Abstract Objective. To identify maternal/pregnancy characteristics, first trimester ultrasound parameters and biochemical indices which are significant independent predictors of small‐for‐gestational age (SGA) and large‐for‐gestational age (LGA) neonates. Design. Retrospective cross‐sectional study. Setting. Two fetal Medicine Units. Population. 4 702 singleton pregnancies presenting for screening for chromosomal abnormalities by nuchal translucency and maternal serum biochemistry at 11–14 weeks. Methods. Reference ranges for birthweight applied to our population were constructed by the Royston and Wright method. Multiple logistic regression was applied to develop first trimester prediction models for SGA and LGA. Main outcome measures. Birth of SGA or LGA neonate. Results. Maternal height, parity, smoking, assisted conception, delta crown–rump length, delta nuchal translucency, free beta human chorionic gonadotrophin and pregnancy‐associated plasma protein‐A were significant independent predictors of SGA. Maternal weight and height, smoking, delta crown–rump length and delta nuchal translucency were significant independent predictors of LGA. Models for SGA (AUC=0.7296, CI: 0.69–0.76, p <0.0001) and LGA (AUC=0.6901, CI: 0.65–0.72, p <0.0001) were derived, applicable to routine obstetric population at low risk for these conditions. For 20% screen positive rate the modeling achieves sensitivities of about 55% for SGA and 48% for LGA neonates. Conclusion. Prediction for birthweight deviations is feasible using data available at the routine 11–14 weeks’ examination. Delta CRL and delta nuchal translucency were significant independent predictors for both SGA and LGA.
Abstract Purpose: to explore the impact of anticoagulants (aspirin and/or low molecular weight heparin (LMWH)) in the uterine artery flow at 11-13 weeks of gestation. Materials and Methods: retrospective study on singleton viable pregnancies presenting for routine 11-13 weeks’ ultrasound scan. Maternal and fetal variables were assessed as to their influence on uterine artery pulsatility index (UtA-PI). Results: 5,606 pregnancies were analyzed. Increasingmaternal age, higher BMI, large fibroids and higher PAPP-A levels were associated with lower Ut-A PI, whereas history of pre-eclampsia/hypertension in a previous pregnancy, smoking and increased fetal ductus venosus PI were associated with higher Ut-A PI levels. The strongest effect was exerted by history of PET/hypertension, maternal PAPP-A MoM and fetal ductus venosus PI. Anticoagulant treatment had no significant influence. Conclusion: prior treatment with aspirin and/or LMWH does not alter the Ut-A PI. Screening models for pre-eclampsia can be used in women receiving anti-coagulant therapy.
The aim of this article was to predict small for gestational age (SGA, at or less than the fifth birth weight percentile) and large for gestational age (LGA, at or greater than the 95th birth weight percentile) fetuses by using maternal and fetal parameters from the second and third trimester ultrasound examinations.This article is a retrospective cohort study on 1979 singleton pregnancies that had a routine 20 to 24 weeks anomaly and a 30 to 34 weeks growth ultrasound scans. SGA delivered before 30 gestational weeks were excluded.Second trimester estimated fetal weight (EFW2 ), uterine arteries pulsatility index (PI), and maternal pregnancy characteristics were predictive for SGA (SGA second trimester model: R(2) = 0.225, area under the curve [AUC] = 0.815) and LGA (LGA second trimester model: R(2) = 0.203, AUC = 0.793). Third trimester EFW (EFW3 ), EFW2 , uterine arteries PI2 , umbilical PI, and maternal pregnancy characteristics improved the prediction of SGA (SGA combined model: R(2) = 0.423, AUC = 0.896) and LGA (LGA combined model: R(2) = 0.383, AUC = 0.882). Contingent screening with risk stratification by the second trimester model performed equally well for SGA (AUC = 0.882) and LGA (AUC = 0.861) as the combined models.Second trimester model performs well in the prediction of SGA and LGA. The addition of third trimester scan offers substantial improvement. Contingency screening is feasible with similar effectiveness.
Changes in ARCR, protein S,C and antithrobin III in women with preeclampsia and other hypertensive disorders of pregnancy. Objective: The purpose of the study is to investigate the relationship between changes in protein C,S,antithrombin III and APCR and hypertensive disorders of pregnancy. Methods: Pregnant women with preeclampsia are included in the study. The women in the control group are matched for age, parity, weight and gestational age and they had an uncomplicated pregnancy.In every woman 30ml of venous blood was taken. Results: 59 women are included in the study.30 other women are included in the control group.The women with hypertensive disorders have been separated in three groups.Group 1: 38 women with preeclampsia without other complications (IUGR, eclampsia, HELLP).Group 2: 18 with preeclampsia and related complications .Group 3: 17 women with IUGR regardless they had preeclampsia or not. 31.5% of the women with preeclampsia alone, had abnormal values of APCR which became 50% when they had other disorders (IUGR, HELLP,eclampsia).The percentage in the IUGR group was 35% while in the control group was 6%. From the 35 women with abnormal values of protein S in the three groups, 14 (40%) had abnormal value of APCR Conclusion: APCR can be used as a strong marker of relationship between preeclampsia and thrombophilia. On the contrary, protein S reduces significantly in both normal and complicated pregnancies. We can assume that the decrease in protein S is not the cause of APCR (due to its cofactor relationship) because only 40% of the women with hypertensive disorder have both abnormal APCR and protein S.
The aim of the study was to examine the clinical value of cervical assessment by transvaginal ultrasonography in women with symptoms of preterm labour. We prospectively evaluated 172 women with singleton pregnancies and symptoms of preterm labour. Gestational age ranged between 24 and 34 weeks. All women underwent cervical assessment with transvaginal ultrasonography and were given intravenous tocolytics. The only parameter evaluated was cervical length. Women with multiple pregnancies, gestational age < 24 weeks or > 34 weeks, cervical dilatation > 2 cm, placenta previa, premature rupture of membranes, or cervical cerclage were excluded from the study. The outcome measure was delivery before 34 weeks' gestation. The preterm delivery rate before 34 weeks was 37%. The sensitivity of a cervical length of less than 20 mm was 56%, while the specificity was 96%. A cervical length < 20 mm was also 90% predictive of preterm delivery, while the negative predictive value (NPV) of a cervical length of more than 20 mm was 79%. Cervical assessment in women with symptoms of preterm labour can distinguish those at high risk for preterm delivery. Cervical sonography can be a valuable adjunct to the clinical evaluation of these patients.
Dear Editor, We would like to comment on the Letter to the Editor by Dr Tjalma concerning our article “Acute Complete Nonpuerperal Uterine Inversion” published in the September issue of the journal (1). First of all, we thank Dr Tjalma for his comments concerning the “Anterior Abdominal Approach for a NonPuerperal Uterine Inversion” (2). The comments on the retroperitoneal approach of the inverted uterus and the anterior opening of the vaginal wall are both very interesting and informative. We agree that this approach provides a safe access to the tissues surrounding the uterus. It is however inevitable in the clinical management of this urgent situation to try initially to re-position the uterus. Therefore, manipulation of the tissues will undoubtedly occur. The Haultain procedure appears as a safe approach allowing direct visualization of the abdominal cavity and pelvic structures and has been favored by other authors even in cases of malignancy (3). It is also a faster approach compared to the retroperitoneal one, thus, probably more effective in cases of emergency with considerable blood loss, as in the case we report. We do agree however that in case of malignancy the retroperitoneal approach mentioned by Dr Tjalma is also appropriate, by dissecting and identifying all pelvic structures and obtaining an adequate, clear-margin specimen for pathological evaluation.
We examined a 20-year-old primigravida by ultrasound at 21 weeks of gestation during routine anomaly scanning. Several fetal deformities were demonstrated: the upper part of the body was in the amniotic cavity, while the lower part was in the celomic cavity. A large abdominal wall defect was detected with herniation of the liver and the intestine. The limbs were deformed, the spine had severe kyphoscoliosis, and the umbilical cord was very short. These findings were suggestive of a body stalk anomaly. Termination of the pregnancy was offered and decided by the parents. The pathology report confirmed the ultrasonographic diagnosis.
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