A structurally normal fetus at the 11- to 14-week ultrasound does not guarantee a newborn without congenital anomalies: a cohort study

OBJECTIVE

The objective of this study was to analyze the influence of maternal demographic characteristics and abnormal first-trimester sonographic markers on congenital anomalies (CAs) at birth when the fetus is structurally normal at the 11- to 14-week ultrasound.

METHODS

This prospective cohort study comprised high-risk women undergoing routine antenatal care. Detailed assessments of fetal anatomy and first-trimester sonographic markers were performed at 11-14 weeks of pregnancy. Multilevel regression analysis was used to determine the effects of maternal characteristics and abnormal first-trimester sonographic markers on the incidence of CA at birth.

RESULTS

Three hundred and ten patients were evaluated, and 41 patients (13.2%) had an anomalous newborn. The presence of a specific indication at the first-trimester ultrasound (OR: 2.72; CI 95% 1.09-6.74) or a nuchal translucency (NT) thickness greater than 2.5 mm increased the risk of CA at birth by three fold (OR: 3.10; CI 95% 1.07-9.59). High adjusted risks for trisomies 21, 18 and 13 increased the likelihood of having a structurally abnormal newborn by five, twelve and six fold, respectively.

CONCLUSION

Increased NT and/or high adjusted risks for trisomies 21, 18, and 13 increase the risk of CA at birth, even in fetuses with a structurally normal 11- to 14-week ultrasound scan.

[Review of risks of biological agents and preventive measures to safeguard the health of compost production workers]

A review of studies made in the compost production industry showed the biological agents posing a risk for workers were fungi and thermophile bacteria, gram-negative bacteria and endotoxins, with a prevalent inhalation exposure to airborne contaminated dusts. Medical examinations revealed cases of extrinsic allergic alveolitis due to A. fumigatus, and more frequently irritative and infectious disorders occurring especially in conditions of poor environmental hygiene and macroscopic dust pollution. For the evaluation of the air dispersion of microorganisms, which is high in compost transport and turning operations, at present no exposure limit values are available for biological agents; nevertheless, the concentrations measured were often higher than the limit values proposed for other manufacturing sectors by individual authors and by regulatory agencies in Europe, and were comparable to values observed in other industrial settings for which adverse health effects have been shown. Although the number of studies available are few in number, the results suggest that the hazards posed by microorganisms and the poor environmental hygiene conditions often encountered can undoubtedly be a source of risk for workers, which at present is difficult to establish but significant considering the high airborne concentrations of contaminated dust. Besides technical measures to avoid environmental macroscopic dispersion of dusts, measurement of airborne microbiological contaminants is also recommended. Health surveillance needs to be aimed at identifying subjects with hypersusceptibility to the infectious action of the pathogenetic and/or allergenic agents or with hypersensitivity to the same, and also to periodic control of respiratory organs.