OBJECTIVE:the management of the second stage of labor and its optimal duration are controversial, particularly for nulliparous women. Our aim is to analyze the impact of a prolonged second stage on perinatal morbidity in our institution.MATERIAL AND METHODS:this is a retrospective study conducted in the University Hospital of Liège (Belgium) from January to July 2019. The 160 patients included were divided into two groups according to the duration of the second stage and compared in terms of mode of delivery, maternal and neonatal morbidity.RESULTS:group 1 (85 %) had a second stage of labor inferior to 3 hours and group 2 (15 %) ? 3 hours. The cesarean deliveries for non-engagement of the fetus were significantly higher in group 2. No significant difference was observed in terms of maternal morbidity. The median Apgar score at 5 minutes was higher in group 1. The proportion of babies transferred to neonatal intensive care and to the neonatology department was higher in group 2.CONCLUSION:we mainly noted an increase in neonatal morbidity when the second stage exceeded 3 hours, which is consistent with literature where an increase in maternal morbidity is also described. Prolonging the second stage therefore seems inappropriate to us in the current state of knowledge.

We report the case of a 24-year-old female patient with spontaneous rupture of a splenic artery aneurysm in the third trimester of pregnancy. Pregnancy, throughout the physiological and hormonal changes it imposes, promotes the occurrence of aneurysm of the splenic artery and its rupture. Although this is a rare complication, its prognosis is severe and its typical clinical picture associating abdominal pain, hypotension and anemia is misleading for the clinician who likelier evokes a retroplacental hematoma or an uterine rupture. The maternal and foetal survival depends on rapid diagnosis and multidisciplinary management. Thus, it's important for the clinician to consider this differential diagnosis when abdominal pain or hemoperitoneum occurs in pregnant woman, particularly during the third trimester of pregnancy.

Summmary : In Belgium, as in most developed countries, routine antenatal screening for cytomegalovirus (CMV) remains controversial and is not recommended. However, 1-2 % of seronegative pregnant women will develop a primary infection during pregnancy and, with a prevalence of 0.7 % of live births, CMV is the leading cause of congenital infection. Among infected newborns, 20 to 25 % will develop auditory or neurological sequelae. The initial objective of our study was to evaluate, from a cohort of 48 patients followed in the antenatal diagnosis Unit of the University Hospital of Liège, the rates of maternal-fetal transmission, medical termination of pregnancy and rates of sequelae in infected newborns and to compare them with findings found in the literature. The second objective was to synthesize the current state of knowledge on maternal-fetal CMV infection and, in the light of recent data on prenatal treatment with valaciclovir, to propose a screening and management algorithm for primary CMV infection in the first trimester of pregnancy.

In Wallonia, almost one fourth of cesarean sections are performed on nulliparous women with vertex nonanomalous singleton gestations who underwent induction of labor. The purpose of this study is to compare maternal and neonatal outcomes with elective induction of labor versus spontaneous onset of labor. Data for all deliveries at CHU de Liège over a two-year period were obtained. Women with vertex nonanomalous singleton gestations who delivered from 3900 to 40+6 weeks were selected. We tested the association of elective induction and operative vaginal delivery, cesarean section, post-partum hemorrhage, episiotomy and perineal lacerations, length of labor, length of stay, 1-min and 5-min APGAR inferior to 7 and admission to neonatal intensive care unit. Length of stay was significantly longer in all induced women. In nulliparous women, there was a 45 % probability of operative vaginal delivery or cesarean section delivery in those who underwent elective induction of labor. In light of these results, it seems that our policy of elective induction of labor in nulliparous women is causing unnecessary and potentially avoidable interventions.

The term «denial of pregnancy», although used in current medical practice since 1970, does not yet have a universal definition. The literature allows to define it as «the non-recognition of a pregnancy beyond the first trimester, which can last until delivery and cover it». The changes related to pregnancy are biologically reduced or incorrectly perceived or even ignored. Although often wrongly considered as a rare phenomenon, the literature describes it as having a prevalence of 2 to 3 cases per 1.000 viable deliveries. This case report associated with a short review of the literature aims to optimise the clinician awareness, leading to the diagnosis as well as the potential perinatal consequences linked to this phenomenon.

Perinatal studies over the last ten years report that 3 % of pregnant women have alcohol consumption. The malformative and neurological consequences of prenatal exposure to alcohol have been known for more than 50 years. Research has shown that the effects of alcohol during pregnancy and breast-feeding go far beyond visible abnormalities at birth. Neurological consequences, from minor psychomotor retardation to severe behavioural disorders, make all the severity of this intoxication and justify strict instructions to refrain from taking alcohol during pregnancy and breast-feeding.

Antenatal diagnosis of the amniotic band syndrome often occurs during the second trimester of pregnancy when complex and asymmetrical limb deformities are observed. As vital prognosis depends on the gravity of malformations, lesion assessment should be as accurate as possible. Color doppler US screening is useful and could unravel limb vascular compression by an amniotic band. A vascular stop predicts in utero limb amputation. We hereby report the case of a 30-year-old patient pregnant with a fœtus presenting 4-limb deformities. One limb was highly suspected of undergoing amputation. Facing those heavy-burden anomalies, the patient asked for a medical termination of her pregnancy.

Objective: To challenge, with a modern sonographic approach and a numerical model, the Reynolds's concept which suggests that the vascular structure of the umbilical cord could act as a pulsometer facilitating the venous return to the foetus. Method: Forty-five patients between 20 and 28 weeks of gestation were included in the study. The blood maximum velocity in the umbilical vein, measured at both foetal and placental ends, was assessed. Several sonographic parameters of the cord, including the diameter of the umbilical vein at both extremities, cord cross-sectional area and Wharton's jelly section surface were measured. We compare our data with those of a numerical model. Results: A difference in maximum velocity between the two extremities of the umbilical vein (Delta(UV) V-max) was noted. The maximum velocity was significantly higher at the foetal umbilical end (14.12 +/-3.18 cm/s) than at the placental end (11.93 +/-2.55 cm/s; p < 0.0001). The mean difference is 22 +/- 2.3 cm/s. No difference in the umbilical vein diameter was measured at both cord ends (umbilical 4.85 +/-0.9 mm, placental 4.86 +/-0.87 mm, p <0.0001). There is no significant relationship between Delta(UV) V-max and the cord cross-sectional area or Wharton's jelly index. Conclusion: Modifications of the spatial velocity profile together with the pulsometer model could explain the maximum velocity changes that is measured in the umbilical vein along the cord. This numerical model consolidates the sonographic observations. (C) 2019 Published by Elsevier Masson SAS.

Optimal choice of delivery site after a diagnosis of congenital heart disease (CHD) improves neonatal mortality and morbidity. We report the CHU of Liège experience and review the international recommendations. Between 2011 and 2016, 54 fetuses were diagnosed with CHD in our service. Retrospectively we estimated the appropriateness of the site of delivery considering the postnatal outcome. We confronted our experience with the recent international recommendations for in utero transfer to a tertiary center. The latter are based on the risk of hemodynamic instability at birth but differ for the ductal-dependent cardiopathy. The postanatal evolution and the low emergency transfer rate (4 %) in our series demonstrate the quality of our policy. We propose to validate the French transfer in utero recommendations for our obstetrical department, especially for ductal-dependent cardiopathy.

OBJECTIVE:The purpose of this pilot study is to compare the 2D scanning measurement of the foetal femoral diaphysis using anterior or lateral/external incidence at ultrasound.METHODS:In August 2016, 30 consecutive patients underwent a second trimester morphology ultrasound between 21 and 24 weeks of gestation by a senior sonographist. In each case, the femur length was measured either with an anterior angle, estimating the straight aspect of the diaphysis or with a lateral angle, assessing its curved aspect. The two measures were collected prospectively. The difference between paired measurements was calculated and expressed in percentage (mm) and in percentile.RESULTS:The median difference between the two ultrasound angles in terms of femur length was 3,55% and in terms of percentile variation was 17,16.CONCLUSION:An anterior angle of measurement of the femur length seems to allow an optimal measure of the straight and longest aspect of the diaphysis. According to our results, this angle should be considered when scoring the quality of a morphological ultrasound, but further and larger studies should be done to confirm our hypothesis.

The imperforation of the hymen is a relatively rare congenital malformation. It usually manifests itself in adolescence by a hematocolpos. Hematocolpos is the vaginal retention of menstrual blood at puberty. It results clinically in painful amenorrhea and more rarely in a pelvic mass syndrome. The diagnosis is easy, it is primarily clinical. Pelvic ultrasound and nuclear magnetic resonance are the complementary examinations to be performed as a preoperative assessment and to detect any associated genito-urinary malformations.

Terminal chromosome 1q deletion is rarely reported but causes typical malformations that have been well described in childhood. Clinical features include facial dysmorphy, growth and/or psychomotor retardation, brain agenesis or hypoplasia of the corpus callosum, epilepsy and occasional urogenital or cardiac malformations. The diagnosis of this condition is usually made at birth. The rare cases of antenatal diagnosis were based on microcephaly and growth retardation. In the present case, the foetus presented with an hypoplasia of the corpus callosum, a dysmorphic profile and a single umbilical artery. The foetal echocardiography suggested a non- compaction of the left ventricular myocardium. No microcephaly or growth retardation were noted. We compare our antenatal findings to those described in the literature with the aim to better define the antenatal phenotype of the terminal chromosome 1 deletion syndrome.

We report the case of a late stillbirth which unexpectedly occurred in a patient without any medical history and after a meticulous obstetrical follow up. Stillbirth is unfortunately not unusual and implies a complete etiological work up. In the present observation, the Kleihauer test and anatomoclinical examination concluded that the death was due to an acute cerebral anoxy resulting from a massive fetomaternal hemorrhage (HFM). HFM is rarely considered as the cause of a late stillbirth, but its occurrence is certainly underestimated. Yet, if HFM is identified before fetal death, an .adequate management could considerably improve the fetal prognosis and, sometines, save the child's life.

We report on the case of a fetus in whom a prenatal ultrasound performed at 22 weeks of gestation allowed the diagnosis of a double anomaly of the systemic venous return, with a persistent right umbilical vein and the agenesis of the inferior vena cava with azygos continuity. The fetus showed also a large umbilical hernia and a right sided microphtalmia. Fetal growth was normal. Genetic anomalies were excluded by karyotype and CGH array. Cesarean section was performed at 39 weeks of gestational age for breech presentation. The neonate adapted well. Post-natal examination confirmed pre-natal diagnosis. Thoraco-abdominal CT-scan performed at 8 days of age showed additional right upper lobe bronchial atresia with relative hypoplasia of the right pulmonary artery and right hepatic lobe hypotrophy. It also showed a short segmental infra diaphragmatic aplasia of the vena cava with dilation of the azygos vein running along the homolateral diaphragmatic coupola that drained into superior vena cava and malposition of the mesenterial vessels without any intestinal malrotation. Anomalies of the fetal cardinals and umbilical veins are the result of early abnormal venous system development in the embryo, the etiology of which is unknown. Usually, abnormal systemic venous return only affects one vessel. The presence of a double anomaly as described in this case is exceptional. A persistent right umbilical vein is reported in 0.2 to 0.4% of antenatal screening. The variant with intrahepatic transition is the most frequent and isolated form. The exceptional, form with hepatic bypass, is commonly part of a polymalformative syndrome. Agenesis of the inferior vena cava (IVC) with azygos continuity is a rare anomaly (0,2-3% of antenatal screening). Its significance relates to its frequent association with complex congenital heart diseases. The prognosis of anomalies of cardinals and umbilical veins depends on the presence of associated cardiac and extra cardiac malformations that might impact prenatal counseling and parental decision to continue or interrupt pregnancy. Careful repeated pre and post-natal evaluation is necessary to exclude polymalformative syndrome despite of normal molecular genetic examination.