Ultrasonic localization of a displaced laminaria tent

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Non-resolution of pelvic sonographic abnormality after chemotherapy for persistent trophoblastic disease. A word of caution

A case of persistent trophoblastic disease (PTD) is presented in whom pelvic sonography demonstrated persistent uterine abnormality and dilated adnexal vessels after cessation of chemotherapy. Hysterectomy was performed on account of subsequent uterine bleeding. A viable tumour was not demonstrated in the hysterectomy specimen. In the absence of haemorrhagic complications persistent sonographic abnormality should not necessarily indicate hysterectomy, especially when hCG levels are normal.link_to_subscribed_fulltex

Estimation of fetal weight in utero from symphysis-fundal height and abdominal girth measurements

The ability to estimate fetal weight accurately from symphysis-fundal height (SFH) and abdominal girth (AG) measurements was evaluated. Multivariate regression analysis was performed on measurements made on 208 primi-gravidas within 48 hours of delivery. A better correlation with birth-weight was obtained with the SFH than with the AG. The equation BW= -1.515 + 0.092 (SFH) + 0.016 (AG) yielded a coefficient of multiple correlation of 0.7259. Using this equation, the mean percentage prediction errors were 5.7% ± 4.2 (SD) in fetuses between 2,500 and 3,500 g (n = 156), 9.4% ± 5.25 (SD) in those larger than 3,500 g (n = 33), and 19.1% ± 8.2 (SD) in those smaller than 2,500 g (n = 19). All the generated equations similarly underestimated the fetal weight in the larger babies and overestimated in the smaller babies. Inclusion of quadratic and logarithmic functions as well as skin-fold thickness measurements into the equations did not decrease the error or alter the distribution of errors. It was concluded that although fetal weight estimation may be reasonably accurate between 2,500 g and 3,500 g, the error is too great for the method to be clinically useful in the smaller and larger babies. Moreover, a theoretical basis for a high sensitivity in the detection of small for dates fetuses from these parameters would be difficult to establish.link_to_subscribed_fulltex

Polyhydramnios in Hong Kong

One hundred and thirty nine Chinese women with polyhydramnios complicating pregnancy were delivered at University Obstetrics Unit, Tsan Yuk Hospital, Hong Kong from 1965 to 1982. The incidence of polyhydramnios in this study population was 0.21%. Among the 139 cases of polyhydramnios, 48 (34.5%) were associated with no cause (idiopathic), 4 (2.9%) with diabetes mellitus, 58 (41.7%) with congenital malformations, 9 (6.5%) with hydrops foetalis, 14 (10.1%) with multiple gestations, 4 (2.9%) with chorinoangioma of the placenta, and 2 (1.4%) presented as acute hydramnios. There was no maternal mortality. Higher incidences of accidental haemorrhage )3.6%), malpresentations (11.5%) and cord prolapse (1.4%) were encountered. Postpartum haemorrhage (2.2%) and manual removal of placenta (2.2%) were only slightly increased in occurrence. The foetal mortality was 59.7%. Prematurity and foetal malformations incompatible with life were the two major contributing factors. Atresia of the upper gastro-intestinal tract (23 cases) was the commonest foetal abnormality observed (34.4%). Hydrops foetalis (9 cases) and skeletal anomalies (9 cases) were next on the list and each constituted 13.4%. Obstetrical pelvic ultrasonography is useful in the detection and serial monitoring of polyhydramnios as well as in the prenatal diagnosis of congenital malformations of the foetus.link_to_subscribed_fulltex

Aetiological factors in the genesis of pregnancy hydronephrosis

In order to identify possible aetiological factors in the genesis of physiological hydronephrosis in pregnancy, the degree of pelvic-calyceal dilatation in 90 asymptomatic pregnant women was correlated with levels of plasma oestradiol, progesterone, 24-hour urinary oestriol, the site of the placenta, birth-weight of the fetus, and pelvic inlet measurements. A grading system based on maximum calyceal diameter was used; 90% of the patients were found to have at least mild dilatation on the right side. No correlation was demonstrated between the degree of hydronephrosis and the levels of oestradiol, progesterone and 24-hour urinary oestriol excretion. The birth-weight of the fetus and its relationship with the pelvic inlet measurements also did not correlate with the occurrence of hydronephrotic changes in the kidneys. The only significant positive finding was a higher incidence of moderate and severe hydronephrosis occurring in patients with a right-sided placenta than compared with the left (x2 = 4.77; p<0.05), although the sensitivity and specificity in predicting hydronephrosis from a right-sided placenta is low (53% and 66% respectively). Our results support the hypothesis of a mechanical aetiology in the genesis of pregnancy hydronephrosis, where vascular compression on the ureters may be an important contributory factor. Our study has also shown that urinary tract infection and reduction of creatinine clearance were not more common in patients with moderate or severe pelvic-calyceal dilatation.link_to_subscribed_fulltex

Advanced pregnancy in the rudimentary horn of a bicornuate uterus

Ultrasound was useful for the diagnosis of advanced pregnancy in the non-communicating rudimentary horn of a bicornuate uterus. The role of ultrasonography in early diagnosis of this condition in order to improve fetal salvage was discussed.link_to_subscribed_fulltex