Ultrasound observation of amnion dysmorphism at 14.5–16 weeks

The presence of chorio-amniotic separation and amnion anomalies was recorded in 9500 patients referred for vaginal ultrasound examination at 14.5–16 weeks' gestation. In all patients with a change in the amnion, a search for fetal anomalies was performed and pregnancy outcome was checked. Amnion dysmorphism was observed in 30 cases. The main findings were a floating membrane which changed its configuration when the uterus was tilted and multiple intrauterine amniotic sheets. In no case was attachment of the fetus to the membranes noted. There was no fetal abnormality and pregnancy outcome was favourable in all patients. In conclusion, ultrasound visualization of amnion dysmorphism in early pregnancy is not associated with an adverse pregnancy outcome.     

Prenatal diagnosis of ventricular septal defect and overriding aorta at 14 weeks' gestation,using trans vaginal sonography

Two fetuses with heart abnormalities were detected by transvaginal sonography at 14 weeks of gestation. In the first fetus, a ventricular septal defect and an overriding aorta were detected and a diagnosis of tetralogy of Fallot was suggested. In addition, cystic hygroma and omphalocoele were visualized and the cytogenetic study revealed trisomy 18. In the second fetus, ventricular septal defect, pericardial effusion, and omphalocoele were detected.     

Lessons learned and success of initiatives to rehabilitate degraded forests in Guangdong Province,China

The harvesting of communal natural resources by ‘outsiders’ (i.e. harvesters from other villages or towns) was investigated in ten rural villages in South Africa. Participatory Rural Appraisal (PRA) techniques were used to collect data in focus groups in each village. A case study quantifying the outflow of fuelwood was also conducted in one of the villages. Harvesting by outsiders was reportedly widespread and, in the case of fuelwood, a cause for concern. Of 13 recorded resources, the three most commonly harvested by outsiders were fuelwood, plants for traditional medicine and river sand for brick-making. An increase in harvesting by outsiders over the last decade was widely reported. This was related to socio-economic changes, largely associated with the first democratic elections in 1994. Key socio-economic drivers of this increased harvesting were: 1) the breakdown of institutional control of resources, 2) rising unemployment, and 3) a pervasive sense of entitlement associated with new-found political freedom and democracy. Evidence suggests that the increased harvesting by outsiders is a reality, rather than a xenophobic accusation, and that it poses a threat to the sustainability of communal resources in rural areas. This is discussed within the context of South Africa as a society in transition.     

Chemical fractionation of phosphorus in stabilized biosolids

Three chemicals-ferrous sulfate (FeSul), calcium oxide (CaO), and aluminum sulfate (alum)-were applied at different rates to stabilize P in fresh, anaerobically digested biosolids (FBS) obtained from an activated sewage treatment plant. A modified Hedley fractionation procedure was used to assess P forms in these sludge-borne materials and in a biosolids compost (BSC) prepared from the same FBS. Each biosolids material exhibited a unique pattern of P distribution among fractions. The most available P forms, namely: (i) water-soluble P (WSP); (ii) membrane-P; and (iii) NaHCO(3)-P, were stabilized by small rates of each of the chemicals; but the P transformation into more stable forms depended on the type of chemical added. The stabilized P forms were enhanced by high rates of CaO and FeSul, but were reduced by high rates of alum. The organic P (P(o)) in the first three fractions of the FeSul- and alum-stabilized biosolids was enhanced by the chemical addition, and P(o) transformation from NaOH-P(o) into NaHCO(3)-P(o) was found in calcium-stabilized biosolids. A positive relationship was found between NaHCO(3)-P(o) and the NaHCO(3)-extracted organic C in all chemically stabilized biosolids. One-step extraction by NaHCO(3) or NaOH underestimated P extraction compared to the stepwise extraction. The reported results are consistent with solid-state P speciation reported earlier and contribute important information for optimizing biosolids stabilization to reduce P loss after incorporation in soils and for maximizing soil capacity to safely store pre-stabilized biosolids.     

Early transvaginal sonographic diagnosis of alobar holoprosencephaly

Holoprosencephaly is a cerebral anomaly resulting from incomplete cleavage of the primitive prosencephalon or forebrain. Early detection of this anomaly is very important since the most severe form is incompatible with life. The diagnosis also signals the need for a chromosomal determination since chromosomal abnormalities have been associated with this anomaly. An early diagnosis of alobar holoprosencephaly at 14 weeks' gestation, employing transvaginal sonography, is reported. Our findings are compared with prenatal transabdominal sonographic findings of holoprosencephaly which have been reported during the last decade in the literature.     

The significance of early second-trimester sonographic detection of minor fetal renal anomalies

A study of 6350 consecutive transvaginal ultrasound examinations was performed as part of a routine fetal evaluation. Twenty-one cases (0.33 per cent) of early second-trimester sonographic detection of minor renal abnormalities (unilateral renal agenesis, pelvic kidney, and double collecting system) are presented. The sonographic diagnosis was made at 14–18 weeks of pregnancy and confirmed, in all of the 21 fetuses, postnatally or by post-mortem. A high incidence of associated fetal anomalies (24 per cent) and parental renal abnormalities (14 per cent) was demonstrated. Transvaginal sonography was found to be a useful tool for diagnosing these renal anomalies as early as 14 weeks of pregnancy. The likelihood of various associated anomalies and long-term implications on renal function raise questions concerning the prenatal management of such patients.     

Prenatal diagnosis of cystic fibrosis: Ultrasonographic appearance of meconium ileus in the fetus

Four often fetuses carrying a risk of 1:4 for cystic fibrosis were found to have low levels of microvillar enzymes in the amniotic fluid obtained between 17 and 18 weeks' gestational age. On sonography performed prior to the amniocentesis, three fetuses showed enlarged bowel loops. At autopsy, meconium ileus was detected. Enlarged bowel loops are a sign which has not been described previously so early in pregnancies.     

Prenatal diagnosis of familial congenital pyloric atresia

Familial congenital pyloric atresia is a rare malformation of the fetal gastrointestinal tract. It usually manifests as maternal polyhydramnios and enlarged fetal stomach on ultrasound scan. Sonographic prenatal diagnosis and management of a pregnancy complicated by familial congenital pyloric atresia are presented.     

Screening for Down's syndrome in older women based on maternal serum alpha-fetoprotein levels and age: Preliminary results

We report the results of screening for Down's syndrome (DS) in older women using published rate schedules based on maternal serum alpha-fetoprotein (MSAFP) and age. Five hundred and seventeen patients aged 35 years and older, who were referred for a mid-trimester genetic amniocentesis, were first tested for MSAFP and then underwent an amniocentesis. Individual risks for DS, combining MSAFP and age, were derived using three different published rate schedules. Theoretical selection for amniocentesis was made using the cut-off level of the average collective risk for a 35-year-old woman (1:380 at live birth or 1:270 at amniocentesis). Six affected pregnancies (five with DS and one with trisomy 18), which were diagnosed prenatally, were all found to be at a higher risk than the specified cut-off. These cases would have been diagnosed in any event, using any of the published rate schedules. According to these rate schedules, between 39 and 45 per cent of the patients would be in the lower risk group and therefore would have been counselled not to undergo amniocentesis. Further studies should be conducted in order to reach conclusive screening policies for DS in older women.