Prenatal echocardiography in Trisomy 18 - the key to diagnosis and further management in the second half of pregnancy.

OBJECTIVES: Trisomy 18 is an autosomal chromosomal disorder, which is associated with numerous ranges of congenital anomalies. Purpose of this largest study in Poland was to analyze diagnosis and follow-up of fetuses with the prenatal diagnosis of Trisomy 18 in our tertiary center. MATERIAL AND METHODS: The study was conducted in a tertiary center for fetal cardiology. The inclusion criteria comprised fetuses with karyotype of Trisomy 18. Data on number of delivery, number of pregnancy, cardiac and extracardiac diseases, type and date of childbirth, sex, birth date, Apgar score, survival time and autopsy were analyzed. RESULTS: There were 41 fetuses with diagnosis confirmed by amniocentesis: 34 were females, 7 males. CHD was detected prenatally in 73% cases at mean gestational age of 26 weeks. The most common CHD was AV-canal (13 cases, 43%) and VSD (13 cases, 43%). In 1999-2010 the average time to detect a heart defect was 29 weeks, in 2011-2021 it was 23 weeks (p < 0.01, U-Mann-Whitney). IUGR was diagnosed in the 3rd trimester in 29 cases (70%), polyhydramnion in 21 cases (51%). CONCLUSIONS: Congenital heart defects in female fetuses with intrauterine growth restriction in 3rd trimester with polyhydramnios and in subsequent pregnancy, regardless of maternal age, were typical prenatal findings for Trisomy 18. Heart defects with incomplete septum such as AVC or VSD (which nowadays can be detected in the 1st half of the pregnancy) were the most common anomaly in Edwards Syndrome. These heart defects did not require intervention in the early neonatal period.

Maternal hyperoxygenation during pregnancy as a tool in fetal disease diagnosis and treatment.

Maternal hyperoxygenation (MHO) consists of giving pregnant women (60% to 100%) oxygen through a facemask and using ultrasound assess or monitor the influence on fetal cardiovascular circulation. This review discusses the findings and the utility of acute and chronic MHO in various fetal diseases.

Normograms in Prenatal Life of Stomach and Urinary Bladder in the Second and Third Trimesters of Pregnancy.

Aim: The aim of this study was to prepare normograms for the fetal stomach, urinary bladder, and stomach to urinary bladder index in healthy fetuses. Material and methods: The study was conducted based on the data extracted from the database of our tertiary center in the years 2016-2019. The study group, comprising 867 fetuses, demonstrated normal biometry and normal heart structure, normal heart function, no extracardiac malformations, and no extracardiac anomalies. The stomach to urinary bladder index was analyzed in the study group. The examinations were performed with the use of the following ultrasound machines: Voluson E10, Philips and Voluson Expert, with convex transabdominal transducers. Linear regression analysis based on Microsoft Excel was used for statistical analysis. Results: The average size of the stomach in healthy fetuses between the 14-40th week of gestation was 18 mm (8-40 mm), the average urinary bladder measurement was 17 mm (15-42 mm), and the fetal stomach to urinary bladder index was constant: 1.26 (0.09-3.93). Conclusions: The normograms for the stomach, urinary bladder and the stomach to urinary bladder index prepared based on our study group can contribute to an improvement in the accuracy of examination and provide an unified organization of the description of fetuses. These normograms constitute an additional marker for the assessment of fetal condition. A clear disproportion in the size of the urinary bladder and stomach can be helpful in terms of paying more attention to fetuses with untypical features in screening centers.

Fetal kidney measurement - additional biometric parameter for accurate gestational age assessment.

OBJECTIVES: Ultrasound examination - recommended in the prenatal period - allows for an assessment of fetal anatomy and well-being and for monitoring its growth trend. Determining gestational age is important in monitoring the developing fetus. Research is increasingly being conducted in search of further biometric components that may improve ultrasound techniques in terms of predicting the gestational age. It should be noted that a fairly large number of publications focus on the accessibility of fetal kidneys to diagnostic imaging during routine ultrasound examination. The reported study was an attempt to answer the question whether fetal kidney dimensions correlated with gestational age. The obtained results are presented as fetal kidney normograms for particular weeks of gestation. MATERIAL AND METHODS: The study covered by dissertation was conducted among patients hospitalized at the Provincial Specialist Hospital in Zgierz, Department of Gynecology, Obstetrics and Endoscopic Therapy, in the period from 1st April 2019 to 30th November 2019. The study group included patients in a single pregnancy. The control group was not included in the study. The ultrasound examinations, which are the basis of the study, were carried out using the PHILIPS Affiniti 70 ultrasound device, with a frequency of 3.5 MHz transabdominal transducer. All data were subjected to statistical analysis using the Statistica 13.1 program. CONCLUSIONS: Kidney dimensions strongly correlated with gestational age. Fetal kidney growth was a linear process in normal pregnancy. Fetal kidney measurements can provide additional biometric parameters for accurate gestational age assessment.