Leiðbeiningar um ómskoðun á meðgöngu

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenEftirfarandi leiðbeiningar um ómskoðun á meðgöngu voru samdar að beiðni landlæknis og birtar 1985-1986 (1) og endurskoðaðar í september 2000. Góðar ábendingar samstarfsmanna á kvennadeild Landspítalans og lækna frá öðrum stofnunum eru þakkaðar. Þessum leiðbeiningum er ætlað að stuðla að réttri og hóflegri notkun ómskoðana á meðgöngu. Leiðbeiningarnar eru almenns eðlis og ekki tæmandi varðandi notagildi ómskoðana í mæðravernd né heldur er ætlunin að telja upp allar mögulegar ábendingar og frábendingar. Við samningu þessara leiðbeininga var einkum tekið mið af verklagsreglum á Norðurlöndum (2,3), enda eru vaxtarstaðlar fyrir fóstur á Íslandi svipaðir og þar (4). Lagt er til að á meðgöngu sé að jafnaði gerð ein megin ómskoðun við 18-19 vikna meðgöngu, en aðrar skoðanir aðeins ef læknisfræðilegt tilefni (ábending) er til. Að auki má bjóða fósturskoðun til að meta líkur á litningagalla og hugsanlega sjá ummerki um nokkra aðra sköpulagsgalla við 11-13 vikna meðgöngulengd. Skoðun við 18-20 vikur er notuð til að fá góða vitneskju um meðgöngulengd, sem er reiknuð út á þeim tíma fyrir allar konur, og yfirleitt er hægt að skoða fóstur vel með tilliti til sköpulagsgalla jafnframt því að staðsetja má fylgju í leginu með nákvæmni. Ekki er mælt með því að allar konur séu skoðaðar á lokaþriðjungi meðgöngu, vegna þess að þær slembirannsóknir (randomized trials), sem gerðar hafa verið á þessum tíma, hafa ekki sýnt ávinning af slíkum skoðunum. Á þeim tíma er því miðað við að læknisfræðileg ábending fyrir skoðun sé fyrir hendi

Ein ungewöhnlicher Tumor der Nickhautdrüse eines Hundes - ein Fallbericht

Ein Tumor der Nickhautdrüse wurde bei einer 13jährigen Chihuahuahündin diagnostiziert. Histopathologic des resezierten Gewebes ergab ein alpokrines Adnexom mit squamöser Metaplasie. Die Literatur bezüglich der Nickhautdrüsenvorfälle und -tumoren wurde diskutiert, eine Geschwulst dieser Art wurde unseres Erachtens in der Literatur noch nicht beschrieben

Ultrasonographic Biometrical Studies on Reproductive Organs of rbST Treated Pregnant Kundhi Buffaloes

Biometrical studies were conducted on sixty four gravid uteri with estimated gestation period of 1st, 2nd, 3rd and 4th month of pregnancy in Kundhi buffaloes. Sixteen specimens for each month of gestation were collected from Hyderabad slaughterhouse to evaluate techniques for measurement of reproductive organs. The measurements for fetometry and morphometry of reproductive organs by ultrasound machine and manually (by measuring tape and vernier caliper) were performed and compared. The Ultrasound examinations were performed through diagnostic ultrasound machine equipped with multi-frequency 5-10MHz transrectal linear array transducer. Analysis revealed that the ovary, foetus, foetal fluid and uterus progressively increased significantly (P<0.01) in weight during 4th month of the gestation than 1st, 2nd and 3rd month of gestation period in rbST treated Kundhi buffaloes. Ovaries with CL were significantly (P<0.01) heavier than the ovary in which CL was absent. Corpus leutum was significantly lighter (P<0.01) during 1st month of pregnancy than 2nd, 3rd and 4th month of pregnancy in rbST treated Kundhi buffaloes. Gravid uterus was significantly heavier (P<0.01) during 4th month of pregnancy than 1st, 2nd and 3rd month of pregnancy in rbST treated Kundhi buffaloes. There was no significant difference between the measurements of oviduct, cervix and vagina during 1st to 4th month of pregnancy. The placenta, foetal fluid and foetus progressively increased significantly in size as gestation period progressed. The ultrasonographic fetometric and morphometric threshold of CRL, TD and UD and foetal weight was steadily increased in rbST treated Kundhi buffaloes. There was significant increase (P<0.05) in the CRL, TD, UD and foetus weight/volume at 4th month of pregnancy than 1st , 2nd and 3rd month of pregnancy in rbST treated Kundhi buffaloes. In conclusion, the overall data indicated that the examination for ultrasonographic fetometry and morphometry of reproductive organs of kundhi buffaloes for evaluation of fetal development, estimation of gestational age and formulation of fetal chart through reproductive organs were more suitable as compare to manual biometrical evaluation

Pre- and early-postnatal nutrition modify gene and protein expressions of muscle energy metabolism markers and phospholipid fatty acid composition in a muscle type specific manner in sheep.

We previously reported that undernutrition in late fetal life reduced whole-body insulin sensitivity in adult sheep, irrespective of dietary exposure in early postnatal life. Skeletal muscle may play an important role in control of insulin action. We therefore studied a range of putative key muscle determinants of insulin signalling in two types of skeletal muscles (longissimus dorsi (LD) and biceps femoris (BF)) and in the cardiac muscle (ventriculus sinister cordis (VSC)) of sheep from the same experiment. Twin-bearing ewes were fed either 100% (NORM) or 50% (LOW) of their energy and protein requirements during the last trimester of gestation. From day-3 postpartum to 6-months of age (around puberty), twin offspring received a high-carbohydrate-high-fat (HCHF) or a moderate-conventional (CONV) diet, whereafter all males were slaughtered. Females were subsequently raised on a moderate diet and slaughtered at 2-years of age (young adults). The only long-term consequences of fetal undernutrition observed in adult offspring were lower expressions of the insulin responsive glucose transporter 4 (GLUT4) protein and peroxisome proliferator-activated receptor gamma, coactivator 1α (PGC1α) mRNA in BF, but increased PGC1α expression in VSC. Interestingly, the HCHF diet in early postnatal life was associated with somewhat paradoxically increased expressions in LD of a range of genes (but not proteins) related to glucose uptake, insulin signalling and fatty acid oxidation. Except for fatty acid oxidation genes, these changes persisted into adulthood. No persistent expression changes were observed in BF and VSC. The HCHF diet increased phospholipid ratios of n-6/n-3 polyunsaturated fatty acids in all muscles, even in adults fed identical diets for 1½ years. In conclusion, early postnatal, but not late gestation, nutrition had long-term consequences for a number of determinants of insulin action and metabolism in LD. Tissues other than muscle may account for reduced whole body insulin sensitivity in adult LOW sheep

Umbilical Artery Doppler Measurements in Last Week of Pregnancy and Correlation with Vitality of Newborn Lambs

Background: There is a high lamb mortality rate during the first 3 days of life, resulting in sheep flock economic losses and neonate welfare concerns. A significant number of neonatal deaths could be avoided by preventive management, early diagnosis, and consequently well-timed intervention. The aim of the study was to evaluate the use of umbilical artery Doppler to predict the vitality score (APGAR) of lambs at birth, and its use as a screening tool for detecting high-risk neonatal cases in the last week of gestation, describing changes in the resistivity and pulsatility index in singletons and twins. Materials, Methods & Results: A total of 27 White Dorper pregnant ewes were studied: 19 multiparous (ewes, 2 to 4-years-old) and 8 primiparous (yearling, up to 1-year-old). From 130 days of pregnancy, gestational ultrasound was performed weekly until delivery, but only data from the last pre-partum scan for each ewe was included. The inclusion criteria for the analysis of the umbilical arteries Doppler were the positioning of the fetus and the quality of the images obtained. Identification of each of the twin fetuses after birth was performed by reference to ultrasound fetometry and its correlation with birth weight. The vitality score at birth (APGAR) was used to classify each group, regardless of the characteristic of eutocic or dystocic delivery, with Group 1 lambs having normal vitality (APGAR ≥ 7) and Group 2 lambs having low vitality (APGAR < 7). A transabdominal Doppler ultrasound of 28 fetal umbilical arteries was performed in the last week before delivery (146 ± 2.4 days of gestation), and the results were compared with the vitality scores of lambs at birth. There were 53.6% of lambs (15/28) with normal vitality scores (Group 1), and 46.4% of lambs (13/28) had low vitality scores (Group 2). The umbilical artery Doppler ultrasound analyzes of the resistance index (RI), the pulsatility index (PI), and the RI and PI oscillations determined by the resistivity index gradient (RIgrad), the resistivity index variations (RIvar%), the pulsatility index gradient (PIgrad) and the pulsatility index variation (PIvar%) were established for each fetus. Pearson’s correlation was performed for each umbilical artery Doppler ultrasound variable and vitality score of each lamb, and the T Student’s test was performed between Groups 1 and 2. There were no statistically significant differences between groups. Furthermore, the RI values or oscillations did not correlate with the lambs' vitality score, and mildly increased PI values need to be interpreted with caution. Neonatal vitality in lambs was correlated with pulsatility index oscillations: PIgrad (r = 0.4005; P = 0.0346) and PIvar% (r = 007; P = 0.0299). Discussion: Measurement of umbilical artery RI and PI is possible in ewes with singleton and twin pregnancies in the last week of gestation. High PI of the umbilical artery did not correlate with a low lamb vitality score at birth, as previously described in human fetal medicine. The PI alone cannot be correlated with APGAR in lambs, but the PIgrad and PIvar% analyzes should be performed. In conclusion, the RI and PI values, if analyzed in isolation, show no correlation with the vitality scores of lambs at birth. However, making multiple measurements to derive associations between maximum and minimum values of PI such as PIgrad and PIvar% in the same fetus, could help to screen for high-risk neonates. Keywords: sheep, ultrasound, neonatal risk, Apgar

Differential Diagnosis of Monotonous Fetal Heart Rate

The aim was to explore the possibility to forecast a risk of hypoxic lesions in a monotonous fetal heart rate via ECG measurements by the methods of time and frequency analysis. The study involved 50 healthy pregnant women with singleton pregnancy at 37-41 weeks of gestation along with 17 pregnant women in the same period of gestation who had a monotonous fetal heart rate registered of various origin. The registration of fetal heart rates was performed using fetal monitor “Monica AN24” (“Monica Healthcare Ltd”, United Kingdom), transabdominal, using ECG electrodes. The software package “Monica DK” has been used to retrieve the “beat-to-beat” data. Analysis of experimental data was carried out on the basis of LABVIEW® software (National Instruments®, USA). The analysis of time parameters for fetal hypoxia showed a sharp decline in the spread function and a sharp increase in the concentration function. Spectral analysis showed a significant decrease in the ratio of high- to low-frequency components of the spectrum. In the analysis of fetal ECG, the ST segment depression was noted, which is also indicative of fetal hypoxia