Improvement in uterine artery doppler indices via hysteroscopic metroplasty.

OBJECTIVE: the objective of our research was to study uterine artery doppler indices and their evolution over time after metroplasty and subsequent pregnancy in patients whose septate uterus was the only explanation for infertility. MATERIALS AND METHODS: a retrospective study. The uterine arteries of 78 patients with septate uteri were evaluated using endovaginal color doppler ultrasound before and after metroplasty. Fifty-one patients became pregnant after metroplasty and were selected as study group, pregnancy occurred within 17 months. By comparing uterine artery doppler indices before and after metroplasty, we observed that the resistive index (RI) and pulsatility index (PI) post surgery were significantly lower compared to premetroplasty levels. RESULTS: all pregnant women in the study group showed uterine resistive indexes within normal ranges, they all underwent scheduled cesarean in-tervention. Gestational evolution was normal in all patients (mean score of Apgar and birth weight); no neonatal complications were observed. CONCLUSION: metroplastic intervention in women with septate uterus as the sole cause of infertility may be a plausible alternative for patients wishing to carry a pregnancy.

Conjoined twins: what ultrasound may add to management.

INTRODUCTION: Conjoined twins occur in approximately 0.2:10,000 births; the obstetrician and sonographer only rarely examine them. In Western countries, discovery of conjoined twins is often made by the end of the first trimester; however, in the third world, conjoined twins are often discovered only at birth. OBJECTIVE: To evaluate how ultrasound techniques, when possibly available, may improve management and counseling when conjoined twins are confirmed. MATERIAL AND METHODS: The authors report two different cases of union of two equal twins with sole umbilical cord. RESULTS: The two cases presented with non contributive medical history and no prior teratogen exposure and an unfavorable prognosis. Early discovery of viable conjoined twins permits assessment of the best route of delivery and a planning for serial sonography and fast MRI to plan eventual separation surgery or fetus after-birth surviving possibilities.

Full-term-pregnancy effects of antenatal betamethasone administration on short-term variation as assessed by computerized cardiotocography.

OBJECTIVE: to verify whether there are other than transitory effects of antenatal betamethasone (administered for fetal lung maturity [FLM] enhancement) on fetal heart rate (FHR) variability detected by computerized cardiotocography (cCTG) in cases where formerly steroid-treated fetuses reached term. MATERIALS AND METHODS: cCTG of one hundred sixty-four women (study group) exposed to antenatal betamethasone for risk of preterm delivery in third trimester period were compared to controls (pregnancies who presented risk of preterm labour in the same period of cases, although with no steroids administration). cCTG was performed weekly as of standard schedule when pregnancies reach term from 37-40 weeks' gestation for cases and controls. RESULTS: regarding data concerning cCTG at term for cases and controls, no significant difference was found for FHR, Acc (accelerations) 10 min, and FM (fetal movements) between groups. LV (low variation)/min and LV/msec were absent in cCTG parameters of fetuses in the study group. Instead, for all weeks studied (37 to 40), cCTG parameters were higher for HV (high variation)/msec, STV(short term variation)/msec, and Acc 15 in cases with respect to controls. CONCLUSION: interestingly, maternal corticosteroid administration may be related to higher fetal reactivity when fetuses exposed to steroid therapy reach term. Our observation may help in the interpretation of a "more reactive" CTG trace in babies whose mothers previously received steroid therapy for FLM enhancement.

Betamethasone effects on umbilical arteries and ductus venosus Doppler velocity waveforms in growth-restricted fetuses.

UNLABELLED: We studied intrauterine-growth-restricted (IUGR) fetuses with absent or reversed umbilical artery end-diastolic flow (EDF) velocity in order to evaluate the benefit of antenatal steroid therapy. Perinatal outcomes after betamethasone were evaluated where end diastolic flow returned (group I), compared with data from fetuses with persistent absent-reverse end diastolic(ARED) flow (group II). OBJECTIVES/METHODS: We recruited sixty-four IUGR fetuses, 28-32 weeks' gestation, whose umbilical artery spectral tracings showed ARED flow and positive a-wave in the ductus venosus at admission. RESULTS: Group I, 21 cases of restored EDF after betamethasone: Significant, persistent return of umbilical artery EDF flow and persistent ductus venosus a-wave were documented. Group II, 43 cases of persistent ARED flow: Persistent ARED flow in umbilical arteries and deterioration of ductus venosus waveform with significant, increasing pulsatility index and/or a-wave disappearance were documented. In group I, cardiotocographic alterations were delayed contrasted with group II, (p = 0.03). Neonatal complications in group II were eight cases of intraventricular hemorrhage; two cases of retinopathy of prematurity; three neonatal deaths, one fetal demise; and a higher incidence of neonatal respiratory distress syndrome. CONCLUSIONS: Betamethasone treatment may have beneficial effects on restoring end-diastolic umbilical artery velocimetry and precordial waveforms. These spectral Doppler changes are related to delayed cardiotocographic alterations and to better perinatal outcomes.

Unicornuate uteri associated with contralateral renal agenesis and ovarian anomalies.

Our findings regarding two cases of unicornuate uterus validate that conventional transvaginal ultrasound is helpful in diagnosing uterine anomalies. Moreover, anomalies of the urinary system and the contralateral ovary should always be considered.