Zusammenfassung
Der nichtinvasive Pränataltest (NIPT) ermöglicht eine Entdeckungsrate für das Down-Syndrom von 99,2 % und übertrifft damit das Ersttrimesterscreening (ETS), erfüllt aber nicht die ...Kriterien für eine vollwertige Diagnostik. Die sonographische Untersuchung des Feten im Rahmen des ETS ermöglicht auch die differenzierte Beurteilung des Feten und ist unverzichtbarer Bestandteil einer vollwertigen Beurteilung des Feten am Ende des ersten Trimenon, da angeborene Fehlbildungen deutlich häufiger sind als chromosomale Aberrationen. Darüber hinaus ermöglicht die Beurteilung sonographischer Zusatzmarker im Rahmen des ETS eine präzise Einordnung in Risikogruppen. Der NIPT hat seine Berechtigung vor allem im intermediären Risikobereich. Die suffiziente Interpretation des Befunds und die Beratung der Schwangeren sind entscheidend für die richtige Auswahl diagnostischer Schritte.
The Miocene is a relatively recent epoch of the Earth's history with warmer climate than today, particularly during the middle Miocene Climatic Optimum (MMCO, approximately 17–15Ma). Although the ...cause of the warming is probably not only attributable to CO2, but also to changes in orography and configuration of ocean gateways, this time interval represents an ideal case study to test the ability of climate models to simulate warm climates comparable to those that the Earth may experience in the near future. However, even with higher than present-day CO2 concentrations, the MMCO warming inferred from terrestrial proxy data has been difficult to reproduce in climate models.
Since fossil flora do not provide direct information on climate, but on flora and vegetation, climate model results are generally compared to climate reconstructions obtained from the fossil flora. In this study, we apply an alternative method by simulating palaeovegetation from the outputs of the climate model, using a dynamic vegetation model. Model vegetation reconstruction can then be compared to the vegetation cover indicated by the fossil flora record at the various localities, provided that a common classification of plant functional types (PFTs) is used for the data and the model. Here, we reconstruct the vegetation of the middle Miocene with the global dynamic vegetation model CARAIB, using the climatologies derived from five atmospheric general circulation models. The reliability of the simulations is examined on a presence/absence basis of PFTs by comparison of vegetation reconstructions to palaeoflora data recorded in the Northern Hemisphere and the Tropics.
This comparison provides an overall agreement around 60% between model and data, when all sites and tree types are considered. Three model simulations out of five show to be better at predicting the absence than the presence. The presence of warm-temperate mixed forests in the middle latitudes, dominated by broadleaved deciduous warm temperate and subtropical trees is generally well reproduced in CARAIB simulations. However, poor agreement is obtained for the presence of tropical PFTs out of the Tropics and for warm PFTs at latitudes northward of 50°N, where climate models remain too cold to produce assemblages of trees consistent with the data. Nevertheless, the model–data comparison performed here highlights several mismatches that could result not only from missing feedbacks in the climate simulations, but also from the data. The results of the likelihood analysis on presence/absence of PFTs illustrate the uncertainties in the PFT classification of the Neogene floral records. The coexistence of some PFTs in the palaeovegetation data is impossible to reproduce in the vegetation model simulations because of the climatic definition of the modern PFTs. This result indicates either a bias in the identification of modern analogues for fossil plant taxa, or a possible evolution of environmental requirements of certain plants.
Our purpose was to assess the impact of prenatally diagnosed ventriculomegaly (VM) on the course of advancing pregnancy and the postnatal outcome of affected fetuses.
In this retrospective survey ...109/28,935 (3.8 per 1,000) singleton pregnancies with abnormal width of the fetal lateral ventricle system diagnosed by antenatal ultrasound examination at the University Hospital of Schleswig-Holstein, Campus Lübeck, were reviewed between 1993 and 2007. Clinical data and pregnancy outcome information were derived from a standardized parental questionnaire or from hospital records. Postnatal follow-up was obtained in >90%.
Forty-seven cases with isolated VM (IVM; 43%) and 62 fetuses (57%) with nonisolated VM were diagnosed. In the IVM group 19 cases had mild and 28 fetuses severe VM. Of 62 cases with non-IVM there were 32 with mildly dilated ventricles and 30 had severe enlargements. Chromosomal aberrations were present in 5 fetuses (4.6%) of the non-IVM group. Thirty-four pregnancies (31%) were terminated on parental request (10 IVM/24 non-IVM). The risk of abnormal neurodevelopmental outcome was highest in the presence of associated anomalies (irrespective of the extent of dilatation) and in cases with severe IVM (91 and 68%, respectively). In contrast, 13/14 children with mild IVM showed an age-related normal psychomotor behavior. Fetuses with severe VM had a 2.2- (IVM) to 3.6-fold (non-IVM) elevated risk of progressive dilatations compared to mild VM. In our study the fetuses with asymmetrical bilateral IVM tended to have severe ventricular enlargements more often.
As reported previously we found a positive association between neurodevelopmental delay and the degree of lateral ventricular dilatation. The presence of additional abnormalities is generally a poor prognostic sign and accompanied by a nonfavorable postnatal outcome.
The aim of the study was to describe the response of fetal lung vasculature to maternal hyperoxygenation (MH) in the case of prenatally diagnosed hypoplastic left heart (HLH) with intact or ...restrictive (IAS/RAS) and without restriction of the atrial septum. Furthermore, the ability of MH to differentiate between newborns with HLH who do not require immediate atrial septostomy and newborns who will undergo immediate left atrial septoplasty after birth was evaluated.
Cross-sectional prospective study of fetuses ≥ 26 weeks of gestation with prenatally diagnosed HLH. Lung perfusion (LP) was qualitatively assessed by color Doppler interrogation and LP was quantitatively measured using the pulsatility index for veins (PIV). Measurements were performed both with the mother breathing room air (LPRA) and after receiving 100% oxygen for 10 minutes (LPMH). The oxygen test was defined as positive if MH led to an increase in lung perfusion and as negative if MH did not lead to an increase.
A total number of 22 pregnancies with hypoplasia of the left heart structures were included. 6/20 cases presented with an intact or restrictive atrial septum (IAS/RAS). All of these fetuses presented with a reduced LPRA. MH led to an increase in LP in 2/6 cases. The overall 30-day-survival rate was 83.3% (5/6). In 14/20 fetuses an open septum was detected. 11 cases had a normal LPRA, and the LPRA was reduced in 3/14 fetuses. The overall 30-day-survival rate was 92.9% (13/14).
MH might be a useful adjunct in the assessment of pulmonary vasculopathy in fetuses with HLH.
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