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The failure of uterine arteries to change their shape to support the placenta may be one of the causes of premature rupture of the fetal membranes, according to a study of 113 pregnant women. During the early stages of pregnancy, the placenta invades the lining of the uterus and blood vessels are changed to allow blood to flow through the placenta.

Failure to detect color Doppler flow signals from the arteries within the placental villi may be associated with intrauterine growth retardation (IUGR) and fetal distress, but villous artery flow velocity waveforms appear to have no association with IUGR. Doppler ultrasound studies were undertaken among 192 normal pregnancies and 29 pregnancies with fetal IUGR. Doppler studies of the umbilical artery were compared with those of the villous artery and correlated with the presence of IUGR and outcome. Color Doppler flow signals from the villous arteries were found in all normal pregnancies, but not in eight of the IUGR pregnancies. Six of those eight fetuses (88%) experienced fetal distress either prior to or during labor, and two of the babies died (25%). Among the 21 IUGR fetuses with villous artery flow signals, 3 (14%) experienced distress and none died. Umbilical artery velocity waveforms were abnormal in eight of the 21 IUGR fetuses with villous artery flow signals, but villous artery waveforms were abnormal in only one of these cases.

OBJECTIVE: Our aim was to evaluate the utility of ultrasonographic humeral length measurements for detection of fetuses with Down syndrome in the midtrimester of gestation. STUDY DESIGN: Ultrasonographic biometry data obtained before genetic amniocenteses on 43 fetuses with Down syndrome and 204 randomly chosen normal fetuses were analyzed. Regression equations relating biparietal diameter to humeral length and femoral length were used to calculate ratios of observed-to-expected length and sensitivity and specificity at various cutoff points. RESULTS: Humeral length in Down syndrome fetuses was significantly shorter than in normal controls (p

Advancing technology has made the fetus and its environment even more accessible to prenatal diagnosis and treatment. The current approach to prenatal diagnosis relies mainly on the use of high-resolution ultrasonography. However, as attempts are made to conduct antenatal diagnoses earlier in gestation, the limits of ultrasonography are approached. Embryoscopy allows for direct visualization of the first-trimester fetus with a fiberoptic endoscope. A customized side channel enables the operator to pass a variety of diagnostic tools and gain access into the fetal circulation. The further development and refinement of this technology are expected to change early prenatal diagnosis and treatment considerably. The potential contribution of this technique to perinatal medicine is readily apparent when it is placed in historic context. Undoubtedly, many ethical, legal, and regulatory questions will have to be addressed before the full potential of embryoscopy is realized. The responsibility for the judicious use of this powerful technology for prenatal intervention will have to be shared by the scientific community and a well-informed public. (Am J Obstet Gynecol 1992;166:775-80.)

A subdural hematoma is a swelling or mass of blood pooled beneath the dura mater, the outer membrane covering the spinal cord and brain. The presence of subdural hematoma in the fetus can be detected before birth by transvaginal ultrasonography, a diagnostic method in which sound waves are used to visualize internal structures. In transvaginal ultrasonography, the ultrasonic transducer (the device that sends and receives sound waves) is inserted into the vagina. The cranium or skull of the fetus in a head-down position can be completely visualized using this technique. Magnetic resonance imaging (MRI), another diagnostic method, involves the use of electromagnetic energy to visualize internal structures, and helps to confirm a diagnosis of subdural hematoma in the fetus. During MRI, the fetus is momentarily paralysed with the drug pancuronium, which is administered into the umbilical cord to prevent fetal movement. The outcome of a fetus with subdural hematoma depends on the severity of the bleeding and the underlying cause, but it is often poor. However, brain function can not be predicted on the basis of ultrasonography findings, and efforts should be made to increase the survival of the fetus with subdural hematoma. The fetus should be delivered as soon as the lungs have matured. Fetal blood should be monitored for the development of anemia (decreased number of red blood cells) and coagulation disorders. Blood transfusion should be provided if necessary. Because of head enlargement, the fetus should be delivered by cesarean section. A case is described in which fetal subdural hematoma was diagnosed by transvaginal ultrasonography and MRI. The fetal blood was monitored and blood transfusion was performed. Although there was evidence of fetal lung maturation, delivery was delayed to prevent other complications of prematurity. The infant was delivered nine days after the transfusion, but died six hours after birth due to massive bleeding within the brain. (Consumer Summary produced by Reliance Medical Information, Inc.)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0002-9378(96)80057-3 Byline: Siegfried Rotmensch Author Affiliation: Department of Obstetrics and Gynecology, Rabin Medical Center, Campus Golda, 7 Keren Kayemet St., Petah Tiqva 49372, Israel

Whether karyotyping is indicated in a fetus with choroid plexus cysts who is otherwise structurally normal is still controversial. Many authors have suggested basing the decision on cyst size, bilaterality, persistence with advancing gestational age, and association with other anomalies. We report a case of large bilateral choroid plexus cysts in a fetus with trisomy 21 who had no evidence of congenital anomalies or ultrasonographic signs of Down syndrome. Cyst sizes diminished by half over a 3-week period of follow-up. It appears that diminishing size alone should not be considered sufficient reassurance about the normality of the fetal karyotype. A similar case has been previously reported, and it is conceivable that choroid plexus cysts are associated not only with trisomy 18 but also with trisomy 21. (Am J Obstet Gynecol 1992;166:591-2.)