Ultrassonografia morfológica de primeiro trimestre: importante ferramenta para rastreio de aneuploidias e pré-eclâmpsia / First-trimester morphological ultrasound: important tool for aneuploidy and pre-eclampsia screening

No início do século 20, as altas taxas de mortalidade materna e infantil estimularam o desenvolvimento de um modelo de atendimento pré-natal que mantivesse características parecidas até os dias atuais. Nesse modelo, haveria maior concentração de visitas durante o final do terceiro trimestre de gestação, devido às maiores taxas de complicações nas fases finais da gestação e à dificuldade de prever a ocorrência de resultados adversos durante o primeiro trimestre. Atualmente, a avaliação clínica durante o primeiro trimestre, com auxílio da ultrassonografia e marcadores bioquímicos, pode prever uma série de complicações que acometem a gestação, incluindo cromossomopatias, pré-eclâmpsia, restrição de crescimento fetal, anomalias fetais e trabalho de parto pré-termo.

At the beginning of the 20th century, the high rates of maternal and infant mortality stimulated the development of a model of prenatal care that maintained similar characteristics until the present day. In this model, there would be a greater concentration of visits during the end of the third trimester of pregnancy, due to the higher rates of complications in the final stages of pregnancy and the difficulty in predicting the occurrence of adverse outcomes during the first trimester. Currently, clinical evaluation during the first trimester, with the aid of ultrasound and biochemical markers, can predict a series of complications that affect pregnancy, including chromosomal disorders, preeclampsia, fetal growth restriction, fetal anomalies and preterm labor.

Anomalías congénitas disruptivas asociadas con misoprostol. Reporte de un caso / Disruptive congenital anomalies associated with misoprostol. Case report

Resumen ANTECEDENTES: La exposición prenatal al misoprostol puede asociarse con un espectro de defectos congénitos que varían desde anomalías del sistema nervioso central, secuencia de Moebius, defectos en la pared abdominal, defectos transversales en las extremidades hasta alteraciones fetales. Esos defectos se observan más comúnmente con esquemas de solo misoprostol para inducción del aborto. Por esos antecedentes es importante que la historia clínica de toda paciente obstétrica sea exhaustiva para permitir identificar el antecedente de la exposición prenatal luego de un aborto fallido. CASO CLINICO: Paciente de 21 años, con 32 semanas de embarazo, con diagnóstico de feto con ventriculomegalia. En la evaluación ecográfica destacó la ventriculomegalia triventricular severa, simétrica y la angulación de ambas extremidades inferiores en varo. La resonancia magnética reportó: ventriculomegalia no comunicante severa, bilateral, simétrica, por probable estenosis del acueducto de Silvio. Cariotipo 46,XY y perfil TORCH negativo. El embarazo finalizó mediante cesárea, por indicación fetal a las 35 semanas. La evaluación al nacimiento reportó: parálisis facial bilateral, macrocefalia y pie equino varo bilateral. Al volver a interrogar a la paciente refirió haber sido tratada con misoprostol en el primer trimestre del embarazo, con fines abortivos. Al descartar las alteraciones cromosómicas e infecciosas se estableció el diagnóstico de secuencia Moebius. CONCLUSIONES: La exposición prenatal al misoprostol está relacionada con la aparición de defectos vasculares en algunos fetos expuestos. Aún no se ha determinado el espectro preciso ni la estimación potencial de teratogenicidad. La historia clínica es el pilar para la asociación en estos casos.

Abstract BACKGROUND: Prenatal misoprostol exposure can be associated with a spectrum of birth defects, ranging from central nervous system abnormalities, Moebius sequence, abdominal wall defects, as well as transverse limb defects, fetal abnormalities are more commonly seen with the use of the misoprostol-only regimen for induction of abortion, such that a thorough medical history is essential to detect a history of prenatal exposure after a failed abortion. CLINICAL CASE: A 21-year-old patient, with a 32-week pregnancy, who attended the institute with a diagnosis of a fetus with ventriculomegaly, the ultrasound evaluation highlighted severe symmetric triventricular ventriculomegaly and angulation of both lower extremities in varus, magnetic resonance imaging reported severe non-communicating ventriculomegaly Symmetric bilateral, due to probable stenosis of the aqueduct of Silvio, the karyotype reported 46, XY, as well as a negative TORCH profile, however, a cesarean section was performed for fetal indication at 35 weeks, the evaluation at birth showed bilateral facial paralysis, macrocephaly and foot Bilateral equinus varus, upon re-examination the patient referred the use of misoprostol in the first trimester of pregnancy for abortive purposes, so as there were no chromosomal or infectious alterations, a Moebius sequence was suggested. CONCLUSIONS : Prenatal exposure to misoprostol is related to the appearance of vascular disruption defects in some exposed fetuses, the precise spectrum and potential estimation of teratogenicity have not yet been determined, the clinical history is the mainstay for the association in these cases.

Significado clínico del diagnóstico prenatal de la protuberancia corial en el tamizaje del primer trimestre de la gestación / Clinical significance of prenatal diagnosis of chorionic bump in the first trimester screening

Resumen OBJETIVO: Determinar el significado clínico y el desenlace obstétrico y perinatal luego de la detección de una protuberancia corial en el estudio de tamizaje del primer trimestre de la gestación. MATERIALES Y MÉTODOS: Estudio de cohorte prospectiva efectuado, de abril del 2019 a diciembre 2021, en pacientes referidas para tamizaje del primer trimestre a una unidad de Medicina y Cirugía Fetal de tercer nivel de referencia (Prenatalia Medicina Fetal San Javier, Guadalajara, Jalisco, México). Criterio de inclusión: pacientes con medición de la longitud cráneo caudal comprendida entre 45 y 84 mm durante el tamizaje prenatal del primer trimestre. Se reportaron los hallazgos ecográficos, se obtuvieron información y datos clínicos relevantes de los expedientes electrónicos y cuando se consideró necesario se contactó al ginecoobstetra tratante y a las pacientes. Se utilizó estadística descriptiva con medidas de tendencia central y dispersión. Para el análisis comparativo se utilizó χ2 y U de Mann Whitney para contrastar diferencias entre grupos. RESULTADOS: Se evaluaron 1359 embarazos y la protuberancia corial se documentó en 19 de ellos. En 9 de 19 casos se asoció con sangrado del primer trimestre, previo a la exploración ecográfica. En 16 de 19 casos se encontraron dimensiones de la protuberancia corial mayores a 10 mm. Además, la protuberancia se asoció con episodios de amenaza de parto pretérmino en 13 de los 19 casos. CONCLUSIONES: La protuberancia corial es un hallazgo poco frecuente durante el tamizaje del primer trimestre que se asocia con sangrado y episodios de amenaza de parto pretérmino.

Abstract OBJECTIVE: To determine the clinical significance and obstetric and perinatal outcome after detection of a chorionic protrusion in the first trimester screening study. MATERIALS AND METHODS: Prospective cohort study performed in patients referred for first trimester screening to a third level referral Fetal Medicine and Surgery unit (Prenatalia Medicina Fetal San Javier, Guadalajara, Jalisco, Mexico) from April 2019 to December 2021. Patients with craniocaudal length measurements between 45 and 84 mm during first-trimester prenatal screening were included. Ultrasound findings were reported, relevant clinical information and data were obtained from electronic records, and the treating obstetrician-gynecologist and patients were contacted when necessary. Descriptive statistics with measures of central tendency and dispersion were used. For comparative analysis, 2 and Mann Whitney U were used to contrast differences between groups. RESULTS: 1359 pregnancies were evaluated and chorionic protrusion was documented in 19 of them. In 9 of 19 cases it was associated with first trimester bleeding prior to ultrasound examination. Chorionic protrusion was found to be larger than 10 mm in 16 out of 19 cases. In addition, the protrusion was associated with episodes of threatened preterm labour in 13 of 19 cases. CONCLUSIONS: Chorionic protrusion is a rare finding during first trimester screening that is associated with bleeding and episodes of threatened preterm labour.

Ultrasonographic diagnosis and prognosis of transposition of the great arteries at 11-13 + 6 weeks gestation / 中华超声影像学杂志

Objective:To investigate the value of ultrasonography in diagnosis of transposition of great arteries of the fetus at 11-13 + 6 weeks gestation. Methods:A prospective study was conducted on fetuses screened by ultrasound in the first trimester in Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region between January 2015 and March 2022. Fetal heart structure was screened by three-section screening method. Fetuses with suspected transposition of the great arteries at 11-13 + 6 weeks gestation underwent followed-up ultrasound examination, chromosome and gene test results. The ultrasound characteristics and prognosis pregnancy outcomes were summarized. Results:Twenty-one cases of transposition of the great arteries were detected by ultrasonography, including complete transposition of great arteries (20 cases) and congenitaly corrected transposition of the great arteries (1 case). Two cases were miss diagnosed. Twenty-one cases showed parallel signs of two major arteries on grayscale outflow section at 11-13 + 6 weeks gestation. There were 6 cases with aneuploid ultrasonographic soft markers abnormality, 2 cases with extracardiac malformation. Chromosome and microarray analysis were performed in 13 cases. 4 cases with chromosomal abnormality. Four cases of chromosomal abnormalities were associated with ultrasonographic soft markers abnormality, and 1 case with extracardiac malformation.In the 23 cases, 20 cases were induced, 1 miscarried, and 2 delivered to term. Among the fetuses delivered at term, 1 case died before neonatal operation and 1 case survived. Conclusions:Standardized ultrasound scan at 11-13 + 6 weeks has high accuracy in diagnosis of transposition of the great arteries. And the incidence of chromosomal abnormality is high with ultrasonographic soft markers abnormality or extracardiac malformation.

Ductus venosus as a marker of fetal growth in first trimester in a population of Colombian pregnant women / Ductus venoso como marcador de crecimiento fetal en primer trimestre en una población de gestantes colombianas

Abstract Objectives: to evaluate the relationship between the ductus venosus (DV) and the variables of fetal growth in the first trimester in a Colombian pregnant population. Methods: a descriptive cross-sectional study was carried out with secondary data obtained from a multicenter study.526 patients were included between weeks 11 and 14 for gestational ultrasound follow-up attended in three health care institutions in Bogotá, Colombia, between May 2014 and October 2018. A bivariate descriptive analysis was carried out where the relationship between the characteristics of the DV in the first trimester and ultrasound findings. Results: the flow wave of the DV in the first trimester was normal in the entire sample, with a pulsatility index of the ductus venosus (DVPI) of 0.96±0.18. In addition, a negative correlation was found between the crown-rump length (CRL) and the DVPI (p<0.05). Conclusion: there is a relationship between the DVPI regarding the CRL, indicating an interest in this early marker in relation to fetal growth alterations; however, more studies are required to determine the usefulness of this variable with respect to fetal growth.

Resumen Objetivos: evaluar la relación entre el ductus venoso (DV) y las variables del crecimiento fetal en primer trimestre en una población de gestantes colombianas. Métodos: se realizó un estudio transversal descriptivo con datos secundarios obtenidos de un estudio multicéntrico. Se incluyeron 526 pacientes entre las semanas 11 a 14 para seguimiento ecográfico gestacional atendidas en tres instituciones prestadoras de salud en Bogotá, Colombia, entre mayo del 2014 y octubre del 2018. Se realizó un análisis descriptivo bivariado donde se evaluó la relación entre las características del DV en primer trimestre y los hallazgos ecográficos. Resultados: la onda de flujo del DV en primer trimestre fue normal en la totalidad de la muestra, con un índice medio de pulsatilidad del ductus venoso (IPDV) de 0,96±0.18. Se encontró una correlación negativa entre la longitud cefalocaudal (LCC) y el IPDV (p<0.05). Conclusión: existe una relación entre el IPDV respecto a la LCC, señalando un interés de este marcador temprano en relación con las alteraciones del crecimiento fetal, sin embargo, se requieren más estudios para determinar la utilidad entre esta variable respecto al crecimiento fetal

Medical versus surgical method of pregnancy termination during first trimester

Background: Medical as well as surgical methods for abortion is performed worldwide since many years. Medical methods are safe till first trimester of pregnancy. The present study is intended to compare success rate and side effects of both method of abortion during first trimester. Aims and Objectives: The aim of the study was to study and compare the success rate in both the methods of termination of pregnancy in first trimester and to study side effects and complications as well as satisfaction among study participants undergoing termination of pregnancy during first trimester in both methods. Materials and Methods: A prospective comparative study was conducted at the Department of Obstetrics and Gynecology of one of the teaching medical institute of Ahmedabad among women seeking Medical termination of pregnancy with less than or equal to 9 weeks of gestation. Total 150 participants were selected using purposive sampling (75 in each group). Group A consist of patients having medical termination of pregnancy by medical method and Group B consist of cases that required termination of pregnancy by surgical method. Results: Mean age of the patients in Group A was 27.98 � 4.57 years and Group B was 27.58 � 4.22 years. Proportion of complete abortion in medical and surgical method was 88% and 96%, respectively. Surgical method had more effectiveness and success rate for complete abortion as compare to medical method. The mean duration of bleeding per vagina in both groups were more among Group A. Abdominal pain and gastrointestinal symptoms such as nausea, vomiting, diarrhea, and fever were also found to be more in Group A as compared to Group B. Those who had medical method were more satisfied than surgical method. Conclusion: Both methods are safe and effective as far as termination of first trimester pregnancy is concerned. Proper counseling with appropriate selection can bring safe and effective outcome in first trimester of termination of pregnancy

Hemorragias durante el primer trimestre del embarazo: revisión narrativa / Bleeding in the first trimester of pregnancy, narrative review

Resumen ANTECEDENTES: Las hemorragias durante el primer trimestre del embarazo son un problema que se atiende en la práctica clínica obstétrica diaria. Las conductas de atención suelen estar protocolizadas en casi todas las instituciones; sin embargo, la evidencia científica actual sugiere que algunas de esas conductas no tienen una evidencia sólida que las apoye. OBJETIVO: Revisar la bibliografía reciente y resumir las principales recomendaciones para la atención de casos de hemorragia en el primer trimestre del embarazo. METODOLOGÍA: Estudio retrospectivo basado en la búsqueda bibliográfica de artículos en inglés que contuvieran los términos MeSH: "First Trimester", "Hemorrhage", "Bleeding", "Ectopic Pregnancy" "Abortion", "Incomplete Abortion", "Miscarriage", "Early Pregnancy Loss", "Threatened Abortion" y "Gestational Trophoblastic Disease". Se incluyeron ensayos clínicos controlados, estudios de casos y controles, estudios de cohorte prospectivos y retrospectivos, guías de práctica clínica, protocolos, revisiones sistemáticas y metanálisis incluidos en la base de datos PubMed de 2014 a 2021. RESULTADOS: Se encontraron 54 artículos completos, de los que se descartaron 38 por duplicidad en la información, falta de pertinencia o no actualizados. Al final, solo se incluyeron 16 artículos para la revisión narrativa. CONCLUSIONES: Las hemorragias durante el primer trimestre, si bien son frecuentes no dejan de ser un reto diagnóstico por su amplio espectro de manifestaciones clínicas y causas. Siempre es necesario correlacionar la evaluación clínica completa con los hallazgos ecográficos y las concentraciones de β-hCG y descartar las causas no obstétricas del sangrado, independientemente de la sospecha diagnóstica inicial.

Abstract BACKGROUND: Hemorrhage in the first trimester of pregnancy is a problem seen in daily obstetric clinical practice. Care behaviors are usually protocolized in almost all institutions; however, current scientific evidence suggests that some of these behaviors do not have strong evidence to support them. OBJECTIVE: To review the recent literature and summarize the main recommendations for the care of cases of hemorrhage in the first trimester of pregnancy. METHODOLOGY: Retrospective study based on a literature search of English language articles containing the MeSH terms: "First Trimester", "Hemorrhage", "Bleeding", "Ectopic Pregnancy", "Abortion", "Incomplete Abortion", "Miscarriage", "Early Pregnancy Loss", "Threatened Abortion" and "Gestational Trophoblastic Disease". Controlled clinical trials, case-control studies, prospective and retrospective cohort studies, clinical practice guidelines, protocols, systematic reviews and meta-analyses included in the PubMed database from 2014 to 2021 were included. RESULTS: We found 54 complete articles, of which 38 were discarded due to duplicity in information, lack of relevance or not updated. In the end, only 16 articles were included for narrative review. CONCLUSIONS: First trimester hemorrhage, although frequent, is still a diagnostic challenge due to its wide spectrum of clinical manifestations and causes. It is always necessary to correlate the complete clinical evaluation with ultrasound findings and β-hCG concentrations and to rule out nonobstetric causes of bleeding, regardless of the initial diagnostic suspicion.

Diagnostic value of ultrasound in fetal posterior fossa anomalies at 11-13 + 6 gestational weeks / 中华超声影像学杂志

Objective:To explore the diagnostic value of ultrasound in posterior fossa anomalies (PFA) at 11-13 + 6 gestational weeks by measuring brainstem (BS), brainstem-to-occipital bone (BSOB) diameter and BS/BSOB ratio. Methods:A total of 209 normal fetuses (control group) were randomly selected from Beijing Obstetrics and Gynecology Hospital, Capital Medical University, between March 2018 and November 2021. Reference ranges for BS, BSOB diameter and BS/BSOB ratio were obtained on the mid-sagittal view of the fetal profile and the relationship of three parameters and crown-rump length (CRL) was investigated. The intra- and inter-observer reliabilities were determined by intraclass correlation coefficient (ICC) in 30 normal fetuses. Fourteen fetuses diagnosed with PFA in the same period including 10 cases of cystic posterior fossa malformations (cPFM) and 4 cases of open spine bifida (OSB) were retrospectively selected to compare BS, BSOB diameter and the BS/BSOB ratio with control group.Results:BS and BSOB diameters were successfully obtained in all control fetuses (100%), and the intra- and inter-observer reliabilities for BS and BSOB diameters were good (ICC=0.877, 0.846 and 0.939, 0.895). In the control group, BS and BSOB diameter linearly correlated with CRL ( r=0.867, 0.794; all P<0.001), while the BS/BSOB ratio was 0.75 (0.71, 0.79). There were significant differences of BSOB diameter and BS/BSOB ratio between control group and PFA group (all P<0.05). Except for one isolated vermian hypoplasia (VH), the BSOB diameters in 9 (90%) cases of cPFM were above the 95th percentile of the calculated normal range and were below the 5th percentile in 4(100%) cases of OSB.Except for one isolated VH, the BS/BSOB ratio in 9 (90%) cases of cPFM was below the 5th percentile of the calculated normal range. The BS/BSOB ratio in 4 (100%) cases of OSB was above the 95th percentile of the calculated normal range. Conclusions:The measurements of BS and BSOB diameter are feasible with good repeatability. Abnormal BSOB diameter and BS/BSOB ratio are suggestive for PFA. The posterior fossa of isolated VH can be normal in the first trimester.

Efficiency of preeclampsia screening based on biomarkers of aneuploidy screening in first trimester / 中华围产医学杂志

Objective:To evaluate the performance of biomarkers in aneuploidy screening in the first trimester-pregnancy associated plasma protein A(PAPP-A) combined with Fetal Medicine Foundation (FMF)'s competing risk model in screening preeclampsia among our population.Methods:This study was based on a prospective cohort of singleton pregnant women who underwent aneuploidy screening in the first trimester in Nanjing Drum Tower Hospital from January 2017 to September 2020. Mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), and PAPP-A were converted into multiples of median (MoM) using the algorithm disclosed on the website of the FMF (fetalmedicine.org). The predictive outcomes of maternal factors alone or in combination with MAP, UtA-PI, and PAPP-A (alone or in combination) were calculated. Chi-square test, Fisher's exact test or rank sum test were used for comparison among groups and Bonferroni method for pairwise comparisons. Receiver operating characteristic (ROC) curve was used to evaluate the screening efficiency and to calculate the sensitivities of predicting preeclampsia, term and preterm preeclampsia at false-positive rates of 5% and 10%. The predictive performance of this model was further compared to the screening strategy that was recommended in Diagnosis and treatment of hypertension and pre-eclampsia in pregnancy: a clinical practice guideline in China (2020). Results:Among the 5 144 singleton pregnancy women who were recruited in the cohort, 4 919 cases were included and analyzed in this study. A total of 223 cases were diagnosed as preeclampsia (4.5%), including 55 preterm (1.1%) and 168 term preeclampsia (3.4%). The median of MoM values of MAP, UtA-PI, and PAPP-A in the non-preeclampsia group were around 1.0±0.1. Statistical significance was observed in the difference of MAP, UtA-PI, and PAPP-A Mom between women with preterm preeclampsia and those without preeclampsia [1.061 (0.999-1.150) vs 0.985 (0.935-4.043), 1.115 (0.873-1.432) vs 1.039 (0.864-1.236), 0.820 (0.493-1.066) vs 1.078 (0.756-1.508)], which was also seen in the difference of MAP and PAPP-A Mom between women with term preeclampsia and those without preeclampsia [1.065 (1.002-1.133) vs 0.985 (0.935-4.043), 1.007 (0.624-1.393) vs 1.078 (0.756-1.508)] (all P<0.025). The combination screening with maternal factors+MAP+UtA-PI+PAPP-A was noted for the best efficiency. In predicting preeclampsia preterm and term preeclampsia at the false-positive rate of 10%, the sensitivity of the model was 53.0%, 76.4% and 44.6% respectively. Using the screening method recommended in Diagnosis and treatment of hypertension and pre-eclampsia in pregnancy: a clinical practice guideline in China(2020), the proportion of people at high risk of preeclampsia was 5.9% (290/4 919), and the sensitivity for predicting preterm preeclampsia was 25.5% (14/55), which was significantly lower than the combination screening with maternal factors+MAP+UtA-PI+PAPP-A [65.5% (36/55)] when using the same proportion of high-risk population. Conclusion:The preeclampsia screening model based on aneuploidy screening biomarkers in the first trimester--PAPP-A in combination with materral factors, MAP, UtA-PI, can effectively screen preterm preeclampsia in the local population without increasing the laboratory costs.

Relationship between fetal ultrasonic soft markers and adverse pregnancy outcomes during the first trimester / 中华超声影像学杂志

Objective:To explore the relationship between soft markers found in the first trimester (11-13 + 6 gestational weeks) ultrasound screening and fetal adverse pregnancy outcomes. Methods:Single pregnancy fetuses were selected from the Multicenter Clinical Study of First Trimester Screening in China during August 2017 to August 2020. The types and detection rate of soft markers during the first trimester were compared. The correlation between positive soft markers and adverse pregnancy outcomes was analyzed by binary Logistics regression.Results:A total of 16 625 fetuses with complete follow-up outcomes were included in the group. Six hundred and seven ultrasonic soft markers were detected in 556 fetuses with positive soft markers during the first trimester, and the first four most frequently occurred were increased nuchal translucency (NT) (2.08%, 345/16 625), echogenic intracardiac focus (EIF) (0.94%, 156/16 625), hypoplasia of fetal nasal bone (0.20%, 34/16 625), single umbilical artery (SUA) (0.19%, 31/16 625). Among 556 fetuses, the incidence of adverse pregnancy outcome in fetuses with two or more positive soft markers was 32.50% (13/40), which was significantly higher than fetuses with single positive soft marker (11.05%, 57/516), and the difference was statistically significant (χ 2=5.055, P<0.001). The incidence of adverse pregnancy outcome in positive soft markers fetus associated with structural abnormalities was 80.77% (21/26), which was significantly higher than fetuses with isolated positive soft marker (12.08%, 64/530), and the difference was statistically significant (χ 2=90.310, P<0.001). Binary logistic regression analysis showed choroid plexus cyst (CPC), SUA, echogenic bowel (EB), absent/reversed a-wave of ductus venosus, hypoplasia of fetal nasal bone, increased NT, and EIF were closely related to the adverse pregnancy outcomes (all P<0.05). However, there were no significant correlations between tricuspid regurgitation (TR), pyelectasis (PYE) and fetal adverse pregnancy outcomes (all P>0.05). Conclusions:The ultrasonic soft markers during the first trimester are of great significance in predicting fetal adverse pregnancy outcomes. For multiple positive soft markers or positive soft markers combined with structural abnormalities, more attention should be paid to them and comprehensive evaluation is required to be carried out.

Value of atrioventricular valve regurgitation in screening for atrioventricular septal defect in the first trimester / 中华超声影像学杂志

Objective:To investigate the value of atrioventricular valve regurgitation in predicting atrioventricular septal defect (AVSD) in the first trimester.Methods:Fetuses were examined prospectively by ultrasound at 11-13 + 6 weeks in Maternity & Child Healthcare Hospital of Guangxi Zhuang Autonomous Region between February 2016 and February 2021. Congenital heart disease was screened and atrioventricular valve regurgitation was observed in fetuses of gestational age 11 to 13 + 6 weeks using color Doppler in four-chamber view and three vessels and trachea view. Results:Totally 43 549 fetuses of gestational age 11 to 13 + 6 weeks were screened by echocardiography, of whom 37 cases were screened out with AVSD, including complete atrioventricular septal defect (31 cases), partial atrioventricular septal defect(3 cases) and intermediate atrioventricular septal defect(1 cases), 2 cases were misdiagnosed, and ultrasonic scanning in the second trimester found 2 missed cases of intermediate atrioventricular septal defect. Atrioventricular valve regurgitation was observed in 91.89% of atrioventricular septal defects (34/37) in the first trimester, 59.46% (22/37) nuchal translucency greater than 95th percentile, 29.73% (11/37) absence of nasal bone, 32.43% (12/37) ductus venosus A wave inversion, and 40.54% (15/37) had tricuspid regurgitation. The sensitivity of common atrioventricular valve regurgitation in predicting atrioventricular septal defect is better than other ultrasonic indexes. Conclusions:Atrioventricular regurgitation can be used as a clue to predict atrioventricular septal defect in the first trimester, which is beneficial to detect atrioventricular septal defect in the first trimester.

Glucemia materna de primer trimestre de embarazo y probabilidad de padecer diabetes gestacional. Categorización según índice de masa corporal pregestacional / Maternal glycemia of first trimester of pregnancy and probability of suffering gestational diabetes. Categorization according to pregestational body mass index

Introducción: la glucemia de ayuno >85 mg/dl en el primer trimestre de embarazo es uno de los factores de riesgo para el desarrollo de diabetes gestacional (DG). El aumento del sobrepeso y obesidad en las mujeres en edad fértil junto con la ganancia de peso excesiva a lo largo del embarazo son predisponentes para el desarrollo de esta patología, además de favorecer el estado de hipertrigliceridemia materna que en su conjunto predisponen a la macrosomía fetal. Entender la asociación entre estas variables es de importancia para individualizar el riesgo y tomar conductas precoces a fin de disminuir las complicaciones materno/fetales. Objetivos: primario: determinar la probabilidad de desarrollar DG según glucemia de ayunas del primer trimestre de embarazo (GA1erT>85 mg/dl) por categoría de índice de masa corporal (IMC), edad y ganancia de peso materno. Secundario: comparar trigliceridemia (TG) materna del último trimestre, peso fetal y glucemia de ayuno (GA) de prueba de tolerancia oral a la glucosa (PTOG) según IMC en pacientes con y sin DG. Determinar la prevalencia de macrosomía. Materiales y métodos: se analizaron historias clínicas (HC) de pacientes con DG de la Unidad de Diabetes y Embarazo y del Servicio de Maternidad de pacientes sin DG del Hospital Perrupato, San Martín, Mendoza. Los criterios de inclusión fueron: edad >18 años, registros completos de historias clínicas y diagnóstico de DG por PTOG. Se incluyeron 127 HC de pacientes con DG y 169 HC de pacientes sin DG, y se categorizaron según IMC pregestacional: IMC <24,9, IMC 25-30 y IMC >30. Resultados: para la variable de GA1erT>85 mg/dl en la categoría de IMC <24,9 la probabilidad de padecer DG fue 15 veces superior respecto a presentar un valor glucémico inferior, para el IMC 25-30 fue 9,2 veces más probable, mientras que para el IMC >30 fue 10,7 veces más probable, con efecto de magnitud grande para las tres categorías de IMC. No hubo diferencias entre peso fetal entre las distintas categorías de IMC analizadas (p=0,14, 0,36 y 0,59 respectivamente). Se observó aumento en el valor de GA de la PTOG en todas las categorías de IMC del grupo con DG (p=0,002, 0,01 y <0,001 respectivamente). La TG materna del último trimestre fueron significativamente más altos en las categorías de IMC <24,9 y 25-30 (p=0,04 y 0,026 respectivamente). La prevalencia de macrosomía aumentó en relación al incremento del IMC. Conclusiones: la glucemia de ayuno del primer trimestre demostró ser un fuerte predictor de DG en todas las categorías de IMC evaluadas.

Introduction: fasting blood glucose >85 mg/dl in the first trimester of pregnancy is one of the risk factors for the development of gestational diabetes (GD). The increase in overweight and obesity in women of childbearing age, and the excessive weight gain throughout pregnancy, are predisposing to the development of this pathology leading a rol in maternal hypertriglyceridemia, favoring to fetal macrosomia. Understanding the association between these variables is important to individualize the risk and take early behaviors in order to reduce maternal/fetal complications. Objectives: primary: determine the probability of developing GD according to fasting glycemia of the firts trimester of pregnancy (>85 mg/dl) by body mass index (BMI) category, age and maternal weight gain. Secondary: compare maternal triglyceridemia (TG) of the last trimester, fetal weight and fasting glycemia of oral glucose tolerance test (OGTT) according to BMI in patients with and without GD. Determine the prevalence of macrosomia. Materials and methods: medical records (MR) of patients with GD from the Diabetes and Pregnancy Unit and from the Maternity Service of patients without GD from the Perrupato´s Hospital, San Martin, Mendoza. Included were: age over 18 years, complete records of MR, diagnosis of GD by OGTT. 127 MR from patients with GD and 169 MR from patients without GD were included and classified according to pre-pregnancy BMI: BMI <24.9, BMI 25-30 and BMI> 30. Results: GD OR for category A was 15 times, for category B it was 9.2 times and for category C 10.7 times with large magnitude effect for the three categories. There were no differences between fetal weight (p=0.14, 0.36 and 0.59 respectively). fasting glycemia OGTT was significant in all categories (p=0.002; 0.01 and <0.001 respectively), maternal TG in the last trimester were significant in categories A and B (p=0.04 and 0.026 respectively). The prevalence of macrosomia increased in relation to the increase in BMI. Conclusions: fasting blood glucose of the first trimester is a strong predictor of DG in all evaluated categories.

Role Of Ultrasound In First Trimester Bleeding Per Vaginum

Background:Bleeding per vaginum in the first trimester is a common obstetric situation ranging from an insignificant episode to life threatening emergency. The major causes are abortion, ectopic, and molar pregnancy. Ultrasonography is playing an increasing role in the management of such patients. The aim of this study was to determine the role of first trimester bleeding on obstetrical ultrasound.Material And Methods:This was a retrospective observational study done at urban health care Hospital Ahemdabad, a tertiary care teaching hospital. All obstetric cases with a history of bleeding per vaginum in the first trimester of pregnancy between July2019 and December2019 were included. A complete general physical and pelvic examination was done to arrive at a clinical diagnosis. Patients were then subjected to ultrasound examination. Clinical diagnosis and ultrasound diagnosis were correlated.Result:150 of all 2000 obstetric cases had the first trimester bleeding (incidence of 7.5%). Commonest causes were abortion (78.66%), ectopic (6%), and molar pregnancy (2%). Of 150 cases, 106 cases were correctly identified by ultrasonography. 44 cases proved by sonography were misdiagnosed by clinical examination with a disparity of 52.38%. In this study, 56% pregnancies were clinically diagnosed as viable, but only 34% pregnancies were viable.Conclusion:When the first trimester of pregnancy is complicated by vaginalbleeding, the history and clinical findings are often misleading and if relied upon can only lead to a delay in diagnosis and management.This study reinforces that USG is important to establish a definitive diagnosis, differential diagnosis and subsequent management.

Falsos positivos del cribado de trisomía 21 y 18 del primer trimestre y complicaciones obstétricas / Adverse outcomes in pregnancies with false positive trisomy 21 and 18 screening results

OBJETIVO: Analizar si los casos positivos de cribado combinado de trisomía 21 (t21) o trisomía 18 (t18) en ausencia de aneuploidía (falsos positivos- FP) se relacionan con complicaciones de la gestación, ajustando por factores demográficos y clínicos de riesgo. MATERIAL Y MÉTODOS: Estudio retrospectivo de casos y controles anidado en una cohorte de pacientes que acudieron para cribado del primer trimestre. Los casos fueron las pacientes con FP de riesgo combinado de t21 superior a 1/270 o riesgo de t18 superior a 1/100. Se consideraron complicaciones de la gestación: óbito fetal, parto prematuro menor de 34 semanas o prematuro menor de 37 semanas, preeclampsia, retrasos de crecimiento, pequeño para la edad gestacional (CIR, PEG) y diabetes gestacional (DG). Se ajustó por obesidad, edad, paridad, tabaquismo, y técnicas de reproducción asistida. RESULTADO: Se obtuvieron 204 casos de FP, 149 FP para trisomía 21, 41 para trisomía 18, y 14 FP para ambos riesgos. Se encontró asociación estadísticamente significativa de FP t21 con óbito fetal (OR=3,5; ic95% 1,4-8,7; p=0,01), parto prematuro menor de 37 semanas (OR=2,2; IC95% 1,4-3,4; p=0,001), preeclampsia (OR =2,6; IC95% 1,17-6,1; p=0,02), PEG (OR =2,2; IC95% 1,2-4,1; p=0,02), CIR (OR=2,8; IC95% 1,6-5,1; p=0,001), y DG (OR=2,1; IC95% 1,2-3,7; p=0,01). Los FP t18 se asociaron con óbito (OR=8,9; IC95% 2,9-27; p=0,002). CONCLUSIÓN: Los FP del cribado del primer trimestre, para trisomía 21 y trisomía 18, se asocian con resultados obstétricos adversos.

We have studied whether positive cases of combined trisomy 21 (t21) or 18 (t18) screening in the absence of aneuploidy (false positives -FP-) are related to pregnancy complications adjusting for demographic and clinical risk factors. METHODS: Retrospective case-control study nested in a cohort of patients who came for first trimester aneuploidy screening. The cases were patients with FP combined risk of t21 (greater than 1/270) or t18 risk (greater than 1/100). The control group was a sample of patients with low-risk screening. We considered pregnancy complications: stillbirth, premature delivery before 34 and 37 weeks, preeclampsia, growth retardation, small for gestational age (FGR, SGA), and gestational diabetes (GD). Or were adjusted for obesity, age, parity, smoking, and assisted reproduction techniques. RESULTS: 204 cases of FP were obtained, 149 FP for trisomy 21, 41 for trisomy 18, and 14 FP for both risks. A statistically significant association between t21 FP was found with stillbirth (OR = 3.5; 95% CI 1.4-8.7; p = 0.01), preterm delivery less than 37 weeks (OR = 2.2; 95% CI 1.4-3.4; p = 0.001), preeclampsia (OR = 2.6; 95% CI 1.17-6.1; p = 0.02), SGA (OR = 2.2; 95% CI 1, 2-4.1; p = 0.02), FGR (OR = 2.8; 95% CI 1.6-5.1; p = 0.001), and GD (OR = 2.1; 95% CI 1.2 −3.7; p = 0.01). FP t18s were associated with fetal loss (OR= 8.9 (95% CI 2.9-27) p = 0.002. CONCLUSION: FP from first trimester screening for t21 and t18 are associated with adverse obstetric outcomes.

Ultrasonographic diagnosis of fetal cleft lip and palate during first-trimester (11-13 + 6 gestational weeks) / 中华超声影像学杂志

Objective:To explore the clinical value of prenatal ultrasound in diagnosis of fetal cleft lip and palate during first-trimester (11-13 + 6 gestational weeks). Methods:Ultrasonographic images were retrospectively selected from those fetuses who underwent first trimester scanning during July 2017 to June 2020 in the Affiliated Suzhou Hospital of Nanjing Medical University. Fetal facial mid-sagittal section and the retronasal triangle (RNT) section were combined together to evaluate whether the fetuses had cleft lip and palate (CLP) or not. All fetuses were followed up to birth or induced abortion.Results:A total of 5 520 fetuses were enrolled, with crown-rump length (CRL) between 45-84 mm. Seven cases of different types of CLP were detected by the 2 combined sections, including 4 cases with unilateral CLP, 1 case with median CLP, and 2 cases with bilateral CLP, which were confirmed by follow-up. In addition, 2 cases of isolated cleft lip (CL) were missed.Conclusions:Combination of fetal facial mid-sagittal section and RNT section is useful for the early diagnosis of fetal cleft lip and palate during first-trimester scanning.

Uterine artery Doppler in first trimester in prediction of adverse pregnancy outcome in Dharmapuri district of Tamil Nadu

Background: Pregnancies are complicated by hypertensive disorders of about 5-10% and hemorrhage, sepsis, and fetal growth restriction constitute a triad contributing to maternal morbidity and mortality. Hypertensive disorders in pregnancy vary from mildly elevated blood pressure to severe hypertension with multi-organ dysfunction. The study aims to evaluate the first-trimester uterine artery Doppler in the prediction of the development of adverse pregnancy outcomes.Methods: This prospective longitudinal observational was done in Dharmapuri Medical College and Hospital were selected for this study. Totally 150 pregnant women were included in the study. 75 were controls and 75 cases. The study period was from June 2018 to February 2019. Evaluating the optimal definition of abnormal first trimester.Results: Previous obstetric history in the study population. In the study group 3% of bad obstetric history (BOH) present. In the case group, 5% has BOH due to 2 neonatal death and 2 term intrauterine device (IUD), uterine artery Doppler parameters to predict adverse pregnancy outcomes, and association of gestational hypertension in the study groups. In the control group, 1%, and the case group 5% of them had gestational hypertension. Out of 4, 3 had an average uterine artery Doppler more than 2.3 (maximum of 2.7) and 1 had single uterine artery Doppler abnormality.Conclusions: The study showed that first-trimester uterine artery Doppler with single and average uterine artery pulsatility index (PI) >95th centile (2.3) has a better screening value in my population. The overall performance of the first-trimester uterine artery Doppler in the prediction of adverse pregnancy outcomes is valuable.

Clinical study of role of ultrasound in first trimester vaginal bleeding

Background: Vaginal bleeding is a serious cause which needs an emergency consultation. Major causes are abortion, ectopic pregnancy and molar pregnancy others like cervical erosion, polyp and carcinoma. The objective is to identify cause, assess the prognosis and institute appropriate management.Methods: Prospective study in MMC and RI, OBG, Mysore from November 2015 to September 2017. General physical and pelvic examination done for provisional clinical diagnosis and subjected to Ultrasound. Clinical diagnosis and ultrasound diagnosis were correlated.Results: 100 cases of first trimester bleeding evaluated by Ultrasonography with an incidence 2.37%. Most common cause was abortion (81.6%) then molar (10%) and ectopic pregnancy (9%). Out of 100 cases, 72 cases confirmed, 28 cases proved by ultrasound which was misdiagnosed on clinical examination with disparity of 72 between clinical and ultrasound diagnosis. 13 cases viable pregnancy by ultrasonography with sensitivity, specificity, NPV and PPV of 100% and 69 cases nonviable pregnancies with sensitivity, specificity and NPV of 100%. 9 cases ectopic pregnancy were diagnosed on ultrasound with sensitivity 100%, specificity 98.9%, PPV 99% and accuracy 99%. Clinical diagnosis in diagnosing viable pregnancies has sensitivity 76.92%, specificity 64.36% and PPV 24.39%. In diagnosis nonviable pregnancies, clinical diagnosis, poor statistical correlation with sensitivity 77.58, specificity 83.33%, PPV 86.53% and NPV 72.91%. Ultrasonographic diagnosis proved as very accurate on statistical correlation.Conclusions: Ultrasound is sensitive, cost effective and non-invasive diagnostic tool in first trimester bleeding. In this study, it helped in correct diagnosis of clinically misdiagnosed cases apart from confirming the diagnosis in others.

Screening for preeclampsia in the first trimester and aspirin prophylaxis: our first year / Rastreio de pré-eclâmpsia no primeiro trimestre e profilaxia com aspirina: o nosso primeiro ano

Abstract Objective Preeclampsia is a major cause of perinatal and maternal morbidity and mortality. Our objective is to assess the performance of a combined screening test for preeclampsia in the first trimester and the prophylactic use of low-dose aspirin. Methods Prospective study of all women attending our hospital for the first-trimester screening of aneuploidies, between March 2017 and February 2018 (n = 1,297). The exclusion criteria weremultiple pregnancy andmajor fetal abnormalities. Preeclampsia screening was performed with an algorithm that includes maternal characteristics, and biophysical and biochemical biomarkers. High-risk was defined as a risk ≥ 1:50 of earlyonset preeclampsia (before 34 weeks), in which cases low-dose aspirin (150mg at night) was offered to these women from screening until 36 weeks. Results From the 1,272 enrolled participants, the majority were Caucasian (1,051; 82.6%) and multiparous (658, 51.7%). Fifty patients (3.9%) screened high-risk for preeclampsia, and all started a low-dose aspirin regimen, with good compliance (96%). Early-onset preeclampsia was found in 3 pregnant women (0.24%), and total preeclampsia was diagnosed in 25 (2.02%), compared with 28 (0.75%) cases of early preeclampsia (p = 0.0099) and 98 (2.62%) of total preeclampsia (p = 0.2904) before the implementation of screening. Conclusion There was a lower incidence of both, early-onset and total preeclampsia, after the introduction of universal screening and prophylactic use of low-dose aspirin. This reduction was statistically significant in early-onset preeclampsia. The association of a first-trimester combined screening model and aspirin prophylaxis appears to be useful in predicting and reducing the incidence of early-onset preeclampsia, in a routine care setting.

Resumo Objetivo A pré-eclâmpsia é uma causa importante de morbi-mortalidade materna e perinatal. Os objetivos do nosso estudo foram avaliar a implementação do rastreio combinado de pré-eclâmpsia no primeiro trimestre e o uso profilático de aspirina em baixa dose. Métodos Estudo prospetivo das mulheres referenciadas ao nosso hospital para realização do rastreio do primeiro trimestre de aneuploidias, entre março de 2017 e fevereiro de 2018 (n = 1.297). Os critérios de exclusão foram gravidez múltipla e anomalias fetais graves. O algoritmo usado no rastreio da pré-eclâmpsia combina características maternas, e marcadores biofísicos e bioquímicos. Definiu-se alto risco como risco de pré-eclâmpsia precoce (antes das 34 semanas) ≥ 1:50, tendo sido recomendada aspirina em baixa dose (150 mg à noite) desde o rastreio até às 36 semanas. Resultados Das 1.272 participantes, a maioria era caucasiana (1.051; 82,6%) e multípara (658; 51,7%). Cinquenta grávidas (3,9%) foram consideradas de alto risco para pré-eclâmpsia e todas iniciaram aspirina em baixa dose, com boa adesão (96%). Pré-eclampsia precoce foi diagnosticada em 3 grávidas (0,24%), e no total foram diagnosticados 25 casos de pré-eclâmpsia (2,02%), comparativamente com 28 (0,75%) casos de pré-eclampsia precoces (p = 0,0099) e 98 (2,62%) casos totais de préeclâmpsia (p = 0,2904) observados antes da implementação do rastreio. Verificou-se uma menor incidência de pré-eclâmpsia precoce e total após introdução do rastreio universal e uso profilático de aspirina. A redução da pré-eclâmpsia precoce foi estatisticamente significativa. Conclusão A associação de um modelo de rastreio combinado no primeiro trimestre com o uso profilático de aspirina é aparentemente eficaz na redução do risco de préeclâmpsia precoce.

Prospective study of complications of first trimester medical termination of pregnancy at tertiary care center

Background: MTP (is common procedure done by obstetrician under certain circumstances as per MTP rules and guideline, but it has certain complication and data about complication are not fully available. The aims of this study are to analyse various complication and causes of this complication following MTP presenting at our hospital.Methods: This study was conducted in 100 patients coming to Pannadhay Rajkiya Mahila Chikitsalaya, RNT Medical college, Udaipur attending OPD (including emergency OPD) and IPD during August and September 2019 after MTP. This Study also included maternal mortality among all women participated in the study.Results: A total of 100 cases included in study attended OPD (including emergency OPD) and IPD during study period. All cases were eligible for inclusion in the study. Medical method of abortion (MMA) was the most common method of termination of pregnancy adopted by patient. Prolonged bleeding, anaemia and Incomplete abortion was the common complication related to MTP and manual vacuum aspiration was done in majority of cases to manage incomplete abortion in our hospital setting.Conclusions: The high rate of MTP related morbidity is due to induced abortion continue to be done at inappropriate places using inappropriate methods by person not eligible to do so.

A study of maternal outcome in first trimester bleeding

Background: The outcome of first trimester vaginal bleeding is a matter of debate. Vaginal bleeding is common and potentially alarming symptom in early pregnancy. First trimester bleeding is a common occurrence. It has been estimated to occur in 15-25% of all pregnant women. Objective of this study was to evaluate the various maternal outcomes in women with first trimester bleeding.Methods: This prospective observational study was conducted in the postgraduate department of obstetrics and gynecology, SMGS Hospital, Government Medical College, Jammu, Jammu and Kashmir, India. The study included 200 pregnant women presented with first trimester bleeding. All the women were followed prospectively till delivery and early postpartum period for various outcomes such as preterm delivery, PROM, PPROM, anemia, oligohydramnios, placental abruption, placenta previa and postpartum hemorrhage.Results: Out of 200 patients studied, 19% patients aborted. Ectopic and molar pregnancy was seen in 5% and 1.5% patients respectively. Out of 74.5% patients who continued pregnancy, maternal complications included anemia (52%), PROM (14.09%), oligohydramnios (6.71%), placenta previa (5.37%), PPH (4.03%), PPROM (2.68%), preeclampsia (2.01%), gestational hypertension (1.34%), abruption and post-datism (0.67% each).Conclusions: From the results of this study, it can be concluded that first trimester bleeding can be a predicting factor in terms of mother and infant consequences of pregnancy and it is necessary to increase the knowledge of pregnant women in this regard for closer care.