Relation of cervical length at 22-24 weeks of gestation to demographic characteristics and obstetric history

Preterm delivery is the main cause of neonatal death and ultrasonographic cervical assessment has been shown to be more accurate than digital examination in recognizing a short cervix. This is a cross-sectional study, involving 1131 women at 22-24 weeks of pregnancy, designed to determine the distribution of cervical length and to examine which variables of demographic characteristics and obstetric history increase the risk of a short cervix (15 mm or less). The distribution of maternal demographic and obstetric history characteristics among patients with cervical length ú15 mm was analyzed and compared to the findings for the general population. Risk ratios (RR) between subgroups were generated from this comparison. Median cervical length was 37 mm and in 1.5 percent of cases it was 15 mm or less. The proportion of women with a short cervix (<=15 mm) was significantly higher among patients with a low body mass index (RR = 3.5) and in those with previous fetal losses between 16-23 weeks (RR = 33.1) or spontaneous preterm deliveries between 24-32 weeks (RR = 14.1). We suggest that transvaginal sonographic measurement of cervical length be performed as part of a routine midtrimester ultrasound evaluation. There are specific variables of demographic characteristics and obstetric history which increase the risk of detecting a short cervix at 22-24 weeks.

Biochemical profile of amniotic fluid for the assessment of fetal and renal development

Creatinine plays a key role in the function and maturation of fetal kidneys throughout pregnancy. It is important to identify other markers that may help in the diagnosis of renal dysfunction. Our aim was to determine the profile of and the correlation between biochemical markers to be used to assess renal function and maturation of the fetus in the amniotic fluid during pregnancy and to determine the distribution of normal values for creatinine, N-acetyl-ß-D-glucosaminidase (NAG), ß2-microglobulin, glucose, urea, sodium, potassium, phosphorus, calcium, uric acid, albumin, and osmolality in three gestational age groups. This was a cross-section study that assessed 115 samples of amniotic fluid during three different periods of pregnancy, i.e., 13 to 20, 27 to 34, and 36 to 42 weeks. Concentrations of creatinine, NAG, urea, potassium and uric acid increased during pregnancy (P<0.05). ß2-Microglobulin, glucose, sodium, phosphorus, calcium, and albumin concentration and osmolality decreased (P<0.05), whereas ß2-microglobulin, glucose and uric acid presented significant correlations with gestational age and creatinine, respectively (r>0.6, P<0.05). Urea, potassium and phosphorus showed mild correlations with both (r>0.5, P<0.05). NAG, sodium, albumin and osmolality did not show significant correlations (r<0.5, P<0.05). These tests confirmed the important role of creatinine in terms of correlation with gestational age. ß2-Microglobulin, glucose and uric acid were significant as markers of function and maturation of fetal kidneys, whereas NAG did not demonstrate a useful role for the assessment of renal maturation

Alfafetoproteína: valores normais no líquido amniótico entre 14 e 21 semanas / Alphafetoproteín: amniotic fluid normal values between 14 and 21 weeks

Objetivo. Definir uma curva de normalidade dos valores de alfafetoproteína (AFP) no líquido amniótico em gestantes entre 14 e 21 semanas de gravidez no Hospital de Clínicas de Porto Alegre. Materiais e Métodos. Nas 137 mulheres que procuraram o diagnóstico pré-natal e tiveram indicaçao de coleta de líquido amniótico. A alfafetroproteína foi dosada em todas as amostras por enzima imunoensaio. Foram selecionadas 109 gestaçoes normais (sem malformaçoes, cariótipo normal, nao-gemelares) e cujas amostras de líquido amniótico nao eram sanguinolentas. Essas foram divididas quanto à idade gestacional e tiveram calculadas as medianas dos valores de AFP e seus múltiplos. Resultados. As medianas da alfafetoproteína (KUI/ml) para cada idade gestacional foram as seguintes: 14 semanas: 16,32; 15 semanas: 14,36; 16 semanas: 13,43; 17 semanas: 10,93; 18 semanas: 8,22; 19 semanas: 7,35; 20 semanas: 5,62; 21 semanas: 4,47. Conclusao. O estabelecimento de uma curva normal de AFP em nosso serviço permite a utilizaçao deste exame para pacientes em risco de defeitos de fechamento de tubo neural. Permite também que sejam analisadas amostras enviadas para estudos citogenéticos ou metabólicos de maneira a identificar fetos com níveis elevados de AFP que necessitarao de estudos ultrasonográficos mais detalhados pela possibilidade de defeitos morfológicos.

Association of ovarian volume and serum LH levels in adolescent patients with menstrual disorders and/or hirsutism

Pelvic ultrasonography was performed on 25 adolescent patients with menstrual disorders and/or hirsutism. Clinical and endocrinologic state was evaluated by history, physical examination and assays of serum LH, FSH, prolactin, testosterone and androstenedione levels in order to determine a possible association between hormonal levels and ovarian volume in the etiologic investigation of these adolescent girls. Patients aged 12 to 19 years, mean 14.92 years (menarche at 12 to 16 years; mean, 12.32 years) were divided into three groups according to ovarian size at ultrasonography: group I, N = 13, both ovaries 2-10 cm3; group II, N = 5, one of the ovaries > 10 cm3; group III, N = 7, both ovaries > 10 cm3. A strong correlation between serum LH levels and ovarian volume (r = 0.647, P < 0.0001) was observed. Moreover, when comparing the hormonal levels of all three groups, serum LH levels were significantly higher in group III (group I, 3.92 +/- 3.49; group II, 5.25 +/- 2.71; group III, 9.77 +/- 3.11 mIU/ml; mean +/- SD, P < 0.003) while testosterone and androstenedione levels showed a tendency to also be higher, but this difference was not significant. This hormonal pattern is suggestive of polycystic ovary syndrome (PCOS). The present results suggest that ovarian size of more than 10 cm3 at pelvic ultrasound in adolescent girls with menstrual disorders and/or hirsutism might be predictive of PCOS and emphasize the importance of careful assessment of ovarian volume by ultrasound