ABSTRACT
INTRODUCTION: Many abnormalities are observed in the morphology and pathology of the umbilical cord. The aim of the study was to assess the role of 3D sonography in pathology of true umbilical cord knots. MATERIAL AND METHODS: In our materials we observed 10 cases of true umbilical cord knots in a population of 2,864 deliveries. The 2-dimensional transverse scan of the umbilical cord was shown in 3- and 4-dimensional volume scan in order to get a precise image. RESULTS: Four knots were diagnosed prenatally, 3 knots were not diagnosed before the delivery and in the 3 remaining cases ultrasound examinations were not undertaken because the patients were in the course of delivery. In the pregnant subjects with diagnosed true umbilical cord knot once a week the Doppler blood flow indices were examined in the umbilical cord sections before and after the knot. In the three shown cases there were no signs of constriction or tightening of the knot. Four newborns were delivered spontaneously and five by caesarean section. In none of the cases was a pathological FHR trace an indication for emergency delivery. CONCLUSIONS: Four-dimensional and Color Doppler examination is very important to diagnose a true umbilical cord. To make a precise diagnosis a longer observation of the abnormality is necessary and its repeated confirmation by color Doppler and power Doppler. This diagnosis requires strict monitoring of fetal wellbeing during pregnancy and the delivery. Perfection of true umbilical cord knot diagnoses may reduce sudden and unforeseen fetal distress.
ABSTRACT
OBJECTIVE: In many publications the transvaginal ultrasound is regarded as the first step to diagnose the cause of uterine bleeding in perimenopausal women. In order to improve the sensitivity and specificity of the conventional ultrasound physiological saline solution was administered to the uterine cavity and after expansion of its walls the interior uterine cavity was examined. And this procedure is called 2D sonohysterography (SIS 2D). By the ultrasound scanners which enable to get 3D real time image a spatial evaluation of the uterine cavity is possible. Clinical value of the real time 3D sonohysterography and 2D sonohysterography compared to hysteroscopy with histopathological examination in perimenopausal women. MATERIAL AND METHODS: The study concerned a group of 97 perimenopausal women with abnormal uterine bleeding. In all of them after a standard transvaginal ultrasonography a catheter was inserted into the uterine cavity. After expansion of the uterine walls by administering about 10 ml of 0,9% saline solution the uterine cavity was examined by conventional sonohysterography. Then a 3D imaging mode was activated and the uterine interior was examined by real time 3D ultrasonography. The ultrasound results were verified by hysteroscopy, the endometrial lesions were removed and underwent a histopathological examination. RESULTS: In two cases the SIS examination was impossible because of uterine cervix atresion. In the rest of examined group the SIS 2D sensitivity and specificity came up to 72 and 96% respectively. In the group of SIS 3D the sensitivity and specificity reached 83 and 99% respectively. CONCLUSIONS: Adding SIS 3D, a minimally invasive method, to conventional sonohysterography improves the precision of diagnosis of endometrial pathology, allows to get three-dimensional image of the uterine cavity and enables examination of endometrial lesions. The diagnostic precision of this procedure is similar to the results achieved by hysteroscopy.
Subject(s)
Endosonography/methods , Hysteroscopy/methods , Imaging, Three-Dimensional/methods , Perimenopause , Uterine Hemorrhage/diagnostic imaging , Uterus/diagnostic imaging , Adult , Endometrium/diagnostic imaging , Endometrium/pathology , Female , Humans , Middle Aged , Sensitivity and Specificity , Uterine Hemorrhage/diagnosis , Uterine Hemorrhage/pathology , Uterus/pathologyABSTRACT
THE PURPOSE OF THE RESEARCH: Analysis of the course of pregnancy and labor in patients qualified for the prenatal diagnostic tests program in Opole Region. MATERIAL AND METHODS: 2513 pregnant women participated in the program. There were 1763 (70.1%) patients above 35 years of age, out of whom 515 women (20.5%) were qualified for amniocentesis and 394 of them (15.6%) decided to undergo the test. Within the group of patients who underwent amniocentesis, 39 karyotypes (9.8%) were found. Analysis of the number of amniocenteses carried out and the number of detected fetal defects showed that initially the number of invasive tests was rising. However since 2007, i.e. since the introduction of biochemical diagnostic tests based on Kryptor technology a significant decrease of amniocenteses tests has been observed, while the rate of detected chromosome aberrations in fetuses has not changed. The course of pregnancy and labor in patients above 35 years of age, who gave birth to children in Gynecology and Obstetrics Hospital in Opole, has also been analyzed. The investigated group comprised 106 patients who underwent amniocentesis, and 138 patients who did not consent to having the invasive test. Apart from a small difference in average birth weight, the analysis of infant condition and their biophysical parameters after the labor has not shown any significant differences. In both groups gestational diabetes was the most frequent disease, and statistically it was diagnosed more often in patients who had not undergone amniocentesis. No statistically significant differences in the frequency of occurrence of other pregnancy complications have been found. CONCLUSIONS: 1. Amniocentesis carried out due to genetic indications between 150th and 20th week of pregnancy may be considered to be a procedure which is safe both for a mother and a fetus. 2. Amniocentesis does not affect the course of pregnancy or the mode of delivery in any significant way. 3. Proper genetics counseling service based on biochemical research enables to decrease the number of amniocenteses tests, while the rate of detected chromosome defects in fetuses remains unchanged.
