Adenomyosis in pregnancy mimicking morbidly adherent placenta.

The objective of this study was to illustrate a false-positive diagnosis of adherent placenta due to underlying adenomyosis. A 34-year-old woman was diagnosed for placenta previa totalis with adherent placenta at 33 weeks, based on the findings of loss of clear space or distinguishing outline separating the placenta and uterine wall, presence of intraplacental lacunae and densely atypical vessels in the lesion. Caesarean hysterectomy was performed at 35 weeks. Pathological findings revealed placenta previa totalis with adenomyosis beneath the placenta at the lower segment, with no adherent placenta. In conclusion, this report underlines the importance of possible false-positive test of prenatal ultrasound and MRI findings of adherent placenta caused by underlying adenomyosis which could obliterate the outline distinguishing the placenta and myometrium and atypical vessels secondary to decidualisation and hypervascularity from pregnancy. This case may probably encourage physician to beware of false-positive test of adherent placenta due to adenomyosis.

Comparison of fetal cardiac spatiotemporal image correlation segmental analysis between cardiac- and body-based scrolling.

OBJECTIVES: The purpose of this study was to compare success rates for depiction of the 5 typical transverse planes in the fetal upper thorax between cardiac- and body-based scrolling techniques. METHODS: Spatiotemporal image correlation volume data sets acquired at the 4-chamber view level were obtained from low-risk singleton pregnancies with healthy fetuses. Each data set was analyzed by the authors using both cardiac- and body-based techniques. With the cardiac-based technique, the exact 4-chamber view was first identified as an initial plane before scrolling, whereas with the body-based technique, a volume data set was first manipulated to get the fetal orientation in the exact dorsal supine position as an initial plane. In both techniques, the volumes were then scrolled through the upper thorax to identify the standard planes, including the 4-chamber, 5-chamber, 3-vessel, 3-vessel and trachea, and aortic arch views. RESULTS: An analysis of 50 volume data sets to evaluate intraobserver and interobserver variability in the success rates for the 4-chamber, 5-chamber, 3-vessel, 3-vessel and trachea, and aortic arch views showed good agreement. In an analysis of 296 separate data sets, cardiac-based scrolling was associated with significantly higher success rates than body-based scrolling in all standard planes (P < .05). CONCLUSIONS: Cardiac-based scrolling resulted in higher success rates for obtaining the standard spatiotemporal image correlation planes than body-based scrolling. Therefore, examiners in the early part of the learning curve should be encouraged to first identify a perfect 4-chamber view at the start of an examination.

Hemodynamic assessment of indomethacin-induced fetal heart failure in high-output state.

Hemodynamic study was performed on a 32-year-old woman presenting at 27 weeks' gestation. Ultrasound revealed a single normal fetus with mild cardiomegaly, polyhydramnios, and placental chorioangioma. Doppler study showed increased middle cerebral artery peak systolic velocity, normal Tei index, and forward flow of "a" wave with normal preload in the ductus venosus. Twelve hours after initiation of indomethacin for tocolysis, frank hydrops fetalis developed rapidly. The right ventricle showed poor contractility and performance. Markedly increased preload in ductus venosus with reversed "a" wave and pulsations in the umbilical vein were demonstrated. This study suggests that indomepacin treatment in fetal high-cardiac output state should be used with extreme caution.

Outcomes of pregnancy complicated by heart disease at Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To determine pregnancy outcomes of women complicated by heart disease. MATERIAL AND METHOD: Pregnant women complicated with heart disease between January 1993 and December 2007, at Maharaj Nakorn Chiang Mai Hospital, were recruited to a retrospective cohort study. The normal controls were identified to match the cases with a ratio of 2:1. The main outcomes for comparison included fetal mortality and morbidity focusing on preterm birth and fetal growth restriction. RESULTS: One hundred twenty five pregnant women with heart disease and 250 controls were recruited. Rheumatic heart disease was more common than congenital heart disease (48.8% and 44.8%). The baseline characteristics were similar between both groups. The prevalence of operative vaginal delivery was significantly higher in the study group (32.8% and 4.4%, p < 0.001) while the cesarean section rate was similar. The prevalence of fetal death, low Apgar score, preterm births, fetuses with low birth weight, and fetal growth restriction and were significantly higher in the study group with a relative risk of 6.0, 3.0, 2.2, 1.92, and 1.8, respectively. CONCLUSION: Rheumatic heart disease is still prevalent. The fetal outcomes especially fetal death, preterm birth, intrauterine fetal growth restriction, low birth weight, and birth asphyxia were more common among pregnancies complicated by heart disease.