Performance of an automatic quantitative ultrasound analysis of the fetal lung to predict fetal lung maturity.

OBJECTIVE: The objective of the study was to evaluate the performance of automatic quantitative ultrasound analysis (AQUA) texture extractor to predict fetal lung maturity tests in amniotic fluid. STUDY DESIGN: Singleton pregnancies (24.0-41.0 weeks) undergoing amniocentesis to assess fetal lung maturity (TDx fetal lung maturity assay [FLM]) were included. A manual-delineated box was placed in the lung area of a 4-chamber view of the fetal thorax. AQUA transformed the information into a set of descriptors. Genetic algorithms extracted the most relevant descriptors and then created and validated a model that could distinguish between mature or immature fetal lungs using TDx-FLM as a reference. RESULTS: Gestational age at enrollment was (mean [SD]) 32.2 (4.5) weeks. According to the TDx-FLM results, 41 samples were mature and 62 were not. The imaging biomarker based on AQUA presented a sensitivity 95.1%, specificity 85.7%, and an accuracy 90.3% to predict a mature or immature lung. CONCLUSION: Fetal lung ultrasound textures extracted by AQUA provided robust features to predict TDx-FLM results.

Feasibility and reproducibility of fetal lung texture analysis by Automatic Quantitative Ultrasound Analysis and correlation with gestational age.

OBJECTIVE: To evaluate the feasibility and reproducibility of fetal lung texture analysis using a novel automatic quantitative ultrasound analysis and to assess its correlation with gestational age. METHODS: Prospective cross-sectional observational study. To evaluate texture features, 957 left and right lung images in a 2D four-cardiac-chamber view plane were previously delineated from fetuses between 20 and 41 weeks of gestation. Quantification of lung texture was performed by the Automatic Quantitative Ultrasound Analysis (AQUA) software to extract image features. A standard learning approach composed of feature transformation and a regression model was used to evaluate the association between texture features and gestational age. RESULTS: The association between weeks of gestation and fetal lung texture quantified by the AQUA software presented a Pearson correlation of 0.97. The association was not influenced by delineation parameters such as region of interest (ROI) localization, ROI size, right/left lung selected or sonographic parameters such as ultrasound equipment or transducer used. CONCLUSIONS: Fetal lung texture analysis measured by the AQUA software demonstrated a strong correlation with gestational age. This supports further research to explore the use of this technology to the noninvasive prediction of fetal lung maturity.

Resultados perinatales en amenazas de parto prematuro con colonización endocervical por Ureaplasma urealyticum / Perinatal results in threatened preterm labor related to Ureaplasma urealyticum colonization

Objetivo. Valorar los resultados perinatales en embarazadas con episodios de amenaza de parto prematuro y colonización concomitante por Ureaplasma urealyticum detectada mediante cultivos endocervicales. Material y métodos. Entre enero del 2002 y diciembre del 2003 se incluyeron un total de 72 mujeres con uno o más episodios de amenaza de parto prematuro entre las 24 y 36,6 semanas de gestación, en cuyo ingreso se realizó un cultivo endocervical para micoplasmas genitales. Criterios de exclusión: embarazos múltiples, rotura prematura de membranas previa a la amenaza de parto prematuro. Se compararon los resultados perinatales entre las pacientes con y sin colonización concomitante por U. urealyticum. Resultados. Al comparar el grupo de mujeres con cultivo endocervical positivo a U. urealyticum (30 pacientes) y el grupo con cultivo negativo (42 pacientes) no se encontraron diferencias estadísticamente significativas respecto a la edad materna, la nuliparidad, la longitud cervical o el test de Bishop. La edad gestacional en el momento del parto fue muy similar en ambos grupos, así como los resultados perinatales. No se observó ningún caso de corioamnionitis ni sepsis neonatal. Discusión. En mujeres con episodios de amenaza de parto prematuro, la positividad del cultivo endocervical para U. urealyticum al ingreso no se asocia a mayor riesgo de parto pretérmino ni aumenta la morbilidad perinatal (AU)

Objective. To assess the perinatal results in pregnant women with threatened preterm labor and detection of Ureaplasma urealyticum by endocervical culture. Material and methods. Seventy-two pregnant women with at least one episode of preterm labor between 24 and 36.6 weeks of pregnancy from January 2002 to December 2003 were included in our study. An endocervical culture for genital mycoplasmas was performed at admission. Exclusion criteria consisted of multiple pregnancy and premature rupture of membranes prior to the episode of threatened preterm labor. Perinatal results were compared in women with positive and negative cultures to U. urealyticum. Results. There were 30 women with a U. urealyticum-positive culture and 42 women with a U. urealyticum-negative culture. There were no statistically significant differences in maternal age, nulliparity rate, cervical length or Bishop's score. Gestational age at delivery and perinatal results were highly similar in the two groups. There were no cases of chorioamnionitis or neonatal sepsis. Discussion. In women admitted to hospital for threatened preterm labor, detection of U. urealyticum in endocervical culture at admission is not related to an increased risk of preterm birth or with increased perinatal morbidity (AU)

Clinical and inflammatory markers in amniotic fluid as predictors of adverse outcomes in preterm premature rupture of membranes.

OBJECTIVE: We sought to evaluate gestational age, cervical length, amniotic fluid interleukin (IL)-6, and selected proteomic biomarkers as independent predictors of adverse outcome in preterm premature rupture of membranes (PPROM). STUDY DESIGN: This was a prospective cohort study of 65 consecutive women with PPROM (20.0-34.6 weeks). Gestational age, cervical length, amniotic fluid IL-6, and proteomic biomarkers (calgranulins A and C, and neutrophil defensins 1 and 2) were evaluated at diagnosis. The predictive value for intraamniotic infection and neonatal composite morbidity was calculated by logistic regression. RESULTS: Proteomic biomarkers were independent predictors of intraamniotic infection (odds ratio, 22.1; P=.011) and neonatal composite morbidity (odds ratio, 17.6; P=.02). With the exception of a trend between gestational age and neonatal morbidity (P=.054), none of the other parameters were independent predictors of outcome measures. CONCLUSION: Selected proteomic biomarkers were the only independent predictors of adverse outcomes in PPROM. Contrary to what is reported in preterm labor with intact membranes, gestational age, cervical length, and IL-6 were not.

Parto diferido del segundo gemelo / Delayed-interval delivery in twin pregnancy

La incidencia de embarazos múltiples se ha incrementado en los últimos años. Las pacientes con embarazos múltiples están en riesgo de parto prematuro con una alta asociación a mortalidad y morbididad perinatal. El parto del primer gemelo en una gestación múltiple va normalmente seguido por el parto del siguiente en un corto periodo. Es raro observar un intervalo prolongado entre el parto de los dos fetos de un embarazo múltiple. Nosotros reportamos 7 casos de embarazos múltiples con un parto diferido del segundo gemelo. Basándonos en nuestra experiencia y en la revisión de la literatura, concluimos que el parto diferido del segundo gemelo en edades gestacionales extremas, con un control exhaustivo de las condiciones fetales y maternas, está recomendado para mejorar la supervivencia y disminuir la morbilidad en el segundo gemelo (AU)

The incidence of multiple pregnancies has increased in the last few years. Patients with multiple pregnancies are at risk of preterm delivery associated with high perinatal mortality and morbidity. Delivery of the first twin in a multiple gestation is usually followed by delivery of the second twin shortly thereafter. A prolonged interval between delivery of the fetuses in a multiple pregnancy is infrequent. We report seven cases of multiple pregnancies with delayed- interval delivery of the second twin. On the basis of our experience and a review of the literature, we conclude that delayed delivery of the second twin in very preterm gestational ages, with careful observation of fetal and maternal status, is recommended to improve survival and decrease morbidity in the second twin (AU)