Increased pulsatility index of uterine artery Doppler between 26 and 28 weeks of gestation and adverse perinatal outcomes.

OBJECTIVE: To compare adverse perinatal outcomes in pregnant women with or without normalization of the mean pulsatility index (PI) uterine artery Doppler between 24 and 28 weeks of gestation. METHODS: Retrospective cohort which pregnant women were divided into three groups: normal uterine artery Doppler between 20-24 and 26-28 weeks (controls), abnormal uterine artery Doppler between 20-24 and normal between 26-28 weeks (anUtA), and abnormal uterine artery Doppler between 20-24 and 26-28 weeks (aaUtA). To compare adverse perinatal results between the groups Chi-square test was used. Binary logistic regression was used to assess the ability of uterine artery Doppler to predict birthweight < 10th and composite perinatal outcomes. RESULTS: Birthweight was significantly lower in the aaUtA compared to anUtA (2687 vs 3248 grams, p = 0.0479). A significant negative correlation was observed between the mean PI uterine artery Doppler during the 3rd trimester and birthweight (r = -0.13, R2 = 0.035, p = .0192). The prevalence of composite perinatal outcomes was significantly higher in aaUtA compared to anUtA (25.9 vs 0%, p = .013). Mean PI uterine artery Doppler during the 3rd trimester was significant predictor for birthweight < 10th (OR: 2.74, CI 95% = 1.03-7.3), but the protodiastolic notch and the association between mean PI uterine artery Doppler and protodiastolic notch were not. CONCLUSION: Maintenance of altered uterine artery Doppler during the 3rd trimester was associated with higher prevalence of composite perinatal outcomes and lower birthweight compared to its late normalization. Although modest, uterine artery Doppler in the 3rd trimester proved to be predictor of birthweight < 10th.

Fetal structural anomalies diagnosed during the first, second and third trimesters of pregnancy using ultrasonography: a retrospective cohort study.

BACKGROUND: The prevalence of congenital abnormalities in general populations is approximately 3-5%. One of the most important applications of obstetric ultrasound is in detection of fetal structural defects. OBJECTIVE: To assess fetal structural anomalies diagnosed using ultrasound in the three trimesters of pregnancy. DESIGN AND SETTING: Retrospective cohort study at the Mário Palmério University Hospital of the University of Uberaba (Universidade de Uberaba, UNIUBE), from March 2014 to December 2016. METHODS: Ultrasound data at gestational weeks 11-13 + 6, 20-24 and 32-36 were recorded to identify fetal anomalies in each trimester and in the postnatal period. The primary outcome measurements were sensitivity, specificity, positive predictive value and negative predictive value for detection of fetal anomalies and their prevalence. RESULTS: The prevalence of anomalies detected using ultrasound was 2.95% in the prenatal period and 7.24% in the postnatal period. The fetal anomalies most frequently diagnosed using ultrasound in the three trimesters were genitourinary tract anomalies, with a prevalence of 27.8%. Cardiac anomalies were diagnosed more often in the postnatal period, accounting for 51.0% of all cases. High specificity, negative predictive value and accuracy of ultrasound were observed in all three trimesters of pregnancy. CONCLUSION: Ultrasound is safe and has utility for detecting fetal anomalies that are associated with high rates of morbidity and mortality. However, the low sensitivity of ultrasound for detecting fetal anomalies in unselected populations limits its utility for providing reassurance to examiners and to pregnant women with normal results.

The impact of first-trimester intrauterine hematoma on adverse perinatal outcomes.

PURPOSE: The aim of this study was to evaluate whether the presence of an intrauterine hematoma (IUH) on an early pregnancy ultrasound scan showing a live fetus was related to adverse perinatal outcomes. METHODS: We performed a retrospective cohort study to evaluate pregnant women who underwent an ultrasound examination in early pregnancy, between 6 weeks 0 days and 10 weeks 6 days. We compared the perinatal outcomes between women with and without firsttrimester IUH using the Mann-Whitney and Fisher exact tests. Furthermore, we performed a stepwise regression analysis to identify possible predictors of miscarriage among maternal characteristics, ultrasound parameters, and IUH. RESULTS: During the study period, data from 783 pregnancies were included, and the incidence of IUH was 4.5% (35 of 783). We observed a higher proportion of miscarriage following the scan (28.6% vs. 10%, P=0.003) and a larger yolk sac diameter during the scan (4.8 mm vs. 3.8 mm, P<0.001) in the pregnant women with first-trimester IUH. There was no significant difference regard the prevalence of low birth weight (LBW; P=0.091), very LBW (P=0.370), or extremely LBW (P=0.600) between cases with IUH and without IUH, the cesarean section rate (68% vs. 81%, P=0.130), preterm delivery (16% vs. 16%, P>0.999), or the incidence of first-trimester vaginal bleeding (31% vs. 20%, P=0.130). Moreover, heart rate (HR) was the only variable that predicted miscarriage with statistical significance (P=0.017). CONCLUSION: Women with first-trimester IUH had a higher risk of miscarriage after the ultrasound scan. HR was the only variable that predicted miscarriage with statistical significance.

The impact of gestational diabetes and hypothyroidism on the third-trimester ultrasound parameters and in adverse perinatal outcomes: a retrospective cohort study.

OBJECTIVE: To assess the impact of gestational diabetes and hypothyroidism on the third-trimester ultrasound parameters and in adverse perinatal outcomes. METHODS: We performed a retrospective cohort study with 817 singleton pregnant women between 26w0d and 37w6d of gestation which were divided in four groups: 56 gestational diabetes mellitus (GDM), 63 hypothyroidism, 14 GDM + hypothyroidism, and 684 controls. The following ultrasound parameters were assessed: mean uterine artery pulsatility index (PI), umbilical artery PI, middle cerebral artery PI, single deepest pocket (SDP) and cerebroplacental ratio (CPR). Adverse perinatal outcomes were the following: low birth weight, macrosomia, and Agar score at 1st min <7. These four groups were compared using the Kruskall-Wallis and χ(2) tests. RESULTS: Pregnant women from GDM showed higher weight (p < 0.001), BMI (p < 0.001), SDP (p < 0.001) and newborns with higher birth weight (p = 0.008) and macrosomia (p = 0.02) than other groups. Comparing with control, hypothyroidism showed higher SDP (p < 0.05). CONCLUSION: Pregnant women with GDM showed higher risk of macrosomic newborns than other three groups. Both pregnant women with GDM and hypothyroidism showed higher SDP than normal pregnancies.

Reference values for the fetal lateral ventricle atrium measurement in the second and third trimesters of pregnancy in a Brazilian population.

OBJECTIVE: To establish reference values for the fetal atrium lateral ventricle measurements in the second and third trimesters of pregnancy in a Brazilian population. METHODS: A retrospective cross-sectional study was performed with low-risk pregnant women who underwent ultrasound examination at 16-41 weeks of gestation. The atrium of lateral ventricle measurement was performed in the transventricular plane at the end of choroid plexus. We assessed reference curves (percentiles 5th, 50th and 95th) for the atrium of lateral ventricle measurement with gestational age (GA), using the best-fit polynomial equation, and determination coefficient (R(2)) and modeling the variability. RESULTS: The fetal atrium of lateral ventricle measurements was assessed in 519 singleton pregnancies. However, seven fetuses were excluded because of central nervous system malformations, and therefore data from 512 pregnancies were included in the analysis. The mean ± standard deviation (range) of the fetal atrium lateral ventricle measurement (mm) was 5.1 ± 1.4 (1.6-9.7). A best-fit curve was a first-degree polynomial regression: atrium lateral ventricle = 6.455 - 0.049 × GA (R(2) = 0.05). CONCLUSION: Reference values for the fetal atrium lateral ventricle measurements in the second and third trimesters of pregnancy in a Brazilian population were established.

Unconditional reference values for the amniotic fluid index measurement between 26w0d and 41w6d of gestation in low-risk pregnancies.

OBJECTIVE: To establish reference values for the amniotic fluid index (AFI) measurement between 26w0d and 41w6d of gestation in a Brazilian population. METHODS: We performed a cross-sectional study with 1984 low-risk singleton pregnant women between 26w0d and 41w6d of gestation. AFI was measured according to the technique proposed by Phelan et al. Maternal abdomen was divided into four quadrants using the umbilicus and linea nigra as landmarks. Single vertical pocket in each quadrant was measured and the AFI was generated by the sum of these four values without umbilical cord or fetal parts. All ultrasound exams were performed by only two experienced examiners. AFI was expressed as median, interquartile range, mean and ranges in each gestational age (GA) interval. Polynomial regressions were performed to obtain the best fit with adjustment by the determination coefficient (R(2)). RESULTS: Mean of AFI ranged from 14.0 ± 4.1 cm (range, 9.7-14.0) at 26w0d to 8.3 ± 4.7 cm (range, 1.9-16.5) at 41w6d, respectively. The best polynomial regression fit curve was a first-degree: AFI = 16.29-0.125*GA (R(2) = 0.01). According the scatterplot, AFI values practically did not vary with advancing GA. CONCLUSION: Reference values for the AFI measurement between 26w0d and 41w6d of gestation in a low-risk Brazilian population were established.

Reference ranges for the uterine arteries Doppler and cervical length measurement at 11-13(+6) weeks of gestation in a Brazilian population.

OBJECTIVE: To establish references ranges for the uterine arteries (UtA) Doppler and cervical length (CL) measurements at 11-13(+6) weeks of gestation in a Brazilian population. METHODS: We performed a retrospective cross-sectional study with singleton low-risk pregnant women who underwent first trimester ultrasound exams of fetuses with crown-rump length (CRL) ranging from 45 to 84 mm. The mean UtA Doppler and CL measurements were performed by transvaginal route. The mean pulsatility index (PI) of uterine arteries was obtained with color Doppler at the level of cervico-corporeal junction. The CL was obtained in a sagittal view using the cervical gland area as landmark. We determined mean ± standard deviation (SD), ranges for mean PI of UtA and CL in each gestational age. Polynomial regression was performed to establish reference values. RESULTS: We have assessed 598 first-trimester pregnancies: the CL measurement was obtained from 497, while the mean PI UtA Doppler was available in 450 pregnant women. The mean CL ranged from 33.41 to 35.58 mm while the PI UtA Doppler ranged from 1.89 to 1.45. The best fit curves were: CL = 30.790 + 0.057 × CRL and UtA PI = 2.411-0.011 × CRL. CONCLUSION: References ranges for the mean UtA PI Doppler and CL measurement at 11-13(+6) weeks of gestation in a Brazilian population were established.

Reference range for the pulsatility index ductus venosus Doppler measurement between 11 and 13 + 6 weeks of gestation in a Brazilian population.

OBJECTIVE: To establish reference range for the pulsatility index (PI) ductus venosus (DV) Doppler measurement between 11 and 13 + 6 weeks of gestation in a Brazilian population. METHODS: A retrospective cross-sectional study was performed with 430 singleton pregnancies. The PI DV Doppler measurement was performed as routine during the first trimester screening. DV was identified by color Doppler and the pulsed Doppler gate was placed in the distal portion of the umbilical sinus. When at least three typical DV waveforms were obtained, PI DV was measured manually in one waveform. Polynomial regression was used to obtain the best fit using PI DV Doppler measurement and crown-rump length (CRL) with adjustments by the determination coefficient (R(2)). 5th, 50th and 95th percentiles for the PI DV Doppler measurements at each gestational were determined. RESULTS: The mean of PI DV Doppler measurement was 1.1 ± 0.2 (range 0.8-3.7). The linear regression was the best fit: PI DV measurement = 1.288-0.0034*CRL (R(2 )= 0.03). CONCLUSIONS: Reference range for the PI DV Doppler measurement between 11 and 13 + 6 weeks of gestation in a Brazilian population was established.