Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study.

OBJECTIVE: Velamentous insertion of the umbilical cord, with a reported incidence of 1% in singleton pregnancies, has been associated with several obstetric complications including fetal growth restriction, prematurity, congenital anomalies, low Apgar scores, fetal bleeding and retained placenta. The aim of this study was to determine the feasibility of identifying velamentous insertion of the umbilical cord during routine obstetric ultrasound. DESIGN: This was a prospective, cross-sectional ultrasound study in 832 unselected second- and third-trimester singleton pregnancies. Color Doppler ultrasound was routinely performed to identify the placental cord insertion site. The role of three-dimensional (3D) ultrasound in evaluating the placental cord insertion site was also studied in a subset of 50 pregnancies from this population. RESULTS: The placental cord insertion site was identified in 825/832 (99%) cases. Visualization was not achieved in seven third-trimester pregnancies with a posterior placenta. A velamentous insertion was suspected prenatally in eight cases, seven of which were confirmed after delivery as velamentous and one as markedly eccentric (battledore placenta). 3D ultrasound performed poorly at evaluating placental cord insertion site, being less efficient due to poor-quality resolution and far more time-consuming than the combined use of gray-scale and color Doppler ultrasound. CONCLUSIONS: Velamentous insertion of the umbilical cord can reliably be detected prenatally by gray-scale and color Doppler ultrasound. 3D imaging had limited value in the evaluation of the placental cord insertion site in our subset of patients. Systematic assessment of the placental cord insertion site at routine obstetric ultrasound has the potential of identifying pregnancies with velamentous insertion and, therefore, those at risk for obstetric complications including vasa previa.

[Blood flow in umbilical artery in fetus with intrauterine growth retardation]. / Flujo sanguíneo en la arteria umbilical en fetos con retardo de crecimiento intrauterino.

Many studies of Doppler blood flow velocimetry show an association between alteration of flow waves and adverse perinatal outcome in growth retarded fetus. In our study, 74 cases of growth retarded fetuses were evaluated with umbilical artery Doppler. Sixty-five showed the presence of diastolic flow and all of them had good perinatal outcome, regardless the score of the different indexes. On the other hand, those cases with absent (7) and reversed diastolic flow (2) were correlated with obstetric intervention, low birth weight, neonatal complications and perinatal mortality. We conclude that monitoring with umbilical artery Doppler in growth retarded fetuses is a good method to detect those who present hypoxia.

[Intrauterine weight index in fetal growth retardation]. / Indice ponderal intrauterino (IPI) en el retardo de crecimiento fetal (RCIU).

The intra uterine ponderal index (IPI) estimated by ultrasound examination (US) in 79 patients with intrauterine growth retardation (IUGR) is presented. The IPI was calculated using the following formula: [formula: see text] 13.2 (DFO) + 22 (DAT) + 8.9 (DAP) - 48.4 (LF) - 7469.1, and ETF = 0.55 (LF) + 8.66. Correlation indexes (r) of EPF, ETF and IPI with neonatal weight, length and ponderal index were 0.92, 0.87 and 0.51 (p < 0.001). The IPI revealed a gradual increase with respect to gestational age ranging from 1.63 to 3.08. The p 10 of the IPI was 1.96 for pregnancies of 30 to 34 weeks and 2.35 for pregnancies of 35 to 39 weeks. Those cases of IUGR with IPI < p 10 (n = 7) had a higher incidence of cesarean section (86% vs 30%, p < 0.01), intrapartum fetal distress (71% vs 11%, p < 0.01), Apgar score of < 7 at 5' (29% vs 1.4%, p < 0.05), PBF < 5 points (43% vs 4.7%, p < 0.01), and moderate or severe neonatal morbidity (57% vs 21%, p < 0.05) than those with IPI > or = p 10 (n = 72). No difference were found with respect to the presence of antepartum meconium (29% vs 6%, p = 0.09). In conclusion, ultrasonographic estimation of the IPI is another element of the examination that can help in the diagnosis of fetal condition in cases of IUGR, permitting to distinguish those fetuses that, having and estimated weight below the tenth percentile in a growth curve, are in higher perinatal risk.

[Intravascular fetal transfusion in the management of perinatal hemolytic disease]. / Transfusión fetal intravascular en el manejo de la enfermedad hemolítica perinatal.

Five pregnancies with severe blood cell isoimmunization were managed with intrauterine intravascular transfusions. The procedures were performed percutaneously under direct ultrasound visualization. A total of 14 transfusions, of 16 attempted, were successfully performed. The 5 fetuses required more than one transfusion. Only one died before been born. The other four are alive and without sequelae. Technical aspects of the procedure as well as its indications, advantages, and historical drawbacks are discussed.

[Fetal echocardiography I: Foundations]. / Ecocardiografía fetal I: Fundamentos.

Fundamentals of fetal echocardiography are stated, describing a detailed identification of the fetal heart and the echographic, visualization of the great vessels. The importance of prenatal diagnose of congenital fetal cardiac malformations is emphasized.

[Fetal echocardiography II: Prenatal diagnosis of congenital heart defects. Preliminary experience]. / Ecocardiografía fetal II: Diagnóstico prenatal de cardiopatías congénitas. Experiencia preliminar.

A preliminary experience of 28 selective patients is related by authors in the prenatal diagnose of fetal congenital cardiopathy. Echocardiographic findings are evaluated as well as neonatal outcome and the obstetrics approach.

[Ultrasonographic estimation of fetal weight in intrauterine growth retardation. Comparative analysis of 4 formula]. / Estimación ultrasonográfica del peso fetal en retardo del crecimiento intrauterino. Análisis comparativo de cuatro fórmulas.

The accuracy of estimated fetal wight determined by US scan in 70 fetuses with IUGR was analyzed using different formulas. The formula used in our Service showed the best correlation between estimated fetal weight and birth weight (R = 0.92), with estimation error not significant and +/- 8.3% variability. The foreign formulas showed significant estimation error and over 10% variability, therefore, in our population the use of the local formula is recommended.

[Nonimmune fetal hydrops secondary to fetal tachycardia: their intrauterine diagnosis and treatment]. / Hidrops fetal no immune secundario a taquicardia fetal: diagnóstico y tratamiento intrauterino.

A case of nonimmune hydrops fetalis (NIHF) secondary to fetal supraventricular tachycardia (SVT) diagnosed at 33 weeks gestation is presented. Administration of digoxin to the mother yielded normal fetal heart rhythm and frequency as well as progressive resolution of hydrops after 24 hours of initiation of therapy. Causes of NIHF and diagnostic approach are mentioned. Diagnosis and management of fetal arrhythmias are discussed. The successful perinatal outcome obtained in this case and the literature review, recommend the use of antiarrhythmic drugs therapy in cases of NIHF secondary to SVT.