Excellent correlations were found for both observers in the use of rotation angles of 15 degrees and 30 degrees . Since a significantly faster evaluation was obtained by using a 30 degrees rotation step it must be preferred to assess the FB volume. Our results show that the VOCAL technique, with a plane rotation of 30 degrees , can be used in a simple way to estimate fetal urine production.

Statistical data indicate that rates of caesarean births are increasing worldwide, 1 being particularly high in some countries, including Brazil; 2 however, consensus ends here. This is a controversial subject, particularly with regard to what would be the ideal caesarean rate and what are the determinants of high caesarean rates in some countries. Although factors that seem to contribute to a rise in caesarean rates all over the world are probably common to different countries, the reasons why countries with similar characteristics have distinct caesarean rates whereas high rates are observed in countries with different social and economic status are questions that reinforce this conundrum. 1Rates of caesarean births in Brazil have increased in the last decades. 2 In the early 1970s the rate of caesarean births in Brazil was close to 15%. The rate increased to 30% in the early 1980s, achieving 40% in the early 1990s. The stability observed in the period 1990-2000 was followed by an additional increase, which took the caesarean rates above 50% in 2012;2,3 however, these rates should be viewed in more detail, taking into account geographic and financial variations.Regarding regional differences, caesarean rates are in the range 35-45% in some states of Brazil, especially those in the north and north-east regions, which are more rural and poorer. On the other hand, states in the south, southeast, and central west regions, which are typically urban and wealthier states, have rates in the range 55-65%.3 As shown in Figure 1, the caesarean rate for Brazil as a whole is markedly affected by the high incidence of caesarean sections performed in the richest states of the country, which are also more densely populated, and where the number of deliveries is greater.The most remarkable discrepancies are observed when caesarean delivery rates in the public and private sectors are compared. According to population-based studies, caesarean rates in the private sector are significantly higher (80-90%) 2,4 than in the public system (35-45%). 2,4 As the vast majority of health care in the private sector is provided through health insurance, the percentage rates of caesarean births in Brazilian states are significantly associated with the local coverage of private health insurance (Figure 2). These data indicate that the high rates of caesarean sections in Brazil are related to the characteristics of the private sector of the health system. In this context, it is important to emphasise that the obstetric care provided by health insurance is centred on the doctor, without the participation of other professionals, and in opposition to the guidelines and models of multidisciplinary attendance recommended by Brazilian and international organisations.5 Most private obstetricians, as well as anaesthetists and paediatricians, go to the hospital after a phone call to tell them that their patients have gone into labour, regardless of the day of the week or time of day. 6This feature obviously does not favour intended vaginal deliveries, w...

We report the prenatal diagnosis of 2 cases of Pentalogy of Cantrell in the first trimester. In case 1, sonographic evaluation revealed ectopia cordis, omphalocele, and cystic hygroma at 10 weeks' gestation. In case 2, sonographic assessment during the first trimester detected ectopia cordis and omphalocele at 11 weeks' gestation. In both cases, the patient opted for elective pregnancy termination, and Pentalogy of Cantrell was confirmed in 2 male fetuses. We discuss the role of Doppler imaging and 3-dimensional sonography as complementary methods to conventional sonographic assessment of abdominal wall defects at early pregnancy.

We report a case of a 23-year-old pregnant woman, who underwent amniocentesis after ultrasound (US) examination in the first trimester which revealed a nuchal translucency thickness of 2.9 mm. Cytogenetic analysis revealed complete tetrasomy of the short arm of chromosome 9. Further US evaluation in the second trimester revealed Dandy-Walker malformation, ventriculomegaly, bilateral clubfoot, lip and palate clefts, arthrogryposis and hyperechoic kidneys with bilateral pelvic dilatation. At 30 weeks of gestation, a placental abruption was noted and a Cesarean section was performed. The infant died shortly after birth. A review of previous cases of tetrasomy 9p shows that the remarkable sonographic findings are ventriculomegaly, intrauterine growth restriction, genitourinary anomaly, Dandy-Walker malformation, cleft lip/palate and limb malformation, but the association of tetrasomy 9p and increased nuchal translucency had not been reported.

Maternal hypertension may alter physiological parameters, dysregulating the release of hormones such as adipokines, thus influencing the fetal growth course. This study investigated whether hypertensive disorders of pregnancy alter cord blood adipokine levels and correlate these with anthropometric parameters in preterm infants. This is a prospective cohort study with pregnant women < 37-week gestation with and without hypertension and their offspring. Cord blood leptin, adiponectin, and ghrelin were analyzed by LUMINEX®. These adipokines were compared between the groups exposed or not to gestational hypertension using non-parametric statistical tests. The hypertensive pregnancies had significantly higher cord blood leptin (1.00 (IQR 0.67-1.20 ng/mL)) and adiponectin (18.52 (IQR 17.52-25.13 μg/mL)) levels than those without hypertension (0.07 (IQR 0.06-0.08 ng/mL) and 8.13 (IQR 6.50-8.68 μg/mL), respectively, p < 0.0001). The adipokine levels were higher in AGA and SGA infants in the exposed group for both moderate and late preterm. SGA had significantly higher ghrelin levels than the AGA infants. Ghrelin levels were negatively correlated with birth weight (r = − 0.613, p < 0.001), birth length (r = − 0.510, p < 0.001), head circumference (− 0.346, p < 0.002), and gestational age (r = − 0.612, p < 0.001).Conclusions: Our findings demonstrate an increase in adipokine levels in the cord blood of preterm newborn infants exposed to maternal hypertension. What is Known:• Clinical evidence suggests that concentration of the serum adipokines may be affected by risk of hypertension in both adults and pregnant women.• Maternal profile as hypertension alters intrauterine environment and could affect the function of fetal metabolism, impairing fetal growth.