Prenatal Diagnosis and Management of a Fetal Goiter Hypothyroidism due to Dyshormonogenesis.

Fetal goiter is a rare disorder not expected to be found during a healthy woman's pregnancy. It can be a prenatal manifestation of congenital hypothyroidism due to thyroid dyshormonogenesis and it can lead to serious perinatal complications. A vascularized fetal neck mass was detected at 29 weeks' gestation of a healthy primigravida. Magnetic resonance was suggestive of goiter causing airway deviation without polyhydramnios. Maternal thyroid function was normal and thyroid antibodies were negative. Two intra-amniotic levothyroxine infusions were performed at 32 and 33 weeks. Serial imaging control showed no progression of the mass. Elective caesarean section was performed at 38 weeks. The male newborn was admitted to the intensive care unit due to cardiorespiratory insufficiency with pulmonary hypertension. Hormonal assays revealed primary congenital hypothyroidism and ultrasonography confirmed diffuse goiter. Levothyroxine was started. Currently, he is 6 years old with adequate growth and normal psychomotor development. Genetic study found a heterozygous mutation in the TPO gene.

Is it Worth to Evaluate the Fetal Heart With Color Doppler Scan at 11 to 13+6 Weeks?

This study was conducted to try to achieve the success rate to detect fetal cardiac malformations and/or tricuspid regurgitation with color Doppler during first trimester ultrasound scan within a short period (less than 3 minutes) in a general low-risk population. For this purpose, we started a prospective study, evaluating 240 consecutive single pregnancies, by a single examiner, during the first trimester ultrasound scan (crown to rump length between 45 and 84 mm) using a Voluson E8 system (GE Healthcare, Zipf, Austria) with a 2- to 8-MHz RAB 4-8-D transabdominal probe. Pulsed-wave and color Doppler flow mapping was used to assess the blood flow through the tricuspid valve. In addition, color Doppler was used to evaluate the 4-chamber view, the great vessels ("V sign"), and the right subclavian artery. Blood flow in the tricuspid valve could be examined in 206 cases (85.8%). Of these, tricuspid regurgitation was detected in 17 cases (7.1%) with both pulsed-wave and color Doppler. The 4-chamber view, the V sign, and the right subclavian artery could be evaluated in 188 cases (78.3%). One case of aberrant right subclavian artery and 2 suspicious of cardiac malformations were detected. In our opinion, using color Doppler during first trimester ultrasound scan, even for a short period (<3 minutes), probably adds important information about the fetal heart.

Mother's anxiety and depression and associated risk factors during early pregnancy: effects on fetal growth and activity at 20-22 weeks of gestation.

To examine effects of mother's anxiety and depression and associated risk factors during early pregnancy on fetal growth and activity. Repeated measures of mother's anxiety (State-Anxiety Inventory (STAI-S)) and depression (Edinburgh Postnatal Depression Scale (EPDS)) and related socio demographics and substance consumption were obtained at the 1st and 2nd pregnancy trimesters, and fetus' (N = 147) biometric data and behavior was recorded during ultrasound examination at 20-22 weeks of gestation. Higher anxiety symptoms were associated to both lower fetal growth and higher fetal activity. While lower education, primiparity, adolescent motherhood, and tobacco consumption predicted lower fetal growth, coffee intake predicted lower fetal activity. Vulnerability of fetal development to mother's psychological symptoms as well as to other sociodemographic and substance consumption risk factors during early and mid pregnancy is suggested.