Machine Learning to Predict Outcomes of Fetal Cardiac Disease: A Pilot Study.

Prediction of outcomes following a prenatal diagnosis of congenital heart disease (CHD) is challenging. Machine learning (ML) algorithms may be used to reduce clinical uncertainty and improve prognostic accuracy. We performed a pilot study to train ML algorithms to predict postnatal outcomes based on clinical data. Specific objectives were to predict (1) in utero or neonatal death, (2) high-acuity neonatal care and (3) favorable outcomes. We included all fetuses with cardiac disease at Sunnybrook Health Sciences Centre, Toronto, Canada, from 2012 to 2021. Prediction models were created using the XgBoost algorithm (tree-based) with fivefold cross-validation. Among 211 cases of fetal cardiac disease, 61 were excluded (39 terminations, 21 lost to follow-up, 1 isolated arrhythmia), leaving a cohort of 150 fetuses. Fifteen (10%) demised (10 neonates) and 65 (48%) of live births required high acuity neonatal care. Of those with clinical follow-up, 60/87 (69%) had a favorable outcome. Prediction models for fetal or neonatal death, high acuity neonatal care and favorable outcome had AUCs of 0.76, 0.84 and 0.73, respectively. The most important predictors for death were the presence of non-cardiac abnormalities combined with more severe CHD. High acuity of postnatal care was predicted by anti Ro antibody and more severe CHD. Favorable outcome was most predicted by no right heart disease combined with genetic abnormalities, and maternal medications. Prediction models using ML provide good discrimination of key prenatal and postnatal outcomes among fetuses with congenital heart disease.

Guideline No. 401: sonographic cervical length in Singleton Pregnancies: techniques and clinical applications

To assess the association between sonography-derived cervical length measurement and preterm birth. To describe the various techniques to measure cervical length using sonography. To review the natural history of the short cervix. To review the clinical uses, predictive ability, and utility of sonography-measured short cervix. Reduction in rates of prematurity and/or better identification of those at risk, as well as possible prevention of unnecessary interventions. Intended Users Clinicians involved in the obstetrical management or cervical imaging of patients at increased risk of a short cervix. Women at increased risk of a short cervix or at risk of preterm birth. Literature published up to June 2019 was retrieved through searches of PubMed and the Cochrane Library using appropriate controlled vocabulary and key words (preterm labour, ultrasound, cervix, cervical insufficiency, transvaginal, transperineal, cervical length, fibronectin). Results were restricted to general and systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies. There were no date or language restrictions. Grey (unpublished) literature was identified through searching the websites of health technology assessment agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The evidence and this guideline were reviewed by the Diagnostic Imaging Committee of the Society of Obstetricians and Gynaecologists of Canada, and the recommendations were made and graded according to the rankings of the Canadian Task Force on Preventive Health Care ( Online Appendix Table A1). Preterm birth is a leading cause of perinatal morbidity and mortality. Use of the sonographic technique reviewed in this guideline may help identify women at risk of preterm birth and, in some circumstances, lead to interventions that may reduce the rate of preterm birth.

No. 352-Technical Update: the role of early comprehensive fetal anatomy ultrasound examination

OBJECTIVE: This guideline presents an evidence-based technical update and recommendations for the performance of early comprehensive fetal anatomic scanning (ECFAS) at 11 to 16 weeks' gestation. OPTIONS: Patients at high risk for fetal anomalies and in whom traditional mid-second trimester transabdominal imaging may be challenging or who may benefit from earlier identification of fetal anomalies may be suitable for early fetal anatomy scanning. OUTCOMES: This practice may result in earlier identification of fetal anomalies and provide earlier intervention options in high-risk populations and/or in populations where mid-econd trimester transabdominal scanning is challenging. TARGET POPULATION: This population consists of obstetrical patients in whom mid-second trimester ultrasound scanning will be technically challenging and patients who are at higher risk for major fetal anomalies. EVIDENCE: Published literature was retrieved through searches of PubMed and Medline in 2016 using key words. Results were restricted to controlled clinical trials, reviews, and observational studies published in English. There were no date restrictions, and searches were updated in the guideline to 2016. Grey (unpublished) literature was identified through searching the websites of health technology assessment and clinical practice guidelines and national and international medical specialty societies. No relevant studies were found. VALIDATION METHODS: The content and recommendations were drafted and agreed on by the principal authors. The Board of the SOGC approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework. BENEFITS, HARMS, AND/OR COSTS: It is anticipated that there will be an increase in earlier detection of major fetal anomalies in the target population with the benefits of earlier interventions for those individuals. In areas where the service is not available the patient may need to travel to a nearby centre. Early fetal anatomy scanning is considered to be safe and is not expected to cause a risk to the pregnancy. GUIDELINE UPDATE: Evidence will be reviewed 5 years after publication to decide whether all or part of the guideline should be updated. However, if important new evidence is published before the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations. SPONSORS: This technical update was developed with resources funded by the SOGC.

2-Methoxyestradiol regulates VEGFR-2 and sFlt-1 expression in human placenta.

INTRODUCTION: 2-Methoxyestradiol (2-ME), a metabolite of estradiol, has been identified as an initiator of cytotrophoblast transformation to an invasive phenotype, with low levels implicated with the onset of preeclampsia. Here, we investigated the effects of 2-ME on VEGFR-2, sFlt-1 and HIF1α expression in human placenta. METHODS: First trimester human placental villous explants were maintained at 3% and 20% O2. Samples were treated with 0.5 µM 2-ME with or without 1 mM DMOG or 0.2 mM CoCl2 for 17 h. Western and qPCR analyses were performed for VEGFR-2, sFlt-1 and HIF1α expression levels. sFlt-1 specific ELISA was also performed on conditioned explant media. RESULTS: Placental explants maintained at 3% O2 revealed decreased protein and transcript levels of VEGFR-2 with increased sFlt-1 and HIF1α. Overnight treatment with 0.5 µM 2-ME rescued altered expression levels of VEGFR-2, sFlt-1 and HIF1α. 2-ME also decreased levels of sFlt-1 in conditioned explant media. While 2-ME treatment rescued decreased levels of VEGFR-2 in DMOG and CoCl2-treated explants, no effect was observed for sFlt-1 levels. Furthermore, 2-ME was observed to further exacerbate elevated HIF1α levels by DMOG and CoCl2. DISCUSSION: 2-ME rescues altered levels of VEGFR-2, sFlt-1 and HIF1α in hypoxic placental explants, suggesting potential therapeutic measures for the treatment of preeclampsia. However, the unaltered sFlt-1 levels and enhanced HIF1α levels by 2-ME in DMOG and CoCl2 treated explants suggests 2-ME also elicits its effects through HIF1α-independent pathways.

Rhombencephalosynapsis: prenatal imaging and autopsy findings.

OBJECTIVES: Rhombencephalosynapsis is a rare, but increasingly recognized, brain malformation characterized by congenital fusion of the cerebellar hemispheres and absence of the vermis. Rhombencephalosynapsis is associated with significant developmental delay, seizures and involuntary head movements. We report four cases, with correlation of prenatal and postnatal imaging and autopsy findings. METHODS: Over a 2-year period, four cases of rhombencephalosynapsis were diagnosed in the perinatal period, three in one center and one in another center. The clinical cases were reviewed, and correlation was made between the prenatal and postnatal imaging and autopsy findings where available. RESULTS: All cases presented initially with ventriculomegaly on prenatal ultrasound examination. Subsequent magnetic resonance imaging (MRI) established the diagnosis in two cases and postnatal MRI established the diagnosis in a further two cases. Autopsy was available and confirmed the diagnosis in two cases. In one case the pregnancy was terminated, two infants died in the neonatal period and one died in infancy. CONCLUSIONS: The cases in this perinatal series of rhombencephalosynapsis showed a very poor prognosis. The presence of ventriculomegaly on prenatal ultrasound imaging should alert the physician to consider rhombencephalosynapsis in the differential diagnosis. MRI appears to be the imaging modality of choice in establishing the diagnosis.

Singaporean humor: a cross-cultural, cross-gender comparison.

One hundred and nineteen undergraduate students (62 men and 57 women) of Chinese origin at the National University of Singapore answered three self-report humor questionnaires. Students were also asked to supply their favorite joke (M. A. Johnson, 1991) and a description of a person with an outstanding sense of humor (M. Crawford & D. Gressley, 1991). These responses were compared with results obtained using the same questionnaires and methods in previous studies in Israel and the United States. In general, means and reliabilities of results obtained from the Singapore study replicated those found in other countries. However, Singaporean participants reported significantly less use of humor for coping. Content analysis of jokes supplied by Singaporean students reflected conservative values: Compared with American students, they reported a significantly greater number of jokes with aggressive content and relatively fewer jokes with sexual content. Contrary to expectations, very few gender differences were found. Regardless of gender, a majority of participants nominated a man as an example of a person with an outstanding sense of humor.

Johanson-Blizzard syndrome: a prenatal ultrasonographic diagnosis.

Johanson-Blizzard syndrome is a rare autosomal recessive disorder characterized by aplasia of alae nasi, pancreatic insufficiency, aplasia cutis, anorectal anomalies and postnatal growth restriction. In this case report, we describe the prenatal sonographic findings of Johanson-Blizzard syndrome in a 21-week pregnancy of a consanguineous couple. Sonographic findings of aplastic alae nasi (beak-like nose) and dilated sigmoid colon led to the prenatal diagnosis. This is the first report of the prenatal sonographic diagnosis of Johanson-Blizzard syndrome.

Use of humor in managing clinical anxiety.

Going to the dentist can be a stressful event, often causing anxiety in the child patient. A sampling of pediatric dentists was undertaken to study their use of humor in the clinical setting. Dentists use both common and individual types of humor and create a playful/humorous atmosphere with verbal and nonverbal cues to their patients.