Measurements in First-Trimester Abortion Products: A Pathologic Study.

CONTEXT.­: Related to the advances in prenatal diagnosis and the emergence of medically challenging situations, there has been an increased interest in conducting a pathologic study of first-trimester abortion products. OBJECTIVE.­: To evaluate measurements across a large group of first-trimester spontaneous abortion specimens. Potential goals include a validation of prenatal embryo and gestational-sac measurements as a function of gestational age (GA). DESIGN.­: A retrospective case study of first-trimester spontaneous abortions between June 2015 and April 2017 in Centro de Genética Clínica Embryo-Fetal Pathology Laboratory, Porto, Portugal. Considering the inclusion criteria, 585 complete gestational sacs, 182 embryos, and 116 umbilical cords were selected. We recorded the weight of the gestational sacs and embryos and measurements of gestational sacs, umbilical cords, and embryo crown-rump length. Models were computed using regression techniques. RESULTS.­: Gestational-sac diameter percentiles 5, 25, 50, 75 and 95 were calculated according to GA, and at each 1-week interval the diameter increased an average of 3 mm. Umbilical cord length percentiles 5, 25, 50, 75 and 95 were calculated according to GA, and at each 1-week interval, the length increased an average of 1.35 mm. Embryo crown-rump length estimated mean ± SD values were GA 6 weeks, 5.3 ± 2.3 mm; GA 7 weeks, 9.4 ± 4.8 mm; GA 8 weeks, 13.7 ± 8.2 mm; GA 9 weeks, 20.8 ± 9.1 mm; GA 10 weeks, 22.6 ± 13.4 mm; GA 11 weeks, 29.4 ± 12.9 mm; and GA 12 weeks, 52 mm. CONCLUSIONS.­: Pathologic measurements obtained should be compared to expected measurements and correlated with ultrasound findings, clinical information, and microscopic findings. Deviations from expected values could lead to an understanding of early pregnancy loss.

Value of Bishop score and ultrasound cervical length measurement in the prediction of cesarean delivery.

AIM: The aim of this study was to evaluate the role of Bishop score and cervical length in predicting the outcome of induced labor. MATERIAL AND METHODS: A prospective observational study was performed during a year in women undergoing labor induction. Prior to the procedure, Bishop score was evaluated by transvaginal digital examination and cervical length was measured by transvaginal ultrasound. Demographic data and labor details were recorded. RESULTS: A total of 197 women were analyzed; 166 women had a vaginal delivery (84.3%) and 31 had a cesarean section (15.7%). On univariate analysis, nulliparity, Bishop score >5 and cervical length <30 mm were all associated with cesarean delivery. On multivariate analysis, only nulliparity remained significantly associated with cesarean delivery and the other characteristics did not achieve statistical significance. When women were stratified according to parity, there was a significant association between cesarean delivery and nulliparity, but not multiparity. CONCLUSIONS: Our results suggest that Bishop score and cervical length are good predictors of successful induction of labor, particularly in nulliparous women.

Velamentous cord insertion in a singleton pregnancy: an obscure cause of emergency cesarean-a case report.

Approximately 2% of low-risk pregnant women still require an emergency Cesarean section after the onset of labor. Because it is likely that half of these cases are associated with placental and umbilical cord abnormalities, it is thought that prenatal detection of such abnormalities would reduce the number of emergency cesarean sections in low-risk women. Velamentous cord insertion is an abnormal cord insertion in which the umbilical vessels diverge as they traverse between the amnion and chorion before reaching the placenta. With a reported incidence of 1% in singleton pregnancies, it has been associated with several obstetric complications. This condition has been diagnosed by ultrasonography with a sensitivity of 67% and specificity of 100% in the second trimester. The present case highlights the importance of the systematic assessment of the placental cord insertion site at routine obstetric ultrasound and the potential of identifying pregnancies with velamentous insertion and, therefore, those at risk for obstetric complications.