Objective To investigate the value of prenatal ultrasound in diagnosing fetal persistent right umbilical vein (PRUV) and structural malformations.Methods From April 2007 to August 2011,38 827 pregnant women in Obstetrics and Gynecology Hospital of Fudan University accepted ultrasound examination,among which 109 fetuses were found PRUV.The relation between PRUV and other structural abnormalities was retrospectively analyzed.Results The incidence of PRUV was 0.28％ (109/38 827) including 100 singletons and 9 twins.Among the 109 cases of PRUV confirmed by the prenatal ultrasound diagnosis,95 cases did not complicate with fetal structural abnormality (90 singletons,5 twins),and had normal deliveries with healthy infants.Four infants were tested for their chromosomes and got normal results.The rest 14 fetuses with PRUV suffered from fetal structural abnormality (12.8％,14/109),among which,10 fetus (71.4％,10/14) suffered from cardiovascular abnormality such as endocrinal cushion defeats,double outlet right ventricle,single atrium and single ventricle.Nine pregnant women accepted artificial terminations.Only one of the 14 fetuses had chromosome test and got normal result.Conclusions Once PRUV was diagnosed by prenatal ultrasound,it is suggested to check the fetus carefully,especially the cardiovascular system.

Objective　To assess fetal cardiac hypertrophy and ventricular function in fetuses of diabetic mothers. Methods　Study group was consist of 23 fetuses of diabetic pregnancies. Control group was consist of 108 fetuses of normal pregnancies. Cardiac size was measured by ultrasound as inter-ventricular septal (IVS) thickness and ventricular diastolic and systolic (VD and VS) dimensions and perimeter. Cardiac function was expressed as ventricular shortening fraction 1 (VSF1) (ventricular diastolic perimeter -ventricular systolic perimeter/ventricular diastolic perimeter)and ventricular shortening fraction 2 (VSF2) (ventricular diastolic dimension-Ventricular systolic dimension/ventricular diastolic dimension).Fetal birth weight was recorded. Results　 IVS of study group （6.1±0.7） mm, which was significantly thicker than IVS of control group （4.4±0.7） mm. Left ventricular diastolic dimension (LVDD) and Left ventricular systolic dimension (LVSD) of study group were （3.3±0.8）cm2 and （2.2±0.6） cm2, which were greater than those of control group （2.6±0.6） cm2 and （2.0±0.5） cm2. Right ventricular diastolic dimension (RVDD) and Right ventricular systolic dimension (RVSD) of study group were （3.9±0.7） cm2　and （2.6±0.7） cm2, which were also greater than those of control group （3.5±0.5） cm2 and （2.4±0.7） cm2. Left ventricular shortening fraction 1 of left ventricular (LVSF1) of study group was 0.20±0.07, which was greater than that of control group （0.12±0.04）. LVSF2 of study group was 0.35±0.11，which was greater than that of control group too （0.23±0.10）. Right ventricular shortening fraction 1 of left ventricular (RVSF1) of study group was 0.19±0.05，which was greater than that of control group （0.13±0.11）. RVSF2 of study group was 0.33±0.09，which was greater than that of control group （0.23±0.14）. Estimated fetal birth weight of study group was （4 076±608） g, which was greater than that of control group （3 440±377） g. Conclusion　These findings showed that fetal hyperinsulinemia result in fetal weight increasing, global cardiac enlarger inter-ventricular septal thickness larger and revealed hypercontractillty of ventricle in fetuses of diabetas mothers.

Objective　To investigate the characteristics of fetal growth in uterus. Methods　A total of 695 term singleton infant were studied. Various ultrasound measurements (including Biparietal diameter BPD, Transverse abdomen-diameter AD, femur length FL) obtained from 26 weeks' gestation to term. 147 cases were macrosomia. 48 cases were intra-uterine growth retardation (IUGR). 500 cases were normal weight. We assessed the tendency of BPD/AD and AD/FL of fetal. Results　BPD/AD ratio of macrosomia was lowest, and BPD/AD ratio of IUGR was highest of them. The tendency of BPD/AD ratio were declined in gestation. AD/FL ratio of macrosomia were highest, and AD/FL ratio of IUGR was lowest of them. The tendency of AD/FL ratios were smooth in gestation. Conclusion　The tendency of fetal growth in uterus showed that the add of abdominal diameter contributed to gain in weight.

Objective To explore the application value of INTERGROWTH-21st standard evaluate intrauterine growth restriction (IUGR).We aimed at predicting IUGR with ultrasonic fetal growth measurements.Methods A prospective cohort of singleton pregnancy scanned after 28 gestational weeks was constructed.The Z-score values of growth measurements were calculated using the INTERGROWTH-21st standard.Logistic regression equation was used to establish the prediction formula.Finally,the new formula was compared with the traditional Hadlock method to predict the accuracy of IUGR.We assessed outcomes for consenting participants who attended research scans and delivered at the Obstetrics and Gynecology Hospital of Fudan University.Results A total of 834 patients fulfilling the inclusion criteria were included.After the exclusion of 143 lost cases,565 of control cases and 126 of IUGR cases were obtained.The sensitivity,specificity,positive predictivevalue,negative predictive value,false positive rate and false negative rate of prediction model wererespectively:88.9 ％,85.4 ％,57.7 ％,97.2 ％,14.6 ％,11.1 ％.In contrast,the values of Hadlock wererespectively:81.7％,82.7％,51.2％,95.3％,17.3％,18.3％.Conclusions This study shows aprediction model of IUGR.INTERGROWTH-21st standard improved the diagnostic accuracy of IUGR,especially enhanced the positive predictive value.

Objective To assess the diagnostic value of Logistic model in differentiating between malignant and benign ovarian lesions. Methods Thirty-five indexes of clinical and ultrasound data were recorded in 601 ovarian lesions confirmed by surgical pathology. The Logistic model was developed on a training set( n - 400) and tested on a test set( n = 201). Results Variable selection resulted in a set of 10 variables for the models: personal history of ovarian cancer, maximal diameter of the lesion, maximal diameter of the solid component, multilocular-solid tumor, solid tumor, ascites, flow within papillation, irregular walls, very strong intratumoral blood flow (i. e. color score 4) and acoustic shadows. Test set area under the receiver-operating characteristics curve was 0.963 with a sensitivity 93.9% and a specificity 93. 1 %. Conclusions Logistic model can accurately separate malignant from benign ovarian masses.

Objective To follow up the changes of postnatal cardiac sizes and function in infants of mothers with gestational diabetes mellitus (GDM). Methods Eighteen GDM mothers with euglycemia (GDM group) and 24 gestational age-matched normal pregnant women (control group),having prenatal examination and delivered in Women's Hospital of Fudan University from January to August in 2007, received fetal echocardiographic examination in late pregnancy. Infants of these GDM mothers and 24 age-matched healthy infants of normal pregnancy (control group) received sonographic follow up. Cardiac sizes and function were evaluated and compared. Results At birth, there were six (33.3%) infants of large for gestational age (LGA) and 12(66.7%) appropriate for gestational age(AGA) in GDM group, while in the control group, there were two LGA (8. 3%) and 22(91.7%)AGA infants (x2 =3. 840, P= 0. 05). Both the interventricular septum and left ventricular walls in GDM fetuses were thicker than in control fetuses (P ＜ 0.05). No increase in the thickness of ventricular walls was observed till infantile period. However, the end-systolic thickness of left ventricular walls in LGA infants was still larger than in control infants [(4.55 ± 0.37) mm vs (4. 13±0.39)mm, P＜0. 05], and end-diastolic left ventricular long-diameters were also larger [(37. 3±2.3) mm vs (34.6±2.6) mm] (P＜0. 05). In GDM fetuses, the peak velocities of aorta and pulmonary artery and left cardiac output were higher than in the controls (P＜ 0. 01 ), and right/left cardiac outputs ratios were lower (1.198±0.206 vs 1. 430±0. 321, t= -2.668,P=0. 011). Till infantile period, only right/left cardiac outputs ratios in AGA infants of GDM group were larger than in controls (P＜0. 05). GDM fetuses' left atrial shortening fraction and tricuspid E/A ratios were smaller (P＜0. 05). In infantile period, only left atrial shortening fraction in GDM infants was still smaller than in controls (0. 356 ± 0. 040 vs 0. 386 ± 0. 041, t = - 2. 332, P = 0. 025). Left and right ventricular Tei index in GDM fetuses were 0. 482±0. 129 and 0. 414±0. 094, both larger than those of control fetuses (0. 309 ± 0. 074 and 0. 283 ± 0. 072) (t = 5. 075 and 5. 129, P = 0. 000 ). Till infantile period they both became significantly lower and no differences were found among LGA, AGA and control infants. Conclusions The cardiac sizes and function at 2-3 months of age, in infants of GDM mothers with good glucose control, became better than that in uterus.

Objective To evaluate the pregnancy outcomes and prognosis of fetuses with different levels of ventriculomegaly.Methods Fetuses with ventriculomegaly subjected to the multidisciplinary consultation in the Obstetrics and Gynecology Hospital of Fudan University between January 2004 and December 2013 were included in this study.The fetuses were divided into three groups according to the width of the lateral ventricles on ultrasound examination as follows:mild ventriculomegaly (Mild Group,≥ 10 -＜12 mm,151 cases),moderate ventriculomegaly (Moderate Group,≥ 12-＜15 mm,56 cases) and severe ventriculomegaly (Severe Group,≥ 15 mm,34 cases).All cases were followed up with additional ultrasound scans during pregnancy and follow up was continued until the children were almost nine years old.Chi square test,Fisher's exact test and Bonferroni method were used to analyze the data.Results Two hundred and forty one fetuses were followed up.Ninety-one cases were terminated,and 150 were born (105 cases in Mild Group,30 cases in Moderate Group,and 15 cases in Severe Group).During ultrasound follow up of the 150 cases,the lateral ventricle width regressed in 42 cases (28.0％) and remained stable in 108 cases (72.0％).In the regressed group,the ventricle width in 31 cases in the Mild Group regressed to normal and a hearing abnormality was noted in one case after birth.In the Moderate Group,the lateral ventricle width in nine cases regressed to normal,one case had mild ventriculomegaly,and none of these cases showed abnormalities after birth.One case in the Severe Group showed no abnormalities,while the width of the lateral ventricles decreased to 14.0 and 16.0 mm.With regard to the outcomes of lateral ventricle width with or without regression,one of 42 cases in the regressed group had a significant abnormality,while 19 of 108 cases in the stable group [eleven cases (14.9％,11/74) in Mild Group,two (10.9％,2/20) in Moderate Group,and six (6/14) in Severe Group] showed significant abnormalities.Statistically significant differences were found between the two groups [2.4％(1/42) vs 17.6％(19/108),x2=4.940,P=0.026].When the outcomes of the three groups were compared,12 of 105 cases in the Mild Group (11.4％),two of 30 cases in the Moderate Group (6.7％),and 6 of 15 cases in the Severe Group (6/15) had significant abnormalities.Statistically significant differences were found between the three groups (x2=6.908,P=0.032).Statistical significance was observed in the Moderate Group and Severe Group (x2=4.929,P=0.026),while the Mild Group had a more favorable prognosis than the Severe Group (x2=5.266,P=0.022).Chromosomal examinations were carried out in 57 cases and the incidence of chromosomal abnormalities was 8.8％(5/57) [7.0％ (3/43),1/8 and 1/6 in the three groups,respectively].Infection screening was performed in 29 cases and one case was found to be positive for rubella virus-IgM,two cases were positive for cytomegalovirus-IgM,and one case was positive for toxoplasma gondii-IgM.Conclusions Pregnancy outcomes and the prognosis of fetal ventriculomegaly are associated with the degree and progression of ventricular dilatation.

Objective: To observe the influence of different tocopherol isoforms on oxidized low density lipoprotein (oxLDL) or recombinant human C reactive protein (rhCRP) induced expression of intercellular adhesion molecule 1 (ICAM 1) in human umbilical vein endothelial cells (HUVECs) and to investigate the potential mechanisms and effects of different tocopherols on atherosclerosis. Methods: Cultured HUVECs were incubated with oxLDL,oxLDL+? tocopherol,oxLDL+? tocopherol,oxLDL+mixed tocopherols,rhCRP,rhCRP+? tocopherol,rhCRP+? tocopherol, rhCRP+mixed tocopherols for 24 hours, respectively. The ICAM 1 expressions of protein and mRNA were detected by cell enzyme linked immunosorbent assay (ELISA), flow cytometric technique and RT-PCR. Results : Incubation of HUVECs with oxLDL or rhCRP for 24 hours significantly increased ICAM 1 expressions of proteins and mRNA . The different tocopherols inhibited oxLDL induced ICAM 1 expression in HUVECs in a concentration dependent manner(50-200 ?mol/L) and mixed tocopherols were more potent than ? tocopherol or ? tocopherol alone. However, rhCRP induced ICAM 1 expression in HUVECs was not inhibited by tocopherols. Conclusion :The different tocopherols inhibited oxLDL induced ICAM 1 expression in HUVECs and mixed tocopherols were more potent than ? tocopherol or ? tocopherol alone, which may be important for the beneficial effects of tocopherols on atherosclerosis and cardiovascular disease.

Objective To explore the clinical value of color Doppler ultrasonography in the diagnosis of uterine carcinosarcoma (UCS).Methods The clinical data and ultrasonographic manifestations of 63 cases of UCS proved by operation and pathology in Obstetrics and Gynecology Hospital of Fudan University from January 2003 to December 2014 were retrospectively analyzed.The clinical features and characteristics of ultrasound images in UCS were summarized and classified according to their ultrasonographic features.Results It mostly occurred in postmenopausal women (77.8％).The average age of the 63 patients of UCS was (57.7 ± 11.5) years old.The most common symptoms of UCS were postmenopauseal vaginal bleeding (57.1％),menstrual disorders (20.6％),vaginal discharge (11.1％),uterine mass or thickened endometrium (11.1％).Tumor marker CA125 was evaluated in 36 women and found to be elevated in 15 women (41.7％),60％ of which (9/15) was less than 200 U/mL.Six cases (16.7％) of relative higher level of serum CA125 (＞ 200 U/mL) were at advanced stage or with malignant ovarian tumors.The sonographic findings of UCS had three types:Uterine cavity type (71.4％),endometrium type (14.3％),and myometrium type (14.3％).The ultrasonographic characteristics of uterine cavity type and myometrium type were fuzzy boundary,irregular shape,and internal uneven echo.Color doppler flow image showed rich blood signals and low resistance index (0.55 + 0.11) of the surrounding and internal artery of the lesions.The large volume of lesion was the characteristic of myometrium type.Conclusions UCS is a very aggressive and extremely rare tumor with the symptoms of postmenopauseal vaginal bleeding,menstrual disorders,vaginal discharge,et al.There are three types of sonographic findings of UCS:uterine cavity type,endometrium type and myometrium type.To strengthen the understanding of UCS and combined with clinical manifestations,the transvaginal color Doppler ultrasound was helpful to early detection,early diagnosis and making the appropriate treatment.

Objective To summarize the experience of multidisciplinary consultation for prenatal fetal deformity, and to explore the mode suitable for China. Methods The Obstetrics and Gynecology Hospital of Fudan University and Children's Hospital of Fudan University established a joint multidisciplinary consultation center, including obstetrics, pediatrics, pediatric surgery, ultrasound and other departments. A total of 3 378 pregnant women visited the consultation center from July 31, 2003 to August 1, 2013. After consultation, treatment was divided into three classes:pregnancy termination, pregnancy continuation and perinatal treatment. Follow-up was made through correspondence and telephone communication. Retrospective analysis on reasons for consultation, fetal structural abnormalities of the classification system, chronological order of abnormalities, gestational weeks of diagnosis, maternal-related factors, treatment and prognosis was performed. Results (1) Reasons for consultation:Among 3 378 women undertaking prenatal multidisciplinary consultation, 3 243 (96.00%) were due to fetal factors, and 135 (4.00%) were due to maternal factors. (2) Classification of fetal structural abnormalities:Among the 3 243 cases undertaking consultation with fetal factors, fetal abnormality was found in 80.85%(2 622/3 243). The most common were neurological abnormalities(23.19%, 608/2 622), followed by urinary tract malformation (20.25%, 531/2 622) and cardiovascular malformation (15.48%, 406/2 622). These were followed by digestive system malformation, limb deformities and space-occupying lesions. There were 156 cases of multiple malformations. (3) Average gestational weeks for diagnosis of fetal deformity:The 2 622 cases of fetal deformity were diagnosed at a mean (26.7± 2.1) of gestational weeks (21.1–30.4 weeks). Urinary tract malformations were detected at (24.0±0.7) weeks, whereas digestive system malformations were detected at (28.3±2.6) weeks. (4) Induced labor:Induced labor cases accounted for 35.66% (935/2 622), among which, 92 cases were fetal intrauterine death and 843 cases were active choice. The several highest induced labor rates resulted from multiple malformations (75.64%, 118/156), abdominal wall defects (62.22%, 28/45), diaphragmatic hernia (61.54%, 24/39), cleft lip and palate (55.32%, 26/47) and cardiovascular malformations (49.51%, 201/406). For nervous system (27.80%, 169/608), urinary tract (25.80%, 137/531) and digestive system malformations (26.94%, 66/245), induced labor rates were <30%. For abdominal lesions (14.04%, 25/178) and sacrococcygeal teratoma (13.64%, 3/22), induced labor rates were<15%. (5) Continuation of pregnancy in 1 687 cases:Cesarean section was conducted in 1 046(61.94%). Neonatal death occurred in 117(6.94%).(6) Perinatal treatment:Twenty-one cases were treated during pregnancy, including thirteen cases with fetal ascites and hydrothorax treated by drainage, five cases with fetal anemia treated by intrauterine transfusion and three cases with fetal tachycardia treated by digoxin. Ten cases were treated by ex-utero intrapartum treatment. After birth, 297 newborns immediately underwent neonatal surgery. Among these, 259 cases underwent radical surgery, eleven palliative surgery, and sixteen elective surgery after follow-up. Conclusions Prenatal multidisciplinary consultation can make comprehensive multidisciplinary assessment of fetal prognosis and improve the diagnosis and treatment of structural malformations.