Area of Wharton's jelly as an estimate of the thickness of the umbilical cord and its relationship with estimated fetal weight.

BACKGROUND: To build a reference curve for the area of Wharton's jelly (WJ) in low-risk pregnancies from 13 to 40 weeks and to assess its relationship with estimated fetal weight (EFW). METHODS: 2,189 low-risk pregnancies had the area of WJ estimated by ultrasound and the 10th, 50th and 90th percentiles calculated using a third-degree polynomial regression procedure. EFW by ultrasound was correlated with the measurement of the area of WJ. RESULTS: The area of WJ increased according to gestational age (R² = 0.64), stabilizing from the 32nd week onwards. There was a significant linear correlation between area of WJ and EFW up to 26 weeks (R = 0.782) and after that 5t remained practically constant (R = 0.047). CONCLUSION: The area of WJ increases according to gestational age, with a trend to stabilize at around 32 weeks of gestation. It is also linearly correlated with EFW only up to 26 weeks of gestation.

Inter- and intra-observer variability in Sonographic measurements of the cross-sectional diameters and area of the umbilical cord and its vessels during pregnancy.

BACKGROUND: The purpose of the study was to evaluate inter- and intra-observer variability in sonographic measurements of the cross-sectional area of the umbilical cord and the diameters of its vessels in low-risk pregnancies of 12 to 40 weeks of gestation. METHODS: A prospective cross sectional study was performed in 221 pregnant women at different gestational ages. Measurements were carried out also by a second observer to evaluate inter-observer variability and repeated once again by the first observer to assess intra-observer variability. The linear correlation between the measurements (Spearman's coefficient of correlation) and their reliability through the intraclass correlation coefficient (ICC), the Cronbach's alpha coefficient and the limits of agreement proposed by Bland and Altman were evaluated. RESULTS: The results showed that inter-observer and intra-observer variability did not show any significant difference between examiners. A good linear correlation between the measurements and reliability was obtained, with values of R, ICC and Cronbach's alpha all above the standard limits. CONCLUSION: It is possible to conclude that inter- and intra-observer variability in the measurements of the umbilical cord and its vessels was small; their reliability and agreement were good.

Componente distólico ausente na artéria umbilical: análise de 30 casos / Absent end-diastolic velocity in umbilical artery: review of 30 cases

Foram analisados 30 casos de componente diastólico ausente na artéria umbilical fetal diagnosticados no Serviço de Ultra-Sonografia do Centro de Atençao Integral à Saúde da Mulher da UNICAMP. A época da interrupçao da gestaçao, a idade gestacional variou de 26 a 36 semanas, com peso fetal de 470 a 172Og, com grande incidência de retardo de crescimento intra-uterino (93,3 por cento). Todos os fetos necessitaram de cuidados na Unidade de Terapia Intensiva. Mortalidade perinatal total foi de 43,3 por cento.

Prenhez cervical: consideraçöes a respeito de dois casos / Cervical pregnancy: considerations about two cases report

Apresentam-se dois casos de prenhez cervical. Uma paciente atendida em processo hemorrágico agudo, sendo submetida a curetagem uterina, laparotomia com histerectomia total e ligadura de artéria hipogástrica unilateral, com diagnóstico anatomopatológico de prenhez cervical. A outra, na 12 (semana de gestaçao, com diagnóstico da patologia, foi submetida a curetagem por aspiraçao, tamponamento da cavidade cervical e ligadura de ambas as artérias hipogástricas. Esta paciente teve duas gestaçoes posteriormente: a primeira, seguida de aborto na décima semana e, a segunda, de evoluçao a termo, com recém-nascido vivo, em boas condiçoes. Enfatiza-se o fato de que com diagnóstico precoce pode-se programar a abordagem terapêutica, aumentando-se a possibilidade de conseguir a manutençao do útero e, conseqüentemente, a capacidade reprodutiva da paciente.

Aspectos clínicos e anatomopatológicos da adenomiose / Clinical and anatomopathologycal aspects of the adenomiosis

Foram revisados os aspectos clínicos e anatomopatológicos de 216 histerectomias consecutivas realizadas no período de março de 1986 à março de 1988 no Departamento de Gineclogia da Faculdade de Ciências Médicas da UNiversidade Estadual de Campinas (FCM-CAISM-UNICAMP). Em 20 casos (9,2%) o anatomopatológico revelou a presença de adenomiose. Os principais sintomas observados nessas pacientes foram: sangramento genital anormal em 50% dos casos, dor pélvica em 3% e outros em 20%. A maior associaçäo de adenomiose foi com a miomatose uterina em 60% dos casos. Os autores concluem que a história clínica e inspecäo do útero näo säo conclusivos e uma maior acuracidade diagnóstica préo-operatória só poderá ser obtida nos casos sintomáticos, confirmada apenas com o anatomopatológico