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Protein C global assay tests the global function of the protein C pathway, the most clinically significant anticoagulant pathway in humans. The objective of this study is to assess the difference in protein C global assay levels, throughout twin gestation, in naturally conceiving and ART-treated women. This is a prospective cohort longitudinal study of pregnant women with twin gestation. Protein C Global evaluation was performed on frozen blood samples. Ninety-eight women with twin pregnancy, thirty-eight naturally conceived and sixty following ART, were evaluated on four occasions: during the first, second, and third trimesters, and 6 weeks or later after delivery (baseline). Protein C global assay levels were lower throughout pregnancy as compared to basal levels in both the naturally conceived and ART-conceived groups. However, protein C global assay levels were similar between the ART-conceived and naturally conceived twin pregnancies in all three trimesters. Perinatal complications were associated with decreased protein C global assay levels during the third trimester, although no difference was encountered between naturally conceived and ART-complicated twin pregnancies. While protein C global assay levels drop during twin pregnancy, there is no difference between ART-conceived and naturally conceived gestations. Decreased levels of protein C global assay during the third trimester were similarly associated with perinatal complications in both groups. Our results imply that twin pregnancy of itself is a more dominant factor for perinatal complications as compared to other factors, such as subfertility or the exposure to ART per se.

BACKGROUND AND OBJECTIVES Vaginal pixelated low power and long pulses (LPLP) CO2 laser has been suggested as an optional treatment for stress urinary incontinence (SUI) with many studies reporting short-term improvements. The objective of this study was to assess the 1-year subjective and objective efficacy of vaginal CO2 laser in women with urodynamic SUI. STUDY DESIGN/MATERIALS AND METHODS This was a prospective multicenter study. Patients with confirmed urodynamic SUI graded as mild or moderate were included. We used three sessions of fractional pixelated CO2 laser for vaginal application and followed up the patients at 6 and 12 months. We used the following measures at follow-up: 1-hour pad test (ICS protocol), questionnaires including Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ), Patient Global Impression of Improvement (PGI-I), and a 3-day urinary diary. The urodynamic assessment was repeated at 6 months. RESULTS Fifty-two patients with SUI had three laser treatments, of whom 48 completed a 6-month follow-up and 42 patients completed 12-month follow-up. No serious adverse events were recorded during the study period. A significant reduction on the 1-hour pad test was found from baseline (6.3 ± 1.6 g) to the 12-month follow-up (3.7 ± 1.4 g, P

Background Mycoplasma and Ureaplasma have been extensively studied for their possible impact on pregnancy, and their involvement in newborn diseases. This work examined Mycoplasma and Ureaplasma carriage among gravidas women and newborns in Israel, as well as associations between carriage and demographic characteristics, risk factors, pregnancy outcomes, and newborn morbidity rates. Methods A total of 214 gravidas women were examined for vaginal pathogen carriage through standard culture and polymerase chain reaction assay. Pharyngeal swabs were collected from newborns of carrier mothers. Clinical and demographic data were collected and infected newborn mortality was monitored for 6 months. Results Nineteen mothers were carriers, with highest prevalence among younger women. Pathogen carriage rates were 2.32% for Mycoplasma genitalium (Mg), 4.19% for Ureaplasma parvum (Up) and 2.32% for Ureaplasma urealyticum (Uu). Arab ethnicity was a statistically significant risk factor (p = 0.002). A higher prevalence was seen among women residing in cities as compared to villages. Thirteen (68%) newborns born to carrier mothers were carriers as well, with a higher prevalence among newborns of women delivering for the first time, compared to women that had delivered before. Infection rates among newborns were 20% for Mg (p = 0.238), 100% for Up (p Uu (p = 0.058), with more male than female newborns being infected. No association was found between maternal carriage and newborn morbidity. Conclusions Maternal Mycoplasma or Ureaplasma carriage may be associated with ethnicity and settlement type. Further studies will be needed to identify factors underlying these associations and their implications on delivery.

Vaginal pixelated low power and long pulses (LPLP) COThis was a prospective multicenter study. Patients with confirmed urodynamic SUI graded as mild or moderate were included. We used three sessions of fractional pixelated COFifty-two patients with SUI had three laser treatments, of whom 48 completed a 6-month follow-up and 42 patients completed 12-month follow-up. No serious adverse events were recorded during the study period. A significant reduction on the 1-hour pad test was found from baseline (6.3 ± 1.6 g) to the 12-month follow-up (3.7 ± 1.4 g, P 0.05) was found. PGI-I showed 75.0%, 61.9%, and 64.3% improvements at 3, 6, and 12 months, respectively. PFDI improved significantly and consistently from baseline until 12 months (37.2 ± 3.89 to 16.1 ± 3.7, P 0.05). Similarly, PFIQ showed significant improvements from the first treatment up to 12 months. Urodynamic assessment at 6 months showed that 41.4% of patients had no stress incontinence.The vaginal CO

To evaluate the outcome of twin pregnancies that were complicated by rupture of membranes at 13-20 weeks of gestation and were managed by expectant management or by selective termination. A retrospective cohort study of all bichorionic twin pregnancies that were referred to three fetal medicine units between 2001 and 2016, due to rupture of membranes of one sac at 13-20 weeks of gestation. Women without clinical signs of infection who opted for expectant management or selective termination were included. 20 patients met the inclusion criteria. 7 of them were managed expectantly and 13 underwent selective termination. In the expectant management group there was one case of fetal demise and two cases of neonatal death, resulting in a survival rate of 79 %. The median gestational age at delivery was 30 weeks. 3 neonates suffered from prematurity-related complications and 2 suffered from oligohydramnios-related orthopedic complications. Following selective termination the survival rate was 50 % (all fetuses that were not reduced), the median gestational age at delivery was 39 weeks, and the neonatal outcome was favorable. The maternal outcome was favorable in both groups. Selective termination in twin pregnancies complicated by rupture of membranes at 13-20 weeks has a favorable outcome and should be offered.ZIEL: Bewertung des Outcomes von Zwillingsschwangerschaften mit vorzeitigem Blasensprung („rupture of membranes“) zwischen 13–20 Schwangerschaftswochen, die durch abwartendes Management oder selektiven Schwangerschaftsabbruch behandelt wurden. Eine retrospektive Kohortenstudie aller bichorionischen Zwillingsschwangerschaften, die zwischen 2001 und 2016 aufgrund eines Blasensprungs zwischen 13–20 Schwangerschaftswochen an 3 Pränatalzentren überwiesen wurden. Eingeschlossen wurden Frauen ohne klinischen Hinweis auf eine Infektion, die sich für ein abwartendes Management oder den selektiven Fetozid entschieden. Zwanzig Patientinnen erfüllten die Einschlusskriterien, davon wurden 7 abwartend behandelt und bei 13 erfolgte ein selektiver Fetozid. In der Gruppe mit abwartendem Management gab es einen intrauterinen Fruchttod und 2 neonatale Todesfälle, was eine Überlebensrate von 79 % ergab. Das mediane Gestationsalter bei Entbindung betrug 30 Wochen, 3 Neugeborene hatten frühgeburtliche Komplikationen und 2 Kinder orthopädische Komplikationen bedingt durch Oligohydramnie. Nach selektivem Abbruch betrug die Überlebensrate 50 % (alle nichtreduzierten Föten), das mediane Gestationsalter bei Entbindung betrug 39 Wochen und der neonatale Outcome war günstig. In beiden Gruppen war der maternale Outcome gut. Der selektive Fetozid bei Zwillingsschwangerschaften mit vorzeitigem Blasensprung zwischen 13–20 Schwangerschaftswochen hat einen günstigen Outcome und sollte angeboten werden.

Background: Team-based learning (TBL) is a structured form of small-group learning for students which emphasizes out-of-class preparation towards guided application of knowledge in class. Values and knowledge education (VaKE) is a teaching method in which a “dilemma” is used as a motivation and trigger of knowledge acquisition. The goal of this study was to compare and evaluate medical students’ knowledge and achievements in a combination of these two methods (TBL+VaKE) vs. TBL alone. Methods: Every academic year we teach 3-4 groups of 8-10 medical students in each group, at their 5th year of MD studies. We recruited all groups of students since we started the study and alternately used one of the educational approaches on them, TBL or TBL+VaKE. Our study’s module was “diabetes in pregnancy”. Results: On all issues, the TBL+VaKE received higher scores. The difference for “complexity of decision making” question reached statistical significance. Furthermore, when we compared the two groups questionnaire answers, we detected statistical significance of p=0.02 (T test) for the difference between the two sets of scores. Conclusions: “Diabetes and pregnancy” module for 5th year meducal school students had better knowledge acquisition when a moral dilemma was added to the module (TBL+VaKE vs TBL).

The pathophysiology of the genuine empty follicle syndrome (EFS) is still debated. Ovarian aging has been contested as a cause of this condition. Our aim was to investigate the occurrence of the genuine EFS in cases of a low number of mature follicles in a prospective manner. Ninety-five infertile women were recruited and evaluated following conventional controlled ovarian stimulation (COS) with ≤ six follicles of ≥14 mm diameter on the day of hCG administration. Enrolled women were 37.5 ± 5.2 years of age with basal FSH level of 9.1 ± 3.7 mIU/L, antral follicle count (AFC) of 6.9 ± 4.6, and number of ≥14 mm follicles (on the day of hCG) of 3.4 ± 1.5. Among the 95 women, four were complicated by the genuine EFS (4.2%) with features of the depleted ovarian reserve. Comparison between these four cases and the 91 controls revealed significant differences between age, AFC, number of ≥14 mm follicles, and serum E

Background: In recent years, there has been growing interest in the effect of maternal exposure to physiological, environmental, and also psychological factors during gestation on child development. Several independent studies link maternal stress during pregnancy to emotional and behavioral problems in the child. Objectives: This study aimed to observe the effect of maternal cognitive activity on fetal brain blood flow to determine whether systematic maternal mathematical activity during pregnancy might influence child brain development. Method: Thirty-five women in the 28th to 40th week of pregnancy engaged in mathematical activities. Fetal middle cerebral artery (MCA), pulsatility index (PI) and peak systolic velocity (PSV) were monitored before, during, and after the activity. Results: Brain activity and blood flow were shown to be intimately linked. We observed a significant decrease in fetal brain MCA resistance, as evidenced by decreased MCA PI, towards the end of the mathematical activity. This may result in increased blood flow in the arteries supplying most brain regions and, possibly, increased brain activity. Conclusions: A correlation between the mother’s engagement in mathematical activities and fetal brain blood flow may lead to enhancement of the fetus’s brain function and a cognitive advantage for the child.

To explore serum endocrine dynamics, specifically LH levels, following rLH supplementation to rFSH following GnRH-antagonist treatment in the advance reproductive age. Women were prospectively and similarly treated employing rFSH and the flexible GnRH-antagonist protocol, while rLH was supplemented only to the study group. Serum FSH, LH, E2, and P were evaluated throughout the follicular phase. Three strategies were a priori planned to examine endocrine dynamics among women enrolled. While serum LH drop were similar before GnRH-antagonist stimulation, it dropped more times in the control group compared to the study group. Among women receiving rFSH only, serum LH levels dropped ≤2, ≤1 and ≤0.5 mIU/mL in 71.4, 46.4, and 28.6% of cases, while this occurred only in 38.7% (P = 0.01), 6.5% (P = 0.0004) and 3.2% (P = 0.007) of women receiving combined rFSH and rLH treatment, respectively. The same trend was found when serum LH dropped in at least two occasions following the GnRH-antagonist administration. Conversely, serum LH diagrams throughout the follicular phase did not differ between the two groups. Furthermore, individual area under the curve values of LH, E2, and P was similar between the two groups following GnRH-antagonist initiation. Different strategies to explore LH dynamics following the GnRH-antagonist administration have resulted in diverse results, implying the need for a consensus definition of LH threshold for adequate folliculogenesis and steroidogenesis. Such action would pave the way for understanding which groups of patients may benefit from rLH supplementation.

The cornerstone of concerns over trial of labor after cesarean (TOLAC) is the risk of uterine rupture. The purpose of this study was to document the rate of uterine rupture during TOLAC and to delineate its severity and consequences.We retrospectively collected the data on vaginal and cesarean deliveries after a previous cesarean section with specific emphasis on uterine rupture and dehiscence in our center from 2006 through 2013.22,670 deliveries were registered, with 18.2% rate of cesarean section. 2890 women had a single cesarean scar; of them 1206 delivered vaginally and 194 were re-operated during unsuccessful TOLAC. Seven cases of uterine rupture and 16 cases of dehiscence were recorded. There were no maternal, intrapartum or neonatal deaths, and no cesarean hysterectomy. There was one re-laparotomy, one ICU admission, and one blood transfusion; one neonate was admitted to NICU. TOLAC was successful in 86.1% of cases.Cautious selection and close monitoring of candidates are the cornerstones of successful management of TOLAC. Readily available facilities for emergency cesarean delivery and concerted obstetrical team can save the mother and child from catastrophic complications.

The aim of this study was to determine whether the route of extended-spectrum β-lactamase (ESBL) transmission to hospitalized newborns was from their mothers during delivery. Neonatal intensive care unit (NICU) hospitalized newborns were sampled for ESBL presence by stool cultures on the first and fourth days of life. Mothers of ESBL-positive newborns were sampled for possible correlation detection. Bacteria isolates were molecularly identified and susceptibility tests for antibiotic agents were performed. Of the 225 newborns, 14 (6.2%) were ESBL positive, 10 (4.4%) were Escherichia coli positive, and 4 (1.7%) were Klebsiella pneumoniae positive. Among the 14 mothers of positive newborns, 13 (92.8%) were found ESBL positive and one mother of a newborn with E. coli carriage was found ESBL negative. Genes encoding for ESBL resistance were identified. Antibiotic sensitivity and resistance were tested. This study demonstrated that ESBL bacteria carrier neonates hospitalized in NICU may be a result of transmission from mother to baby during delivery.

Objectives Guidelines recommend antibiotic treatment for every episode of asymptomatic bacteriuria throughout pregnancy in order to reduce maternal and fetal complications. We evaluated intra- and post-partum, as well as puerperal maternal and neonatal outcomes of an untreated group of pregnant women with asymptomatic bacteriuria at term. Methods This was a single center prospective cohort study. We enrolled women who came for labor or checkups, 37–42 weeks gestation, with singleton, vertex presentation. On admission, women gave a urine sample; we compared maternal, obstetric and neonatal data from the positive culture group to the negative culture. Results Among 248 pregnant women recruited, 205 negative and 32 positive urine cultures were collected. None of the women that participated in this study developed pyelonephritis during hospitalization or during the puerperium. No significant differences were detected between the two groups in terms of age, nulliparity, gestational age at delivery, length of hospitalization, birth type, intra- or post-partum fever, antibiotic treatment during labor or post-partum. Conclusions No increased maternal or neonatal adverse effects were observed in women with untreated ASB detected at term.

Objective To investigate the occurrence of the “vanishing follicle” phenomenon in women with low number of developing follicles in assisted reproduction. Study design Women with ≤ 6 follicles on the day of hCG administration with ≥ 14 mm diameter were prospectively studied. Primary outcome measures were disappearance of ≥14 mm and all-diameter follicles on the day of oocyte pick-up compared to the day of hCG administration. Results Among the 120 women recruited, 95 were found eligible and completed the study. The “vanishing follicle” phenomenon occurred in 3.1% (95% confidence level: 0.7%–9.0%) and 18.9% (95% confidence level: 11.6%–28.3%) of cases affecting ≥14 mm and all-diameter follicles, respectively. In all cases, mid-late follicular serum LH and P levels remained within normal follicular phase range and trans-vaginal scan did not show signs of ovulation. Markedly, the main significant difference between the study and control groups in the ≥14 mm follicle group was serum E2 level on the day of hCG administration; median (Interquartile range), corresponding to 395 (382.0–405.5) versus 823.0 (544.5–1291.0) pg/mL, respectively (P = 0.04). The same trend was encountered in all-diameter vanishing follicles group but it did not reach significance. Interestingly, in all-diameter vanishing group, chronic smoking and the P/E2 ratio on the hCG day were significantly higher than controls. Post hoc multiple logistic regression analysis of data in accordance with the Bologna criteria reveled that antral follicle count was found to significantly affect the development of the “vanishing follicle” phenomenon. Conclusions The “vanishing follicle” phenomenon occasionally occurs in women with low number of developing follicles during assisted reproduction with no signs of ovulation. Our preliminary findings suggest that this phenomenon may be related to exhausted ovarian reserve however, an early-unrecognized LH elevation could not be ruled out.

(1) To compare the accuracy of vagino-rectal enriched culture (EC) and a rapid polymerase chain reaction (PCR) test for the detection of Group B streptococcus (GBS) carrier status at 35-37-week gestation and at onset of labor. (2) To assess the conversion rate of GBS carrier status between 35-37 weeks to the onset of labor according to the EC/PCR tests. A prospective study was performed at a women's health clinic, referred to give birth at one medical center.Low risk pregnant women at 35-37-week gestation who did not know their GBS carrier status.Participants were evaluated for GBS status both at 35-37 weeks and at labor onset. Correlation between tests was calculated by Spearman correlation.One hundred and ten specimens were analyzed. Correlations: EC-PCR: 35-37 weeks - very high (r = 0.8), at labor - high (r = 0.5).35-37 weeks and at labor - high (r = 0.39); PCR-PCR: 35-37 weeks and at labor- high (r = 0.7).Both the EC and Xpert PCR tests are accurate for detecting GBS carrier, both at 35-37 weeks and at labor onset. We did not detect a significant conversion of the GBS status from negative at 35-37 weeks to positive at onset of labor.

In the last few years more robust evidence is emerging to point out at an increased rate of prematurity and low birth weight in singleton pregnancies following ART. Whether this increased rate is related to ART practice or to infertility per se, is still an open question. Our aim in this study was to explore this question by evaluating Protein C (ProC) Global assay in infertile women before ART treatment.A cohort of 95 unselected and consecutive infertile women, eligible for ART, was prospectively recruited for the study. The control group included 77 matched healthy fertile women with a history of spontaneous conceptions. Pro C Global assay was evaluated in both groups. A full thrombophilic work-up was performed in the study group.ProC Global assay level was found to be significantly lower in the study as compared to the control group, corresponding to 0.78 ± 0.16 and 0.88 ± 0.16, respectively (P 0.01). As well, abnormal ProC Global assay level of ≤ 0.8 was significantly higher in the study as compared to control group corresponding to 53 % and 29 %, respectively. ProC Global assay level was significantly lower in women within the study group found to have APCR, factor V Leiden and high factor VIII level, any thrombophilia or combined thrombophilia when compared to women without these thrombophilic risk factors.Reduced ProC Global assay level is encountered in infertile women prior to ART treatment. This finding may suggest a unique anticoagulation Protein C pathway in infertile as compared to fertile women. Further studies are encouraged to explore this finding.

Objective To investigate the association between thrombophilic risk factors and poor ovarian response in an assisted reproductive technologies (ART) setting. Study design This is a preliminary prospective cohort study in a university affiliated reproductive medicine unit. Eighty-nine infertile women undergoing IVF-ET treatment were recruited. Following IVF-ET treatment, the 28 women that had ≤3 oocytes on retrieval were the study group, and the 61women that had ≥ 4 oocytes on retrieval were the control group. All women underwent ovarian reserve testing and thrombophilia work-up prior to treatment. Results Patients’ characteristics, except for chronological age, were similar between the two groups. Women in the study group had clear manifestations of low ovarian reserve, evident by ovarian reserve testing, controlled ovarian hyper-stimulation and IVF-ET treatment results, as compared to the control group. The incidence of all thrombophilias tested was similar between the study and control group. Moreover, the incidence of any single or combined thrombophilia was also similar between the two groups. Logistic regression model analysis and Pearson correlation tests did not show significant correlation between number of oocytes retrieved and thrombophilia. Furthermore, basal ovarian reserve tests did not differ between women with and without thrombophilia. When only the 48 women ≤ 35 years of were analyzed, the five women in the study group had significantly higher incidence of a single as well as combined thrombophilia as compared to the 43 controls. Conclusions Thrombophilic risk factors have no correlation with poor ovarian response in the general infertile population undergoing ART. Whether premature low ovarian reserve is linked to thrombophilia remains to be established.

To investigate the occurrence of multinucleated blastomeres (MNB) in poor ovarian response (POR) women defined under the Bologna criteria. This observational study was designed in a prospective controlled manner. Among 380 cases evaluated for eligibility, 102 women were found suitable and recruited; 51 with POR in accordance with the Bologna criteria defined as the study group and 51 with normal ovarian response defined as the control group. Among the 51 women in each group, 8 and 2 did not achieve embryos in the study and control group, respectively (P

Objective To gain insight into the ovarian stromal blood flow in women with polycystic ovary syndrome (PCOS) as compared with women with normal ovulation, good ovarian reserve, and infertility and to evaluate the role of stromal flow in these patients to predict clinical pregnancy in an assisted reproductive technologies setting. Design A prospective observational cohort study. Setting A university-affiliated reproductive medicine unit. Patient(s) Eighteen consecutive patients with PCOS (study) compared with 101 patients with normal ovulation and infertility (control), undergoing their first IVF-ET treatment at our unit. Women with low ovarian reserve were excluded a priori from evaluation. Basal ovarian reserve parameters and stromal flow studies were conducted as routinely performed in our unit, in a natural cycle before starting treatment. Intervention(s) None. Main Outcome Measure(s) Basal ovarian endocrine, sonographic, and stromal flow studies were compared between the groups. After completion of treatment, the stromal flow studies were compared between conception and nonconception cycles. Result(s) Patients' characteristics and basal ovarian reserve, including endocrine and sonographic parameters, were similar between the PCOS and control groups. Only antral follicle count and LH/FSH ratio were higher in the PCOS as compared with the control group, corresponding to 15.11 ± 6.05 versus 9.05 ± 4.77 and 1.14 ± 0.64 versus 0.79 ± 0.37, respectively. Basal stromal flow indices were similar between the PCOS group and the group with normal ovulation and good ovarian reserve. Clinical pregnancy rate per initiated cycle was 50.0% and 39.6% in the PCOS and control groups, respectively, with no significant difference. Flow indices were similar between conception cycles in the PCOS and control groups. As well, the indices did not differ significantly between conception and nonconception cycles within the PCOS and control groups. Conclusion(s) Basal ovarian stromal blood flow does not differ between women with PCOS and women with normal ovulation, good ovarian reserve, and infertility. Moreover, stromal flow has no predictive value, in these patients, for clinical pregnancy achievement in an IVF-ET setting.

Objectives Ebstein anomaly and atrio-ventricular septal defect involve a profound change in the appearance of the atrio-ventricular septum (AVS). AVS is the area between the insertion of the mitral valve and the tricuspid valve leaflets to the ventricular septum. In normal fetuses, the tricuspid valve has an apical displacement relative to the mitral valve. We aimed to create a nomogram of its normal dimensions, beginning in the 11th gestational week. Methods Measurement of the length of the AVS was performed during ultrasonographic fetal echocardiography, in the four-chamber view from 11 to 34 gestational weeks in otherwise normal pregnancies. In addition, standard fetal biometry was measured. Linear regression analysis was used to evaluate the correlation between variables. Results Two hundred and ninety-two examinations of normal fetuses were included. A positive correlation was found between AVS length and gestational age (r2 = 0.96, P < 0.001), each week adding 0.165 mm (β = 0.165, P < 0.001). AVS length was also proportional to inter-ventricular septum (IVS) length with increasing gestational age (r2 = 0.882, β = 0.94, P < 0.001). Positive linear correlation was obtained between AVS length and fetal biometry (P < 0.001). Conclusion We provide a nomogram for AVS length which can be used as a reference when either Ebstein anomaly or atrio-ventricular septal defects are suspected. Copyright © 2011 John Wiley & Sons, Ltd.

Calponin, a specific smooth muscle contraction regulatory troponin-like protein, is present in large quantities in uterine smooth muscle. Serum troponin levels rise in acute myocardial infarction, and creatine phosphokinase levels rise at high physical activity, both due to destruction of cardiac and striated muscle fibers. We hypothesize that the active labor process may cause uterine smooth muscle cell damage, which may result in rising maternal serum calponin levels. This was a preliminary study, searching for a new biomarker for preterm labor.The study group included laboring term primiparous women with a singleton fetus. The control group included similar demographic and pregnancy characteristics pregnant women not in labor. Maternal serum levels of calponin basic isoform were measured evaluated and compared in both groups.Study group included 100 pregnant women. Calponin serum levels were higher in the active labor (794 ± 974 ng/mL) than in the group not in labor (591 ± 587 ng/mL), although it did not reach statistical significance. Gender and neonatal weight were similar in the two study groups.Calponin serum levels showed moderate elevation during active labor, compared to the levels in a cohort of pregnant comparable women at the same gestational weeks but not in labor.

To gain insight into the morphology of the first polar body (1 PB) in ICSI patients and to explore whether it could predict mature oocyte viability and performance in this setting.Seventy two consecutive women planned to perform ICSI treatment were prospectively recruited for this study. All oocytes retrieved underwent evaluation for nuclear maturity and accurate assessment of 1 PB morphology. MII oocytes were cultured in separate groups in each woman in accordance with two different categories of 1 PB morphology. Category A included normal intact round or ovoid 1 PB and category B included abnormal fragmented 1 PB. Each oocyte was followed throughout fertilization, embryo cleavage and embryo transfer. Cycles that reached embryo transfer, were divided into three groups in accordance with 1 PB morphology. Group I included only category A 1 PB embryos, group II included categories A and B 1 PB embryos, whereas group III included only category B 1 PB embryos.A total of 687 oocytes were aspirated and 553 MII oocytes underwent ICSI leading to 410 zygotes showing normal fertilization on day one. Three hundred ninety seven embryos cleaved on day two and a total of 176 embryos were replaced into the uterus. Clinical implantation and pregnancy rates were significantly correlated with the morphology of the 1 PB corresponding to 31%, 9% and 2% and 61%, 24% and 5%, in groups I, II and III respectively.Our findings demonstrate that 1 PB morphology is related to mature oocyte viability and it has the potential to predict oocyte performance and pregnancy achievement in infertile women undergoing ICSI treatment.

To gain insight into the physiological significance of basal ovarian stromal blood flow and to assess whether its detection ability is related to ovarian reserve in infertility patients undergoing in vitro fertilization (IVF) - embryo transfer (ET) treatment. Thirty two consecutive infertile women scheduled for IVF-ET treatment were prospectively evaluated. Basal ovarian hormonal, ovarian volume and stromal blood flow studies were performed on day 3 of a natural cycle before treatment. The performer of the ultrasound studies was blinded to the clinical data. Women in the study were divided into two groups in accordance with estradiol level on the day of administration of human chorionic gonadotropin. Day-3 follicle-stimulating hormone and ovarian volume were significantly poorer in the women with low (group A) as compared with good (group B) ovarian reserve. Likewise, the numbers of follicles > or =14 mm in diameter, oocytes retrieved and embryos achieved were significantly lower in group A than group B. Six clinical pregnancies were obtained in group B, whereas no pregnancy was obtained in group A. Nine out of the 15 (60%) women in group A had undetectable basal stromal blood flow in at least one of the ovaries, whereas only one of the 17 (6%) women in group B had undetectable flow (p < 0.002). Basal stromal peak systolic blood flow velocity, pulsatility index and resistance index mean values did not differ significantly between the two groups. We conclude that undetectable basal ovarian stromal blood flow in at least one ovary is related to low ovarian reserve in infertile women undergoing IVF-ET. It seems that undetectable basal stromal blood flow is not solely a technical issue, but rather linked to the pathophysiology of ovarian aging.

Objective The purpose of our study was to determine whether the current antibiotic regimen for preterm premature rupture of membranes (PPROM) is adequate for covering the current causative agents and sensitivities of chorioamnionitis and early-onset neonatal sepsis. Study Design During a 3-year period, we retrieved the results from placental and amniotic membrane cultures obtained at delivery in cases of maternal fever, chorioamnionitis, and PPROM, and from blood cultures obtained from neonates with early-onset sepsis (EOS) in three participating hospitals. Sensitivity of pathogens to antimicrobial agents was performed using routine microbiologic techniques. Results There were 1,133 positive placental or amniotic cultures, 740 (65.3%) were from gram-negative Enterobacteriaceae. There were 27 neonates diagnosed with EOS with positive blood cultures. Aerobic Enterobacteriaceae accounted for 14 cases (52%) and group B streptococcus for 7 cases (26%). Of the Escherichia coli and Klebsiella sp., only 38% were sensitive to ampicillin. Conclusion Local pathogens and their antibiotic sensitivity profiles should be explored every few years and an effective antibiotic protocol chosen to cover the main pathogens causing chorioamnionitis and EOS. Consideration should be made for changing ampicillin in women with PPROM to a regimen with better coverage of gram-negative Enterobacteriaceae.

Women with complete absence of oocytes during retrieval, as well as those with less than the 10th percentile of the expected number of oocytes retrieved, have clear manifestations of low ovarian reserve. It seems that this occurrence is a gradual biological phenomenon related to the basic pathophysiology of ovarian aging.

Objective Evaluation of fetal cardiac contractility by two-dimensional ultrasonography and construction of nomograms of area shortening fraction, end-diastolic area and end-systolic area of fetal cardiac ventricles during uncomplicated pregnancy. Materials and Methods Fetal echocardiography was performed on 160 pregnant women between 14 and 28 weeks' gestation. Measurements were taken on the four-chamber view. The area of each ventricle was measured by tracing the endocardium at the end of systole and at the end of diastole. Area shortening fraction was calculated by the following formula: SF = (Ad − As)/Ad (SF–area shortening fraction, Ad–end-diastolic ventricular area, As—end-systolic ventricular area). Results A statistically significant increase in normal fetal area shortening fraction, end-diastolic area and end-systolic area of both ventricles with advancing gestational age was established. There were no significant differences in the area shortening fraction between right and left ventricles. Conclusions Area shortening fraction shows good correlation with gestational age. Nomogram of area shortening fraction, end-diastolic area and end-systolic area of both ventricles can be used as the reference for evaluation of ventricle size and cardiac contractility in normal and pathological cases. Copyright © 2004 John Wiley & Sons, Ltd.

Objective To construct a normal range for the internal diameter of the fetal descending colon and rectum during gestation. Subjects and Methods This was a prospective, cross-sectional study including 379 healthy pregnant women with normal singleton pregnancies at 19–40 weeks of gestation. Measurements of the fetal descending colon (maximum internal diameter) and the fetal rectum (at the level of the bladder, measuring the anteroposterior diameter), were performed by high-resolution transabdominal sonography. Results Adequate bowel measurements were obtained in all 379 fetuses. The diameter of the descending colon and rectum plotted as a function of gestational age had a sigmoid curve; the curve estimation was expressed by a cubic regression equation with R2 of 0.848 and 0.831, respectively (P < 0.0001). The normal mean and the 95% prediction limits were defined. Conclusion The present data provide a normal range of fetal bowel (descending colon and rectum) diameters from the early second trimester of pregnancy onwards. They may allow intrauterine assessment of the development of the fetal colon and may serve as reference values in the detection of anomalies of the fetal bowel. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.

OBJECTIVE: To estimate whether the risk of neonatal thyrotoxicosis was related to the value of maternal thyroid-stimulating immunoglobulin in women with Graves disease. METHODS: The records of pregnant women undergoing testing for thyroid-stimulating immunoglobulin over a 10-year period were analyzed. Neonatal thyrotoxicosis was defined as the presence of tachycardia, goiter, hydrops, tremulousness, voracious appetite, irritability, cardiomegaly, or congestive heart failure, with elevated thyroid hormone levels. The relationship between maternal thyroid-stimulating immunoglobulin values and the development of thyrotoxicosis was examined. The sensitivity, specificity, and positive and negative predictive values were calculated using an arbitrarily chosen cutoff for thyroid-stimulating immunoglobulin. RESULTS: Twenty-nine women with a history of Graves disease and positive thyroid-stimulating immunoglobulin values were available for analysis. Of the 35 live births, there were six cases of neonatal thyrotoxicosis (17.1%). A maternal thyroid-stimulating immunoglobulin value at least 5 index units predicted neonatal thyrotoxicosis with a sensitivity of 100%, specificity of 76.0%, positive predictive value of 40.0%, and negative predictive value of 100%. CONCLUSION: Pregnancies complicated by high values of maternal thyroid-stimulating immunoglobulin appear to be at risk of developing neonatal thyrotoxicosis.

Objective Doppler ultrasound has been used to study the flow velocities through the valves and arteries of the fetal heart. Using transvaginal sonography, we sought to determine normal values for flow velocities through the fetal heart valves at 14–16 weeks of gestation. Methods Eighty-seven normal fetuses were examined. The flow velocity waveforms were visualized using Doppler ultrasound with the sample volume calipers placed just distally to the four fetal valves. Peak E- and A-wave velocities were recorded for the tricuspid and mitral valves and peak systolic flow velocities were recorded for the ascending aorta and pulmonary arteries. Linear regression for comparison of flow velocities with gestational age was performed. Results There was no significant correlation between any of the velocities and gestational age. Conclusions Flow velocities through the fetal cardiac valves remain unchanged at 14–16 weeks of gestation as measured by transvaginal Doppler sonography. Copyright © 2002 ISUOG

Objective To construct cross-sectional reference range of the penile length during pregnancy, measuring it from the proximal edge of the corpus cavernosum to the tip of the glans penis. Methods Fetal penile length was measured by high resolution transvaginal ultrasound at 14 to 16 weeks and by transabdominal ultrasound at 17 to 35 weeks' gestation. Results Fetal penile length increased significantly with gestational age (GA), from 7 mm at 14 weeks' to 50 mm at 35 weeks' gestation. Penile length measurements were strongly related to the biometric fetal measurements. Conclusions A reference range of the fetal penile length was constructed, measured from the proximal edge of the corpus cavernosum to the tip of the glans penis at 14 to 35 gestational weeks. This reference range can assist in early identification of true penile maldevelopment, which obligate further diagnostic workup, as opposed to the benign disorder of buried or concealed fetal penis. Copyright © 2011 John Wiley & Sons, Ltd.

This report presents an unusual case of absolute non-obstructive azoospermia revealed to be a male 46,XY true hermaphrodite who was successfully treated to father healthy monozygotic twins. A 27-year-old infertile male with non-obstructive azoospermia previously underwent an unsuccessful testicular sperm extraction procedure and refused donor sperm insemination.Revising the patient’s old records revealed that he was born with ambiguous genitalia. He had a 46,XY karyotype and was raised as a male. During childhood he underwent ambiguous genitalia reconstruction, right orchiopexy and left salpingo-oophorectomy that revealed a gonadoblastoma. A new treatment was employed performing testicular fine needle aspiration leading successfully to a monozygotic twin pregnancy. As far as is known, this is the first reported case of healthy twins fathered by a male 46,XY true hermaphrodite.

Objective: To gain insight into the physiologic as well as the clinical significance of premature luteinization in the long gonadotropin-releasing hormone agonist (GnRH-a) cycles and to evaluate whether it may be a manifestation of low ovarian reserve. Design: Prospective evaluation. Setting: A university-affiliated reproductive medicine unit. Patient(s): Seventy-six consecutive infertile women. Intervention(s): The long GnRH-a protocol was used for IVF-ET treatment. Main Outcome Measure(s): Women in the study were prospectively evaluated in their first cycle of treatment and were divided into those with (study group) or without premature luteinization (control group). Premature luteinization was defined as P/E 2 ratio of more than 1 on the day of hCG administration. Result(s): Thirty-one (41%) of the women in the study demonstrated premature luteinization. Patients' characteristics were comparable between the two groups. Late follicular P/E 2 ratio was significantly and considerably higher in the study as compared to the control group, 2.4 ± 1.7 and 0.7 ± 0.2, respectively. Ovarian reserve parameters including day 3 FSH, E 2 level on hCG day, total amount of hMG, number of follicles, oocytes, and embryos were significantly inferior in the study as compared to the control group. P levels on hCG day were significantly higher in the study as compared to the control group, 1.9 ± 0.7 ng/mL and 1.2 ± 0.6 ng/mL, respectively. However, LH levels on hCG day did not differ between the groups, 1.4 ± 0.7 mIU/mL and 1.2 ± 0.7 mIU/mL, respectively. The clinical pregnancy rate was significantly lower in the premature luteinization group as opposed to controls, 13% and 42%, respectively. Conclusion(s): Premature luteinization, defined as late follicular P/E 2 >1, in long GnRH-a cycles seems to adversely affect clinical outcome. Our findings in this setting support the notion that premature luteinization could be related to low ovarian reserve and that this manifestation is not necessarily an LH-dependent event.

Congenital cardiac diverticula are transmural localized protrusions within the free wall of the ventricles. Right ventricular diverticula are rarely diagnosed during the fetal period, and due to their rarity, their natural history remains unclear. We present a case of prenatal diagnosis of right ventricular diverticulum at 22 weeks’ gestation. No other pathological findings were detected, the pregnancy and delivery were uneventful, and the diverticulum disappeared before the age of 3 months. Echocardiography of the infant at 1 year of age revealed no cardiac diverticulum or any cardiac anomaly and showed normal heart function. Literature review of all cases published to date reveal good outcome of right ventricular diverticula. We suggest reassuring our patients about the good prognosis of this cardiac anomaly.

Objective: To gain insight into the physiologic significance of premature luteinization and to evaluate whether it could be a manifestation of low ovarian reserve. Design: Retrospective evaluation. Setting: Reproductive medicine unit. Patient(s): Thirty-one consecutively seen women with normal ovulation and unexplained infertility. Intervention(s): Induction of superovulation with hMG coupled with synchronized IUI. A GnRH agonist was not used during the study. Main Outcome Measure(s): Premature luteinization was defined as a progesterone/estradiol ratio of >1 on the day of hCG administration. Patients were evaluated during their first cycles of hMG treatment and then were divided into those with (study group) and those without (control group) premature luteinization. The ovarian reserve parameters were compared between the two groups. Result(s): Nineteen of the 31 patients with unexplained infertility demonstrated premature luteinization. Patient characteristics were similar between the study and control groups. Mean (±SD) day 3 FSH levels were 8.2 ± 3.3 and 6.6 ± 1.7 mIU/mL in the study and control groups, respectively. Mean (±SD) day 3 estradiol levels were significantly higher in the study than in the control group (74 ± 49 pg/mL vs. 30 ± 17 pg/mL, respectively). Mean (±SD) estradiol levels on the day of hCG administration also differed significantly between the study and control groups (760 ± 539 pg/mL vs. 1,568 ± 675 pg/mL, respectively). Likewise, the number of follicles that were ≥15 mm on the day of hCG administration was significantly lower in the study than in the control group (2.9 ± 1.5 vs. 4.3 ± 1.3, respectively). The total dose of hMG and duration of administration were similar in the two groups. The clinical pregnancy rates after four cycles of treatment were 15.8% and 41.7% in the study and control groups, respectively. Conclusion(s): This preliminary work suggests that, in cycles that are not treated with a GnRH agonist, signs of premature luteinization in patients with unexplained infertility could be an early manifestation of low ovarian reserve. It appears that hMG treatment in this group of patients could uncover the pathogenesis of their infertility.

Introduction: The aim of this study was to assess the effect of mild pressure applied on the abdominal wall by the ultrasound transducer on fetal cephalic indices. Material and Methods: We examined by ultrasound 60 fetuses of healthy women, at 20-24 weeks of pregnancy, during routine prenatal evaluation. For every fetus biparietal diameter and head circumference were measured, with and without applying mild pressure by the ultrasound transducer. The weight and gestational age (GA) were calculated. Results: The pressure applied by the transducer had a significant effect on the cephalic indices and on the weight and GA evaluations (p < 0.001). Fetal positioning significantly affected the impact that applied pressure had on head circumference and on the weight evaluation derived from it (p < 0.05). Discussion: Applied pressure by an abdominal ultrasound probe affects cephalic indices and the derived weight and GA estimations. This may lead to incorrect diagnoses or hide pathological findings. The effect of applied pressure depends on fetal positioning. The examiner must be aware of this effect when evaluating the results of the measurements.

The clinical outcome of intrauterine insemination (IUI) treatment cycles employing a gonadotrophin-releasing hormone agonist [GnRHa, triptorelin (Decapeptyl)] or human chorionic gonadotrophin (HCG) for ovulation induction was compared. A group of 48 patients presenting with amenorrhoea, oligomenorrhoea or unexplained infertility were all treated with human menopausal gonadotrophins (HMG) from day 5 of the cycle, on an individualized schedule. They were then randomly divided into two groups to receive either a single s.c. injection of 0.1 mg triptorelin or a single i.m. injection of 10,000 IU HCG after follicular maturation. IUI was performed approximately 24 and 48 h following the injection. A transitory increase in serum luteinizing hormone and follicle stimulating hormone concentrations was achieved following injection of GnRHa. A total of 24 patients received 72 treatment cycles with GnRHa, producing 11 conceptions (15.3%) and two abortions (18.2%), resulting in a term pregnancy rate of 13.6%. There were four cases of grade 3-4 ovarian hyperstimulation syndrome (OHSS), two of which were conception cycles. In all, 24 patients underwent 68 cycles treated with HCG, producing 18 conceptions (26.5%) and six abortions (33.3%), resulting in a term pregnancy rate of 19.0%. There were eight cycles of grade 3-4 OHSS, two of which were conception cycles. These results show that an s.c. injection of a relatively low dose of GnRHa can be as effective as HCG in producing pregnancy in IUI treatment cycles.

Recent studies report that superovulation combined with intrauterine insemination (IUI) is more successful than superovulation alone, IUI alone or superovulation with intracervical insemination in couples with male subfertility. Our study evaluated two superovulation protocols in the management of male factor infertility using IUI: (A) clomiphene citrate and human chorionic gonadotropin (HCG) and (B) human menopausal gonadotropin and HCG. Fifteen couples with severe oligoasthenozoospermia (OAS) were treated with protocol A in 54 cycles, and no pregnancies were achieved. Eight of the 15 couples with severe OAS subsequently received protocol B for 24 cycles and elicited no pregnancies. Thirty-seven couples with moderate OAS received protocol A for 169 cycles, and 2 pregnancies ensued (5.4% per couple and 1.12% per cycle). Twelve of the 35 nonpregnant couples with moderate OAS then received protocol B for 31 cycles, and 4 pregnancies were recorded (33.3% per couple and 12.9% per cycle).

To evaluate the role of early follicular stromal flow studies in predicting ovarian response during IVF-ET treatment and to assess their correlation with ovarian reserve parameters and clinical pregnancy achievement.One hundred and sixty-eight consecutive and unselected infertile women undergoing their first IVF-ET treatment were included in the study. Basal ovarian reserve and stromal Doppler flow studies were performed in a natural cycle before starting treatment. Four Doppler indices were measured; peak systolic velocity (PSV), pulsatility index (PI), resistance index (RI) and systole/diastole ratio (S/D). Following completion of IVF-ET treatment Pearson's correlation analysis was performed to examine the correlation between Doppler indices, ovarian response, basal ovarian reserve parameters and clinical pregnancy achievement.A positive correlation was found between the number of ≥14 mm follicles on hCG day and PSV. The number of ≥14 mm follicles and retrieved oocytes had a significant negative correlation with RI and S/D ratio. As well, the number of fertilized oocytes had a significant negative correlation with S/D ratio. Absence of a Doppler signal in one or both ovaries was significantly higher in the women with poor response (31%) as compared to women with normal response (16%). In addition, RI correlated positively with basal FSH as well as FSH/LH ratio and negatively with AFC. The S/D ratio had a negative correlation with AFC (p = 0.027). A significant positive correlation between PSV, total ovarian volume (p = 0.011) and mean ovarian volume (p = 0.019) was detected. However, no correlation between all four Doppler indices and age was detected. Moreover, Doppler indices did not differ significantly between conception and non-conception cycles following IVF-ET treatment.Early follicular stromal Doppler signals is correlated with ovarian response as well as basal ovarian reserve parameters, but have no correlation with age neither with clinical pregnancy achievement in infertile women undergoing IVF-ET treatment.

We evaluated the effectiveness of color and spectral Doppler examination of the ovarian vasculature flow, using transvaginal sonography (TVS) in 65 women prior to laparoscopy due to suspected ovarian torsion. There were 15 cases of ovarian torsion. In all of them, a pathology was detected by the color and spectral Doppler examination. Of the 50 patients without torsion at laparoscopy, one had abnormal Doppler studies. Color and spectral Doppler can demonstrate the presence or absence of arterial and venous flow in cases of suspected torsion of the ovary.

A rare case of extrahepatic biliary atresia was diagnosed by a combination of prenatal ultrasound and measurements of fetal digestive enzymes in amniotic fluid. Ultrasound at 15 and 18 weeks' gestation failed to detect the gall bladder, and amniotic fluid digestive enzyme values were below the fifth percentile. The patient decided to terminate the pregnancy. Post-abortal pathological examination confirmed the diagnosis.

To construct cross-sectional reference range of the penile length during pregnancy, measuring it from the proximal edge of the corpus cavernosum to the tip of the glans penis.Fetal penile length was measured by high resolution transvaginal ultrasound at 14 to 16 weeks and by transabdominal ultrasound at 17 to 35 weeks' gestation.Fetal penile length increased significantly with gestational age (GA), from 7 mm at 14 weeks' to 50 mm at 35 weeks' gestation. Penile length measurements were strongly related to the biometric fetal measurements.A reference range of the fetal penile length was constructed, measured from the proximal edge of the corpus cavernosum to the tip of the glans penis at 14 to 35 gestational weeks. This reference range can assist in early identification of true penile maldevelopment, which obligate further diagnostic workup, as opposed to the benign disorder of buried or concealed fetal penis.

A total of 177 M-mode echocardiography studies were done on three groups of fetuses at different gestational ages: group I, normally grown fetuses; group II, intrauterine growth-retarded fetuses (IUGR); and group III, fetuses of diabetic mothers. Adjusted for gestational age and for fetal weight, the hearts of fetuses with IUGR were found to have an increased minor axis dimension due to free wall hypertrophy. No ventricular dilation was found in this group. Furthermore, IUGR fetuses have a larger heart proportionally to their body weight, raising the possibility of a "sparing effect" in this particular group. The hearts of fetuses of diabetic mothers were also found to have a significantly larger cardiac size than that of a group of normally grown fetuses. The increase was secondary to free wall hypertrophy, interventricular septal hypertrophy, and right ventricular dilation. This study confirms previous reports about fetal diabetic cardiomegaly and documents the contribution of the different cardiac components to this increase in size. The free wall hypertrophy found in these two groups may occur by different processes, which needs to be further investigated.

Objective : To evaluate the clinical effectiveness and safety of endometrial ablation by hysteroscopic instillation of hot saline using the Hydro-Therm-Ablator ® (HTA) system. Methods : A total of 14 patients with menorrhagia, underwent the HTA procedure under general anethesia. Follow up of 9–18 months is reported. Three patients had undergone tubal ligation years before the procedure and one underwent it immediately after HTA at the same session. Results : One procedure was cancelled due to technical problems, and roller-ball ablation was performed. There were no procedure related complications. A total of 11 patients reported significant reduction in bleeding, or amenorrhea, 9–18 months after the HTA procedure. One patient, although eumenorrheic after the ablation, considered the procedure a failure and requested hysterectomy. One patient with menorrhagia 3 months after the procedure, had a second HTA ablation and is now amenorrheic. Conclusions : This series of patients who underwent HTA ablation had successful reduction of menorrhagia to oligomenorrhea or amenorrhea.

The aim of this study was to present the outcome of bichorionic twin pregnancies complicated by early second trimester rupture of membranes in one sac. Data regarding all cases of ruptured membranes at 13–20 weeks in bichorionic twin pregnancies were collected retrospectively from three fetal medicine units. Patients who have chosen to terminate the pregnancy were excluded from the study. Between January 2003 and July 2009, nine patients met inclusion criteria. Three out of nine couples decided on expectant management, and six preferred selective feticide. With expectant management one fetus died in utero and take home baby rate was 83% (5 of 6 fetuses), delivered at 27–32 weeks. When selective termination was performed, all non-reduced fetuses were born alive at 33–40 weeks. Two survivors of rupture of membranes had limb contractures, none had lung hypoplasia. One patient had clinical signs of amnionitis, which was ruled out later on pathological examination. Her post partum course was uncomplicated. Our data suggest that rupture of membranes in one sac of bichorionic twins at 13–20 weeks has favorable prognosis whether an intervention is preformed or not. Nonetheless, selective termination may have an advantage over expectant management, since gestational age at delivery was higher when selective termination was performed.

Ebstein anomaly and atrio-ventricular septal defect involve a profound change in the appearance of the atrio-ventricular septum (AVS). AVS is the area between the insertion of the mitral valve and the tricuspid valve leaflets to the ventricular septum. In normal fetuses, the tricuspid valve has an apical displacement relative to the mitral valve. We aimed to create a nomogram of its normal dimensions, beginning in the 11th gestational week.Measurement of the length of the AVS was performed during ultrasonographic fetal echocardiography, in the four-chamber view from 11 to 34 gestational weeks in otherwise normal pregnancies. In addition, standard fetal biometry was measured. Linear regression analysis was used to evaluate the correlation between variables.Two hundred and ninety-two examinations of normal fetuses were included. A positive correlation was found between AVS length and gestational age (r(2) = 0.96, P0.001), each week adding 0.165 mm (β = 0.165, P0.001). AVS length was also proportional to inter-ventricular septum (IVS) length with increasing gestational age (r(2) = 0.882, β = 0.94, P0.001). Positive linear correlation was obtained between AVS length and fetal biometry (P0.001).We provide a nomogram for AVS length which can be used as a reference when either Ebstein anomaly or atrio-ventricular septal defects are suspected.

Objective To determine the normal level of the conus medullaris (CM) of the spinal cord of normal fetuses at 20 to 24 weeks’ gestation using abdominal sonography. Methods Using a 4 to 8 MHz ultrasound abdominal transducer, CM was imaged in the midsagittal plane with the fetal spine facing toward the transducer. The CM ending level was located by counting the vertebrae caudal starting at T12, which was identified by lowest fetal rib. The CM locations were defined according to their positions relative to the vertebrae. Results One hundred and ten consecutive pregnant women were included in the study. The CM was clearly demonstrated in 78 (71%) of these cases. Most of the scanned fetuses had the CM ending height adjacent to vertebrae L2, L2–3 inter-space and L3 (73/78, 93%). The L1–2, L2, L2–3, and L3 vertebral groups did not differ in mean gestational weeks, maternal age, or fetal gender. Conclusion The level of the CM can be determined at 20 to 24 weeks’ gestation in about 70% of fetuses. Most of the scanned fetuses had the CM ending height adjacent to vertebrae L2, L2–3 vertebral space, and L3 (73/78, 93%). When detected lower than the third lumbar vertebra it should prompt prenatal and postnatal surveillance. Copyright  2010 John Wiley & Sons, Ltd.