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1.
Isr Med Assoc J ; 22(1): 27-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927802

RESUMO

BACKGROUND: Congenital heart defects (CHD) may be associated with neurodevelopmental abnormalities mainly due to brain hypoperfusion. This defect is attributed to the major cardiac operations these children underwent, but also to hemodynamic instability during fetal life. Advances in imaging techniques have identified changes in brain magnetic resonance imaging (MRI)in children with CHD. OBJECTIVES: To examine the correlation between CHD and brain injury using fetal brain MRI. METHODS: We evaluated 46 fetuses diagnosed with CHD who underwent brain MRI. CHD was classified according to in situs anomalies, 4 chamber view (4CV), outflow tracts, arches, and veins as well as cyanotic or complex CHD. We compared MRI results of different classes of CHD and CHD fetuses to a control group of 113 healthy brain MRI examinations. RESULTS: No significant differences were found in brain pathologies among different classifications of CHD. The anteroposterior percentile of the vermis was significantly smaller in fetuses with abnormal 4CV. A significantly higher biparietal diameter was found in fetuses with abnormal arches. A significantly smaller transcerebellar diameter was found in fetuses with abnormal veins. Compared to the control group, significant differences were found in overall brain pathology in cortex abnormalities and in extra axial findings in the study group. Significantly higher rates of overall brain pathologies, ventricle pathologies, cortex pathologies, and biometrical parameters were found in the cyanotic group compared to the complex group and to the control group. CONCLUSIONS: Fetuses with CHD demonstrate findings in brain MRI that suggest an in utero pathogenesis of the neurological and cognitive anomalies found during child development.


Assuntos
Lesões Encefálicas/embriologia , Feto/diagnóstico por imagem , Cardiopatias Congênitas/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/embriologia , Encéfalo/patologia , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/patologia , Estudos de Casos e Controles , Ecocardiografia , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Neuroimagem , Gravidez , Diagnóstico Pré-Natal/métodos
2.
Ultraschall Med ; 39(5): 513-525, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29879745

RESUMO

OBJECTIVE: To evaluate the added value of fetal MRI to ultrasound in detecting and specifying callosal anomalies, and its impact on clinical decision making. METHODS: Fetuses with a sonographic diagnosis of an anomalous corpus callosum (CC) who underwent a subsequent fetal brain MRI between 2010 and 2015 were retrospectively evaluated and classified according to the severity of the findings. The findings detected on ultrasound were compared to those detected on MRI. An analysis was performed to assess whether fetal MRI altered the group classification, and thus the management of these pregnancies. RESULTS: 78 women were recruited following sonographic diagnoses of either complete or partial callosal agenesis, short, thin or thick CC. Normal MRI studies were obtained inµ19 cases (24 %). Among these, all children available for follow-up received an adequate adaptive score in their Vineland II adaptive behavior scale assessment. Analysis of the concordance between US and MRI demonstrated a substantial level of agreement for complete callosal agenesis (kappa: 0.742), moderate agreement for thin CC (kappa: 0.418) and fair agreement for all other callosal anomalies. Comparison between US and MRI-based mild/severe findings classifications revealed that MRI contributed to a change in the management for 28 fetuses (35.9 %), mostly (25 fetuses, 32.1 %) in favor of pregnancy preservation. CONCLUSION: Fetal MRI effectively detects callosal anomalies and enables satisfactory validation of the presence or absence of callosal anomalies identified by ultrasound and adds valuable data that improves clinical decision making.


Assuntos
Agenesia do Corpo Caloso , Corpo Caloso , Imagem por Ressonância Magnética , Ultrassonografia Pré-Natal , Agenesia do Corpo Caloso/diagnóstico por imagem , Criança , Corpo Caloso/diagnóstico por imagem , Feminino , Feto , Humanos , Recém-Nascido , Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos
3.
Menopause ; 24(1): 73-76, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27648663

RESUMO

OBJECTIVE: Local estrogens are used for the treatment of genitourinary symptoms of menopause. The efficacy and adverse effects of both estrogen-containing vaginal tablets (VT) and estrogen-containing vaginal creams (VC)/gels are comparable. Our objective was to assess the compliance and adherence to treatment in a large population. METHODS: A retrospective study on women aged 40 to 89 was performed in the Central District of the "Clalit" Health Services between 2006 and 2014. Demographic data on all women and usage details were electronically recorded. Patients eligible for analysis used VT or VC for at least 4 consecutive months. RESULTS: A total of 2,269 patients used continuous monotherapy, of them 1,782 patients received treatment only with VC and 487 received treatment only with VT. Sixty-four percent of women treated with VT were treated for at least 4 months compared with 39% of women administered with VC (P < 0.000006). After 6 months of treatment, 83% of women with VT were asked for another prescription compared with 54% of women with VC (P < 0.001). The mean duration of treatment was 1,002 ±â€Š38 days for the VT-treated women, and 787 ±â€Š25 days for the VC-treated group (P < 0.000006). CONCLUSIONS: The present study showed superiority in the compliance and adherence of postmenopausal women to treatment with estrogen tablets over estrogen gel.


Assuntos
Estrogênios/administração & dosagem , Adesão à Medicação/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Cremes, Espumas e Géis Vaginais/administração & dosagem , Administração Intravaginal , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Menopausa/fisiologia , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Vagina/patologia
4.
Prenat Diagn ; 36(7): 650-5, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27135789

RESUMO

OBJECTIVE: The purpose of our study was to describe the sonographic appearance of triploidy in early pregnancy. METHODS: We report the sonographic characteristics of a cohort of fetal triploid cases detected at targeted ultrasonographic vaginal examinations between 12 and 16 weeks of gestation from 2008 to 2014. Indications for fetal karyotype following ultrasound were maternal request, advanced maternal age, increased nuchal translucency, and/or fetal abnormalities. RESULTS: Triploidy was detected in 25 cases during the 6 years of the study period with an estimated incidence of ~1 in 5000 pregnancies. Four cases had molar changes in the placenta. Among the remaining 21 cases, a consistent sonographic pattern was noted, which included the combination of asymmetric growth restriction with abdominal circumference lagging 2 weeks behind head circumference in 21/21, oligohydramnios in 20/21, abnormal posterior fossa or enlarged fourth ventricle in 20/21, and absent gall bladder in 17/21. Other findings present in more than 50% of cases included cardiac (70%) and renal (55%) abnormalities, clenched hands (55%), and hypoplastic lungs (67%). CONCLUSION: Fetal triploidy can manifest at 12-16 weeks with molar changes in the placenta or with a cluster of unusual sonographic findings whose presence should prompt appropriate testing for diagnosis in early pregnancy. © 2016 John Wiley & Sons, Ltd.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Transtornos Cromossômicos/diagnóstico por imagem , Retardo do Crescimento Fetal/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Pulmão/anormalidades , Oligo-Hidrâmnio/diagnóstico por imagem , Triploidia , Anormalidades Urogenitais/diagnóstico por imagem , Abdome/diagnóstico por imagem , Anormalidades Múltiplas/epidemiologia , Adulto , Transtornos Cromossômicos/epidemiologia , Feminino , Retardo do Crescimento Fetal/epidemiologia , Quarto Ventrículo/anormalidades , Quarto Ventrículo/diagnóstico por imagem , Vesícula Biliar/anormalidades , Vesícula Biliar/diagnóstico por imagem , Glossoptose/diagnóstico por imagem , Glossoptose/epidemiologia , Cabeça/diagnóstico por imagem , Cardiopatias Congênitas/epidemiologia , Humanos , Imagem Tridimensional , Cariotipagem , Rim/anormalidades , Rim/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumopatias/epidemiologia , Idade Materna , Micrognatismo/diagnóstico por imagem , Micrognatismo/epidemiologia , Medição da Translucência Nucal , Oligo-Hidrâmnio/epidemiologia , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal , Anormalidades Urogenitais/epidemiologia , Adulto Jovem
5.
Prenat Diagn ; 36(5): 407-17, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26865185

RESUMO

OBJECTIVE: The objective of this study is to evaluate the fetal cerebral vasculature by three-dimensional (3D) ultrasonography and Doppler technologies in normal fetuses and to describe a systematic method for analysis of volume data sets. METHODS: 3D volumes of the fetal brain were acquired prospectively in 25 patients between 12.3 and 36.3 weeks' gestation. Volumes were acquired with high-definition Doppler flow. The feasibility of identifying the fetal cerebral blood vessels and venous sinuses was analyzed. RESULTS: A step-by-step systematic approach to identify the cerebral vasculature from ultrasonographic volume data sets was developed. The volumes were rotated into a standard anatomic orientation in the multiplanar display, and then, by systematic navigation, the vessels were demonstrated. Arteries of the circle of Willis, basilar artery, pericallosal artery, and internal carotid arteries were demonstrated in more than half of the fetuses. Tiny vessels such as those that supply the cerebellum and those that branch from the pericallosal artery were demonstrated in less than 50% of the volumes. CONCLUSIONS: The essential fetal cerebral vessels can be visualized by 3D volume analysis. Systematic analysis enables identification of the fetal brain arteries, veins, and sinuses and provides knowledge about anatomical variations and the diversity of human anatomy. © 2016 John Wiley & Sons, Ltd.


Assuntos
Encéfalo/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Veias Cerebrais/diagnóstico por imagem , Cavidades Cranianas/diagnóstico por imagem , Encéfalo/irrigação sanguínea , Ecoencefalografia , Feminino , Feto , Idade Gestacional , Humanos , Imagem Tridimensional , Gravidez , Estudos Prospectivos , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal
6.
J Matern Fetal Neonatal Med ; 29(8): 1318-21, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26177055

RESUMO

OBJECTIVE: Evaluate physiologic factors associated with reduced maternal perception of fetal movements (RFM). METHODS: A historical cohort study of all women (years 2011-2013, n = 399) that visited the maternal emergency room (ER) (gestational age 24 + 0-42 + 0) due to RFM (group A), that was compared to a control group consisted from women with normal perception of fetal movements (group B). Groups were compared for maternal characteristics (age, gravity, parity, BMI), gestational age, placental location, gestational age at birth and fetal outcomes (birth-weight and Apgar scores). RESULTS: In a multivariate regression analysis, including maternal age, height, weight, BMI, gestational age on admission to ER, gravity, parity and placental location, only two variables remained significantly associated with RFM - nulliparity (OR = 2.28, p = 0.001) and anterior placenta (OR = 1.44, p = 0.034). Group A was not associated with lower Apgar scores (1 and 5-min, p = 0.40 and 0.57, respectively) or low birth-weight (p = 0.76), nor was it associated with prematurity (p = 0.41), low (<7) 5-min Apgar score, fetal death or neonatal death. CONCLUSIONS: Reduced fetal movements are associated with anterior placenta and nulliparity.


Assuntos
Movimento Fetal , Percepção , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Análise Multivariada , Paridade , Placenta/fisiologia , Gravidez
7.
J Ultrasound Med ; 34(12): 2263-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26573099

RESUMO

OBJECTIVES: The purposes of this study were to assess the feasibility of fetal thymus measurement between 13 and 16 weeks' gestation, to evaluate the potential difference using color Doppler sonography with the thy-box technique, and to construct normal percentile ranges. METHODS: This retrospective study included 287 healthy singleton pregnancies. The fetal thymus was shown in an axial plane of the upper mediastinum. Color Doppler imaging was applied to outline the thy-box: ie, the area between the brachiocephalic artery posteriorly and internal mammary arteries laterally. Measurements of the lateral and anteroposterior diameters of the thymus with and without color Doppler imaging were compared. RESULTS: The thymus was shown in 95% of the cases (273 of 287) between 13 and 16 weeks' gestation. The mean lateral thymus diameter ± SD with color Doppler imaging (5.30 ± 0.7 mm) was significantly longer in comparison to the measurement without color Doppler imaging (5.06 ± 0.8 mm; P < .001), whereas the anteroposterior diameter was significantly shorter (3.19 ± 0.9 versus 3.26 ± 0.8 mm; P = .044). Normal percentiles of thymus measurements for gestational age were constructed. CONCLUSIONS: The fetal thymus can be clearly and accurately shown as early as 13 weeks' gestation by using the thy-box. Measurements with color Doppler imaging were significantly different from those without and hence are preferable, as color Doppler imaging can delineate the thymus borders more accurately.


Assuntos
Algoritmos , Interpretação de Imagem Assistida por Computador/métodos , Timo/anormalidades , Timo/diagnóstico por imagem , Hiperplasia do Timo/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Estudos de Viabilidade , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Variações Dependentes do Observador , Gravidez , Segundo Trimestre da Gravidez , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Timo/embriologia
8.
Prenat Diagn ; 35(11): 1097-105, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26183900

RESUMO

OBJECTIVES: The purpose of this study was to demonstrate the normal perimeter and area of the three orthogonal planes (axial, sagittal and coronal) of the fetal Sylvian fissure along pregnancy using 3-dimensional (3D) ultrasound. METHODS: Ultrasound volumes of fetal head were acquired prospectively in 55 fetuses between 12 and 33 gestational weeks. All volumes were analyzed offline by two examiners separately. The largest axial, sagittal and coronal planes of the Sylvian fissure were identified, and the area and perimeter were measured. RESULTS: Measurements of the Sylvian fissure were demonstrated in 54 out of 55 volumes (98%). In all three planes, a linear growth was demonstrated along gestation. All measurements significantly correlated to gestational age and head circumference (p < 0.01). The Sylvian fissure was found to grow asymmetrically, more at the anterior-posterior direction than laterally or to the inferior-superior directions. CONCLUSIONS: The Sylvian fissure grows linearly and has a distinct form in each developmental stage. The fissure is identifiable and measurable as early as 12 weeks gestation.


Assuntos
Encéfalo/embriologia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/embriologia , Estudos Transversais , Ecoencefalografia , Feminino , Desenvolvimento Fetal , Humanos , Imagem Tridimensional , Tamanho do Órgão , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal
9.
Med Sci Monit ; 21: 1124-30, 2015 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-25892459

RESUMO

BACKGROUND: Fetal sex and maternal age are each known to affect outcomes of pregnancies. The objective of the present study was to investigate the influence of the combination of maternal age and fetal sex on pregnancy outcomes in term and post-term singleton pregnancies. MATERIAL AND METHODS: This was a retrospective study on term singleton pregnancies delivered between 2004 and 2008 at the Chaim Sheba Medical Center. Data collected included maternal age, fetal sex, and maternal and neonatal complications. The combined effect of fetal sex and maternal age on complications of pregnancy was assessed by multivariable logistic regression models. RESULTS: The study population comprised 37,327 pregnancies. The risk of operative deliveries increased with maternal age ≥ 40 and in pregnancies with male fetuses. The risk of maternal diabetes and of longer hospitalization increased as maternal age increased, and in women ≥ 40 carrying male fetuses. The risk of hypertensive disorders increased in pregnancies with males as maternal age advanced. The risk of shoulder dystocia and neonatal respiratory complications increased in male neonates born to women<40. The risk of neonatal hypoglycemia increased in males for all maternal ages. CONCLUSIONS: Risk assessment for fetal sex and advanced maternal age were given for different pregnancy complications. Knowledge of fetal sex adds value to the risk assessment of pregnancies as maternal age increases.


Assuntos
Idade Materna , Resultado da Gravidez , Caracteres Sexuais , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez
10.
J Ultrasound Med ; 34(5): 847-52, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25911719

RESUMO

OBJECTIVES: The thymus has a pyramidal shape, which is best shown in coronal planes. The aim of this study was to evaluate the potential of virtual organ computer-aided analysis to estimate fetal thymus volume in normal pregnancies. METHODS: Three-dimensional volume data sets from the axial upper mediastinal section were acquired from 37 normal pregnancies between 12 and 35 weeks' gestation. Thymus volume was calculated by virtual organ computer-aided analysis by 2 separate examiners. In 12 cases, volumes were also acquired with 4-dimensional sonography and spatiotemporal image correlation software to assess the variability in thymus size between the systolic and diastolic periods of fetal heart motion. Linear regression analysis was used to assess the relationship between the fetal thymus volume and gestational age. Paired Student t tests were used to evaluate both the level of agreement for interobserver and intraobserver variability and the difference between diastolic and systolic thymus volumes. RESULTS: Identification of the borders of the thymus and calculation of its volume were successful in 28 patients (77.7%). Statistically significant linear growth of the thymus during pregnancy, from 12 to 35 weeks, was found. The growth coefficient for each gestational age was 0.43 (95% confidence interval, 0.355 to 0.504; P < .001). The difference in thymus size between systole and diastole was minor (0.0798 cm(3); 95% confidence interval, -0.044 to 0.203 cm(3)). Interobserver and intraobserver variability was not statistically significant. CONCLUSIONS: Although the thymus has a complex shape, it was possible to determine its borders and to calculate its volume by virtual organ computer-aided analysis in 77.7% of cases. Linear growth during pregnancy was found, and the minor changes during systole and diastole could be explained by condensation of the soft tissue of the thymus secondary to cardiac activity.


Assuntos
Imagem Tridimensional/métodos , Aprendizado de Máquina , Timo/diagnóstico por imagem , Timo/fisiologia , Ultrassonografia Pré-Natal/métodos , Interface Usuário-Computador , Algoritmos , Feminino , Humanos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Tamanho do Órgão/fisiologia , Gravidez , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Timo/embriologia
11.
Prenat Diagn ; 35(7): 699-702, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25800990

RESUMO

OBJECTIVE: Hirschsprung disease (HD) is a rare gastrointestinal disorder. Our aim was to study the prenatal ultrasound findings of children who were diagnosed with HD after birth. METHODS: The study population included children who suffered from HD between 1990 and 2008. Data of anomaly scan findings in prenatal ultrasound, demographic and post-natal physical abnormalities and treatment were retrieved from medical files and interviews with the parents. RESULTS: Twenty-two patients confirmed histopathological diagnosis of HD at age of 1 day to 15 months. Nineteen fetuses had anomaly scan during pregnancy, which revealed minor sonographic abnormalities in three fetuses; two of them had hyperechogenic bowel. One fetus with hyperechogenic bowel had polyhydramnion, and another had a family history of three brothers with HD. A third fetus had dilated pelvic kidney. None of them had sonographic evidence of bowel dilatation. After birth, six patients (31%) were found to have other structural anomalies: ventriculoseptal defect, atriseptal defect, atrio-ventricular septal defect, and pyloric stenosis. CONCLUSIONS: Abnormal sonographic findings of fetal bowel are absent in the vast majority of fetuses who are diagnosed with HD after birth. In women with a family history of HD, a third trimester anomaly scan may be warranted.


Assuntos
Doença de Hirschsprung/diagnóstico por imagem , Ultrassonografia Pré-Natal , Intestino Ecogênico/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Terceiro Trimestre da Gravidez , Estudos Retrospectivos
12.
J Matern Fetal Neonatal Med ; 28(10): 1202-7, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25065620

RESUMO

OBJECTIVE: To examine the outcomes of pregnancy and newborn following an event of maternal medical compromise during pregnancy. METHODS: A retrospective study was performed on all patients hospitalized following an event of medical compromise during pregnancy. Medical compromise was divided to acute or chronic bleeding, major or complicated operations, and admission to intensive care unit (ICU). Data collected included maternal, fetal, neonatal and child's follow-up. RESULTS: The study included 51 pregnant patients and 58 fetuses. The study group had increased risk of preterm deliveries (35.0 versus 6.5%, p < 0.001), cesarean delivery (55.0 versus 22.7%, p < 0.001) and low Apgar scores (5.0 versus 0.45%, p = 0.002). Patients with acute bleeding had higher rates of cesarean sections, preterm deliveries, admissions to neonatal ICU and neonatal mortality. Two cases of fetal abnormalities included brain abnormalities and pericardial effusion. Three terminations of pregnancies were performed: two in patients in ICU due to severe maternal medical condition and one in the fetus with brain abnormalities. CONCLUSIONS: Maternal medical compromise during pregnancy increases the risk for preterm deliveries, cesarean delivery and low Apgar scores. Acute bleeding was the main cause of medical compromised and with the higher rates of adverse outcomes.


Assuntos
Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adulto , Cesárea/estatística & dados numéricos , Criança , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Saúde Materna , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco
13.
J Ultrasound Med ; 33(12): 2207-10, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25425381

RESUMO

This series describes the sonographic characteristics and pregnancy outcomes of fetuses with abnormal insertion of the umbilical vein (UV) into the inferior vena cava (IVC). We conducted a retrospective study that described the sonographic features of 6 patients who underwent a routine anatomic scan during early pregnancy. Six patients had a diagnosis of abnormal insertion of the UV to the IVC; in 3, the diagnosis was made at 12 weeks' gestation. Cardiac anomalies were detected in 3 patients, including ventricular septal defects, pericardial effusion, tricuspid and mitral regurgitation, and an aberrant right subclavian artery. Four had noncardiac anomalies, including cystic hygroma and skeletal, brain, and abdominal anomalies. Only 1 fetus who presented with UV insertion into the IVC as an isolated finding had a normal karyotype, resulting in term vaginal delivery. Four other patients had chromosomal abnormalities, including trisomies 13 and 21, Turner mosaicism of 45,XO/46,XY, and Robertsonian translocation, and 1 patient terminated the pregnancy without a karyotype evaluation. Abnormal insertion of the UV into the IVC with agenesis of the ductus venosus can be seen as early as the first trimester. When detected, a detailed anatomic examination should be performed, as well as a fetal karyotype evaluation. Isolated cases of insertion of the UV into the IVC at a position lower than usual may have a good prognosis.


Assuntos
Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Veias Umbilicais/anormalidades , Veias Umbilicais/diagnóstico por imagem , Fístula Vascular/diagnóstico por imagem , Veia Cava Inferior/anormalidades , Veia Cava Inferior/diagnóstico por imagem , Adulto , Transtornos Cromossômicos/diagnóstico por imagem , Feminino , Humanos , Gravidez
14.
J Ultrasound Med ; 33(4): 681-5, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24658948

RESUMO

OBJECTIVES: The purpose of this study was to investigate the ability to depict the 4-chamber and 3-vessel and trachea views of the fetal heart using 3-dimensional sonography. METHODS: Three-dimensional color Doppler volumes of the fetal heart were acquired prospectively in 31 fetuses between 19 and 25 gestational weeks. The initial plane consisted of the 4-chamber view. Postprocessing included navigation within the volume solely in plane A in the caudal direction to visualize the stomach and in the cephalic direction to the plane of the 3-vessel and trachea view to visualize the pulmonary artery, the aorta, the V shape and color of the arches, the superior vena cava, and the trachea. The feasibility of showing these organs was evaluated. RESULTS: The estimated time for volume acquisition and manipulation was about 60 seconds. The detection rates for the 4-chamber view, stomach, 3-vessel view, trachea, and V sign were 100%, 93.5%, 92.0%, 77.4%, and 83.9%, respectively, with interobserver agreement of 0.76 to 1.0. CONCLUSIONS: We describe a simple technique in which a single sweep on 3-dimensional sonography starting at the level of the 4-chamber view can visualize the situs, stomach, 4-chamber view, and transverse view of the outflow tracts of the heart.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Ecocardiografia Tridimensional/métodos , Coração Fetal/diagnóstico por imagem , Posicionamento do Paciente/métodos , Traqueia/diagnóstico por imagem , Traqueia/embriologia , Ultrassonografia Pré-Natal/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Tamanho do Órgão , Gravidez , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
15.
J Matern Fetal Neonatal Med ; 27(8): 839-43, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24047512

RESUMO

OBJECTIVE: Sex differences in long and short-term outcomes for infants are observed. This has also been shown for several neonatal complications in preterm neonates. We aimed to evaluate whether sex impacts neonatal outcome among term neonates. Furthermore, we were interested in whether small-for-gestational age male and female neonates at term presented with different patterns of neonatal complications. METHODS: Data on all term singleton deliveries and respective neonatal outcomes between 2004 and 2008 at a single tertiary medical center were utilized for this retrospective cohort study. Immediate neurological complications were defined as one or more of the following: intraventricular hemorrhage, convulsions, asphyxia and acidosis. Neonatal complications were compared between male and female term infants, as well as male and female term small-for-gestational age (SGA) neonates. RESULTS: 37,342 singleton neonates were born ≥37 weeks' gestation. 19,112 neonates were males. Birth weight, cesarean sections and operative deliveries were significantly higher for males. Neonatal hypoglycemia and immediate neurological complications were significantly more frequent in males. For term SGA's, low 5-min apgar scores (<7) at 39-40 weeks were 2.65 times higher for males compared with females, as was hypoglycemia. CONCLUSIONS: Male infants at term, especially male SGA infants, are more likely to encounter complications during labor and require special neonatal care due to metabolic and/or neurological complications.


Assuntos
Doenças do Recém-Nascido/epidemiologia , Recém-Nascido Pequeno para a Idade Gestacional , Razão de Masculinidade , Adulto , Peso ao Nascer , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Recém-Nascido , Masculino , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Adulto Jovem
16.
Prenat Diagn ; 33(5): 436-41, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23494892

RESUMO

OBJECTIVE: The aim of this research was to evaluate the ability of three-dimensional (3D) ultrasound for demonstrating the palate of fetuses at high risk for cleft palate. METHOD: Fifty-seven fetuses at high risk for cleft palate were referred for specialist ultrasound at 12-40 weeks' gestation. A detailed assessment of palate was made using both two-dimensional and 3D ultrasounds on the axial plane. Antenatal diagnoses were compared with postnatal findings. RESULTS: Cleft palate was suspected in 13 (22.8%); a normal palate was demonstrated in 38 (67%), and in six (10.2%), the palate view could not be obtained. Mean gestational age at the first visit was 27 weeks 6 days (range of 12-40 weeks 3 days). Examination after delivery revealed that one of the 38 fetuses with presumed normal palate had a cleft hard palate, and one had a cleft soft palate (false negative 5%). Among the 13 fetuses with suspected cleft palate, three had an intact palate (false-positive 23%). Sensitivity, specificity, positive predictive value, and negative predictive value of detection of palatal clefts were 71.4%, 91.9%, 62.5%, and 94.4%, respectively. CONCLUSION: Using 3D technology, we diagnosed a cleft palate in 83% of high-risk cases, with 5% false negative. 3D technology might produce some technical artifacts resulting in a 23% false-positive rate.


Assuntos
Fissura Palatina/diagnóstico por imagem , Imagem Tridimensional , Palato/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Fissura Palatina/epidemiologia , Feminino , Feto/anormalidades , Idade Gestacional , Humanos , Imagem Tridimensional/métodos , Imagem Tridimensional/estatística & dados numéricos , Recém-Nascido , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal/estatística & dados numéricos
17.
J Ultrasound Med ; 32(4): 587-92, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23525383

RESUMO

OBJECTIVES: The purpose of this study was to examine the uterine cavity within 48 hours of delivery using 2- and 3-dimensional sonography after normal vaginal deliveries, instrumental deliveries, exploration of the uterine cavity, and cesarean deliveries. METHODS: A prospective study was performed in puerperal women with normal clinical examination findings. Measurements of the uterine length and width were taken in the midsagittal and coronal planes. Midsagittal measurements of the endometrium using 2- and 3-dimensional sonography and virtual organ computer-aided analysis were performed. Comparisons were made between normal and surgical vaginal deliveries, cesarean deliveries, and after exploration of the uterine cavity. RESULTS: A total of 123 patients were examined. Seventy-seven patients had normal vaginal deliveries; 21 had assisted vaginal deliveries; and 25 had cesarean deliveries. Thirteen underwent exploration of the uterine cavity. The uterine volume increased significantly as the birth weight increased and after cesarean delivery (P < .05). No correlation was found between the endometrial volume and parity, birth weight, and mode of delivery, including no correlation with exploration. Five cases of placental residua were found in asymptomatic women. All delivered vaginally. None underwent exploration of the uterus. All had irregular echogenic masses in the uterine cavity with positive color Doppler findings. The endometrial thickness and volume were significantly higher in these patients. CONCLUSIONS: Sonography along with Doppler assessment has added value in the clinical evaluation of the puerperal women, being able to also show residua in asymptomatic women. Three-dimensional sonography did not show an advantage over 2-dimensional sonography in the estimation of the puerperal uterus or residua.


Assuntos
Parto Obstétrico , Endométrio/diagnóstico por imagem , Imagem Tridimensional , Período Pós-Parto , Peso ao Nascer , Cesárea , Extração Obstétrica , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Ultrassonografia Doppler/métodos
18.
J Perinat Med ; 40(5): 489-93, 2012 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-22945274

RESUMO

OBJECTIVE: To examine the correlation between measurements of crown rump length (CRL), nuchal translucency (NT), and birth weight in dichorionic (DC) and monochorionic (MC) twin pregnancies. METHODS: A retrospective analysis was performed on all twin term pregnancies delivered between 2001 and 2007 at the McGill University Health Center. Data collected included maternal age, CRL and NT measurement, results of glucose challenge test, birth weight and length, gestational age at delivery, and fetal gender. RESULTS: The study population comprised 792 fetuses: 94 MC/DA and 698 DC/DA. Maternal age, gestational age at delivery, birth weight, and birth length were all significantly higher for the DC group. Male fetuses had significantly higher NT and higher birth weight than female fetuses. Discordance in CRL was found to correlate with discordance in birth weight in the entire study population (P<0.0001, R=0.25), in the DC twins (P<0.0001, R=0.275), but not in MC twins (R=0.10, P=0.33). CRL discordance above the 90th percentile (>12%) predicted 14/40 pregnancies with birth weight discordance above the 90th percentile (>24%) [P<0.001, LR=4.1 (2.6-6.2)]. CRL discordance above the 95th percentile (>16%) predicted 5/21 pregnancies with birth weight discordance above the 95th percentile (>30%) [P<0.001, LR=5.5 (2.6-10.4)]. NT discordance was correlated with CRL discordance (R=0.15, P<0.0001), but not with birth weight, regardless of chorionicity or gender. CONCLUSION: In twin pregnancies, CRL discordance in first trimester can predict discordance of more than 25% in neonatal birth weight.


Assuntos
Peso ao Nascer , Estatura Cabeça-Cóccix , Medição da Translucência Nucal , Gravidez de Gêmeos , Gêmeos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Primeiro Trimestre da Gravidez , Adulto Jovem
19.
Med Sci Monit ; 18(9): PH77-81, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22936200

RESUMO

BACKGROUND: To compare maternal and neonatal outcomes of term macrosomic and adequate for gestational age (AGA) pregnancies. MATERIAL/METHODS: A retrospective analysis was performed on all term singleton macrosomic (birth weight ≥4000 g) and AGA (birth weight >10th percentile and <4000 g) pregnancies delivered at our hospital between 2004 and 2008. Data collected included maternal age, gestational age at delivery, mode of delivery, birth weight, fetal gender, maternal and neonatal complications. Comparisons were made between macrosomic and AGA pregnancies and between different severities of macrosomia (4000-4250 g, 4250-4500 g and ≥4500 g). RESULTS: The study population comprised of 34,685 pregnancies. 2077 neonates had birth weight ≥4000 g. Maternal age and gestational age at delivery were significantly higher for macrosomic neonates. Significantly more macrosomic neonates were born by cesarean section, and were complicated with shoulder dystocia, neonatal hypoglycemia, and had longer hospitalization period (both in vaginal and cesarean deliveries). Specifically, the odds ratio (OR) relative to AGA pregnancies for each macrosomic category (4000-4250 g, 4250-4500 g and ≥4500 g) of shoulder dystocia was 2.37, 2.24, 7.61, respectively, and for neonatal hypoglycemia 4.24, 4.41, 4.15, respectively. The risk of post partum hemorrhage was statistically increased when birth weight was >4500 g (OR=5.23) but not for birth weight between 4000-4500 g. No differences were found in the rates of extensive perineal lacerations between AGA and the different macrosomic groups. CONCLUSIONS: Macrosomia is associated with increased rate of cesarean section, shoulder dystocia, neonatal hypoglycemia, and longer hospitalization, but not associated with excessive perineal tears. Increased risk of PPH was found in the >4500 g group.


Assuntos
Distocia/epidemiologia , Macrossomia Fetal/epidemiologia , Hipoglicemia/epidemiologia , Mortalidade Materna/história , Hemorragia Pós-Parto/epidemiologia , Resultado da Gravidez/epidemiologia , Cesárea/estatística & dados numéricos , Distocia/etiologia , Feminino , Macrossomia Fetal/complicações , Peso Fetal/fisiologia , História do Século XXI , Humanos , Israel/epidemiologia , Modelos Logísticos , Razão de Chances , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Retrospectivos
20.
Acta Obstet Gynecol Scand ; 91(7): 844-9, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22471810

RESUMO

OBJECTIVE: To compare maternal and neonatal outcomes of term large for gestational age (LGA) pregnancies and adequate for gestational age (AGA) pregnancies. DESIGN: Retrospective analysis. SETTING: Large university research medical center. POPULATION: All term singleton LGA (birthweight ≥ 90th percentile) and AGA pregnancies (birthweight 10.1-89.9th percentile) delivering between 2004 and 2008. METHODS: Data collected included maternal age, gestational age at delivery, mode of delivery, birthweight, fetal sex, and maternal and neonatal complications. Birthweight percentiles were determined according to locally derived gender-specific birthweight tables. MAIN OUTCOME MEASURES: Comparisons between LGA and AGA pregnancies and between LGA 90-94.9th, 95-98.9th and ≥ 99th percentile. RESULTS: The study population comprised 34 685 pregnancies; 3900 neonates matched the definition of term LGA. Maternal age and gestational age at delivery were significantly higher for LGA neonates. Significantly more LGA neonates were born by cesarean section, and significantly more LGA pregnancies were complicated by postpartum hemorrhage (PPH), shoulder dystocia or neonatal hypoglycemia, and had a longer hospitalization period. Maternal and neonatal risks increased as birthweight increased from the 90-94.9th to 95-98.9th to ≥ 99th percentile. Specifically, the risks of shoulder dystocia (odds ratio 2.61, 3.35 and 5.11, respectively), PPH (odds ratio 1.81, 2.12 and 3.92, respectively) and neonatal hypoglycemia (odds ratio 2.53, 3.8 and 5.19, respectively) all increased linearly with birthweight percentile. CONCLUSIONS: Large for gestational age pregnancies are associated with an increased rate of cesarean section, PPH, shoulder dystocia and neonatal hypoglycemia, as well as longer hospitalization. These risks increase as the birth percentile rises. These risks need to be emphasized in pre-delivery counseling.


Assuntos
Macrossomia Fetal/epidemiologia , Idade Gestacional , Doenças do Recém-Nascido/epidemiologia , Resultado da Gravidez , Adolescente , Adulto , Cesárea/estatística & dados numéricos , Distribuição de Qui-Quadrado , Distocia/epidemiologia , Feminino , Humanos , Hipoglicemia/epidemiologia , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Idade Materna , Pessoa de Meia-Idade , Hemorragia Pós-Parto/epidemiologia , Gravidez , Estudos Retrospectivos
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