes for these patients.

Introduction: Gestational age is frequently estimated based on last menstrual period and on ultrasonography. Many people are unaware of their last menstrual period due to irregular menstruation and ultrasonography is bound to have a bias, thereby posing difficulties in the estimation of gestational age. Placenta is a fetal organ which provides the physiological link between pregnant women and her fetus. Placental growth can be estimated by measuring the thickness and estimating its volume. Placental thickness is directly related to the gestational age of the fetus till certain weeks of pregnancy. Objectives: To study the correlation between ultrasonographic placental thickness and gestational age of the fetus. Methods: This is an observational study done at ESIC Medical College & PGIMSR Chennai. 333 cases were recruited for the present study to determine the normal placental thickness for various gestational age and to study the correlation between ultrasonographic measurement of placental thickness and gestational age of the fetus. Results: Placental thickness for gestational age 11-40 weeks calculated, it gradually increased from 14.6 mm at 11weeks to 38.9mm at 40 weeks gestation. Correlation coefficient is 0.98 and p value

The effects of acute maternal hemorrhage on uterine blood flow and fetal circulation were investigated in pregnant sheep. Nine chronically instrumented pregnant sheep (114-128 d gestation), phlebotomized from the iliac artery at the point of origin of the uterine artery, were studied at baseline, after acute hemorrhage, and immedi- ately and two h after replacement of the blood. Maternal hemorrhage caused a reduction in uterine blood flow as well as both fetal hypoxemia and acidemia. Changes in fetal organ blood flow measured by radionuclide-labeled microspheres showed that blood flow to the brain, heart, and adrenal glands increased (p < 0.05), whereas blood flow to the other major organs did not change significantly. Rapid replacement of blood restored all parameters to baseline values. We conclude that acute maternal hemor- rhage causes a reduction in uterine blood flow, fetal hypox- emia, and acidemia with a secondary increase in blood flow to the high priority organs. Rapid replacement of blood reverses these effects. (Pediatr Res 27: 552-556, 1990)