Importance of Follow-Up and Early Detailed Evaluation in Early Onset Growth Restricted Fetuses.

Early onset fetal growth restriction (EO-FGR) is associated with significant feto-maternal complications, therefore efforts should be made to identify the causes and the potential outcome of the pregnancy. Some of the pitfalls in first-trimester imaging of the fetal anomalies are related to the inadequacy of the examination, because of the fetal position and limited clarity in relation to the size of the structures being examined. In this paper we present a case where careful ultrasound scan follow-up and the use of both approaches transabdominal and transvaginal were useful to complete a detailed structural evaluation as part of the diagnosis, management and prognosis of a fetuses diagnosed with EO-FGR in the first trimester and a triploidy with atypical ultrasound features.

Fetal Kidneys Ultrasound Appearance in the First Trimester - Clinical Significance and Limits of Counseling.

OBJECTIVE: The objective of this study was to determine the visualizing rate of fetal kidneys at various gestational ages in late first trimester (FT) and to establish the clinical significance of their two-dimensional ultrasound (2DUS) appearance in the FT. METHODS: In a prospective cross-sectional study, 1456 women from an unselected population underwent a detailed assessment of fetal anatomy at 11+0 -13+4 weeks of gestation with the use of transabdominal sonography. Information on the ultrasound findings, antenatal course and perinatal outcome was obtained in 1331 cases. RESULTS: 44 cases in which a congenital kidney disease was detected by ultrasound in the prenatal period were identified. The renal pathology was suspected in the FT in 8 cases, and confirmed by a standard test (postmortem autopsy or second-trimester scan) in 4 cases. The standard detailed second-trimester scan at 18-22 weeks diagnosed another 23 cases but refuted suspicion in 4 FT positive cases. The third trimester added another 17, all confirmed by the postpartum scan. For FT presence or absence of congenital renal anomalies, sensitivity, specificity, +LRs and -LRs of 2DUS were 9.09%, 99.69%, 29.25, and 0.91. CONCLUSION: FT prenatal kidneys' visualization is critically dependent on the gestational age. FT diagnosis holds uncertainty. An early diagnosis carries a risk of providing a false-positive or a false-negative result, because the differentiation of the renal system is delayed or the diagnosis is not amenable yet to prenatal ultrasound. No FT findings can exclude the mid-trimester follow-up ultrasound scan. Second and third trimester scan are relevant for congenital kidney diseases.

Statistical Correlations of the Spontaneous Abortion with Trombophilia and Other Associated Pathologies.

15-20% of all known pregnancies progress with a miscarriage or an ectopic pregnancy. The recurrent miscarriage is a delicate clinical situation because with all the advances in genetic and immunologic research the incriminating factors haven't been discovered yet. The treatment is also subject to controversies, being perceived as either ineffective or aggressive. A number of 376 pregnant women with a gestational age smaller than 12 weeks have been selected, 226 of them with spontaneous abortion. In the study group of patients with previous spontaneous abortions we have found a series of associated pathology. From the cases with secondary non idiopathic recurrent miscarriage we have identified 4 cases of thrombophilia with antiphospholipid syndrome, 2 cases of thrombocytosis, one case of autoimmune thyroiditis, one case of uterine tumor, one case of MTHFR C homozygous thrombophilia and one case of FVL heterozygous thrombophilia. Knowing the correlations between the recurrent miscarriage and the hereditary thrombophilia as well as the options of treatment for increasing the chances of having a pregnancy with a normal evolution direct the doctors in testing the patients with recurrent miscarriage for hereditary thrombophilia.

Acceptability of Intrapartum Ultrasound Monitoring - Experience from a Romanian Longitudinal Study.

OBJECTIVES: To assess the acceptability of intrapartum ultrasound (IPUS) labor monitoring in unselected Romanian women attending a tertiary maternity unit and the patients' experience of the examination (i.e. the perceived difficulty regarding the evaluation protocol). METHODS: The research was a prospective longitudinal observational study on unselected low-risk women that delivered in our unit. IPUS monitoring of active labor was proposed for observational purposes in low-risk population. Transabdominal and transperineal scans were performed hourly in the first stage of labor and at every 15 minutes in the second stage. The second day after birth, consenting women were invited to take part in a questionnaire survey with features regarding the patient's impression about the ultrasound monitoring scans during labor, and the acceptability of having an IPUS protocol for labor monitoring in the future. RESULTS: From 200 parturient women questioned, 98% of them agreed to IPUS investigation protocol. The demographic characteristics did not influence the acceptance. However, due to the small number of women declining IPUS we were not able to compare the characteristics and perceptions of women who declined the scan with those who accepted it. Most of the women (93% of accepters and 75% of decliners) had little difficulty deciding whether or not to have the scan protocol. All laboring women who had the IPUS scan found it an acceptable experience; 21% of women without epidural anesthesia rated the perceived difficulty as "mild" or "discomforting". Women rated having the IPUS scan as being significantly less difficult than having a cervical smear, transvaginal scan or having a digital clinical evaluation. 67% of the studied patients expressed increased confidence while being able to follow along the medical personnel the progression of the labor on the ultrasound screen. 97% of the consenting women who had the IPUS scans and all the 4 decliners said they would definitely or probably agree such ultrasound monitoring in a future labor, if this technique is proven useful for the labor outcome. CONCLUSIONS: IPUS protocol for labor monitoring was overwhelmingly acceptable in our population of women, despite the fact that they were learning about the procedure for the first time. The demographic characteristics did not influence acceptance, but due to the high rate of acceptance, predictors of acceptance could not be analyzed. More than two thirds of the patients expressed increased confidence while being able to follow along the medical personnel the progression of the labor on the ultrasound screen and almost all the participants were willing to have the procedure again in future, further reinforcing their favorable attitude to the procedure.

Agenesis of ductus venosus in sequential first and second trimester screening.

OBJECTIVE: The goal of this study is to evaluate the potential of first trimester (FT) screening in the diagnosis of agenesis of the ductus venosus (ADV) and to study its prevalence in a low-risk population, the associated conditions, and pregnancy outcome. METHOD: Prospective, sequential screening study at two tertiary units with morpho-functional evaluation of the ductus venosus during the first and second trimester screening. We quantified the FT detection rate, prevalence, and associated conditions: umbilical shunting type, concomitant anomalies, and outcome. RESULTS: In 6114 consecutive pregnancies, we identified 11 cases of ADV. Ten (91%) were identified during the FT examination. The prevalence was 1 in 556, similar for both centers (1/478 vs. 1/691). Major structural defects and fetal effusions were detected in 8 (73%). twenty two percent had a major chromosomal abnormality. In 3 cases, the anomaly was isolated and had normal outcome, independent of liver by-pass, caliber of the shunt, and NT thickness. CONCLUSIONS: Agenesis of the ductus venosus can be detected during FT. The early detection of ADV is important given its high association with major abnormalities.

Improved detection rate of structural abnormalities in the first trimester using an extended examination protocol.

OBJECTIVE: To assess the potential of first-trimester sonography in the detection of fetal abnormalities using an extended protocol that is achievable with reasonable resources of time, personnel and ultrasound equipment. METHODS: This was a prospective two-center 2-year study of 5472 consecutive unselected pregnant women examined at 12 to 13 + 6 gestational weeks. Women were examined using an extended morphogenetic ultrasound protocol that, in addition to the basic evaluation, involved a color Doppler cardiac sweep and identification of early contingent markers for major abnormalities. RESULTS: The prevalence of lethal and severe malformations was 1.39%. The first-trimester scan identified 40.6% of the cases detected overall and 76.3% of major structural defects. The first-trimester detection rate (DR) for major congenital heart disease (either isolated or associated with extracardiac abnormalities) was 90% and that for major central nervous system anomalies was 69.5%. In fetuses with increased nuchal translucency (NT), the first-trimester DR for major anomalies was 96%, and in fetuses with normal NT it was 66.7%. Most (67.1%) cases with major abnormalities presented with normal NT. CONCLUSIONS: A detailed first-trimester anomaly scan using an extended protocol is an efficient screening method to detect major fetal structural abnormalities in low-risk pregnancies. It is feasible at 12 to 13 + 6 weeks with ultrasound equipment and personnel already used for routine first-trimester screening. Rate of detection of severe malformations is greater in early- than in mid-pregnancy and on postnatal evaluation. Early heart investigation could be improved by an extended protocol involving use of color Doppler.

First trimester two- and four-dimensional cardiac scan: intra- and interobserver agreement, comparison between methods and benefits of color Doppler technique.

OBJECTIVE: To evaluate intra- and interobserver agreement for first-trimester fetal cardiac structural assessment, using two-dimensional (2D) ultrasound (2D-US) and 4D-US (4D spatiotemporal image correlation (STIC) technology), to compare the methods and to assess the advantages of adding color Doppler to each technique. METHODS: Digital videoclips (B-mode and color Doppler) and 4D-STIC volumes (gray-scale and color Doppler) from 632 pregnancies with normal fetal hearts were acquired and stored at the time of detailed first-trimester ultrasound examination. Later analysis on a randomized sample of 100 cases was performed, targeting 11 cardiac structures and features. We compared visualization of fetal heart parameters using 2D-US vs 4D-US and gray-scale vs color Doppler imaging. RESULTS: STIC volumes were considered satisfactory (adequate visualization of at least 8/11 parameters) in 78% of cases and 2D-US acquisitions in 89% of cases. The intra- and interobserver agreement was good for both 2D and 4D methods (kappa > 0.6), and the percentage overall agreement was very high using both methods (95%). 2D- and 4D-US identification of the fetal cardiac parameters did not differ significantly. The differences between gray-scale and color Doppler imaging were statistically significant in identifying similar key cardiac parameters, for both 2D- and 4D-US (P < 0.05). CONCLUSION: Both 2D and 4D methods for assessing first-trimester heart parameters are feasible and repeatable within and between observers. Color Doppler adds valuable information to both methods.

Bilateral struma ovarii: a case mimicking an ovarian neoplasm.

We present a case of bilateral struma ovarii which developed postoperatively and was histopathologically diagnosed after the patient was hospitalized for investigation and treatment of tumoral anexal bilateral formations. There was no evidence of clinical malignancy or metastases. Data from the literature, together with histopathologic, diagnostic and therapeutic aspects of the disease were checked again taking into account the scarcity of this lesion, especially bilaterally.

Incidence of endometrial carcinoma in patients with endometrial hyperplasia.

OBJECTIVE: The purpose of this retrospective study was to establish the risk of developing endometrial adenocarcinoma in patients diagnosed with endometrial hyperplasia. MATERIAL AND METHODS: The incidence of endometrial hyperplasia and its relation with endometrial adenocarcinoma was evaluated in 1,139 patients who presented with abnormal bleeding between January 2000 and December 2004; D&C was performed in all cases. There were 591 (51.88%) cases of simple endometrial hyperplasia, out of which 110 (18.61% from 51.88%) cases had atypia, 60 (5.26%) cases of complex hyperplasia, out of which 19 (31.66% from 5.26%) had atypia, and the remaining 488 (42.84%) had different forms of mixed hyperplasia. RESULTS: The incidence of endometrial adenocarcinoma was 3.87% in atypical hyperplasia and 0.81% in other forms, and was related only to cases with atypia in which the incidence was 0.61%. CONCLUSIONS: The most indicated measure to prevent endometrial carcinoma in cases with complex endometria hyperplasia with atypia is hysterectomy, while for other forms of hyperplasia, hormonal treatment is used but only under strict control.

[Hysterectomy of "necessity"--current evaluation]. / Histerectomia de "necesitate"--evaluare actuala.

Hysterectomy after caesarian section is a radical surgery intervention. The obstetricians take the decision as a last surgical attitude in major obstetrical emergency. We tried in this study to analyze the causes of post-caesarian section, because this surgical intervention is a mutilant one. In many cases this surgical intervention had been effectuated for abundant hemorrhage, uterine hypotonia, utero-placentar apoplexy. In some cases the intervention was indicated from the beginning of intervention. The clinic evolution after hysterectomy was a good one without major complications.