RESUMO
Ultrasound has become an essential diagnostic tool in gynecology, and every practicing gynecologist must be able to differentiate normal from pathologic findings, such as benign or malignant pelvic masses, adnexal torsion, pelvic inflammation disease, endometriosis, ectopic pregnancies, and congenital uterine malformations at least on a basic level. A standardized approach to the correct settings of the ultrasound system, the indications for gynecologic ultrasound investigations, and the sonographic appearance of normal anatomy and common pathologic findings in the standard planes are important prerequisites for safe and confident clinical management of gynecologic patients. Based on current publications and different national and international guidelines, updated DEGUM, ÖGUM, and SGUM recommendations for the performance of basic gynecologic ultrasound examinations were established.
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Doenças dos Anexos , Ginecologia , Gravidez , Humanos , Feminino , Ultrassonografia , Doenças dos Anexos/diagnóstico por imagemRESUMO
This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for standardization to implement the ultrasound evaluation in labor ward and improve the clinical management of labor. Ultrasound in labor can be performed using a transabdominal or a transperineal approach depending upon which parameters are being assessed. During transabdominal imaging, fetal anatomy, presentation, liquor volume, and placental localization can be determined. The transperineal images depict images of the fetal head in which calculations to determine a proposed fetal head station can be made.
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Parto Obstétrico , Apresentação no Trabalho de Parto , Parto Obstétrico/métodos , Feminino , Cabeça/diagnóstico por imagem , Humanos , Placenta , Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal/métodosRESUMO
Gynecological sonography is the central and most frequently used technical examination method used by gynecologists. Its focus is on the clarification of masses of the uterus and the adnexa, fertility diagnosis, clarification of bleeding disorders and chronic and acute pelvic problems, pelvic floor and incontinence diagnosis as well as the differential diagnosis of disturbed early pregnancy. The indication for diagnostic and therapeutic interventions, preoperative planning and postoperative controls are largely based on the findings of gynecological sonography. These examinations are particularly dependent on the experience of the examiner.Based on the proven multi-stage concept of obstetric diagnostics, gynecological sonography should primarily be performed by an experienced and specialized examiner in patients for whom the initial gynecological examinations have not yet led to a sufficient assessment of the findings. So that the expert status required for this has an objective basis, the Gynecology and Obstetrics Section of DEGUM in cooperation with ÖGUM and SGUM implemented the option of acquiring DEGUM Level II for gynecological sonography. The effectiveness of the care in the multi-level concept depends on the quality of the ultrasound examination at level I. Quality requirements for the basic examination and the differentiation between the basic and further examination have therefore already been defined by DEGUM/ÖGUM. The present work is intended to set out quality requirements for gynecological sonography of DEGUM level II and for the correspondingly certified gynecologists.Common pathologies from gynecological sonography and requirements for imaging and documentation are described.
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Ginecologia , Obstetrícia , Feminino , Exame Ginecológico , Humanos , Gravidez , Ultrassonografia/métodosRESUMO
Ogden syndrome is a rare lethal X-linked recessive disorder caused by a recurrent missense variant (Ser37Pro) in the NAA10 gene, encoding the catalytic subunit of the N-terminal acetyltransferase A complex (NatA). So far eight boys of two different families have been described in the literature, all presenting the distinctive and recognizable phenotype, which includes mostly postnatal growth retardation, global severe developmental delay, characteristic craniofacial features, and structural cardiac anomalies and/or arrhythmias. Here, we report the ninth case of Ogden syndrome with an independent recurrence of the Ser37Pro variant. We were able to follow the clinical course of the affected boy and delineate the evolving phenotype from his birth until his unfortunate death at 7 months. We could confirm the associated phenotype as well as the natural history of this severe disease. By describing new presenting features, we are further expanding the clinical spectrum associated with Ogden syndrome and review other phenotypes associated with NAA10 variants.
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Estudos de Associação Genética , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico , Doenças Genéticas Ligadas ao Cromossomo X/genética , Predisposição Genética para Doença , Mutação , Acetiltransferase N-Terminal A/genética , Acetiltransferase N-Terminal E/genética , Adulto , Análise Mutacional de DNA , Eletroencefalografia , Feminino , Genótipo , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Fenótipo , Gravidez , Diagnóstico Pré-Natal , Radiografia , SíndromeRESUMO
BACKGROUND: Operative vaginal delivery and, in particular, rotational forceps delivery require extensive training, specific skills, and dexterity. Performed correctly, it can reduce the need for difficult late second-stage cesarean delivery and its associated complications. When rotation to occiput anterior position is achieved, pelvic trauma and anal sphincter injury commonly associated with direct delivery from occiput posterior positions may be avoided. OBJECTIVE: We report the original and novel use of real-time intrapartum ultrasound simultaneously during Kielland's rotational forceps delivery to monitor correct execution and increase maternal safety. STUDY DESIGN: This is a prospective observational study performed at the Charité University Hospital in Berlin between 2013 and 2018. Simultaneous, real-time, intrapartum suprapubic ultrasound during Kielland's rotational forceps deliveries were performed in a series of laboring women with normal fetuses and arrest of labor in the late second stage and with a fetal head malposition, requiring operative vaginal delivery. In addition to vaginal palpation for head station, rotation, and asynclitism, intrapartum ultrasound was also used to objectively determine head station, head direction, and midline angle. The operator was not blinded to the ultrasound findings. The delivering obstetrician examined the woman and performed the delivery. An assistant, trained in intrapartum ultrasound, placed a curved-array transducer transversely in the midline just above the pubic bone to display the forceps blades being applied and the rotation of the fetal head in occiput anterior position. RESULTS: In all 32 laboring women included in the study, the blades were applied correctly and the fetal heads successfully rotated to an occiput anterior position with direct ultrasound confirmation, and vaginal delivery was achieved. There were no cases of difficult application, repeat application, slippage of the blades, or rotation of the fetal head in the wrong direction. Maternal outcomes showed no vaginal tears, cervical tears, or postpartum hemorrhage >500 mL. There was 1 case of third-degree perineal tear (3a). Neonatal outcomes included mild hyperbilirubinemia (n=1), small cephalohematoma conservatively managed (n=1), and early-onset group B streptococcus sepsis secondary to maternal colonization (n=1). There were no neonatal deaths. CONCLUSIONS: Ultrasound guidance during Kielland's rotational forceps delivery is an original and novel approach. We describe the use of intrapartum ultrasound in assessing fetal head station and position and also to simultaneously and objectively monitor performance of rotational forceps delivery. Intrapartum ultrasound enhances operator confidence and, possibly, patient safety. It is a valuable adjunct to obstetrical training and can improve learning efficiency. Real-time ultrasound guidance of fetal head rotation to occiput anterior position with Kielland's forceps may also protect the perineum and reduce anal sphincter injury. This novel approach can lead to a renaissance in the safe use of Kielland's forceps.
Assuntos
Extração Obstétrica , Complicações do Trabalho de Parto , Forceps Obstétrico , Ultrassonografia Pré-Natal , Adolescente , Adulto , Extração Obstétrica/educação , Feminino , Humanos , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Adulto JovemRESUMO
INTRODUCTION: In cases of placenta accreta spectrum, a precise antenatal diagnosis of the suspected degree of invasion is essential for the planning of individual management strategies at delivery. The aim of this work was to evaluate the respective performances of ultrasonography and magnetic resonance imaging for the antenatal assessment of the severity of placenta accreta spectrum disorders included in the database. The secondary objective was to identify descriptors related to the severity of placenta accreta spectrum disorders. MATERIAL AND METHODS: All the cases included in the database for which antenatal imaging data were available were analyzed. The rates of occurrence of each ultrasound and magnetic resonance imaging descriptor were reported and compared between the Group "Accreta-Increta" (FIGO grades 1 & 2) and the Group "Percreta" (FIGO grade 3). RESULTS: Antenatal imaging data were available for 347 women (347/442, 78.5%), of which 105 were included in the Group "Accreta - Increta" (105/347, 30.2%) and 213 (213/347, 61.4%) in the Group "Percreta". Magnetic resonance imaging was performed in addition to ultrasound in 135 women (135/347, 38.9%). After adjustment for all ultrasound descriptors in multivariate analysis, only the presence of a bladder wall interruption was associated with a significant higher risk of percreta (Odds ratio 3.23, Confidence interval 1.33-7.79). No magnetic resonance imaging sign was significantly correlated with the degree of severity. CONCLUSIONS: The performance of ultrasound and magnetic resonance imaging to discriminate mild from severe placenta accreta spectrum disorders is very poor. To date, the benefit of additional magnetic resonance imaging has not been demonstrated.
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Imageamento por Ressonância Magnética/normas , Placenta Acreta/classificação , Placenta Acreta/diagnóstico por imagem , Diagnóstico Pré-Natal/métodos , Índice de Gravidade de Doença , Ultrassonografia Pré-Natal/normas , Estudos de Coortes , Bases de Dados Factuais , Europa (Continente) , Feminino , Humanos , Gravidez , Sensibilidade e Especificidade , Estados UnidosRESUMO
The worldwide incidence of abnormally invasive placenta is rapidly rising, following the trend of increasing cesarean delivery. It is a heterogeneous condition and has a high maternal morbidity and mortality rate, presenting specific intrapartum challenges. Its rarity makes developing individual expertise difficult for the majority of clinicians. The International Society for Abnormally Invasive Placenta aims to improve clinicians' understanding and skills in managing this difficult condition. By pooling knowledge, experience, and expertise gained within a variety of different healthcare systems, the Society seeks to improve the outcomes for women with abnormally invasive placenta globally. The recommendations presented herewith were reached using a modified Delphi technique and are based on the best available evidence. The evidence base for each is presented using a formal grading system. The topics chosen address the most pertinent questions regarding intrapartum management of abnormally invasive placenta with respect to clinically relevant outcomes, including the following: definition of a center of excellence; requirement for antenatal hospitalization; antenatal optimization of hemoglobin; gestational age for delivery; antenatal corticosteroid administration; use of preoperative cystoscopy, ureteric stents, and prophylactic pelvic arterial balloon catheters; maternal position for surgery; type of skin incision; position of the uterine incision; use of interoperative ultrasound; prophylactic administration of oxytocin; optimal method for intraoperative diagnosis; use of expectant management; adjuvant therapies for expectant management; use of local surgical resection; type of hysterectomy; use of delayed hysterectomy; intraoperative measures to treat life-threatening hemorrhage; and fertility after conservative management.
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Cesárea , Histerectomia , Placenta Acreta/terapia , Hemorragia Pós-Parto/prevenção & controle , Corticosteroides/uso terapêutico , Tratamento Conservador , Técnica Delphi , Gerenciamento Clínico , Feminino , Idade Gestacional , Hospitalização , Humanos , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Posicionamento do Paciente , Hemorragia Pós-Parto/terapia , Gravidez , Stents , Ureter , Conduta ExpectanteRESUMO
INTRODUCTION: The primary aim of this study was to ascertain the prevalence of the individual conditions and of associated anomalies in fetuses with the prenatal diagnosis of enlarged posterior fossa (PF) and to explore the diagnostic accuracy of ultrasound in these anomalies. The secondary aim was to evaluate the postnatal outcome of children affected by PF anomalies. MATERIAL AND METHODS: All fetuses with enlarged PF detected by prenatal sonography at a referral center from 2001 to 2015 were analyzed retrospectively. Some were also studied by fetal magnetic resonance imaging (MRI) or volume ultrasound examinations. Fetal sonographic and MRI were compared using following classification: Dandy-Walker malformation (DWM); megacisterna magna (MCM); Blake's pouch cyst; isolated vermian hypoplasia; vermian agenesis; PF arachnoid cyst (AC); and cerebellar hypoplasia (CH). RESULTS: The ultrasound diagnoses of the 69 fetuses were as follows: MCM (n = 29; of these isolated n = 15), DWM (n = 28, isolated n = 4), vermian hypoplasia (n = 5, isolated n = 4), Blake's pouch cyst (n = 4, isolated n = 1), CH (n = 2; none isolated) and AC in the PF (n = 1, isolated). Thirteen of the 41 karyotyped fetuses were aneuploid, including seven with DWM. Associated malformations were found in 37/69 cases. There were 39 live births, including 11 with confirmed DWM, six of whom show a normal development. Twelve infants with isolated MCM show normal development. There were eight false-positive prenatal diagnoses (or resolution until birth) of "enlarged PF": three with Blake's pouch cyst, two with MCM and one with vermian hypoplasia. CONCLUSIONS: An enlarged PF requires specific diagnoses for the best possible counseling. The term "Dandy-Walker variant" should not be used anymore. Isolated MCM and Blake's pouch cyst can either resolve or be normal variants, but may also indicate the presence of a more severe anomaly or associated malformations.
Assuntos
Cistos Aracnóideos/epidemiologia , Fossa Craniana Posterior/diagnóstico por imagem , Síndrome de Dandy-Walker/epidemiologia , Diagnóstico Pré-Natal , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/embriologia , Fossa Craniana Posterior/anormalidades , Fossa Craniana Posterior/embriologia , Síndrome de Dandy-Walker/diagnóstico por imagem , Síndrome de Dandy-Walker/embriologia , Diagnóstico Diferencial , Feminino , Idade Gestacional , Humanos , Imageamento por Ressonância Magnética , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Suíça/epidemiologiaRESUMO
AIMS: This study aimed to assess the feasibility and accuracy of nongated four-dimensional echocardiography (4DE) for determining left ventricular (LV) stroke volume (SV) and mass in a fetal heart-sized LV model. METHODS: A balloon was inserted into the LV of 20 fresh rabbit hearts and attached to a calibrated pulsatile pump. Ten hearts retaining the right ventricle were imaged in Group A. Ten hearts without the right ventricles (RVs) attached were imaged in Group B. Nongated 4D volumes were obtained using a Philips iU-22 system with an X6-1 matrix probe at SVs ranging from 1 to 5 mL at increments of 1 mL. At each SV, the volume displacement of the heart was measured at end-systole and end-diastole. Mass was determined by displacement at the conclusion of the experiment. RESULTS: The images were analyzed offline by manually tracing endocardial and epicardial boundaries of stacked contours. An excellent correlation in SV and mass between echo-derived values and displacement values was demonstrated and accompanied by high coefficients of determination (R2 ) in both groups (SV: Group A: R2 = 0.9461, Group B: R2 = 0.9811; Mass: Group A: R2 = 0.9223, Group B: R2 = 0.9602; all P < 0.001). Bland-Altman analyses showed a slight overestimation in both groups for both SV and LV mass. CONCLUSIONS: Nongated 4DE was demonstrated to be feasible and that it could accurately define SV and ventricular mass for a fetal heart-sized LV model.
Assuntos
Ecocardiografia Quadridimensional/métodos , Coração Fetal/diagnóstico por imagem , Ventrículos do Coração/anatomia & histologia , Ventrículos do Coração/diagnóstico por imagem , Volume Sistólico/fisiologia , Animais , Estudos de Viabilidade , Processamento de Imagem Assistida por Computador/métodos , Modelos Animais , Tamanho do Órgão , Coelhos , Reprodutibilidade dos TestesAssuntos
Biometria , Feto , Peso Fetal , Idade Gestacional , Humanos , Valores de Referência , Ultrassonografia Pré-NatalRESUMO
OBJECTIVE: Abnormally invasive placenta (AIP) poses diagnostic and therapeutic challenges. We analyzed clinical cases with confirmed placenta increta or percreta. DESIGN: Retrospective case series. SETTING: Multicenter study. POPULATION: Pregnant women with AIP. METHODS: Chart review. MAIN OUTCOME MEASURES: Prenatal detection rates, treatment choices, morbidity, mortality and short-term outcome. RESULTS: Sixty-six cases were analyzed. All women and all but three fetuses survived; 57/64 women (89%) had previous uterine surgery. In 26 women (39%) the diagnosis was not known before delivery (Group 1), in the remaining 40 (61%) diagnosis had been made between 14 and 37 weeks of gestation (Group 2). Placenta previa was present in 36 women (54%). In Groups 1 and 2, 50% (13/26) and 62% (25/40) of the women required hysterectomy, respectively. In Group 1 (unknown at the time of delivery) 69% (9/13) required (emergency) hysterectomy for severe hemorrhage in the immediate peripartum period compared with only 12% (3/25) in Group 2 (p = 0.0004). Mass transfusions were more frequently required in Group 1 (46%, 12/26 vs. 20%, 8/40; p = 0.025). In 18/40 women (45%) from Group 2 the placenta was intentionally left in situ; secondary hysterectomies and infections were equally frequent (18%) among these differently treated women. Overall, postpartum infections occurred in 11% and 20% of women in Groups 1 and 2, respectively. CONCLUSIONS: AIP was known before delivery in more than half of the cases. Unknown AIP led to significantly more emergency hysterectomies and mass transfusions during or immediately after delivery. Prenatal diagnosis of AIP reduces morbidity. Future studies should also address the selection criteria for cases appropriate for leaving the placenta in situ.
Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Placenta Acreta/diagnóstico por imagem , Placenta Prévia/diagnóstico por imagem , Hemorragia Pós-Parto/prevenção & controle , Diagnóstico Pré-Natal/estatística & dados numéricos , Ultrassonografia Pré-Natal/estatística & dados numéricos , Adulto , Bélgica/epidemiologia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Comorbidade , Feminino , Humanos , Período Periparto , Placenta Acreta/epidemiologia , Placenta Acreta/terapia , Placenta Prévia/epidemiologia , Placenta Prévia/terapia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/terapia , Gravidez , Cuidado Pré-Natal/métodos , Medição de Risco , Adulto JovemRESUMO
OBJECTIVE: Uterine anomalies (UA) occur in up to 6.7% of women. Breech is eight times more likely to occur with UA which may not be diagnosed prior to pregnancy and may only be found in the third trimester with breech. The objective of the study is to assess the prevalence of both already known and newly sonographically diagnosed UA in breech from 36 weeks of gestation and its impact on external cephalic version (ECV), delivery options and perinatal outcomes. STUDY DESIGN: We recruited 469 women with breech at 36 weeks of gestation over a 2-year period at the Charité University Hospital, Berlin. Ultrasound examination was performed to rule out UA. Patients with known and newly 'de novo' diagnosed anomalies were identified and delivery options and perinatal outcomes analyzed. RESULTS: The 'de novo' diagnosis of UA at 36-37 weeks of pregnancy with breech was found to be significantly higher compared to the diagnosis prior to pregnancy with 4.5% vs 1.5% (p < 0.001 and odds ratio 4 with 95% confidence interval 2.12-7.69). Anomalies found included 53.6% bicornis unicollis, 39.3% subseptus, 3.6% unicornis and 3.6% didelphys. A trial of vaginal breech delivery was successful in 55.5% of cases when attempted. There were no successful ECVs. CONCLUSION: Breech is a marker for uterine malformation. Diagnosis of UA with breech can be up to four times improved with focused ultrasound screening in pregnancy even from 36 weeks of gestation prior to ECV to identify missed anomalies. Timely diagnosis aids antenatal care and delivery planning. Importantly, definitive diagnosis and treatment can be planned postpartum to improve outcomes in future pregnancies. ECV plays a limited role in selected cases.
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Apresentação Pélvica , Anormalidades Urogenitais , Versão Fetal , Gravidez , Feminino , Humanos , Apresentação Pélvica/diagnóstico por imagem , Apresentação Pélvica/epidemiologia , Apresentação Pélvica/terapia , Parto ObstétricoRESUMO
POLA1 encodes a subunit of the DNA polymerase alpha, a key enzyme for the initiation of DNA synthesis. In males, hemizygous hypomorphic variants in POLA1 have been identified as the cause of X-linked pigmentary reticulate disorder (XLPDR) and a novel X-linked neurodevelopmental disorder termed Van Esch-O'Driscoll syndrome (VEODS), while female carriers have been reported to be healthy. Nullisomy for POLA1 was speculated to be lethal due to its crucial function, while the effect of loss of one allele in females remained unknown. Here, we report on a three-generation family harboring a deletion of POLA1 in females showing subfertility as the only phenotype. Our findings show that heterozygous deletions or truncating variants in females with skewed X inactivation do not cause VEODS and support the hypothesis of very early embryonic lethality in males with POLA1 nullisomy.
Assuntos
Doenças Genéticas Ligadas ao Cromossomo X , Deficiência Intelectual , Masculino , Feminino , Humanos , DNA Polimerase I/genética , Doenças Genéticas Ligadas ao Cromossomo X/genética , Genes Ligados ao Cromossomo X , Heterozigoto , Deficiência Intelectual/genética , FertilidadeRESUMO
BACKGROUND: Commercial flow-cytometric methods for counting residual white blood cells (rWBCs) in leukoreduced blood products use calibration beads for estimation of the measured sample volume. A bead-free flow-rate calibration method is developed and validated. STUDY DESIGN AND METHODS: The analyzed volume was calculated by acquisition time (ACQ). Twenty-nine spiking series of red blood cell (RBC) or platelet (PLT) products were prepared containing levels ranging from 0.08 × 10(6) up to 2048 × 10(6) WBCs/L. Nearly WBC-free triple-leukofiltered RBCs or PLT concentrates (PCs) served as background. Propidium iodide (PI) was used to identify rWBCs. Five RBC series were compared against a commercially available kit (LeukoSure, Beckman Coulter). Routine capabilities were tested on 41 RBC and 92 PC samples of two independent transfusion services. RESULTS: The lower detection limit in RBC was 0.08 × 10(6) rWBCs/L for ACQ and 0.16 for LeukoSure. Criteria for linearity, accuracy, and precision were fulfilled within the range of 0.5 × 10(6) to 512 × 10(6) WBCs/L. For PCs, all these criteria were fulfilled between 0.5 × 10(6) and 32 × 10(6) rWBCs/L (lower detection limit of 0.25) for PI. ACQ and LeukoSure agreed sufficiently (81%) when tested on routine RBCs or PCs. CONCLUSION: A residual WBC count of fewer than 0.5 × 10(6) WBCs/L can be accurately counted using the ACQ approach at a total reagent cost of less than 0.5 per sample.
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Citometria de Fluxo/métodos , Contagem de Leucócitos/economia , Contagem de Leucócitos/métodos , Procedimentos de Redução de Leucócitos/métodos , Calibragem , Custos e Análise de Custo , Transfusão de Eritrócitos/normas , Citometria de Fluxo/economia , Humanos , Contagem de Leucócitos/instrumentação , Limite de Detecção , Plaquetoferese/normas , Controle de QualidadeRESUMO
PURPOSE: To evaluate diffusion-weighted magnetic resonance (MR) imaging of the human placenta in fetuses with and fetuses without intrauterine growth restriction (IUGR) who were suspected of having placental insufficiency. MATERIALS AND METHODS: The study was approved by the local ethics committee, and written informed consent was obtained. The authors retrospectively evaluated 1.5-T fetal MR images from 102 singleton pregnancies (mean gestation ± standard deviation, 29 weeks ± 5; range, 21-41 weeks). Morphologic and diffusion-weighted MR imaging were performed. A region of interest analysis of the apparent diffusion coefficient (ADC) of the placenta was independently performed by two observers who were blinded to clinical data and outcome. Placental insufficiency was diagnosed if flattening of the growth curve was detected at obstetric ultrasonography (US), if the birth weight was in the 10th percentile or less, or if fetal weight estimated with US was below the 10th percentile. Abnormal findings at Doppler US of the umbilical artery and histopathologic examination of specimens from the placenta were recorded. The ADCs in fetuses with placental insufficiency were compared with those in fetuses of the same gestational age without placental insufficiency and tested for normal distribution. The t tests and Pearson correlation coefficients were used to compare these results at 5% levels of significance. RESULTS: Thirty-three of the 102 pregnancies were ultimately categorized as having an insufficient placenta. MR imaging depicted morphologic changes (eg, infarction or bleeding) in 27 fetuses. Placental dysfunction was suspected in 33 fetuses at diffusion-weighted imaging (mean ADC, 146.4 sec/mm(2) ± 10.63 for fetuses with placental insufficiency vs 177.1 sec/mm(2) ± 18.90 for fetuses without placental insufficiency; P < .01, with one false-positive case). The use of diffusion-weighted imaging in addition to US increased sensitivity for the detection of placental insufficiency from 73% to 100%, increased accuracy from 91% to 99%, and preserved specificity at 99%. CONCLUSION: Placental dysfunction associated with growth restriction is associated with restricted diffusion and reduced ADC. A decreased ADC used as an early marker of placental damage might be indicative of pregnancy complications such as IUGR. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10092283/-/DC1.
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Imagem de Difusão por Ressonância Magnética/métodos , Insuficiência Placentária/diagnóstico , Adulto , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Estatísticas não Paramétricas , Ultrassonografia Pré-NatalRESUMO
BACKGROUND: Different therapeutic approaches have been used in fetal-neonatal alloimmune thrombocytopenia, but many centers administer immunoglobulin G infusions to the pregnant woman. We studied the effect of maternal antenatal immunoglobulin infusions on fetal platelet counts in pregnancies with fetal alloimmune thrombocytopenia. DESIGN AND METHODS: We retrospectively analyzed the clinical courses of fetuses with fetal alloimmune thrombocytopenia whose mothers were treated with immunoglobulin G infusions in a single center between 1999 and 2005. In a center-specific protocol, weekly maternal immunoglobulin G infusions were given to 25 pregnant women with previously affected neonates and four women with strong platelet antibodies, but no previous history of fetal alloimmune thrombocytopenia; before each infusion diagnostic fetal blood sampling was performed to determine fetal platelet counts and immunoglobulin G levels. RESULTS: There were 30 fetuses with fetal alloimmune thrombocytopenia, confirmed by initial fetal blood sampling showing fetal platelet counts between 4×10(9)/L and 130×10(9)/L and antibody-coated fetal platelets using a glycoprotein specific assay. Despite weekly antenatal maternal immunoglobulin G infusions fetal platelet counts did not change significantly. Maternal and fetal immunoglobulin G levels, measured before every infusion, increased significantly with the number of maternal immunoglobulin G infusions. CONCLUSIONS: In this group of fetuses with fetal alloimmune thrombocytopenia no consistent increase of fetal platelets was achieved as a result of regular maternal immunoglobulin G infusions.
Assuntos
Imunoglobulina G/administração & dosagem , Imunoglobulinas Intravenosas/administração & dosagem , Fatores Imunológicos/administração & dosagem , Trombocitopenia Neonatal Aloimune/tratamento farmacológico , Adulto , Feminino , Humanos , Infusões Intravenosas , Contagem de Plaquetas , Gravidez , Estudos Retrospectivos , Trombocitopenia Neonatal Aloimune/sangueRESUMO
Three-dimensional (3D) ultrasound of the fetal heart is increasingly being used in prenatal diagnosis. While very detailed fetal cardiac studies can be performed using the various 3D ultrasound modalities, their utility for screening for fetal heart disease is yet to be proven. With the emergence of even newer technologies such as quantification techniques and two-dimensional matrix arrays, further improvements are imminent.
Assuntos
Ecocardiografia Tridimensional/tendências , Coração Fetal/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Ecocardiografia Tridimensional/métodos , Feminino , Coração Fetal/fisiologia , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/embriologia , Humanos , GravidezRESUMO
AIM: Postpartum haemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality. Studies have reported an increase in incidence of postpartum haemorrhage in recent years. Our goal was to investigate changes in the incidence of postpartum haemorrhage (PPH) and its risk factors in Switzerland from 1993 to 2014. METHODS: This population-based retrospective cohort study used data from the national Swiss Hospital in-patient database for obstetric and gynaecological hospital admissions - "Arbeitsgemeinschaft Schweizer Frauenkliniken" (ASF Statistik). All patients with deliveries between January 1993 and December 2014 were included. We used the database codes to identify patients with PPH, maternal factors, pregnancy-related and delivery-related factors. Significant changes in temporal trends were determined using Mantel-Haenszel test for trend. Multivariable logistic regression analyses were conducted to assess PPH and risk factors. RESULTS: Births complicated by PPH in Switzerland increased from 2.5% in 1993 to 4.5% in 2014 (p <0.001), paralleled by an increase in uterine atony. Failure to progress during the second stage of labour (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.5-1.6), oxytocin augmentation (OR 1.2, 95% CI 1.2-1.3), vacuum extraction (OR 1.1, 95% CI 1.1-1.2), and especially abnormally invasive placenta (OR 10.4, 95% CI 9.5-11.5) and placenta praevia (OR 4.9, 95% CI 432-5.6) were factors with the highest risk for postpartum haemorrhage. CONCLUSIONS: Postpartum haemorrhage is a relatively common and potentially dangerous obstetric complication with increasing incidence over the last two decades in Switzerland. Its increase over time has been paralleled by an increase in uterine atony.
Assuntos
Hemorragia Pós-Parto/epidemiologia , Resultado da Gravidez , Inércia Uterina , Adolescente , Adulto , Parto Obstétrico , Feminino , Humanos , Incidência , Gravidez , Estudos Retrospectivos , Fatores de Risco , Suíça/epidemiologiaRESUMO
OBJECTIVE: To investigate effects of betamethasone on fetal growth and neonatal outcomes in twins. METHODS: A retrospective cohort study was conducted of twins delivered at one center in Berlin, Germany, between 1993 and 2011. The betamethasone group included twin pregnancies with preterm labor, cervical shortening, preterm premature rupture of membranes, or vaginal bleeding, and exposure to betamethasone between 23(+5) and 33(+6) weeks. The control group included twin pregnancies with no betamethasone exposure matched for length at delivery. Fetal growth and neonatal anthropometric data were analyzed by twin-pair structure, dose, and gestational age (linear mixed model). RESULTS: Overall, 1922 live-born twin pairs (653 betamethasone group, 1269 controls) were included. Compared with controls, late-preterm twins exposed to betamethasone were lighter (mean difference -126g), had a smaller head circumference (-0.4cm), and a shorter body length (-0.8cm) after adjustment for confounders (P<0.05). Female neonates from mixed or same-sex twin pairs had a lower birth weight than controls (betamethasone ≤16mg: -114g; betamethasone 24mg: -124g; betamethasone >24mg: -187g), with no detectable improvement in neonatal morbidity (hyperbilirubinemia, respiratory distress, asphyxia) or mortality. CONCLUSION: Betamethasone reduced birth weight, head circumference, and length of female preterm neonates in twin pairs in a dose-dependent manner. The neonatal mortality and morbidity were not improved by betamethasone.
Assuntos
Betametasona/administração & dosagem , Desenvolvimento Fetal/efeitos dos fármacos , Gravidez de Gêmeos , Adulto , Antropometria , Estudos de Coortes , Parto Obstétrico , Relação Dose-Resposta a Droga , Feminino , Alemanha , Idade Gestacional , Humanos , Gravidez , Resultado da Gravidez , Nascimento Prematuro , Estudos RetrospectivosRESUMO
OBJECTIVE: To determine the effects of betamethasone on fetal growth and neonatal outcomes. METHODS: A retrospective cohort study was performed of deliveries that occurred at Charité University Hospital Berlin, Germany, between January 1996 and December 2008. The betamethasone group included women with preterm labor and symptomatic contractions, cervical insufficiency, preterm premature rupture of membranes, or vaginal bleeding. Women in the control group were matched for gestational age at time of delivery and had not received betamethasone. Fetal growth changes and neonatal anthropometry were compared. RESULTS: Among 1799 newborns in the betamethasone group and 42 240 in the control group, betamethasone was associated with significantly lower birth weight (154 g lower on average) after adjusting for confounders (e.g. hypertension, smoking, and maternal weight), sex, and gestational age at delivery (P<0.05). The higher the dose, the greater the difference in mean birth weight versus controls in births before 34(+0)weeks (≤16 mg -444 g; 24 mg -523 g; >24 mg -811 g), without a detectable improvement in neonatal morbidity or mortality. There was a dose-dependent decline in expected fetal weight gain as estimated by serial ultrasonography examinations 6-8 weeks after betamethasone administration (P<0.05). CONCLUSION: Betamethasone exposure reduces fetal weight gain in a dose-dependent manner without improving neonatal morbidity or mortality.