A fetal thyroid goiter detected by ultrasonography at 20 weeks of amenorrhea (WA) was diagnosed at 23 WA by a second ultrasound examination and a TSH assay in amniotic fluid. Since a sample of fetal blood at 27 WA showed that hypothyroidism was compensated and that goiter size and amniotic fluid volume were stable, intra-amniotic injection of 300 μg of L-thyroxine was delayed until 36 WA. This injection was performed before delivery to avoid potential perinatal complications (dystocia and neonatal respiratory distress) caused by large goiters.

Background Evidence suggests that cervical cerclage should be offered to women after three or more previous preterm births (PTB) or second-trimester losses. Ultrasound-indicated cerclage reduces the rate of recurrent PTB in women with previous PTB or late miscarriage and a shortening cervix before 24 weeks. Patient selection is therefore critical for this intervention. Aim To assess the impact of a specialist antenatal service for women at risk of PTB on patient selection for cervical cerclage, cerclage rates and pregnancy outcome after surgery. Methods Women undergoing cervical cerclage were identified from the prospectively collected Anaesthetic Obstetric Procedure database and the PTB clinic database at University College London Hospital. Data on cervical cerclage and pregnancy outcomes were collected. Results There were 210 cases of cerclage; 85 cases before the PTB clinic was established (January 2005–December 2008), and 125 cases since (January 2009–December 2012). The rate of cerclage per 1000 women delivered fell from 6 to 5. Median gestational age at cerclage placement fell after establishment of the clinic (17+0/40, 13+2–23+3 to 15+2/40, 12+2–23+4 weeks). The proportion of rescue cerclages fell (26% to 12%) and the proportion of elective cerclages (history-indicated) doubled (44% to 88%). The median GA at delivery increased from 28+2/40 (17+0–39+5) to 35+2/40 (18+0–41+5). Conclusion The introduction of a specialist antenatal service for women at risk of PTB results in better patient selection for cerclage, earlier placement of cerclage, a reduction in rescue cerclages, and a lower rate of PTB and late miscarriage in those women who undergo surgery.

ranged from 11%-61%; no guideline was deemed suitable for use. Only Swiss and Canadian guidelines were considered useable with significant modifications. Conclusion Several international guidelines on perinatal care of 22-25 wk GA infants exist. Using the AGREE-II tool, we identified many deficits in the quality of these guidelines. Not a single guideline was deemed suitable for use using the AGREE-II tool. Use of poorly developed guidelines may be detrimental to decision-making, thus there is a need for transparent and rigorous guidelines regarding the perinatal care of 22-25 wk GA infants.