Fetal MR imaging results can show abnormalities in the fetal brain after CMV infection, even when US results are normal. The early detection of some brain abnormalities, such as microencephaly and cortical anomalies, may substantially influence the prognosis of fetal infection.

Objective To review the experience of performing selective feticide with bipolar cord coagulation (BCC) in complicated monochorionic (MC)

Objective To identify fetal cord blood prognostic markers of symptomatic congenital human cytomegalovirus infection (HCMV).Design Retrospective observational study.Setting Fetal medicine unit in Milan and Medical virology unit in Pavia, Italy.Population HCMV-infected and -uninfected fetuses of mothers with primary HCMV infection during the period 1995-2009.Methods Overall, 94 blood samples from as many fetuses of 93 pregnant women experiencing primary HCMV infection were examined for multiple immunological, haematological and biochemical markers as well as virological markers. Congenital HCMV infection was diagnosed by detection of virus in amniotic fluid, and symptomatic/asymptomatic infections were determined by ultrasound scans, nuclear magnetic resonance imaging, histopathology or clinical examination at birth. Blood sample markers were retrospectively compared in symptomatic and asymptomatic fetuses with congenital infection.Main outcome measures A statistical analysis was performed to determine the value of each parameter in predicting outcome.Results Univariate analysis showed that most nonviral and viral markers were significantly different in symptomatic (n = 16) compared with asymptomatic (n = 31) fetuses. Receiver operator characteristics analysis indicated that, with reference to an established cutoff for each marker, the best nonviral factors for differentiation of symptomatic from asymptomatic congenital infection were b 2 -microglobulin and platelet count, and the best virological markers were immunoglobulin M antibody and DNAaemia. b 2 -Microglobulin alone or the combination of these four markers reached the optimal diagnostic efficacy. ConclusionsThe determination of multiple markers in fetal blood, following virus detection in amniotic fluid samples, is predictive of perinatal outcome in fetuses with HCMV infection.

Objective To assess whether the addition of fourdimensional (4D) ultrasound to a conventional twodimensional (2D)

An excess of structural anomalies is observed in twins compared to singletons. Approximately 1-2% of twin pregnancies may face the dilemma of expectant management versus selective termination following diagnosis of an anomaly affecting only one fetus. If the option of selective fetocide is considered, the main variable determining the technique to achieve this aim is chorionicity. In a dichorionic pregnancy, passage of substances from one twin into the circulation of the co-twin is unlikely due to the lack of placental anastomoses, hence KCl can be injected safely into the circulation of the affected twin to produce fetal asystole. In monochorionic twin pregnancies, selective termination needs to be performed by ensuring complete and permanent occlusion of both the arterial and venous flows in the umbilical cord of the affected twin, in order to avoid acute haemorrhage from the co-twin into the dying fetus, which may lead to death or organ damage. Bipolar cord coagulation under ultrasound guidance is associated with approximately 70-80% survival rates.

In this extremely selected group of fetuses with isolated, mild VM and no risk factors, MRI may not be indicated in the prenatal imaging protocol.

The knowledge of a range of normality and interindividual variability of linear biometrical values for the developing brain between 20th and 24th weeks of gestation may be valuable in assessing normal brain development in clinical settings.

We have established size charts for fetuses from Italian couples using the recommended statistical approach. Since the mean birthweight in this study is not statistically different from the official birthweight reported for the Italian population, these reference intervals, developed according to the currently approved statistical methodology, can be employed during second- and third-trimester obstetric ultrasound of fetuses from Italian couples.