Prenatal sonographic monitoring of idiopathic megacystis.

This case report is of a female fetus diagnosed with severe idiopathic megacystis at 21 weeks of pregnancy. Sonographic monitoring demonstrated normal amniotic fluid volume and renal structures, absence of hydronephrosis, ureteral dilation, and associated abnormalities. Conservative management was chosen with postnatal confirmation of diagnosis. The neonate presented seizures, and subsequent magnetic resonance imaging demonstrated transverse sinus thrombosis with adjacent ischemic damage. At present, the infant is 2 years old, and she is thriving normally and maintains urinary continence with spontaneous voidings.

Prenatal diagnosis by 3D ultrasound and MRI of an unusual malformation of cortical development with brain-in-brain appearance.

A 31-year-old pregnant woman was referred for isolated mild ventriculomegaly and failure to visualize the left lateral ventricle's anterior horn on second trimester sonography (US). Three-dimensional US suspected a frontal lesion deviating the midline. MRI revealed a mass compressing the ventricle. Follow-up MRI described a "brain-in-brain" malformation: infolded microgyric cortex and white matter in frontal lobe extending to frontal horn and midline, irrorated by hypertophic Heubner artery. Conservative approach was chosen. Neurodevelopment at 1 year is normal.

Ultrasound imaging after evacuation as an adjunct to beta-hCG monitoring in posthydatidiform molar gestational trophoblastic neoplasia.

OBJECTIVE: The purpose of this study was to identify prognostic factors associated with development of gestational trophoblastic neoplasia (GTN) after hydatidiform mole (HM). STUDY DESIGN: A retrospective analysis of 189 patients with HM was performed. We recorded features such as maternal age, HM history, blood group, gestational age, uterine volume at evacuation, presence of theca lutein cysts, vaginal bleeding, and transvaginal ultrasonography with color Doppler imaging. We considered risk predictors to be the presence of nodules and hypervascularization within the myometrium or endometrium (positive ultrasound imaging). An univariate and multivariate analysis, with the COX nominal logistic model, was performed. RESULTS: Fourteen patients experienced GTN (7.4%). After univariate analysis, uterine size (P = .0139) and positive ultrasound results (P < .0001) were associated significantly with GTN development. At multivariate analysis, only positive ultrasound results maintained significance (likelihood ratio test: chi(2) = 0.0000). CONCLUSION: The risk of GTN is increased in patients with uterine involvement that is assessed by ultrasound imaging. None of the other prognostic factors that were evaluated was predictive of GTN development.

Endometrial evaluation with transvaginal ultrasound during hormone therapy: a prospective multicenter study.

OBJECTIVE: To assess the value of endometrial thickness as a marker of endometrial abnormality risk during hormone therapy (HT) and to study the correlation between abnormal bleeding and abnormal endometrial histology in patients with thick endometrium. DESIGN: Prospective multicenter study. SETTING: University and general hospitals outpatient centers. PATIENT(S): Postmenopausal women (702) on HT. INTERVENTION(S): Biendometrial thickness was measured by transvaginal sonography (TVS) between day 5 and day 10 after the last P intake and, when present, after the end of the menstrual-like bleeding. MAIN OUTCOME MEASURE(S): Hysteroscopy and biopsy were performed within 5 days from TVS on all patients with an endometrial thickness >4.5 mm (precision scale 0.5 mm). RESULT(S): Endometrial thickness >4.5 mm was observed in 20.5% of patients. One hundred sixteen hysteroscopies and biopsies were performed. Hyperplasia, polyps, and endocavitary fibroids were detected in 15%, 24%, and 8% of cases, respectively. The positive predictive value of TVS examination was 47%. Endometrial thickness was the only variable significantly and independently associated with histologic abnormalities and endocavitary fibroids. Abnormal bleeding occurred in 17.1% of patients. Among 17 patients detected with thick endometrium and hyperplasia, 8 cases showed abnormal bleeding. CONCLUSION(S): Sonographic endometrial thickness of 4.5 mm provides a sensitive tool to select HT patients who might benefit from hysteroscopy and biopsy. Abnormal bleeding is not a sensitive sign of hyperplasia in patients with thick endometrium.

Prevalence and prognosis of atrial septal aneurysm in high risk fetuses without structural heart defects.

BACKGROUND: The aim of this study was to evaluate the prevalence and prognostic implications of the association between atrial septal aneurysm (ASA) and fetal arrhythmias in a population of high risk fetuses. METHODS: One thousand three hundred and two fetal echocardiograms performed during high risk pregnancies from the 17th to the 41st week of gestation were retrospectively evaluated for the presence of ASA and/or arrhythmias. An ASA was defined as redundant tissue extending at least halfway across the left atrium. Patients with an ASA were distinguished in two subgroups according to whether there was (subgroup 1) or was not (subgroup 2) cyclical contact of the atrial septum with the left atrial wall or with the mitral valve. Arrhythmias were documented during mono/two-dimensional echocardiography and Doppler evaluation. RESULTS: Out of 1223 patients considered for the study, 93 (7.6%) fetuses had an ASA; among these 93 fetuses, 33 (36%) had premature atrial beats (p < 0.001). Ten of these patients were included in subgroup 1, and 7 of them (70%) exhibited premature atrial beats (p = 0.016 vs subgroup 2). No arrhythmias other than premature atrial beats were observed in these patients. None of them received any therapy during observation. All of them developed a regular sinus rhythm within 3 months of life. CONCLUSIONS: On the basis of these data, we can speculate that, if accurately searched for, ASA is often present (7.6%) and is likely to represent a mechanical stimulus for the generation of premature atrial beats. Indeed, our data show an important correlation between the degree of bulging and the presence of arrhythmias, supporting the hypothesis of a mechanical stimulus. However, the observed arrhythmias did not appear to be prone to degeneration. In conclusion, ASA observed during fetal life is often associated with premature atrial beats, which are apparently in direct relation with the degree of bulging of the atrial septum. On the other hand, an ASA almost invariably disappears at birth and is not associated with major arrhythmias.