ABSTRACT

K E Y W O R D S:early fetal echocardiography; hypoplastic left heart; in-utero progression ABSTRACTWe describe a case of aortic stenosis in the first trimester that progressed to hypoplastic left heart syndrome. CASE REPORTA 36-year-old woman, gravida 4 para 0, was referred to our unit for first-trimester ultrasound screening at 11 + 3 weeks of gestation. Her obstetric history consisted of two early miscarriages and an intrauterine fetal death because of placental abruption at 21 weeks of gestation. On transvaginal and transabdominal ultrasound examination (HDI 5000, Philips, Solingen, Germany) using 4-7-MHz curvilinear abdominal and 4-8-MHz transvaginal transducers a fetus with a crown-rump length of 54.3 mm (consistent with gestational age), nuchal translucency within the normal range (1.7 mm) and a present nasal bone was seen. No structural anomalies were detectable. Transabdominal and transvaginal fetal echocardiography using a segmental approach was then performed. The fetal heart rhythm was regular at 169 bpm and there was a situs consistent with situs solitus. Two-dimensional (2D) B-mode echocardiography revealed a normal four-chamber view with a cardiothoracic ratio of 0.426 without any signs of left ventricular dysfunction (Figure 1a). The diameter of the heart was 6 mm. The diameter of the aortic valve was 1.4 mm and that of the pulmonary valve was 1.5 mm. Color flow mapping revealed normal blood flow across the atrioventricular valves into both chambers but revealed turbulent flow at the aortic valve (Figure 1b,c). Increased and disturbed aortic blood velocity of 1.8 m/s during spectral Doppler analysis was detected, leading to the diagnosis of aortic valve stenosis (Figure 1d). The blood velocity in the pulmonary trunk was 33 cm/s -within the normal range for gestational age -and the E/A ratios of the tricuspid and mitral valves were also within the normal range (0.459 and 0.419, respectively). Ductus venosus flow velocity waveforms showed positive flow during the a-wave. There was absent end-diastolic flow in the umbilical artery. Chorionic villus sampling revealed a normal male karyotype and exclusion of a microdeletion 22q11.At 16 + 6 weeks of gestation hypoplastic left heart syndrome was diagnosed. The left ventricle appeared hyperechogenic, globular and dysfunctional on 2D echocardiography. The diastolic diameter (6 mm) and length of the left ventricular chamber were significantly decreased. The diameter of the aortic valve was 1.1 mm,

The perinatal prognosis in cases of eclampsia could be improved if it were possible to predict its onset so that appropriate treatment could be given as early as possible. The investigators performed cerebral magnetic resonance imaging (MRI) in 41 women with severe preeclampsia in an attempt to identify ways in which this imaging procedure can be most effective. Six patients had systemic seizures and 14 had visual symptoms apart from retinal detachment. Urinary protein exceeding 2.5 g daily was noted in 12 cases. All patients received magnesium sulfate prophylactically, and some also received alpha methyldopa, labetalol hydrochloride, or calcium channel blockers such as nicardipine. All participants had MRI studies regardless of whether headaches or visual symptoms were part of the picture.Abnormal MR images were obtained in 11 patients, 9 with vasogenic edema and 3 with minor cerebral embolism. Vasoconstriction was observed in 4 cases. Six of the 11 patients with abnormal MRI findings had seizures. Abnormal cerebral MRI findings had a predictive accuracy of 85%. Only 14% of patients had been diagnosed by radiologic imaging. Diastolic blood pressure and elevated serum levels of liver enzymes predicted abnormal MRI findings with 83% accuracy. Thirty-three women underwent emergency cesarean section. Labor was induced in 5 cases, leading to vaginal delivery. Three women delivered spontaneously. The neonatal prognosis was consistently good, and all women recovered without sequelae.Although MRI may not be clinically cost-effective when done routinely in women with preeclampsia, it is recommended when delivery is delayed in those with severe preeclampsia. This is especially the case when diastolic blood pressure and liver enzymes are elevated. In women with eclampsia, MRI should be repeated until cerebral edema no longer is present. ABSTRACTPreterm birth (PTB) remains the leading cause of perinatal morbidity and mortality and also is associated with cerebral palsy and suboptimal performance at school. Adverse outcomes are especially likely if there is intrauterine infection and inflammation. Because of its subclinical nature, however, the diagnosis depends on examining amniotic fluid, a relatively invasive procedure. In this study, amniotic fluid and cervical fluid were evaluated, and the presence in the latter of interleukin (IL)-6 and IL-8 was related to microbial invasion of amniotic fluid, intraamniotic inflammation, and PTB in women with singleton pregnancies who were in preterm labor before 34 weeks gestation and whose membranes were intact. Cervical fluid was sampled from the external cervical os within 12 hours of admission in 91 women and amniotic fluid in 56. The polymerase chain reaction technique was used to detect Ureaplasma urealyticum and Mycoplasma hominis. Interleukins 6 and 8 were estimated by enzyme-linked immunosorbent assay.Women had a median gestational age of 30 weeks at the time of the study; 38% delivered before 34 weeks gestation. No woman had clinical chorioamnionitis. Although the presence o...