Increased nuchal translucency and diaphragmatic hernia. A case report.

Increased nuchal translucency (NT) thickness is present in 40% of fetuses with diaphragmatic hernia, including 80% of those that result in neonatal death and in 20% of the survivors. A 33-year-old nulliparous woman had first trimester scan at 12 weeks. The fetus had a NT of 2.3 mm, normal ductus venosus (DV), and tricuspid doppler and present nasal bone. Pregnancy-associated plasma protein A (PAPP-A) was 0.59 MoM and beta-human chorionic gonadotropin (b-hCG) 2.56 MoM. The couple did not opt for chorionic villous sampling (CVS) and repeat ultrasound examination was advised. At 18 weeks, ultrasound revealed left sided diaphragmatic hernia. The couple consented for termination of the pregnancy. The molecular test showed normal karyotype and male gender. In such cases with intrathoracic herniation of abdominal viscera, the increased NT may be the consequence of venous congestion due to mediastinal compression. The prolonged compression of the lungs causes pulmonary hypoplasia. Increased NT with normal fetal karyotype is associated with structural fetal anomalies like diaphragmatic hernia and screening at 16-18 weeks is imperative.

Uterine inversion after controlled cord traction during caesarean section: a case report.

INTRODUCTION: Inversion of the uterus during caesarean section is a rare but life-threatening complication of the procedure that requires immediate treatment, which is reversion and awareness due to the very serious adverse effects that it may have. MATERIALS AND METHODS: The authors present a case of a 34-year-old para 1 woman of Greek ethnicity who underwent a scheduled caesarean section at 39 weeks of gestation. During the procedure, a uterine inversion occurred as a controlled cord traction was applied in order to achieve placental detachment, after the delivery of the baby. It was managed by immediate manual uterine reversion, which was performed after exteriorization of the uterus. There were no adverse effects. CONCLUSION: Uterine inversion during caesarean section is a serious complication, but fortunately very rare. However, the obstetrician should be aware that the complication should be quickly identified and act without hesitation because it is critical for the well being of the patient.

Sonographic assessment of fetal subcutaneous fat tissue thickness as an indicator of gestational diabetes.

OBJECTIVE: We used ultrasound to measure fetal subcutaneous fat in pregnancies with normal and abnormal glucose tolerance tests (GTT). STUDY DESIGN: Thirty-five women with singleton pregnancies between 24 and 26 weeks' gestation participated in our study. We measured fetal subcutaneous fat tissue thickness in 20 women with abnormal GTT (Group A, study group) and 15 women with normal GTT (Group B, control group). Maximum subcutaneous fat tissue thickness of the fetuses was measured at three different levels of the fetal body, from the inner to the outer aspect of the echogenic subcutaneous fat. One measurement was taken at the level of the biparietal diameter (BPD), a second at the level of the abdominal circumference (AC) and the third was performed sagittally at the level of the thoracic spine (TS). RESULTS: Each variable was tested separately for statistically significant differences between the two groups using two statistical tests, the parametric Student's t-test and the non-parametric Mann-Whitney (M-W) test. Both tests verified a statistically significant difference for the three variables of interest (HC, AC and TS) between the two groups. Receiver Operating Characteristic (ROC) curves were used to determine the diagnostic value of each of the three variables regarding the detection of gestational diabetes. Finally, all three variables were used to construct a linear discriminant analysis model in order to evaluate their combined discrimination ability. CONCLUSION: Assessing these parameters using a noninvasive tool such as ultrasound could enhance the detection of gestational diabetes and limit the potential morbidity resulting from undiagnosed gestational diabetes. It could be useful in women who are unable to tolerate GTT or have poor follow-up during pregnancy.