Prenatal Diagnosis Of Congenital Anomalies

Eunice Kennedy Shriver National Institute Of Child Health & Human Development

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Abstract

I. A Wireless and Wearable Multimodal Sensor to Non-Invasively Monitor Transabdominal Placental Oxygen Saturation and Maternal Physiological Signals ​Poor placental development and placental ​disorders can lead to adverse pregnancy outcomes such as preeclampsia, fetal growth restriction, ​preterm labor and ​fetal death. This study introduces two sensors, which use a near-infrared spectroscopy (NIRS) technique to measure placental oxygen saturation transabdominally. The first one, an NIRS sensor, is a wearable device consisting of multiple NIRS channels. The second one, a Multimodal sensor, which is an upgraded version of the NIRS sensor, is a wireless and wearable device, integrating a motion sensor and multiple NIRS channels. A pilot clinical study was conducted to assess the feasibility of the two sensors in measuring transabdominal placental oxygenation in 36 pregnant women (n = 12 for the NIRS sensor and n = 24 for the Multimodal sensor). Among these subjects, 4 participants had an uncomplicated pregnancy, and 32 patients had either maternal pre-existing conditions/complications, neonatal complications, and/or placental pathologic abnormalities. ​The results suggest that patients with ​pregnancy complications (69.5 ± 5.4%), placental pathologic abnormalities (69.4 ± 4.9%), and neonatal complications (68.0 ± 5.1%) had statistically significantly lower transabdominal placental oxygenation levels than those with an uncomplicated pregnancy (76.0 ± 4.4%) (F (3,104) = 6.6, p = 0.0004). Additionally, this study shows the capability of the Multimodal sensor in detecting the maternal heart rate and respiratory rate, fetal movements, and uterine contractions. These findings demonstrate the feasibility of the two sensors in the real-time continuous monitoring of transabdominal placental oxygenation to ​monitor at-risk pregnancies ​with the hope of guiding timely clinical interventions, ​and improving pregnancy outcomes. II. Prenatal Diagnosis of Subamniotic Placental Cysts High-resolution ultrasound was used to ascertain the nature of cystic structure on the chorionic surface of the placenta in a fetus presenting with an estimated fetal weight below the third percentile consistent with fetal growth restriction. Multiple cysts covered more than 50% of the placental surface and the peak systolic velocity of the middle cerebral artery was elevated (1.58 multiples of the median) suggesting fetal anemia. There was also reverse in diastolic velocities in the umbilical artery indicative of severe placental disease. Amniotic fluid analysis showed no evidence of congenital infection, however heme products were detected by spectrophotometric analysis. An elevated maternal alpha-fetoprotein was consistent with maternal fetal hemorrhage. Fetal distress required preterm delivery via cesarean at 29 weeks. The placenta showed multiple cysts containing old and fresh blood of fetal origin. Comprehensive analysis of the case indicated that subamniotic hemorrhage within the placental cysts. The case illustrates the power of imaging in prenatal diagnosis of anomalies.