Isolated short femur in the second-trimester US examination is associated with a subsequent delivery of SGA and LBW neonates.

Objective: To determine the association of amniotic fluid sludge with impending preterm delivery in women in preterm labor with intact membranes. Methods: This was a retrospective cohort study in women at 22–34 weeks’ gestation in preterm labor with intact fetal membranes between February 2008 and May 2009. 16 women with amniotic sludge were identified. Each case of amniotic sludge was matched with 3 randomly selected controls. The primary outcome was delivery within 48 h of examination. Results: Mean cervical length was shorter in women with sludge than women without sludge (20.5 ± 9.0 vs. 27.9 ± 6.9 mm, p = 0.0016). There was a significant difference in the mean ultrasound-to-delivery interval in women with and without sludge (21.7 vs. 49.4 days, p = 0.006). Logistic regression analyses demonstrated that amniotic fluid sludge is a strong independent predictor of impending preterm delivery within 48 h (OR 11.2, 95% CI 1.2–125.9), 7 days (OR 3.8, 95% CI 1.2–17.3) and 14 days (OR 7.5, 95% CI 1.8–30.4). Conclusions: Amniotic fluid sludge on ultrasound scan is associated with impending preterm delivery in women in preterm labor with intact membranes.

Prenatal imaging and postnatal pathologic work-up in a case of fetal hepatic hamartoma and placental mesenchymal dysplasiaFetal hamartoma constitutes a rare benign lesion of the mesenchymal tissue. We describe here the antenatal diagnosis and management of a giant hepatic mesenchymal hamartoma in conjunction with placental mesenchymal dysplasia.A 29-year-old woman, gravida 2 para 1, was referred to our tertiary center at 13 + 3 weeks' gestation because of a large space-occupying lesion arising from a multiloculated placenta. The initial sonographic findings were suspicious for a partial hydatidiform placenta in addition to a stalked hypoechogenic round structure connected to the placenta, consistent with a placental chorangioma. Maternal β-human chorionic gonadotropin (β-hCG) and alpha fetoprotein (AFP) levels were within normal ranges. The fetus showed normal biometric measurements. Nuchal translucency screening revealed a risk of 1 in 2959 for trisomy 21. Biweekly follow-up scans were performed. At 20 weeks, targeted ultrasound revealed a hypoechogenic infradiaphragmatic cystic mass ( Figure 1). The lesion measured 19 × 17 × 19 mm and showed marked septation and rapid growth, reaching a size of 74 × 47 × 50 mm by 23 weeks without measurable perfusion (Figure 2). At this time the diagnosis of a large progredient hamartoma was assumed. At 27 + 4 weeks inpatient admission was necessary because of preterm labor, prompting an immediate Cesarean section. Preoperative ultrasound showed continuing growth of the hepatic mass to 98 × 73 × 86 mm. A premature female infant was delivered weighing 1452 g, with Apgar scores of 5 and 8 at 5 and 10 min, respectively.The infant was immediately admitted to the neonatal unit in good general condition.Repeat abdominal punctures of the cystic lesion were performed for decompression and optimization of pulmonary function (removal of a total of 760 mL of clear fluid). The mass subsequently decreased in size, leaving an echogenic area in the left hepatic lobe. Gross inspection showed a huge jelly-like placenta with multiple cysts, as seen prenatally. Histopathological findings and immunohistochemistry were consistent with placental mesenchymal dysplasia (PMD) (Figure 3).Several terms have been used in previously published reports that allude to the same placental condition, such as mesenchymal stem villous hyperplasia or pseudopartial mole 1,2 . However, the main characteristic finding, apart from enlarged dysplastic villi with myxoid stroma, is the absence of abnormal trophoblast proliferation in contrast to hydatidiform mole.The differential diagnosis of PMD and its postpartum confirmation is of particular importance, as it might mimic a molar placenta. This placental anomaly is potentially associated with an adverse pregnancy outcome, including intrauterine growth restriction, fetal demise and neonatal death. Recent reports suggest a female : male ratio of PMD of 4:1 3 . The vascular endothelial growth factor-D, which has been mapped to Xp22.31, may play a key role 3,4 . According ...

We report a fetus scanned by color Doppler ultrasound at 37 weeks for suspicion of growth restriction with an extremely rare variation of duplicated middle cerebral artery. Three-dimensional color power Doppler and tomographic ultrasound imaging enhanced our incidental finding.

Antecedentes: El hallazgo ecográfico de fémur corto (longitud menor del percentil 5) en la valoración ecográfica rutinaria del feto del segundo trimestre plantea un desafío diagnóstico y de manejo. Clásicamente ha sido asociado a cromosomopatías y displasia esquelética. Existen pocos reportes que valoran los resultados perinatales de los fetos con fémur corto en el examen del segundo trimestre. Objetivos: Determinar la asociación de fetos con fémur corto aislado en fetos del segundo trimestre y recién nacidos con restricción del crecimiento intrauterino (RCIU) y su asociación con otros resultados perinatales adversos. Diseño: Estudio de cohorte retrospectivo. Institución: Unidad de Medicina Fetal, Instituto Nacional Materno Perinatal, Lima, Perú. Participantes: Gestantes de 16 a 28 semanas. Intervenciones: Para cumplir con el tamaño muestral, se seleccionó los fetos evaluados durante el periodo de tres años (2006 a 2008) que cumplieron los criterios de inclusión. Se clasificó los fetos de 278 gestantes de 16 a 28 semanas en dos grupos: 89 con longitud de fémur corto aislado como único hallazgo, sin RCIU al momento de la evaluación (casos), y 189 fetos con longitud de fémur normal (controles). Se excluyó las gestantes cuyos fetos tenían anormalidades cromosómicas o estructurales y aquellas gestaciones con embarazos múltiples. Se realizó un análisis univariado mostrando porcentajes y medidas de tendencia central y un análisis bivariado con la prueba t, para las variables continuas, y la prueba exacta de Fisher, para las variables categóricas. Principales medidas de resultados: Asociación del fémur corto fetal con complicaciones fetales y maternas. Resultados: El grupo de fetos con fémur corto aislado tuvo recién nacidos con peso promedio significativamente menor que las gestantes de fetos con longitud de fémur normal, con una diferencia estadística y clínicamente significativa de 412,3 g (P=0,000), encontrándose un mayor porcentaje de recién nacidos con RCIU en 14,6% versus 6,8% en el grupo control (p=0,000). Calculamos un OR de 2,32 (IC95%:1,03 a 5,23) para RCIU. Además, se observó que las gestantes con fetos de fémur corto aislado desarrollaron hipertensión gestacional (11,2% versus 4,8%, p=0,046) y preeclampsia (11,2% versus 2,1%, p=0,001). Asimismo, hubo mayor número de casos con puntaje de Ápgar <7 a los 5 minutos en el grupo de fetos con fémur corto (4,5% versus 0,5%, p=0,02). Igualmente, hubo dos casos de muerte perinatal en el grupo de fetos con fémur corto aislado. Conclusiones: El fémur corto, como hallazgo ecográfico aislado en fetos del segundo trimestre, está asociado a recién nacidos con RCIU y con gestaciones complicadas con hipertensión gestacional o preeclampsia. Este es la cohorte más grande publicada hasta el momento de fetos con fémur corto aislado.