Anatomic parameters of omphaloceles and their association with anatomic, genetic, or syndromic malformations: a retrospective study.

PURPOSE: This retrospective study aims to describe anatomical parameters of omphaloceles and to analyze their association with anatomical, genetic, or syndromic malformations. METHODS: Cases were selected from digital records of two university centers, a certified regional registry and personal records. Patients from 1998 to 2018 with omphalocele and live birth (LB), termination of pregnancy due to fetal anomaly (TOPFA) and fetal death (FD) were included. Cases born outside Western Switzerland and/or with upper or lower coelosomy were excluded. RESULTS: We analyzed 162 cases with the following distribution: 57 (35%) LB, 91 (56%) TOPFA and 14 (9%) FD. TOPFA was significantly more frequently performed in cases with non-isolated omphalocele, i.e., omphaloceles with associated major malformations (especially cardiovascular and genitourinary), genetic/chromosomal anomalies, or syndromes. For LB, associated anatomical malformations, genetic or chromosomal anomalies were not significantly associated with the size of the omphalocele or the liver involvement. CONCLUSIONS: The proportion of cases resulting in TOPFA was higher among fetuses with major malformations, genetic or chromosomal anomalies. Despite the large size of this cohort, and in contrary to previous publications, the size of the omphalocele and/or liver involvement does not allow for conclusions regarding the presence or number of associated malformations, genetic or chromosomal anomalies.

Congenital toxoplasmosis after adalimumab treatment before pregnancy.

We present a case of congenital toxoplasmosis (TXP) in a woman with Toxoplasma gondii infection more than 6 months before conception. The woman has been treated with adalimumab for ankylosing spondylitis for 4 years until 5 months before conception. TXP serology at the first trimester was compatible with infection prior pregnancy. An ultrasound performed at 26 weeks gestation (WG) showed cerebral echogenic lesions compatible with intrauterine infection. Amniocentesis was performed which confirmed TXP fetal infection. Termination of the pregnancy was performed upon parent's requests and the fetal autopsy confirmed the diagnosis. Here, we discuss the potential role of immunosuppressive treatments, such as adalimumab, in the risk of congenital toxoplasmosis and the importance of counseling before pregnancy.

[Out-of-hospital delivery : present state and perspectives]. / Accouchement extrahospitalier : état des lieux et perspectives.

Out-of-hospital delivery is rare in Switzerland and it accounted for 2,5 % of all the births in 2015. In Switzerland, out-of-hospital childbirth is not subject to any official regulations. It takes place mainly in midwifery units (1,6 %) and at home (0,9 %), by independent midwifes. One in six women needs to be transferred to a hospital because of complications. Perinatal mortality is higher in out-of-hospital childbirth and the hospital is the safest place to give birth. The level of intervention may be lower, maybe because the women choosing to give birth in alternative settings are at lower risk.

L'accouchement extrahospitalier est un phénomène rare en Suisse et concernait 2,5 % des naissances en 2015. En Suisse, il n'est pas soumis à une réglementation officielle. Il a lieu majoritairement en maison de naissance (1,6 %) puis à domicile (0,9 %), par une sage-femme indépendante. Parmi ces parturientes, une femme sur six doit être référée à une équipe hospitalière en raison de complications durant le travail. La mortalité périnatale est plus élevée lors d'un accouchement extrahospitalier, ce qui place l'hôpital comme le lieu le plus sûr pour accoucher. En contrepartie, le niveau d'intervention pourrait être plus bas quand l'accouchement est planifié hors de l'hôpital, mais ceci pourrait être dû au fait que ces femmes sont à bas risque.

Severe and Progressive Fetal Ventriculomegaly Leading to the Diagnosis of Periventricular Nodular Heterotopias with Good Outcome.

Severe fetal ventriculomegaly is generally associated with poor prognosis in terms of survival and neurodevelopment outcome. As such, many parents opt to terminate the pregnancy independently of a known etiology. We report here the case of a female fetus with severe progressive ventriculomegaly due to the unexpected presence of bilateral nodular periventricular heterotopias visualized on MRI of a fetal brain. Reaching a structural diagnosis was perceived as a relief for the parents and the pregnancy was continued. Neurodevelopment assessment at 3 years of age is normal with no epilepsy.