Discordant uterine artery velocity waveforms as a predictor of subsequent miscarriage in early viable pregnancies.

OBJECTIVE: Our purpose was to determine whether an abnormal uterine perfusion pattern was associated with subsequent pregnancy loss after fetal cardiac activity was documented. STUDY DESIGN: Pulsatility indexes of both the right and left uterine arteries were obtained by transvaginal color Doppler ultrasonography in 318 consecutive viable pregnancies between 6 and 12 weeks' gestation. The Delta uterine artery pulsatility index value, expressed as the highest uterine artery pulsatility index value minus the lowest value, was calculated for each pregnancy. Women were subsequently classified as having continuing pregnancies or pregnancy loss before 20 weeks' gestation. To predict subsequent pregnancy loss, Doppler findings were adjusted for maternal age, history of previous abortion, presence of subchorionic hematoma, embryonic bradycardia, and gestational age by means of multivariate logistic regression analysis. RESULTS: Twenty-four pregnancies (8%) were spontaneously aborted before 20 weeks' gestation. Both Delta uterine artery pulsatility index (odds ratio 2.9, 95% confidence interval 1.5-5.8) and history of previous abortion (odds ratio 3.1, 95% confidence interval 1.2-8.2) were significantly associated with pregnancy loss in the multivariate logistic regression analysis. The sensitivity and specificity of the multivariate logistic regression model to predict abortion were 75% and 85%, respectively, significantly higher than the diagnostic performances of qualitative and quantitative variables considered individually. CONCLUSION: Discordant uterine artery pulsatility indexes in the first trimester were strongly associated with subsequent pregnancy loss. This suggests that uterine ischemia may be implicated in certain cases of early pregnancy loss after documentation of fetal cardiac activity during the first trimester.

[Cyto-histologic evaluation of parametrial involvement in cervico-uterine cancer using aspiration puncture guided by transvaginal echography]. / Evaluación cito-histologica del compromiso parametrial en cáncer cérvico-uterino mediante punción aspirativa guiada por ecografía transvaginal.

Vaginal tact is not sufficient for staging the extension of cervical Ca in its adnexal compromise. The use of transvaginal echography with a cytological hystological parametrial biopsy allow the diagnosis to be certified. In 23 cases studied, 21 epidermoid carcinoma and one adenocarcinoma related with of original cervical tumor were revealed. The clinical staging had a 8.3% error margin.

[Color Doppler of the utero placental territory and its relationship with the placental localization: normal and elevated resistance groups]. / Doppler color del territorio útero-placentario y su relación con la ubicación placentaria: grupos de resistencia normal y elevada.

Forty two pregnancies of gestational age between 20 and 40 weeks were studied, 26 with normal uterine artery resistance; Group A, and 16 with elevated UA resistance; Group B. Three categories of placental location were established: Type I; central, Type II; partially lateralized including uterine midline, Type III; completely lateralized not including uterine midline. A Diasonic doppler duplex color equipment was used to assess the systole/diastole ratio (s/d ratio). Five different pints of the uteroplacental vascular territory were evaluated in each patient; right and left bottom uterine artery (cervico ithsmical union), right and left top UA (laterally outstanding point of the uterine wall), and inter villous space. The results were analyzed with Statview (Macintosh) statistics software. Placental Type II, prevailed on Group A, Type III prevailed on Group B, Types II and III were predominantly located on the right side of the uterus. S/D ratio was higher in Group B than in Group A in all five sites. S/D rel was higher on left side than on right side measurements. On Group B, left placental side patients had significantly higher s/d rel on non placental uterine artery than right placental side patients. When one altered uterine Doppler flow value is found, all the uteroplacental vascular territory show a high resistance patterns. The lateral placental location patterns tend to express higher resistance values. Right lateral placental locations have even higher resistance values than left ones. The placental location classification is suggested as a screening method for detecting the group of patients in risk of having altered values of Uterine Doppler Flow Velocimetry.

[Ultrasonography-guided transvaginal puncture of ovarian cysts]. / Punción vía transvaginal de quistes ováricos guiada por ultrasonografía.

Presenting the experience in 18 cases of ovarian cystic transvaginal puncture guided by ultrasonography. The cystic selected for puncture were unilateral, regular contours, uniloculated without internal papillae, without ascites. This procedure was made in women on reproductive age with failure to medical treatment.

[Sexually transmitted microorganisms and immunoglobulins in the amniotic fluid in mothers who carry sexually transmitted diseases]. / Germenes de transmisión sexual e inmunoglobulinas en el líquido amniótico, en madres portadoras de enfermedades de transmisión sexual.

Fetal behaviour as an intrauterine patient is unknown. In the diagnosis of sexually transmitted diseases (STD) and in the criteria for treatment only the mother is considered leaving the fetus out. The presence of immunoglobulin M in the amniotic fluid is an indicator of fetal infection and could allow an accurate diagnosis of fetal disease or treatment, if the measurement is related to the presence or absence of organism in the amniotic fluid. In this way, the study of fetal behaviour under these conditions could be done. The objective of this research was to determine the presence of STD organism in the amniotic fluid of the STD infected pregnant women and to evaluate the prevalence and evolution of these pathologies in the fetus. No STD organism, nor immunoglobulin M were found in the 13 samples of amniotic fluid (8 pre and 5 post-treatment) of infected pregnant women. The presence of microorganisms and its relation to immunoglobulin M was not observed. More cases are needed to arrive to a conclusion regarding fetal immunology and to a better understanding of antibacterial properties of the amniotic fluid. We concluded that no contamination in the amniotic fluid or fetal infection was found in pregnant women with STD.

[Vibration and acoustic stimulation during labor with external monitoring. Pathology of fetal heart rate]. / Estimulación vibroacústica en el trabajo de parto con monitorización externa. Patología de la frecuencia cardíaca fetal.

Vibratory acoustic stimulation was done in patients with an abnormal fetal heart rate tracing in external continuous electronic monitoring during labor, correlating with Apgar score, meconium staining and umbilical cord pH, describing a 83.3% sensitivity, 81.3% specificity and 62.5% positive predictive value. The authors recommend the use of vibratory acoustic stimulation in those cases with an abnormal fetal heart rate tracing in external continuous electronic monitoring, when we can not install internal electronic monitoring or obtain a fetal blood pH on assessment of fetal well-being.