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Background: The available data on the relationship between diet/folic acid and congenital heart disease (CHD) are not consistent. This study aimed to investigate the relationship between the intake and supplementation of folic acid and other selected factors in mothers and the risk of congenital heart defects in fetuses. Methods: A case–control study was conducted. The study group included pregnant women with fetuses from singleton pregnancies with prenatally diagnosed heart defects in the fetus (n = 79) and pregnant women whose course of pregnancy was normal with no heart defects or other developmental anomalies diagnosed in the fetus (n = 121). The patients were diagnosed at a reference center in Poland. The women completed a lifestyle questionnaire and FFQ and precisely described their use of dietary supplements. A univariate logistic regression model was used to evaluate the association between folic acid and selected risk factors and CHD. The association was significant and included such risk factors such as nutritional status, medications taken, smoking, and alcohol consumption. Additionally, the time of starting folic acid supplementation turned out to be statistically significant. The reference period of supplementation was the period before pregnancy. Results: Lack of supplementation increases the risk of heart defects in children by more than four times compared to supplementation before pregnancy (OR = 4.19; p = 0.0117), whereas supplementation beyond the eighth week of gestation increases the risk almost threefold (OR = 2.90; p = 0.0474). The presence of congenital defects in the family is also an important factor. Conclusions: A history of congenital heart defects or other defects, lack of periconceptional folic acid supplementation, and lack of dietary supplementation before pregnancy were associated with congenital heart defects in the fetus. Place of residence, parents' education, lifestyle habits such as smoking and alcohol consumption, nutritional status before pregnancy, and mother's diseases did not show a significant relationship with congenital heart defects in the children. There is an urgent need to develop preventive strategies and conduct extensive public education. [ABSTRACT FROM AUTHOR]

The echocardiographic monitoring of a fetus with multiple nuchal cords around the fetal neck is important as it may result in cardiac remodeling and preferential streaming, thus affecting the condition of the fetus. The main aim of our study was to assess whether the collision of the umbilical cord around the fetal neck can lead to discrepancies in the size of the pulmonary artery and the aorta in the three-vessel view and to an increase in the size of the heart, which may result from the compression of the carotid arteries caused by the umbilical cord wrapping around the fetal neck. A total number of 854 patients were included in this study and divided into three groups. Group A (control group) included 716 fetuses (84%) without the umbilical cord around the fetal neck. Group B (study group B) included 102 fetuses (12%) with one coil of the umbilical cord around the fetal neck. Group C (study group C) included 32 fetuses (4%) with two coils of the umbilical cord around the fetal neck. The range of the gestational age of the patients considered for this study was 27–40.2 weeks based on the ultrasound biometry and was not statistically different between the analyzed groups A, B and C (p > 0.05). The Pa/Ao index was calculated by dividing the value of the width of the pulmonary artery (in mm) to the width of the aorta (in mm) measured in the ultrasound three-vessel view. We found that fetuses that the fetuses with one and two coils of the umbilical cord around the neck showed significantly higher values of the width of the pulmonary trunk with the unchanged value of the aorta width. Therefore, we also observed significantly higher values of the ratio of the pulmonary trunk to the aorta for the fetuses wrapped with the umbilical cord around the neck compared with the control group without the umbilical cord around the neck (. Moreover, in the fetuses with one and two coils of the umbilical cord around the fetal neck, an increased amount of amniotic fluid was observed, whereas larger dimensions of CTAR in the fetuses with two coils of the umbilical cord around the neck were present (p < 0.05). The wrapping of the fetus with the umbilical cord around the fetal neck may induce the redistribution of blood flow, leading to fetal heart enlargement and disproportion and may be the cause of polyhydramnios. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate whether selected prenatal markers obtained from fetal echocardiography can predict postnatal outcome in congenital diaphragmatic hernia (CDH) patients. We also aimed to verify the prognostic value of lung-to-head ratio (LHR). Material and methods: The study group included 29 fetuses with CDH. We analyzed potentially prognostic parameters measured using fetal echocardiography and fetal ultrasound. The assessed parameters were compared between the group of patients with CDH who survived to discharge (n = 21) and the subset of patients who died before discharge from hospital (n = 8). Results: In survivors, mean z-score for ascending aorta (AAo) diameter was 0.23 ±0.98 vs. - 1.82 ±1.04 in patients who died (t-test, p = 0.0015). In survivors, the main pulmonary artery/ascending aorta ratio was 1.22 ±0.17 vs. 1.46 ±0.21 in patients who died (t-test, p = 0.017). In survivors, the LHR was 1.81 ±0.96 vs. 0.95 ±0.6 in patients who died (t-test, p = 0.019). In survivors, the observed to expected LHR was 57 ±30% vs 30 ±18% in patients who died (t-test, p = 0.018). Conclusions: Narrowing of the ascending aorta in CDH fetuses is a poor prognostic factor associated with increased mortality in neonates. Our study also confirmed the prognostic value of LHR. [ABSTRACT FROM AUTHOR]

Maternal urogenital infections during pregnancy are worldwide frequent problem. The aim was to analyze influence of maternal genitourinary infection on fetal cardiac function, pregnancy development and obstetrical outcomes. This was a single-center cohort study on fetuses (average at 28th week) in two groups: with maternal urogenital infections (study group n=49) and control group with no infections (n=59). Parvovirus B19, toxoplasmosis, cytomegalovirus, herpes simplex infections, congenital malformations, fetal growth restriction, chronic maternal diseases, as well as patients with body mass index (BMI) >25 kg/m2 were excluded. We analyzed: maternal age, time of delivery, neonatal birth weight, Apgar scores, average time of hospitalization of newborns after birth and several fetal echocardiographic parameters. The only statistical differences was found for shorter isovolumetric relaxation time (IRT) (40 ± 10 vs. 45 ± 9; p=0.03) and longer ejection time (ET) [ms] for right ventricle (RV) (176 ± 24 vs. 164 ± 18; p=0.01). Thick placenta was observed more frequent in study group than in controls (36.7 vs. 16.9%; p= 0.02). The missing link for explanation of these findings was coincidence with thick placenta. This is probably the first observation suggesting that thick placenta (>5 cm) may affect fetal RV function in normal heart anatomy: prolongation of right ventricular ET and shortening of fetal right ventricular IVRT. [ABSTRACT FROM AUTHOR]

Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive disease caused by a mutation in the 7-dehydrocholesterol reductase gene (DHCR7) on chromosome 11, which leads to 7-dehydrocholesterol reductase enzyme defects. This results in the building up of toxic by-products of cholesterol production in the blood and the nervous system. All this affects the growth and development of human body systems. We presented a case of a fetus of a pregnant woman with a high-risk pregnancy after IVF. The patient was referred for a fetal karyotype test, which showed a male sex (46, XY). This woman was referred to our centre for fetal heart evaluation. Based on our protocol established at the Department of Prenatal Cardiology of the Institute of the Polish Mother's Health Centre in Lodz, our examination starts with obstetrical screening, including ultrasound fetal gender evaluation. At this point of examination, the fetus presented ambiguous genitalia and fetal polydactyly. The fetal echocardiographic examination revealed atrioventricular septal defect. The presence of ambiguous genitalia and atrioventricular septal defect allowed us to suspect SLOS. As a result, further diagnostic steps were suggested, and the diagnosis was confirmed. The family chose comfort care with no postnatal intervention and planned the next pregnancy with another donor. We would like to underline the importance of a detailed ultrasound protocol before fetal echocardiographic examination for its proper interpretation. [ABSTRACT FROM AUTHOR]

Introduction: Fetal echocardiography in third trimester is relatively rare reported and there is no data, what is the clinical meaning of the main pulmonary artery (MPA) dilatation in third trimester or before the delivery in fetuses with congenital heart defect. We analyzed the neonatal follow‐up in cases of significantly dilated MPA diameter to better understand its clinical significance. Material and Methods: Retrospectively 238 healthy singleton fetuses were selected as a reference group. Consecutive percentiles for MPA diameter according to the gestational age were calculated. In second step, we selected cases whose MPA diameter measured at the level of three vessel trachea view (3VT view) was pointedly above 95th centile in third trimester of pregnancy, according to the obtained data of our healthy population. Results: There were 11 fetuses, with dilated MPA diameter (range 12–13.5 mm), who had last echocardiography performed at 37.6 weeks of gestation. There were 11 isolated heart defects: 7 cases with HLHS, 2 with d‐TGA, and 2 cases with CoA. Mean neonatal weight was 3,345 g, with Apgar score 8–10. About 10 newborns out of 11 had cardiac surgery at the mean 12th day of the postnatal life and 8 of them died on the mean 23rd day. Autopsy was performed in 5 cases. In all of them histopathology reports described pulmonary hypertension in addition to cardiac structural abnormalities. Conclusion: Severe dilation of the fetal MPA before the delivery suggested prenatal abnormal lung development and was a poor prognostic factor. In these cases postnatal pulmonary hypertension should be suspected. [ABSTRACT FROM AUTHOR]

Nonimmune hydrops fetalis is observed with the frequency of 1:3000 cases diagnosed pre- and postnatally. In the following paper the authors analyzed the course of pregnancy complicated by fetal ascites and polyhydramnios with the appearance of colonic ileus and they presented the postnatal condition of the baby The preliminary diagnosis was confirmed after birth and the newborn was operated in the second day of his life. The congenital small bowel atresia was qualified as a III B type (Grossfeld qualification), which is called the "pagoda" syndrome [3]. The colonic atresia is located then around the superior mesenteric vessels, which leads to colonic necrosis (Figure 1).

This paper presents a case of a pregnant woman who was admitted to the obstetrics and gynecology department because of a new onset of uncontrolled diabetes in 27 weeks gestation. The maternal and fetal diabetic complications suggested a chronic character of the disease which must have been undiagnosed before pregnancy. Many of the co-existing infections caused a life-threatening ketoacidosis. Fortunately with the adequate treatment it was possible to ensure appropriate birth weight of the newborn baby despite the ultrasound markers for LGA (Large For Gestational Age) observed during pregnancy. Intensive insulin therapy was obligatorily continued by the mother after the delivery.

Introduction: Methods of macrosomic fetal weight estimation are associated with large deviations and statistically significant errors. Fetal macrosomia might be better predicted by using fetal ultrasound measurements and maternal characteristics., Material and Methods: Ultrasound evaluation of fetal weight was performed in 113 singleton fetuses one week (max. 7 days) before delivery. Retrospectively all newborns with birth weight o A new logarithmic estimation formula proposed by Hart and co. was compared with commonly used formulas of Shepard, Campbell, Hadlock I, Hadlock II, Hadlock Ill. Exclusion criteria were: multiple pregnancies, intrauterine deaths, structural or chromosomal abnormalities. The new formula established by Hart (loge EFW = 7.6377445039 + 0.0002951035 x maternal weight + 0.0003949464 x HC + 0.0005241529 x AC + 0,0048698624 x FL) uses fetal biometric measurements and maternal weight as two different parameters: EFW- estimated fetal weight, maternal weight--weight measured at one week (max. 7 days) before delivery HC--fetal head circumference, AC--abdominal circumference, FL--femur length., Results: The new Hart formula gives the lowest mean percentage error (MPE) : -0.74% and mean absolute percentage error (MAPE) : 3.38%, as compared to other routinely used formulas which presented statistically significantly higher MPE and AMPE With the new formula 84 of estimated fetal weights fell within +5% of the actual weight at birth, 111 within +/- 10% and 112 within +/- 15% and +/- 20%., Conclusions: The presented ultrasound formula demonstrated a more precise macrosomic fetuses weight estimation with the lowest MPE and MAPE as compared to the others and might be introduced when fetal macrosomia is suspected.