Variation of amniotic fluid γ-glutamyl transferase level at 19-23 +6 gestational weeks in normal pregnancies / 中华围产医学杂志

Objective:To detect the levels of γ-glutamyl transferase (GGT) in the amniotic fluid of normal pregnancies at 19-23 +6 gestational weeks and to analyze the changes in GGT level with gestational age. Methods:This study retrospectively collected the amniotic fluid supernatant from 383 singleton pregnant women (102, 103, 82, 68 and 28 cases at 19-19 +6, 20-20 +6, 21-21 +6, 22-22 +6, 23-23 +6 weeks of gestation, respectively) who underwent amniocentesis for prenatal diagnosis but had normal genetic diagnosis results in Cheeloo Hospital of Shandong University from January 2021 to September 2022. The levels of GGT in the amniotic fluid supernatant were tested and the statistical parameters including xˉ± s, min-max, median ( M), P1, P2.5, P5, P95, P97.5 and P99 values of GGT levels at each gestational week were calculated. GGT were non-normal data and converted into natural logarithms (lnGGT), and a least square linear regression equation was established to analyze the relationship between lnGGT and gestational week. Results:At 19-19 +6, 20-20 +6, 21-21 +6, 22-22 +6, and 23-23 +6 gestational weeks, the xˉ± s of amniotic fluid GGT were (385.8±235.7), (331.8±219.4), (253.7±197.9), (226.7±166.4), and (155.3±96.8) U/L, and the weekly declines were 14.0%, 23.5%, 10.6%, and 31.5%, respectively; the M values were 311.0, 288.0, 199.0, 160.5, and 105.5 U/L, and the weekly declines were 7.4%, 30.9%, 19.3%, and 34.3%, respectively; the P1- P99 were 67.1-1 404.5, 63.2-1 189.1, 36.0-849.8, 44.0-787.3, and 32.0-375.6 U/L, respectively. lnGGT was negatively correlated with gestational age ( R 2=0.148, P<0.001). Conclusions:In normal pregnancies at 19-23 +6 gestational weeks, GGT levels in amniotic fluid decrease with gestational age. Therefore, gestational age should be considered when establishing the reference value for amniotic fluid GGT in normal pregnancies.

The follow-up observation on the abnormal elevation of fetal pulmonary artery systolic pressure at middle and late stages by Doppler echocardiography / 中华超声影像学杂志

Objective To investigate the outcome of fetus with abnormal increase of pulmonary artery systolic pressure at second and third trimester by color Doppler ultrasound . Methods Ninety-five fetuses with a little or mild tricuspid regurgitation ( control group) and 60 fetuses with moderate and severe tricuspid regurgitation (observation group) were included . The degree ,velocity ,and differential pressure of tricuspid regurgitation were measured and the variations of baseline information and the measured value of pulmonary systolic pressure between the two groups were compared . As for the follow -up on observation group ,the pressure of fetus with high pulmonary systolic pressure ( > 20 mmHg) was repeatedly measured every 4 weeks until it return to normal . Results There were significant differences in terms of gestational weeks ,velocity and pressure of tricuspid regurgitation ,as well as pulmonary systolic pressure between the two groups ( P < 0 .001) . Pulmonary systolic pressure was positively correlated with gestational weeks , velocity and pressure of tricuspid regurgitation ( r = 0 .442 ,0 .998 ,0 .999 ;all P < 0 .001 ) ,but had no correlations with the age of pregnant women ( r = - 0 .001 , P = 0 .674) . The follow-up revealed that ,in observation group , 47 cases ( 78 .3％ , systolic pressure < 50 mmHg ) presented with the decreased pulmonary systolic pressure ,the disappeared or the slight appeared regurgitation before birth ,meanwhile , 13 ( 21 .7％ ,systolic pressure ≥ 50 mmHg) exhibited severe tricuspid regurgitation and persistent pulmonary elevation ,with the highest of more than 70 mmHg accompanying the varying degrees of right heart failure . Only one of 13 fetuses died due to persistent pulmonary hypertension and hypoxia ( oxygen saturation <45％ ) . The fetal pulmonary artery systolic pressure of the remaining 12 cases recovered from 5 to 105 days after birth ,with normal heart function . Conclusions The majority of fetal pulmonary arterial hypertension complicated with obvious tricuspid regurgitation is reversible functional alteration , which can restore normality in most cases before or after birth .

Study on prenatal diagnosis of fetal malformations of cortical development by ultrasonography / 中华超声影像学杂志

Objective To explore sonographic manifestation of fetal malformations of cortical development.Methods From August 2012 to January 2014 three hundred and twenty-five pregnancy women referred to our institution for fetal brain MRI,which were diagnosed or suspected of central nervous system abnormalities by prenatal ultrasound examination.Results In 325 of cases,14 cases (4％) were diagnosed of malformations of cortical development.Ten eases were indicated by prenatal ultrasound,including three cases of heterotopic gray matter,six cases of microcephaly and one case of hemimegalencephaly; four cases were missed by prenatal ultrasound,including two cases of schizencephaly,one case of tuberous sclerosis,and one case of hypoplasia.Conclusions Cortical malformations can be diagnosed by prenatal ultrasonography based on typical imaging characteristics.Prenatal ultrasound combined with MRI is a powerful tool in diagnosing fetal malformations of cortical development.

Embolization of uterine arteriovenous malformation

Background: uterine arteriovenous malformation is a rare but potential life-threatening source of bleeding. A high index of suspicion and accurate diagnosis of the condition in a timely manor are essential because instrumentation that is often used for other sources of uterine bleeding can be lead to massive hemorrhage

Case: we describe here a case of uterine arteriovenous malformation. A 32-year-old woman presented abnormal vaginal bleeding following the induced abortion. A diagnosis of uterine arteriovenous malformation made on the basis of Doppler ultrasonraphy was confirmed through pelvic angiography. The embolization of bilateral uterine arteries was performed successfully

Conclusion: uterine arteriovenous malformation should be suspected in patient with abnormal vaginal bleeding, especially who had the past medical history incluing cesarean section, induced abortion, or Dillation and Curethage and so on. Although angiography remains the gold standard, Doppler ultrasonography is also a good noninvasive technique

Ultrasonography score in comparison with pelvic anterior posterior diameter for the prognostic evaluation of fetal hydronephrosis / 中华超声影像学杂志

Objective To determine whether prenatal ultrasonography (US) score is more effective than renal pelvic anterior posterior diameter (PAPD) for the prognostic evaluation of fetal hydronephrosis.Methods Fetuses with hydronephrosis (PAPD≥ 10 mm) were examined by prenatal US in the third trimester.PAPD,renal parenchyma thickness (RPT) and pelvicaliceal morphology (PM) were measured and graded from 0 to 3 score on the basis of severity of hydronephrosis,then the total US score of each kidney was obtained.According to the follow-up results after birth,all the cases were divided into two groups:physiological and pathological hydronephrosis.Via Z test,paired comparison was made to analyze area under the curve (AUC) of US score and each of the other three factors.Results Confirmed by postnatal US and other clinical examinations,of 198 kidneys (158 cases ) with hydronephrosis,139 (70.20％ ) were physiological hydronephrosis and 59 (29.80％ ) were pathological hydronephrosis.AUC of PAPD,RPT,PM,US score was 0.897 (minimum),0.957,0.944 and 0.982 (maximum) respectively,and there was significant difference between AUC of US score and each of the other three ( P ＜0.05).US score was the best approach for differential diagnosis of fetal hydronephrosis.Conclusions Prenatal US score is more effective and accurate than the single factor (PAPD,RPT,PM) to differentiate fetal physiological and pathological hydronephrosis.It was a new quantitative method to evaluate the prognosis of fetal hydronephrosis,and should be disseminated and applied clinically.

Clinical value and effectiveness of sonography screening for fetal chromosomal abnormalities in the middle and late pregnancy / 中华超声影像学杂志

Objective To evaluate the clinical value and effectiveness of ultrasound screening for fetal chromosomal abnormalitie in the middle and late pregnancy. Methods Fetuses who were detected with abnormal ultrasound findings during the middle and late pregnancy, and high risk of maternal serum screening underwent amnioeentesis or eordocentesis for fetal chromosome karyotypes. Results (1) A total of 31 cases with fetal malformation diagnosed by ultrasound were analysed for fetal chromosome karyotypes, and 8 (25.8%) cases were proved with fetal abnormal chromosome karyotypes. There were 3 cases of cervical springwater cyst accompany with edema,and all were fetal abnormal chromosome karyotypes. There were 3 cases of cervical pachyderma,and 2 were fetal abnormal chromosome karyotypes. There was one case with multiple malformations, one with Dandy-Walker malformation and one with holoprosencephaly malformation,all were revealed fetal abnormal chromosome karyotypes. (2) A total of 516 cases with high risk of Down's syndrome and trisomy 18 by maternal serum screening were analysed for fetal chromosome karyotypes,and 14(2.710%) cases were proved with fetal abnormal chromosome karyotypes, which include 7 cases of Down's syndrome and 7 cases of other fetal abnormal chromosome karyotypes. (3) A total of 544 (516 + 28)cases with high risk by the combination of ultrasound and maternal serum screening were analysed for fetal chromosome karyotypes, and 21 (3.86%) cases were proved with fetal abnormal chromosome karyotypes, the rate of detection higher than only maternal serum screening 42.43%.Conclusions Fetal structure abnormalities were the effective ultrasound signs for fetus chromosomal abnormalities screening in the middle and late pregnancy. The combination of ultrasound and maternal serum screening can improve the rate of fetus chromosomal abnormalities screening and be an effective way to retrieve false-positive and lower risk of maternal serum screening.

Study of the size and configuration of the third ventricle of the normal fetus in the second and third trimester by ultrasonography / 中华超声影像学杂志

Objective To observe the normal configuration and size of the third ventricle in the second and third trimester fetuses in a normal population by ultrasonography. Methods The third ventricular width and configuration were obtained by antenatal ultrasonography in 765 fetuses with gestational age between 27 weeks and term.The relationship Between the width and the gestational age was analyzed.Results The third ventricle width 0～3 mm and showed the increased tendency; the correlation coefficient ( r ) between the width of the third ventricle and the gestationl week was 0.473 ( P＜0.01).The third ventricle was seen as a single echogenic line in 8(4.8%) of 165 fetuses, 145(61.5%) of all fetuses had parallel echogenic lines outlining a fluid-filled lumen, the V-shaped configuration of the third ventricle was seen in 12(7.3%) of the fetuses.Conclusions The third ventricle width shows the increased tendency in the second and third trimester.The parallel echogenic line becomes the prominent ultrasonography appearance in the second and third trimester fetuses.It's usefull to observe the normal ultrasonic apperance of the third ventricle in diagnosing the fetal central nervous abnormities.

Gray-scale contrast enhancement ultrasonography in rabbit liver and VX_2 tumor / 中华超声影像学杂志

Objective To evaluate the hemodynamic features of VX_2 tumor and peri-neoplastic liver parenchyma with low mechanical index gray-scale contrast enhancement.Methods Ultrasound contrast agent SonoVue((0.1) ml/kg) was applied respectively in 8 VX_2-bearing rabbits by intravenous bolus injection.Corresponding parameters of the time-intensity curve:time to enhancement(ET),time to peak intensity(PIT),peak signal intensity(PSI) and mean transit time(MTT) were measured using low mechanical index contrast gray-scale imaging and Wash-in/Wash-out time-intensity curve software.Results Gray-scale imaging delineated clearly the dynamic enhancement of the VX_2 tumor and the surrounding liver parenchyma.The ET and PIT were definitely earlier,the PSI lower and the MTT absolutely shorter in VX_2 tumors than those in the liver parenchyma.There were significant differences of parameters derived from the time-intensity curve between VX_2 tumors and liver parenchyma(P

Application of interventional ultrasound to prenatal diagnosis of fetal chromosomal abnormalities / 中华超声影像学杂志

Objective To evaluate the role of interventional ultrasound technique in prenatal diagnosis of fetal chromosomal abnormalities.Methods Percutaneous ultrasound-monitored amniocentesis and cordocentesis were performed on 186 pregnant women with indicantions for prenatal diagnosis to detect karyotype of the fetus.Results All the cases were punctured successfully.Percutaneous ultrasound-monitored amniocentesis was performed in 105 pregnant women.The archievement rate of the aminiotic fluid was 97.1%,and the detection rate of the chromosomal abnormality was 8.8%.Percutaneous ultrasound-monitored cordocentesis were performed in 81 pregnant women.The archievement rate of the cord blood was 98.8%,and the detection rate of the chromosomal abnormality was 5.0%.There was no significant deviation between them.The valid indications of the puncture included the abnormal serology screening results of pregnant women,the history of abnormal deliveries,the history of the trisomy 21,and the abnormal fetus detected by ultrasound,the last of which was higher than the other indications at the detection of the chromosomal abnormality.Conclusions Interventional ultrasound technique proves to be valid in the prenatal diagnosis,and ultrasound detection of abnormal fetus indicates the possibility of the fetal chromosomal abnormality.

Value of transrectal three-dimensional ultrasound in diagnosis of polycystic ovarian syndrome in virgin patients / 中华超声影像学杂志

Objective To evaluate the diagnostic value of transrectal three-dimensinal ultrasonography for virgin polycystic ovarian syndrome(PCOS) patients.Methods Transrectal three-dimensional ultrasonography were performed on 45 virgin patients with PCOS,30 with polycystic ovary(PCO) and 25 controls.Ovarian follicle numbers(FN),ovarian volume(OV),ovarian stroma area(SA),total area(TA) and SA/TA ratio and correspondent biochemical parameters were measured.Results Transrectal ultrasonography was more reliable than abdominal ultrasonography in the detection of delicate structure of ovary in virgin patients.This method was noninvasive,convenient,distinct and sensitive.Patients with PCOS showed sinificantly higher SA and SA/TA compared to those of the PCO group and control group.Conclusions In the case of detection of PCOS in virgin patients,transrectal three-dimensional ultrasonography combined with transabdominal ultrasonography can improve the precision of the diagnosis of PCOS.The SA/TA ratio might be considered as the ultrasound diagnostic parameter in PCOS.

Ultrasonic diagnosis in fetal congenital absence of the radius / 中华超声影像学杂志

Objective To discuss the feature of the ultrasonic image of the fetal congenital absence of the radius. Methods Five cases with congenital absence of the radius were examined by colour Doppler sonography and compared with normal fetuses. Results There were four characteristics of ultrasonic imaging:①The length of three radius was 0 cm in the six disabled limbs,others were 4 time s shorter than the normal identical pregnant fetuses. ②All the disabled limbs showed that the forearm was short and bent, and the hand was lopsided. ③All the cases were combined with hydramnios. ④Three abnormal fetuses were combined with other deformies.Conclusions Ultrasound is superior to other methods in diagnosing fetus congenital absence of the radius.