Prenatal ultrasonographic findings of adhesion-membrane complex and its relation with obstetric history

Background: Intrauterine adhesions are usually detected incidentally during routine obstetric ultrasound and remain one of the reasons for concern for both clinicians and patients. Objective: Our objective was to document ultrasonographic findings of intrauterine adhesions detected in obstetric ultrasound and to investigate their correlation with obstetric history. Study Design: Detailed scans were performed in 685 singleton pregnancies at 16-24 weeks' gestation. Intrauterine adhesion was referred to as "adhesion-membrane complex'' (AMC). Patients were divided into three groups: Group I consisted of patients with >= 1 therapeutic D&C associated with pregnancy but with neither vaginal delivery nor Cesarean section (CS). Group II consisted of patients with >= 1 CS but with neither vaginal delivery nor therapeutic D&C associated with pregnancy. Group III consisted of patients who were in their first pregnancy. Ultrasonographic properties of AMC and relationship between AMCs and obstetric history were investigated. Results: The incidence of AMC in Group I (n = 108), Group II (n = 189), and Group III (n = 388) was 11.1% (n = 12), 1.05% (n = 2) and 1.03% (n = 4), respectively. Positive history of D&C is associated with significantly increased risk of AMC (risk ratio:10.778; 95% confidence interval: 3.55-32.75). Also, previous history of CS is not associated with significantly increased risk of AMC (risk ratio: 1.026; 95% confidence interval: 0.19-5.55). The AMCs were located in the upper half in 7 (38,9%) and in the lower half of the uterus in 11 (61.1%) patients. The midpoint thickness of the AMC was between 0.75 and 5.10 mm (mean: 2.65 mm; SD +/- 1.2). The width of the AMC was between 2 and 52 mm (mean: 20.98; SD +/- 15.3), the heights of the AMCs were 5-60 mm (mean: 33.27 mm; SD +/- 17.0). In ten of the AMC positive patients (55.6%) a thick and bulbous free end and in eleven of them (61.1%) a "Y image" was detected. The mean gestational age at birth was 37.4 (SD +/- 3.3) weeks in 18 patients with AMC. There were no intrauterine fetal or perinatal deaths. None of the neonates had congenital abnormalities. Conclusions: Intrauterine adhesions detected in obstetric ultrasonography were redefined and renamed in a more comprehensible manner. Our results pointed out that while the positive history of D&C is associated with significantly increased risk of AMC, previous history of CS is not associated with significantly increased risk of AMC

Intertwin membrane cord insertion in dichorionic twin pregnancy: The description and comparison with other umbilical cord insertion types

Purpose Multiple pregnancy is associated with high perinatal mortality and morbidity. Abnormal cord insertions more common in twin pregnancies compared to singleton pregnancies and velamentous cord insertion is related with poor pregnancy outcomes. There is no definition of velamentous cord insertion into the intertwine membrane between two fetuses in the literature. Methods In our single-center cross-sectional study, monochorionic-diamniotic and dichorionic-diamniotic twins who were admitted to our clinic between 18 + 0 and 23 + 6 weeks of pregnancy were enrolled in this study. We evaluated fetal, placental, and umbilical cord abnormalities in addition to fetal growth restrictions and weight discordance by ultrasonography. Results Although abnormal cord insertion frequency was significantly higher in monochorionic twins (p = 0.003), intertwin membrane cord insertion could only occur in dichorionic twins. In cases with cord insertion anomaly; FGR and weight discordance was observed more frequently (p < 0.001 and p = 0.003, respectively). Weight discordance, the presence of abnormal cord insertion and abnormal UAD were found as statistically significant predictors of FGR (p < 0.001, p = 0.021, and p < 0.001, respectively). Conclusion Intertwin membrane insertion is a novel umbilical cord insertion abnormality. The presence of abnormal umbilical cord insertion is a risk factor for poor pregnancy outcomes in twin pregnancies

Is Cystatin C a Promising Parameter to Determine Postnatal Outcome of Prenatally Diagnosed Infravesical Obstruction?

Purpose: We investigated the prognostic power of cystatin C to determine renal functional outcome in patients with prenatally diagnosed infravesical obstruction

Sonographic depiction of fetal ureters

Aims: Classic literature states that the fetal ureter should not be visible unless dilated. Our main objective was to produce an effective, reproducible method for fetal ureter depiction during an anatomic survey. Our secondary objectives were to record the frequency of visible ureters among normal fetuses and among fetuses with mild pyelectasis and also to determine the diameter of the sonographically demonstrated ureter

Fetal nasal bone assessment in first trimester Down syndrome screening

Objective: To evaluate the contribution of nasal bone assessment in the first trimester Down syndrome screening. Methods: The fetuses which underwent first trimester screening with nuchal translucency (NT) measurement were evaluated for the absence or presence of nasal bone according to the instructions described by the Fetal Medicine Foundation, London. Results: Among the 1,807 fetuses included in the study, 9 had trisomy 21. The detection rate of Down syndrome with NT measurement was 77.8% (7/9) with a false-positive rate of 4.5%. Incorporation of biochemical tests (PAPP-A, and free beta-hCG measurement) into the screening increased the detection rate to 88.9% (8/9) and decreased the false-positive rate to 3.6%. The prevalence of absent nasal bone was 7/1,798 (0.39%) in chromosomally normal fetuses, and 3/9 (33.3%) in Down syndrome fetuses. Sensitivity, specificity, positive predictive and negative predictive values of absence of nasal bone for trisomy 21 are 33.3% (CI: 0.12-0.64), 99.6% (CI: 0.99-0.99), 30% (95% CI: 0.11 0.53) and 99.7% (95% CI: 0.99-0.99), respectively. The positive likelihood ratio of absent nasal bone was 85.6 (95% CI: 26.2-279.5), and the negative likelihood was 0.67 (95% CI: 0.42-1.06). When nasal bone assessment was incorporated into the NT risk assessment or combined test, the detection rate of trisomy 21 was not changed, however, the false-positive rate decreased to 3.4 and 3%, respectively. Conclusion: The absence of fetal nasal bone has a high positive likelihood ratio for Down syndrome in the first trimester screening, and the presence of nasal bone may potentially lower the need for invasive testing. Copyright (C) 2008 S. Karger AG, Basel

Prenatal Diagnosis of Torcular Hemphill Thrombosis Report of 2 Cases and Review of the Literature

Prenatally diagnosed thrombosis of the torcular herophili is very rare, and it is sometimes misdisgnosed due to unfamiliarity. Sonography with color Doppler imaging is the key imaging modality for prenatal diagnosis of torcular herophili thrombosis. Typical prenatal sonographic findings include a well-defined triangular anechoic collection in the occipital region and an echogenic structure within the collection, which represents the thrombus. Fetal magnetic resonance imaging is usually used as an adjunctive modality for prenatal diagnosis, as it confirms the diagnosis by providing more precise anatomic information and better characterization of the lesion. We present 2 cases of thrombosis of an ectatic torcular herophili with serial sonographic and magnetic resonance imaging examinations, as well as a review of the literature regarding the prenatal diagnosis of torcular herophili thrombosis

Intrapericardial Diaphragmatic Hernia Report of 2 Cases With Prenatal Diagnosis

An intrapericardial diaphragmatic hernia is a very rare congenital abnormality, with only a few cases reported in the English literature. The triad includes a massive pericardial effusion, bilateral pulmonary compression with or without pulmonary hypoplasia, and herniation of part of the liver into the pericardium. We report 2 cases of intrapericardial diaphragmatic hernias diagnosed prenatally in our obstetrics and gynecology unit