Does a ‘notched’ nuchal translucency indicate Down syndrome fetuses or other adverse pregnancy outcome?

The aim of the present study was to assess the sonographic contour of the increased nuchal translucency (NT) and to correlate this with pregnancy outcome. Fifty sonographic images of fetuses with increased NT [>95th centile thickness of the normal range for crown–rump length (CRL) between 38 and 84 mm] were retrospectively assessed. In all the cases a complete pregnancy and even infancy follow-up (<36 months) was available. The NT appearances were subdivided into two forms: a ‘notched’ or ‘uniform’ appearance. The images were correlated with karyotype results [trisomy 21 (DS) vs euploid cases] and pregnancy outcome. Complicated outcomes were classified as being either DS fetuses, miscarriage or termination of pregnancy because of structural anomaly. Thus 30/35 (86%) of the euploid fetuses had a ‘uniformly’ increased NT, whereas 8/13 DS cases (62%) had a ‘notched’ appearance (Fisher's exact test, p=0.004). Additionally, 27/29 fetuses (93%) which had an uneventful pregnancy outcome had a ‘uniform’ increased NT, whereas 12/26 (57%) of the fetuses which had adverse pregnancy outcome had a ‘notched’ appearance of their NT (Fisher's exact test, p<0.001). Although it was not possible to correlate the sonographic data with post-evacuation microdissection findings, it is possible that a uniformly shaped, increased NT may be more representative of a developmental delay in a normal fetus. Conversely, a ‘notched’ nuchal surface may represent abnormal lymphatic or cardiovascular development more commonly seen in DS fetuses. Copyright © 2001 John Wiley & Sons, Ltd.     

Emotional reactions in women in late pregnancy (24 weeks or longer) following the ultrasound diagnosis of a severe or lethal fetal malformation

We studied the emotional reactions of 41 women in late pregnancy shortly after they had been informed of the diagnosis of ‘severe or lethal fetal malformations’ and 3 months after delivery. In addition, situational variables were explored as determinants of grieving. While grief did not diminish during the study period, psychological instability was less pronounced at 3 months after delivery. More grief reactions were evoked by self-reported easily versus self-reported not easily initiated pregnancy, gestational age between 24 and 34 weeks versus beyond 34 weeks, multiparity versus primiparity, and viewing versus not viewing the baby.     

Second-trimester maternal serum alpha-fetoprotein (MSAFP) iselevated in women with adverse pregnancy outcome associated with inherited thrombophilias

Obstetric complications, such as severe pre-eclampsia, fetal growth restriction, abruptio placentae, or stillbirth are associated with abnormally elevated second-trimester maternal serum alpha-fetoprotein (MSAFP) and β subunit of human chorionic gonadotrophin (βhCG). This has been attributed to placental abnormalities. Women with thrombophilias have been shown to have abnormalities of the placenta resulting in adverse pregnancy outcome in these patients. The purpose of the present study was to evaluate whether women with pregnancy complications and inherited thrombophilias have abnormally elevated second-trimester MSAFP or βhCG. Sixty-two women with pregnancy complications were tested for inherited thrombophilias several months after delivery. The thrombophilia group included 29 women with pregnancy complications and an inherited thrombophilia and the control group included 33 other patients without thrombophilia. Patients in the thrombophilia group had a higher median MoM MSAFP compared to the controls (1.337 vs 1.086, p=0.0516). The incidence of abnormally elevated MSAFP (>2.5 MoM) was also significantly higher in the thrombophilia group compared to controls (21% vs 3%, p=0.04). Neither the median MoM βhCG nor the incidence of abnormally elevated βhCG were significantly different between the groups. We conclude that second trimester MSAFP, but not βhCG, is abnormally elevated in patients with thrombophilia and obstetric complications. Copyright © 2001 John Wiley & Sons, Ltd.     

Prenatal diagnosis of werdnig-hoffmann disease: DNA analysis of a mummified umbilical cord using closely linked microsatellite markers

We present a case of prenatal diagnosis of Werdnig-Hoffmann disease, the most severe type of spinal muscular atrophy (SMA). DNA obtained from a mummified umbilical cord of a deceased affected brother of the index case was analysed with four closely linked microsatellite markers [EF1/2a and EF13/14 (D5S125), MAP1B, and JK53CA (D5S112)], flanking the SMA gene, on chromosome 5q11·2-13·3. The fetus was diagnosed as homozygous for the deleterious SMA gene.     

苯醌对聚合硅酸铁多相UV-Fenton体系的增效机制

通过构建苯醌增效聚合硅酸铁多相UV-Fenton体系,讨论了体系中橙Ⅱ的脱色和降解途径.在研究苯醌浓度对聚合硅酸铁铁离子的释放、Fe²⁺与Fe³⁺之间的转化、H₂O₂分解和·OH生成影响的基础上,提出了苯醌对聚合硅酸铁多相UV-Fenton体系的增效机制.结果表明,随苯醌浓度的增加,其紫外光下光解还原聚合硅酸铁并释放Fe²⁺的程度增大、H₂O₂分解速度加快、产生·OH浓度峰值增高且出现的时间提前;苯醌增效体系释放于溶液中的Fe²⁺可以通过Fenton反应转化成Fe³⁺,反应结束后聚合硅酸铁能重新吸附Fe³⁺并使其浓度降低,避免了增效体系铁离子的二次污染.本研究将为多相催化剂催化过程的调控提供新的视角,为多相光助-芬顿反应在有机废水资源化中的应用提供理论依据和技术支持.     

Successful outcome of pregnancy after treatment of maternal anti-ro (SSA) antibodies with immunosuppressive therapy and plasmapheresis

In this short communication we describe a patient with anti-SSA and anti-SSB antibodies whose first child died of congenital complete heart block (CCHB). During her second pregnancy she was treated with prednisolone, azathioprine, and plasmapheresis, and levels of anti-SSA and anti-SSB antibodies fell significantly. The pregnancy evolved uneventfully and resulted in the birth of an unaffected male infant. This is the fourth reported case of a successful outcome of pregnancy after treatment with immunosuppressive drugs in a woman with a significant risk of recurrence of CCHB.