Vasa previa in singleton pregnancies: diagnosis and clinical management based on an international expert consensus.

Background: There are limited data to guide the diagnosis and management of vasa previa. Currently, what is known is largely based on case reports or series and cohort studies.

Objective: This study aimed to systematically collect and classify expert opinions and achieve consensus on the diagnosis and clinical management of vasa previa using focus group discussions and a Delphi technique.

Systematic screening for vasa previa at the 20-week anomaly scan.

Introduction: The presence of vasa previa carries a high risk for severe fetal morbidity and mortality due to fetal bleeding caused by injury to unprotected fetal vessels when rupture of membranes occurs. Previously, it has been shown that prenatal diagnosis significantly improves the outcome. However, systematic screening for vasa previa is not generally performed and clinical studies demonstrating the performance of systematic screening for vasa previa in routine clinical practice are rare.

Screening for Open Spina Bifida in a Routine Clinical Setting at the First-Trimester Scan: A Prospective Multicentre Cohort Study.

Objective: The aim of this study was to investigate the performance of screening for open spina bifida (OSB) integrated into the routine first-trimester screening.

Method: This is a prospective multicentre study of 4,755 women undergoing first-trimester ultrasound scans over a 4-year period. Measurements of the brainstem (BS) diameter and brainstem-to-occipital-bone (BSOB) distance were performed.

Cranial sonographic markers of fetal open spina bifida at 11 to 13 weeks of gestation.

Objectives: To compare the sonographic signs of spina bifida obtained on axial and sagittal views of the fetal head between 11 and 13+6 weeks of gestation.

Methods: This was a retrospective study including 27 cases of spina bifida and 1003 randomly selected controls. Indirect markers of spina bifida were evaluated on stored ultrasound images.

Diagnosis of Fetal Posterior Fossa Malformations in High-Risk Pregnancies at 12-14 Gestational Weeks by Transvaginal Ultrasound Examination.

Objective: To demonstrate sonographic detectable abnormalities of the posterior fossa in fetuses with a crown-rump length of 45-84 mm in high-risk pregnancies.

Methods: This was a prospective, observational study including 47 fetuses with known outcome, whose mothers attended our centers for first trimester tests and showed an abnormal first trimester ultrasound scan. In these fetuses, we examined transvaginal acquired three-dimensional volume blocks for abnormalities of the fetal posterior fossa.

Reference Ranges for Transvaginal Examined Fossa Posterior Structures in Fetuses from 45 to 84 mm Crown-Rump Length.

Objective: The study aimed to describe reference values for structures of the posterior fossa in fetuses with a crown-rump length (CRL) between 45 and 84 mm.

Materials And Methods: This was a prospective, cross-sectional study including 216 normal appearing fetuses. In transvaginal acquired 3-dimensional volume blocks, the longest diameter of the vermis (VE), posterior membranous area (PMA), medulla-oblongata-pons angle (MOPA), diameters of the medulla oblongata (MO) and pons (PO), and the area of Blake's pouch (BP) were measured.

Sonoembryology of the fetal posterior fossa at 11 + 3 to 13 + 6 gestational weeks on three-dimensional transvaginal ultrasound.

Objective: To describe the sonographic appearance and temporal changes of the structures of the posterior cranial fossa in fetuses at a crown-rump length (CRL) between 45 and 84 mm in transvaginal acquired three-dimensional volume blocks.

Methods: This was a prospective, cross-sectional, observational study including 80 fetuses, whose mothers attended Kepler University Hospital Linz or the Ambulatorium für Fetalmedizin Feldkirch for first-trimester sonography. Three-dimensional volume blocks were acquired in a standardized way and after processing the sonographic characteristics of the brainstem, cerebellar vermis, choroid plexus, anterior membranous area (AMA) and Blake's metapore were described.

Prenatal sonographic diagnosis of intrahepatic portosystemic shunts.

The incidence of fetal portosystemic anastomoses is unknown, and it is presumed that many cases remain undetected, as visualization of the hepatic vasculature is not part of the routine 20-week sonographic scan in pregnancy. However, portosystemic anastomoses are associated with fetal growth restriction due to a diminished oxygen supply to hepatocytes and, hence, downregulation of liver function. In these cases, uteroplacental perfusion might be normal.

Perinatal mortality and advanced maternal age.

Objective: To investigate the impact of advanced maternal age on the rate of perinatal mortality.

Design: Retrospective cohort study including all 56,517 singleton hospital deliveries between 1999 and 2008.

Methods: Data were analyzed according to maternal age at delivery in 3 groups of women, 25-34 years, 35-39 years and ≥ 40 years, using the youngest as the reference group.

Doppler evaluation of the posterior cerebral artery in normally grown and growth restricted fetuses.

Objective: To evaluate Doppler parameters of the two segments of the posterior cerebral artery (PCA) in normally grown and growth restricted (IUGR) fetuses.

Methods: Normal reference values of the pulsatility index (PI), peak systolic velocity, end-diastolic velocity, and time-averaged maximum velocity from the two segments of the PCA (segment one, PCA-S1; segment two, PCA-S2) were constructed in 350 pregnant women from 20 to 40 weeks of gestation. The association of the two PCA segments with the middle cerebral artery (MCA), and with the umbilical artery was evaluated in 50 IUGR fetuses.

Outcome of twin reversed arterial perfusion sequence following treatment with interstitial laser: a retrospective study.

Objectives: To determine the outcome of twin reversed arterial perfusion (TRAP) sequence treated with or scheduled for treatment with interstitial laser therapy.

Methods: This is a retrospective study on ten pregnancies diagnosed with TRAP sequence. Seven of the ten pregnancies were treated with interstitial laser therapy, and two pregnancies were scheduled for later treatment.

Changes in central and peripheral circulation in intrauterine growth-restricted fetuses at different stages of umbilical artery flow deterioration: new fetal cardiac and brain parameters.

Objective: To evaluate changes in central and peripheral circulation, including new and standard parameters of the fetal brain and heart in fetuses with intrauterine growth restriction (IUGR) in relation to progressive deterioration of the umbilical artery (UA).

Methods: Seventy-two IUGR fetuses were studied longitudinally. IUGR was defined as an estimated fetal weight <10th centile for gestational age.

Oxygen utilization in newborns at delivery.

Aims: To evaluate the arteriovenous (AV) pH difference in cord blood as a possible indicator of fetal O(2)-utilization at delivery. Furthermore to examine which maternal, fetal and obstetrical factors lead to elevated O(2)-utilization.

Methods: In this retrospective study all singleton live births, delivered within a four-month period at the University Hospital in Innsbruck, Austria, were analyzed.

Congenital fibrosarcoma as cause for fetal anemia: prenatal diagnosis and in utero treatment.

Objectives: To discuss diagnosis and management of a case of a rare fetal tumor complicated by fetal anemia due to intratumoral hemorrhage.

Case Report: We report on a 29-week-old fetus with a tumor in the posterior left shoulder region. The morphologic aspect of the tumor, lack of fetal movements and an increased middle cerebral artery (MCA) peak systolic velocity (PSV) were indicative of fetal anemia caused by intratumoral bleeding.

Prediction of severe fetal anemia in red blood cell alloimmunization after previous intrauterine transfusions.

Objective: This study was undertaken to determine the detection of fetal anemia and false-positive rates by fetal middle cerebral artery peak systolic velocity (MCA-PSV) and the estimated daily decrease of hemoglobin (Hb) in red blood cell alloimmunized pregnancies that had previous fetal transfusions.

Study Design: We examined the relation between MCA-PSV measured before cordocentesis, and fetal Hb at the time of the second (n = 42) and third (n = 31) intrauterine blood transfusions. In addition, the daily Hb drop between the transfusions was calculated.