Doppler study of the peripheral flows in early gestation.

The aim of this study was to determine the first trimester human peripheral arterial and venous blood flow between 5 - 10 weeks of gestation. Two hundred twenty four women with singleton, uncomplicated pregnancies were prospectively studied with transvaginal ultrasound. Ductus venosus, umbilical artery waveforms and pulsatility indexes (PI) were assessed as well as the waveform of the umbilical vein and the mean velocity (V(mean)) of the umbilical artery flow. The heart rate was also obtained and analyzed. The fetal heart rate showed a positive correlation with increasing gestational age R=0.76 (p<0.000001). Recordings from the umbilical artery, umbilical vein and ductus venosus were obtained starting from 7 weeks of gestation. The signal from the ductus venosus presented always as antegrade flow during atrial contractions. The pulsatility index (PI) of DV as well as PI of the umbilical artery remained unchanged during the study (statistically non-significant). The umbilical artery, using Doppler tracing was investigated and an absent diastolic flow was documented in every case. Umbilical artery V(mean) increased from 3.8 + 0.32 cm/s to 9.0 + 0.21 cm/s from 7 to 10 weeks of gestation (p< 0.005). Recordings from the umbilical vein showed the pulsation during atrial contractions. Ductus venosus blood velocity and waveform patterns did not change significantly during the study period. Pulsation in the umbilical vein is a typical Doppler finding at the embryonic time. Placental volume blood flow increased significantly with no change in the placental vascular impedance.

Doppler study of the embryonic heart in normal pregnant women.

OBJECTIVE: To describe normal fetal cardiac and hemodynamic development in normal early first trimester pregnancies. MATERIALS AND METHODS: Eighty-eight women with singleton, uncomplicated pregnancies were prospectively studied with transvaginal ultrasound, pulsed and color Doppler. Heart diameter, heart rate, and inflow and outflow waveforms with valve signals were documented. The proportion of the cardiac cycle of isovolumetric relaxation time (IRT%) and isovolumetric contraction time (ICT%) as well as Tei index were calculated. RESULTS: Ninety-one percent of studies were successful. Heart diameter and the fetal heart rate showed a positive correlation with increasing gestational age: R = 0.80 (p < 0.000001), R = 0.76 (p < 0.000001), respectively. Mean heart diameter at 6 weeks was 1.28 +/- 0.26 mm and mean fetal heart rate was 117 +/- 6 bpm compared to 3.88 +/- 0.54 mm and 171 +/- 6 bpm at 10 weeks. The inflow waveform was monophasic (atrial contraction) in all cases from 6 to 9 weeks. Eight pregnancies (9%) miscarried between 6 and 12 weeks of gestation and the heart exams were characterized by increased IRT% compared with the survivors. In survivors, IRT% decreased between 7 and 8 weeks, from 32.9 +/- 10.7% to 20.8 +/- 5.7% (p < 0.0001). ICT% decreased from 18.6 +/- 4.4% of the cardiac cycle at 8 weeks to 12.6 +/- 4.4% at 9 weeks (p < 0.0008) (after heart development period). CONCLUSIONS: Doppler examination of the fetal cardiac function is possible after 5 weeks of gestation. After 8 weeks of gestation, the fetal heart is morphologically mature but has not yet achieved effective myocardial compliance. The embryonic human heart is dependent on the atrial contraction for ventricular filling throughout the period of cardiac development. Non-survivors manifest myocardial dysfunction.

Search for the pathogenic fungi in amniotic fluid.

Intra-amniotic infection with Candida is rare but considers an etiological factor for preterm rupture of membranes (PROM). The aim of the study was the investigation of the mycotic invasion of the amniotic cavity in pregnant women with PROM and with intact fetal memranes. 170 women were included in two groups: I (n = 150)--women with intact membranes; II (n = 20)--women with PROM. Samples of amniotic fluid were cultured on Sabouraud's medium. Fungal strains were isolated also from vagina, oral cavity and rectum of women with PROM. Intraamniotic infections were absent both in women with PROM and with intact membranes. Candida strains were isolated from vagina, oral cavity, and rectum in the group of women with PROM. Coexisting of multifocal Candida infections in pregnant women with PROM indicates that in those cases mycologic diagnosics should be recomended.

[Transvaginal sonography in prediction of preterm delivery in patients presenting with signs and symptoms of preterm labor]. / Zastosowanie ultrasonografii przezpochwowej w predykcji porodów przedwczesnych w grupie ciezarnych z zagrazajacym porodem przedwczesnym.

OBJECTIVE: The purpose of the study was to assess the clinical value of transvaginal sonography in the group of women presenting with preterm contractions and cervical changes. MATERIAL AND METHODS: We prospectively evaluated 82 patients between 23-34 weeks of gestation presenting in our department with signs and symptoms of preterm labor, intact membranes and cervical dilatation < 3 cm. In all cases transvaginal sonography was performed. The following parameters were assessed: functional canal length, funneling, cervical diameter and the length of the vaginal portion of the cervix. The primary outcome was delivery < or = 28 days from examination. RESULTS: The rate of preterm delivery (< 37 weeks) was 25.6% (21/82) and 17.1% (14/82) of the patients delivered < or = 28 days from the examination. Among the analyzed parameters, the significant difference between patients delivered < or = 28 and > 28 days from examination, was noticed only for the functional canal length (21.6 mm vs 30.1 mm; p < 0.001). The analysis of ROC curves showed that functional canal length had the highest diagnostic capability. Two important thresholds were found--20 mm and 31 mm. For predicting delivery < or = 28 days the functional canal length < or = 20 mm had sensitivity of 57.1%, specificity of 92.6%, PPV of 61.5% and NPV of 91.3%. The cutoff value of 31 mm had sensitivity of 100%, specificity of 47.1%, PPV of 28% and NPV of 100%. In multiple logistic regression analysis only FCL < or = 20 mm (OR 8.18; p = 0.027) was independently associated with PTD. CONCLUSIONS: 1. The shortening of the functional canal length (< or = 20 mm) is predictive of impending preterm delivery and the functional canal length > 31 mm is the indicator of the absence of labor. 2. Cervical sonography can be a valuable adjunct to the clinical assessment of patients with signs and symptoms of preterm labor.

[Fetal fibronectin as a predictor of preterm delivery in patients with preterm contractions and cervical changes]. / Fibronektyna plodowa jako marker porodu przedwczesnego w grupie ciezarnych z przedwczesna czynnoscia skurczowa i zmianami szyjki macicy.

OBJECTIVE: The purpose of the study was to assess the clinical value of fetal fibronectin assay in the group of women presenting with preterm contractions and cervical changes. STUDY DESIGN: We prospectively evaluated 82 patients between 23-34 weeks of gestation presenting with signs and symptoms of preterm labor, intact membranes and cervical dilatation < 3 cm. In all cases cervico-vaginal samples were collected and assayed for the presence of fetal fibronectin. The primary outcome was delivery < or = 28 days from examination. RESULTS: The rate of preterm delivery (< 37 weeks) was 25.6% (21/82) and 17.1% (14/82) of the patients delivered < or = 28 days from the examination. The mean Bishop score was significantly higher in patients delivered < 28 days (5.9 +/- 1.2 vs 4.7 +/- 1.4; p = 0.004). Positive result of fFN (> 0.05 mg/ml) was found in 71.4% of patients that were delivered < or = 28 days and in 7.4% delivered > 28 days (p < 0.001). For predicting delivery < or = 28 days the positive fFN testing had sensitivity of 71.4%, specificity of 92.7%, PPV of 66.7% and NPV of 94%. The cutoff value for Bishop's score > or = 5 had sensitivity of 85.7% and specificity of 48.5%. Performing fFN testing only in patients with Bishop score > or = 5 resulted in the sensitivity of 71.4%, specificity of 95.6%, PPV of 76.9% and NPV of 94.2%. CONCLUSIONS: Fetal fibronectin is a very good predictor of imminent preterm delivery. It needs further research whether performing of the fFN assay can be limited only to the patients with the estimated Bishop's score > or = 5.

[Serial amniocentesis in TTTS]. / Seryjne amnioredukcje w przypadkach TTTS.

AIM OF THE STUDY: The aim of our study was to estimate the efficacy of serial amniocentesis in cases of acute polyhydramnion in TTTS. We analyzed the time and the route of delivery, as well as the status of newborns. MATERIAL AND METHODS: The study group consisted of 13 twins with confirmed hydramnios. In each case thorough examination allowed to make the diagnosis of TTTS. After the examination patients were prepared for amnioreduction. During the procedure the excess of amniotic fluid was removed through the punction needle. RESULTS: The therapy of TTTS was based mainly on serial amniocentesis. In 2 cases, due to an extremely high amniotic volume, the therapy was started with placing the catheter to provide continuous amniotic drainage. The volume of AF removed during the single amniocentesis varied between 700-3000 ml and depended on AFI and the gestational age. In one case maternal treatment with indomethacin was introduced beside amniocentesis and in 3 pregnancies the Digoxin therapy was implemented together with amniocentesis. In all cases the deliveries were preterm. The mean donor weight was 730 +/- 290 g and the mean recipient weight was 1145 +/- 435 g (the difference was approximately 37%). In 7 cases we observed an intrauterine demise of one fetus. The 5th min Apgar score was 1 pt (median). When the analysis was performed after exclusion of stillborns, the median Apgar score for donors and recipients was 4 and 2 pt respectively. CONCLUSIONS: 1. Acute TTTS is a rare pathology occurring in monochorionic twin gestations. 2. The concomitant pathologies include: acute hydramnios, preterm labor and delivery, intrauterine growth restriction, cardiac failure. 3. Serial amniocentesis are effective in significant prolongation of gestation (the mean interval between diagnosis and delivery 24 days). 4. The improvement of perinatal outcomes in twin gestations complicated by TTTS can be achieved by the combination of serial amniocentesis and the laser ablation of anastomoses.

[Doppler evaluation as a predictor of asphyxia in fetuses with intrauterine growth retardation (IUGR)]. / Dopplerowskie cechy centralizacji krazenia we wczesnej ocenie niedotlenienia u plodów z wewnatrzmacicznym zahamowaniem wzrostu (IUGR).

Many papers showed that the pulsatility index of the fetal middle cerebral artery decreases during gestation. We observed equalization of the PI in MCA and PI in UMB in the perinatal period (after 38 weeks of gestation). We observed the increase the diastolic cerebral flow through the brain in cases of hypoxia. We interpreted that situation as a vasomotor response to fetal hypoxia (for example in IUGR). This phenomenon, is called in the literature as brain sparing effect. The aim of our study was estimation of application Doppler technique in diagnosis of changes in circulatory system in pregnancies complicated by intrauterine growth restriction (IUGR). We included 66 fetuses with IUGR and sonographic signs of the brain sparing effects, without any congenital malformation, oedema and genetic abnormalities to the study group. We included 1730 foetuses from normal, physiological pregnancies to the control group. In all cases time of gestation were calculated from Naegele's rule and were confirmed in sonographic examination before 16 weeks of gestation. SGA fetuses were defined on the basis of ultrasonographic measurements of BPD, HC, AC, FL and weight below 10th percentile of our reference curve. Sonographic examination were performed on Acuson 128 XP/10 with transducers (2.5 MHz-5 MHz). We performed Doppler examinations in MCA and UMB. Redistribution (brain sparing effect) was diagnosed when CPR (cerebroplacental ratio) was less than 1. We analysed the way and time of delivery and neoanatal follow up. Obtained in advance of researches results made possible expression of following conclusions: 1. Use of Doppler techniques in pregnancies complicated by IUGR makes possible diagnosis of hypoxia that helps in settlement of continuing or ending of pregnancy. 2. Changes in Doppler flows in foetus resoluteness outdistance irregular other values of biophysical methods of foetus monitoring.

[Twin pregnancy complicated by intrauterine death of one twin]. / Ciaza blizniacza powiklana obumarciem wewnatrzmacicznym jednego plodu.

In twin pregnancies single intrauterine death of one fetus is associated with significant morbidity and mortality of the surviving infant. The aims of our retrospective study were to review conditions of twin pregnancies complicated with SIUD in Polish Mother's Memorial Hospital in Lódz between 1989-1999 and to assess the fetal outcome when conservative management had undergone. In this study we reviewed 30 twin gestations involving the intrauterine death of one fetus. The incidence of preterm delivery among pregnancies with fetal death was 83.3%; Caesarean section was the method of delivery in 53.3% cases. Monochorionic placentation was found in 60%. Conservative management until there is no risk for the fetus is apt.

Fetal bladder catheterization in severe obstructive uropathy before the 24th week of pregnancy.

OBJECTIVE: Fetal obstructive uropathy is simple to diagnose before the 24th week of life. Drainage of the pathologically enlarged fetal bladder avoids development of hydronephrosis and destruction of kidneys and, obviously, prevents development of secondary oligohydramnios and pulmonary hypoplasia. The aim of our study was to evaluate the usefulness of a fetal bladder shunt in cases of obstructive uropathy before the 24th week of gestation. METHODS: From January 1997 we diagnosed 6 cases of fetal obstructive uropathy before the 24th week of gestation. In all cases oligohydramnios or ahydramnios was also observed. After evaluation of the renal function on the basis of fetal urine samples, we shunted 5 fetuses. After routine preparation of the operative field, a special puncture needle was inserted through the abdominal wall of mother and fetus into the fetal bladder. Through the needle a fetal bladder catheter was inserted between the fetal bladder and the amniotic sac. After shunt placement, fetal urine fills the amniotic sac and the fetal bladder is decompressed. After the procedure, the patients were hospitalized and serial sonographic examinations were performed to evaluate shunt function. Bladder size, presence and size of hydronephrosis, and volume of amniotic fluid were evaluated. RESULTS: The Rocket Medical catheters have an excellent 'shape memory'. All but 1 newborns had a good perinatal outcome. Mean Apgar score was 8 at 1 min, weight at delivery was between 1,700 and 3,100 g. No pulmonary hypoplasia was observed. All deliveries were after the 33rd week of gestation (range 33-38 weeks). The minimum drainage time was 11 weeks, maximum 18 weeks. In 2 cases premature delivery occurred because of premature rupture of the membranes. One newborn died of respiratory distress syndrome. CONCLUSIONS: Early bladder drainage (before the 24th week of gestation) enables delivery of newborns with a good perinatal outcome, without pulmonary hypoplasia. This method of therapy limits renal damage and allows time for normal development of the fetal lungs.

[Prenatal echocardiography of aortic stenosis]. / Stenoza aortalna wykrywana prenatalnym badaniem echokardiograficznym.

UNLABELLED: Between 1991-1995 five cases of fetal critical aortic stenosis were diagnosed by fetal echocardiography at the Polish Mother's Memorial hospital. The main cause for referral for fetal ECHO was fetal ascites detected during routine obstetrical ultrasound scan in four cases and positive family history in one case. Pregnant women had fetal echocardiography monitoring as in-patients. During the first examination, the mean aortic valve size was 3.9 mm, mean shortening fraction of LV was 15.8%, mean heart/chest area ratio was 0.51. In one case pharmacological treatment with digoxin (due to fetal congestive heart failure) and steroids (to stimulate fetal lung maturity) was introduced. Amniocentesis due to severe polyhydramnios and fetal ascites drainage were also performed in this case. The were 2 fetal demises at 26 and 28 weeks of pregnancy, 3 cesarean section due to fetal distress during the first period of labour. The pH of umbilical blood was > 7.2. The newborns died between days 2-4 of life. CONCLUSIONS: Aortic valve stenosis can be diagnosed prenatally. This type of fetal heart defect has a poor prognosis.

[Infection with parvovirus B19 in pregnant women]. / Infekcje parvowirusem B19 u kobiet ciezarnych.

The viral infection caused by Parvovirus B19 which occurs at pregnant women may be reason of many different kinds of complications during pregnancy. Until this time it is not known the frequency of the Parvovirus infections at pregnant women in Poland. We have based our studies on a group of 78 pregnant women with symptoms of a abortion, a premature imminent labour, premature labor and intrauterine death of foetus. In 10 cases (12.8%) we have confirmed a presence of antibodies IgM class antiparvovirus B19 at patients serum. It seems that the Parvovirus infection is one of most often reasons of unsuccessful pregnant.

[Evaluation of the value of clinical doppler sonography and sonographic contrast media for assessment of tubal patency]. / Ocena wartosci klinicznej sonografii dopplerowskiej i sonograficznego srodka kontrastowego w badaniu droznosci jajowodów.

The tubal factor still remains one the most often reason of female infertility. The applying of colour Doppler sonography and up-to-date constant medium (Echovist-Schering) make possible the comparison of clinical value between colour Doppler imaging and others presently used diagnostic methods. The aim of this study was the comparison of results obtained by means of hysterosalpingography, laparoscopy and hysterosalpingosonography (HSSG) directly observing tubal flow as an estimation of tubal patency.

[Treatment of infertility in marriage using a method of transcervical gamete introduction into the fallopian tube under control of USG]. / Leczenie nieplodnosci malzenskiej metoda przezszyjkowego gamet do jajowodu pod kontrola USG.

GIFT under USG control (USGIFT) was performed in 18 females between may and december of 1992. The ovulation was stimulated by gonadotropin and Clomid. In result we obtained four pregnancies--three normal uterine pregnancies and one ectopic pregnancy. One of these pregnant women gave birth to a child in February 1993.

[Echocardiography of the fetal heart. Analysis of 350 successive examinations]. / Echokardiografia serca plodu. Analiza kolejnych 350 badaán.

From July 1st 1990 do June 30th 1992 517 fetal echocardiography examinations were performed at the Department of Sonography, Polish Mother Memorial Hospital, (Toshiba 270 SA or Acuson 128 XP) between 20th and 41st gestation weeks. The medical indications for fetal heart examinations were presented. On the basis of echo preliminary diagnoses with 350 newborn's clinical assessment, our own results were reviewed. Correct heart anatomy was described in 94%. In conclusions we suggest that fetal heart assessment (anatomy of the 4 chambers) should be included in a routine screening obstetrical scan in the second half of the pregnancy.