First trimester malformation screening.

First trimester fetal malformation screening still represents a diagnostic challenge in modem obstetrics. Being solely dependent on ultrasound instrumentation, and the skill and experience of the operator, recently improved by introducing high frequency transvaginal approach and digital image processing. This opens a new field of ultrasound in obstetrics called sonoembriology. Until now sonoembriology in routine clinical practice resulted in numerous reports about early detection of rare anomalies and uncommon syndromes. The reported sensitivity of sonoembriology with a respect to a final pregnancy outcome was more than 60% of all malformations in total, while in combination with ultrasound screening in second trimester, increases to in excess of 80%. The commonest anomalies detected by sonoembriology are anomalies of the head and brain, heart, abdominal wall, unbilical cord, urinary tract and skeleton. There is an important role of sonoembriology in the assessment of the nuchal translucency in the screening programme for chromosomal anomalies. This changes the well-known concept "fetus as a patient" to "embryo as a patient" and opens new frontiers in fetal diagnosis and therapy.

[Polycystic ovary syndrome--Doppler parameters]. / Policisticni ovarijski sindrom--doplerski parametri.

OBJECTIVE: To evaluate the value of transvaginal color and pulsed Doppler measurements of the uterine and ovarian arteries in infertile patients with polycystic ovarian syndrome (PCOS). STUDY DESIGN: Prospective controlled trial included forty (40) patients with PCOS and 40 healthy women. All the patients were examined by transvaginal color and pulsed Doppler on the 5th, 10th, 12th, 15th, 21st and 24th day of the menstrual cycle. The hormonal profile (estradiol (E2), luteinizing hormone (LH), follicular stimulating hormone (FSH), progesterone, testosterone and prolactin) was correlated to the Doppler results. RESULTS: The flow velocity patterns of uterine and ovarian vessels showed changes during the normal ovulatory menstrual cycle, while in the patients with PCOS these changes did not occur. The high resistance index (RI = 1.0) with reverse flow was detected in both ovarian arteries in PCOS group, and showed no cyclic changes. Ovarian stromal and hilar arterial impedance (0.54 +/- 0.05) as well as uterine artery resistance index (0.91 +/- 0.09) did not show significant changes during the menstrual cycle. CONCLUSIONS: Our study suggests that a large fraction of patients suffering from PCOS has elevated uterine artery resistance index despite normal plasma E2 levels. It can be postulated that excessive production of ovarian factor (other than E2) may increase the uterine resistance and alter the endometrial receptivity. This finding may explain why endometrial receptivity is shown to be poor in patients with PCOS. Estimation of uterine and ovarian arterial impedance values seems to have clinical impact in the management of these patients attending an in vitro fertilization program.

Successful pregnancy after hysteroscopic removal of grade I endometrial carcinoma in a young woman with Lynch syndrome.

In a woman at the age of 30, carcinoma of the endometrium was diagnosed after hysteroscopic polypectomy. Her family history fulfilled Bethesda diagnostic criteria for Lynch syndrome or hereditary nonpolyposis colon cancer. Conservative treatment was chosen based on the tumor grade, her age, and her desire for pregnancy. Three months after high-dose progesterone treatment successful conception was achieved. In this report, we suggest that individual approach should be considered in young women with low-grade endometrial carcinoma, positive family history, and unfulfilled motherhood.

Doppler information pertaining to the intrapartum period.

The aim of the study was to evaluate the use of color-Doppler velocimetry during the labor. 325 intrapartal measurements of the umbilical artery, fetal aorta, middle cerebral artery and arcuate arteries were performed in a group of 105 patients. The resistance index (RI) and pulsatility index (PI) were measured. During the active labor the RI and PI of the umbilical artery remained unchanged. The impedance in arcuate arteries have increased (p < 0.05). The RI and PI of the middle cerebral artery showed non significantly increased mean values when compared with the corresponding values during pregnancy. But, a short term, transitory decreased impedance is registered during the decrement slope of contraction. Since fetal outcome was normal in all newborns, these changes are considered as physiologic.