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Ultrasound in Obstetrics and Gynecology 04/2013; · 3.01 Impact Factor
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ABSTRACT: Objectives The purpose of this study was to examine the uterine cavity within 48 hours of delivery using 2- and 3-dimensional sonography after normal vaginal deliveries, instrumental deliveries, exploration of the uterine cavity, and cesarean deliveries. Methods A prospective study was performed in puerperal women with normal clinical examination findings. Measurements of the uterine length and width were taken in the midsagittal and coronal planes. Midsagittal measurements of the endometrium using 2- and 3-dimensional sonography and virtual organ computer-aided analysis were performed. Comparisons were made between normal and surgical vaginal deliveries, cesarean deliveries, and after exploration of the uterine cavity. Results A total of 123 patients were examined. Seventy-seven patients had normal vaginal deliveries; 21 had assisted vaginal deliveries; and 25 had cesarean deliveries. Thirteen underwent exploration of the uterine cavity. The uterine volume increased significantly as the birth weight increased and after cesarean delivery (P < .05). No correlation was found between the endometrial volume and parity, birth weight, and mode of delivery, including no correlation with exploration. Five cases of placental residua were found in asymptomatic women. All delivered vaginally. None underwent exploration of the uterus. All had irregular echogenic masses in the uterine cavity with positive color Doppler findings. The endometrial thickness and volume were significantly higher in these patients. Conclusions Sonography along with Doppler assessment has added value in the clinical evaluation of the puerperal women, being able to also show residua in asymptomatic women. Three-dimensional sonography did not show an advantage over 2-dimensional sonography in the estimation of the puerperal uterus or residua.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 04/2013; 32(4):587-92. · 1.25 Impact Factor
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ABSTRACT: Objectives: To evaluate the clinical significance of the head progression distance (HPD), measured by trans- perineal ultrasound, during prolonged second stage of labor. Methods: This is a prospective study of women, at 37 or more weeks of gestation, with failure to progress in the second stage of labor. Trans-perineal ultrasound examination was performed during pushing, with an empty urinary bladder, by a single operator, who was blinded to the results of the digital examination. The HPD measurement was defined as a vertical line that connects the infrapubic line to the lowest part of the bony skull. Associations were examined between HPD and digital examination of the fetal head station, feto- maternal characteristics, modes of delivery, and perinatal outcomes. Results: Sixty-six patients in prolonged second stage of labor participated in the study. Seventeen (25.7%) delivered by spontaneous vaginal delivery, 38 (57.5%) by instrumental vaginal delivery, and eleven (16.8%) by CS. The overall mean HPD was 6.50 cm ( ± 1.35, CI 95% 6.16-6.83). HPD did not associate with head positions or mode of delivery, but correlated positively with fetal head station and neonatal head circumference measured after delivery. Logistic regression and receiver-operating curve analysis demonstrated a non significant value of HPD, during prolonged 2(nd) stage, in predicting mode of delivery. Conclusion: Although HPD in prolonged second stage labor could not predict mode of delivery, it may be used as an ancillary tool for fetal head station assessment. Copyright © 2013 ISUOG. Published by John Wiley & Sons, Ltd.
Ultrasound in Obstetrics and Gynecology 01/2013; · 3.01 Impact Factor
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ABSTRACT: The objectives of this series were to describe the prenatal sonographic findings of a fetal isolated prominent left brachiocephalic vein with its in utero natural history and neonatal outcome and to discuss the differential diagnosis, especially with a total or partial anomalous pulmonary venous return malformation. We reviewed all cases referred to 2 tertiary medical centers with the presenting finding of a prominent, upper thorax transverse vein entering the superior vena cava. The primary suspicion of a subjective dilated left brachiocephalic vein, as a part of a supracardiac anomalous pulmonary venous return malformation, was investigated by a systematic anatomic evaluation. After exclusion of other cardiac and structural anomalies, we followed the pregnancies and their outcomes. Eight cases were recruited during a 7 year period. The mean maternal age was 31 years, and the mean gestational age at the time of diagnosis was 17 weeks. In 7 cases, the dilatation was not evident during 6 weeks of follow up. In 1 case, the dilatation was evident until delivery at 39 weeks and was not apparent on postnatal echocardiography or spiral computed tomography. All neonates developed without any heart or other complications. We conclude that after exclusion other malformations, a prominent left brachiocephalic vein is a benign transient phenomenon that does not persist post-partum in the neonate.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 01/2013; 32(1):181-6. · 1.25 Impact Factor
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ABSTRACT: The pituitary gland is crucially important in the function of the endocrine axis. So far, antenatal depiction of the pituitary gland was possible only using magnetic resonance imaging. We describe antenatal visualization of the pituitary gland using 2- and 3-dimensional sonography. The appearance of the gland on sonography seems to be superior compares to prenatal magnetic resonance imaging. In cases with midline anomalies of the brain, face, or cranium, depiction of the pituitary gland is feasible and recommended.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2012; 31(10):1675-80. · 1.25 Impact Factor
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ABSTRACT: A spontaneous intra-amniotic hemorrhage is a very rare condition, which has been previously described in symptomatic patients. We report a case of an asymptomatic spontaneous intra-amniotic hemorrhage at 38 weeks of gestation, resulting in a favorable maternal and neonatal outcome following sonographic antenatal detection of an intra-amniotic blood clot. This pathology should be acknowledged, since a good clinical outcome depends on early diagnosis.
Fetal Diagnosis and Therapy 12/2011; 31(1):73-5. · 1.05 Impact Factor
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ABSTRACT: The purpose of this study was to describe the characteristics and outcomes of umbilical cord hernias diagnosed prenatally.
We conducted a retrospective study of all pregnancies with the diagnosis of a fetal umbilical cord hernia during a 5-year period. All women received care from a multidisciplinary team and underwent complete meticulous sonography for structural malformations as well as fetal echocardiography and amniocentesis.
Between 2004 and 2009, isolated fetal umbilical cord hernias were diagnosed in 8 pregnant women. The gestational ages at the time of referral ranged from 16 to 28 weeks (median, 20 weeks). In 1 case, intrauterine fetal death occurred at 35 weeks due to rupture of the umbilical cord. All remaining cases were delivered at 36 to 40 weeks, and the neonates underwent corrective surgery with good outcomes.
Despite 1 case complicated by intrauterine fetal death in this study, the outcome of an isolated fetal umbilical hernia seems favorable.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2011; 30(12):1629-32. · 1.25 Impact Factor
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ABSTRACT: The purpose of this study was to report the outcomes of fetuses with the finding of an umbilical cord cyst during nuchal translucency examination in a low-risk population.
A retrospective study was conducted in a large tertiary referral academic center over a 3-year period. All fetuses with umbilical cord cysts during the nuchal translucency scan were recruited, and their medical data concerning the pregnancy and neonatal course were analyzed.
Eight fetuses (0.7%) had a diagnosis of an umbilical cord cyst among the 1080 nuchal translucency examinations. The mean cyst diameter was 19 mm (range, 10-38 mm). The male to female ratio was 6:2. Isolated umbilical cord cysts were found in 5 cases (62.5%), and in all, the nuchal translucency measured less than 2 mm; the cysts resolved; and the outcomes were normal. Three fetuses (37.5%) had additional associated malformations. In all of them, the cysts persisted during pregnancy. Two of them had increased nuchal translucency (3.2 and 4.2 mm). In these 2 cases, 1 fetus had a hypoplastic left heart with a normal karyotype, and the other had multiple malformations and trisomy18. Both pregnancies were terminated. The third case, with normal nuchal translucency, had an ectopic kidney and a patent urachus, which closed spontaneously at 23 weeks and resulted in a normal pregnancy outcome.
A favorable outcome is expected when an umbilical cord cyst diagnosed during late first trimester presents as an isolated finding associated with normal nuchal translucency and resolves later on.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 11/2011; 30(11):1547-51. · 1.25 Impact Factor
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ABSTRACT: The purpose of this study was to establish in utero reference ranges for the fetal umbilical cord insertion-to-genital tubercle length in early gestation.
A prospective cross-sectional study was performed on 140 normal low-risk singleton pregnancies between 12 and 18 weeks' gestation. The umbilical cord insertion-to-genital tubercle length was measured in a midsagittal section with high-resolution transvaginal or transabdominal sonography. The mean and 95% prediction limits were defined for each gestational week and analyzed by regression equations and correlation coefficients.
Adequate measurements were obtained in 134 patients. The umbilical cord insertion-to-genital tubercle length as a function of gestational age was expressed by the following regression equation: umbilical cord insertion-to-genital tubercle length = -3.079452 + 1.09 × week (R(2) = 0.7117). The correlation R(2) = 0.7117 was found to be highly statistically significant (P < .001). The normal mean and 95% prediction limits were defined for each gestational week. During the study period, 2 cases were referred to our unit because of nonvisualization of the urinary bladder. The umbilical cord insertion-to-genital tubercle lengths in these cases were below the 95th percentile, confirming the diagnosis of bladder exstrophy.
The normative data established in this study may be helpful for early pre-natal diagnosis congenital bladder exstrophy.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 02/2011; 30(2):237-41. · 1.25 Impact Factor
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ABSTRACT: Gender is determined by the genetic, gonadal and hormonal/ phenotypic sex. Genetic sex is determined at conception. The establishment of the gonadal sex (ovary/testis) and the phenotypic sex (external and internal genitalia) is a complicated multistep process which is determined during fetal life mainly during the first trimester. Recently more genes have been found to be involved in this process. Prenatal diagnosis of fetal gender can be made using ultrasound technology, genetic and hormonal examinations. Nowadays using a vaginal and abdominal transducer for US examination recognition of external and internal genitalia of both genders is possible. The determination of gender during fetal life is important not only as a matter of curiosity; in some cases of ambiguity (for example congenital adrenal hyperplasia) prenatal treatment can change the natural history of the disease. Prenatal diagnosis can also subtype the ambiguity, and its severity can be established. In this review we describe our experience in prenatal diagnosis and establishment of the fetal gender, the subtypes of ambiguity and our suggestion for the process of diagnostic work-up.
Pediatric endocrinology reviews: PER 10/2009; 7(1):12-21.
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 04/2007; 26(3):373-6. · 1.25 Impact Factor
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ABSTRACT: The purpose of this series was to describe the prenatal diagnosis and pregnancy outcome of fetuses affected by a transient idiopathic fetal sternal cyst.
Two fetuses had the diagnosis of an isolated presternal cyst at routine sonography at 15 weeks. A follow-up sonographic examination was done, and the neonates were examined after birth.
In both cases, the cyst disappeared at 20 weeks' gestation, and both fetuses had only a small dimple at the location of the cyst.
An isolated presternal cyst is an extremely rare finding. It should be followed sonographically, and if it disappears within a few weeks, the diagnosis of a dermal inclusion cyst should be suspected. Parents can be informed to anticipate a small depression on the neonate's chest.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 04/2007; 26(3):367-9. · 1.25 Impact Factor
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The Israel Medical Association journal: IMAJ 04/2006; 8(3):219-20. · 1.02 Impact Factor
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ABSTRACT: This study investigated the effect of intravaginal administration of probiotics immediately after oocyte retrieval on vaginal colonization and outcome of the IVF-embryo transfer cycle. One hundred and seventeen women who underwent ovarian stimulation and IVF were randomized immediately after oocyte retrieval into two groups: those who received intravaginal probiotics (study group, n = 50) and those who did not (control group, n = 67). Vaginal colonization with lactobacilli and pregnancy rate were compared between the two groups. No significant between-group differences were observed in patient age, oestrogen and progesterone concentrations on day of human chorionic gonadotrophin administration, number of oocytes retrieved, fertilization rate, number of embryos transferred, or pregnancy rate. The presence of lactobacilli in the vagina during oocyte retrieval or embryo transfer did not improve the pregnancy rate. Furthermore, intravaginal administration of lactobacilli following oocyte retrieval did not affect the prevalence of lactobacilli during embryo transfer, or the pregnancy rate. Intravaginal probiotic supplementation immediately after oocyte retrieval has no effect on vaginal colonization or pregnancy rate in IVF cycles.
Reproductive biomedicine online 08/2005; 11(1):71-5. · 2.04 Impact Factor
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ABSTRACT: To examine the safety and outcome of induction of labour in women with heart disease.
Prospective single-centre comparative study.
Major university-based medical centre.
One hundred and twenty-one pregnant women with heart disease.
The sample included all women with acquired or congenital heart disease who attended our High-Risk Pregnancy Outpatient Clinic from 1995 to 2001. The files were reviewed for baseline data, cardiac and obstetric history, course of pregnancy and induction of labour and outcome of pregnancy. Findings were compared between women who underwent induction of labour and those who did not. Forty-seven healthy women in whom labour was induced for obstetric reasons served as controls.
Pregnancy outcome.
Of the 121 women with heart disease, 47 (39%) underwent induction of labour. There was no difference in the caesarean delivery rate after induction of labour between the women with heart disease (21%) and the healthy controls (19%). Although the women with heart disease had a higher rate of maternal and neonatal complications than controls (17%vs 2%, P= 0.015), within the study group, there was no difference in complication rate between the patients who did and did not undergo induction of labour.
Induction of labour is a relatively safe procedure in women with cardiac disease. It is not associated with a higher rate of caesarean delivery than in healthy women undergoing induction of labour for obstetric indications, or with more maternal and neonatal complications than in women with a milder form of cardiac disease and spontaneous labour.
BJOG An International Journal of Obstetrics & Gynaecology 08/2004; 111(7):669-75. · 3.41 Impact Factor
