Fetal Anatomy

Eating disorders in pregnancy can have profound effects upon both fetus and mother. Critical periods of fetal development may be altered in the presence of maternal undernutrition, and the psychological impact of pregnancy may be severe for the mother. This essay explores how midwives can best support women with eating disorders throughout the antenatal period.

Although published in German, this study may be of interest to scholars of medieval medicine and gender history broadly.  The essay was commissioned as a way to present evidence from medieval illustrated manuscripts to a general audience of practicing physicians.  The study presents selections of gynecological and obstetrical images from manuscripts dating between the 9th and 15th centuries.

Included are images from the following manuscripts:
- Kassel, Landesbibliothek, 2° Ms. med. 7, an. 1435:  figure of a 'disease woman'.
- Oxford, Bodleian Library, MS Ashmole 399, c. 1298:  images of an autopsy scene of a woman and a diagram of the female reproductive organs.
- Oxford, Bodleian Library, MS Laud. misc. 724, ca. 1400 (London):  the fetus-in-utero images from Muscio, here with a depiction of a scene of active labor.
- Utrecht, UB, Ms. 32 (the Utrecht Psalter), early 9th cent.:  depiction of Psalm 48, Verse 6, showing a woman in active labor, being supported by two others.
- Brussels, Bibliothèque Royale de Belgique, MS 3701-15, 9th cent.:  seven images accompanying Muscio's *Gynaecia*, a 6th-cent. Latin translation of Soranus's 2nd-cent. Greek *Gynaikeia*; images depict the anatomy of the uterus as well as a variety of fetal presentations that the midwife needed to envision when intervening in difficult labors.
- Vicenza, Biblioteca Bertoliana, MS G 24, late 12th/early 13th cent.:  depictions of uterine anatomy from another copy of Muscio's *Gynaecia*.
- Munich, Bayerische Staatsbibliothek, Clm 161, late 13th cent.:  another copy of the Muscian fetal images, here having been extracted from their original context and now placed with a copy of al-Zahrawi's *Surgery*, a work translated from the Arabic in the later 12th century.
- images from Rösslin's 1513 *Rosengarten*, a printed German text on childbirth that recycled medieval texts and images for new audiences.

ObjectiveTo examine the performance of the 11–13 weeks scan in detecting non-chromosomal abnormalities.To examine the performance of the 11–13 weeks scan in detecting non-chromosomal abnormalities.MethodsProspective first-trimester screening study for aneuploidies, including basic examination of the fetal anatomy, in 45 191 pregnancies. Findings were compared to those at 20–23 weeks and postnatal examination.Prospective first-trimester screening study for aneuploidies, including basic examination of the fetal anatomy, in 45 191 pregnancies. Findings were compared to those at 20–23 weeks and postnatal examination.ResultsAneuploidies (n = 332) were excluded from the analysis. Fetal abnormalities were observed in 488 (1.1%) of the remaining 44 859 cases; 213 (43.6%) of these were detected at 11–13 weeks. The early scan detected all cases of acrania, alobar holoprosencephaly, exomphalos, gastroschisis, megacystis and body stalk anomaly, 77% of absent hand or foot, 50% of diaphragmatic hernia, 50% of lethal skeletal dysplasias, 60% of polydactyly, 34% of major cardiac defects, 5% of facial clefts and 14% of open spina bifida, but none of agenesis of the corpus callosum, cerebellar or vermian hypoplasia, echogenic lung lesions, bowel obstruction, most renal defects or talipes. Nuchal translucency (NT) was above the 95th percentile in 34% of fetuses with major cardiac defects.Aneuploidies (n = 332) were excluded from the analysis. Fetal abnormalities were observed in 488 (1.1%) of the remaining 44 859 cases; 213 (43.6%) of these were detected at 11–13 weeks. The early scan detected all cases of acrania, alobar holoprosencephaly, exomphalos, gastroschisis, megacystis and body stalk anomaly, 77% of absent hand or foot, 50% of diaphragmatic hernia, 50% of lethal skeletal dysplasias, 60% of polydactyly, 34% of major cardiac defects, 5% of facial clefts and 14% of open spina bifida, but none of agenesis of the corpus callosum, cerebellar or vermian hypoplasia, echogenic lung lesions, bowel obstruction, most renal defects or talipes. Nuchal translucency (NT) was above the 95th percentile in 34% of fetuses with major cardiac defects.ConclusionAt 11–13 weeks some abnormalities are always detectable, some can never be and others are potentially detectable depending on their association with increased NT, the phenotypic expression of the abnormality with gestation and the objectives set for such a scan. Copyright © 2011 John Wiley & Sons, Ltd.At 11–13 weeks some abnormalities are always detectable, some can never be and others are potentially detectable depending on their association with increased NT, the phenotypic expression of the abnormality with gestation and the objectives set for such a scan. Copyright © 2011 John Wiley & Sons, Ltd.

Clues to predict the response to intravenous immunoglobulins (IVIG) and the development of coronary artery abnormalities (CAA) in children with Kawasaki syndrome (KS) are still undefined. We examined retrospectively the medical charts of children hospitalized between February 1990 and April 2009 with diagnosis of KS. A total of 32 Italian patients with a mean age of 23.8 months were analyzed and all received IVIG according to two schemes: 0.4 g/(kg day) for 5 days or 2 g/kg in a single infusion, combined with oral acetylsalicylic acid. General, clinical and laboratory data were registered. Each patient was evaluated with echocardiography at admission, then with 3-day and weekly frequency, respectively, during hospital stay and for the first 6–8 weeks since onset, and finally with a regular 6–12 month follow-up over time, according to patient risk stratification. Five patients showing significantly higher values of C-reactive protein (CRP) at admission were IVIG-resistant after the first infusion (P = 0.04) in comparison with the remaining 27. Five patients out of 32 developed CAA, with no statistical significance when analyzed for IVIG dosage or IVIG-resistance. The demonstration of CAA was significantly higher in children aged <12 months (P = 0.037). Our experience, limited to a single-center cohort of 32 patients with KS, though treated with two different IVIG schemes, has shown that higher values of CRP and younger age at onset are nodal points in determining, respectively, a failure in the response to IVIG and an increased occurrence of CAA.