Placenta accreta is associated with IVF pregnancies: a retrospective chart review.

OBJECTIVE: To study the association between placenta accreta (PA) and in vitro fertilisation (IVF) pregnancies. DESIGN: Retrospective chart review. SETTING: Tertiary care centre in Jerusalem, Israel. SAMPLE: During January 2004-February 2009, 25,193 deliveries occurred in our hospital, including 752 (3%) deliveries of IVF pregnancies. METHODS: Placenta accreta was only diagnosed when there were histological findings from the placenta associated with the suitable clinical course. Demographic, obstetrical and fertility characteristics of these patients were retrieved from hospital files. MAIN OUTCOME MEASURE: Rates of PA in pregnancies achieved with IVF versus rates of PA in spontaneous pregnancies. RESULTS: The rate of PA in the IVF group was 12/752 (16/1000) pregnancies, compared with 30/24,441 (1.2/1000) among spontaneous pregnancies (P < 0.0001; OR 13.2; 95% CI 6.7-25.8). Among the variables examined, parity, rate of caesarean delivery in the index pregnancy, and birthweight differed significantly between IVF and spontaneous pregnancies. CONCLUSIONS: The odds of developing PA are significantly higher in IVF pregnancies than in spontaneous pregnancies. These differences may stem from differences in the endometrial environment, or from changes to the endometrium wrought by IVF treatment protocols.

Added value of the gray-scale whirlpool sign in the diagnosis of adnexal torsion.

OBJECTIVE: Adnexal torsion is a common gynecologic emergency affecting females of all ages. Expedient diagnosis and treatment are important, particularly in young fertile patients to preserve ovarian viability. Classical parameters for the clinical and sonographic diagnosis of adnexal torsion have very high false-positive rates, approaching 50%. The sonographic 'whirlpool' sign has been shown to be effective for visualizing the torsed part in the prenatal diagnosis of malrotation of the midgut with volvulus, as well as scrotal and ovarian torsion. We aimed to evaluate the efficacy of the whirlpool sign in the diagnosis of torsion, as compared to a protocol based on 'classic' sonographic signs of torsion alone. METHODS: This was a retrospective chart review. Files of all patients who underwent laparoscopy for suspected torsion at our center between January 2006 and May 2009 were extracted and reviewed. Ultrasound reports were retrieved from our computerized database. Patients were assigned to the study group if the whirlpool sign had been investigated during pre-procedural evaluation or to the control group if only the standard protocol had been applied. RESULTS: Eighty women were referred for laparoscopy for suspected adnexal torsion during the study period. In 22 women the ultrasound investigation had included the whirlpool sign (study group) while 58 had been examined by the standard protocol (control group). Twenty women in the study group had a positive whirlpool sign on ultrasound, 18 of whom (90.0%) had confirmed torsion on laparoscopy. In the control group 32 of 58 (55.2%) women had confirmed torsion on laparoscopy. CONCLUSION: The addition of the sonographic whirlpool sign to the preoperative sonographic evaluation of patients with suspected torsion appears to improve the rate of true-positive diagnoses as confirmed by laparoscopy. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.

Application of free-hand three-dimensional echocardiography in the evaluation of fetal cardiac ejection fraction: a preliminary study.

OBJECTIVE: To investigate the feasibility of using free-hand three-dimensional (3D) echocardiography to evaluate fetal cardiac function. METHODS: 3D cardiac data were collected during screening examinations for 37 normal fetuses with gestational ages of between 16 and 26 weeks. Processing of the 3D volumes included separation of the end-diastolic and end-systolic slices, segmentation of right and left ventricles, measurement of end-diastolic and end-systolic volumes, and calculation of the ejection fraction (EF) for each ventricle. In 21 fetuses at 21-24 weeks, right and left ventricle volumes and EF were compared. RESULTS: Twenty-five cases were appropriate for final statistical analysis. The volume of the ventricles increased with gestational age and estimated fetal weight. There was no significant trend in the difference between the volumes and EF of the right and left ventricles in the 21-24-week subgroup. The mean right and left ventricular EF were 54 +/- 11.2% and 57.5 +/- 14.6%, respectively. The mean combined EF of ventricles during gestation was 55.1 +/- 10.7% and seemed to remain constant during the gestational ages studied. CONCLUSIONS: 3D echocardiography can provide estimates of ventricular volume and function and may in future be used for evaluation of fetuses with congenital heart disease and cardiac dysfunction.