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Ultrasound in Obstetrics and Gynecology 12/2012; · 3.01 Impact Factor
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ABSTRACT: Objective: To determine if in fetuses with aneuploidies the diameter of the fourth cerebral ventricle at 11-13 weeks' gestation is different from euploid fetuses. Methods: The fourth ventricle at 11-13 weeks' gestation was assessed in 62 cases of trisomy 21, 32 of trisomy 18, 10 of trisomy 13, and 12 of triploidy and compared to 410 normal euploid fetuses. Transvaginal sonography was carried out and 3D brain volumes were acquired. The fetal head was assessed in an axial plane and the diameter of the fourth ventricle was measured. Values in aneuploid and euploid fetuses were compared. Results: The diameter of the fourth ventricle in trisomy 18, trisomy 13 and triploidy, but not in trisomy 21, was significantly higher than in euploid fetuses. In the euploid fetuses the median diameter of the fourth ventricle was 1.9 mm and the 95th percentile was 2.5 mm. The measurements were above the median and the 95th percentile in 25 (78.1%) and 17 (53.1%) cases of trisomy 18, in 10 (100%) and 8 (80.0%) of trisomy 13, and in 10 (83.3%) and 10 (83.3%) of triploidy. Conclusions: In trisomy 18, trisomy 13 and triploidy the diameter of the fourth ventricle at 11-13 weeks' gestation is increased.
Fetal Diagnosis and Therapy 07/2012; · 1.05 Impact Factor
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ABSTRACT: The main objective of this study was to evaluate the spectrum of cardiac anomalies found in routinely performed fetal autopsies and to establish the correlation between prenatal and postmortem diagnosis.
A retrospective study of fetal autopsies was performed. Cases with cardiac anomalies were analyzed. Seven main categories were established and each case was assigned to a single group. Cardiac defects were also classified as isolated or with associated anomalies. In the cases with prenatal diagnosis, we performed a correlation between prenatal and postmortem findings.
Abnormal cardiac findings were identified in 99 fetuses (13.6%). The two most common categories were septal defects and complex anomalies, each occurring in 21 fetuses (21.2%). Sixty-seven (67.7%) had associated anomalies. Septal anomalies were more frequent in cases with associated anomalies (p=0.012). Prenatal diagnosis had been performed in 50 cases. There was complete agreement between prenatal and postmortem diagnosis in 36 cases (72%), and major agreement with additional information in ten (20%). When the echocardiogram was not performed by a specialist, the number of cases classified with complete disagreement was higher (33.3% vs 2.4%) (p=0.002).
The high prevalence of cardiac defects in lost pregnancies, some of them lacking prenatal diagnosis, highlights the importance of examining the heart in all cases.
European journal of obstetrics, gynecology, and reproductive biology 05/2012; 163(2):142-7. · 1.97 Impact Factor
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ABSTRACT: To examine the possible association between aneuploidies and fetal lateral cerebral ventriculomegaly in the first trimester of pregnancy.
Three-dimensional brain volumes were acquired by transvaginal ultrasound examination at 11-13 weeks' gestation in 410 euploid fetuses and 63 fetuses with trisomy 21, 34 with trisomy 18 and seven with trisomy 13. Lateral ventricles were assessed in a transverse view, just above the roof of the third ventricle and measurements of the areas of the lateral ventricles and choroid plexuses were obtained. The ratio between choroid plexus and lateral ventricle areas (CLR) was calculated. Measurements in aneuploid fetuses were compared to those in euploid fetuses.
In euploid fetuses the lateral ventricle and choroid plexus areas increased, whereas the CLR decreased with fetal biparietal diameter. In fetuses with trisomy 21, lateral ventricle and choroid plexus areas were smaller but CLR was not significantly different from that in euploid fetuses. In trisomy 18 and 13 fetuses, CLR was significantly smaller than in euploid fetuses. The CLR was below the 5(th) centile of normal range in 11 (32.4%) fetuses with trisomy 18 and in six (85.7%) with trisomy 13.
There is evidence of ventriculomegaly at 11-13 weeks' gestation in most fetuses with trisomy 13 and one third of fetuses with trisomy 18.
Ultrasound in Obstetrics and Gynecology 05/2012; 40(3):282-7. · 3.01 Impact Factor
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ABSTRACT: To assess whether gestational diabetes mellitus (GDM) is associated with non-elective cesarean section.
A retrospective cohort study was conducted at the Department of Obstetrics of a level III hospital. Between January 2004 and November 2007, women admitted in labor or with spontaneous rupture of membranes, at term, and with a singleton cephalic presenting fetus were eligible. From these, 220 women with GDM and 660 glucose-tolerant women, delivered immediately after, were selected. The association between GDM and non-elective cesarean was estimated using modified Poisson regression analysis. Relative risks were adjusted for age, pre-pregnancy body mass index, gestational weight gain, previous cesarean, gestational age at delivery and birthweight.
Non-elective cesarean section rate for women with GDM was 19.5% compared to 13.5% for non-diabetic women. The crude relative risk of cesarean section was 1.45 (95% CI 1.04-2.02) for women with GDM. After adjustment for confounders, the association between GDM and non-elective cesarean section remained positive and statistically significant (RR = 1.52; 95% CI 1.06-2.16). No significant differences in cesarean indications were found between the two groups.
GDM was disclosed as a risk factor for non-elective cesarean section. Knowledge of the condition may have influenced obstetrical practice, favoring cesarean delivery.
Journal of Obstetrics and Gynaecology Research 01/2012; 38(1):154-9. · 0.94 Impact Factor
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ABSTRACT: To determine if in fetuses with open spina bifida at 11-13 weeks' gestation there are alterations in the cerebral ventricular system.
In this study we selected 10 cases of open spina bifida and 410 normal singleton pregnancies which subsequently resulted in the delivery of phenotypically normal neonates. In all cases transvaginal sonography was carried out at 11-13 weeks' gestation and three-dimensional (3D) brain volumes were acquired. The fetal head was systematically assessed in a series of transverse views and measurements were obtained of the area of the lateral ventricles, the diameter of the roof of the third ventricle, the diameter of the aqueduct of Sylvius and the diameter of the fourth ventricle. The measurements obtained on the normal and affected fetuses were compared.
In normal fetuses the area of the lateral ventricles and the diameter of the roof of the third ventricle increased, the diameter of the aqueduct of Sylvius decreased and the diameter of the fourth ventricle did not change significantly with biparietal diameter (BPD). In fetuses with open spina bifida, compared with normal fetuses, the measurements of the lateral ventricle area, the diameter of the roof of the third ventricle, the diameter of the aqueduct of Sylvius and the diameter of the fourth ventricle were significantly decreased (P < 0.01).
In fetuses with open spina bifida at 11-13 weeks' gestation the intracranial collection of cerebrospinal fluid is substantially reduced.
Ultrasound in Obstetrics and Gynecology 12/2011; 39(6):620-4. · 3.01 Impact Factor
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ABSTRACT: Given the importance of surgery within the specialty of Obstetrics and Gynecology it is crucial to understand the process of wound healing and the suture available to surgical repair. The selection of the type of suture depends on the tissue and anatomical location. The approximation of wound edges can be made with natural or synthetic suture, mono or multifilament. Three properties of a suture material affect its handling: memory, elasticity and knot strength. Tensile strength, tissue reaction and capability to be absorbed are other important characteristics of the suture material.
Acta medica portuguesa 12/2011; 24 Suppl 4:1051-6. · 0.09 Impact Factor
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ABSTRACT: To examine if assessment of ductus venosus (DV) flow, crown-rump length (CRL) and nuchal translucency (NT) thickness can predict the discordance in birth weight in monochorionic (MC) twin pregnancies resulting in two live births.
In this prospective study, we assessed CRL, NT and DV flow at 11(+0)-13(+6) weeks' gestation in 326 MC twin pregnancies. The study population included 237 pregnancies without major abnormalities or prenatal interventions resulting in two live births. We examined the value of DV flow and discordance in NT and CRL in the prediction of discordance in birth weight.
In the 237 MC twin pregnancies the median discordance in birth weight was 8.0% (range 0-42.2%). There was no significant association between discordance in either CRL or NT and discordance in birth weight (P=0.116 and P=0.332). In pregnancies with abnormal DV flow in at least one of the fetuses the median discordance in birth weight was higher than in those with normal DV flow in both twins (13.2% vs. 7.8%, P=0.006).
In uncomplicated MC twin pregnancies, abnormal DV flow in at least one of the fetuses is associated with a higher discordance in birth weight than in those with normal flow in both fetuses.
Journal of Perinatal Medicine 06/2011; 39(4):467-70. · 1.70 Impact Factor
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Journal of clinical pathology 03/2011; 64(8):733-4. · 2.43 Impact Factor
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ABSTRACT: A report on a difficult case of first trimester pregnancy bleeding in a 39-year-old woman solved by hysterectomy. The diagnosis was clarified by pathological examination that showed a cervical ectopic pregnancy with perforation.
Fertility and sterility 03/2011; 95(3):1091-3. · 3.97 Impact Factor
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ABSTRACT: Parvovirus B19 is a small single-stranded DNA virus and a potent inhibitor of erythropoiesis due to its cytotoxicity to erythroid progenitor cells. Although adult disease is generally mild, fetal parvovirus B19 infection can cause spontaneous abortion in early pregnancy and aplastic anemia, nonimmune hydrops fetalis and in utero fetal demise. The prevalence of parvovirus B19 maternal infection during pregnancy is about 1-2%. The vertical transmission occurs in 10-35%, being highest in the first and second trimesters. The risk of adverse fetal outcome is 10%. In contrast to the second or third trimester, in pregnancies affected by increased nuchal translucency (NT) in the late first trimester, the prevalence of maternal infection was not higher than in the general population. We report a case of first-trimester parvovirus B19 infection with increased NT and reversed a-wave in the ductus venosus (DV) at 11 weeks, with fetal demise 2 weeks later.
Fetal Diagnosis and Therapy 02/2011; 30(2):150-2. · 1.05 Impact Factor
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ABSTRACT: To evaluate the contribution of prenatal and postmortem examinations in establishing the aetiology of acrania.
Retrospective evaluation of 14 cases of acrania managed through elective termination of pregnancy.
The median maternal age was 30 years (range 18-40) and median gestational age at diagnosis was 13 weeks (range 12-15). One mother had epilepsy and was taking anticonvulsants and another had uncontrolled type II diabetes mellitus. Only 3 women were using folic acid at conception. Chromosomal abnormalities were detected in 3 of 8 cases analyzed. Unilateral anopthalmia, cervical rachischisis, midline facial and limb defects coexisted with acrania in 4 cases. Acrania with craniofacial dysmorphism and asymmetrical finger amputation were observed in a case of amniotic band syndrome. A previous history of anencephaly was documented in 1 case.
Acrania is a characteristic phenotypic expression of a variety of different aetiologies. Investigation with cytogenetic studies and postmortem are essential to provide a definitive answer. This will provide a better understanding of the underlying aetiology and help establish the recurrence risk for future pregnancies.
Fetal Diagnosis and Therapy 12/2010; 29(2):166-70. · 1.05 Impact Factor
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Prenatal Diagnosis 03/2008; 28(2):162-4. · 2.11 Impact Factor
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Fetal Diagnosis and Therapy 02/2007; 22(2):159-60; author reply 160. · 1.05 Impact Factor
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ABSTRACT: The EXIT procedure (EX utero Intrapartum Treatment) encompasses a multidisciplinary approach to situations in which airway obstruction is anticipated. Uteroplacental circulation is maintained to avoid neonatal hypoxemia while intubation is attempted. Not only is it useful in congenital diaphragmatic hernia with intrauterine tracheal occlusion, but new indications have been proposed. We present two cases in which EXIT procedure was adopted (huge cervical mass with tracheal compression and a highly vascularized cephalocervical mass) for the same purpose on different grounds. Our two cases stress once more the importance of combining fetal ultrasound and magnetic resonance imaging in the characterization of cervical masses and its usefulness in programming the procedure with a multidisciplinary team.
Fetal Diagnosis and Therapy 02/2007; 22(2):107-11. · 1.05 Impact Factor
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ABSTRACT: Fetal/neonatal alloimmune thrombocytopenia (NAIT) results from fetomaternal mismatch for human platelet alloantigens leading to antibody-mediated destruction of fetal platelets. This is one of the most common causes of severe thrombocytopenia in the newborn with an incidence of 1/800-1,000. In the most severe cases, NAIT may result in intracranial hemorrhage and may lead to death or neurologic sequelae. We report a case of fetal hydrocephalus caused by NAIT and discuss the importance of making an accurate prenatal diagnosis to improve the management of the current pregnancy and the outcome of subsequent pregnancies. Screening of female siblings of affected cases is recommended in order to detect at-risk individuals.
Fetal Diagnosis and Therapy 02/2007; 22(5):321-4. · 1.05 Impact Factor
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ABSTRACT: The aim of this study is the critical evaluation of cases of elective termination of pregnancy (TOP) in the Prenatal Diagnosis Center of S. João Hospital.
We performed a retrospective study of cases of elective TOP over a 43-month period in a tertiary referral hospital. The fetal indications for termination were analyzed. A comparative study of the prenatal diagnosis, established by ultrasound, and the results of postmortem findings, was performed. These were classified as having complete agreement, complete disagreement and major agreement with additional information.
In total, during this period, 76 elective terminations of pregnancy were performed due to fetal causes. The number of fetal identified grounds was 25 cases of chromosomal abnormalities, 36 cases of morphological anomalies and 15 cases of other fetal situations. The comparison between ultrasound and fetopathologic findings showed complete agreement of diagnosis in 61.1% of cases, and no case of absolute discordance was identified. Major concordance with additional information was found in 38.9% of cases, with an increased risk of recurrence in six cases, and a decreased estimated risk of recurrence in three cases.
This study reinforces the importance of the systematic evaluation of all cases of elective TOP by autopsy performed by a specialist fetal pathologist. This is the most reliable way of assessing the adequacy of prenatal diagnosis and implementing quality control. More than corroborating or correcting the prenatal diagnosis, systematic autopsy may establish a definite diagnosis, adjust prognosis and may be helpful in counseling the parents for a future pregnancy.
Prenatal Diagnosis 12/2006; 26(11):1084-8. · 2.11 Impact Factor
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ABSTRACT: Twin-twin transfusion syndrome is a devastating complication of monochorionic twin pregnancies. The presence of increased nuchal translucency thickness (NT) in one of the monochorionic twins has been associated with an increased risk of developing this syndrome. One of the most plausible mechanisms for increased nuchal translucency is heart failure, indirectly manifested by abnormal blood flow in the ductus venosus. We aimed to clarify the pathophysiology of increased NT found more frequently in monochorionic twins prone to develop twin-twin transfusion syndrome.
We present 50 cases of monochorionic twin pregnancies in which nuchal translucency thickness was measured and ductus venosus blood flow evaluation was performed at 11-14 weeks of gestation.
Whenever the fetuses of a twin pregnancy were found to have discrepant nuchal translucency thickness measurements and abnormal flow in the ductus venosus was found in the fetus with increased nuchal translucency thickness, twin-twin transfusion syndrome eventually developed. Progression to twin-to-twin transfusion syndrome was not observed in the twins displaying no intertwin difference in nuchal translucency thickness measurements and it was not observed in those with discrepant nuchal translucency thickness but normal flow in the ductus venosus of both fetuses. In the two cases which developed twin-to-twin transfusion syndrome, fetoscopic laser coagulation of the vascular anastomoses was successfully carried out at 18 weeks and normalization of the venous return was recorded.
Both increased nuchal translucency and abnormal flow in the ductus venosus in monochorionic twins may be early manifestations of haemodynamic imbalance between donor and recipient. The combined evaluation of both parameters in monochorionic twin pregnancies may constitute an effective method for identifying those at risk of developing twin-to-twin transfusion syndrome.
Journal of Maternal-Fetal and Neonatal Medicine 09/2005; 18(2):79-86. · 1.50 Impact Factor
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ABSTRACT: First or second trimester screening in twin pregnancies is feasible and still efficacious by using either a combination of ultrasound and maternal serum biochemistry in the first trimester or maternal serum biochemistry in the second trimester. Special care, however, should be emphasized in what concerns biochemical screening, since it is much less sensitive in multiples. These "pseudo-risks" have been challenged for their scientific and clinical validity, however. Until more data are available from larger studies on the distribution of markers in concordant or discordant twins, nuchal translucency estimated for each fetus should be the predominant factor by which women who present with increased risk should be counseled regarding invasive testing. In dizygotic pregnancies, pregnancy-specific risk should be calculated by summing the individual risk estimates for each fetus. In monozygotic twins, the risk should be calculated based on the geometric mean of both nuchal translucency measurements, not forgetting that the false-positive rate of nuchal translucency screening is expectantly higher than in singletons.
Obstetrics and Gynecology Clinics of North America 04/2005; 32(1):81-96, ix. · 1.70 Impact Factor
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ABSTRACT: Human placental circulation in the first trimester of pregnancy remains a subject of scientific debate. Most of the acquired knowledge on the physiological background of maternal-fetal interface relies on old studies, most of them performed in non-hemochorial placentas and using light and electron microscopy for the pathological specimens' evaluation. Recently, some ultrasonographic research in this field, using pulsed-wave and/or colour Doppler, yielded contradictory results. The availability of these non-invasive methods should allow the in vivo investigation of placental circulation since early phases of human pregnancy. A more recent technique Power Doppler should be preferred considering its resolution, angle-independence, higher sensitivity for lower velocities and absence of known harmful bioeffects in the early periods of gestation. We provide an overview on first trimester maternal-fetal circulation, assessed by non-invasive techniques, namely by transvaginal power Doppler ultrasonography, trying to contribute to a better understanding of the anatomo-physiological aspects of human placental circulation.
The Ultrasound Review of Obstetrics & Gynecology 02/2005; 5(1):23-28.
