Although it is known that cardiac parameters have abnormal values in severely affected fetuses with intrauterine growth restriction (IUGR), recent research suggested that subclinical cardiac dysfunction may be present from the early stages of fetal deterioration. The identification and monitoring of cardiac dysfunction may be relevant for the management of these cases.

In this prospective observational study, we evaluated 17 IUGR fetuses from nulliparous pregnant women diagnosed with pre-eclampsia. Cardiac structural assessment was performed using segmental sequential analysis. Cardiac function was assessed by conventional echocardiography and Tissue Doppler Imaging (TDI).

Gestational age at admittance ranged between 24 and 30 weeks. A severe form of pre-eclampsia was diagnosed in 2 of 17 cases. Conventional cardiac examination showed low left and right ventricular diastolic filling with low E and A velocities, and increased myocardial performance indexes for both ventricles. Using TDI we observed decreased myocardial velocities and impaired contractility (demonstrated by low left and right diastolic velocities, as well as increased E’/A’ ratios).

Our study confirms the presence of early cardiac dysfunction in IUGR fetuses. Further studies are warranted to confirm the utility of TDI in obstetric ultrasound routine examination for monitoring fetal cardiac function in high-risk pregnancies.

Caracostea G, Stamatian F. Assessment of Cardiac Dysfunction in the Intrauterine Growthrestricted Fetuses from Pre-eclamptic Mothers. Donald School J Ultrasound Obstet Gynecol 2014;8(2):123-127.

The objective of this prospective study was to analyze the effect of vaginal micronized progesterone (VMP) daily administrated in women with recurrent pregnancy loss, recurrent miscarriage, and/or preterm birth on neonatal outcomes.

In the treat group patients received 200 mg/day VMP (14 days/month, during the luteal phase) from preconception until completed 36 weeks of gestation. Women from the control group did not receive VPM treatment. Ultrasonographic examination was performed for gestational age confirmation, assessment of cervical length and congenital malformation screening in fetus.

Compared with the control group, the women from the VMP group had a decreased time to conception, lower frequency of miscarriages and higher gestational age at delivery. Newborns from mothers treated with VPM had significantly higher birth weight than newborns from the control group of mothers (p = 0.022). The frequency of stillbirths and the need for oxygen supplementation and mechanical ventilation was lower in the newborns from treated group of mother compared with control group.

Vaginal micronized progesterone 200 mg/day from preconception to 36 weeks of gestation in women with recurrent pregnancy loss reduced the frequency of miscarriages, stillbirths, preterm births and neonatal morbidity.

Russu M, Stănculescu R, Păun M, Marin JA. Neonatal Outcomes after Preconceptional Vaginal Micronized Progesterone Administration in Recurrent Pregnancy Loss: Five Years Prospective Study. Donald School J Ultrasound Obstet Gynecol 2014;8(2):128-133.

We present our experience in prenatal diagnosis and obstetrical management of congenital lung malformations (CLM).

The diagnosis of CLM was performed during routine second and third trimester fetal morphology assessment. The extent of the disease was established according to the type, localization and size of the pulmonary lesion and the presence of fetal complications (mediastinal shift, fetal hydrops, hydramnios). Termination of pregnancy (TOP) was indicated in cases associated with extrapulmonary anomalies, untreatable cases and fetal hydrops. After delivery a pulmonary X-ray and surgical examination was performed in all newborns.

We diagnosed 15 cases with congenital lung malformations. Of these, 9 had congenital cystic adenomatoid malformation (CCAM). TOP was performed in 6 cases with CCAM. Three cases had a favorable pre/postnatal evolution. Bronchopulmonary sequestration (BPS) was diagnosed in 3 cases, all with favorable perinatal evolution. Right pulmonary agenesis was diagnosed in one case and the outcome was neonatal death. One case of congenital high airway obstruction syndrome was followed by TOP. One case of severe bilateral pulmonary hypoplasia (secondary to a severe bilateral hydrothorax) resulted in neonatal death.

Obstetrical management is established individually depending on the severity of the cases.

Iliev G, Dumitrascu I, Grigore M, Mihalceanu E, Scripcaru D, Zoican G, Aprodu G, Bivoleanu A, Petrariu A, Stamatin M. Lung Malformations: Prenatal Ultrasound Diagnosis and Obstetrical Management. Donald School J Ultrasound Obstet Gynecol 2014;8(2):134-143.

Age at delivery has increased in the past decades, leading to a continuous growth of the number of women planning a pregnancy after the age of forty. Because delivering after this age is associated with an increased rate of maternal complications, the objective of this study was to analyze the delivery related issues in women ≥40 years of age.

This was a retrospective study conducted in the 1st Clinic of Obstetrics and Gynecology, Cluj-Napoca in a 3-year period. One hundred and forty-two patients ≥40 years of age that delivered between 2010 and 2012 were included in the analysis.

The frequency of deliveries after the age of 40 was 2.42% of all the deliveries. Eighty percent of nulliparous and 51.72% of multiparous women delivered by cesarean section. A significantly higher percentage of primiparous women delivered by cesarean section compared to secundiparous women (p = 0.0007). Fetal weight was significantly higher in multiparous than in primiparous women in the CS group (p = 0.01). No differences were observed between the Apgar scores according to the delivery mode or parity in the study group.

Delivery after 40 years of age is associated with an increased number of obstetrical interventions.

CS: Cesarean section; 1p: Primiparous; 2p: Secundiparous; 3p: Tertiparous; >1p: Multiparous.

Rotar I, Muresan D, Tanc M, Cotutiu P, Giurgiu C, Stamatian F. Childbearing after 40 Years: A Challenge of the Modern Obstetrics. Donald School J Ultrasound Obstet Gynecol 2014;8(2):144-148.

Olga M, Elena T, Luybov A, Irina B, Sergey L. Ultrasound Features of the Formation of the Maternalplacental Complex in Cases of Hyperandrogenism as Observed during the First and Second Trimesters of Pregnancy. Donald School J Ultrasound Obstet Gynecol 2014;8(2):149-154.

Bonilla-Musoles F, Raga F, Bonilla F Jr, Castillo JC, Luna OC. Gynecological Tumors Image using High Definition Ultrasound (HDlive US). Donald School J Ultrasound Obstet Gynecol 2014;8(2):155-163.

Malhotra N, Malhotra J, Bora NM, Bora R, Malhotra K. Fetal Origin of Adult Disease. Donald School J Ultrasound Obstet Gynecol 2014;8(2):164-177.

Maeda K, Kurjak A. Diagnostic Ultrasound Safety. Donald School J Ultrasound Obstet Gynecol 2014;8(2):178-183.

Sheikh M, Kupesic Plavsic S. Role of Ultrasound in the Assessment of Female Infertility. Donald School J Ultrasound Obstet Gynecol 2014;8(2):184-200.

Primary cardiac tumors are rare in the fetal and neonatal period (0.0017-0.28%), but considerably more frequent than the metastatic ones; most of them are benign. The objective of this study was to analyze the clinical and echocardiographic features of cardiac tumors during the neonatal period.

In the period of 6 years (2007-2012), we diagnosed five newborns with cardiac tumors of which two newborns with left ventricle tumors suggestive of rhabdomyomas, both diagnosed in utero; a newborn with multiple heart and brain tumors, suggestive of tuberous sclerosis, who died after 24 days; a newborn with tricuspid valve papillary fibroelastoma, hemodynamically stable during the monitoring; and a newborn of the mother with high-risk pregnancy with a single right atrial tumor.

Cardiac tumors are rare but have good prognosis when not accompanied by arrhythmias or hemodynamic changes. Echocardiographic evaluation is an effective method for the diagnosis and monitoring of patients with cardiac tumors.

Hăşmăşanu M, Opriţa S, Kovacs T, Andreica S, Mátyás M, Decean E, Stamatian F, Zaharie G. Cardiac Tumors in the Neonatal Period: Clinical Features and Echocardiographic Evaluation. Donald School J Ultrasound Obstet Gynecol 2014;8(2):201-207.

Pelinescu-Onciul D, Toma AI, Steriu M, Cuzino AI, Gavril-Parfene C, Cozinov A, Olteanu R, Craiu D. Antenatal Cerebral Hemorrhages: Evolution and Outcome. Donald School J Ultrasound Obstet Gynecol 2014;8(2):208-217.

Mátyás M, Blaga L, Hăşmăşanu M, Zaharie G. Congenital Chylothorax: Diagnosis Problems. Donald School J Ultrasound Obstet Gynecol 2014;8(2):218-221.

Stamatian F, Kovacs T, Militaru M, Caracostea G. Apert Syndrome in the Era of Prenatal Diagnosis. Donald School J Ultrasound Obstet Gynecol 2014;8(2):222-225.

Shailaja N, Namrata K, Krishna L, Vanishree, Bhat BS, Kirtan K, Swathi G. Outcome of a Rare Case of Fetal Solitary Cardiac Rhabdomyoma not Associated with Tuberous Sclerosis. Donald School J Ultrasound Obstet Gynecol 2014;8(2):226-228.