Maternal serum placental growth factor at 11-13 weeks in chromosomally abnormal pregnancies.

OBJECTIVES: To investigate the potential value of maternal serum placental growth factor (PlGF) in first-trimester screening for trisomy 21 and other major chromosomal abnormalities. METHODS: The maternal serum concentration of PlGF at 11 + 0 to 13 + 6 weeks was measured in 609 euploid and 175 chromosomally abnormal pregnancies, including 90 with trisomy 21, 28 with trisomy 18, 19 with trisomy 13, 28 with Turner syndrome and 10 with triploidy. The levels of PlGF were compared in cases and controls, and were assessed for association with free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A). RESULTS: Logistic regression analysis demonstrated in the euploid group that significant independent contributions for log PlGF were provided by fetal crown-rump length, maternal weight, cigarette smoking and ethnic origin; after correction for these variables the median multiple of the median (MoM) PlGF was 0.991. Significantly lower values were observed in pregnancies with trisomy 21 (0.707 MoM), trisomy 18 (0.483 MoM), trisomy 13 (0.404 MoM), triploidy (0.531 MoM) and Turner syndrome (0.534 MoM). Significant contributions in the prediction of trisomy 21 were provided by maternal age, serum PlGF, PAPP-A and free beta-hCG, and the detection rates of screening with the combination of these variables were 70% and 80% at respective false-positive rates of 3% and 5%. CONCLUSIONS: Maternal serum PlGF concentration at 11-13 weeks of gestation is potentially useful in first-trimester screening for trisomy 21 and other major chromosomal abnormalities.

Prenatal diagnosis of left atrial isomerism.

OBJECTIVE: To describe the cardiac anomalies and outcome in the fetus with left atrial isomerism. METHODS: All fetuses with a diagnosis of left atrial isomerism between 1998 and 2008 were identified. Gestational age at diagnosis, the nuchal translucency, the karyotype, the cardiac findings and outcome were noted. A literature search from 1990 identified four publications reporting 10 or more cases of fetal left atrial isomerism. The same data, where available, were collected from these papers for comparison. RESULTS: There were 41 fetuses with this diagnosis seen in our centre. All cases had an interrupted inferior vena cava with azygous continuation. Associated cardiac defects were similar in our series and in the 129 cases reported in the literature and are therefore grouped together. They included complete atrioventricular septal defect (68%), complete heart block (38%), viscerocardiac heterotaxy (54%), double outlet right ventricle (23%), right ventricular outflow tract obstruction (35%), left ventricular outflow tract obstruction (21%) and total anomalous pulmonary vein drainage (5%). In our series, there were 22 pregnancy terminations, seven intrauterine deaths, one neonatal death, one infant death and one was lost to follow-up. Of the continuing pregnancies only 50% in our series and 60% in the reported series survived. CONCLUSION: Left atrial isomerism presents a varied spectrum of cardiac malformations when it is detected prenatally. Complete heart block, complex cardiac abnormalities and fetal hydrops are poor prognostic features. Those with only minor cardiac malformations are at risk postnatally for biliary atresia and for bowel obstruction due to malrotation.

Maternal serum placental growth factor at 11 + 0 to 13 + 6 weeks of gestation in the prediction of pre-eclampsia.

OBJECTIVE: To investigate the potential value of maternal serum placental growth factor (PlGF) in first-trimester screening for pre-eclampsia (PE). METHODS: The concentration of PlGF at 11 + 0 to 13 + 6 weeks' gestation was measured in samples from 127 pregnancies that developed PE, including 29 that required delivery before 34 weeks (early PE) and 98 with late PE, 88 cases of gestational hypertension (GH) and 609 normal controls. The distributions of PlGF multiples of the median (MoM) in the control and hypertensive groups were compared. Logistic regression analysis was used to determine the factors with a significant contribution for predicting PE. RESULTS: In the control group significant independent contributions for log PlGF were provided by fetal crown-rump length, maternal weight, cigarette smoking and racial origin, and after correction for these variables the median MoM PlGF was 0.991. In the early-PE and late-PE groups PlGF (0.611 MoM and 0.822 MoM, respectively; P < 0.0001) and pregnancy-associated plasma protein-A (PAPP-A) (0.535 MoM; P < 0.0001 and 0.929 MoM; P = 0.015, respectively) were reduced but in GH (PlGF: 0.966 MoM; PAPP-A: 0.895 MoM) there were no significant differences from controls. Significant contributions for the prediction of PE were provided by maternal characteristics and obstetric history, serum PlGF and uterine artery pulsatility index (PI) and with combined screening the detection rates for early PE and late PE were 90% and 49%, respectively, for a false-positive rate of 10%. CONCLUSION: Effective screening for PE can be provided by a combination of maternal characteristics and obstetric history, uterine artery PI and maternal serum PlGF at 11 + 0 to 13 + 6 weeks' gestation.

Delayed interval delivery in twin pregnancy: a case report. We present a case of delayed interval delivery in twins.

We report a case of diamniotic, dichorionic pregnancy presented at 24 weeks with premature rupture of the first amnionic sac. Seven days later, premature labour and delivery of the first twin took place, with unfortunate outcome. The second twin was left in utero. The management included combination of tocolytics, antibiotics and cervical cerclage. Caesarean section was performed 48 days later, at 32 weeks and we delivered a live male infant, successfully.