Diagnosis of fetal infection has depended on identification of pathogens by means of microbiological cultures, immunologic techniques, and special molecular biology techniques that can identify organisms known or suspected of being associated with adverse outcomes of pregnancy. Rubella, cytomegalovirus (CMV), herpes simplex virus (HSV), and human immunodeficiency virus (HIV), for example, are capable of gaining access to the amniotic cavity and producing fetal infection, even when amniotic membranes are intact. Intrauterine invasion by viruses can be associated with maternal symptoms of infection or can be completely silent. In many instances extensive fetal compromise with irreversible structural damage or fetal death will have occurred by the time infection is confirmed by culture or other histopathological methods. The evidence of fetal infection may be as subtle as nascent intrauterine growth restriction (IUGR), mildly inappropriate calcification of fetal organs, placenta, cord, and membranes, and failure to adequately develop fetal fat reserves. The evidence of infection may be as dramatic as obvious fetal malformation, severe central nervous system structural damage, or fetal death. Sonography is capable of detecting most of the grave alterations and some of the subtle effects that are typical of fetal infection.

We diagnosed 12 cases of abdominal wall defects. The cases diagnosed occurred in 6 fetuses with omphalocele, 3 with gastroschisis, 2 with prune-belly syndrome, and 1 with pentalogy of Cantrell. Except for 1 case of gastroschisis first diagnosed on the basis of three-dimensional ultrasonography at 14 weeks' gestation, all cases were first detected by two-dimensional transabdominal ultrasonography and then reevaluated with threedimensional ultrasonography using multiplanar and orthogonal plane modes. Although the original diagnosis was accurate on the basis of two-dimensional ultrasonography in 11 of 12 cases, additional information was obtained by three-dimensional scanning in all cases. Our experience suggests that in cases in which abdominal wall defects are first detected by two-dimensional ultrasonographic scanning, the additional information gained by complementary three-dimensional ultrasonographic scanning can be useful for more-efficient counseling and postnatal therapeutic planning.

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RESUMOObjetivo: avaliar as repercussões ultra-sonográfi cas do tabagismo materno na placenta, com ênfase no seu grau de maturação (calcifi cação), e correlacionar estes achados com o padrão hemodinâmico útero-placentário com uso da doplervelocimetria das artérias uterinas e umbilicais. Métodos: estudo prospectivo do tipo coorte envolvendo 244 gestantes, sendo 210 não-fumantes e 34 fumantes. Cada paciente submeteu-se a quatro exames ecográfi cos sendo o primeiro até a 16ª semana, para datar a gestação. Subseqüentemente, na 28ª, 32ª e 36ª semana, foram efetivadas novas ultra-sonografi as para biometria fetal, avaliação da ecotextura placentária e estudo doplerfl uxométrico das artérias uterinas e umbilicais. O achado ultra-sonográfi co de placenta grau III antes da 36ª semana foi considerado como calcifi cação precoce. Para análise estatística foram aplicados os testes do χ 2 e o exato de Fisher na avaliação comparativa dos graus placentários, e o teste de Mann-Whitney para o índice de resistência das artérias uterinas e umbilicais. Resultados: não foram observadas diferenças signifi cantes na freqüência de placenta grau III e no índice de resistência das artérias uterinas entre as fumantes e não fumantes, nas diferentes idades gestacionais. O índice de resistência da artéria umbilical na 32ª semana foi significantemente maior nas tabagistas (0,64 versus 0,61, p<0,05). Conclusões: não se evidenciou associação do tabagismo com aceleração da maturação placentária. Neste estudo o vício de fumar esteve associado a alterações vasculares da circulação útero-placentária apenas na 32 a semana de gravidez. PALAVRAS-CHAVE:Tabaco; Complicações da gravidez; Placenta/ultrasonografi a; Circulação placentária; Fluxometria por laser-doppler; Tabagismo ABSTRACTPurpose: the study the effects of maternal cigarette smoking during pregnancy on placental maturation (calcifi cations) and the placental-uterine circulation, evaluated through umbilical and uterine Doppler. Methods: prospective cohort study involving 244 pregnant women, 210 of them non-smokers and 34 smokers. Participants were submitted to four serial sonograms. The fi rst was performed up to the 16th week of pregnancy to determine gestational age, and the other three at 28, 32 and 36 weeks for fetal biometry, evaluation of placental texture and Doppler studies of the uterine and umbilical arteries. Premature placental calcifi cation was defi ned as grade III before 36 weeks. The χ 2 and Fisher exact tests were used to compare placental grading, and the Mann-Whitney test to evaluate the resistance index of uterine and umbilical arteries. Results: the frequency of grade III placenta and the resistance of the uterine arteries did not differ signifi cantly between smokers and non-smokers, at all gestational ages. Umbilical artery Doppler was signifi cantly higher in smokers than in non-smokers at 32 weeks. Conclusions: no association was found between cigarette smoking and premature placental calcifi cation. Smoking was associated with increased umbilical artery resistance at ...

Infection during pregnancy is common and the developing fetal brain is vulnerable to vertical transmission due to immaturity of the fetal immune system. Infection is a major cause of multiple organ abnormalities, including the neuraxis, due to the neurotropism of the infectious agents. This review sets out to give an overview of fetal infection, review the general principles of the nature and timing of the infectious insult with respect to outcomes, review the neuroimaging of infection by ultrasound and magnetic resonance imaging (MRI), and review the various pathogens involved, including the two most common, cytomegalovirus (CMV) and Toxoplasma, and also other common viral and nonviral infections.

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