RESUMO
OBJECTIVE: To investigate human femur development in fetal growth restriction (FGR) by analyzing femur morphometrics and distal epimetaphyseal features on prenatal magnetic resonance imaging (MRI). METHODS: This was a retrospective study of 111 fetuses (mean gestational age (GA), 27 + 2 weeks (range, 19-35 weeks)) with FGR associated with placental insufficiency without other major abnormalities and 111 GA-matched normal controls. On 1.5-Tesla echoplanar MRI, femur morphometrics, including diaphyseal length, epiphyseal length and epiphyseal width, were assessed. Using a previously reported grading system, epimetaphyseal features, including cartilaginous epiphyseal shape, metaphyseal shape and epiphyseal ossification, were analyzed qualitatively. To compare FGR cases and controls, the paired t-test was used to assess morphometrics, generalized estimating equations were used for epimetaphyseal features and time-to-event analysis was used to assess the visibility of epiphyseal ossification. RESULTS: There were significant differences in femur morphometrics between FGR cases and controls (all parameters, P < 0.001), with bone shortening observed in FGR. No significant differences were found in the distribution of epimetaphyseal features between FGR cases and controls (epiphyseal shape, P = 0.341; metaphyseal shape, P = 0.782; epiphyseal ossification, P = 0.85). Epiphyseal ossification was visible at a median of 33.6 weeks in FGR cases and at 32.1 weeks in controls (P = 0.008). CONCLUSIONS: On prenatal MRI, cases with FGR associated with placental insufficiency exhibit diaphyseal and epiphyseal shortening of the femur. However, FGR cases and normal controls share similarly graded distal epimetaphyseal features. Consequently, these features may not be appropriate MRI characteristics for the identification of FGR. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Assuntos
Retardo do Crescimento Fetal , Insuficiência Placentária , Gravidez , Feminino , Humanos , Retardo do Crescimento Fetal/diagnóstico por imagem , Retardo do Crescimento Fetal/patologia , Insuficiência Placentária/diagnóstico por imagem , Placenta/diagnóstico por imagem , Estudos Retrospectivos , Fêmur/diagnóstico por imagem , Idade Gestacional , Imageamento por Ressonância Magnética/métodos , Ultrassonografia Pré-NatalRESUMO
OBJECTIVES: Corpus callosal agenesis (CCA) is one of the most common brain malformations and is generally associated with a good outcome when isolated. However, up to 25% of patients are at risk of neurodevelopmental delay, which currently available clinical and imaging parameters are inadequate to predict. The objectives of this study were to apply and validate a fetal magnetic resonance imaging (MRI) anatomical scoring system in a cohort of fetuses with isolated CCA and to evaluate the correlation with postnatal neurodevelopmental outcome. METHODS: This was a retrospective cohort study of cases of prenatally diagnosed isolated CCA (as determined on ultrasound and MRI), with normal karyotype and with known postnatal neurodevelopmental outcome assessed by standardized testing. A fetal brain MRI anatomical scoring system based on seven categories (gyration, opercularization, temporal lobe symmetry, lamination, hippocampal position, basal ganglia and ventricular size) was developed and applied to the cohort; a total score of 0-11 points could be given, with a score of 0 representing normal anatomy. Images were scored independently by two neuroradiologists blinded to the outcome. For the purpose of assessing the correlation between fetal MRI score and neurodevelopmental outcome, neurodevelopmental test results were scored as follows: 0, 'below average' (poor outcome); 1, 'average'; and 2, 'above average' (good outcome). Spearman's rank coefficient was used to assess correlation, and inter-rater agreement in the assessment of fetal MRI score was calculated. RESULTS: Twenty-one children (nine females (42.9%)) fulfilled the inclusion criteria. Thirty-seven fetal MRI examinations were evaluated. Mean gestational age was 28.3 ± 4.7 weeks (range, 20-38 weeks). All fetuses were delivered after 35 weeks' gestation with no perinatal complications. Fetal MRI scores ranged from 0 to 6 points, with a median of 3 points. Inter-rater agreement in fetal MRI score assessment was excellent (intraclass correlation coefficient, 0.959 (95% CI, 0.921-0.979)). Neurodevelopmental evaluation was performed on average at 2.6 ± 1.46 years (range, 0.5-5.8 years). There was a significant negative correlation between fetal MRI score and neurodevelopmental outcome score in the three areas tested: cognitive (ρ = -0.559, P < 0.0001); motor (ρ = -0.414, P = 0.012) and language (ρ = -0.565, P < 0.0001) skills. Using fetal MRI score cut-offs of ≤ 3 (good outcome) and ≥ 4 points (high risk for poor outcome), the correct prognosis could be determined in 20/21 (95.2% (95% CI, 77.3-99.2%)) cases. CONCLUSION: By assessing structural features of the fetal brain on MRI, it may be possible to better stratify prenatally the risk of poor neurodevelopmental outcome in CCA patients. © 2020 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Assuntos
Agenesia do Corpo Caloso/diagnóstico por imagem , Feto/diagnóstico por imagem , Imageamento por Ressonância Magnética/estatística & dados numéricos , Transtornos do Neurodesenvolvimento/diagnóstico por imagem , Agenesia do Corpo Caloso/complicações , Agenesia do Corpo Caloso/embriologia , Encéfalo/diagnóstico por imagem , Encéfalo/embriologia , Pré-Escolar , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/embriologia , Corpo Caloso/fisiopatologia , Feminino , Feto/embriologia , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética/métodos , Masculino , Transtornos do Neurodesenvolvimento/etiologia , Valor Preditivo dos Testes , Gravidez , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Ultrassonografia Pré-NatalRESUMO
OBJECTIVE: Normal cognitive development usually requires a structurally intact and complete cerebellar vermis. The aim of this study was to evaluate whether quantification by fetal magnetic resonance imaging (MRI) of vermis- and brainstem-specific imaging markers improves the definition of cystic posterior fossa malformations (cPFM). METHODS: Fetuses diagnosed with cPFM that had an available midsagittal plane on T2-weighted MRI were identified retrospectively and compared with gestational-age (GA) matched brain-normal controls. Fetuses with cPFM were assigned to three groups, according to standard criteria (vermian size and brainstem-vermis (BV) angle): normal vermian area and BV angle < 25° (Group 1); reduced vermian area and/or BV angle of 25-45° (Group 2); and reduced vermian area and BV angle > 45° (Group 3; Dandy-Walker malformation (DWM) group). The number of differentiable vermian lobules and the areas of the vermis, mesencephalon, pons and medulla oblongata were quantified, correlated with and controlled for GA, and compared between the study groups. RESULTS: In total, 142 cases of cPFM were included, with a mean GA of 25.20 ± 5.11 weeks. Cases comprised Blake's pouch cyst (n = 46), arachnoid cyst (n = 12), inferior vermian hypoplasia (n = 5), megacisterna magna (n = 35) and classic DWM (n = 44). In the control group, 148 fetuses were included, with a mean GA of 25.26 ± 4.12 weeks. All quantified areas and the number of differentiable vermian lobules had a significant positive correlation with GA. The number of vermian lobules and the areas of all quantified regions, except for that of the medulla oblongata, differed significantly between the study groups (P ≤ 0.015 for all). The control group had the highest number of differentiable vermian lobules and the DWM group had the lowest (P < 0.01). CONCLUSIONS: Prenatal MRI assessment of vermian lobules is a useful addition to standard neuroradiological and neurosonographic techniques. The quantification of vermian lobules using fetal MRI allows further differentiation of cPFM into subgroups and thereby improves the classification of hindbrain malformations. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
Assuntos
Síndrome de Dandy-Walker/diagnóstico por imagem , Malformações do Sistema Nervoso/diagnóstico por imagem , Adulto , Fossa Craniana Posterior/anormalidades , Fossa Craniana Posterior/diagnóstico por imagem , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Valor Preditivo dos Testes , Gravidez , Diagnóstico Pré-NatalRESUMO
OBJECTIVES: To optimize the imaging assessment of fetal hindbrain malformations, this observational magnetic resonance imaging (MRI) study aimed to assess whether fetal vermian lobulation can be quantified accurately and whether the relative growth of vermian lobules is uniform. METHODS: This retrospective study included singleton fetuses which underwent T2-weighted MRI in vivo with a 1.5-Tesla (T) scanner or within 24 h postmortem with a 3-T scanner between January 2007 and November 2016 at the Medical University of Vienna. We included only those showing normal structural brain development on ultrasound and MRI and which had image quality appropriate for quantitative analysis, i.e. good image quality and a precise midsagittal slice. Fetal brains were segmented and, for all discernible vermian lobules, we determined the mean relative area contribution (MRAC, the proportion of the lobule relative to the total vermian area, in terms of number of voxels). Inter- and intrarater measurement variability of a representative selection (21 cases) was determined by intraclass correlation coefficient (ICC) for voxel-based differences. A linear regression model was used to assess the correlation between the relative size of each vermian lobule (i.e. MRAC) and gestational age. RESULTS: A total of 78 fetuses scanned in vivo aged 18-32 gestational weeks and seven fetuses scanned postmortem aged 16-30 weeks had a precise midsagittal slice and image quality sufficient for quantitative analysis. After 22 weeks of gestation, seven of the nine known vermian lobules could be discriminated reliably. The MRAC showed a mean ± SD difference of only 2.89 ± 3.01% between in-vivo and postmortem measurements. The ICC of voxel-based interrater differences was mean ± SD, 0.91 ± 0.05 and the intrarater ICC was 0.95 ± 0.03. Growth of cerebellar lobules was non-uniform: the MRAC of culmen and DFT (declive + folium + tuber) increased with gestational age, whereas that of lingula, centralis, pyramis and nodulus decreased. The growth of the uvula showed no significant correlation with gestational age. CONCLUSIONS: Fetal vermian lobulation can be assessed accurately and reliably after 22 weeks on precise midsagittal sequences with 1.5-T T2-weighted MRI. Fetal vermian lobules show non-uniform growth, with expansion of DFT and culmen at the expense of the other vermian lobules. Evaluation and elucidation of vermian lobulation in normal fetuses should enable better characterization of fetuses with hindbrain malformations. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Vermis Cerebelar/anormalidades , Imageamento por Ressonância Magnética , Diagnóstico Pré-Natal , Autopsia , Vermis Cerebelar/diagnóstico por imagem , Vermis Cerebelar/embriologia , Feminino , Idade Gestacional , Humanos , Valor Preditivo dos Testes , GravidezRESUMO
OBJECTIVE: To evaluate the usefulness of chromosome microarrays as a second-tier test in prenatal genetic testing. METHODS: We prospectively analyzed 75 high-risk pregnancies undergoing invasive prenatal genetic testing in which the karyotype either was normal or had findings other than a common non-mosaic autosomal aneuploidy. RESULTS: Chromosomal microarray analysis (CMA) was performed successfully in all cases. Pathological copy-number variations (CNVs) explaining the phenotypes were found in 11 cases (14.7%). Four cases were detected with an unbalanced translocation. In three of these cases, subsequent genetic analysis demonstrated that a parent was an unknown carrier of a balanced translocation. Among the 67 cases with normal karyo-types, submicroscopic rearrangements with pathological significance were detected in five (7.5%) and CNVs of unclear significance were detected in one (1.5%). CMA was able to discriminate correctly between true mosaicism and confined or pseudomosaicism in all six mosaic cases. CONCLUSION: CMA is a valuable second-tier test in high-risk pregnancies for which identification or further delineation of genetic aberrations is important. Its higher resolution results in a higher detection rate of aberrant cases, with a clear clinical benefit for estimation of risk of recurrence.
Assuntos
Aberrações Cromossômicas , Transtornos Cromossômicos/diagnóstico , Doenças Fetais/diagnóstico , Cariótipo , Análise em Microsséries/métodos , Diagnóstico Pré-Natal/métodos , Transtornos Cromossômicos/genética , Feminino , Doenças Fetais/genética , Testes Genéticos/métodos , Humanos , Cariotipagem/métodos , Gravidez , Estudos ProspectivosRESUMO
OBJECTIVE: In view of the implementation of magnetic resonance imaging (MRI) as an adjunct to ultrasonography in prenatal diagnosis, this study sought to demonstrate normal penile growth on prenatal MRI. METHODS: This was a retrospective study of MRI of 194 male fetuses (18-34 weeks' gestation) with normal anatomy or minor abnormalities. On sagittal T2-weighted MRI sequences, we measured penile length from the glans tip to the scrotal edge (outer length) and from the glans tip to the symphyseal border (total length). Descriptive statistics, as well as correlation and regression analysis, were used to evaluate penile length in relation to gestation. T-tests were calculated to compare mean outer/total length on MRI with published ultrasound data. RESULTS: Mean length values, including 95% CIs and percentiles, were defined. Penile length as a function of gestational age was expressed by the following regression equations: outer mean length = - 5.514 + 0.622 × gestational age in weeks; total mean length = - 8.865 + 1.312× gestational age in weeks. The correlation coefficients, r = 0.532 and r = 0.751, respectively, were statistically significant (P < 0.001). Comparison of outer penile length on MRI with published ultrasound penile length data showed no significant differences, while total penile length on MRI was significantly greater than ultrasound penile length (P < 0.001). CONCLUSION: Our MRI results provide a reference range of fetal penile length, which, in addition to ultrasonography, may be helpful in the identification of genital anomalies. Outer penile length on MRI is equivalent to penile length measured on ultrasound, whereas total length is significantly greater.
Assuntos
Doenças dos Genitais Masculinos/diagnóstico , Imageamento por Ressonância Magnética , Pênis/crescimento & desenvolvimento , Diagnóstico Pré-Natal/métodos , Biometria , Feminino , Doenças dos Genitais Masculinos/diagnóstico por imagem , Doenças dos Genitais Masculinos/embriologia , Idade Gestacional , Humanos , Masculino , Pênis/diagnóstico por imagem , Pênis/embriologia , Gravidez , Reprodutibilidade dos Testes , Estudos Retrospectivos , Análise para Determinação do Sexo/métodos , Ultrassonografia Pré-NatalRESUMO
OBJECTIVE: In view of the increasing use of fetal magnetic resonance imaging (MRI) as an adjunct to prenatal ultrasonography, we sought to demonstrate the visualization of upper extremity abnormalities and associated defects on MRI, with regard to fetal outcomes and compared with ultrasound imaging. METHODS: This retrospective study included 29 fetuses with upper extremity abnormalities visualized with fetal MRI following suspicious ultrasound findings and confirmed by postnatal assessment or autopsy. On a 1.5-Tesla unit, dedicated sequences were applied to image the extremities. Central nervous system (CNS) and extra-CNS anomalies were assessed to define extremity abnormalities as isolated or as complex, with associated defects. Fetal outcome was identified from medical records. MRI and ultrasound findings, when available, were compared. RESULTS: Isolated upper extremity abnormalities were found in three (10.3%) fetuses. In 26 (89.7%) fetuses complex abnormalities, including postural extremity disorders (21/26) and structural extremity abnormalities (15/26), were demonstrated. Associated defects involved: face (15/26); musculoskeletal system (14/26); thorax and cardio/pulmonary system (12/26); lower extremities (12/26); brain and skull (10/26); and abdomen (8/26). Of the 29 cases, 18 (62.1%) pregnancies were delivered and 11 (37.9%) were terminated. MRI and US findings were compared in 27/29 cases: the diagnosis was concordant in 14 (51.9%) of these cases, and additional findings were made on MRI in 13/27 (48.1%) cases. CONCLUSIONS: Visualization of upper extremity abnormalities on fetal MRI enables differentiation between isolated defects and complex ones, which may be related to poor fetal prognosis. MRI generally confirms the ultrasound diagnosis, and may provide additional findings in certain cases.
Assuntos
Anormalidades Múltiplas/diagnóstico , Imageamento por Ressonância Magnética , Diagnóstico Pré-Natal , Extremidade Superior/patologia , Anormalidades Múltiplas/embriologia , Anormalidades Múltiplas/patologia , Adolescente , Adulto , Biometria , Feminino , Humanos , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Extremidade Superior/embriologia , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: Although "corpus callosum agenesis" is an umbrella term for multiple entities, prenatal counseling is based reductively on the presence (associated) or absence (isolated) of additional abnormalities. Our aim was to test the applicability of a fetal MR neuroimaging score in a cohort of fetuses with prenatally diagnosed isolated corpus callosum agenesis and associated corpus callosum agenesis and correlate it with neurodevelopmental outcomes. MATERIALS AND METHODS: We performed a single-center retrospective analysis of a cohort of cases of consecutive corpus callosum agenesis collected between January 2011 and July 2019. Cases were scored by 2 raters, and interater agreement was calculated. Outcome was assessed by standardized testing (Bayley Scales of Infant and Toddler Development, Kaufman Assessment Battery for Children) or a structured telephone interview and correlated with scores using 2-way ANOVA. RESULTS: We included 137 cases (74 cases of isolated corpus callosum agenesis), imaged at a mean of 27 gestational weeks. Interrater agreement was excellent (0.98). Scores were higher in associated corpus callosum agenesis (P < .0001) without a significant score difference between complete and partial corpus callosum agenesis (P = .38). Outcome was assessed in 42 children with isolated corpus callosum agenesis and 9 with associated corpus callosum agenesis (mean age, 3.1 years). MR imaging scores correctly predicted developmental outcome in 90.7% of patients with isolated corpus callosum agenesis, improving neurodevelopmental risk stratification in corpus callosum agenesis. CONCLUSIONS: The scoring system is very reproducible and can differentiate isolated corpus callosum agenesis and associated isolated corpus callosum agenesis (significantly higher scores) but not between partial and complete corpus callosum agenesis. Scores correlated with outcome in isolated corpus callosum agenesis, but there were too few associated postnatal cases of isolated corpus callosum agenesis to draw conclusions in this group.
Assuntos
Agenesia do Corpo Caloso , Agenesia do Corpo Caloso/diagnóstico por imagem , Corpo Caloso/diagnóstico por imagem , Feminino , Feto , Humanos , Imageamento por Ressonância Magnética , Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-NatalRESUMO
BACKGROUND AND PURPOSE: On the basis of a single multidynamic multiecho sequence acquisition, SyMRI generates a variety of quantitative image data that can characterize tissue-specific properties. The aim of this retrospective study was to evaluate the feasibility of SyMRI for the qualitative and quantitative assessment of fetal brain maturation. MATERIALS AND METHODS: In 52 fetuses, multidynamic multiecho sequence acquisitions were available. SyMRI was used to perform multidynamic multiecho-based postprocessing. Fetal brain maturity was scored qualitatively on the basis of SyMRI-generated MR imaging data. The results were compared with conventionally acquired T1-weighted/T2-weighted contrasts as a standard of reference. Myelin-related changes in T1-/T2-relaxation time/relaxation rate, proton density, and MR imaging signal intensity of the developing fetal brain stem were measured. A Pearson correlation analysis was used to detect correlations between the following: 1) the gestational age at MR imaging and the fetal brain maturity score, and 2) the gestational age at MR imaging and the quantitative measurements. RESULTS: SyMRI provided images of sufficient quality in 12/52 (23.08%) (range, 23 + 6-34 + 0) fetal multidynamic multiecho sequence acquisitions. The fetal brain maturity score positively correlated with gestational age at MR imaging (SyMRI: r = 0.915, P < .001/standard of reference: r = 0.966, P < .001). Myelination-related changes in the T2 relaxation time/T2 relaxation rate of the medulla oblongata significantly correlated with gestational age at MR imaging (T2-relaxation time: r = -0.739, P = .006/T2-relaxation rate: r = 0.790, P = .002). CONCLUSIONS: Fetal motion limits the applicability of multidynamic multiecho-based postprocessing. However, SyMRI-generated image data of sufficient quality enable the qualitative assessment of maturity-related changes of the fetal brain. In addition, quantitative T2 relaxation time/T2 relaxation rate mapping characterizes myelin-related changes of the brain stem prenatally. This approach, if successful, opens novel possibilities for the evaluation of structural and biochemical aspects of fetal brain maturation.
Assuntos
Encéfalo , Imageamento por Ressonância Magnética , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Meios de Contraste , Humanos , Estudos RetrospectivosRESUMO
Prophylactic anti-D is a very safe and effective therapy for the suppression of anti-D immunization and thus prevention of haemolytic disease of the foetus and newborn. However, migration from countries with low health standards and substantial cuts in public health expenses have increased the incidence of anti-D immunization in many "developed" countries. Therefore, this forum focuses on prenatal monitoring standards and treatment strategies in pregnancies with anti-D alloimmunization. The following questions were addressed, and a response was obtained from 12 centres, mainly from Europe.
Assuntos
Antígenos de Grupos Sanguíneos/imunologia , Isoanticorpos/administração & dosagem , Complicações Hematológicas na Gravidez/terapia , Isoimunização Rh/terapia , Sistema do Grupo Sanguíneo Rh-Hr/imunologia , Feminino , Sangue Fetal/imunologia , Hemoglobina Fetal/análise , Humanos , Isoanticorpos/sangue , Isoanticorpos/imunologia , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/imunologia , Complicações Hematológicas na Gravidez/prevenção & controle , Isoimunização Rh/imunologia , Isoimunização Rh/prevenção & controle , Imunoglobulina rho(D)RESUMO
The purpose of this prospective study was to investigate whether the antenatal characterization of fetal facial clefts can be improved by three-dimensional ultrasonographic visualization of fetal tooth buds. Between January 1996 and June 1998, seventeen consecutive fetuses with facial clefts were examined for fetal maxillary tooth buds in the cleft area using three-dimensional multiplanar reconstruction. It was possible in all cases to classify the clefts either as cleft lip alone or unilateral cleft lip and palate or bilateral cleft lip and palate. Three-dimensional computed tomography and histological jaw sections of three stillborn infants were produced in order to examine the correlation between the sonographic, radiographical and histological findings. The prenatal characterization of the facial clefts by means of a visualization of the tooth buds showed to be accurate postnatally in all cases. The sonographic proof of tooth buds might gain increasing importance as this technique seems to facilitate and improve the prenatal classification of suspected facial clefts.
Assuntos
Anormalidades Craniofaciais/embriologia , Dente/embriologia , Ultrassonografia Pré-Natal/métodos , Adulto , Fenda Labial/diagnóstico por imagem , Fenda Labial/embriologia , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/embriologia , Anormalidades Craniofaciais/diagnóstico por imagem , Feminino , Idade Gestacional , Humanos , Maxila/embriologia , Maxila/patologia , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Dente/diagnóstico por imagemRESUMO
In order to investigate a presumed association of certain anamnestic data with Chlamydia trachomatis infection of infertile women, appropriate specimens were examined from 100 patients of an infertility clinic. PCR and nucleic acid hybridization were positive in 5% of the patients, corresponding in both tests; IgG was found in 31% and IgA in 5% of patients. The prevalence was highest in the age-group of 26-35 years (21 of 55) and higher in patients who had been trying to conceive for > 2 years (12 of 37) as than those trying < or = 2 years (3 of 13). The proportion of IgG-positive women was significantly (p = 0.03) smaller in Turkish patients (3 of 22) than in those of other origin (11 of 33 from former Yugoslavia and 15 of 39 Austrian women). The prevalence was higher in patients with reported pelvic inflammatory disease (11 of 30) as compared to patients without (15 of 50). With a pathological state of the Fallopian tubes the prevalence was 12 of 25, with normal tubes 6 of 18 (p > 0.05). Thus, there seem to exist anamnestic hints as to chlamydial infections. Because of their high prevalence in patients with sterility we recommend screening for chlamydial infection prior to undertaking any invasive diagnostic procedure of the Fallopian tubes.
Assuntos
Infecções por Chlamydia/complicações , Chlamydia trachomatis , Infertilidade Feminina/etiologia , Doença Inflamatória Pélvica/complicações , Cervicite Uterina/complicações , Adolescente , Adulto , Áustria/epidemiologia , Infecções por Chlamydia/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Infertilidade Feminina/epidemiologia , Pessoa de Meia-Idade , Doença Inflamatória Pélvica/epidemiologia , Cervicite Uterina/epidemiologiaRESUMO
The complication of a break of the surgical needle during the suture of an episiotomy and the disappearance of the fragment in the perineal tissue has not been dealt with in the available literature. From our own material, a frequency of 0.17/1000 (n = 22,374) can be calculated. For the authors, the best method of coping with this complication is the removal of the needle fragment under a portable digital imaging system with two needleholders according to Bozemann.
Assuntos
Episiotomia/instrumentação , Migração de Corpo Estranho/cirurgia , Complicações Intraoperatórias/cirurgia , Agulhas , Períneo/cirurgia , Técnicas de Sutura/instrumentação , Adulto , Falha de Equipamento , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Períneo/diagnóstico por imagem , Gravidez , RadiografiaAssuntos
Patógenos Transmitidos pelo Sangue , Extração Obstétrica , Infecções por HIV/prevenção & controle , Hepatite B/prevenção & controle , Hepatite C/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente , Complicações Infecciosas na Gravidez/prevenção & controle , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Transmissão de Doença Infecciosa , Feminino , Infecções por HIV/transmissão , Hepatite B/transmissão , Hepatite C/transmissão , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Gravidez , Complicações Infecciosas na Gravidez/etiologia , Fatores de Risco , Precauções UniversaisRESUMO
Vulvar hematomas, resulting from obstetric traumata represent a rare complication. The author describes a respective case and gives a survey on literature regarding vulvar hematomas. The advantages and disadvantages of conservative and surgical treatment are discussed.
Assuntos
Hematoma/terapia , Transtornos Puerperais/terapia , Vulva/lesões , Adulto , Terapia Combinada , Feminino , Hematoma/diagnóstico por imagem , Humanos , Transtornos Puerperais/diagnóstico por imagem , Ultrassonografia , Vulva/diagnóstico por imagemRESUMO
Cigarette smoking exerts a carcinogenous effect in various organs, either by direct contact or by distant nocivity. The authors present a survey of literature dealing with the effect of cigarette smoking on the female genital tract. The respective data show clearly that cigarette smoking may induce carcinoma of the cervix, whereas no significant correlation between cigarette smoking and carcinoma of the uterus can be established. Epidemiologic, etiologic and pathogenetic aspects of cigarette smoking and its influence on the genital tract are presented and discussed.
Assuntos
Fumar/efeitos adversos , Neoplasias do Colo do Útero/etiologia , Neoplasias Uterinas/etiologia , Áustria/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Estadiamento de Neoplasias , Fumar/epidemiologia , Fumar/patologia , Abandono do Hábito de Fumar , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/patologiaRESUMO
OBJECTIVE: The aim of our study was to determine the significance of antenatally detected hyperechogenic foci in the fetal heart. DESIGN: Prospective study. SUBJECTS AND METHODS: During a 21-month period, 6995 women underwent a sonographic screening investigation. A detailed structural survey was performed on each fetus according to our sonography protocol, including a four-chamber view and an evaluation of the great vessels, as permitted by gestational age. We prospectively identified each fetus with an echogenic intracardiac focus. RESULTS: A total of 150 fetuses with this sonographic finding were identified. The incidence rate was 2.15%. In 114 patients (76%), prenatal karyotyping was performed. The aneuploidy rate was 4.4%. CONCLUSIONS: The echogenic intracardiac focus can be easily diagnosed in most cases. This should prompt an extensive search for other 'soft' markers. The presence of an echogenic intracardiac focus as a single soft marker should raise the question of prenatal karyotyping. It might help in the decision-making regarding invasive prenatal testing in cases with an otherwise low risk for chromosomal abnormality. In cases with other markers for chromosomal abnormality (advanced maternal age, sonographic signs, positive serum marker screening), the presence of an echogenic intracardiac focus should be an additional incentive for a chromosomal examination.
Assuntos
Aberrações Cromossômicas/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Coração Fetal/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adolescente , Adulto , Aneuploidia , Aberrações Cromossômicas/epidemiologia , Aberrações Cromossômicas/genética , Transtornos Cromossômicos , Feminino , Doenças Fetais/epidemiologia , Doenças Fetais/genética , Idade Gestacional , Humanos , Incidência , Cariotipagem , Idade Materna , Gravidez , Estudos ProspectivosRESUMO
We report on a rare in utero appearance of the rupture of the fetal bladder caused by low urinary tract obstruction with subsequent urinary ascites. The findings on prenatal sonography, postnatal X-ray examinations and postnatal surgical treatment are described and the literature is reviewed.
Assuntos
Ascite/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Uretra/anormalidades , Obstrução Uretral/diagnóstico por imagem , Doenças da Bexiga Urinária/diagnóstico por imagem , Adulto , Ascite/etiologia , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Gravidez , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Uretra/diagnóstico por imagem , Obstrução Uretral/complicações , Obstrução Uretral/cirurgia , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/cirurgiaRESUMO
A 31-year-old Caucasian women was referred to our department after IUGR was suspected by her gynaecologist at 29 weeks' amenorrhea in her second pregnancy. Multiple anomalies were detected by prenatal ultrasound in the 29th week of gestation. Chordocentesis was performed and revealed a Trisomy 22 in all fetal blood cells. The pregnancy was terminated. Post-mortem investigations excluded chromosomal mosaicism. Prenatal ultrasound findings and post-mortem features are presented.
Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Cromossomos Humanos Par 22 , Retardo do Crescimento Fetal/diagnóstico por imagem , Trissomia , Ultrassonografia Pré-Natal , Anormalidades Múltiplas/genética , Anormalidades Múltiplas/patologia , Aborto Eugênico , Adulto , Feminino , Feto/patologia , Humanos , Recém-Nascido , Mosaicismo , Gravidez , Terceiro Trimestre da GravidezRESUMO
In a prospective, randomized study, Bartholin's cysts were depicted in 36 patients by means of ultrasound imaging. Patients were requested to return for a follow-up US examination after surgery. We were able to show that Bartholin's cysts can easily be expressed with ultrasonographic techniques. In clinical practice, this approach may not only help to improve diagnostics, but may also make therapy measurable and, for the first time, objectifiable.