Nicola Fratelli

ObjectiveTo investigate the natural history, associated abnormalities and outcome in fetuses diagnosed prenatally with agenesis of the corpus callosum (ACC).To investigate the natural history, associated abnormalities and outcome in fetuses diagnosed prenatally with agenesis of the corpus callosum (ACC).MethodsA retrospective study of all cases of prenatally detected ACC was performed in patients referred to two tertiary units between January 1993 and October 2003. Associated abnormalities, pregnancy outcome and infant follow-up were recorded.A retrospective study of all cases of prenatally detected ACC was performed in patients referred to two tertiary units between January 1993 and October 2003. Associated abnormalities, pregnancy outcome and infant follow-up were recorded.ResultsACC was diagnosed in 117 cases. In 82 (70%) cases this was associated with other fetal structural (n = 49) or chromosomal abnormalities (n = 33). ACC was classified as an isolated prenatal finding in 35 (30%) cases. Assuming normal development in all cases lost to follow-up, significant developmental delay was present in 36% (95% CI, 15–65%) of isolated ACC. Furthermore, developmental delay was present in all cases with ventriculomegaly of at least 15 mm and in one of four cases with ventricular measurements less than 15 mm.ACC was diagnosed in 117 cases. In 82 (70%) cases this was associated with other fetal structural (n = 49) or chromosomal abnormalities (n = 33). ACC was classified as an isolated prenatal finding in 35 (30%) cases. Assuming normal development in all cases lost to follow-up, significant developmental delay was present in 36% (95% CI, 15–65%) of isolated ACC. Furthermore, developmental delay was present in all cases with ventriculomegaly of at least 15 mm and in one of four cases with ventricular measurements less than 15 mm.ConclusionsThe outcome of prenatally detected ACC is mainly dependent on the presence or absence of associated anomalies. The full assessment of fetal ACC mandates karyotyping, MRI and a search for more subtle ultrasound features of certain genetic syndromes. In this series, at least 36% (95% CI, 15–65%) of cases with isolated ACC exhibited significant developmental delay when assessed postnatally. Copyright © 2007 John Wiley & Sons, Ltd.The outcome of prenatally detected ACC is mainly dependent on the presence or absence of associated anomalies. The full assessment of fetal ACC mandates karyotyping, MRI and a search for more subtle ultrasound features of certain genetic syndromes. In this series, at least 36% (95% CI, 15–65%) of cases with isolated ACC exhibited significant developmental delay when assessed postnatally. Copyright © 2007 John Wiley & Sons, Ltd.

The metabolic syndrome that occurs in preeclampsia reflects the complex interactions between immunological alterations and the systemic inflammation that have been shown to take place during this complication of human pregnancy. Inositol phosphoglycans play a definite role ...

ABSTRACT To assess the value of early transabdominal uterine artery Doppler ultrasound for the prediction of gestational outcomes in pregnancies at high risk for preeclampsia. This was an observational study. Doppler ultrasound of the uterine arteries at 11-14 weeks of gestation was performed in 76 women at high risk for preeclampsia. Abnormal uterine Doppler was defined by the presence of bilateral notching or by a mean resistance index (RI) >0.80. Adverse outcomes evaluated were preeclampsia, fetal growth restriction, placental abruption, intrauterine death, and complications requiring delivery before 34 weeks of gestation. Among 76 women, 30 (39%) had abnormal uterine Doppler and 46 (61%) had normal Doppler waveform configuration and RI. Abnormal uterine flow was related to a significantly higher incidence of preeclampsia (17% vs. 0%; p = 0.0041), fetal growth restriction (27% vs. 0%; p = 0.0002), intrauterine death (13% vs. 0%; p = 0.0109), and iatrogenic preterm delivery (20% vs. 2%; p = 0.0086). When the Doppler was normal, the negative predictive value for complications requiring delivery before 34 weeks was 98%. Normal impedance to flow in uterine arteries between 11 and 14 weeks of gestation is strongly related to a normal pregnancy outcome in women at high risk for preeclampsia.

To assess the role of first trimester uterine artery Doppler in pregnancies previously complicated by pre-eclampsia. Case-control study in two tertiary referral hospitals. A total of 56 singleton pregnancies in women with a previous pregnancy complicated by pre-eclampsia (Group 1). For each case, two parous controls (Group 2) and two nulliparous controls (Group 3) with normal pregnancy outcome were matched. Doppler examination of the uterine arteries at 11-14 weeks' gestation. Mean uterine artery resistance index (UtARI) and notching. Pregnancy outcome. UtARI did not vary significantly between the three groups (0.73, 0.70 and 0.71, respectively). Women in Group 1 had a significantly higher prevalence of uterine artery notching than those in Group 2 (73 vs 57%, p=0.04). In Group 1, the UtARI and prevalence of notching was not significantly increased when pregnancies were subsequently complicated by pre-eclampsia (p=0.60 and 0.61, respectively). However, in 12 pregnancies requiring delivery before 37 weeks due to pre-eclampsia, fetal growth restriction, abruption or intrauterine fetal death, the UtARI was significantly higher than in the 44 pregnancies with normal outcome (p=0.04). A combination of UtARI and notching showed sensitivities up to 75% and negative predictive values up to 88% for adverse outcome before 37 weeks. In pregnancies following a previous gestation complicated by pre-eclampsia, first trimester uterine artery Doppler findings are similar to those observed in nulliparous women. In these high-risk women, a combination of UtARI and notching can predict the risk of adverse outcome before 37 weeks.