Three-dimensional power Doppler placental vascularisation indices in early pregnancy: a pilot study.

The objective of our study was to assess 1st trimester placental vascularisation using three-dimensional (3D) power Doppler vascular indices. A cross-sectional study was used involving 41 normal pregnancies from 7 to 10 + 6 weeks. Placental volume was obtained using the 30° virtual organ computer-aided analysis (VOCAL) method. The mean, median, standard deviation (SD), minimum and maximum values were calculated for three vascular indices: the VI, vascularisation index; the FI, flow index and the VFI, vascularisation and flow index. Pearson's correlation coefficient (r) was used to assess the correlation between vascular indices and crown-rump length (CRL). Our results showed mean (± SD) values ranged from 8.66 ± 12.04 to 15.34 ± 13.89 for the VI, from 63.83 ± 43.61 to 109.22 ± 33.87 for the FI and from 9.52 ± 13.86 to 20.59 ± 22.97 for the VFI. There was no correlation between CRL and VI (r = 0.073, p = 0.630) nor VFI (r = 0.147 and p = 0.037); there was a weak correlation between CRL and FI (r = 0.332, p = 0.037). It was concluded that the FI was the only 3D power Doppler vascular index that was correlated with CRL between 7 and 10 + 6 weeks' gestation.

Evaluation of placental volume at 7-10+6 weeks of pregnancy by 3D-sonography.

The aim of the study was to establish normative data for placental volume (PV) at 7-10+6 weeks of gestation using three-dimensional ultrasound (3DUS). The cross-sectional study involved 70 healthy pregnancies between 7 and 11 weeks. The VOCAL (Virtual Organ Computer-aided Analysis) method with a 30 degrees rotation angle and six planes was used for volumetric calculations. Regression models were constructed to assess the correlation between PV and crown-rump length (CRL) adjusted by the determination coefficient (R2). The method proposed by Royston and Wright was used to establish the 2.5th; 10th; 50th; 90th and 97.5th percentiles (percentile=mean+KxSD). The intraclass correlation coefficient (ICC), Bland-Altman graphs and Student's paired t-tests were used to assess intra- and interobserver variability. PV ranged from 1.7 to 42.6 cm3, with a mean of 13.6cm3 (+/-9.4cm3). There was a strong correlation between PV and CRL; the exponential equation was the model that best expressed the correlation between them (R2=0.76). For CRL between 9 and 40 mm, the mean PV increased 10.5 times, while CRL increased only 4.4 times. Inter- and intraobserver correlation were excellent (ICC=0.979 and 0.971, respectively). Bland-Altman graphs indicated a good reproducibility with a mean intraobserver and interobserver difference of 0.2 cm3 (95% CI: -0.7-1.2cm3) and -0.2cm3 (95% CI: -1.3-0.9cm3), respectively. Reference limits were generated for first trimester PV assessed by 3DUS using the VOCAL method. There is a strong correlation between PV and CRL. Placental volume obtained through this method was highly reproducible.

Anti-Lewis alloimmunization: report of seven cases.

OBJECTIVE: The purpose of this study was to investigate the perinatal results of seven pregnant women with anti-Lewis antibodies and evaluate the need to screen for these antigens during routine prenatal care. SETTING: São Paulo Universtity Hospital, São Paulo, Brazil. POPULATION: 200 Rh-negative pregnant women with a positive indirect Coombs test, managed during a 6-year period. METHODS: The charts of all patients were reviewed to collect pertinent data and the variables were analyzed. MAIN OUTCOME MEASURES: Indirect Coombs test titer, intrauterine transfusion, mode of delivery, gestational age at birth, birthweight, neonatal transfusion, duration of neonatal hospitalization and perinatal mortality. RESULTS: All newborn infants were classified as adequate for gestational age at birth and none needed intrauterine or neonatal transfusions. All infants, except one, were discharged in good health on the third day after birth. CONCLUSIONS: Alloimmunized pregnancies (Levis antigens) have good perinatal results.

Percutaneous fetal surgery using epidural catheter: preliminary experience acquired from 24 cases.

OBJECTIVE: The objective of the following study is to report the experience acquired from 24 percutaneous fetal surgeries for cavity drainage using epidural catheter instead of the commercially available catheter. METHODS: Twenty-four percutaneous fetal surgeries for cavity drainage were performed, due to the following anomalies: 13 cases of lower urinary tract obstruction, nine cases of pleural effusion, and two cases of pulmonary cystic adenomatoid malformation type I. In order to verify that catheter adequacy, technical and obstetric complications derived from its use were assessed. Technical complications were difficulty in inserting the catheter and/or its functionality; and obstetric complications were the presence of bleeding, amniotic infection, preterm labor or premature rupture of membranes. RESULTS: The technical complications were the following: difficulty in passing the catheter through epidural needle in one case; one case of catheter drawn back with the needle; two cases of catheter dislodgment; and four cases of non-functionality of the catheter. Among the obstetric complications, there was only one case of preterm labor, and except from one fetus with chromosomal pathology, all the other 23 newborns were alive after 1 week. CONCLUSIONS: The use of the epidural catheter can be seen as a viable alternative to percutaneous surgeries of fetal cavity shunting, due to its low cost and similar complications to the use of the conventional catheter.