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Redundant foramen ovale (RFO) is defined as an abnormally redundant foramen ovale flap that extends at least halfway across the left atrium. The exact pathogenesis is unknown. Premature, isolated, in utero RFO is rare. The prevalence in general population is unknown as it may be easily ignored on routine fetal echocardiography. The reported frequency in fetuses referred for echocardiographic examination is 0.6-1.7%. It can cause right ventricular volume overload leading to fetal hydrops and subsequent cardiac failure. In such cases, prompt delivery depending on fetal gestational age may be instrumental for the survival of the neonate. 67% can develop cardiac arrhythmias which generally resolves at birth. The most common is premature atrial contractions though rarely, supraventricular tachycardia can also occur. RFO usually occurs in isolation but when associated with congenital heart disease, it carries a poor prognosis. Several series have reported redundant foramen ovale in echocardiographic and autopsy findings in children and adults but only few reports on the antenatal detection of isolated RFO has been described. We discuss two prenatal cases of isolated redundant foramen ovale diagnosed in the third trimester. They were followed up two weekly without development of any complications and delivered at term. After delivery, the infants had no history or symptoms of cardiac distress. Echocardiography showed a structurally normal heart. Hence, if there are no associated anomalies in a case of redundant foramen ovale, the prenatal management need not be altered.

The objective of our study was to appraise the incidence and significance of persistent right umbilical vein (PRUV), the most common foetal venous aberration. Based on a south Indian antenatal cohort, we identified 23 cases of PRUV amongst 20,452 foetuses of consecutive pregnancies, from 2009 to 2014, yielding an incidence of 1 in 889 total births (0.11%). The median maternal age was 24 (IQR, 22-26) years, and median gestational age at diagnosis was 23 (IQR, 22-24) weeks. Intrahepatic drainage of PRUV was seen in 91.3% cases. In three cases (13%), ductus venosus was absent. In 52.2% of the cases, additional major abnormalities were observed - predominantly cardiovascular (39.1%). The common minor marker was single umbilical artery (13%). The karyotype was found to be normal in six cases (26%) which underwent invasive testing. When associated anomalies were inconsequential or absent, the postnatal outcome was good, which reflected in 60.9% of our cases.

The incidence of conjoined twins as reported in a worldwide epidemiological study is 1.47 per 100,000 births. It varies from 1 in 45,000-200,000 births. Conjoined twins following assisted reproduction are even rarer and we report one such case. A 36-year-old woman who conceived by intracytoplasmic sperm injection, was referred to the feto-maternal unit for nuchal translucency scan. A diagnosis of thoracopagus conjoined twins was made on ultrasound at 12 weeks 3 days of gestation. The couple was counseled in detail and they opted for termination. Pregnancy was terminated medically and the ultrasound diagnosis was confirmed. Assisted reproduction techniques involve a risk of conjoined twins and the present case report supports this. Early diagnosis of conjoined twins and determination of the type of fusion is possible. This aids in discussing the prognosis and counseling the couple regarding options of termination or continuation of pregnancy.

The anatomic causes for fetal right atrial dilatation with tricuspid regurgitation include Ebstein anomaly, tricuspid dysplasia, unguarded tricuspid orifice, and Uhl anomaly. Unguarded tricuspid orifice is characterized by complete or partial agenesis of the tricuspid valvular and subvalvular structures. It is commonly associated with pulmonary atresia. Its prenatal diagnosis is usually associated with unfavorable prognosis. We present a prenatally diagnosed case of fetal unguarded tricuspid orifice with description of its diagnostic workup, along with a review of literature, to enhance the understanding of this rarely reported entity. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:370-374, 2017.

The chief objectives of our study were to assess the incidence and significance of fetal aberrant right subclavian artery (ARSA) in a nonreferral cohort of south Indian antenatal woman, and to compare it with other second trimester markers of Down syndrome. This was a prospective study conducted at Edappal hospital, India. After satisfying inclusion and exclusion criteria, 2000 consecutive antenatal women, seeking prenatal care and planning delivery at the same center, were recruited in a consecutive fashion. ARSA was identified as a retrotracheal arterial vessel in the axial three vessel trachea view, coursing towards right axilla. During February 2015 to January 2016, nine cases of ARSA were identified amongst 2000 antenatal women, yielding an incidence of 0.45 % (95 % CI 0.2-0.9 %). Of these, eight cases (8/9, 89 %) were isolated with normal karyotype, and negative for 22q11 microdeletion. Down syndrome was prenatally diagnosed in four cases (4/2000, 0.2 %), with ARSA detected in one case [sensitivity-25 %, specificity-99.6 %, positive likelihood ratio (?LR)-62.5 %, negative likelihood ratio (-LR)-0.75 %; Odds ratio 82.8 %, 95 % CI 7.8-883]. Of the significant second trimester minor markers, an absent nasal bone was the most common (13/ 2000, 0.65 %), followed by ARSA. All the isolated cases had normal neonatal outcomes. ARSA is relatively common second trimester aneuploidy marker, associated with high global ?LR but nil isolated ?LR. Indication for fetal karyotype in isolated cases seems to be weak.

Zika virus (ZIKV) belongs to the family of flaviviruses and is transmitted by mosquitoes of the genus Aedes (A. aegypti and A. albopictus). ZIKV infection in pregnancy can have serious implications on the fetus and the neonate. Vertical transmission to the fetus can occur irrespective of symptomatic or asymptomatic infection in the pregnant woman and the risk can persist throughout pregnancy. The exact frequency of maternal-to-fetal transmission of Zika virus is difficult to determine accurately. The greatest risk of serious fetal sequelae is seen if the infection occurs within the first and second trimester. However, they can also be seen with infections in the third trimester. This document describes the presentation, fetomaternal manifestations, role of prenatal Ultrasound in diagnosis of infection, testing methods and the management in pregnancy and screening in the neonatal period. In the absence of robust evidence as to the definite effects, this document is aimed at providing practice recommendations for the management of this infection.

Fetal hypothyroid goiters are observed in 1:40,000 births. They are usually attributed to underlying thyroid glandular dysgenesis, dyshormonogenesis, or an adverse effect of maternal anti-thyroid drugs. The objective of the present case report is to outline the details of a twin gestation with hypothyroid goiter in both fetuses managed by intramniotic levothyroxine administration. The index pregnancy was of dichorionic twin gestation in which the mother was receiving oral propylthiouracil. Fetal goiters were first detected in ultrasound performed at 31 weeks of gestation. The hypothyroid nature of goiters was confirmed by cordocentesis from both sacs. Intramniotic administration of 100 μg of levothyroxine into both sacs was performed twice at the interval of two weeks. The response to treatment was assessed by amniotic fluid thyroid hormone levels, and serial measurement of thyroid gland volume. Emergency cesarean section was performed at 35 weeks due to preterm labor. Both fetuses were euthyroid at birth and were discharged in good health.