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Background: In this study, we aimed to evaluate the effect of s-FLT-1 and PlGF concentrations in women in the first trimester of pregnancy on the pulsatility index of the ductus venosus and the right and left uterine arteries. Methods: A total of 108 pregnant women in their first trimester were included in the study, with 87 assigned to the experimental group and 21 to the control group. Ultrasound examination were performed to measure the uterine artery pulsatility index, resistance index, ductus venosus pulsatility index, and blood sampling levels of biomarkers such as b-HCG; PAPP-A; s-FLT-1 and PlGF. Results: There was a significant negative relationship between PAPP-A concentration and the risk of fetal growth restriction, and a significant negative relationship between PlGF concentration and the risk of preeclampsia and fetal growth restriction in women in their first trimester of pregnancy. There was also a significant positive relationship between sFLT-1/PLGF ratio and the risk of developing preeclampsia. No significant relationships were found between the concentrations of biomarkers beta-HCG, PAPP-A, sFLT-1, PlGF, and any of the parameters PIUARt, PIUALt, Mean uterine arteries, and DVPI. Summary: In conclusion, this study did not find conclusive evidence to support the hypothesis that beta-HCG, PAPP-A, s-FLT-1, and PlGF concentrations in women in the first trimester of pregnancy have a significant effect on the Pulsatility Index of the ductus venosus and the Right and left Uterine Arteries. Further research is needed to investigate these potential associations.

The aim of this non-randomized study was to evaluate the impact of spine joint mobility and chest mobility on inhalation and exhalation, and to assess the abdominal muscle strength in patients undergoing surgery for colorectal cancer with one of the following methods: anterior resection, laparoscopic anterior resection or abdominoperineal resection. In patients who were successively admitted to the Department of Surgical Oncology at the Oncology Center in Bydgoszcz, the impact of spine joint mobility, muscle strength and chest mobility on inhalation and exhalation wasassessed three times, i.e., at their admission and three and six months after surgery. The analysis included 72 patients (18 undergoing abdominoperineal resection, the APR group; 23 undergoing laparoscopic anterior resection, the LAR group; and 31 undergoing anterior resection, the AR group). The study groups did not differ in terms of age, weight, height, BMIor hospitalization time (p > 0.05). Three months after surgery, reductions in spine joint mobility regarding flexion, extension and lateral flexion, as well asreductions in the strength of the rectus abdominis and oblique muscles, were noted in all study groups (p < 0.05). In comparison between the groups, the lowest values suggesting the greatest reduction in the range of mobility were recorded in the APR group. Surgical treatment and postoperative management in colorectal cancer patients caused a reduction in spine mobility, abdominal muscle strength and chest mobility. The patients who experienced those changes most rapidly and intensively werethose undergoing abdominoperineal resection.

Objective: To assess whether there are differences in first-trimester fetal hepatic artery flows depending on pregnancy outcomes. Methods: The prospective study conducted in 2012–2020 included 1841 fetuses from singleton pregnancies assessed during the routine first-trimester ultrasound examination (between 11- and 14-weeks’ gestation). Also, each fetus was examined to determine their hepatic artery flows by measuring the artery’s pulsatility index (HA-PI) and peak systolic velocity (HA-PSV). Results: The fetuses that were classified as belonging to the adverse pregnancy outcome group (those with karyotype abnormalities and congenital heart defects) were characterized by a significantly lower HA-PI and higher HA-PSV compared to normal outcome fetuses. Conclusion: Hepatic artery flow assessment proved to be a very useful tool in predicting adverse pregnancy outcomes, in particular karyotype abnormalities and congenital heart defects.

Diabetes mellitus is the most common metabolic complication in pregnancy and increasing worldwide. In Europe, it occurs in 3-5% of pregnant women. The rate of twin pregnancy has been increased similarly to gestational diabetes mellitus (GDM). Twin pregnancy is associated with a higher complication rate compared to singleton pregnancy. The growing prevalence of GDM and twin pregnancy has given rise to their increasing concurrent presentation.The retrospective analysis included 212 twin-pregnant patients. The analysis excluded cases of miscarriage and early fetal death in the first trimester of pregnancy. The influence of GDM on the condition of newborns and mothers after delivery was analyzed. For statistical analysis R 3.6.2 software was used.No statistically significant relationship between GDM and Non-GDM group and periparturient complications was found. Birth weight was significantly higher in the GDM G2 group. Apgar Score was the lowest in the GDM G1 group. In the group of larger newborns of the GDMG1 group respiratory distress syndrome (RDS) , a higher incidence of second-degree intracranial bleeding and grade II of preterm retinopathy were observed. There was no statistically significant relationship between GDM G1, GDM G2 and other neonatal complications.In summary, our results indicate that GDM in twin pregnancy does not increase the risk of cesarean section but increases some neonatal complications. In conclusion women with twin pregnancies complicated by GDM require specialist care during pregnancy and childbirth should take place in a third-level reference center.

A balance within the immune system is necessary for the proper development of ovarian follicles. Numerous cytokines were detected in follicular fluid, the role of which in reproductive physiology seems crucial. They influence the development and maturation of the follicle, ovulation, and corpus luteum formation, as well as embryo implantation and maintenance of pregnancy. The analysis of follicular fluid requires its collection by puncturing of the ovary, which is usually executed in connection with various gynaecological procedures. When interpreting such test results, clinical indications for a given procedure and the method of patient preparation should be taken into account. This review revealed the results of currently available studies on the concentration of pro-inflammatory cytokines in follicular fluid in various forms of infertility. Additionally, it presented cytokines, whose concentration has a significant impact on the size of ovarian follicles, their number, the effectiveness of in vitro fertilisation, development of the embryo, and chances of correct implantation. Despite the many recent publications, the knowledge of follicular fluid immunology in the context of reproductive pathology is superficial and further research is required to extensively understand the roles of individual cytokines in reproductive pathology. In the future, this knowledge may enable patients’ individual qualifications to individual methods of infertility treatment, as well as the possible adjustment of the treatment regimen to the patient’s immune profile.

Background: Allergy is associated with the loss of tolerance of environmental antigens, combined with a pathological immune response. There were no studies up to date that would show whether the quality of semen decreases in people with allergic diseases. Material and methods: The research included men who reported to the Gynecological Outpatient Clinic due to reproductive difficulties, defined as the lack of pregnancy after one year of regular intercourse. Semen quality was assessed according to the World Health Organization (WHO) standard. All patients underwent skin prick tests with the most important inhalation allergens (such as hazel, silver birch, mugwort, rye, dog, cat, Dermatophagoides farinae, Dermatophagoides pteronyssinus, alder, Alternaria alternata, Cladosporium herbarum, and grass mix). The data was statistically analyzed. Results: Results of 52 patients aged 25–52 years (34.62 ± 4.96) were analyzed. The mean BMI (Body mass index) was 28.25 (+ −3.77). It was found that 38 men (73%) had increased body weight, and 14 men (26.9%) were obese (BMI > = 30). 13 patients were smokers (25%), and 24 patients (46%) had skin tests positive for at least one inhaled allergen. Sperm tail defects were statistically more significant in patients allergic to birch, rye, cat, alder, and grass. In patients allergic to Alternaria alternata, head defects were statistically more significant ( p < .05). No association was found between allergy to house dust mites, mugwort, hazel, and dogs and the deterioration of semen. Conclusion: Allergy due to inhalation allergens had an influence on the quality of male semen. Further research is necessary to establish the immunological bases of this phenomenon.

Introduction: Progesterone is essential for both the initiation and the maintenance of pregnancy. The immunological effects of progesterone are mediated by the progesterone-induced blocking factor (PIBF), which is an immunomodulatory factor with anti-abortive properties. The aim of the research was to establish the cytokine profile and PIBF1 concentration in follicular fluid (FF) of patients undergoing in vitro fertilization (IVF). Methods: Seventy-eight patients who qualified for IVF underwent a detailed medical interview, including the course of fertility treatment and physical, gynecological, and cytological examinations. The concentration of PIBF1, IL-18, IL-2, IL-4, IL-6, IL-10, interferon-γ (IFN-γ), IL-1α, IL-1β, IL-5, IL-8, and IL-15 in FF during ovarian puncture was measured using commercially available ELISA kits. Results: IL-1 beta concentration was lower in the FF of patients with successful IVF. IL-8 concentration in FF correlated with the number of cumulus-oocyte complexes (COC-1), metaphase II (MII), and top-quality embryos. PIBF1 concentration had a positive correlation with the number of MII and top-quality embryos. IL-2 and IL-6 concentrations were positively correlated with the number of COC-1 and MII. An important parameter in assessing the chances of successful IVF is the number of top-quality embryos achieved. Conclusion: Higher PIBF1 concentration in FF may indicate a greater possibility of successful IVF due to the higher number of top-quality embryos. IL-1 beta concentration was found to be lower in the FF of patients with successful IVF. Therefore, PIBF1 and IL-1 beta in FF could be candidates for a marker of successful IVF.

Objectives: The aim of the study was to compare effects of addition of two methods of ductus venosus (DV) flow assessment: qualitative — the assessment of shape of the A-wave (positive or negative), and quantitative — based on the pulsatility index for veins (DVPI) to the basic screening for trisomy 21 at 11 to 13 + 6 weeks of pregnancy. Material and methods: The ultrasound examination was performed in 8230 fetuses in singleton pregnancies at 11– –13 + 6 wks, as a part of a routine screening for chromosomal defects. In DV A-wave was assessed and DVPI was calculated. After the scan blood sample was taken for first trimester biochemistry (BC). Risk for chromosomal defects was calculated and high-risk patients were offered an invasive test for karyotyping. Results: Basic screening with following combination of markers: MA, NT and BC provided lowest detection rate (DR) 87.50% for FPR = 6.94%. After adding qualitative DV A-wave assessment DR increased to 88.75% for FPR = 5.65%. The best DR = 93.75% for FPR = 5.55% was achieved when quantitative DVPI was added. The application of the Receiver Operating Curves curve confirmed validity of the addition of DV flow assessment to the screening model. The highest diagnostic power of the test was achieved when DVPI was added, with the ROC AUC of 0.974. Conclusions: The assessment of DV flow performed at 11–13 + 6 weeks increases DR for trisomy 21 and reduces FPR. The screening model based on the quantitative DV flow analysis (DVPI) gives better results compared to the qualitative flow assessment.

Objectives: The aim of the study was to analyze the origin of birth defects in pregnant women from the Kujawy-Pomerania Region, and to identify factors affecting the formation of developmental disorders in the Province. Material and methods: The correlation between maternal age and fetal defects was investigated. We also attempted to determine whether environmental or family factors play a role in the formation of fetal abnormalities. Results: The analysis confirmed a correlation between the incidence of chromosomal aberrations and maternal age. Conclusions: Higher rates of neural tube defects were observed in fetuses born to mothers who did not take folic acid. The influence of other factors on developmental anomalies was not confirmed.

The subject matter of this publication is the legal assessment of endogenous infection - the specific type of hospital infections. The main aim of the publication is to answer the question of whether medical and legal grounds exist for civil liability for endogenous infections and for treating those infections as cases of medical malpractice or medical events. The research method adopted is a case study. The authors have analysed a civil lawsuit for compensation instituted by an infected patient against a Polish hospital, adjudicated in 2013. The main conclusion of the publication is to postulate distinguishing medical malpractice from complications resulting from the reactions of the human body to treatment. The authors argue that endogenous infections should be treated as the latter-mentioned of these two cases.

Objective: A voluminous umbilical cord has been described in diabetic pregnancies. The aim of this study was to see if measurements of cord diameters might be of value in the evaluation of diabetic pregnancies and especially those suspected of a large for gestational age (LGA) fetus. Methods: In an observational, prospective study umbilical cord areas and vessel diameters were measured between gestational age of 22 and 40 weeks in transverse ultrasound images of the central part of the cord in 141 normal and 135 diabetic pregnancies of which 30 were suspected of being LOA. Wharton's jelly area was calculated by subtracting the vessel area from the total transverse cord area. Normal reference curves were constructed for gestational age. Results: Umbilical cord and Wharton's jelly areas increased with gestation. The vessel area leveled out at 32-33 weeks of gestation and the umbilical vein area decreased after 36 weeks of gestation. The umbilical cord parameters in diabetic pregnancies did not differ from controls. Cord areas were enlarged in 1/3 of the LGA fetuses. Conclusion: Umbilical cord area measurements are of limited value for the evaluation of diabetic pregnancies suspected having a LGA-fetus. (Less)

Background: The accepted standard for assessing the wellbeing of the newborn is the Apgar score and blood gas analysis. However, the prediction of neonatal morbidity or mortality is limited. In small-for-gestation (SGA) fetuses at 18-38 weeks of gestation, pO(2) is

The placenta is vital for fetal growth and development. Improvement in ultrasound and magnetic resonance imaging have improved our understanding of placental morphology that can be important as in the case of placental accrete/percreta. Functional imaging is presently mainly performed by the use of Doppler ultrasound and can give information on placental perfusion, which can be vital for clinical diagnosis. This review summarizes the present knowledge on placental imaging and it's clinical value in high-risk pregnancies.

BACKGROUND: Fetal chronic hypoxia leads to centralization of circulation in order to spare the vital organs brain, adrenals and the heart. This can be documented by Doppler ultrasound. Increased blood velocity in the fetal middle cerebral artery (MCA) is an acknowledged sign of centralization of circulation in chronic hypoxia, and is called brain sparing. AIM: Our aim was to assess the relationship between signs of brain sparing in the MCA and umbilical cord blood gases at birth. STUDY DESIGN: A prospective study. SUBJECTS: Singleton 57 high-risk pregnancies (outcome was compared with 21 normal pregnancies). METHODS: MCA Doppler was performed within 24 h of elective caesarean section in high-risk pregnancies. Umbilical cord blood gases were analysed at birth. MAIN OUTCOME MEASURES: Cord blood gases were related to signs of centralization of fetal circulation in the MCA. RESULTS: No correlation between signs of brain sparing in the MCA and cord blood gases. Apgar score at 5'

A voluminous umbilical cord has been described in diabetic pregnancies. The aim of this studywas to see if measurements of cord diameters might be of value in the evaluation of diabetic pregnancies and especially those suspected of a large for gestational age (LGA) fetus.In an observational, prospective study umbilical cord areas and vessel diameters were measured between gestational age of 22 and 40 weeks in transverse ultrasound images of the central part of the cord in 141 normal and 135 diabetic pregnancies of which 30 were suspected of being LGA. Wharton's jelly area was calculated by subtracting the vessel area from the total transverse cord area. Normal reference curves were constructed for gestational age.Umbilical cord and Wharton's jelly areas increased with gestation. The vessel area leveled out at 32-33 weeks of gestation and the umbilical vein area decreased after 36 weeks of gestation. The umbilical cord parameters in diabetic pregnancies did not differ from controls. Cord areas were enlarged in 1/3 of the LGA fetuses.Umbilical cord area measurements are of limited value for the evaluation of diabetic pregnancies suspected having a LGA-fetus.

Three-dimensional (3-D) ultrasound imaging has improved evaluation of organ circulation and might contribute new information on maternal and fetal blood supply. Flow index (FI) of 3-D color images has been proposed as a measure of perfusion. The aim of this study was to evaluate whether the 3-D FI is a parameter of volume flow and flow velocity in a human vessel and in a flow phantom. A 1-cm-long strip of the uterine artery was recorded in 3-D power Doppler (3D-PD) mode in a cross-sectional study of 170 normal singleton pregnancies between 26 and 42 weeks’ gestation. A fixed ultrasound system installation was used during the examination. The VOCAL™ software integrated in the ultrasound unit calculated vessel volume and FI. Reproducibility of the measurements was tested. The method was also tested on a commercially available flow phantom. Reproducibility measurements gave satisfactory results, both in terms of inter- and intraobserver variation. Unexpectedly, in normal pregnancy, the uterine artery FI decreased slightly with gestation. Uterine artery vessel volume increased, however, with gestational age. A poor correlation was found between the FI and both flow velocity and volume flow in the flow phantom. In conclusion, 3D-PD imaging can give impressive anatomical pictures of organ vascular tree. However, the new FI is poorly related to flow velocity or volume of flow. (E-mail: saemundur.gudmundsson@med.lu.se )

Objective Signs of increased uterine artery vascular impedance in mid-gestation are strongly related to pre-eclampsia later in pregnancy. Whether this is true for the late third trimester is, however, unclear. The aim of the present study was to analyze the frequency of increased uterine artery vascular impedance in the third trimester, and its relationship to abnormal umbilical artery Doppler and adverse outcome of pregnancy. Methods This was a retrospective study of uterine and umbilical artery Doppler velocimetry in 570 pregnancies complicated by pre-eclampsia. The managing clinician was informed only about the umbilical artery flow. The Doppler recordings were related to severity of pre-eclampsia, prematurity, fetal growth restriction, and rates of Cesarean section and admission to neonatal intensive care. Results Increased umbilical artery vascular impedance was seen in 59 cases (10.4%), seven having absent or reversed end-diastolic flow. Uterine artery notching was seen in 145 cases (25%), 88 (15%) having bilateral notches. Either increased uterine artery pulsatility index (PI) or notching, or both, were seen in 207 women (36.3%). In 108 women with severe pre-eclampsia, 38 (35.2%) had uterine artery notching. Signs of increased uteroplacental vascular impedance were more common in severe than in mild pre-eclampsia (57.4% vs. 31.4%), in premature than in term pregnancies (70.9% vs. 28.4%), and were more prevalent than abnormality in the umbilical artery (36.3% vs. 10.4%). Conclusion Only one-third of pre-eclamptic cases showed signs of increased uterine artery vascular impedance in the third trimester. However, signs of increased vascular impedance were much more frequent in the uterine than in the umbilical arteries and were strongly related to adverse outcome of pregnancy. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.

Three-dimensional (3-D) ultrasound (US) has greatly improved evaluation of organ circulation. The aim of this study was to explore the possible use of this new technique in normal and high-risk pregnancies. Fetal brain, lung and placenta 3-D power Doppler signal intensity were recorded in 115 normal singleton pregnancies (24 to 42 weeks gestation) and in 67 high-risk pregnancies. Mean image pixel signal intensity was calculated for each organ and a brain-lung ratio. In normal pregnancy, placental and lung signal intensity increased until 33, with a rapid decrease after 38, weeks of gestation. Fetal cerebral signal intensity increased with gestational age. Placental and fetal lung signal intensity was significantly lower in high-risk pregnancies than in the control group, with increased fetal brain and brain-lung ratios. The present results suggest a reduction of placental perfusion after 38 weeks of gestation in normal pregnancy, with redistribution of fetal circulation. Lung signal intensity increased abruptly at 32 weeks of gestation, which might reflect lung maturity. The new method showed signs of centralization of fetal circulation at the end of gestation. The results might suggest a possible clinical use for fetal surveillance in high-risk pregnancies.

Objective In previous pilot studies, fetal vein of Galen (GV) blood velocity has been shown to be non-pulsatile in normal pregnancies. A pulsating pattern in high-risk pregnancies has been related to adverse outcome of pregnancy. The aim of this study was to establish reference ranges for fetal cerebral venous blood flow and compare them to the recordings in high-risk pregnancies in terms of predicting adverse perinatal outcome. Methods The GV, straight sinus (SS) and transverse sinus (TS) were located by color Doppler ultrasound in 189 normal pregnancies between 23 and 43 weeks of gestation. Recordings were also made in 102 pregnancies complicated by pregnancy-induced hypertension and/or intrauterine growth restriction. The following parameters were measured: peak systolic velocity, minimum diastolic velocity, time-averaged maximum velocity, pulsatility index for veins (PIV) and preload index (PLI). GV pulsations were noted. In high-risk pregnancies, Doppler measurements were correlated to pregnancy outcome, including emergency operative intervention and/or neonatal distress. Umbilical vein and umbilical, uterine and middle cerebral artery blood velocities were also recorded at the same time. Results In normal pregnancy, pulsating venous blood velocity was observed in GV in 8% of cases, in SS in 79% of cases and in TS in 100% of cases. GV and SS maximum velocity increased with gestational age and TS-PIV showed linear decreasing values and TS-PLI showed increasing values with gestational age. In high-risk pregnancies, pulsating blood velocity in the GV was found in 59 (58%) cases and was related to adverse outcome of pregnancy including mortality. Abnormal values for TS-PIV and PLI and SS maximum velocity were found in nine, six and five cases, respectively and were only related to perinatal mortality. GV pulsations were more frequent than umbilical venous pulsations. Conclusions Of the fetal cerebral veins studied, the presence of pulsations in the GV seems to be the best predictor of adverse outcome of high-risk pregnancy. Pulsations in the GV are more frequent than in the umbilical vein and might therefore appear earlier during worsening fetal condition, and thus be of potential value for fetal surveillance in high-risk pregnancies. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

Background. Umbilical artery Doppler velocimetry is a routine method for fetal surveillance in high-risk pregnancy. Uterine artery Doppler seems to give comparable information, but it can be difficult to interpret as there are two arteries, which might show notching and/or increased pulsatility index (PI) as signs of increased vascular impedance. Combining the information on vascular resistance on both sides in a new score might simplify and improve evaluation of placental circulation. Methods. Uterine and umbilical artery Doppler velocimetry was evaluated in 633 high-risk pregnancies. The managing clinician was informed only about the umbilical artery flow. The umbilical artery flow spectrum was semiquantitatively divided into four blood flow classes (BFC), expressing signs of increasing vascular resistance. The uterine artery Doppler flow spectrum was divided into five uterine artery scores (UAS), taking into account presence/absence of notching and/or increase in PI. By adding UAS to BFC, a new placental score (PLS) was constructed with values ranging from 0 to 7, indicating general placental vascular resistance. The scores were related to three outcome variables: small-for-gestational age (SGA), premature delivery (

Aim: To record blood flow velocimetry in the superior mesenteric, hepatic and middle cerebral arteries for detection of circulation redistribution and prediction of perinatal outcome in fetuses with absent or reversed diastolic flow in the umbilical artery. Study design: The fetal superior mesenteric, hepatic and middle cerebral artery blood velocimetry was recorded in 33 pregnancies complicated by pregnancy-induced hypertension and/or intra-uterine growth retardation between 27 and 41 weeks of gestation. Uterine artery and umbilical vein velocimetries were also recorded. Results: An abnormal mesenteric artery pulsatility index (PI) was found in four cases; two newborns died due to prematurity, growth retardation and necrotizing enterocolitis. An abnormal fetal hepatic artery PI was found in 17 cases. The brain-sparing effect in the middle cerebral artery was found in 16 cases; three newborns died after delivery. Signs of redistribution in mesenteric, hepatic and middle cerebral artery velocimetry were not related to most of the perinatal outcome variables. Umbilical vein velocimetry correlated with low arterial and venous pH. All perinatal mortalities had umbilical venous pulsations. Conclusions: Signs of visceral circulation redistribution could not predict adverse outcome. Umbilical venous pulsations were, however, seen in nearly all fetuses; this was the only variable suggesting adverse outcome in the present study of severely compromised fetuses.

Aim. The aim of this study was to evaluate umbilical artery (UA) and uterine artery (Ut.A) Doppler velocimetry in a low-risk pregnancy group with decreased fetal movements. Material and methods. Eight hundred and eighty-eight women were examined because of decreased fetal movements. All fetuses were alive on maternal admission. In all cases, UA and Ut.A Doppler velocimetries were performed, as well as a nonstress test (NST). The managing clinician was informed only of the UA Doppler. Results. In the group of 135 women who gave birth within 2 days, UA velocimetry was abnormal in seven fetuses. In 11 cases, Ut.A vascular resistance was abnormal and in 18 cases 'notch' was stated. There were 19 emergency sections in this group. Signs of increased placental vascular resistance were correlated with need for operational delivery because of fetal distress. Among the remaining 753 women who delivered after more than 2 days after examination, UA velocimetry showed abnormality in five fetuses. In 42 cases the Ut.A pulsatility index was abnormal and in 118 cases an early end diastolic 'notch' was present. There was one perinatal death in this group. Conclusions. Decreased fetal movement perception by mothers should be taken seriously. Abnormal placental Doppler was an infrequent finding in these low-risk pregnancies. However, adding UA and Ut.A Doppler velocimetries to conventional NST surveillance might be reassuring for managing clinicians.

Background Studies on blood flow velocity in the fetal middle cerebral artery have revealed signs of brain sparing in chronic hypoxia. These signs of brain sparing can disappear in the terminal case, but whether this applies to the whole brain or only parts of it is unknown. Methods Velocity waveforms of the middle cerebral, anterior cerebral and posterior cerebral arteries were recorded in 221 pregnancies complicated by pregnancy-induced hypertension. The presence of brain sparing (pulsatility index < 2 standard deviations) was noted and correlated to outcome of pregnancy, including emergency operative intervention and/or neonatal distress. Results Signs of brain sparing in the anterior cerebral artery were found in 90 fetuses, and in the middle cerebral and posterior cerebral arteries in 52 and 65, respectively. Signs of brain sparing in the anterior cerebral artery showed the strongest relationship to adverse perinatal outcome. The anterior cerebral artery was the only vessel in which signs of brain sparing were predictive of perinatal mortality. Conclusions Velocimetry of the anterior cerebral artery appears to be superior to that of the middle cerebral and posterior cerebral arteries as a means to predict adverse perinatal outcome. Anterior cerebral artery brain sparing may therefore be less transitory than sparing in the middle cerebral and posterior cerebral arteries, possibly suggesting that the frontal lobes are spared longer than the lateral and occipital regions of the fetal brain.

OBJECTIVE: Reverse end-diastolic flow is the most pathological type of the umbilical artery flow velocity waveform. We aimed to investigate whether additional prognostic information can be obtained from umbilical artery waveforms in cases with reverse end-diastolic flow. SUBJECTS AND METHODS: Umbilical artery Doppler velocity waveforms from 44 fetuses with reverse end-diastolic flow were analyzed and the following parameters measured: the highest amplitude and the area below the maximum velocity curve of forward and reverse flow (A, B and C, D, respectively) and the duration of forward and reverse flow (Tc and Td, respectively). Ratios A/B, C/D and Tc/Td were calculated. The cut-off values for A/B, C/D and Tc/Td with the best predictive values for perinatal death were established with the help of receiver operating characteristics curves. The three curves were compared with each other. RESULTS: Of the three ratios, A/B and C/D had the best capacity to predict perinatal death. Both ratios had acceptable sensitivities, specificities and positive predictive values. In this regard, A/B and C/D were comparable. The cut-off values for A/B and C/D were 4.3 and 4.52, respectively. Survivors had I significantly higher A/B and C/D ratios than non-survivors (P = 0.0001 and 0.0003, respectively). Significantly more fetuses with A/B or C/D below the established cut-off values had pulsations in the venous system (P < 0.05). In fetuses with a gestational age < =210 gestational days the survival rate was significantly higher in those with A/B or C/D above the cut-off values (P = 0.03 and 0.003, respectively). CONCLUSIONS: The A/B or C/D ratio can be used for quantification of the reverse end-diastolic flow waveforms in the umbilical artery and may offer additional information to the evaluation of fetal condition. (Less)

Although retrograde menstruation is observed in up to 90% of women, endometriosis actually develops in only 15% of women. There is considerable evidence in the literature that ectopic endometrial cells are able to evade immune surveillance and that the immune response in the microenvironment of ectopic lesions is limited. Endometriosis develops when a deficiency in the local immune response has been generated, and progression of the disease is related to the intensity of this process. Over the last couple of decades it has been well known that T regulatory lymphocytes (Tregs) play a crucial role in controlling a variety of physiological and pathological immune responses. In this review we have focused on the physiological alteration of Treg cell infiltration into the endometrium during the reproductive processes of women. We discuss how a disturbance in Treg cell expansion is involved in generating such pathological processes as miscarriage and ectopic pregnancy development. We hypothesize about the role Treg cells might play in the survival of endometriosis foci in ectopic localization and in the evasion of such lesions from host immune surveillance.

Studies on fetal lung/brain circulation by means of power Doppler technique have suggested a marked reduction in lung perfusion in high-risk pregnancies as a sign of circulation redistribution. The ratio between lung/brain perfusion might therefore give a new method to predict fetal circulation centralization. Objective: The aim of the present study was to obtain fetal lung and cerebral artery ratio in normal and high-risk pregnancies. Study design: Doppler samples from proximal right pulmonary artery blood velocities and middle cerebral artery (MCA) were recorded cross-sectionally in 228 normal singleton pregnancies at gestational age 22 to 40 weeks. MCA / right pulmonary artery pulsatility index (PO ratio was calculated. Doppler samples from proximal right pulmonary artery and MCA were also recorded in 89 high-risk singleton pregnancies and the results related to perinatal outcome. Results: In the normal controls, right pulmonary artery PI remained stable until 30 weeks of gestation with slight increase thereafter until term. The MCA to right pulmonary artery PI ratio increased between 22 and 28 weeks of gestation with the rapid fall towards term. In the high-risk pregnancies group, right pulmonary artery PI showed no significant correlation to perinatal outcome, but signs of brain-sparing in the MCA were correlated to all adverse outcome parameters. Conclusion: Velocimetry of the middle cerebral artery is better than velocimetry of right pulmonary artery in predicting adverse outcome of pregnancy The brain/lung PI ratio does not improve the prediction of adverse outcome of pregnancy. (Less)

Chorioangioma (chorionic angioma) is the most common non-malignant placental tumor. Taking into account its morphological structure, it can have significant influence on fetal condition and pregnancy, depending on its size. In the presented case a substantial placental tumor was diagnosed and complications typical for chorioangioma, such as fetal hemodynamic disorders, polyhydramnios, gestational diabetes and premature labor, were observed. The applied treatment led to normalization of the fetal and maternal condition and to prolongation of the pregnancy.

BACKGROUND: Pulsation in the flow velocity waveform in the umbilical vein is related to perinatal mortality but the flow velocity waveform in the fetal vein of Galen is normally even and without fluctuation. OBJECTIVES: To establish whether blood flow velocity pulsations in the vein of Galen in high-risk pregnancies are related to outcome. STUDY DESIGN: The vein of Galen was located by colour Doppler ultrasound in 102 pregnancies complicated by severe pregnancy-induced hypertension. The blood velocity waveform was recorded by pulsed Doppler within 2 days of delivery and the presence pulsations related to pregnancy outcome, including emergency operative intervention and neonatal distress. Umbilical artery and vein and uterine artery blood flow velocity waveform were also recorded at the same time. The clinicians managing the women were unaware of the venous flow results. RESULTS: Pulsation were present in the vein of Galen in 68 cases and in the umbilical vein in 21. Both were significantly related to adverse outcome. Pulsations in the vein of Galen were seen in all seven perinatal deaths. CONCLUSIONS: Since umbilical venous pulsation are a late sign of fetal compromise, and pulsations in the vein of Galen seem to appear earlier, thus being an intermediate sign of fetal compromise that might be of great value for fetal surveillance.

Normally, blood flows evenly in the umbilical vein, without fluctuation. A pulsating pattern has been reported during fetal heart failure and asphyxia. Recently we have noticed two types of pulsating pattern; its relationship to adverse outcome is unclear. In a prospective multicenter study, recording of umbilical cord venous blood flow was conducted in high-risk pregnancies admitted for routine artery Doppler. In cases of pulsating flow or signs of vascular resistance in the umbilical artery, the examination was extended to the intra-abdominal part of the umbilical vein. Venous pulsation, single or double, were noted and correlated to perinatal outcome. Venous flow pulsatility was noted in 83 fetuses during 2 years, 26 had a double pulsating pattern, which was closely related to increased vascular resistance in the umbilical artery and perinatal mortality. A single pulsating venous pattern in one location had a good prognosis. In conclusion a double pulsating venous pattern, especially if extending to the cord, is an ominous finding in high-risk pregnancy associated with poor perinatal outcome. A single pulsating pattern predicted a much better outcome and might be an indication for delivery in the high-risk case.

Objective: Prospectively evaluate semi-quantitative computer analysis of power Doppler (PD) signals in the placenta, fetal brain, lung, liver, kidney and spleen in high-risk pregnancies in relationship to perinatal outcome and also to compare tissue blood flow in the fetal brain and placenta with Doppler velocimetry. Methods: PD signals were recorded in 180 high-risk pregnancies between 27 and 41 weeks of gestation. Images from PD angiographic scans were transmitted for computer analysis of pixel intensity. Mean flow signal intensity was recorded for each organ. The PD brain/lung ratio was calculated. The PD results were plotted on reference values and related to perinatal outcome. Middle cerebral (MCA), umbilical (UA) and uterine artery (Ut. A) velocimetry was also performed. Results: High-risk pregnancies displayed lower PD signal intensity from the placenta, fetal lung, liver and kidney as compared to normals. However, the brain and spleen signals showed higher intensities suggesting increased tissue perfusion. PD signals from the fetal brain, lung, placenta and PD brain/lung ratio were correlated with perinatal outcome. The PD signal intensity from the fetal liver, kidney and spleen showed poor correlation with perinatal outcome. Fetal brain tissue blood flow showed better correlation with the outcome than MCA velocimetry. Placental tissue blood flow results were similar in predicting outcome to those obtained by means of UA and Ut. A velocimetry. Conclusion: In comparison with conventional Doppler velocimetry, computer analysis of PD signals, give similar results in the prediction of adverse perinatal outcome.

Objectives Animal studies have shown that hypoxic fetuses redistribute their blood flow, giving preferential supply to the brain, heart and adrenal glands. The aim of this study was to establish whether blood velocity waveforms in the human fetal adrenal artery and middle cerebral artery showed signs of redistribution of fetal circulation in high-risk pregnancy, and to analyze the relationship between signs of such redistribution and the outcome of pregnancy. Methods Fetal middle adrenal artery and middle cerebral artery waveforms were recorded between 27 and 41 weeks of gestation in 102 pregnancies complicated by pregnancy-induced hypertension. Signs of fetal adrenal-sparing were deemed present when the pulsatility index (PI) fell below the fifth percentile of the normal range. Signs of fetal brain-sparing were deemed present when the cerebral artery PI was below the mean −2 SD of the normal range and the cerebroplacental PI ratio was < 1.08. Results Signs of adrenal sparing were found in 64 cases and brain sparing in 32 cases. Fetal adrenal sparing was strongly associated with adverse perinatal outcome; all perinatal mortality cases showed signs of adrenal sparing. There was a significant positive correlation between the fetal adrenal artery PI and umbilical arterial and venous pH. Conclusions Signs of adrenal sparing are frequent in high-risk pregnancies. Adrenal artery velocimetry may be a useful procedure for fetuses at risk for hypoxemia. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

Objective: Computer analysis of organ power Doppler (PD) imaging has recently become available. The aim of the study was to evaluate gestational trends in placenta-, fetal lung-, liver- and kidney-blood flow in normal pregnancies and relate it to signals in high-risk pregnancies. Methods: PD signals were recorded in normal singleton pregnancies between 26 and 42 weeks of gestation. Signals were also recorded in 63 high-risk pregnancies. Fixed preinstalled PD system installations for each organ were used during examinations. Images from PD scan were recorded on video tape and off-line analysed by computer. Mean flow signal intensity was calculated for each organ. Umbilical and uterine artery Doppler velocimetry were also recorded in high-risk pregnancies. Results: PD signals from the four organs indicated increasing organ blood flow until approximately 34 weeks of gestation, from where the organ signals seemed to decrease. High-risk pregnancies seemed to have lower PD signal intensity, which was more pronounced in cases with signs of placental vascular resistance. Conclusion: The results suggest that a decrease in fetal organ blood flow might indicate a centralisation of fetal circulation in normal pregnancy at term, as a physiological response to a decrease in placental perfusion. In the high-risk pregnancies the placental and fetal organ blood flow seem to be even further reduced, suggesting a more intense centralisation of circulation.

Compared to conventional color Doppler ultrasound imaging, the new color Doppler modality "color Doppler energy" (CDE) has improved the possibility of visualizing blood vessels having low blood-flow velocities, but appears to be influenced by the settings of the ultrasound instrument and motion artefacts. The aim of this methodological study was to evaluate the effects of the different factors on the CDE signal. The CDE mode of a commercially available ultrasound system (Acuson 128 XP) was tested in an in vitro study. The effect of depth, angle of insonation, flow velocity, instrument power output, gain and other instrument settings were evaluated. The CDE signals obtained were stored on videotape and subsequently subjected to off-line computer analysis. The CDE signal intensity was found to be influenced mainly by fluid flow velocity, but was also affected by depth and instrument settings. Gain and power had, however, limited influence in this setting. Thus, the intensity of the CDE signal is influenced by several factors. Our results emphasize the need for optimum fixed preinstalled instrument settings when attempting to quantify organ perfusion by use of this new technique.

The aim of this study was semiquantitative evaluation of tissue blood flow in the fetal lung before and after administration of betamethasone. This was carried out by means of computer analysis of ultrasound Doppler signals obtained by the color Doppler energy (CDE) technique. CDE signals were recorded in 20 singleton pregnancies with appropriate growth and imminent preterm delivery between 26 and 33 weeks of gestation. The CDE signal recordings were made before and after intramuscular administration of betamethasone 8 mg/day for 3 days. Fixed preset CDE system control settings for the fetal right lung were used during the examinations. Images from CDE scans were recorded on S-VHS videotape and transmitted for computer analysis of 8-bit images at 2.56 gray-scale levels. The mean flow signal intensity was recorded for the fatal lung before and after betamethasone administration. Additionally, blood velocity waveforms were measured in the intrapulmonary arteries and veins in the peripheral part of the lung. CDE signals from the fetal lung indicated increased energy values after corticosteroid treatment in 16 cases. In three cases there was no change in CDE signal values, and in one case a fall of the signal value was noted. Blood velocity waveforms from the intrapulmonary arteries showed decreased resistance to flow in 1.5 cases, increased resistance to flow in four cases and no change in one case. No significant differences in venous blood flow velocities were found. In conclusion, the results suggest that there is an increase in fetal lung blood perfusion after maternal corticosteroid administration. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology

Objective: To evaluate hepatic venous blood velocity in normal and high-risk pregnancies. Methods: In a cross-sectional study, blood velocities in the fetal left and right hepatic veins (HVs) were recorded by Doppler ultrasound in 87 normal singleton pregnancies from 18 to 43 weeks of gestation and in 91 high risk pregnancies in a prospective study. The blood velocity waveforms were analyzed for peak velocity during ventricular systole (S), end-systole (ES), diastole (D), and end-diastolic blood velocity corresponding to atrial contraction (A). As the reverse flow during atrial contraction was significantly more pronounced in the right than in the left hepatic vein, only right hepatic venous blood velocimetry was used for evaluation. Results: Right HV velocity manifested increasing S velocity towards the heart and a reduction in reversed blood velocity during atrial contraction with increasing gestational age. ES, D and A blood velocities were unchanged throughout gestation. In the prospective study, the final HV(S - ES)/S ratio before birth was abnormal in only seven cases (7.7%). These seven infants were delivered earlier then the rest of the group, and stayed longer in the neonatal intensive care unit. Otherwise, outcome was similar in the pregnancies with normal and abnormal HV blood velocity. HV blood velocity in cases with normal umbilical artery (UA) velocimetry ( n = 35), increased UA Pulsatility Index ( n = 42), and absent or reversed diastolic blood velocity ( n = 14) differed only by a decrease in ES blood velocity in the latter group, suggesting an increase in cardiac afterload in relation to absent end-diastolic blood velocity in the UA. Conclusion: The minimal changes in fetal hepatic venous blood velocimetry in severely complicated pregnancies suggest the presence of ‘fetal heart sparing.’

Previously, we have found uterine artery blood velocimetry performed with Doppler ultrasound without vessel visualization to be a poor predictor of perinatal outcome. The aim of this study was to ascertain whether the combination of color Doppler imaging with the method would improve its predictive value.In a cross-sectional study of 110 uncomplicated pregnancies, uterine artery blood velocity was recorded bilaterally from 18 to 42 weeks of gestation to obtain reference values for pulsatility index (PI). Using color Doppler imaging, the main uterine artery was located as it crosses the iliac vessels and blood velocity was then recorded with pulsed Doppler ultrasound. The uterine and umbilical blood velocity waveforms were also obtained in 421 complicated pregnancies, and the results related to placental site and perinatal outcome.In uncomplicated pregnancies, the uterine artery PI was unrelated to gestational age using 1.20 as the upper cut-off limit for the mean PI of both vessels (mean+2 s.d.). Corresponding values for unilateral placental localization were 1.00 at the placental side and 1.40 at the non-placental side. Blood velocities obtained using the color Doppler combination were similar to previously presented results. In the complicated pregnancies, significant correlation was found between abnormal perinatal outcome and abnormality of the uterine artery blood velocity waveform, either increased PI (n = 44) or a notch in early diastole (n = 92). The predictive value of an early diastolic notch was superior to an increased PI in predicting abnormal outcome. The mean PI for both uterine arteries was a better predictor of outcome than blood velocity on the placental side. The blood velocity waveforms on the non-placental side were the poorest predictors of outcome.The addition of color Doppler imaging to pulsed wave Doppler ultrasound recording of uterine artery blood velocity improves the predictive value of blood velocity waveforms with regard to the perinatal outcome.

Diagnosis of discordant twins is easily accomplished with modern ultrasound equipment, though diagnosing twin-to-twin transfusion syndrome (TTS) at an early stage might be a problem. The possibility of excluding TTS by Doppler ultrasound is demonstrated in a case with early severe growth restriction of one fetus. Characteristic blood velocity changes in a dying fetus are also illustrated. The Doppler technique has become an accepted method in obstetrics for antenatal surveillance, permitting evaluation of fetal circulation in a non-invasive manner and providing important physiological information on the fetal condition. Absent end-diastolic flow in the umbilical artery (UA) can warrant operative delivery for fetal distress (1). Perinatal mortality is increased fivefold in multiple gestation, as compared with singleton pregnancy (2). The major complications include preterm labor, intrauterine growth retardation (IUGR), TTS, polyhydramnios, oligohydramnios, fetal malformations, and pre-eclampsia. Twin fetuses are generally smaller than singletons and IUGR and intrauterine fetal deaths are more common (3). Before the introduction of the Doppler technique, ultrasound-imaging evaluation of discordant fetal size in twin pregnancy was a problem. Differential diagnosis of TTS and a true growth retardation of one fetus was a frequent worry for the clinician. Doppler examination of the fetal venous circulation with pulsating flow in the umbilical vein has been found helpful in the diagnosis of fetal congestive heart failure (4, 5). The general ultrasound imaging and Doppler findings in TTS are listed in Fig. 1. The information provided by ultrasound imaging and Doppler can thus distinguish between TTS and growth retardation of one fetus and assist the clinician in making a diagnosis and predict the outcome. The following case illustrates characteristic blood velocity findings in a dying fetus. (Less)

Holoprosencephaly is a brain malformation caused by abnormal division of the forebrain into two separate hemispheres. Abnormal structures of the central nervous system often occur with other midline forebrain and face failures. In this report we present a case of a prenatal diagnosis of holoprosencephaly.

Thanatophoric dysplasia was first described in 1967 by Maroteaux. It is one of the most common lethal neonatal dwarfisms. Estimated incidence of thanatophoric dysplasia is 0.2-0.5 per 10,000 births. In the following report we have described a prenatally diagnosed case of recurrent thanatophoric dysplasia in the same patient.