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1.
Artigo em Inglês | MEDLINE | ID: mdl-38923672

RESUMO

We present two critical cases of life-threatening postpartum hemorrhage (PPH) due to amniotic fluid embolism (AFE) complicated by disseminated intravascular coagulopathy (DIC). These cases are the first to show the effectiveness of resuscitative endovascular balloon occlusion of the aorta (REBOA) for patient survival. In Case 1, the patient, experiencing critical conditions with severe PPH and DIC despite conventional treatments, including rapid blood transfusion and fibrinogen concentrate, was air-transferred to our hospital, where REBOA was promptly employed before hysterectomy was completed. Case 2 involved an ambulance-transferred patient with massive PPH and DIC despite conventional treatments. Prehospital REBOA was performed to prevent cardiac arrest during transfer, and hysterectomy was performed in the hospital. Given the rapid deterioration associated with AFE, REBOA can serve as a bridge until complete hemostasis to maintain vital signs and control bleeding in patients unresponsive to standard therapies before hemostatic interventions or during transfer.

2.
Acta Obstet Gynecol Scand ; 102(7): 914-920, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37194424

RESUMO

INTRODUCTION: We aimed to describe physiological changes in endometrial blood flow (minute arterioles running through the endometrium) from ovulation to the mid-luteal phase using superb microvascular imaging. MATERIAL AND METHODS: The study involved 17 women (median age, 32.5 years; first to third interquartile range, 29.8-40.0 years) with regular menstrual cycles who were managed in our institute from 2020 to 2021. The uterus was delineated at the sagittal section using transvaginal ultrasonography incorporated with superb microvascular imaging. For each participant, a total of 28 cycles were observed; 17 cycles observed within one day of ovulation and the implantation period, 5-7 days (D5-7) after ovulation in the same cycle, and nine cycles in which only ovulation was observed, and two cycles in which only D5-7 was observed. Therefore, 26 and 19 images at ovulation and D5-7, respectively, were acquired. Endometrial blood flow was evaluated by depth of the vascular signal in the endometrium and categorized as follows: signals only in the basal layer of the endometrium (grade 1), reaching up to half the endometrium (grade 2), and covering the whole endometrium (grade 3). Changes in the grade of endometrial blood flow from ovulation to D5-7 after ovulation, and the relationship between the grade of endometrial blood flow and the endometrial thickness on ovulation and D5-7 after ovulation, were analyzed. Statistical significance was set at p < 0.05. RESULTS: The endometrial blood flow from ovulation to D5-7 after ovulation during the same menstrual period showed a downgrade in 14 of 17 cycles (82.3%) and no change in the remaining three cycles (17.6%), indicating a decrease in the endometrial blood flow from ovulation to D5-7 after ovulation (p = 0.001). There were differences between the grade of endometrial blood flow and median endometrial thickness on ovulation (grade 1: 5.9 mm, grade 2: 9.1 mm, and grade 3: 11.2 mm); however, no differences in the endometrial thickness were found between the grades on D5-7 after ovulation. CONCLUSIONS: In the normal menstrual cycle, endometrial blood flow decreased from ovulation to the mid-luteal phase, and the endometrial thickness in the ovulatory phase was related to the endometrial perfusion.


Assuntos
Endométrio , Fase Luteal , Feminino , Humanos , Adulto , Endométrio/diagnóstico por imagem , Ovulação/fisiologia , Ciclo Menstrual/fisiologia , Útero/irrigação sanguínea
3.
J Clin Ultrasound ; 51(7): 1179-1181, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37571810

RESUMO

We present the first report of a case with a peculiar configurational change in the lower uterine segment detected during transvaginal ultrasonography observation over a short period of time at 25 weeks of gestation, predicting the presence of uterine scar dehiscence at term.


Assuntos
Cesárea , Cicatriz , Gravidez , Feminino , Humanos , Cicatriz/complicações , Cicatriz/diagnóstico por imagem , Cicatriz/patologia , Útero/diagnóstico por imagem , Útero/patologia , Ultrassonografia
4.
J Obstet Gynaecol Res ; 48(7): 1983-1988, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35491084

RESUMO

We present a case of fetal atrioventricular block, heterotaxy, and ventricular noncompaction observed longitudinally from the first to early second trimesters using B-mode and Doppler imaging, including superb microvascular imaging. At 12 weeks of gestation, the atrial and ventricular rates were 133 and 67 beats/min, respectively, and dextrocardia was noted. At 15 weeks of gestation, detailed sonography revealed ventricular septal defect, interruption of the inferior vena cava, dilated azygos vein, and double-outlet right ventricle. In addition, superb microvascular imaging revealed irregular contours in the anatomical left ventricular wall, indicating prominent trabeculations of the ventricle, which were characteristic findings of ventricular noncompaction. At 21 weeks of gestation, intrauterine fetal death occurred, and the autopsy revealed complex congenital heart disease, including ventricular noncompaction.


Assuntos
Bloqueio Atrioventricular , Comunicação Interventricular , Síndrome de Heterotaxia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Síndrome de Heterotaxia/complicações , Síndrome de Heterotaxia/diagnóstico por imagem , Humanos , Gravidez , Ultrassonografia Pré-Natal/métodos
5.
J Obstet Gynaecol Res ; 47(1): 411-415, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32830398

RESUMO

We present a case of a 34-year-old pregnant woman with a prior cesarean delivery presenting with placenta previa. Placenta previa accreta was diagnosed from missing decidual flow signals using superb microvascular imaging (SMI). At 31 weeks' gestation, B-mode ultrasonography showed that the placenta was attached to the anterior uterine segment, extending over the internal cervical os. In normally appearing myometrium, SMI demonstrated double layers of flow signals underneath the placental basal plate, corresponding to myometrial and decidual flows. The thin myometrium located on the bladder where sonolucent zones were not visible revealed three different flow patterns in the Doppler signals underneath the basal plate as follows: double layers (both myometrium and decidual tissues present); a single layer (myometrium alone) or no layers (decidual tissues missing). A cesarean hysterectomy was performed at 37 weeks, and histology confirmed the presence of placenta accreta.


Assuntos
Placenta Acreta , Placenta Prévia , Adulto , Feminino , Humanos , Placenta , Placenta Acreta/diagnóstico por imagem , Gravidez , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal
6.
J Obstet Gynaecol Res ; 47(2): 495-500, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33164296

RESUMO

AIM: The purpose of this study was to establish a simple method to distinguish premature ventricular contractions (PVC) from premature atrial contractions (PAC) using a fetal Doppler ultrasound arterial pulse waveform to measure time intervals between sinus node restarting. METHODS: We retrospectively identified 14 fetuses with premature contraction (8 with PAC, 6 with PVC). We measured two distinct parts of time intervals using an arterial pulsed-wave Doppler: the two consecutive waveforms just before the premature contraction (2-V interval) and two consecutive waveforms including the premature contraction (XV interval) to measure time intervals between sinus node restarting. We then evaluated the time difference between the 2-V and XV intervals in PVC compared to PAC. RESULTS: For PVC, the difference between the 2-V interval and the XV interval was significantly shorter than that for PAC. A cut-off point of 33 ms, where a difference ≤33 ms was clearly shown to be associated with a PVC and a difference more than 33 ms signified a PAC was demonstrated. CONCLUSION: The 2-V and XV interval measurements, used to measure time intervals between sinus node restarting, could easily distinguish PVC from PAC in utero. Therefore, this study could potentially be a feasible and effective method for obstetricians or sonographers to employ usefully.


Assuntos
Complexos Ventriculares Prematuros , Pressão Arterial , Feto , Humanos , Estudos Retrospectivos , Ultrassonografia Doppler de Pulso
7.
Artigo em Inglês | MEDLINE | ID: mdl-33047457

RESUMO

We present a patient with systemic lupus erythematosus receiving long-term steroid therapy, who had myometrial thinning, markedly thickened placenta, and fetal growth restriction (FGR). Blood flow profiles of the myometrium, decidua and placental villous vessels (VV) were described using superb microvascular imaging (SMI) at 35 weeks' gestation. Images showed no decidual blood flow underneath the placenta sitting on a thin myometrium and sparse VV distribution and non-visualization of peripheral VV flow. Emergency cesarean hysterectomy was performed at 36 weeks. Histological findings showed missing decidua on the thin myometrium, which indicated placenta accreta spectrum, and massive perivillous fibrin deposition and increased numbers of syncytial knots in the placenta. We speculated that the thick placenta and peculiar VV flow profiles resulted from congestion of the intervillous space and intervillous underperfusion/low intraplacental oxygenation, respectively, resulting in FGR. Superb microvascular imaging is useful for diagnosing placenta accreta spectrum and understanding the pathophysiology of thick placenta and FGR.

8.
J Perinat Med ; 47(4): 393-401, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-30817303

RESUMO

Background This study aimed to analyze age-related changes in shear wave speed (SWS) of the normal uterine cervix. Methods We studied 362 women with a normal singleton pregnancy at 12-35 weeks' gestation. The SWS of the cervix was measured using transvaginal ultrasonography at the internal os region of the anterior cervix (IOA), posterior cervix (IOP) and cervical canal (IOC), and at the external os region of the anterior cervix (EOA), posterior cervix (EOP) and cervical canal (EOC). The following parameters were analyzed: (1) time trend of SWS of the individual sampling points, (2) comparison of SWS in the internal cervical region and SWS in the external cervical region, and (3) comparison of SWS between the internal and external cervical regions. Statistical analyses were performed using mixed-effects models. Results The SWS of IOP decreased in bilinear regression, with a critical change in the rate at 22 weeks, whereas the SWS of the remaining points decreased linearly. The estimated values of SWS of IOP at 84, 154 and 251 days were higher than those of IOA and IOC (P<0.001). The estimated values of SWS of IOP at 84 and 154 days were higher than those of EOP (P<0.001). Significant differences between IOP and EOP were shown until 244 days (P<0.05). The estimated value of SWS of IOC at 84 days was higher than that of EOC (P<0.001). Significant differences between IOC and EOC were shown until 210 days (P<0.05). Conclusion The SWS of the uterine cervix in pregnancy decreases with advancing gestation. The SWS of IOP had the highest value among the sampling points with unique characteristics.


Assuntos
Colo do Útero/diagnóstico por imagem , Adulto , Feminino , Humanos , Gravidez , Trimestres da Gravidez , Ultrassonografia Pré-Natal , Adulto Jovem
9.
J Obstet Gynaecol Res ; 44(4): 630-636, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29315994

RESUMO

AIM: We aimed to clarify the usefulness of procalcitonin (PCT) in the evaluation of histological chorioamnionitis (CAM) and in the prediction of neonatal and infantile outcomes as a reference of interleukin-6 (IL-6). METHODS: Subjects were 36 singleton pregnant women delivered at 22-37 weeks' gestation due to threatened premature delivery and/or preterm premature rupture of membranes. Cases were classified into the CAM and non-CAM groups, according to Blanc's criteria. Comparisons were made on umbilical venous and amniotic fluid PCT levels among the groups. The relations between umbilical venous PCT and IL-6 levels and neonatal and infantile outcomes were also analyzed. RESULTS: The umbilical venous PCT level in the CAM group (240.2 pg/mL, 125.4-350.3 pg/mL: median, first quartile-third quartile) was higher than that in the non-CAM group (105.1, 50.2-137.5 pg/mL; P = 0.0006). There were no differences in the amniotic fluid PCT levels between the groups. There was a strong correlation between umbilical venous PCT and IL-6 levels (correlation coefficient: 0.793). Among 10 cases with an umbilical venous PCT level of ≥170.0 pg/mL and six cases with IL-6 ≥ 11.0 pg/mL, six (60.0%) and five cases (83.3%), respectively, had adverse neonatal and infantile outcomes. Among seven cases with adverse neonatal and infantile outcomes, six (85.7%) and five (71.4%) cases showed umbilical venous PCT levels of ≥170.0 pg/mL and IL-6 levels of ≥11.0 pg/mL, respectively. CONCLUSION: Similar to IL-6, the umbilical venous PCT level is a promising parameter for predicting histological CAM and adverse neonatal and infantile outcomes related to in utero inflammatory status.


Assuntos
Líquido Amniótico/metabolismo , Calcitonina/sangue , Corioamnionite/diagnóstico , Sangue Fetal/metabolismo , Doenças do Recém-Nascido/diagnóstico , Corioamnionite/sangue , Feminino , Humanos , Recém-Nascido , Gravidez
10.
Kurume Med J ; 70(1.2): 69-72, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38763740

RESUMO

A 35-year-old pregnant woman was referred to our institution at 33 weeks' gestation for evaluation of a fetal abdominal tumor. B-mode ultrasonography demonstrated a massive lesion. Bidirectional power Doppler mode showed abundant blood flow surrounding the tumor. On superb micro-vascular imaging, various Doppler signal patterns were observed within the tumor, including diffuse fine dotted-like signals, linear flow, and internal shunt flow. Sequential observations of the tumor and cardiac cycles also revealed pulsatile flow beneath the edges of the tumor and continuous fine flow in the central area, resembling a 'centripetal fill-in' appearance on contrast computed tomography. Therefore, we assumed the fetal tumor to be a hepatic hemangioma. Fetal heart failure was detected at 37 weeks' gestation, and a 2,484-g female infant was delivered with 1- and 5-min Apgar scores of 7 and 8, respectively. A postnatal contrast computed tomography examination showed a progressive centripetal fill-in appearance, leading to a diagnosis of hepatic hemangioma. Kasabach-Merritt syndrome was also noted. Intensive treatment was performed, and the infant was discharged at 3 months after birth. In summary, we experienced a case of hepatic hemangioma diagnosed in utero using superb micro-vascular imaging. And basing seamless postnatal treatments on prenatal imaging findings may help to reduce the perinatal mortality.


Assuntos
Hemangioma , Neoplasias Hepáticas , Ultrassonografia Pré-Natal , Humanos , Feminino , Neoplasias Hepáticas/diagnóstico por imagem , Gravidez , Adulto , Hemangioma/diagnóstico por imagem , Ultrassonografia Doppler , Recém-Nascido , Síndrome de Kasabach-Merritt/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Microvasos/diagnóstico por imagem
11.
Kurume Med J ; 69(3.4): 127-133, 2024 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-38233187

RESUMO

AIM: To investigate the natural history of fetal ovarian cysts and elucidate the risk factors for postnatal adverse outcomes in fetal ovarian cysts. METHODS: The study subjects were 18 cases with ovarian cysts prenatally diagnosed using ultrasonography at our hospital between 2007 and 2020. The subjects were classified by cyst characteristics according to echogenic patterns [simple cyst (S) and complex cyst (C)], changes in echogenic patterns (S-to-S, S-to-C, and C-to-C), and diameters (<40 and ≥ 40 mm). Clinical parameters and outcomes were compared between S and C patterns, S-to-S and S-to-C patterns, and <40 and ≥ 40 mm diameters. RESULTS: Cases with S and C patterns (15 and 3, respectively) had median gestational ages of 35 and 36 weeks, respectively, and maximum cyst diameters of 36 and 57mm, respectively. The number of cases with S-to-S, S-to-C and C-to-C patterns were 11, 4 and 3, respectively. The maximum cyst diameter in cases with S-to-C patterns (58 mm) was larger than that in cases with S-to-S patterns (34 mm) (P<0.05). Placental weight in cases with cysts >40 mm and/or cyst expansion was greater than that in cases with neither or both conditions (P<0.05). Spontaneous resolution (before and after birth) occurred in 8 of 9 and 3 of 9 cases with maximum cyst diameters <40 and ≥ 40 mm, respectively. Ovarian function was lost in 2 cases with S-to-C patterns and in 2 cases with C-to-C patterns. CONCLUSION: Cases with cyst diameters ≥ 40 mm and/or cyst expansion during the late third trimester had greater placental weight and more postnatal adverse outcomes.


Assuntos
Idade Gestacional , Cistos Ovarianos , Ultrassonografia Pré-Natal , Humanos , Feminino , Cistos Ovarianos/diagnóstico por imagem , Gravidez , Fatores de Risco , Adulto , Recém-Nascido , Doenças Fetais/diagnóstico por imagem , Estudos Retrospectivos , Resultado da Gravidez
12.
BMC Med Imaging ; 13: 42, 2013 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-24321242

RESUMO

BACKGROUND: Sentinel node biopsy often results in the identification and removal of multiple nodes as sentinel nodes, although most of these nodes could be non-sentinel nodes. This study investigated whether computed tomography-lymphography (CT-LG) can distinguish sentinel nodes from non-sentinel nodes and whether sentinel nodes identified by CT-LG can accurately stage the axilla in patients with breast cancer. METHODS: This study included 184 patients with breast cancer and clinically negative nodes. Contrast agent was injected interstitially. The location of sentinel nodes was marked on the skin surface using a CT laser light navigator system. Lymph nodes located just under the marks were first removed as sentinel nodes. Then, all dyed nodes or all hot nodes were removed. RESULTS: The mean number of sentinel nodes identified by CT-LG was significantly lower than that of dyed and/or hot nodes removed (1.1 vs 1.8, p <0.0001). Twenty-three (12.5%) patients had ≥2 sentinel nodes identified by CT-LG removed, whereas 94 (51.1%) of patients had ≥2 dyed and/or hot nodes removed (p <0.0001). Pathological evaluation demonstrated that 47 (25.5%) of 184 patients had metastasis to at least one node. All 47 patients demonstrated metastases to at least one of the sentinel nodes identified by CT-LG. CONCLUSIONS: CT-LG can distinguish sentinel nodes from non-sentinel nodes, and sentinel nodes identified by CT-LG can accurately stage the axilla in patients with breast cancer. Successful identification of sentinel nodes using CT-LG may facilitate image-based diagnosis of metastasis, possibly leading to the omission of sentinel node biopsy.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Linfografia/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Idoso , Axila , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Japão/epidemiologia , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prevalência , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade
13.
BMC Med Imaging ; 13: 32, 2013 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-24028426

RESUMO

BACKGROUND: We previously demonstrated that superparamagnetic iron oxide (SPIO)-enhanced MR imaging is promising for the detection of metastases in sentinel nodes localized by CT-lymphography in patients with breast cancer. The purpose of this study was to determine the predictive criteria of the size of nodal metastases with SPIO-enhanced MR imaging in breast cancer, with histopathologic findings as reference standard. METHODS: This study included 150 patients with breast cancer. The patterns of SPIO uptake for positive sentinel nodes were classified into three; uniform high-signal intensity, partial high-signal intensity involving ≥50% of the node, and partial high-signal intensity involving <50% of the node. Imaging results were correlated with histopathologic findings. RESULTS: Thirty-three pathologically positive sentinel nodes from 30 patients were evaluated. High-signal intensity patterns that were uniform or involved ≥50% of the node were observed in 23 nodes that contained macro-metastases and no node that contained micro-metastases, while high-signal intensity patterns involving <50% of the node were observed in 2 nodes that contained macro-metastases and 8 nodes that contained micro-metastases. When the area of high-signal intensity was compared with the pathological size of the metastases, a pathologic >2 mm sentinel node metastases correlated with the area of high-signal intensity, however, a pathologic ≤2 mm sentinel node metastases did not. CONCLUSIONS: High-signal intensity patterns that are uniform or involve ≥50% of the node are features of nodes with macro-metastases. The area of high-signal intensity correlated with the pathological size of metastases for nodes with metastases >2 mm in this series.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Carcinoma/diagnóstico , Carcinoma/secundário , Dextranos , Biópsia Guiada por Imagem/estatística & dados numéricos , Imageamento por Ressonância Magnética/métodos , Nanopartículas de Magnetita , Adulto , Idoso , Carcinoma/epidemiologia , Meios de Contraste , Feminino , Humanos , Japão/epidemiologia , Metástase Linfática , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e Especificidade , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Carga Tumoral
14.
J Med Ultrason (2001) ; 40(2): 153-6, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27277105

RESUMO

Congenital aortico-left ventricular tunnel (ALVT) is a rare congenital heart disease. A 27-year-old woman was referred to us at 37 weeks gestation with fetal cardiac enlargement. The left ventricle (LV) of the fetus was enlarged. Fetal aortic valve (AoV) ring diameter spread was observed. Back flow from the AoV margins to the LV was observed. The prenatal diagnosis of the fetus was aortic regurgitation (AR). A male neonate was delivered by cesarean section at 40 weeks gestation. We made the diagnosis of ALVT because the aorta and the LV of the neonate showed a tunnel with blood flow on echocardiography. We took another look at the fetal echocardiography. The neonate underwent surgery for exacerbation of heart failure on the 7th day after birth. Trivial flow from the tunnel and mild AR were observed after surgery.

15.
Ann Surg Oncol ; 18(12): 3422-9, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21607775

RESUMO

BACKGROUND: Superparamagnetic nanoparticle-enhanced magnetic resonance (MR) imaging has been reported to be a promising improvement for diagnostic imaging of lymph node metastases from various tumors. Moreover, sentinel nodes have been reported to be well identified using computed tomography (CT) lymphography (CT-LG) in patients with breast cancer. The aim of this study was to evaluate MR imaging with superparamagnetic iron oxide (SPIO) enhancement for the detection of metastases in sentinel nodes localized by CT-LG in patients with breast cancer. METHODS: This study included 102 patients with breast cancer and clinically negative nodes. Sentinel nodes were identified by CT-LG, and SPIO-enhanced MR imaging of the axilla was performed to detect metastases in the sentinel nodes. A node was considered nonmetastatic if it showed a homogenous low signal intensity and metastatic if the entire node or a focal area did not show low signal intensity on MR imaging. Sentinel node biopsy was performed, and imaging results were correlated with histopathologic findings. RESULTS: The mean number of sentinel nodes identified by CT-LG was 1.1 (range, 1-3). The sensitivity, specificity, and accuracy of MR imaging for the diagnosis of sentinel node metastases were 84.0%, 90.9%, and 89.2%, respectively. In 4 of 10 patients with micrometastases, metastases were not detected, but all 15 patients with macrometastases were successfully identified. CONCLUSIONS: SPIO-enhanced MR imaging is a useful method of detecting metastases in sentinel nodes localized by CT-LG in patients with breast cancer and may avoid sentinel node biopsy when the sentinel node is diagnosed as disease-free.


Assuntos
Neoplasias da Mama/diagnóstico , Dextranos , Doenças Linfáticas/diagnóstico , Linfografia , Imageamento por Ressonância Magnética , Nanopartículas de Magnetita , Tomografia Computadorizada por Raios X , Adulto , Idoso , Meios de Contraste , Feminino , Humanos , Aumento da Imagem , Metástase Linfática , Pessoa de Meia-Idade , Micrometástase de Neoplasia , Estadiamento de Neoplasias , Prognóstico , Sensibilidade e Especificidade , Biópsia de Linfonodo Sentinela
16.
Kurume Med J ; 66(2): 85-92, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34135197

RESUMO

The quality of prenatal diagnosis of fetal abnormalities has advanced with improved resolution of ultrasound imaging and cytogenetic/molecular analysis. In this article, we briefly review the history of diagnosing fetal abnormalities and the current status of prenatal diagnosis during the first trimester (up to the first 14 weeks' gestation), focusing especially on fetal malformations and chromosomal abnormalities. As for detectable morphological abnormalities, roughly half of all major structural anomalies including those in the central nervous system, cardiovascular system and gastrointestinal system can be detected, if not definitely diagnosed. For screening of chromosomal abnormalities, especially for trisomy 21, ultrasound soft markers such as increased nuchal translucency, maternal serum markers and their combinations have been implemented. More recently, non-invasive prenatal testing, by analyzing cell-free DNA in maternal serum, is now available to detect chromosomal abnormalities with higher predictability. Although invasive chorionic villus sampling offers definite diagnosis for chromosomal abnormalities during the first trimester, non-invasive diagnostic techniques are patient-friendly and promising in the future perspectives on prenatal diagnosis for chromosomal abnormalities.


Assuntos
Aberrações Cromossômicas , Doenças Fetais/diagnóstico por imagem , Teste Pré-Natal não Invasivo/métodos , Diagnóstico Pré-Natal , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Trissomia
17.
Taiwan J Obstet Gynecol ; 58(4): 566-569, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307753

RESUMO

OBJECTIVE: We present a case with prenatal diagnosis of Treacher-Collins syndrome in which micrognathia and other facial and ear abnormalities were described using a three- and four-dimensional (3D/4D) ultrasonography in utero. CASE REPORT: A 39-year-old Japanese pregnant woman was referred because of polyhydramnios at 29 weeks' gestation. Conventional ultrasonography showed a hypoplastic mandible on the sagittal section of fetal head. Continuous observation using a 3D ultrasonography additionally demonstrated bilateral downslanting palpebral fissures with symmetry and macrostomia as well as micrognathia. Both ears were microtia and no polydactyly or missing fingers were found. CONCLUSION: The advantage of the rendering mode of 3D images covering entire face including ears and limbs was enhanced by a continuous observation, so called 4D ultrasonography, under a condition of polyhydramnios, providing visual diagnosis in utero.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Imageamento Tridimensional , Disostose Mandibulofacial/diagnóstico por imagem , Poli-Hidrâmnios/diagnóstico por imagem , Resultado da Gravidez , Ultrassonografia Doppler/métodos , Ultrassonografia Pré-Natal , Adulto , Feminino , Idade Gestacional , Humanos , Imageamento por Ressonância Magnética/métodos , Micrognatismo/diagnóstico por imagem , Gravidez , Diagnóstico Pré-Natal/métodos , Doenças Raras , Síndrome
18.
Sci Rep ; 9(1): 10186, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31308415

RESUMO

Peripartum depression is a common, serious complication in mothers. To assess the influence of infant care, sleep and growth on the risk of peripartum depression, 1,271 mothers of healthy one-month-old infants completed comprehensive questionnaires including the Edinburgh Postnatal Depression Scale. Relationships between high depression scores and variables related to infants' care, sleep and growth were assessed adjusting for other variables. High depression scores were found in 233 mothers, which were associated with variables related to infants' care (poor satisfaction with infant care support, p < 0.001; mothers' passive response to night-time fussing, p = 0.001), sleep (dim bedroom lighting, p < 0.05; short sleep duration, p < 0.05) and growth (poor weight gain, p < 0.05), as well as maternal variables (primiparas, p < 0.001; poor income satisfaction, p < 0.001; poor sleep satisfaction, p < 0.001; daytime sleepiness, p = 0.001). Considering the observed association between high depression scores and infants' care, sleep and growth, a multidisciplinary approach accounting for infant care would be required to prevent peripartum depression.


Assuntos
Depressão Pós-Parto/fisiopatologia , Cuidado do Lactente/psicologia , Mães/psicologia , Adulto , Depressão/metabolismo , Depressão/fisiopatologia , Depressão Pós-Parto/metabolismo , Feminino , Humanos , Lactente , Comportamento do Lactente , Mães/estatística & dados numéricos , Período Periparto , Escalas de Graduação Psiquiátrica , Fatores de Risco , Sono/fisiologia , Distúrbios do Início e da Manutenção do Sono/complicações , Inquéritos e Questionários , Fatores de Tempo
19.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 64(12): 1522-31, 2008 Dec 20.
Artigo em Japonês | MEDLINE | ID: mdl-19151521

RESUMO

SWI and MRA employ the FLASH sequence of gradient echo, and there are many similarities in acquisition parameters between the 2 sequences. We designed an acquisition sequence for the simultaneous collection of SWI and MRA. MRA images were simultaneously collected by changing the TE of the SWI sequence to double echo. The first TE was set to 6.15 msec, 8.61 msec, 11.10 msec of the opposed phase to acquire MRA information. The second TE was set to 20.00 msec to acquire magnetic susceptibility-weighted image information. Double echo, MRA, and SWI were performed in 6 volunteers. The MRI system used was the MAGNETOM Trio A Tim System of SIEMENS Co. Magnetic susceptibility-weighted and MRA images could be simultaneously collected. Evaluation of the main trunk of the cerebral artery in the MRA image was possible, but blood vessels became poorly imaged with transition toward the periphery. Arteries and veins were imaged due to the change to double echo on magnetic susceptibility-weighted imaging. The TE to acquire the best MRA was 6.15 msec of the opposed phase. The imaging of blood vessels by simultaneously collected MRA was impaired because of the inability to use TONE and a short TE. Arteries and veins were imaged by susceptibility-weighted imaging because flow compensation did not function at the second TE.


Assuntos
Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Angiografia por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/métodos , Adulto , Artérias Cerebrais/patologia , Humanos , Angiografia por Ressonância Magnética/instrumentação , Imageamento por Ressonância Magnética/instrumentação , Masculino
20.
Sci Rep ; 7: 44749, 2017 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-28303945

RESUMO

Human sleep-wake cycles are entrained by both natural and artificial light-dark cycles. However, little is known regarding when and how the photoperiod changes entrain the biological clock after conception. To investigate the dependence of sleep patterns in young infants on the natural and artificial light-dark cycles, 1,302 pairs of one-month-old infants and their mothers were asked to answer a questionnaire. Birth in spring, longer daytime sleep duration, early/regular light-off times, and longer maternal nighttime sleep duration were identified as independent variables for longer infant nighttime sleep duration in both univariate and multivariate analyses. Longer maternal nighttime sleep duration was dependent on shorter naps and early/regular bed times but not on the season. We found that nighttime sleep duration depended on both natural and artificial diurnal photoperiod changes in one-month-old infants. Although sleep patterns of infants mimicked those of their mothers, nighttime sleep duration depended on the season, and was positively associated with daytime sleep duration, only in the infants. These specific variables, which render sleep patterns of the infants different from those of their mothers, might be a clue to reveal the covert acquisition process of mature circadian rhythms after birth.


Assuntos
Fotoperíodo , Sono/fisiologia , Adulto , Feminino , Humanos , Lactente , Masculino , Mães , Estações do Ano , Inquéritos e Questionários , Fatores de Tempo
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