15 research outputs found
Incidence of uterine rupture in second-trimester abortion with gemeprost alone compared to mifepristone and gemeprost
OBJECTIVES:
To compare uterine rupture rates in women having a medical abortion receiving gemeprost alone to those receiving mifepristone plus gemeprost.
STUDY DESIGN:
We reviewed the records of women undergoing medical abortion at 13 0/7-23 6/7 weeks from January 2007 to December 2014 at a single center in Italy. Prior to January 2011, we used gemeprost 1 mg vaginally every 3 h up to a maximum of five doses. After January 2011, we added mifepristone 200 mg orally 24 h prior to the same gemeprost protocol. The primary outcome of the study was the incidence of uterine rupture. We compared the outcome between women receiving gemeprost alone with the combination of gemeprost and mifepristone.
RESULTS:
One thousand and sixty-one (58.5%) and 753 (41.5%) women underwent medical abortion in the gemeprost-alone and the gemeprost/mifepristone groups, respectively. Five (0.47%) uterine ruptures occurred in the gemeprost and four uterine ruptures occurred in the gemeprost/mifepristone groups, respectively (0.53%) (p=.89). All uterine ruptures occurred in women with prior cesarean delivery.
CONCLUSIONS:
We rep orted no difference in the incidence of uterine rupture between the gemeprost-alone and gemeprost and mifepristone groups.
IMPLICATIONS:
Uterine rupture is a rare complication of second-trimester medical abortion with gemeprost. Use of mifepristone prior to gemeprost does not affect this risk
3D/4D ultrasound: role in assessment of fetal anomalies
Three-dimensional (3D) ultrasound is a natural development of the imaging technology. Fast computers are essential to enable 3D and four-dimensional (4D) ultrasound pictures. 3D ultrasound is an extremely promising imaging tool to image the fetus. The purpose of the report is to evaluate the role of this new technology and to increase awareness of its present clinical usefulness
Aberrant right subclavian artery: incidence and correlation with other markers of Down syndrome in second-trimester fetuses.
OBJECTIVE: To assess the incidence of aberrant right subclavian artery (ARSA) and
other strong markers of Down syndrome and their correlation in a large population
of second-trimester Down syndrome fetuses assessed in a tertiary referral center.
METHODS: Presence or absence of ARSA and other major ultrasound markers of Down
syndrome was assessed in a population of 106 second-trimester Down syndrome
fetuses referred to our unit for expert assessment and/or termination of
pregnancy after karyotyping performed for positive first- or second-trimester
screening or advanced maternal age or on maternal request. All cases in which the
diagnosis of Down syndrome followed the ultrasound detection of major anomalies
or soft markers were excluded from the study, as were all cases with a
gestational age less than 14 + 0 weeks. We searched for the ARSA on the three
vessels and trachea view using color or power Doppler. All fetuses underwent a
thorough anatomic assessment and fetal echocardiography. The other Down syndrome
markers assessed were: absent or hypoplastic nasal bone (NB-), defined as length
5 mm). In addition,
the presence of major cardiac and extracardiac defects was recorded. A
correlation analysis was then performed in order to investigate possible
associations between markers and/or major anomalies. Postmortem or postnatal
diagnostic confirmation was available in all cases.
RESULTS: The mean (SD) gestational age at ultrasound assessment was 20.4 (4.1)
weeks. The incidence of the various variables in the population of Down syndrome
fetuses was: ARSA, 25%; NB-, 43%; nuchal fold ≥ 5 mm, 16%; pyelectasis, 17%;
major heart defects, 41%; atrioventricular septal defect, 25%; and extracardiac
anomaly, 24%. The presence of ARSA did not correlate with any of the other
variables. The only positive correlations (P < 0.05) were between NB- and
pyelectasis, and between cardiac and extracardiac defects.
CONCLUSIONS: This represents the largest Down syndrome population assessed for
ARSA. In this series, the incidence of ARSA was 25%, lower than previously
reported in much smaller series. Its presence did not correlate with the presence
of any other marker or major anomaly, including heart defects
Abnormal or delayed development of the posterior membranous area of the brain: anatomy, ultrasound diagnosis, natural history and outcome of Blake's pouch cyst in the fetus.
Congenital anomalies of upper extremities: prenatal ultrasound diagnosis, significance, and outcome.
The autors assess the role of ultrasound in the prenatal characterization of fetal malformations of the upper extremities (MUE)
Normal and abnormal development of the fetal anterior fontanelle: a three-dimensional ultrasound study.
Effects of a prolonged, 72 hours, interval between mifepristone and gemeprost in second trimester termination of pregnancy: a retrospective analysis
Accuracy of neurosonography and MRI in clinical management of fetuses referred with central nervous system abnormalities
OBJECTIVE:
To assess the accuracy of expert neurosonography (two- and three-dimensional NSG) in the characterization of major fetal central nervous system (CNS) anomalies seen at a tertiary referral center and to report the differential clinical usefulness of magnetic resonance imaging (MRI) used as a second-line diagnostic procedure in the same cohort.
METHODS:
This was a retrospective analysis of all 773 fetuses with confirmed CNS abnormalities referred to our center between 2005 and 2012. The following variables were analyzed: gestational age at NSG and MRI, NSG and MRI diagnoses, indication for MRI (confirmation of NSG findings; diagnostic doubt; search for possible additional brain anomalies), association with other malformations, diagnostic accuracy of NSG vs MRI (no additional clinical value for either MRI or NSG; additional information with clinical/prognostic significance on MRI relative to NSG; additional information with clinical/prognostic significance on NSG relative to MRI, NSG and MRI concordant but incorrect) and final diagnosis, which was made at autopsy or postnatal MRI/surgery.
RESULTS:
CNS malformations were associated with other anomalies in 372/773 (48.1%) cases and were isolated in the remaining 401 (51.9%) cases. NSG alone was able to establish the diagnosis in 647/773 (83.7%) cases. MRI was performed in 126 (16.3%) cases. The indication for MRI was: confirmation of NSG diagnosis in 59 (46.8%) cases; diagnostic query (in the case of inconclusive or uncertain finding on NSG) in 20 (15.9%) cases; search for possible additional brain anomalies in 47 (37.3%) cases. NSG and MRI were concordant and correct in 109/126 (86.5%) cases. Clinically relevant findings were evident on MRI alone in 10/126 (7.9%) cases (1.3% of the whole population) and on NSG alone in 6/126 (4.8%) cases; in all six of these cases, MRI had been performed at < 24 weeks of gestation. In one case, both NSG and MRI diagnoses were incorrect. The main type of malformation in w ich MRI played an important diagnostic role was space-occupying lesions, MRI identifying clinically relevant findings in 42.9% (3/7) of these cases.
CONCLUSIONS:
(1) In a tertiary referral center with good NSG expertise in the assessment of fetal CNS malformations, MRI is likely to be of help in a limited proportion of cases; (2) MRI is more useful after 24 weeks of gestation; (3) the lesions whose diagnosis is most likely to benefit from MRI are gross space-occupying lesions