Search

Objectives To investigate the relationship between second-trimester uterine artery Doppler findings and parity in a large pregnant population. Methods Uterine artery Doppler studies were performed in all singleton pregnancies at 18-23 weeks of gestation. The mean uterine artery resistance index and the presence or absence of protodiastolic notches were recorded. Two groups were identified: pregnancies not complicated by pre-eclampsia, and pregnancies with pre-eclampsia severe enough to require delivery at or before 32 weeks of gestation. Results In the 4132 pregnancies uncomplicated by pre-eclampsia, parity was shown to be an independent predictor for both mean uterine artery resistance index (beta = 0.073, p < 0.001) and the presence of bilateral protodiastolic notches (odds ratio = 0.67; 95% CI, 0.45-0.98). In the 17 pregnancies complicated with severe pre-eclampsia, uterine artery Doppler indices showed a trend towards being better predictors of disease in nulliparous compared with parous women. Conclusion Parity has a significant effect on the resistance index and the prevalence of protodiastolic notching in the uterine artery flow waveforms. This difference is clinically noticeable in its effect on notching. These findings suggest that some permanent modification may persist in the maternal vessels after a successful pregnancy, altering their impedance in subsequent pregnancies. [ABSTRACT FROM AUTHOR]

Objectives To determine reference values for first-trimester uterine artery resistance index (RI) in healthy pregnant women with uncomplicated pregnancies and to investigate the relationship between uterine artery Doppler indices and birth weight. Methods This was a cross-sectional study of 265 consecutive pregnant women attending routine ultrasound examination at 11–14 weeks' gestation. Both uterine arteries were identified using color Doppler ultrasound and the RI was measured. The presence or absence of an early diastolic notch was also noted. Pregnancy outcomes were obtained from the delivery suite database and birth weight was expressed as Z-scores. Results The 5th, 50th and 95th centiles for uterine artery RI between 11 and 14 weeks' gestation were 0.53, 0.71 and 0.85, respectively. Complete pregnancy outcome data were available for 246 fetuses. There was a significant negative correlation between birth weight Z-scores and first-trimester uterine artery mean RI (r = - 0.219, P = 0.001). The difference in birth weight between fetuses with absent and those with bilateral diastolic notches was also significant (P < 0.001). Multiple regression analysis demonstrated that both mean RI (standardized regression coefficient = -0.14, P = 0.039) and uterine artery notching (standardized regression coefficient = -0.17, P = 0.017) contributed independently towards the prediction of birth-weight Z-score. Conclusions A significant negative correlation exists between birth weight and first-trimester uterine artery Doppler parameters, a reliable and non-invasive method of examining uteroplacental perfusion. The value of first-trimester uterine artery Doppler as a prognostic screening tool, either in isolation or in conjunction with maternal biochemistry, remains to be determined. [ABSTRACT FROM AUTHOR]

ABSTRACTObjectiveTo assess the intraobserver repeatability and interobserver reproducibility of Doppler flow velocity measurements of the uterine arteries in pregnant women between 10 and 14 weeks of gestation. MethodsIn this prospective study, Doppler velocimetric indices (maximum peak systolic velocity, end-diastolic velocity, peak systolic velocity/end-diastolic velocity ratio, pulsatility index and resistance index) were measured twice by the same trained observer in each uterine artery of 63 women. In 47 of these women, a second trained observer then repeated the measurements. In addition, both observers classified qualitatively the blood flow with regard to the presence or absence of an early diastolic notch. The coefficient of variation, intraclass correlation coefficients, within observer and between observers repeatability coefficient and Cohen’s kappa coefficient were calculated. ResultsThe best parameter in terms of repeatability and reproducibility in both uterine arteries was the resistance index with a low coefficient of variation and high intraclass correlation coefficient. The other parameters (pulsatility index, peak systolic velocity/end-diastolic velocity ratio, peak systolic velocity and end-diastolic velocity) performed poorly with high coefficients of variation on both sides. Agreement between the repeated observations (inter- and intraobserver) with regard to the presence or absence of an early diastolic notch was good. ConclusionDoppler velocimetry of uterine artery blood flow is technically feasible between 10 and 14 weeks of gestation. This study demonstrates that this technique is prone to measurement errors. Quantitatively, the resistance index appears to be the most repeatable and reproducible measurement at this gestational age. Qualitative assessment of the waveform morphology also shows high levels of intra- and interobserver agreement. [ABSTRACT FROM AUTHOR]

Vein of Galen malformation (VOGM) is a rare congenital vascular malformation representing approximately 1% of intracranial arteriovenous malformations. Ultrasound, colour Doppler studies are non-invasive diagnostic techniques, however MRI is the preferred modality for diagnosing and predicting prognosis. The vein of Galen is a rare congenital malformation. [Extracted from the article]

Abstract Objective Feticide may be achieved by the injection of strong potassium chloride (KCl) into the fetal circulation via the cardiac route, or less frequently, into the umbilical cord. Despite the relative frequency of this procedure, little published information is available on the subject. Subjects and methods This was a retrospective analysis of all feticide procedures carried out prior to legal pregnancy termination in mid trimester of pregnancy from January 1996 to July 2001, in a tertiary fetal medicine referral center. The effect of gestational age and the route of access to fetal the circulation on the dose of strong KCl required to achieve cardiac asystole was evaluated. Results A total of 106 women underwent the procedure of feticide during the study period. Gestational age had no effect on the dose of strong KCl. The median dose of KCl administered by cordocentesis (5 mL) was significantly less (P < 0.001) than the dose required when fetal cardiocentesis was performed for administration of the drug (10 mL). Conclusion This is the first comparative study of feticide by the administration of strong KCl by fetal cardiocentesis and cordocentesis. The study demonstrates that both cardiac and umbilical routes can be used to achieve feticide effectively, without compromising maternal safety. A finding of this study is that significantly smaller doses of KCl were required to achieve fetal cardiac asystole when using the umbilical compared to the cardiac route, although this may be explained by differences in technique. Strong 15% KCl can safely be used to achieve feticide in volumes up to 20 mL for cardiocentesis and 8 mL for cordocentesis. [ABSTRACT FROM AUTHOR]

Abstract Objective To determine the value of performing routine fluorescent in situ hybridization (FISH) for microdeletions of chromosome 22q11 when karyotyping fetuses with increased nuchal translucency. Design This was a prospective observational study carried out over an 18-month period. Fetal karyotyping by chorionic villus sampling was offered to 5429 women attending for a routine booking scan in the first trimester when their nuchal translucency adjusted risk for Down syndrome was ≥ 1 in 300. Cytogenetic samples were routinely tested for the 22q11 microdeletion when the nuchal translucency was ≥ 3 mm. Results The prevalence of increased nuchal translucency ≥ 2.5 mm was 180 (3.3%) and ≥ 3.5 mm was 42 (0.8%). None of 75 fetuses with an increased nuchal translucency and normal karyotype demonstrated a 22q11 microdeletion on FISH analysis. In the same cohort, 3 of 20 (15%) cases of major congenital heart defects in which nuchal translucency was measured, had a nuchal translucency measurement ≥ 2.5 mm. Conclusions Routine FISH analysis for chromosome 22q11 microdeletions at the time of chorionic villus sampling for increased first-trimester nuchal translucency is of limited value. As a significant proportion of fetuses with increased nuchal translucency will be found to have congenital heart defects later in the pregnancy, FISH analysis for chromosome 22q11 microdeletions can be targeted to fetuses with specific congenital heart defects. Tissue from the chorionic villus sampling should therefore be stored for subsequent analysis, until after detailed echocardiography is performed. [ABSTRACT FROM AUTHOR]

FMU ultrasound and MRI confirmed an anterior low lying placenta with full thickness myometrial involvement and bladder invasion. In conclusion, this is a case of a patient with placenta percreta treated conservatively with successful subsequent pregnancy outcome. [Extracted from the article]

An abstract of the conference paper "Early fetal demise of one twin in monochorionic placentation: echogenic bowel and the subsequent diagnosis of aplasia cutis congenita" by B. T. Hollis and colleagues is presented.

Objective: To evaluate the role of ductus venosus (DV) Doppler in pregnancies with an increased nuchal translucency (NT) adjusted risk for the prediction of fetal outcome. Methods: Doppler assessment of the DV was performed in 124 fetuses with a first trimester NT-adjusted risk of >1:300 for Down syndrome. The pregnancy outcome, including karyo-type and structural abnormalities, were ascertained for all pregnancies. Results: The DV Doppler was abnormal in 27 (21.8%) pregnancies with an increased first trimester NT-adjusted risk. The outcome was normal in 69 pregnancies (55.6%). Thirty-nine pregnancies (39.5%) were aneuploid and further six pregnancies had adverse outcomes (three unexplained intrauterine deaths, two structural abnormalities and one major cardiac defect). The sensitivity of abnormal DV in this selected population was 51.3% for aneuploidy and 33.3% for adverse outcome. An abnormal DV Doppler increases the risk for aneuploidy by 11.8 (95% CI: 3.3–42.2). Conclusions: The finding of an abnormal DV Doppler signal increases the risk for aneuploidy 12-fold in a pregnancy with an increased NT-adjusted risk. Although DV Doppler can be used in addition to NT screening for aneuploidy, the sensitivity of DV Doppler is less than previously reported. [ABSTRACT FROM AUTHOR]

Objectives: Failure to visualise the fetal nasal bones at 11-14 weeks of gestation is associated with a significant increase in the risk for trisomy 21. However, it is not known whether the ethnic origin of the mother has any effect on the fetal profile and the prevalence of this marker., Design: Prospective study., Setting: London Teaching Hospital., Population: Four thousand and four hundred and ninety-two consecutive fetuses undergoing routine first trimester ultrasound scanning at 11-14 weeks of gestation in a multiethnic population., Methods: Examination of the nasal bones was attempted in the fetuses., Main Outcome Measure: Rate of visualisation of the fetal nasal bones., Results: Five hundred fetuses were excluded from the analysis because of chromosomal abnormalities or a technically unsatisfactory examination. In the remaining 3992 fetuses, the maternal ethnic origin was African in 13.0%, Asian in 15.3% and Caucasian in 66.0%. Compared with Caucasians, the failure to visualise the fetal nasal bones was significantly higher in women of African (P= 0.0001) but not Asian origin (P= 0.24). A multivariable logistic regression model showed that having a mother of African origin is still significantly associated with an increased likelihood of absent fetal nasal bones compared with Caucasians (odds ratio 2.33), even after correcting for maternal age, parity and crown-rump length., Conclusion: There is a significant difference in the rate of visualisation of the fetal nasal bones in the first trimester in mothers of different ethnic origin. This suggest that corrections for maternal ethnicity will be required to ensure equity of fetal nasal bone screening in multiracial populations. Whether corrections are required for the father's ethnic origin remains to be determined.

Objectives: To correlate transvaginal ultrasound findings with mode of delivery in cases of placenta praevia., Design: Cohort study., Setting: A London Teaching Hospital., Methods: Retrospective review of all cases of placenta praevia diagnosed by transvaginal ultrasound between February 1997 and March 2002., Main Outcome Measures: Likelihood of vaginal delivery and major obstetric haemorrhage., Results: A total of 121 pregnancies were studied with a mean scan-to-delivery interval of 10.5 days. In the 64 women who laboured, the likelihood of vaginal delivery rose significantly as the placental edge to internal os distance increased. Caesarean section rate was 90% when the placental edge-internal os distance was 0.1 to 2.0 cm, falling to 37% when this measurement was over 2.0 cm (P < 0.00045)., Conclusion: Trial of vaginal delivery is appropriate in cases with a placental to internal os distance >2 cm. The term "praevia" should be restricted to cases where the placental edge is < or =2 cm from the internal os, as the likelihood of operative delivery and significant postpartum haemorrhage is high. Cases where the placenta is more than 2 cm from the internal os have a greater than 60% chance of vaginal delivery and should be defined as "low lying" in order to reduce the clinician's bias towards operative delivery.

Objective: To assess the role of ductus venosus Doppler assessment in screening for fetal aneuploidy in pregnancies at 11-14 weeks of gestation., Design: Prospective observational study., Setting: A tertiary referral fetal medicine unit., Population: Two hundred fifty-six consecutive pregnancies between 11 and 14 weeks of gestation referred to our unit., Methods: Nuchal translucency was measured and colour Doppler imaging was used to assess normal (forward) or abnormal (absence/reversed) ductus venosus flow during atrial contraction., Main Outcome Measures: Fetal karyotype, structural abnormalities and pregnancy outcomes., Results: The nuchal translucency measurement was > or = 95th centile in 90 (35.2%) pregnancies, and 123 (48.0%) had a nuchal translucency-related risk of > or = 1:300. There were 46 chromosomally abnormal pregnancies and six euploid pregnancies with adverse outcome. The prevalence of abnormal ductus venosus Doppler waveforms in normal pregnancies was 4.49% (95% CI 1.76-8.76%). The sensitivities of abnormal nuchal translucency measurement alone, ductus venosus velocimetry alone or nuchal translucency and ductus venosus combined for Down's Syndrome were 80.4%, 58.7% and 93.5%, respectively. The likelihood ratios for aneuploidy with abnormal nuchal translucency measurement alone, ductus venosus velocimetry alone or nuchal translucency and ductus venosus combined were 3.33, 9.83 and 3.48, respectively., Conclusion: There is clear association between abnormal flow in the ductus venosus and fetal aneuploidy. The use of ductus venosus velocimetry in combination with nuchal translucency is better than either test alone, since it increases the sensitivity in the detection of Down's Syndrome to 94% and decreases the likelihood ratio of a negative test to 0.08.

Objective: To determine whether Caucasian women ages 28-48 years with newly defined osteoarthritis (OA) would have greater bone mineral density (BMD) and less bone turnover over time than would women without OA., Methods: Data were derived from the longitudinal Michigan Bone Health Study. Period prevalence and 3-year incidence of OA were based on radiographs of the dominant hand and both knees, scored with the Kellgren/Lawrence (K/L) scale. OA scores were related to BMD, which was measured by dual-energy x-ray absorptiometry, and to serum osteocalcin levels, which were measured by radioimmunoassay., Results: The period prevalence of OA (K/L grade > or =2 in the knees or the dominant hand) was 15.3% (92 of 601), with 8.7% for the knees and 6.7% for the hand. The 3-year incidence of knee OA was 1.9% (9 of 482) and of hand OA was 3.3% (16 of 482). Women with incident knee OA had greater average BMD (z-scores 0.3-0.8 higher for the 3 BMD sites) than women without knee OA (P < 0.04 at the femoral neck). Women with incident knee OA had less change in their average BMD z-scores over the 3-year study period. Average BMD z-scores for women with prevalent knee OA were greater (0.4-0.7 higher) than for women without knee OA (P < 0.002 at all sites). There was no difference in average BMD z-scores or their change in women with and without hand OA. Average serum osteocalcin levels were lower in incident cases of hand OA (>60%; P = 0.02) or knee OA (20%; P not significant). The average change in absolute serum osteocalcin levels was not as great in women with incident hand OA or knee OA as in women without OA (P < 0.02 and P < 0.05, respectively)., Conclusion: Women with radiographically defined knee OA have greater BMD than do women without knee OA and are less likely to lose that higher level of BMD. There was less bone turnover among women with hand OA and/or knee OA. These findings suggest that bone-forming cells might show a differential response in OA of the hand and knee, and may suggest a different pathogenesis of hand OA and knee OA.