Three-dimensional ultrasound for routine check-up in in vitro fertilization patients.

AIM: To determine whether three-dimensional ultrasound (3D US) improves diagnosis in patients undergoing in vitro fertilization (IVF). METHODS: Three-dimensional and power Doppler ultrasound were used in examination of 267 patients undergoing IVF on their first visit, during ovulation induction and aspiration of the oocytes. Patients with suspected uterine anomalies and/or abnormalities of the endometrium (N=108) were treated by operative hysteroscopy. On the day of oocyte collection, multiplanar imaging and 3D reconstruction demonstrated cumuli in follicles greater than 15 mm. Cumulus assessment inside the ovarian follicles was correlated to the number of mature oocytes. Power Doppler examination was performed when superposing vessels did not allow the puncture needle to be introduced correctly. RESULTS: The diagnosis was correct in all cases of endometrial polyp, submucous myoma, arcuate uteri, and septate uteri, as confirmed by office hysteroscopy. Intrauterine synechiae were correctly diagnosed preoperatively in one of the four cases. The mean (+/-SD) number of follicles >18 mm was 8.2+/-5.8, and the total number of follicles demonstrating cumulus in all three planes was 6.4+/-5.1. The ratios of cumuli/retrieved oocytes, cumuli/fertilized oocytes, and cumuli/mature oocytes were 6.2+/-4.2, 5.4+/-2.8, and 5.9+/-2.6, respectively. CONCLUSION: 3D US improved recognition of the uterine anatomy, characterization of the surface features, assessment of the ovaries during stimulation cycles, and morphologic and functional evaluation of the anatomic structures of the inner reproductive organs, thus avoiding the need of invasive diagnostic procedures. Puncturing procedures, such as oocyte collection, can be performed more precisely.

Ultrasonic markers of fetal chromosomal abnormalities.

OBJECTIVE: The aim of this brief investigation was to correlate the most common sonographically detectable markers with certain type of chromosomal disorder diagnosed by available karyotyping procedures. STUDY DESIGN: During the 3 year study period fetal karyotyping was performed in 1055 patients for a variety of clinical indication. Twenty one percent (21%; 222/1055) of procedures were done because of sonographically detectable structural disorders related to phenotype expression of chromosomopathies. Sonographic examinations and karyotyping procedures were performed between the 10th and 36th week. The average maternal age was 27 years, unselected. RESULTS: The fetal karyotype was abnormal in 13.5% of cases (30/222). Within the group of single marker, 11.6% (7/60) of karyotypes were abnormal. Multiple markers of chromosomal abnormalities resulted in 14.2% (23/162) of abnormal karyotypes. The most frequent chromosomal disorder detected in sonographic screening is trisomy 18 (50%; 15/30). The data on the frequency of different types of chromosomal abnormalities are given. CONCLUSIONS: The incidence of chromosomal abnormalities for ultrasonographically detectable malformations is much higher than the incidence reported in screening studies based on maternal age or biochemical screening. Trisomy 21 showed the relative lack of variety in phenotypic expression, and nuchal translucency screening has to be accepted rationally. Associated numerous major and minor malformations were the most prominent factors leading to the diagnosis of chromosomopathies, particularly trisomy 18.

Transvaginal color Doppler in the assessment of the uteroplacental circulation in normal early pregnancy.

Transvaginal color Doppler investigation of the uteroplacental circulation was performed on 108 pregnant women with normal intrauterine pregnancy. Decline of resistance index (RI) and pulsatility index (PI) and increase of peak systolic velocity (Ps velocity) were found in all segments of the uteroplacental circulation with advancing gestational age. There was a decrease of RI and PI from the uterine artery through its branches: arcuate, radial and spiral arteries. Ps velocities decreased from the uterine, through the arcuate, to the radial arteries, but Ps velocities in the spiral arteries were higher than those in the radial arteries. According to our results RI seems to be more precise in the assessment of the uteroplacental than the PI.

Transvaginal color Doppler study of middle cerebral artery blood flow in early normal and abnormal pregnancy.

Transvaginal color and pulsed Doppler sonography was performed on 106 singleton pregnant women; 75 had clinically normal pregnancies, and the remaining 31 patients had complicated pregnancies with vaginal bleeding. The gestational ages ranged from the 7th to 18th menstrual weeks. The aim of the study was to establish the earliest gestational age at which intracranial blood flow could be detected, in particular in the middle cerebral artery. The intracranial circulation becomes visible at the 8th week of gestation (7 weeks and 3 days). The end-diastolic component of blood flow is inconstantly present from the 11th to the 13th gestational week, and is always detected thereafter. A significant decrease in the pulsatility index (p < 0.05) and peripheral flow impedance index (p < 0.001) was observed during the early weeks of pregnancy in both the normal and complicated pregnancies. There was no significant difference between the groups (p > 0.05). Results suggest that Doppler studies of middle cerebral arteries in early pregnancy are unlikely to be of value in identifying fetal hemodynamic disorders in the early stages of spontaneous abortion.

[Adrenogenital syndrome in an adolescent]. / Adrenogenitalni sindrom u adolescenata

A case is presented of primary amenorrhea resulting from the hyperfunction of the adrenal cortex. The condition developed in prepuberty. The mode of the establishment of the diagnosis and the effect of dexamethason treatment are discussed.