Peri- and intraventricular cerebral sonography in second- and third-trimester high-risk fetuses: a comparison with neonatal ultrasound and relation to neurological development.

OBJECTIVES: To determine whether periventricular leukomalacia (PVL) and peri- and intraventricular hemorrhages can be detected in fetuses at risk for preterm birth and to establish the clinical significance of this finding. METHODS: Prenatal cerebral sonography was performed in 26 fetuses at risk for uteroplacental insufficiency on the day of inclusion into the study and weekly until delivery. Neonatal cerebral ultrasound examination was performed within 24 h of birth and biweekly until discharge. The infants underwent standardized neurological examinations. RESULTS: During 30 observations, 21/26 fetuses presented in a cephalic position. Successful visualization in the coronal and sagittal planes was significantly correlated with that of a control population (r = 0.615; 95% CI, 0.390-0.771). In 20/21 fetuses at least one observation was adequate for analysis. Eleven cerebral abnormalities were found in nine fetuses, periventricular echodensities in four, intraventricular hemorrhage in two, and localized thalamic densities in five. In six of these infants ultrasound abnormalities persisted after birth. Neurological follow-up at 24 months demonstrated abnormalities in three infants, two infants were normal and one was lost to follow-up. The three infants with normal ultrasound results after birth had a normal follow-up. Five infants with normal antenatal ultrasound results showed ultrasound abnormalities during the neonatal period; four of them developed PVL Grade 1 and one developed PVL Grade 2. The follow-up of two of these infants was normal, two died and one developed spastic tetraplegia. Abnormal antenatal brain sonography was significantly correlated with gestational age at birth (r = 0.487; P = 0.029). CONCLUSION: Peri- and intraventricular echodensities can be detected reliably before birth in fetuses at high risk for uteroplacental insufficiency. When abnormalities persist, there is a high risk for an adverse outcome.

Ultrasonography of the peri- and intraventricular areas of the fetal brain between 26 and 36 weeks' gestational age; a comparison with neonatal ultrasound.

OBJECTIVES: To determine to what extent the peri- and intraventricular areas of the fetal brain can be visualized in coronal and sagittal planes using high-frequency transvaginal ultrasound. DESIGN: In a longitudinal study, fetuses of 30 low-risk pregnancies were studied at 26, 28, 30, 32, 34 and 36 weeks' gestational age. The neonates were examined within the first week of life. Visualization of the peri- and intraventricular areas was systematically scored in six coronal and five sagittal planes. The degree of echogenicity of the periventricular area was assessed. Inter- and intra-observer agreements were calculated. RESULTS: For fetuses in the cephalic position, the highest percentages of visualization of the planes were obtained between 26 and 32 weeks' gestational age (> 70% in four coronal and three sagittal planes). Transient periventricular echodensities were observed at 26 and 28 weeks' gestational age in 6/39 observations in the cephalic position. Small choroid plexus cysts were found in three fetuses with the changes persisting in two until after birth. Seven neonates developed mild periventricular echodensities/translucencies not present during fetal development. The mean interobserver agreement was 0.77 (95% confidence interval (CI) 0.73-0.81). The intra-observer agreement varied between 0.48 and 0.72 (mean 0.6, 95% CI 0.47-0.75). CONCLUSIONS: Transvaginal ultrasonography can be applied as a diagnostic tool to evaluate the peri- and intraventricular areas of the fetal brain. Transient periventricular densities can be encountered between 26 and 28 weeks. Term low-risk neonates may develop transient periventricular densities or translucencies.

Prenatal development of arm posture.

Fetal arm posture was studied longitudinally in 10 uncomplicated pregnancies using real-time ultrasound. Observation were performed at four weekly intervals from 12 to 36 weeks, and at 38 weeks. The percentage of assessments with optimal visualization of elbow, wrist and fingers was 84% at 12 weeks and more than 90% thereafter (range 92-98%). There was a clear developmental trend towards increased flexion. Flexion of the elbow occurred frequently from 12 weeks onwards with an increased incidence at 16 weeks, that in the fingers from 20 weeks onwards and from 28 weeks to term age in the wrist. All three trends were statistically significant. There was considerable intra-individual consistency in terms of the ages at which flexion increased. In fact the increase of flexion occurred one session later in only 6/30 registrations. The combined data of the elbow, wrist and fingers revealed preferential arm posture at 12 weeks with the elbow flexed and the wrist and fingers extended. From 16 to 28 weeks, the predominant posture consisted of elbow flexion, wrist extension and finger flexion and complete flexion thereafter. The development of fetal arm posture does not comply with a proximo-distal trend in that there was first an increase in flexion at the elbow, followed by the fingers and finally the wrist. The implications of our findings for understanding the prenatal development of the central nervous system and subsequent postural adjustments to extrauterine life are discussed.

The effect of flecainide acetate on fetal heart rate variability: a case report.

BACKGROUND: Fetal supraventricular tachycardia is most often treated by maternal application of digoxin. A drug used for second-choice therapy is flecainide acetate. CASE: For a case in which maternal digoxin therapy failed, flecainide caused a lowering of the fetal heart rate (FHR) but, simultaneously, variability and accelerations nearly disappeared. The fetus demonstrated a normal movement pattern. Fetal well-being during delivery was assessed by regular ultrasound observations of fetal movements. Flecainide was not continued after birth, and digoxin therapy was started when tachycardia reappeared. The heart rate changed into a reactive pattern 5 days after birth. Around that time, flecainide levels in the neonatal serum were below the limit of detection. CONCLUSION: Flecainide use can cause the absence of accelerations and poor variability in the FHR.