Sonographic imaging and differential diagnosis of fetal perineal masses

This case series describes our experience with a prenatal diagnosis of fetal perineal masses. We propose a clinical-sonographic approach for prenatal workup in cases presenting perineal findings based on imaging the target sign at the posterior perineal triangle, the fetal genitalia, and sacrum. Targeted, structured prenatal anatomical scan in fetuses presenting with perineal masses may aid in the prenatal differential diagnosis and enable appropriate genetic analysis, prenatal counseling, and postnatal treatment

Sonopelvimetry: An Innovative Method for Early Prediction of Obstructed Labour

To evaluate an innovative sonopelvimetry method for early prediction of obstructed labour. Methods: A prospective study was conducted in two centers.GPS-based sonopelvimetry, laborProTM (Trig Medical Inc., Yoqneam Ilit, Israel) devise, was used prior to labour in nulliparous women at 39 - 42 weeks gestation remote from labor. Maternal pelvic parameters, including inter-iliac transverse diameter, obstetric conjugate and interspinous diameter were evaluated. Fetal parameters included head station, biparietal diameter and occipitofrontal diameter. Data on delivery and outcome were collected from the electronic files. Results: The innovative use of sonopelvimetry was applied to 154 consecutive women, none of the participants complained of discomfort or complications observed. The mean time of examination was 15 + 2 minutes. Mean time of examination to delivery interval was 4.8 days (range 0 - 16 days). Small interspinous diameter and high head station were the best predictors for obstructed labour. Analysis indicated 87% sensitivity and 61% specificity for birth weight fetal head station and ISD combined in predicting obstructed labour with an area under the curve of 0.77. Conclusions: Our results indicate that GPS-based sonopelvimetry combined with fetal estimated weight is a valuable tool in the risk assessment of obstructed labour. Parameters obtained by sonopelvimetry combined with birth weight may be useful

Foetal Sonographic Anogenital Distance Is Longer in Polycystic Ovary Syndrome Mothers

Anogenital distance (AGD) is a biomarker for the prenatal hormonal environment. Androgen excess is a key element in polycystic ovary syndrome (PCOS). The aim of this study was to assess the sonographic foetal AGD in a population of PCOS mothers in comparison to the general population. Foetal AGD was measured prospectively by 2D ultrasound in PCOS mothers and compared to prenatal AGD nomograms. The results were interpreted regarding maternal and foetal characteristics. The mean sonographic foetal AGD centile measurement in PCOS mothers was significantly longer in comparison to the general population (86.04% ± 18.22; p < 0.001). Estimated foetal weight and birthweight were appropriate for gestational age and did not correlate with AGD. Sonographic foetal AGD was significantly longer in PCOS diabetic mothers and in those who conceived following assisted reproduction treatments when compared to the general population (p < 0.001). Our results support the role of AGD as a biomarker of the prenatal hormonal environment and provide evidence for the hyperandrogenic effect in PCOS pregnancies on foetal androgenic status and genitalia development

Assessment of fetal thymus size and BMI in pregnant women with diabetes

Materials and methods: The study group consisted of 63 pregnant women admitted to the Department of Perinatology, Obstetrics and Gynaecology. Inclusion criteria included patients with PGDM – 11 pregnancies, GDM1– 23 pregnancies, and GDM2 – 29 pregnancies. Exclusion criteria included pregnant women with gestational diabetes and history of other comorbidities as well as multiple pregnancies, fetal developmental abnormalities and genetic disorders. Each patient received a detailed fetal ultrasound performed by the team of ultrasound experts specialising in obstetric ultrasonography. Fetal thymus measurements were obtained between 14+5 and 40+0 weeks of gestational age. After the three-vessel view was clearly displayed we assessed longitudinal dimensions of the thymus. The obtained measurements were juxtaposed with nomograms for thymus size in healthy foetuses whose mothers had no history of diabetes. Prior to ultrasound examination the participants were asked to complete a questionnaire regarding their body weight status before 10 weeks of gestational age. Results: The Mann–Whitney U test was used for comparison of two groups, i.e. diabetic pregnancies and non-diabetic pregnancies, whereas Kruskal–Wallis H test was used to compare multiple groups. A linear regression model was used to determine the correlation between the type of diabetes and fetal thymus size as well as between maternal BMI and fetal thymus size. The significance level α was set at 0.05. Thymus size is statistically smaller in foetuses of diabetic mothers when compared to healthy controls. Overweighted and obese pregnancy is not a factor affecting fetal thymus size

Ongoing pregnancy rates in women with low and extremely low AMH levels. A multivariate analysis of 769 cycles.

BACKGROUND: The ideal test for ovarian reserve should permit the identification of women who have no real chance of pregnancy with IVF treatments consequent upon an extremely reduced ovarian reserve. The aim of the current study was to evaluate pregnancy rates in patients with low AMH levels (0.2-1 ng/ml) and extremely low AMH levels (<0.2 ng/ml) and to determine the cumulative pregnancy rates following consecutive IVF treatments. METHODS: We conducted an historical cohort analysis at a tertiary medical center. Serum AMH levels were measured at initial clinic visit and prior to all following treatment cycles in 181 women (769 cycles) with an initial AMH level ≤1 ng/ml, undergoing IVF-ICSI. Main outcome measures were laboratory outcomes and pregnancy rates. RESULTS: Seventy patients undergoing 249 cycles had extremely low AMH levels (≤0.2 ng/ml), whereas 111 patients undergoing 520 cycles had low AMH levels (0.21-1.0 ng/ml). Number of oocytes retrieved per cycle, fertilized oocytes and number of transferred embryos were significantly lower in the extremely low AMH levels group compared to the low AMH levels (P<0.003). Crude ongoing pregnancy rates were 4.4% for both groups of patients. Among 48 cycles of women aged ≥42 with AMH levels of ≤0.2 ng/ml no pregnancies were observed. But, in patients with AMH levels of 0.2-1.0 ng/ml, 3 ongoing pregnancies out of 192 cycles (1.6%) were observed. However, in a multivariate regression analysis adjusted for age and cycle characteristics, no significant differences in ongoing pregnancy rates per cycle between the two groups were evident. Cumulative pregnancy rates of 20% were observed following five cycles, for both groups of patients. CONCLUSIONS: Patients with extremely low AMH measurements have reasonable and similar pregnancy rates as patients with low AMH. Therefore, AMH should not be used as the criterion to exclude couples from performing additional IVF treatments

Cumulative ongoing pregnancy rates for patients with AMH level of 0.2–1 ng/ml or ≤0.2 ng/ml.

<p>Cumulative ongoing pregnancy rates for patients with AMH level of 0.2–1 ng/ml or ≤0.2 ng/ml.</p