RESUMEN
OBJECTIVE: To compare the ability of cytology, human papillomavirus (HPV) testing and co-testing to identify recurrence of patients treated by loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN) 2-3. MATERIALS AND METHODS: Retrospective analysis (R.A.): the medical records of 372 women treated for CIN 2-3 were reviewed. Resection margin, HPV typing, Pap smears, and biopsies post-LEEP were collected. Prospective analysis (P.A.): 97 women were followed post-LEEP by cytology, HPV test and colposcopy every six months. RESULTS: Positive margins were found to be an independent risk factor for recurrent disease (OR 0.192; 95% CI 0.074-0.497 in R.A. and OR 0.096; 95% CI 0.023-0.392 in P.A.). HPV testing showed less sensitivity than cytology (69% vs 84%, respectively in R.A. and 80% vs 100% in P.A.). Co-testing predicted recurrent disease at a sensitivity of 90.6% in R.A. and 100% in P.A. CONCLUSION: Co-testing is the best option in follow-up protocols after treatment for CIN 2-3. If margins are free and co-testing is negative at six and 12 months, 18 months visit could be avoided.
Asunto(s)
Conización , ADN Viral/genética , Recurrencia Local de Neoplasia/patología , Infecciones por Papillomavirus/patología , Displasia del Cuello del Útero/cirugía , Neoplasias del Cuello Uterino/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Colposcopía , Electrocirugia , Femenino , Humanos , Persona de Mediana Edad , Clasificación del Tumor , Recurrencia Local de Neoplasia/virología , Neoplasia Residual , Prueba de Papanicolaou , Papillomaviridae/genética , Infecciones por Papillomavirus/complicaciones , Pronóstico , Estudios Prospectivos , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Factores de Riesgo , Neoplasias del Cuello Uterino/complicaciones , Neoplasias del Cuello Uterino/patología , Frotis Vaginal , Adulto Joven , Displasia del Cuello del Útero/complicaciones , Displasia del Cuello del Útero/patologíaRESUMEN
OBJECTIVE: To evaluate the role of ultrasound in prenatal diagnosis of vasa praevia (VP) and to asses the risk of VP associated with different causal factors. MATERIAL AND METHODS: A retrospective study of the incidence of VP in a series of 12,063 deliveries between January 2000 and March 2005. We also studied the factors that predisposed for VP and the perinatal outcome of pregnancies. RESULTS: The prevalence of VP in our centre during this period was 0.07% (9 cases). All cases were prenatally diagnosed. The mean gestational age at diagnosis was 26 weeks. Multivariate analysis revealed the following associated factors: IVF pregnancies, bilobate or succenturiate placenta, and second-trimester placenta praevia, with an odds ratio of 7.75, 22.11 and 22.86, respectively. CONCLUSIONS: In our series, the prenatal diagnosis of all cases of VP achieved during the second-trimester scan allowed us to avoid any prenatal death related to this condition.
Asunto(s)
Placenta Previa/diagnóstico por imagen , Ultrasonografía Prenatal , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Placenta/diagnóstico por imagen , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , Factores de Riesgo , Cordón Umbilical/diagnóstico por imagenRESUMEN
No disponible
Asunto(s)
Embarazo , Femenino , Humanos , Anomalías Congénitas , Ultrasonografía Prenatal/métodos , Aberraciones Cromosómicas , Primer Trimestre del Embarazo , Biometría , Sensibilidad y Especificidad , BiomarcadoresRESUMEN
OBJECTIVE: To evaluate the role of ductus venosus blood flow assessment at 10-16 weeks' gestation in screening for chromosomal abnormalities. METHODS: Ductus venosus blood flow was prospectively evaluated in 1371 consecutive pregnancies between 10 and 16 weeks of gestation. The pulsatility index for veins was calculated. All cases were screened for chromosomal defects combining maternal age and fetal nuchal translucency thickness. RESULTS: A chromosomal abnormality was found in 20 cases. The overall detection rate, specificity, positive predictive value, negative predictive value and odds ratio for chromosomal abnormalities were 65%, 95.7%, 18.3%, 99.5% and 41 (95% CI 16-108), respectively, when using the 95th centile pulsatility index as a cut-off. CONCLUSIONS: These preliminary results suggest that evaluation of the ductus venosus pulsatility index at 10-16 weeks' gestation is a useful second-line screening test for chromosomal defects. A combination of nuchal translucency measurement and ductus venosus assessment might increase specificity while maintaining an optimal detection rate for chromosomal abnormalities. Such a policy could identify 55% of all chromosomal abnormalities and about 69% of autosomal trisomies, reducing the need for invasive testing to less than 1%.
Asunto(s)
Aberraciones Cromosómicas/diagnóstico por imagen , Corazón Fetal/diagnóstico por imagen , Ultrasonografía Doppler , Ultrasonografía Prenatal , Adulto , Velocidad del Flujo Sanguíneo , Distribución de Chi-Cuadrado , Trastornos de los Cromosomas , Intervalos de Confianza , Femenino , Corazón Fetal/fisiopatología , Humanos , Cariotipificación , Persona de Mediana Edad , Oportunidad Relativa , Valor Predictivo de las Pruebas , Embarazo , Resultado del Embarazo , Primer Trimestre del Embarazo , Segundo Trimestre del Embarazo , Estudios Prospectivos , Flujo Pulsátil , Sensibilidad y EspecificidadRESUMEN
No disponible
Asunto(s)
Adulto , Embarazo , Femenino , Persona de Mediana Edad , Humanos , Trabajo de Parto Prematuro/prevención & control , Ultrasonografía Prenatal/métodos , Estudios Prospectivos , Estudios Longitudinales , Factores de RiesgoRESUMEN
Objetivo: Establecer nomogramas en nuestra población de los parámetros biométricos fetales más utilizados: diámetro biparietal (DBP), perímetro cefálico (PC), perímetro abdominal (PA) y longitud femoral (LF). Material y métodos: Se han recogido de manera retrospectiva y transversal las ecobiometrías de 9.500 gestaciones únicas (500 para cada semana gestacional entre las 23 y 41 semanas) que acudieron a nuestra centro para control ecográfico de rutina. Resultados: El incremento semanal de las biometrías en el intervalo estudiado alcanzó su máximo a las 24 semanas para el PC, PA y LF, y a las 26 para el DBP. El 50 por ciento del incremento ocurrió a las 33 semanas para todas las biometrías. Conclusiones: Los nomogramas descritos en el presente estudio son válidos y pueden ser utilizados en poblaciones con características epidemiológicas y distribuciones de peso al nacer similares a la nuestra. (AU)
Asunto(s)
Embarazo , Humanos , Femenino , Biometría/métodos , Ultrasonografía Prenatal/métodos , Estudios Retrospectivos , Estudios Transversales , Valores de Referencia , Distribución de Chi-Cuadrado , Modelos LinealesRESUMEN
Ten cases of prenatal diagnosis of isolated hypospadias are presented, six of them in the second trimester. The echographical basis for the suspected diagnosis of hypospadias are: anomalous distal morphology of the penis, small lateral folds (dermal remains of the prepuce), small penis with ventral incurving and anomalous urinary stream. The embryogenesis and the clinical utility of prenatal study of the genitals of the fetus, not only to determine the sex, but also to detect anomalies, are discussed.
Asunto(s)
Hipospadias/diagnóstico por imagen , Ultrasonografía Prenatal , Femenino , Humanos , Recién Nacido , Masculino , Pene/diagnóstico por imagen , Pene/patología , Embarazo , Segundo Trimestre del Embarazo , MicciónRESUMEN
A case of the prenatal diagnosis of testicular torsion at 39 weeks' gestation is presented. The affected testicle was observed as a small rounded area of hypoechogenicity with a peripheral echogenic ring without hydrocele. The appearance was suggestive of the chronic phase of testicular torsion. The neonatal genital exploration confirmed the diagnosis.
Asunto(s)
Enfermedades Fetales/diagnóstico por imagen , Torsión del Cordón Espermático/diagnóstico por imagen , Ultrasonografía Prenatal , Adulto , Femenino , Humanos , Masculino , EmbarazoAsunto(s)
Feto/fisiología , Ultrasonografía Prenatal , Micción , Femenino , Humanos , Masculino , EmbarazoRESUMEN
OBJECTIVE: To describe our experience in prenatal diagnosis and perinatal management of congenital atrioventricular heart block, as well as pacemaker treatment in the neonate. MATERIAL AND METHODS: A total of 13 fetuses are included. The diagnosis of atrioventricular dissociation was established by Doppler heart rate sample in the right atrium to show the atrial activity while the sample in the Aorta reflected the ventricular heart rate. Gestational age at diagnosis, ventricular heart rates, autoimmune maternal pathology, maternal blood tests for autoantibodies antiRo+, congenital structural heart disease, fetal hydrops, maternal medical treatment, perinatal results and pacemaker neonatal implantation are described. RESULTS: Gestational age at diagnosis ranged between 22 and 32 (mean 27.6) weeks. Ventricular heart rates ranged between 32 to 80 (mean 54) beats/min. AntiRo+ antibodies were detected in 5 mothers, and clinical systemic lupus erythematosus was found in only one. Four had congenital heart disease (2 ventricular inversion and corrected TGA, 1 complete atrio-ventricular canal and 1 tricuspid atresia). Signs of heart failure and hydrops were detected in 9 fetuses. Treatment with beta-metasona and ritodrine was administered to 7 mothers when the ventricular heart rate dropped below 60 beats/min. Intrauterine fetal death occurred in 3 fetuses with structural congenital heart disease and hydrops. Delivery was performed by cesarean section in 8 preterm fetuses (one them a twins), 3 spontaneous deliveries at term and 3 stillbirth. Postnatal pacemaker implantation was carried out in 9 newborns (3 cases with unicameral temporal right ventricle electrode and 6 cases with permanent bicameral electrodes implanted through the subclavian vein and DDD pacemaker). Follow-up of the bicameral pacemaker group was satisfactory. CONCLUSION: Persistent fetal bradycardia is the first sign to diagnose prenatal complete atrioventricular heart block. Echocardiography asses fetal haemodynamic status and may detect signs of fetal deterioration. Hydrops and further drop in the ventricular heart rate warrant urgent cesarean section and pacemaker management of the newborn.
Asunto(s)
Bloqueo Cardíaco/congénito , Bloqueo Cardíaco/terapia , Femenino , Bloqueo Cardíaco/diagnóstico , Humanos , Recién Nacido , Masculino , Marcapaso Artificial , Embarazo , Diagnóstico PrenatalRESUMEN
In normal pregnancy, end-diastolic flow appears in the umbilical artery around the 13th week of gestation, with a velocity which increases progressively with advancing gestation. The detection of reversed flow in the umbilical artery, the highest expression of an increase in placental vascular resistance, is extremely uncommon in the first half of gestation and, in three of the four cases reported in the literature, there were chromosomal abnormalities. We report a new case of reversed end-diastolic flow in the umbilical artery in a 13-week fetus with increased nuchal translucency thickness, megacystis and tachycardia. Cytogenetic analysis of chorionic villi and amniocytes revealed trisomy 13. The findings provide further evidence for a possible association between reversed end-diastolic flow in the umbilical artery and chromosomal abnormalities. However, the effectiveness of this potential marker in an unselected population requires further evaluation.
Asunto(s)
Aberraciones Cromosómicas/diagnóstico por imagen , Cromosomas Humanos Par 13 , Trisomía/diagnóstico , Ultrasonografía Prenatal , Arterias Umbilicales/fisiopatología , Adulto , Amniocentesis , Velocidad del Flujo Sanguíneo/fisiología , Muestra de la Vellosidad Coriónica , Aberraciones Cromosómicas/genética , Aberraciones Cromosómicas/fisiopatología , Trastornos de los Cromosomas , Diástole , Femenino , Humanos , Cariotipificación , Embarazo , Trisomía/genética , Trisomía/fisiopatología , Arterias Umbilicales/diagnóstico por imagenAsunto(s)
Placenta Previa/diagnóstico por imagen , Ultrasonografía Doppler en Color , Ultrasonografía Prenatal , Arterias Umbilicales/anomalías , Arterias Umbilicales/diagnóstico por imagen , Cordón Umbilical/anomalías , Venas Umbilicales/anomalías , Venas Umbilicales/diagnóstico por imagen , Adulto , Velocidad del Flujo Sanguíneo , Femenino , Humanos , Masculino , EmbarazoAsunto(s)
Anomalías Múltiples/patología , Deformidades Congénitas de las Extremidades , Abdomen/anomalías , Anomalías Múltiples/embriología , Encefalocele/complicaciones , Encefalocele/patología , Femenino , Feto/anomalías , Feto/patología , Humanos , Masculino , Anomalías de la Boca/complicaciones , Anomalías de la Boca/patología , Embarazo , Tórax/anomalías , Cordón Umbilical/anomalíasRESUMEN
We describe the results of routine obstetric ultrasound examination over a period of 22 years (1970-91) at the Institut Universitari Dexeus, Barcelona, Spain. A total of 1006 malformed fetuses or neonates were identified at abortion or delivery. The prevalence of fetal abnormalities was 3.03%. Fetal anomalies were diagnosed antenatally in 788 (78.33%) cases. Early prenatal diagnosis (before 22 weeks of gestation) was made in 598 (59.44%) cases. The detection of malformed fetuses increased from 19.75% in the first phase of the study (1970-74) to 96.33% in the last phase (1990-91). The specificity of the method was over 99% throughout the study period. The most frequently diagnosed anomalies were urinary tract anomalies (22.86% of cases), followed by head and neck anomalies (18.68%), musculoskeletal anomalies (8.64%), heart anomalies (7.35%) and gastrointestinal anomalies (7.35%). The earliest diagnosed malformations were those of the thoracoabdominal wall (81.08%), followed by defects of the urinary tract (70.86%) and of the diaphragm (70.83%).
Asunto(s)
Feto/anomalías , Ultrasonografía Prenatal , Anomalías Congénitas/diagnóstico por imagen , Anomalías Congénitas/epidemiología , Pruebas Diagnósticas de Rutina , Femenino , Edad Gestacional , Humanos , Embarazo , Prevalencia , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , España/epidemiologíaRESUMEN
A case of intrapericardial teratoma diagnosed by ultrasound before birth is described. Planning for delivery and immediate neonatal intensive management allowed successful cardiac surgery, full resection of the tumour and full recovery.