Early prenatal sonographic diagnosis of gastroschisis

We report a case of gastroschisis that was suspected at sonography at 11 weeks + 3 days of amenorrhea. Although early detection does not alter prenatal management of this condition nor does it affect neonatal outcome, it allows early counseling ofthe parents.(c) 2011 Wiley Periodicals, Inc. J Clin Ultrasound 40:526528, 201

Improvement in uterine artery doppler indices via hysteroscopic metroplasty

Objective: the objective of our research was to study uterine artery doppler indices and their evolution over time after metroplasty and subsequent pregnancy in patients whose septate uterus was the only explanation for infertility. Materials and Methods: a retrospective study. The uterine arteries of 78 patients with septate uteri were evaluated using endovaginal color doppler ultrasound before and after metroplasty. Fifty-one patients became pregnant after metroplasty and were selected as study group, pregnancy occurred within 17 months. By comparing uterine artery doppler indices before and after metroplasty, we observed that the resistive index (RI) and pulsatility index (PI) post surgery were significantly lower compared to pre-metroplasty levels. Results: all pregnant women in the study Group showed uterine resistive indexes within normal ranges, they all underwent scheduled cesarean intervention. Gestational evolution was normal in all patients (mean score of Apgar and birth weight); no neonatal complications were observed. Conclusion: metroplastic intervention in women with septate uterus as the sole cause of infertility may be a plausible alternative for patients wishing to carry a pregnancy

Computerized cardiotocography parameters in pregnant women affected by pregestational diabetes mellitus

Aim: To evaluate whether computerized CTG (cCTG) is a reliable method of predicting neonatal outcome in pregnancies complicated by pregestational diabetes at term. Patients and methods: We considered 27 pregnant women affected by pregestational diabetes and 46 normal pregnancies as controls that fulfilled the following criteria: singleton, Caucasian, euglycemic pregnancies at term (>37 weeks gestational age). All women delivered by cesarean section (CS), with an antepartum cCTG performed within one hour before the CS and an UBGA available at birth. No patient was in labor during FHR monitoring. Results: Among cCTG parameters, accelerations 15 bpm, HV min, HV ms and STV were significantly lower in comparison to controls. We observed that in the diabetic pregnant women the parameter STV was not able to predict or to linearly regress with the most important UBGA parameters: pH and pCO(2). Contrarily, in normal pregnancies, the STV linearly regressed with both the pH (p<0.03) and pCO(2) (p<0.04). Conclusions: Computerized FHR criteria may not be applicable to fetuses in pregestational diabetic pregnancies at term. Therefore some criteria should perhaps be modified for a correct interpretation of cCTG in these pregnancies

Validity of amniotic fluid index in preterm rupture of membranes

Preterm premature rupture of membranes (pPROM) complicates up to one-third of preterm deliveries. We studied the Amniotic Fluid Index (AFI) in order to ascertain its validity as a predictive variable of maternal-fetal outcome in pregnancies complicated by pPROM. One hundred and fourteen pregnant women with gestational age between 24 and 34 weeks' gestation at the time of pPROM. Patients were categorized into two groups on the basis of AFI value (AFI or=5 cm=51) performed at the time of admission. AFI numeric values were significantly related to the following maternal-neonatal variables: high maternal body temperature (P7 at 5 min (P<or=0.001). No other significant correlation between the AFI score and others variables (i.e., maternal heart rate, neonatal WBC count or neonatal C-reactive protein [CRP]) were found. Latency in days from pPROM was significantly lower in the group with AFI <5 cm (P<0.05). Interestingly, AFI <5 cm was present in 66% of pregnancies complicated by chorioamnionitis (8/12), and in 70% of neonates affected by RDS at birth (19/27). An AFI score <5 cm at admission may be a useful prognostic variable in the management of third trimester pregnancies affected by pPROM

Conjoined twins: what ultrasound may add to management

Introduction: Conjoined twins occur in approximately 0.2:10,000 births; the obstetrician and sonographer only rarely examine them. In Western countries, discovery of conjoined twins is often made by the end of the first trimester; however, in the third world, conjoined twins are often discovered only at birth. Objective: To evaluate how ultrasound techniques, when possibly available, may improve management and counseling when conjoined twins are confirmed. Material and Methods: The authors report two different cases of union of two equal twins with sole umbilical cord. Results: The two cases presented with non contributive medical history and no prior teratogen exposure and an unfavorable prognosis. Early discovery of viable conjoined twins permits assessment of the best route of delivery and a planning for serial sonography and fast MRI to plan eventual separation surgery or fetus after-birth surviving possibilities

Amniotic fluid lamellar body counts for the determination of fetal lung maturity: An update

Aim: To reassess the cut-off value for lamellar body counts (LBs) for fetal lung maturity (FLM) over a 10-year study period. Patients and methods: 178 pregnancies were selected under strict inclusion criteria and delivered within 48 h from amniocentesis. FLM was determined by amniotic fluid LBs in centrifuged samples (300 × g for 10 min) in a commercially available Coulter Counter. Cases beyond 37 weeks were excluded. Results: Mean gestational age was 33.5±3.0 weeks at amniocentesis and 33.7±3.0 weeks at birth. After reassessing the best compromise between sensitivity and specificity for all cases using the receiver operating characteristic (ROC) procedure, an FLM cut-off value of ≤22,000/μL was obtained. Diagnostic accuracy (and confidence interval, CI) was: sensitivity, 73% (60.0-83.6%); specificity, 81.7% (CI 73.6-88.1%); positive predictive value, 66.2%; and negative predictive value, 86.0%. Conclusion: No significant change in FLM cut-off for LBs was found when comparing the value from this study and the results of our earlier report presented in 1996 (≤22,000 vs. <20,000/μL), although the new value may be more accurate, since it is based on neonatal outcome, with the exclusion of cases in which the diagnosis of FLM is seldom warranted, i.e., ≥37 weeks' gestational age

The combined effect of betamethasone and ritodrine on the middle cerebral artery in low risk third trimester pregnancies

Aims: To evaluate the effect of antenatal betamethasone and ritodrine in third trimester low risk singleton pregnancies by Doppler technology. Subjects and methods: Eighty-four third trimester pregnant women who received a full course of betamethasone and delivering uneventfully were recruited. The Doppler examination included the assessment of the pulsatility index (PI) of the umbilical artery (UA PI) and the middle cerebral artery (MCA PI) prior to treatment (baseline), and 48, 72 and 96 h after the second dose of betamethasone. Results: No significant difference was found in UA PI and UA/MCA values following betamethasone therapy. In contrast, MCA PI decreased significantly 48 h from the last injection of betamethasone in the whole study group (P < 0.001), and returned to basal values at 96 h. We also found that MCA PI was reduced significantly at 48 h in the subgroup under tocolysis (n = 41) and in the subgroup not receiving tocolysis (n = 43). We compared MCA PI values for both subgroups in the four timings, and found a non-significant difference comparing baseline and 96 h values. However, when comparing MCA PI values after 48 and 72 h, significantly lower differences in PI values in both subgroups were found. Conclusion: In low risk pregnancies, betamethasone therapy in the third trimester is related to a significant but transient reduction of MCA PI, which is more pronounced during tocolytic therapy. Although the physiological basis of this effect is currently unclear, it could be related to the local regulation of intracerebral blood flow