Common fetal measurements: a comparison between ultrasound and magnetic resonance imaging.

BACKGROUND: Ultrasound has been the method of choice for antenatal fetal assessment for the past three decades; however, problems may arise in cases of oligohydramnion, unfavorable position of the fetus, and maternal obesity. PURPOSE: To compare ultrasound (US) and magnetic resonance imaging (MRI) for common fetal measurements at 19-30 weeks' gestation, and to assess the effect of high maternal body-mass index (BMI). MATERIAL AND METHODS: 59 low-risk singleton pregnancies were enrolled in a prospective blinded cross-sectional study. In a first session, an experienced obstetrician used a high-resolution US technique and in a second session on the same day MRI was used to measure biparietal diameter (BPD), head circumference (HC), mean abdominal diameter (MAD), abdominal circumference (AC), and femur length (FL). Inter- and intraobserver and intermodality variability was determined using Bland-Altman plots. The effect of maternal BMI was assessed using Spearman's statistics. RESULTS: A total of 45 women aged 19-43 years (median 29 years) attended both US and MRI at median 22 weeks' gestation. The mean differences between US and MRI were 1.6 mm for HC (95% confidence interval [CI] -1.0, 4.3 mm), 1 mm for AC (95% CI -0.2, 4.0 mm), 0.2 mm for MAD (95% CI -0.7, 1.2 mm), 2.2 mm for BPD (95% CI 1.7, 2.7 mm), and 4.6 mm for FL (95% CI 2.9, 6.4 mm). Maternal BMI did not affect the results (Spearman' rho 0.054-0.277; P=NS). The intraobserver agreement for all MRI measurements was acceptable, except for FL, while the interobserver agreement was poor. CONCLUSION: There was good agreement between US and MRI for common fetal measurements, but not for all (i.e., BPD and particularly FL). MRI had a poor interobserver agreement, underscoring the need for technical refinement and reference ranges specifically established for MRI.

[Foetal growth retardation]. / Vekstretardasjon hos fosteret.

BACKGROUND: Intrauterine growth : restriction (IUGR) occurs in 3-10% of all pregnancies : The condition has different adverse effects on the foetus, during childhood and even in adult life. MATERIAL AND METHODS: Literature was retrieved from the Pub Med and Cochrane databases. RESULTS AND INTERPRETATION: The most common limit for IUGR and severe growth restriction is a neonatal weight < 10th percentile. Placental failure, infections or foetal anomalies may cause IUGR before the 32 nd gestational week (early IUGR). Chromosome abnormalities may be the cause of up to 20% of all growth-restricted infants. About 20% of early-onset preeclampsia may cause low birth weight. Up to 10% of infections may also cause IUGR (e.g. HIV, cytomegalovirus, toxoplasmosis, peridontitis, malaria). Monochorial twin pregnancy carries a risk for twin-to-twin transfusion with uneven foetal growth. Systemic vessel diseases (diabetes mellitus with nephropathy and retinopathy, Crohn's disease, systemic lupus erythematosus disseminatus, and antiphospholipid syndrome) may cause growth restriction. The anamnesis and a low symphysis to fundus increment may give suspicion of growth restriction. The diagnosis is verified by ultrasound examination. Preterm delivery carries a risk for neonatal respiratory distress and cerebral haemorrhage. Therefore, two doses of corticosteroid should be given to the mothers in risk of preterm delivery before the 34 th gestational week. Growth restriction between 34 to 37 weeks gestation, associated with serious preeclampsia, is an indication for delivery. Other indications are arrest of foetal growth, pathological cardiotocography or Doppler findings, oligohydramnion or worsening of the maternal condition.

Transvaginal ultrasound-guided aspiration for treatment of tubo-ovarian abscess: a study of 302 cases.

OBJECTIVE: Our purpose was to evaluate the effectiveness and safety of transvaginal ultrasound-guided aspiration together with antibiotic therapy for treatment of tubo-ovarian abscess. STUDY DESIGN: A review of women treated with transvaginal ultrasound-guided aspiration for tubo-ovarian abscess at Haukeland University Hospital, Bergen, Norway, between June 1986 and July 2003 was performed. Immediate clinical response and longer-term follow-up results were assessed. RESULTS: A total of 449 transvaginal aspirations were performed on 302 women. A total of 282 women (93.4%) were successfully treated for transvaginal aspiration of purulent fluid, together with antibiotic therapy. In the other 20 women (6.6%), surgery was performed. The main indications for surgery were diagnostic or therapeutic uncertainty, such as suspected residual tubo-ovarian abscess or pain. No procedure-related complications were diagnosed. CONCLUSION: Transvaginal ultrasound-guided aspiration combined with antibiotics is an effective and safe treatment regimen for tubo-ovarian abscess. The high success rate indicates that it should be a first-line procedure.

Pregnancies following ultrasound-guided drainage of tubo-ovarian abscess.

OBJECTIVE: To study fertility among women treated by means of ultrasound-guided drainage and antibiotics for tubo-ovarian abscess (TOA). DESIGN: Retrospective cohort study. SETTING: A tertiary referral center. PATIENT(S): One hundred women of reproductive age treated for TOA between June 1986 and July 2003. INTERVENTION(S): Transvaginal ultrasound-guided drainage of TOA was performed in all patients. The procedure was repeated if a substantial amount of pus was seen using ultrasonography 2-5 days after the initial aspiration, and repeated later if necessary. MAIN OUTCOME MEASURE(S): Frequency of naturally conceived pregnancies. RESULT(S): Twenty of 38 (52.6%; 95% CI 36.5-68.9%) women who intended to have a child achieved pregnancy naturally and became mothers. In addition, 7 (50%) of 14 women who were not on birth control on a regular basis became pregnant. No ectopic pregnancies were registered. CONCLUSION(S): Ultrasound-guided drainage of TOA in combination with antibiotics seems to preserve fertility in approximately half of the patients.

The management of pelvic abscess.

The optimum treatment for pelvic abscess would be an approach that is safe, efficacious, cost-effective, minimally invasive, and which affects the woman's fertility potential as little as possible. In women of reproductive age tubo-ovarian abscess is one of the most common types of pelvic abscess. Tubo-ovarian abscesses are classically treated with broad-spectrum antibiotics. Frequently this approach fails and surgical intervention becomes necessary in about 25% of all cases. Surgical procedures include laparotomy or laparoscopy with drainage of abscess, unilateral or bilateral salpingo-ophorectomy, and hysterectomy. However, surgery for tubo-ovarian abscess is often technically difficult and associated with complications. An alternative approach is the use of imaging-guided drainage of abscess in combination with antibiotics. Combined data from several studies indicate that ultrasound-guided transvaginal drainage with concomitant antibiotics is especially safe and efficacious. This chapter discusses the management of pelvic abscess with a special focus on transvaginal ultrasound-guided drainage of tubo-ovarian abscess.