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1.
Ultrasound Obstet Gynecol ; 41(4): 366-74, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23239538

ABSTRACT

OBJECTIVE: To describe the sonographic features and pregnancy outcomes of placental mesenchymal dysplasia (PMD), an entity often misdiagnosed as molar pregnancy. METHODS: We reviewed PMD cases from our institution and performed a systematic review of the existing literature. Inclusion criteria for the review were diagnosis of PMD as defined by placental pathology, description of placental morphology on antenatal ultrasound and reporting of pregnancy outcomes. RESULTS: We found three cases of PMD at our institution. Patient 1 had elevated human chorionic gonadotropin (hCG) and an enlarged, hydropic placenta at 13 weeks, suggestive of a molar pregnancy. Patient 2 also had elevated hCG with large, vascular placental lakes on ultrasound suggesting placenta accreta or molar pregnancy. Case 3 involved placentomegaly and fetal anomalies suggestive of Beckwith-Wiedemann syndrome. From the literature review, 61 cases met the inclusion criteria. The most common sonographic features included enlarged (50%) and cystic (80%) placenta with dilated chorionic vessels. Biochemical aneuploidy screening abnormalities were relatively common as were fetal anomalies, Beckwith-Wiedemann syndrome and other genetic abnormalities. Pregnancy complications included intrauterine growth restriction (IUGR; 33%), intrauterine fetal death (IUFD; 13%), and preterm labor (33%). Pregnancies without fetal anomalies, IUGR, IUFD or preterm labor had normal neonatal outcomes despite PMD (9%). CONCLUSIONS: The differential diagnosis of PMD includes molar pregnancy and other placental vascular anomalies. PMD is associated with adverse pregnancy outcome, so heightened surveillance with genetic evaluation, serial growth scans and third-trimester assessment of wellbeing should be considered. PMD must be differentiated from gestational trophoblastic disease because management and outcomes differ.


Subject(s)
Fetal Death/diagnostic imaging , Fetal Diseases/diagnostic imaging , Hydatidiform Mole/diagnostic imaging , Placenta Diseases/diagnostic imaging , Placenta/pathology , Ultrasonography, Prenatal/methods , Beckwith-Wiedemann Syndrome/diagnostic imaging , Diagnosis, Differential , Female , Fetal Death/pathology , Fetal Diseases/pathology , Humans , Hydatidiform Mole/pathology , Infant, Newborn , Placenta/diagnostic imaging , Placenta Diseases/pathology , Pregnancy , Risk Factors
2.
Minerva Ginecol ; 61(2): 127-39, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19255560

ABSTRACT

Multiple gestations account for approximately 3% of all live births, but contribute to a disproportionate 15% of the overall perinatal mortality. Ultrasound evaluation of twin pregnancies serves an important role in surveillance, early detection, and invasive treatment of complications in twin pregnancies, including spontaneous abortion, abnormalities in placentation, preterm labor, growth restriction, congenital abnormalities, fetal demise, fetal mal-presentation, and twin-to-twin transfusion syndrome. A review of literature regarding the indications and use of ultrasound in twin pregnancy is presented.


Subject(s)
Premature Birth/diagnostic imaging , Premature Birth/prevention & control , Prenatal Diagnosis/methods , Twins , Ultrasonography, Prenatal , Abortion, Spontaneous/diagnostic imaging , Congenital Abnormalities/diagnostic imaging , Female , Fetal Diseases/diagnostic imaging , Fetal Diseases/prevention & control , Fetal Growth Retardation/diagnostic imaging , Fetofetal Transfusion/diagnostic imaging , Humans , Labor Presentation , Obstetric Labor, Premature/diagnostic imaging , Placenta/abnormalities , Population Surveillance , Pregnancy , Pregnancy Outcome , Pregnancy, Multiple , Premature Birth/mortality , Risk Assessment , Twins, Dizygotic , Twins, Monozygotic
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