To evaluate the relationship between fetal growth until birth and biparietal diameter (BPD)measured 11 -13 weeks of the gestation. A prospective study was conducted between 2011 and 2012. Ultrasonographic measurement of the BPD was performed between 11 + 0 and 13 + 6 weeks of the gestation in singleton fetuses. If there was discrepancy more than 5 days between pregnancy date from LMP and CRL in 8-10 weeks, EDC was set ultrasonographic findings above LMP. The patients who were introduced due to morphological bnormalities and other complications were excluded in this study. To normalize the distribution of ultrasonographic measurements, z-score of the BPD by gestational dates were calculated using liner regression. Those below 5%tile in the z-scores of BPD were defined as the cases and the others were defined as controls. Light-for-date (LFD) infants were diagnosed as lower than -1.5 of SD score based on the standard of Japanese birth build for Gestational period discrimination. There were 36 cases and 677 controls. The frequencies of abortion including induced abortion in case and control were 11.1% (n = 4) and 1.5% (n = 10) (p = 0.004). The frequencies of morphological abnormality were 8.3% (n = 3) and 1.0% (n = 7) (p = 0.011). The frequencies of preterm delivery were 12.5% (n = 3) and 7.4% (n = 49) (p = 0.011). Z-score of birthweight between two groups were -0.35 ± 0.99 and 0.11 ± 0.96 (p = 0.014). Measurement of BPD between 11 and 13weeks of gestation could prognose fetal or neonatal outcome by determining pregnant date before 10 weeks of gestation.
To clarify whether opening of the uterine isthmus between 11 and 13 weeks' gestation adversely affects the placental development. The uterine cervix and isthmus lengths were measured prospectively using transabdominal ultrasound at 11 to 13+6 weeks' gestation. Following delivery, the pregnancy and delivery course were reviewed. The associations between the conditions of the uterine isthmus during the first trimester and the perinatal complications associated with placental abnormalities were analyzed. A total of 653 cases were analyzed. The isthmus had been completely opened (isthmus length = 0 mm) in 15.9%, 21.6% and 24.1% of the cases at 11, 12 and 13 weeks' gestation. The frequencies of perinatal complications in the cases whose isthmus had been opened (cases) and the other cases (controls) were as follows; 1.4% and 1.0% (ns) for placenta previa, 1.4% and 1.2% (ns) for abnormal cord insertion, 3.5% and 4.3% (ns) for pre-eclampsia, 9.9% and 9.0% (ns) for small for gestational age, and 12.0% and 7.6% (ns) for preterm delivery, respectively. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Abstract Reported is a fetal D andy– W alker malformation that was strongly suspected in the first trimester through measurement of the brainstem–vermis ( B ‐ V ) angle, which was found to be 119° on transvaginal ultrasound examination at 14 weeks and 2 days gestation. Definitive diagnosis of the D andy– W alker malformation was made by magnetic resonance imaging following stillbirth. Ultrasound measurement of the B ‐ V angle may be a useful index for prenatal diagnosis of D andy– W alker anomalies during early pregnancy.
Abstract We experienced a case of uterine wall defect with amniocele in a primigravida woman without any history of uterine surgery. On admission due to acute abdominal pain at 32 weeks' gestation, an ultrasound examination showed a 9 × 7‐cm sized echogenic cystic area in the Morrison pouch. Color D oppler revealed a flow from the uterus into the cystic area through a myometrial defect. During the operation, a 1‐cm defect in the uterine myometrium was found on the right fundus. An intact amniotic sac was prolapsed into the abdominal cavity through the myometrial defect. This was an extremely rare case of unexplained uterine wall defect.
Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
To clarify the usability of ultrasound screening at 36 weeks' gestation for predicting non-reassuring fetal status during labor. Prospective cohort study was conducted between January 2012 and March 2013. Ultrasound screening of placenta and umbilical cord abnormalities were attempted to pregnant women at 20 and 36 weeks' gestation. Subjects who were taken this ultrasound screening and not planned elective Cesarean section were divided into three levels of groups according to the risk of non-reassuring fetal status. After delivery, frequencies of non-reassuring fetal status and emergency Cesarean section rate were compared among these risk groups. Risk A was defined in cases with velamentous cord insertion, marginal insertion on the lower uterus, three or more nuchal cords and/or hyper-coiled cord. Risk B was defined in cases with mild or moderate fetal growth restriction, twice nuchal cords, and/or single umbilical artery. The others were defined as Low risk. Subjects were 790 cases during the present study period. Elective Cesarean sections were performed in 111 cases due to maternal and fetal indications. Therefore, 34 cases of Level A, 45 cases of Level B and 600 cases of Low risk were analyzed. Non-reassuring fetal status was diagnosed in 17.6% (6/34) of Level A group, 11.1%* (5/45) of Level B group and 6.2% (37/600) of Low risk group, respectively. Emergency Cesarean section was performed in 8.8% (3/34) of Level A group, 4.4% (2/45) of Level B group, and 1.0% (6/600) of Low risk group, respectively (*p < 0.05 compared to Low risk). Antenatal ultrasound screening of placental and umbilical cord abnormalities could identify cases of high risk delivery. We believe these screening and appropriate managements of delivery can improve perinatal outcomes.
Abstract Uterine arteriovenous malformation ( AVM ) is a rare cause of abnormal uterine bleeding; nevertheless, it is a potentially life‐threatening condition when the diagnosis is not made. We report a case of uterine AVM with a secondary uterine hematoma diagnosed 2 weeks after curettage due to spontaneous abortion. Ultrasound examination revealed a mixed echogenic mass of approximately 4 cm × 1.5 cm with no blood flow and an additional contiguous heterogeneous mass with turbulent blood flow depicted by color D oppler. Transvaginal sonohysterography enabled us to exclude residual chorionic tissues and to make precise diagnosis of uterine AVM with a secondary hematoma.
Uterine arteriovenous malformation (AVM) is a rare cause of abnormal uterine bleeding; nevertheless it is a potentially life-threatening condition when the diagnosis is not made. We report a case of uterine AVM with a secondary uterine hematoma diagnosed two weeks after curettage due to spontaneous abortion. She attended our department complaining persistent uterine bleeding. Urinary human chorionic gonadotropin (hCG) level was 567 IU/l. By transvaginal ultrasound, a 4 × 1.5 cm mixed echogenic mass with no blood flow appeared to exist in the uterine cavity. Additionally, serpiginous expanded blood vessels were seen within the uterine myometrium, close to the mass, depicting multidirectional high-velocity flow by color Doppler examination. Since the location of both structures in the uterus was unclear, sonohysterography was attempted in order to distinguish the endometrium from the myometrium and rule out residual chorionic tissues and clots. This procedure enabled us to recognize clearly the linear endometrium from the myometrium and to make precise diagnosis of uterine AVM with a secondary hematoma.
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