Ultrasonographic Characteristics of Cortical Sulcus Development in the Human Fetus between 18 and 41 Weeks of Gestation

Background： Fetal brain development is a complicated process that continues throughout pregnancy. Fetal sulcus development has typical morphological features. Assessment of fetal sulcus development to understand the cortical maturation and development by prenatal ultrasound has become widespread. This study aimed to explore a reliable method to assess cortical sulcus and to describe the normal sonographic features of cortical sulcus development in the human fetus between 18 and 41 weeks of gestation. Methods： A cross-sectional study was designed to examine the fetal cortical sulcus development at 18-41 weeks of gestation. Ultrasound was used to examine the insula, sylvian fissure （SF）, parieto-occipital fissure （POF）, and calcarine fissure （CF）. Bland-Altman plots were used for assessing the concordance, and the intraclass correlation coefficient was used for assessing the reliability. Results： SF images were successfully obtained in 100% of participants at 22 weeks of gestation, while the POF images and CF images could be obtained in 100% at 23 weeks of gestation and 24 weeks of gestation, respectively. The SF width, temporal lobe depth, POF depth, and the CF depth increased with the developed gestation. The width of uncovered insula and the POF angle decreased with the developed gestation. By 23 weeks of gestation, the insula was beginning to be covered. Moreover, it completed at 35 weeks of gestation. The intra- and inter-observer agreements showed consistent reproducibility. Conclusions： This study defined standard views of the fetal sulcus as well as the normal reference ranges of these sulcus measurements between 18 and 41 weeks of gestation. Such ultrasonographic measurements could be used to identil fetuses at risk of fetal neurological structural disorders.

Positive Rate of Noninvasive Prenatal Screening for Pregnancies with Fetal Congenital Heart Disease and Its Impact on Pregnancy Outcome

Objective::To evaluate the clinical utility of noninvasive prenatal screening(NIPS)for fetuses with congenital heart disease(CHD)and impact of NIPS results on pregnancy outcome.Methods::This was a retrospective study of pregnant women with fetuses diagnosed with CHDs by sonographic examination,who willing to underwent NIPS as a side-test for fetal aneuploidies.From August 2016 to October 2017,in the sonographic examination center of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region.NIPS was offered to 117 women,19-32 years old,who carried fetuses with CHD diagnosed by fetal ultrasound(mean gestational age=24 weeks).The pregnancy outcomes were followed-up.Results::NIPS positive rate in our pregnancies with CHD fetuses’cohort was 11.1%(13/117),and the positive predictive value for aneuploidies is 85.7%(6/7).In the NIPS positive group(n=13),all pregnancies terminated,76.9%(10/13)of those decisions were made on ultrasound finding alone.In the NIPS negative group(n=104),2 lost follow-up,79 pregnancies terminated,among which 77.2%(61/79)of the decision was made by ultrasound results alone.Twenty-three pregnancies continued and 78.3%of those fetuses carried single type CHD.In terminated pregnancies that did not considered NIPS results(71/115),73.2%(52/71)of those carried fetuses with two or more types of CHDs.Conclusion::NIPS can detect common aneuploidy associated with CHD with high positive predictive value and screening yield.The NIPS result played certain meaningful roles in determining pregnancy outcomes,particularly for fetus with simplex CHD;yet the parents’decision of pregnancy was mainly made based on ultrasound findings.