BackgroundBabies born after midtrimester preterm prelabour rupture of membranes (PPROM) are at risk to develop neonatal pulmonary hypoplasia. Perinatal mortality and morbidity after this complication is high. Oligohydramnios in the midtrimester following PPROM is considered to cause a delay in lung development. Repeated transabdominal amnioinfusion with the objective to alleviate oligohydramnios might prevent this complication and might improve neonatal outcome.Methods/DesignWomen with PPROM and persisting oligohydramnios between 16 and 24 weeks gestational age will be asked to participate in a multi-centre randomised controlled trial. Intervention: random allocation to (repeated) abdominal amnioinfusion (intervention) or expectant management (control). The primary outcome is perinatal mortality. Secondary outcomes are lethal pulmonary hypoplasia, non-lethal pulmonary hypoplasia, survival till discharge from NICU, neonatal mortality, chronic lung disease (CLD), number of days ventilatory support, necrotizing enterocolitis (NEC), periventricular leucomalacia (PVL) more than grade I, severe intraventricular hemorrhage (IVH) more than grade II, proven neonatal sepsis, gestational age at delivery, time to delivery, indication for delivery, successful amnioinfusion, placental abruption, cord prolapse, chorioamnionitis, fetal trauma due to puncture. The study will be evaluated according to intention to treat. To show a decrease in perinatal mortality from 70% to 35%, we need to randomise two groups of 28 women (two sided test, β-error 0.2 and α-error 0.05).DiscussionThis study will answer the question if (repeated) abdominal amnioinfusion after midtrimester PPROM with associated oligohydramnios improves perinatal survival and prevents pulmonary hypoplasia and other neonatal morbidities. Moreover, it will assess the risks associated with this procedure.Trial registrationNTR3492 Dutch Trial Register (http://www.trialregister.nl).
BackgroundFetal growth restriction is, despite advances in neonatal care and uptake of antenatal ultrasound scanning, still a major cause of perinatal morbidity. Neonates with birth weight > 10th percentile are assumed to be appropriate-for-gestational-age (AGA), although many are at increased risk of perinatal morbidity, because of undetected mild restriction of growth potential. We hypothesized that within AGA neonates, reduced fetal growth velocities are associated with adverse neonatal outcome.MethodsA retrospective cohort study of singleton pregnancies, in the Maastricht University Medical Centre (MUMC) between 2010 and 2016. Women had two fetal biometry scans (18–22 weeks and 30–34 weeks of gestational age) and delivered a newborn with a birth weight between the 10th–80th percentile.Differences in growth velocities of the abdominal circumference (AC), biparietal diameter (BPD), head circumference (HC) and femur length (FL) were compared between the suboptimal AGA (sAGA) (birth weight centiles 10–50) and optimal AGA (oAGA) (birth weight centiles 50–80) group. We assessed the association between velocities and neonatal outcomes.ResultsWe included 934 singleton pregnancies. In the suboptimal AGA group, fetal growth velocities were lower (in mm/week): AC 10.72 ± 1.00 vs 11.23 ± 1.00 (p < .001), HC 10.50 ± 0.80 vs 10.68 ± 0.77 (p = 0.001), BPD 3.01 ± 0.28 vs 3.08 ± 0.27 (p < .0001) and FL 2.47 ± 0.21 vs 2.50 ± 0.22 (p = 0.014), compared to the optimal AGA group. Neonates with an adverse neonatal outcome had significantly lower growth velocities (in mm/week) of: AC 10.57 vs 10.94 (p = 0.034), HC 10.28 vs 10.59 (p = 0.003) and BPD 2.97 vs 3.04 (p = 0.043) compared to those with normal outcome. An inverse association was observed between the AC velocity and a composite adverse neonatal outcome (OR) = 0.667 (95%CI 0.507–0.879, p = 0.004), and between the AC velocity and neonates with NICU stay (OR) = 0.733 (95%CI 0.570–0.942, p = 0.015). Neonates with a birthweight lower than expected (based on the abdominal circumference at 20 weeks) had significantly more composite adverse neonatal outcomes 8.5% vs 5.0% (p = 0.047), NICU stays 9.6% vs 3.8% (p < .0001) and hospital stays 44.4% vs 35.6% (p = 0.006).ConclusionsAppropriate-for-gestational-age neonates are a heterogeneous group with some showing suboptimal fetal growth. Abnormal fetal growth velocities, especially abdominal circumference velocity, are associated with adverse neonatal outcome and can potentially improve the detection of mild growth restriction when used in multivariate models.
Conclusion: Prenatal diagnosis of Williams-Beuren syndrome in the second trimester have been previously reported but is uncommon. We describe the atypical features of nuchal edema, small stomach and echogenic cardiac focus at the second trimester. Our case underscores the value of microdeletion screening in fetal growth restriction in association with (mild) softmarkers.
the department of Gynecology and Obstetrics of the MUMC+. 3D power Doppler images were obtained using a 4-8 MHz Voluson E8 (GE Medical Systems, Europe) abdominal transducer between 24-42 weeks of gestation. Vascularisation Index (VI), Flow Index (FI) and Vascularisation-Flow Index (VFI) were calculated with a novel sonobiopsy method in central and peripheral parts of the placenta. Differences between healthy and PS-pregnancies were tested using independent t-test and Mann-whitney U test. Results: VI and VFI were significantly lower in PS-pregnancies compared to healthy pregnancies (VI: 16.98 ± 14.90 vs. 30.03 ± 22.92, p = 0.001 and VFI: 4.31 ± 2.76 vs. 7.83 ± 4.88, p < 0.001). However, FI did not differ significantly between both groups (p = 0.796). The area under the ROC curve discriminating between healthy and PS-pregnancies was 0.74 and 0.78 for VI and VFI, respectively. Furthermore, we found significant differences in VI and VFI between healthy and PS-pregnancies in both central (VI: 30.95 ± 25.61 vs. 20.32 ± 19.67, p=0.009 and VFI: 11.97 ± 4.46 vs. 9.69 ± 3.40, p=0.042) and peripheral (VI: 25.61 ± 18.61 vs. 16.46 ± 13.97, p= 0.018 and VFI: 11.97 ± 4.46 vs. 9.54 ± 3.06, p=0.045) biopsies. Conclusions: VI and VFI are significantly reduced in PS-pregnancies compared to healthy pregnancies, reflecting pathological process underlying placental insufficiency. These results provide promising possibilities for further placental perfusion ultrasound evaluations in PS-pregnancies.
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