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In early 2020, a new coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), arrived in Europe. It infected millions of persons and led to the deaths of thousands by [...]

Objective: To compare the diagnostic performance of postmortem ultrasound (PMUS), 9.4 T magnetic resonance imaging (MRI) and microfocus computed tomography (micro‐CT) for the examination of early gestation fetuses. Method: Eight unselected fetuses (10–15 weeks gestational age) underwent at least 2 of the 3 listed imaging examinations. Six fetuses underwent 9.4 T MRI, four underwent micro‐CT and six underwent PMUS. All operators were blinded to clinical history. All imaging was reported according to a prespecified template assessing 36 anatomical structures, later grouped into five regions: brain, thorax, heart, abdomen and genito‐urinary. Results: More anatomical structures were seen on 9.4 T MRI and micro‐CT than with PMUS, with a combined frequency of identified structures of 91.9% and 69.7% versus 54.5% and 59.6 (p < 0.001; p < 0.05) respectively according to comparison groups. In comparison with 9.4 T MRI, more structures were seen on micro‐CT (90.2% vs. 83.3%, p < 0.05). Anatomical structures were described as abnormal on PMUS in 2.7%, 9.4 T MRI in 6.1% and micro‐CT 7.7% of all structures observed. However, the accuracy test could not be calculated because conventional autopsy was performed on 6 fetuses of that only one structure was abnormal. Conclusion: Micro‐CT appears to offer the greatest potential as an imaging adjunct or non‐invasive alternative for conventional autopsies in early gestation fetuses. Key points: What is already known about this topic?Postmortem imaging of early gestation fetuses is challenging using clinical magnetic resonance imaging (MRI) machines.High‐field MRI and microfocus computed tomography (micro‐CT) have demonstrated nearly perfect concondance with autopsy, whereas PMUS showed mixed results of performance for the examination of early gestation fetuses.A comparison of these three techniques has yet to be performed. What does this study add?Micro‐CT appears to be the best alternative or adjunct to invasive autopsy in comparison with PMUS and micro‐CT for the postmortem examination of fetuses <16 weeks.If micro‐CT is not available, PMUS could be performed with limitations for cardiac examination. [ABSTRACT FROM AUTHOR]

Objective: To determine the learning curve of fetal postmortem ultrasound (PMUS) and evaluate the evolution of its diagnostic performance over the past 8 years. Methods: PMUS was performed by two fetal medicine specialists and two experts on 100 unselected fetuses of 12–38 weeks of gestation in a prospective, double‐blind manner. 21 pre‐defined internal structures were analyzed consecutively by the trainee alone and the expert, with a comparison of diagnosis and immediate feedback. The learning curves for examination duration, non‐recognition of structures and final diagnoses were computed using cumulative summation analysis. Secondly, the expert PMUS diagnostic accuracy using autopsy as the gold standard was compared to the previously published data. Results: The trainees reached expert level of PMUS at 28–36 cases for examination duration (12.1 ± 5.2 min), non‐diagnostic rate (6.5%, 137/2100), and abnormality diagnosis. In a group of 33 fetuses ≥20 weeks who had an autopsy, the experts PMUS performance was improved after 8 years with a reduction of all organs non‐diagnostic rate (6.5 %VS 11.4%, p < 0.01) and higher sensitivity for the heart (100% VS 40.9%, p < 0.01) and the abdomen (100%VS 56.5%, p < 0.05). Conclusion: PMUS offers a short learning curve for fetal medicine specialists and on‐going improvement of diagnostic accuracy over time. Key points: What's already known about this topic? Fetal postmortem imaging has emerged to propose less invasive alternatives to invasive autopsy because of the decline of parental consent.Fetal postmortem ultrasound (PMUS) is a fetal postmortem imaging technique with sensitivity of 74.7% and a specificity of 83.3% for the examination of all gestational age (GA) fetuses.PMUS is less expensive and more easily accessible compared with other fetal postmortem imaging techniques such as Postmortem magnetic resonance imaging (PMMRI). What does this study add? Less than 40 cases were needed by fetal medicine specialists to reach expert‐level PMUS performance for the examination duration, recognition of structures and abnormality diagnosis.The expert PMUS diagnostic accuracy is improved overtime with lower non‐diagnostic image rate and higher sensitivity for cardiac and abdominal examinations. [ABSTRACT FROM AUTHOR]

Objective: A rolling circle amplification (RCA) based commercial methodology using cell-free (cf)DNA to screen for common trisomies became available in 2018. Relevant publications documented high detection but with a higher than expected 1% false positive rate. Preliminary evidence suggested assay variability was an issue. A multi-center collaboration was created to explore this further and examine whether subsequent manufacturer changes were effective. Methods: Three academic (four devices) and two commercial (two devices) laboratories provided run date, chromosome 21, 18, and 13 run-specific standard deviations, number of samples run, and reagent lot identifications. Temporal trends and between-site/device consistency were explored. Proportions of run standard deviations exceeding pre-specified caps of 0.4%, 0.4% and 0.6% were computed. Results: Overall, 661 RCA runs between April 2019 and July 30, 2022 tested 39,756 samples. In the first 24, subsequent 9, and final 7 months, proportions of capped chromosome 21 runs dropped from 39% to 22% to 6.0%; for chromosome 18, rates were 76%, 36%, and 4.0%. Few chromosome 13 runs were capped using the original 0.60%, but capping at 0.50%, rates were 28%, 16%, and 7.6%. Final rates occurred after reformulated reagents and imaging software modifications were fully implemented across all devices. Revised detection and false positive rates are estimated at 98.4% and 0.3%, respectively. After repeat testing, failure rates may be as low as 0.3%. Conclusion: Current RCA-based screening performance estimates are equivalent to those reported for other methods, but with a lower test failure rate after repeat testing. [ABSTRACT FROM AUTHOR]

Rh deficiency syndrome with anti Rh-29 in a multiparous lady causing transfusion reactions. However, when faced with massive, life-threatening haemorrhage in the absence of compatible blood, transfusion of closely but not completely cross-matched blood is permitted using robust protocols to prevent and manage potentially lethal transfusion reactions. Keywords: fetal intrauterine transfusion; isoimmunisation; rhnull phenotype EN fetal intrauterine transfusion isoimmunisation rhnull phenotype 420 422 3 10/13/23 20231001 NES 231001 CASE REPORT The Rh system is made up of over 45 antigens, and alongside ABO, it is one of the most important in transfusion medicine. [Extracted from the article]

Background The aim of this study was to evaluate the performance of magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis in pregnant women. Methods The study was conducted in 2 referral centers in Brussels, Belgium, between March 1st 2009 and January 31st 2017. Pregnant women who presented with abdominal pain and underwent MRI were included. Baseline characteristics, clinical, laboratory, and ultrasound test results were extracted retrospectively from the electronic medical charts. MRI exams were prospectively reevaluated by an experienced radiologist blinded to patient outcome and MRI findings. Visualization of the appendix and assessment of gastrointestinal, genitourinary, and vascular systems were recorded. The diagnosis of acute appendicitis was confirmed by pathology exam. Results In total, 85 patients were included. The appendix was identified in all patients on MRI and acute appendicitis was suspected in 7. The diagnosis was confirmed in 6 patients. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI were 100% (95% confidence interval [95% CI]: 54.1%–100%), 98.7% (95% CI: 93.2–99.9%), 85.7% (95% CI: 46.1–97.7%), and 100%, respectively. In contrast, the sensitivity, specificity, PPV, and NPV of the combination of clinical exam, laboratory findings and/or ultrasound were 100% (95% CI: 54.1%–100%), 62% (95% CI: 50.4–72.7%), 16.7% (95% CI: 13.1–20.96%), and 100%, respectively. [ABSTRACT FROM AUTHOR]

Background: The ovarian‐adnexal reporting and data system‐magnetic resonance imaging (O‐RADS‐MRI) score decreases the incidence of indeterminate adnexal masses from 18% to 31% with ultrasound till 10.8% to 12.5% with MRI. Further improvement of this score may be useful to improve patients' management. Purpose: To evaluate the added value of quantitative diffusion‐weighted imaging (DWI) in the diagnosis of adnexal masses classified according to the O‐RADS‐MRI score. Study type: Prospective cohort study with retrospective DWI analysis. Population: Among 402 recruited patients, surgery was done only in 163 women (median‐age: 51 years) with 201 indeterminate adnexal masses, which were included in the final analysis. Field strength/sequence: Standardized MRI (1.5 and 3‐T) including diffusion and dynamic contrast‐enhanced sequences (diffusion‐weighted single‐shot spin‐echo echo‐planar imaging) were used. Assessment: Two radiologists classified the adnexal masses according to O‐RADS‐MRI and they were blinded to the pathology report. Two methods of quantitative analysis were applied using region‐of‐interest apparent‐diffusion‐coefficient (ROI‐ADC) and whole‐lesion ADC‐histogram (WL‐ADC). Statistical tests: Fisher's exact and Mann–Whitney‐U tests were used to compare variables among malignant and benign lesions. Receiver‐operating‐characteristic (ROC) curves were constructed to examine the sensitivity/specificity of each parameter. ROI‐ADC and WL‐ADC of lesions with O‐RADS‐MRI score‐4 were plotted to identify thresholds of malignant lesions. The improvement of the O‐RADS‐MRI score after adding these thresholds was assessed by two ROC‐curves. A P < 0.05 was considered to be statistically significant. Results: Fifty‐eight of the 201 lesions (28.9%) were malignant. The ROI‐ADC and the WL‐ADC means of malignant lesions were significantly lower than those of benign lesions. Forty‐two lesions (20.9%) had an O‐RADS‐MRI score‐4. In this subgroup, 76% of lesions with ROI‐ADC < 1.7 × 10−3 mm2/sec and WL‐ADC < 2.6 × 10−3 mm2/sec were malignant, whereas only 11.8% with ROI‐ADC ≥ 1.7 × 10−3 mm2/sec or a WL‐ADC ≥ 2.6 × 10−3 mm2/sec were malignant. The overall performance of the O‐RADS‐MRI score combined with these thresholds was improved. Data conclusion: Integrating ADC‐thresholds in O‐RADS‐MRI score‐4 may discriminate low‐to‐intermediate and intermediate‐to‐high malignancy risk groups. Level of Evidence: 2 Technical Efficacy Stage: 2 [ABSTRACT FROM AUTHOR]

To describe the outcomes of sickle-cell disease in pregnancy according to the different treatments adopted before and during pregnancy and to propose a systematic approach to treat sickle-cell disease (SCD) during pregnancy. A retrospective descriptive study compared pregnancy outcomes among women with SCD who stopped hydroxyurea (HU) once pregnant (Group 1), were never treated before and during pregnancy (Group 2) or were treated by HU before conception who received prophylactic transfusion during pregnancy (Group 3). For each group we recorded the population's characteristics and the transfusion-related, obstetrical, perinatal and SCD complications. We found 11 patients for group 1 (9/11 with at least 3 painful crises during the 12 months before conception), 4 for group 2 (3/4 with no sickle-cell complications during the year before pregnancy) and 2 for group 3 (one with previous multiorgan failure (MOF), one with previous stroke). No transfusion-related complication occurred. Group 1 and 2 developed SCD complications and a high number of acute transfusions and hospital admissions. Group 3 showed none of these complications, but one patient developed preeclampsia and preterm birth. Several obstetrical and perinatal complications occurred in group 1. Not treating sickle-cell during pregnancy increases maternal and perinatal morbidity, even in mildly affected women. All sickle-cell pregnancies should be treated, according to the treatment adopted before but also to patient's SCD-history. We propose chronic transfusion to women with previous stroke or MOF or already under transfusion program, and HU for severely and mildly affected patients, respectively from the second and third trimesters. Additional prospective studies are needed to validate the results of the proposed protocol. [ABSTRACT FROM AUTHOR]