19 research outputs found
Prediction of Preterm Delivery by Late Cervical Length Measurement after 24 Weeks
Objective: To examine the value of the cervical length (CL) measurement
at 24-30 gestational weeks in the prediction of spontaneous preterm
delivery (SPD) between 30 and 34 weeks (SPD34) and between 34 and 37
weeks (SPD37). Methods: We performed a prospective cross-sectional
study. CL was measured once by transvaginal ultrasound examination
between 24 and 30 weeks. Results: The study sample consisted of 1,180
low-risk singleton pregnancies. 10 women (0.85%) had a SPD34 and 60
(5.08%) had a SPD37. CL was shorter (p <0.001) in the women who had a
SPD34 (median 11 mm) compared to the women who delivered after 34 weeks
(median 31 mm). CL was shorter (p < 0.001) in the women who had a SPD37
(median 22 mm) compared to the women who delivered after 37 weeks
(median 31 mm). CL predicted SPD34 (OR = 0.837, R-2 = 0.2768, AUC =
0.9406, p < 0.001) and SPD37 (OR = 0.907, R-2 = 0.1085, AUC = 0.7584, p
< 0.001). The model achieved a sensitivity of 70.0 and 38.3% for 10%
false-positive rate for SPD34 and SPD37, respectively. Conclusions: CL
after 24 weeks is significantly shorter in women destined to have a SPD.
In low-risk singleton pregnancies CL performs very well in predicting
SPD34 and adequately in predicting SPD37. (C) 2015 S. Karger AG, Base
First trimester fetal ultrasound parameters associated with PAPP-A and f beta-hCG
Objective: To study the association of f beta-hCG and PAPP-A measured at
11-14 weeks of gestation with delta crown-rump-length (dCRL), delta
fetal heart rate (dFHR) and delta nuchal translucency (dNT). To
calculate adjusted MoM taking into consideration these associations.
Methods: Retrospective cross-sectional study on 5,536 singleton euploid
pregnancies participating in a first trimester screening program for
chromosomal abnormalities by nuchal translucency and maternal serum
biochemistry. Adjusted MoM were calculated for f beta-hCG and PAPP-A and
compared to the observed MoM (calculated by the Fetal Medicine
Foundation screening algorithm). Results: f beta-hCG correlates
positively with dCRL and negatively with dNT, whereas PAPP-A shows a
positive correlation with dNT and a negative one with dCRL and dFHR.
After adjustment for the ultrasound parameters, the median MoM values
for f beta-hCG and PAPP-A changed from 1.02 and 0.92 observed MoM to
0.98 and 0.99 adjusted MoM respectively. The difference between the
observed and adjusted MoM was statistically significant (p < 0.001).
Delta CRL increases with gestation and this effect manifests mainly
after CRL of 62 mm. Conclusions: Adjustment for dCRL, dFHR and dNT
improves the calculation of MoM for f beta-hCG and PAPP-A. CRL
measurement overestimates fetal size at the end of the screening period
11-14 weeks
Towards Detecting Open Spina Bifida in the First Trimester: The Examination of the Posterior Brain
Introduction: Our aim was to examine the value of indirect signs of open
spina bifida in the mid-sagittal view of the posterior brain at the
11-13 weeks’ ultrasound examination and to summarize the current
evidence for the first-trimester diagnosis of spina bifida. Methods:
This was a prospective study in routine obstetric population.The
presence of four almost parallel lines (four-line view) in the posterior
brain was recorded. Biparietal diameter (BPD), intracranial translucency
(IT) and cisterna magna (CM) were measured. The ratio of IT to CM (R
ratio) was calculated. Results: 2,491 pregnancies were examined
prospectively. Updated reference ranges for IT and CM were constructed.
There were 3 cases with open spina bifida, and the four-line view was
abnormal in 2 of them. The abnormal fetuses had smaller BPD as well as
pronounced reduction in the CM and increase in the R ratio. Discussion:
Examination of the posterior brain was feasible in all fetuses in the
setting of the routine 11-13 weeks’ ultrasound examination. Indirect
signs of spina bifida are visible in the mid-sagittal view of the
posterior brain, and the assessment of these structures can be a
reliable tool in the early identification of this abnormality. (C) 2015
S. Karger AG, Base
Prenatal diagnosis and management of fetal pharyngeal teratoma: A case report and review of the literature
We present a case of a fetal pharyngeal teratoma, which was diagnosed at
21 weeks’ gestation. At the time of examination, a mass of mixed
echogenicity was detected that protruded through the mouth. During a
second examination 3 weeks later, the tumor had increased in size, and a
severe polyhydramnios had developed. Intrauterine death of the fetus was
detected at 27 weeks’ gestation. Labor was induced with misoprostol, and
a 1,015-g stillborn female neonate was delivered. Postmortem examination
confirmed the diagnosis of a pharyngeal teratoma. (C) 2007 Wiley
Periodicals, Inc
Screening for pre-eclampsia and small for gestational age fetuses at the 11-14 weeks scan by uterine artery Dopplers
Objective. To assess the role of uterine artery Doppler studies at 11-14
weeks in screening for pre-eclampsia (PET), small for gestational age
(SGA) fetuses, and placental abruption. Methods. Prospective study on 1,
123 women presenting for routine ultrasound examination at 11-14 weeks
for nuchal translucency measurement. Uterine artery blood flow was
studied by transvaginal colour Doppler, the mean pulsatility index (PI)
was calculated, and the presence of a diastolic notch was recorded.
Results. The mean, median and 95th centile of uterine artery PI were
1.71, 1.64 and 2.54, respectively. Bilateral notches were observed in
63.4%, and a unilateral notch in 18.4% of cases. The sensitivity of
mean uterine artery PI >= 95th centile for PET, early onset severe PET
necessitating delivery before 34 weeks, SGA <= 5th centile, SGA
necessitating delivery before 34 weeks, SGA <= 10th centile and
placental abruption were 21.4, 33.3, 17.8, 100, 9.6 and 44.4%,
respectively. One in 6 women with increased resistance in the uterine
arteries at 11-14 weeks will develop a complication related to
utero-placental insufficiency. Conclusions. Abnormal uterine Dopplers at
11-14 weeks identified one-third of women with severe early onset
pre-eclampsia, all fetuses with SGA <= 5th centile that were delivered
at <= 34 weeks, and 40% of cases with placental abruption. Uterine
artery Doppler examination at the 11-14 weeks scan can identify a high
risk population in which preventive or therapeutic interventions might
be effective