Accuracy of ultrasonic age determination and weight prediction in the fetus with preterm premature rupture of membranes

Ultrasonic gestational age determination and fetal weight prediction were performed in 20 patients with preterm premature rupture of the membranes [PPROM], and 10 normal gravides with intact membranes, between the 28th and less than 37 weeks of gestation, to assess of the effect of PPROM on the accuracy of ultrasonic age estimation and fetal weight prediction.All gravides had known menstrual age, and delivered within 24 hours of ultrasonic examination, and the actual birth weight was determined. Using single parameter for gestational age assessment [bipartietal diameters, abdominal circumference or femur length], the bipartietal diameters was the least reliable, as there was significant difference in the mean error between the control and studied groups [p<0.05]. Multiple parameters formulas for gestational age estimation [HC, FL;HC, FL, AC; and HC, FL, BPD, AC], did not appear to add further accuracy to single parameters methods. Using three questions for prediction of fetal weight [BPD, AC, MAD, BPD, FL; and HC, AC, FL], we have found no significant difference in the mean error percent between the control and studied groups. Neither amniotic fluid volume, duration of membrane presence or absence of labor pains affected the accuracy of ultrasonic estimation of gestational age or prediction of fetal weight. It is concluded that PPROM appears to have no deleterious effect on the accuracy of ultrasonic estimation of gestational age and prediction of fetal weight, except when the BPD is used as a single parameter for age estimation

Combined bioelectric and ultrasonographic evaluation of the fetus in pregnancy induced hypertension and diabetic pregnancies

To determine the individual and combined abilities of scored non- stress test [NST] and amniotic fluid volume [AFV] assessment in predicting fetal risk in- utero, and to provide an effective screening protocol for intra-uterine fetal compromise, one hundred near term patients [50 patients with severe pregnancy - induced hypertension, and 50 gravidas with known controlled diabetes mellitus] with a singleton pregnancy, formed the subject of the study. Scored NST, and qualitative AFV assessement were weekly performed for each patient till delivery. The obstetric outcome for each pregnancy was determined [perinatal mortality, intrapartum fetal distress, 5- minutes Apgar score <7, or small for gestational age infant], and the predictive abilities of the results of the last performed tests before delivery were estimated, individually and in combination. The predictive ability of scored NST was : sensitivity 75%, specificity 93.2%, PPV 60% and NPV 96.5%; the predictive ability of AFV assessment was sensitivity 58.3% specificity 92% PPV 50%, and NPV 94.2% while the predictive ability of combined NST+ AFV was: sensitivity 80%, specificity 96% PPV 73%, and NPV 97%. The predictive ability of combined NST and AFV assessment was higher than that of either of the testes alone, in both studied groups. The NST was superior to AFV assessment, specially in diabetic gravidas

Ultrasound assessment of uterine involution

Uterine involution was studied ultrasonographically in 130 patients. The patients included 4 groups: Group I of 40 patients, 20 of them were primiparas and 20 multiparas to study the effect of parity on the rate of involuation. Group II of 30 patients, 15 of them delivered vaginally and the other 15 delivered by cesarean section to study the effect of the mode of delivery on uterine involution. Group III of 20 patients, 10 of them were lactating and the other 10 non-lactating to study the effect of lactation on uterine involution. Group 1 V of 40 patients, 20 of them received ecbolics and the other 20 did not to study the effects of ecbolics. The results have shown that parity and ecbolics have no effects on the rate of uterine involution. The rate of uterine involution was faster in breast feeders and those delivered vaginally compared to non-breast feeders and those delivered by cesarean section [P < 0.05]. Ultrasonography proved to be a useful method for assessing uterine involution

Gall bladder functional changes and maternal serum bile acids in pruritis of pregnancy

Ultrasonographic measurement of the gallbladder volume was taken in 26 women with third-trimester normal pregnancies and in 28 third trimester pregnant women complaining of pruritis of pregnancy. Ultrasonic examinations were performed in the fasting state and 10, 20, 30, 45 and 60 minutes after ingestion of fatty meal. The total and direct bilirubin were assayed, and the fasting and two hours postprandial maternal serum bile acid [Cholyglycin] was estimated for all studied women. Gravidas with pruritis had significantly increased mean resting gallbladder volume [P<0.02] and ejection fraction [P<0.01] as compared to those means of control normal gravidas. The emptying time and residual volume showed non significant difference in the studied groups. Serum total and direct bilirubin levels were normal in the studied groups. There was significant increase in postprandial material serum bile acid [Cholyglycin] in gravidas with pruritis, as compared to their fasting mean [P<0.005] and to the postprandial mean of control normal gravidas [P<0.005]. The results indicated that in gravidas with pruritis, the gallbladder function and the enterohepatic circulation of bile acids were different from normal pregnancies. A new explanation for increased maternal serum bite acids is proposed