Oocyte retrieval in an in vitro fertilization-embryo transfer program: comparison of four methods.

The records of 191 patients involved in 316 treatment cycles over 3 years in an in vitro fertilization-embryo transfer program were reviewed. Follicular aspiration, oocyte retrieval, pregnancy rates, technical difficulty, and complications were compared in four oocyte retrieval methods: 117 laparoscopic retrievals, 116 ultrasound (US)-guided percutaneous transvesical retrievals, 43 US-guided transvaginal retrievals, and 40 combined US and laparoscopic retrievals. The mean number of aspirated follicles (9.14) was greatest in the transvaginal retrieval group, but the ratio of oocytes to punctured follicles was not statistically greater in any of the groups. The overall clinical pregnancy rate per cycle was highest in the transvaginal retrieval group: 12 of 43 cycles resulted in pregnancy, or 27.9%. The number of delivered babies (16.3%) was also highest in the transvaginal retrieval group. US-guided transvaginal oocyte retrieval is recommended as the method of choice.

Doppler waveforms in the fetal aorta and umbilical artery in patients with hypertension in pregnancy.

Pulsed Doppler ultrasound assessment of blood flow was performed in the fetal aorta and umbilical arteries of 41 patients with hypertension in pregnancy. Patients were grouped according to severity of the hypertension and the presence or absence of chronic hypertension. Doppler abnormalities were seen in two patients with chronic hypertension, both of whom delivered small for gestational age infants. Only one patient with mild to moderate preeclampsia had abnormal aortic Doppler assessment and was also delivered of a small for gestational age infant. The highest number of abnormal Doppler waveforms in both fetal aorta and umbilical artery were found in patients with severe preeclampsia. Abnormalities were detected more frequently in the fetal aorta than in the umbilical artery. Doppler assessment was often abnormal before a nonstress test or biophysical profile. The number of abnormal Doppler values correlated with perinatal outcome in patients with severe preeclampsia.

Obstetric ultrasound.

This article addresses the current indications for an obstetric ultrasound and describes the findings that it is reasonable to expect when reading an ultrasound report. The authors discuss several common obstetrical problems focussing the attention on the usefulness of the imaging information. Finally, they provide a glimpse into the future direction of obstetric ultrasound by discussing vaginal scanning, Doppler assessment of fetal blood flow, and routine ultrasound in pregnancy.

Fetal deformation caused by uterine malformation.

Two fetuses are described in whom deformation was caused by uterine malformation (bicornuate uterus). It is necessary to distinguish between fetal malformation and deformation, since the latter type of anomaly indicates that the uterine environment is distorted. Correction of this uterine malformation can significantly improve the prospects for future pregnancies.

Ultrasound evaluation of hydronephrosis of pregnancy.

Four hundred ninety-two patients, including 449 pregnant patients, 39 nonpregnant control patients, and 4 patients with pelvic masses, had renal ultrasonography using gray scale technique. Measurements of renal pelvic diameters in the normal pregnant patients revealed an overall incidence of 63 percent renal pelvic dilatation over the nonpregnant controls. Maximum normal renal pelvic diameters were 1.1 cm on the right and 0.9 cm on the left. The maximum normal expected renal pelvic diameter (97.5 percent confidence level) in pregnancy is 2.7 cm on the right and 1.8 cm on the left in the last two trimesters of pregnancy. There was no significant difference between primiparous and multiparous patients, but pregnant patients were significantly different from controls in every trimester (p less than 0.01). Maximum dilatation occurred at 24--28 weeks of gestation. The right renal pelvis was enlarged to the greatest degree in 90 percent of normal patients. Patients with pelvic masses showed a similar pattern of right-sided hydronephrosis.