Suggested algorithm for cytomegalovirus surveillance in low-risk pregnancies.

Cytomegalovirus (CMV) is the most common cause of intrauterine infection, occurring in 0.2-2.2% of all neonates. The rare but serious neonatal manifestations have prompted widespread discussions of the use of CMV surveillance during pregnancy. This study describes a decision-analysis algorithm for a surveillance protocol to detect the maximal number of primary CMV infections in low-risk pregnancies. The steps of the protocol adhere to the routine antenatal follow-up schedule. All calculations were based on the most stringent data in the literature as applied to a theoretical cohort of 100,000 pregnant women in the general population. By the time of delivery, the protocol failed to detect only four potentially ill neonates in the study group. These cases may be diagnosed and treated postnatally. Incorporation of the protocol in antenatal follow-up can reduce diagnostic confusion, assist clinicians in timing invasive procedures, and potentially spare patients unnecessary terminations of pregnancy.

The accuracy of the preoperative diagnosis in women undergoing emergent gynecological laparoscopy for acute abdominal pain.

OBJECTIVES: To analyze the accuracy of the working diagnosis in emergent laparoscopies and identify variables associated with an accurate or faulty preoperative diagnosis. METHODS: A retrospective cohort study including 217 consecutive women who underwent emergent laparoscopy for acute abdominal pain in 2000-2007. Each case was designated a preoperative-postoperative diagnostic match or mismatch by file review. The agreement between the clinical and preoperative ultrasound findings was analyzed according to the circumstances of imaging tests (Doppler-ultrasound examination performed by a specialist or ultrasound performed by the on-call physician without Doppler examination). RESULTS: On multivariate logistic stepwise regression analysis, the significant independent variables for prediction of preoperative-postoperative diagnostic match (n = 63, 29%) were pregnant state, preoperative clinical-ultrasound match, and duration of symptoms. The circumstances of imaging tests were not a significant predictor for accurate preoperative diagnosis. CONCLUSIONS: In this retrospective analysis, Doppler-ultrasound examination performed by a specialist was not associated with higher accuracy of the preoperative diagnosis in women undergoing emergent laparoscopy for acute abdominal pain. These data should be further validated in future prospective cohorts. Doppler-ultrasound examination performed by a specialist does not add to the accuracy of the preoperative diagnosis in women undergoing emergent gynecological laparoscopy for acute abdominal pain.

Periconceptional cytomegalovirus infection: pregnancy outcome and rate of vertical transmission.

OBJECTIVE: To evaluate pregnancy outcome and rate of vertical transmission in primary maternal periconceptional cytomegalovirus (CMV) infection. METHODS: All women serologically diagnosed with primary periconceptional CMV infection between 1999 and 2008 were included. Periconceptional infection was defined as primary maternal CMV infection occurring within 4 weeks prior to the last reported menstrual period and up to 3 weeks following the expected date of the missed menstrual period. Intrauterine infection was verified by PCR and shell vial culture of amniotic fluid at 22-24 weeks or neonatal urine culture within 48 h of birth. RESULTS: Of the 59 patients studied, 43 (73%) underwent diagnostic amniocentesis. Eleven of the 43 patients (25.5%) were positive for CMV contamination. Ten of the 11 patients (90%) elected to terminate pregnancy. Twelve women (20.3%) declined amniocentesis: of these 2 elected to undergo a first-trimester termination of pregnancy and 10 gave birth to a live-born infant. Six of the ten neonates were negative for CMV and two tested positive for urinary CMV; all eight were healthy on long-term follow-up, and two were lost to follow-up. The remaining four women had a spontaneous first-trimester abortion. CONCLUSION: The risk of transmission of periconceptional CMV infection is lower than previously reported. These data should be borne in mind when counseling affected couples.

Transvaginal sonographic fetal axis determination in early second trimester.

OBJECTIVE: Correct prenatal determination of the fetal right/left axis is essential for the diagnosis of fetal malformations, in particular congenital heart anomalies. A reliable method of transabdominal echocardiographic assessment of the fetal situs in the late second trimester was established. We aimed to determine the validity of the transvaginal approach to assess fetal axis. METHOD: The study group consisted of 108 consecutive women in the second trimester of a singleton pregnancy, undergoing elective transvaginal anatomy scans. All had undergone previous transabdominal echocardiography to establish fetal axis. The same technique was used to assess the fetal axis during the transvaginal study, and the findings were compared. RESULTS: There was total agreement in fetal axis determination between transabdominal and transvaginal scans in all cases. The accuracy of the transvaginal study was not affected by maternal obesity, fetal position or the presence of cardiac malformation (in one case). CONCLUSION: Transvaginal ultrasonography is the reliable and accurate means of determining the fetal axis.

Use of various contraceptive methods and time of conception in a community-based population.

AIMS: To investigate the association between method of contraception and time to conception in a normal community-based population. DESIGN: Prospective, cross-sectional, survey. SETTING: Large comprehensive ambulatory women's health center. PATIENTS AND METHODS: One thousand pregnant women at their first prenatal obstetrics visit were asked to complete a self-report questionnaire. The return to fertility was analyzed by type of contraceptive method, duration of use, and other sociodemographic variables. RESULTS: Response rate was 80% (n=798). Mean age of the patients was 29.9+/-5 years. Seventy-five percent had used a contraceptive before trying to conceive: 80% oral contraceptives, 8% intrauterine device, and 7% barrier methods. Eighty-six percent conceived spontaneously. Contraceptive users had a significantly higher conception rate than nonusers in the first 3 months from their first attempt at pregnancy. Type of contraception was significantly correlated with time to conception. Pregnancy rates within 6 months of the first attempt was 60% for oral contraceptive users compared to 70 and 81% for the intrauterine device and barrier method groups, respectively. There was no correlation between time to conception and parity or duration of contraceptive use. Other factors found to be significantly related to time to conception were older age of both partners and higher body mass index. CONCLUSIONS: Contraception use before a planned pregnancy does not appear to affect ease of conception. Type of method used, although not duration of use, may influence the time required to conceive.

Correlation between fetal gastric size and amniotic fluid volume.

PURPOSE: Since abnormal conditions of the fetal digestive tract may alter both amniotic fluid volume and fetal gastric volume, we sought to determine whether amniotic fluid volume is correlated with fetal gastric volume in normal pregnancy. METHODS: A total of 280 fetal gastric size measurements were made prospectively from routine sonographic examinations of women with normal singleton pregnancies between 16 and 42 weeks of gestation. The fetal stomach was defined as the largest area including the pyloric site on transverse or oblique real-time sonographic scans. Gastric volume was calculated according to the formula for a prolate ellipsoid. The amniotic fluid index (AFI) was used for the evaluation of amniotic fluid volume. RESULTS: Both fetal gastric volume and AFI were significantly correlated with gestational age (R2= 0.422 and R2= 0.128, respectively). Only a weak correlation was found between gastric volume and AFI (R2= 0.036, p <0.001). On multivariate linear regression analysis adjusting for gestational age and fetal biometric measurements, gastric volume was not an independent and significant predictor of AFI. CONCLUSIONS: Although sonographically determined fetal gastric volume measurements appear to be useful in the assessment of fetal digestive tract anomalies, fetal gastric volume has no clinically significant effect on the amniotic fluid volume in normal pregnancy.