Fetal survival in abdominal pregnancy: a review of 11 cases.

PURPOSE: Little has been written regarding the ultrasound imaging features that might allow prediction of fetal viability in abdominal pregnancies. Toward this goal, we present our experience with a series of 11 abdominal pregnancies. MATERIALS AND METHODS: From 1981 to 1993, 11 patients presented to Universidad Catolica, Santiago, and Universidad de Austral, Valdivia, Chile, with third trimester abdominal pregnancies. Five had complete ultrasound examinations, and these five patients were managed expectantly. The other six women presented as acute abdominal emergencies and underwent emergent surgery. RESULTS: Four of five fetuses that survived had a complete placental attachment to the uterus, and one surviving neonate had a partial attachment of the placenta to the uterus. Three fetuses died prior to delivery, and all three had a complete mesenteric placental attachment. Two died in the early neonatal period. One had a complete uterine placental attachment, and the other had a partial attachment. CONCLUSIONS: The survival rate of abdominal pregnancies may be better than is generally believed. Placental attachment to the uterus appears to be a factor related to fetal survival and maternal morbidity. More cases are necessary to determine the feasibility of managing women with abdominal pregnancies expectantly.

Transvaginal hysterosonography: comparison with biopsy in the evaluation of postmenopausal bleeding.

Transvaginal sonography is a highly sensitive method for detecting endometrial thickening. In the postmenopausal woman such thickening is non-specific and can be due to hyperplasia, polyps, submucosal endoluminal fibroids, or carcinoma. In such cases, transvaginal sonography combined with transvaginal hysterosonography may assist in the workup of these endometrial processes. We compared the combination of transvaginal sonography and transvaginal hysterosonography to aspiration endometrial biopsy in the evaluation of women with postmenopausal bleeding. We prospectively performed transvaginal sonography in 148 women within 1 month (range, 10 days to 2 months) after having had an aspiration endometrial biopsy. Transvaginal hysterosonography was then performed in 81 of these women who had endometrial thickness greater than 5 mm. In these 81 patients, transvaginal hysterosonography confirmed 45 lesions: 23 pedunculated endometrial masses and 22 inhomogeneous sessile lesions. Women with positive transvaginal hysterosonography examinations then underwent hysteroscopy or hysterectomy, whereas women with negative examinations were followed conservatively. Forty-one of the 45 cases with endoluminal masses on transvaginal hysterosonography had false-negative aspiration biopsies. Of the five (11%) lesions that were malignant, three resulted in false-negative biopsies, one biopsy revealed hyperplasia, and only one biopsy was true positive. All 36 women with negative transvaginal hysterosonography examinations also had negative biopsy findings. We conclude that the combination of transvaginal sonography and transvaginal hysterosonography is more sensitive in the detection of endometrial pathologic lesions than is endometrial biopsy, and that transvaginal sonography or transvaginal hysterosonography should be included in the evaluation of women with postmenopausal bleeding.

Transvaginal hysterosonography in the evaluation of small endoluminal masses.

Transvaginal sonography is highly sensitive for detecting endometrial mass lesions, but it is nonspecific. Biopsies performed on patients with abnormal findings seen on TVS often are negative. We performed transvaginal hysterosonography prospectively on 48 consecutive patients with endometrial thickness demonstrated on TVS to be between 5 and 10 mm to assess whether this technique would be useful in the evaluation of such patients. TVHS is a simple, painless technique that is performed by placing a small catheter into the endometrial canal and infusing a small amount of saline solution under sonographic visualization. Of 48 suspected lesions, TVHS confirmed only 19 endoluminal masses: 11 fibroids and eight polyps. Polyps tended to be homogeneously echogenic and to have a pedunculated attachment to the uterine wall without interruption of the endometrial lining. Fibroids showed more heterogeneous echogenicity and had a more sessile attachment. Four patients in our series had false-negative biopsy results prior to having had endometrial mass lesions depicted on TVHS. TVHS may prevent unnecessary biopsies in those patients who appear to have abnormalities on TVS. By depicting the nature of the attachment of endoluminal masses to the uterine wall more clearly, TVHS also may help direct subsequent biopsy procedures.

[Blood flow in umbilical artery in fetus with intrauterine growth retardation]. / Flujo sanguíneo en la arteria umbilical en fetos con retardo de crecimiento intrauterino.

Many studies of Doppler blood flow velocimetry show an association between alteration of flow waves and adverse perinatal outcome in growth retarded fetus. In our study, 74 cases of growth retarded fetuses were evaluated with umbilical artery Doppler. Sixty-five showed the presence of diastolic flow and all of them had good perinatal outcome, regardless the score of the different indexes. On the other hand, those cases with absent (7) and reversed diastolic flow (2) were correlated with obstetric intervention, low birth weight, neonatal complications and perinatal mortality. We conclude that monitoring with umbilical artery Doppler in growth retarded fetuses is a good method to detect those who present hypoxia.

[Spontaneous regression of a cystic hygroma]. / Regresión espontánea de un higroma quístico.

A case of a nonseptated cystic hygroma with spontaneous resolution in utero is presented. The clinic, sonographic, and morphologic findings as well as the prognosis of septated and nonseptated cystic hygromas are discussed.

[Transvaginal echography and endometrium in postmenopause]. / Ecografia transvaginal y endometrio en la postmenopausia.

Thirty one postmenopause patients were studied, twenty three had metrorrhagia. They were examined by transvaginal ultrasonography with the purpose of measuring the depth of the endometrium. Endometrium depth < or = 10 mm is associated with minimal risk of endometrial cancer. The relationship between the echographic measurements and endometrium cancer, reveals a sensitive of 75%; specificity of 89%; positive predictive value of 60% and negative of 94%.

[Intrauterine fluid collections as echographic findings in postmenopause]. / Colección líquida intrauterina como hallazgo ecográfico en la postmenopausia.

The possible relationship between the intrauterine accumulation of fluid during the peri and post-menopause period and genital cancer are studied by ultrasonography. In our experience 22% of the patients had endometrial cancer.

[The ultrasonographic characteristics of the endometrium during the spontaneous ovulatory menstrual cycle]. / Caracterización ultrasonográfica del endometrio durante el ciclo menstrual ovulatorio espontáneo.

Six hundred and four serial transvaginal sonograms were performed in 70 normal and healthy women throughout an ovulatory cycle. The endometrium was classified in 4 types (0, 1, 2 and 3) according to: the aspect of the myometria-endometrium and endometrium-endometrium interfaces, and the texture and thickness of the functional layer. Type 0 appears as a smooth, pencil line endometrium. Type 1 has a trilaminar structure with an iso or hypoechoic functional layer. Type 2 is also trilaminar, but myometria-endometrium interfaces are thicker than type 1. Type 3 appears as a thick and homogeneously echogenic image. The relative frequency of each type of endometrium was determined for every day of the menstrual cycle. Day 0 was defined sonographically as the day of follicle rupture. Type 0 was found during and immediately after menstruation. Type 1 was seen during mid-follicular phase and until day +2. Types 2 and 3 were observed post ovulatory in 100% of the cases. The endometrium increases in thickness more during preovulatory phase (mean: 5.5 mm), than in the luteal phase (mean: 2.6 mm). We conclude that this working classification of the endometrium is useful in clinical practice when associated to the ultrasonographic aspect of the ovaries and the moment of the menstrual cycle.

[Intrauterine weight index in fetal growth retardation]. / Indice ponderal intrauterino (IPI) en el retardo de crecimiento fetal (RCIU).

The intra uterine ponderal index (IPI) estimated by ultrasound examination (US) in 79 patients with intrauterine growth retardation (IUGR) is presented. The IPI was calculated using the following formula: [formula: see text] 13.2 (DFO) + 22 (DAT) + 8.9 (DAP) - 48.4 (LF) - 7469.1, and ETF = 0.55 (LF) + 8.66. Correlation indexes (r) of EPF, ETF and IPI with neonatal weight, length and ponderal index were 0.92, 0.87 and 0.51 (p < 0.001). The IPI revealed a gradual increase with respect to gestational age ranging from 1.63 to 3.08. The p 10 of the IPI was 1.96 for pregnancies of 30 to 34 weeks and 2.35 for pregnancies of 35 to 39 weeks. Those cases of IUGR with IPI < p 10 (n = 7) had a higher incidence of cesarean section (86% vs 30%, p < 0.01), intrapartum fetal distress (71% vs 11%, p < 0.01), Apgar score of < 7 at 5' (29% vs 1.4%, p < 0.05), PBF < 5 points (43% vs 4.7%, p < 0.01), and moderate or severe neonatal morbidity (57% vs 21%, p < 0.05) than those with IPI > or = p 10 (n = 72). No difference were found with respect to the presence of antepartum meconium (29% vs 6%, p = 0.09). In conclusion, ultrasonographic estimation of the IPI is another element of the examination that can help in the diagnosis of fetal condition in cases of IUGR, permitting to distinguish those fetuses that, having and estimated weight below the tenth percentile in a growth curve, are in higher perinatal risk.

[Nonimmune fetal hydrops secondary to fetal tachycardia: their intrauterine diagnosis and treatment]. / Hidrops fetal no immune secundario a taquicardia fetal: diagnóstico y tratamiento intrauterino.

A case of nonimmune hydrops fetalis (NIHF) secondary to fetal supraventricular tachycardia (SVT) diagnosed at 33 weeks gestation is presented. Administration of digoxin to the mother yielded normal fetal heart rhythm and frequency as well as progressive resolution of hydrops after 24 hours of initiation of therapy. Causes of NIHF and diagnostic approach are mentioned. Diagnosis and management of fetal arrhythmias are discussed. The successful perinatal outcome obtained in this case and the literature review, recommend the use of antiarrhythmic drugs therapy in cases of NIHF secondary to SVT.

[Intravascular fetal transfusion in the management of perinatal hemolytic disease]. / Transfusión fetal intravascular en el manejo de la enfermedad hemolítica perinatal.

Five pregnancies with severe blood cell isoimmunization were managed with intrauterine intravascular transfusions. The procedures were performed percutaneously under direct ultrasound visualization. A total of 14 transfusions, of 16 attempted, were successfully performed. The 5 fetuses required more than one transfusion. Only one died before been born. The other four are alive and without sequelae. Technical aspects of the procedure as well as its indications, advantages, and historical drawbacks are discussed.

[Fetal echocardiography I: Foundations]. / Ecocardiografía fetal I: Fundamentos.

Fundamentals of fetal echocardiography are stated, describing a detailed identification of the fetal heart and the echographic, visualization of the great vessels. The importance of prenatal diagnose of congenital fetal cardiac malformations is emphasized.

[Fetal echocardiography II: Prenatal diagnosis of congenital heart defects. Preliminary experience]. / Ecocardiografía fetal II: Diagnóstico prenatal de cardiopatías congénitas. Experiencia preliminar.

A preliminary experience of 28 selective patients is related by authors in the prenatal diagnose of fetal congenital cardiopathy. Echocardiographic findings are evaluated as well as neonatal outcome and the obstetrics approach.

[Ultrasonographic estimation of fetal weight in intrauterine growth retardation. Comparative analysis of 4 formula]. / Estimación ultrasonográfica del peso fetal en retardo del crecimiento intrauterino. Análisis comparativo de cuatro fórmulas.

The accuracy of estimated fetal wight determined by US scan in 70 fetuses with IUGR was analyzed using different formulas. The formula used in our Service showed the best correlation between estimated fetal weight and birth weight (R = 0.92), with estimation error not significant and +/- 8.3% variability. The foreign formulas showed significant estimation error and over 10% variability, therefore, in our population the use of the local formula is recommended.

[Deficiency of folates in pregnancy: effect of supplementary folic acid]. / Deficiencia de folatos en el embarazo: efecto de una suplementación con ácido fólico.

Higher folate needs are present during pregnancy, which may lead to tissular deficiency in the mother and to depleted newborn folate reserves. The aim of this work was to assess the prevalence of folate deficiency and to establish the rates of serum and red cell folate in two groups of mothers and newborn infants, one receiving only iron and the other iron and folate during pregnancy. The rates of serum and red cell folate found at the end of pregnancy were significantly higher in the group which received folate; however, the percentage of cases with tissular folate deficiency was low in both groups, with no significant difference (3.8% and 1.3%, respectively). These findings, along with the lack of effect of supplemental folate on erythropoiesis, pose some questions on the usefulness of supplemental folate during pregnancy in our country.