Reproducibility of the fetal cerebral vessels assessment in full and late term pregnancies.

Objective: Data concerning feasibility of the fetal cerebral Doppler examination in full term and late term pregnancy is lacking. Our purpose was to perform an evaluation of these arteries with power Doppler ultrasound, calculating the percentage of identification and measurement and the intraobserver reproducibility.Methods: This was a cross sectional study evaluating a population of 578 normally grown fetuses divided according to the week of examination. The first group included fetuses examined at week 40 (N = 323) and the second fetuses examined at week 41 (N = 255). The three major branches of the internal carotid artery (anterior, middle and posterior cerebral arteries, ACA, middle cerebral artery (MCA), posterior cerebral arteries (PCA)) and their anastomosis (A1, A2, P1, P2) were examined with power Doppler ultrasonography by three independent ultrasonographers. The proportion of vessel identified and measured was calculated and the reproducibility among the three operators was investigated.Results: The major arteries at the circle of Willis were fully identified/measured in 65/56 and 62/48% of fetuses at 40 and 41 weeks. The MCA obtained the higher percentage of identification and measurement at both periods (> 80 and >70%). The entire set of anastomosis were less frequently identified/measured at both periods (50/< 50% of cases), especially in the A2 segment. The best agreement was obtained in the MCA and the worst in the PCA-P1 segment.Conclusions: At 40 and 41 weeks, the fetal cerebral vessels, especially the MCA, are suitable for power Doppler evaluation, providing an interesting tool to evaluate fetal hemodynamics in full and late term pregnancy.

Resting energy expenditure in young patients with cystic fibrosis receiving antibiotic therapy for acute respiratory exacerbations.

BACKGROUND: patients with cystic fibrosis commonly have severe malnutrition and growth retardation. Among possible causes of these manifestations are low caloric intake, loss of nutrients and increased resting energy expenditure. This study was designed to assess the influence of antibiotic therapy for infectious exacerbations on resting energy expenditure in young patients with cystic fibrosis. METHODS: We studied 17 patients with cystic fibrosis (mean age, 13.6 years). All were hospitalized to receive intravenous antibiotic therapy (mean duration, 2 weeks) for acute respiratory exacerbations. At the beginning of therapy and after it ended, all patients underwent blood chemical tests, anthropometrical measures, determination of body composition by bioelectrical impedance, spirometry, and indirect calorimetry. RESULTS: Antibiotic therapy led to a significant improvement in biochemical, spirometric variables and in estimated calorimetry measurements expressed in relation to fat-free mass. These findings suggest that infective exacerbations are among the causes of increased resting energy expenditure in young patients with cystic fibrosis. CONCLUSIONS: Indirect calorimetry may prove useful in the diagnosis of infective exacerbations and in monitoring the effect of antibiotic therapy in patients with cystic fibrosis.

Acceptability of early transvaginal or abdominal sonography in the first half of pregnancy.

OBJECTIVE: To evaluate the acceptability of early transvaginal sonography by pregnant patients. METHODS: A questionnaire was completed by 246 patients and the resulting data were analysed. RESULTS: The incidence of discomfort was higher for the transabdominal than for the transvaginal route. Moreover, the transvaginal approach in early pregnancy, when compared with other transvaginal sonographic examinations was described as more satisfactory in 95% of cases. CONCLUSIONS: Transvaginal sonography in early pregnancy is better tolerated than transabdominal sonography.

Transvaginal assessment of fetal anatomy at 11 to 16 weeks of gestation in relation to fetal position.

OBJECTIVE: To investigate the ability of the high-frequency transvaginal scanning technique to assess embryo-fetal anatomy in early pregnancy in relation to fetal position and in comparison with transabdominal scan. METHODS: A study population of 1,402 pregnant women were examined by transvaginal ultrasonography performed at 10(+1) to 16(+0) weeks of pregnancy. At 14(+1) to 16(+0) weeks of gestation, an ultrasonographic examination was performed in 247 pregnant women by transvaginal and transabdominal route. The criteria necessary for an adequate visualization of fetal organs and structures were met. RESULTS: The visualization rate of complete fetal anatomy increased with increase in menstrual age and fetal position affected this possibility. A detailed brain anatomy was more easily viewed with the fetus in the cephalic or transverse position than in the breech position, whereas the thoracic and abdominal anatomy were viewed more easily with the transverse position compared to the cephalic or breech position. Complete surveys of fetal anatomy were possible in 50% and 62% of women with transabdominal scan and in 85% and 85% with transvaginal one at 15 and 16 weeks' gestation, respectively (p < 0.001). CONCLUSION: A detailed assessment of fetal structures was possible in most cases at 13 weeks of gestation. Fetal position can influence this capability. At 14(+1) to 15(+0) weeks' gestation more anatomical surveys were completed with a transvaginal scan compared to a transabdominal one and this was influenced by fetal position.

Transvaginal sonographic assessment of the fetal urinary tract in early pregnancy.

Fetal renal size in the first trimester and the early second trimester of pregnancy was evaluated by high-frequency transvaginal sonography in 537 singleton fetuses at risk for cytogenetic abnormality but not at risk for congenital kidney disease. The percentage of visualization of both kidneys and bladder at different menstrual ages (11-16 weeks) is presented, and centile reference charts for evaluating kidney growth have been compiled. All kidney measurements were found to increase as pregnancy progressed. At 13 weeks, fetal kidneys and fetal urinary bladder were visualized in 92% of the cases screened. The incidence of pyelectasis was high in our population (4.5%), and this pathology was studied by other sonographic scans during pregnancy and postnatally. All fetuses had normal karyotypes. The results presented provide a reference for the assessment of normal renal morphology and growth in early pregnancy.

[Assessment of uteroplacental circulation with radioisotopes]. / Studium der utero-plazentaren Durchblutung mit Radioisotopen.

The authors have evaluated placental blood flow using a non-invasive radioisotopic approach, with the intravenous administration of 1 mCi 113mIn. The method is evaluated in 20 normal pregnancies, in 24 patients with intrauterine growth retardation, in 8 patients with iso-Rh-immunization and in 9 patients with gestational diabetes. In the group with intrauterine growth retardation 2 pregnancies with extensive fetal malformations were included. In one case without evident histological placental alteration the index was 3.94 at 34 weeks of gestation and 5.62 at 36 weeks of gestation. In the second one with placental infarcts the index was 3.46 at 38 weeks of gestation. Normal pregnancies showed a flow index of 5.50 +/- 1.57 (1 s.d.) units compared to the pathological pregnancies value of 2.74 +/- 0.90 (1 s.d.) units. (p less than 0.001). The conclusions drawn are: The method is very well suited to clinical evaluation of placental blood flow. The evaluation of placental blood flow cannot be directly equated with fetal development as it is not its only determinant. This method is a indirect index of placental function in small for gestational age fetuses with malformations.