Nature and frequency of chromosomal abnormalities in pregnancies with abnormal ultrasound findings: an analysis of 117 cases with review of the literature.

During a 7-year period, 117 fetal karyotypes were available from 131 genetic amniocenteses. These procedures were performed between 14 and 37 weeks' gestation for the following abnormal ultrasound findings: (1) intrauterine growth retardation (IUGR)--61 cases; (2) fetal malformation--71 cases; and (3) amniotic fluid volume (AFV) abnormality--60 cases. Chromosomal abnormalities were identified in 19 cases (16.2 per cent). Aneuploidy was 2.5 times as frequent in the presence of malformations than in their absence. No correlation was demonstrated between specific fetal malformations and specific chromosomal abnormalities. Aneuploidy was also twice as frequent in the presence of symmetrical IUGR than in its absence. No chromosomal abnormalities were found among eight cases of asymmetrical IUGR. Four cases of aneuploidy presented with isolated IUGR, three of these involving the X chromosome. The frequency of aneuploidy was the same with or without abnormalities of AFV (14.3 versus 16.4 per cent). No chromosomal abnormality was found associated with isolated AFV abnormalities.

Umbilical cord hematoma following diagnostic funipuncture.

Major complications associated with funipuncture have been reported but are rare. This is a report of a diagnostic funipuncture performed on a 29-week fetus with a single umbilical artery and multiple malformations. Immediately after the procedure, a voluminous hematoma developed at the site of needle insertion in association with a severe fetal bradycardia. Fetal death was confirmed within 5 minutes of needle insertion. It is hypothesized that the risk of complications of funipuncture may vary according to the clinical indication for the procedure and may be increased in the presence of certain fetal malformations. The rapid evolution of complications, as occurred in the present case, underlines the importance of having a clear plan of management in the event of mishap and discussing this plan with the parents before undertaking diagnostic funipuncture.

Assessment of ovaries by magnetic resonance imaging in patients presenting with polycystic ovarian syndrome.

The demonstration of bilaterally enlarged ovaries with multiple small cysts at ultrasound is the morphological hallmark of polycystic ovarian syndrome (PCOS). However, a number of patients with clinical and biochemical diagnosis of PCOS have ovaries that are without sonographically visible discrete cysts. A better contrast resolution is obtained with magnetic resonance imaging (MRI) and enables visualization of organ structure not seen with other techniques. The purpose of the study was to relate the clinical and biochemical features of 10 patients presenting with a PCOS profile to magnetic resonance imaging and to compare these findings with those observed at ultrasound. With MRI, at least one ovary typical of PCOS could be visualized in eight patients, while this was the case in only three patients with ultrasound. The ultrasound examinations were indeed equivocal in the majority of patients (seven cases). No apparent relationship could be found between the clinical and biochemical parameters and ovarian morphology assessed by MRI or ultrasound. In summary, the present study supports the superiority of MRI technique to assess ovarian morphology over the ultrasound technology used in our study. However, the recent technological advances in ultrasound, and specifically the advent of high frequency transvaginal sonography, will be of particular interest in the study of PCOS.

Ovarian sonographic findings during intermittent intranasal luteinizing hormone-releasing hormone agonist sequentially combined with an oral progestogen as antiovulatory contraceptive approach.

Ovarian ultrasounds were performed in four groups of six or seven women taking intranasal luteinizing hormone-releasing hormone agonist Buserelin (200 micrograms twice daily or 400 micrograms once daily) for periods of 14 or 21 days. Medroxyprogesterone acetate (5 mg by mouth twice daily) was added on days 15 to 21. A pause of 7 days followed each of the four treatment periods. Between days 12 to 15 of the first Buserelin cycle, sonograms showed in 17 cases (68%) various degrees of follicular stimulation ranging from numerous 4- to 10-mm follicles (24%), to 10- to 27-mm developing follicle(s) (24%), to greater than 27-mm ovarian cysts (20%). At the fourth Buserelin cycle, the predominant observation was large follicle(s) in the 14-day schedules, whereas ovarian scans did not reveal follicular stimulation in 66% of the 21-day schedules. The area under estradiol (E2) curves was above control in cycles with induced large follicles mainly in the 14-day schedules at the 200 micrograms/12 hour dose. Occasional brief and low elevation of progesterone was compatible with luteinized follicles. In the 21-day schedules at 400 micrograms/24 hours, absence of follicular development was frequently associated with serum E2 in the early follicular phase range. The most appropriate dosage regimen for potential contraception was 200 micrograms/12 hours for 21 days because it was associated with small follicles and serum E2 was in the range of control cycles.

PIP: This study was aimed at evaluating the ovarian changes during intermittent luteinizing hormone-releasing hormone agonist (LH-RH-A) administration. Ovarian ultrasonic findings were analyzed during 4 successive cycles of LH-RH-A administration in 4 groups of subjects treated with 400 mcg once daily or 200 mcg twice daily of Buserelin and for periods of 14 or 21 days. Intermittent LH-RH-A administration was associated with stimulation of ovarian follicles to various stages of development. After 2 weeks of Buserelin in a 1st treatment cycle, ovarian scans revealed follicular development in 68% of cases--4-10 mm follicles in 24%, 10-27 mm developing follicles in another 24%, and ovarian cysts greater than 27 mm in 20%. At the 4th Buserelin cycle, the predominant finding was large follicles in the 14-day schedules, whereas ovarian scans failed to reveal follicular stimulation in 66% of the 21-day schedules. The most appropriate dosage regimen for potential contraception is 200 mcg/12 hours for 21 days. This regimen was associated with small follicles and serum estradiol was in the range of control cycles.

Ultrasound evaluation of amniotic fluid: outcome of pregnancies with severe oligohydramnios.

Severe oligohydramnios, defined as a condition in which the largest pocket of amniotic fluid measures less than 1 cm in its vertical axis as determined by an ultrasound method, was observed in 113 patients in a population of 15,431 referred high-risk patients (0.7%). In all cases, intervention took place unless there was a recognized structural anomaly or extreme prematurity. Overall gross perinatal mortality was 132.7/1000, and the incidence of major anomaly was 13.3%. With intervention the corrected perinatal mortality rate was 17.7/1000, a rate not significantly different from that observed in the entire population. All end points of perinatal mortality were significantly increased in patients with severe oligohydramnios, in comparison with randomly selected control subjects with normal amniotic fluid. These findings are interpreted to indicate that severe oligohydramnios in a structurally normal fetus is an indication for delivery.

Luteinizing hormone-releasing hormone agonist and uterine leiomyoma: a pilot study.

Ten women with 12 uterine leiomyomas ranging from 7.5 to 420 cc (mean, 112.6 +/- 39.4) were treated with subcutaneous injections of the luteinizing hormone-releasing hormone agonist buserelin, 200 micrograms three times daily for 1 week and then 500 micrograms daily for the rest of the 6-month treatment period. Following initial stimulation the pituitary ovarian axis was suppressed after 3 weeks of treatment with mean serum estradiol ranging between 17 and 36 pg/ml. Seven uterine leiomyomas had a marked regression in size following treatment with luteinizing hormone-releasing hormone agonist; two were undetectable and the volume of the other five diminished by an average of 80%. One tumor did not respond to treatment, two regressed by 25%, and two, following an initial reduction of 65% and 50%, reenlarged during the last 2 months of treatment to 75% and 100% respectively of their initial volume. Luteinizing hormone-releasing hormone agonist is the first medication demonstrated effective in reducing the size of uterine myomas.

The reproducibility of intrapartum cardiotocogram assessments.

Five obstetrician-gynecologists experienced in fetal monitoring assessed 150 intrapartum cardiotocograms obtained with an external transducer. There were three successive blind readings, the first two without any clinical data apart from gestational age. The reviewers indicated whether the tracings showed definite, possible or no abnormalities. The interpretations given by each reviewer for any one tracing were fairly consistent, but they varied markedly from one reviewer to another. The proportion of tracings interpreted as normal ranged from 39% to 74%, and the proportion assessed as abnormal ranged from 3% to 43%. All five observers agreed on the interpretation of 29% of the tracings. Inter-reviewer reproducibility scarcely changed when clinical data were provided. These findings emphasize the need to evaluate all methods of fetal monitoring before they become widespread.

Prediction of human ovulation by rapid luteinizing hormone (LH) radioimmunoassay and ovarian ultrasonography.

Accurate prediction of the time of ovulation is essential for the recovery of a mature oocyte for in vitro fertilization (IVF). The preovulatory luteinizing hormone (LH) surge can be considered the most reliable hormonal change closely related to ovulation. With the use of a rapid LH assay and ovarian ultrasonography, it now appears possible to predict quite accurately the time of ovulation, provided that these technologies are appropriately applied. Therefore, we have used a newly standarized rapid (3-hour) LH radioimmunoassay (RIA) for serial estimation of preovulatory serum LH surge. So far, 21 women have come to our center daily during their 5-day preovulatory period. Blood samples were taken daily every 3 to 5 hours between 7:00 A.M. and 11:00 P.M. Ovarian ultrasonic scans were performed one to three times daily depending on the day of the cycle and the serum LH level. Data show that there is a significant variation in the mean preovulatory follicular size, in the duration of the LH surge, and in the time interval between the initial rise of LH surge and the estimated time of ovulation. Results obtained from six women studied during two to four cycles indicate that each woman has a distinctive hormonal and ultrasonic pattern that appears to be reproducible. Thus it is recommended that such a pattern be appropriately evaluated before attempting laparoscopy for recovery of a mature human oocyte.