PubMed Health⌕ Search

Biomedical subjects

L Raio

Publications and source records attributed to L Raio.

29 records · Page 2Linked to original sources
PubMed1999

Sonographic measurement of the umbilical cord and fetal anthropometric parameters.

OBJECTIVE: To determine reference ranges for the diameter and the cross-sectional area of the umbilical cord during pregnancy and to determine if umbilical cord morphometry is related to fetal size. METHODS: A prospective cross-sectional study was designed to assess the sonographic cross-sectional diameter and area of the umbilical cord. The sonographic umbilical cord measurements were obtained in a plane adjacent to the insertion of the cord into the fetal abdomen. Nomograms for the umbilical cord diameter and area were computed. Fetal biometry included: biparietal diameter, abdominal circumference, and femur length. Polynomial regression analysis was conducted. RESULTS: Five hundred and fifty seven patients were included into the study. The regression equation for the umbilical cord diameter (y) according to gestational age (x) was y=-10.0563+1.4265x+0.0194x2 and for the umbilical cord area (y') was y'=91.6-3.3x+0.03x2-0.00007x3. A significant relationship was found between umbilical cord measurements and fetal anthropometric parameters. CONCLUSION: Reference ranges for umbilical cord diameter and area have been generated. The sonographic diameter and cross-sectional area of the umbilical cord increase as a function of gestational age and both diameter and area correlate with fetal size.

Anthropometry↗
PubMed1999

Prenatal diagnosis of a lean umbilical cord: a simple marker for the fetus at risk of being small for gestational age at birth.

OBJECTIVE: The purpose of this study was to investigate whether the prenatal diagnosis of a 'lean' umbilical cord in otherwise normal fetuses identifies fetuses at risk of being small for gestational age (SGA) at birth and of having distress in labor. The umbilical cord was defined as lean when its cross-sectional area on ultrasound examination was below the 10th centile for gestational age. METHOD: Pregnant women undergoing routine sonographic examination were included in the study. Inclusion criteria were gestational age greater than 20 weeks, intact membranes, and singleton gestation. The sonographic cross-sectional area of the umbilical cord was measured in a plane adjacent to the insertion into the fetal abdomen. Umbilical artery Doppler waveforms were recorded during fetal apnea and fetal anthropometric parameters were measured. RESULTS: During the study period, 860 patients met the inclusion criteria, of whom 3.6% delivered a SGA infant. The proportion of SGA infants was higher among fetuses who had a lean umbilical cord on ultrasound examination than among those with a normal umbilical cord (11.5% vs. 2.6%, p < 0.05). Fetuses with a lean cord had a risk 4.4-fold higher of being SGA at birth than those with a normal umbilical cord. After 25 weeks of gestation, this risk was 12.4 times higher when the umbilical cord was lean than when it was of normal size. The proportion of fetuses with meconium-stained amniotic fluid at delivery was higher among fetuses with a lean cord than among those with a normal umbilical cord (14.6% vs. 3.1%, p < 0.001). The proportion of infants who had a 5-min Apgar score < 7 was higher among those who had a lean cord than among those with normal umbilical cord (5.2% vs. 1.3%, p < 0.05). Considering only patients admitted in labor with intact membranes and who delivered an appropriate-for-gestational-age infant, the proportion of fetuses who had oligohydramnios at the time of delivery was higher among those who had a lean cord than among those with a normal umbilical cord (17.6% versus 1.3%, p < 0.01). CONCLUSION: We conclude that fetuses with a lean umbilical cord have an increased risk of being small for gestational age at birth and of having signs of distress at the time of delivery.

Adult↗
PubMed1999

Prenatal assessment of Wharton's jelly in umbilical cords with single artery.

OBJECTIVE: To investigate whether the amount of Wharton's jelly in non-malformed fetuses with a single umbilical artery is different from that of fetuses with a normal umbilical cord. METHODS: We evaluated patients with singleton pregnancies, non-malformed fetuses and single umbilical artery undergoing sonographic evaluation at a gestational age ranging from 19 to 41 weeks' gestation. The cross-sectional areas of the umbilical cord and of the umbilical vessels were measured. The amount of Wharton's jelly was calculated by subtracting from the total cross-sectional area of the umbilical cord the areas of the artery and of the vein. The umbilical cord cross-sectional area, the umbilical artery and vein areas as well as the amount of Wharton's jelly were plotted on previously published nomograms. RESULTS: Twenty-two patients met the inclusion criteria. The umbilical cord cross-sectional area was within the normal range in 20 (90.1%) cases. The umbilical artery and vein areas were above 2 standard deviations from the mean in 20 cases and in 11 cases (50%), respectively. The amount of Wharton's jelly was below 2 standard deviations from the mean in all cases. An abnormal insertion of the umbilical cord (marginal, velamentous) was present in five cases (22.7%). CONCLUSIONS: A reduction of Wharton's jelly is frequently present in cases of single umbilical artery. The increased perinatal morbidity and mortality observed in cases of single umbilical artery, even in the absence of congenital or chromosomal abnormalities, could be in part the consequence of a reduced amount of Wharton's jelly.

Adult↗
PubMed1999

Prenatal assessment of the Hyrtl anastomosis and evaluation of its function: case report.

The presence of a communicating vessel, the Hyrtl anastomosis, between the umbilical arteries is well described in pathological studies. Using different injection techniques, it has been speculated that this vessel acts as a pressure-equalizing mechanism between the different lobes of the placenta. However, its detection during fetal life has never been reported. We report on two cases of ultrasonographic detection and Doppler assessment of the Hyrtl anastomosis during pregnancy. A pulsatile blood flow from the umbilical artery with higher resistance to that with lower resistance has been demonstrated at the level of the Hyrtl anastomosis, which was confirmed after delivery. In addition, this report supports the hypothesis that the anastomosis plays an important role in regulating the blood pressure in the placental lobes and in equalizing the blood pressure between umbilical arteries.

Adult↗
PubMed1998

The clinical significance of antenatal detection of discordant umbilical arteries.

OBJECTIVE: To evaluate the clinical significance of the antenatally detected discordant umbilical arteries (UAs). METHODS: Women with singleton gestations undergoing sonographic evaluations were examined for the presence of discordant UAs. Transverse and longitudinal diameters as well as the area of both UAs were measured. Doppler flow velocity waveforms were recorded from both arteries. Macroscopic and microscopic examination of the umbilical cord was performed after delivery and the area of each artery was measured. Mann-Whitney U test and Spearman rank correlation were used for statistical purposes. RESULTS: Data are presented as median (range). Discordance between UAs was found in 14 of 1012 women who underwent sonographic examinations. The vessel diameters and areas differed significantly between the discordant UAs (diameter 2.9 [1-4.3] versus 4.5 [3.8-6.5] mm, P < .001; area 6.6 [0.78-14.5] versus 16.25 [11.33-33.16] mm2, P < .001). A significant difference between UA size was confirmed after delivery (area 1.68 [0.9-3.06] versus 4.17 [1.12-13.8] mm2, P < .005). The difference in the area of the UAs in utero and at microscopic examination correlated significantly (r = .94, P < .05). In all cases, the resistance index was higher in the smaller artery than in the larger artery (0.71 [0.59-0.8] versus 0.6 [0.48-0.75] P < .01). Abnormal insertion of the umbilical cord or an abnormality of the placenta was present in eight cases. Perinatal death occurred only in a trisomic infant born at 24 weeks' gestation. CONCLUSION: The clinical significance of discordant UAs is that newborns are generally in good condition at birth and placental anomalies are common in this group of parturients. Abnormal Doppler velocimetry of the smaller UA should be taken with caution, because it does not seem to be associated with poor perinatal outcome.

Adult↗
PubMed1998

[Vascular diameter and resistance indices in normal fetuses with a single umbilical artery].

OBJECTIVE: This study was undertaken to investigate the vascular-adaptive mechanism of fetuses with a single umbilical artery (SUA) and without structural anatomical abnormalities. METHODS: A cohort study including fetuses with the diagnosis of SUA at routine ultrasonographic examination was designed. The diagnosis of SUA was confirmed by color Doppler imaging and by histological examination of the umbilical cord after delivery. The inner artery and vein diameters were measured and the resistance-index (RI) of the SUA was calculated. RESULTS: Eleven fetuses were studied. The artery and vein diameters were 2 standard deviations above the mean, when plotted in reference ranges, in 12 out of 17 (70.5%) and 8 out of 16 (50%) measurements, respectively. The RI-values were below the 5th and 50th percentile in 50% (6/12) and 75% (9/12) of the measurements, respectively. CONCLUSION: A dilatation of the single artery occurs to reduce the impedance in this vessel and to preserve a sufficient feto-placental blood flow. In addition the umbilical vein also increases in size.

Adult↗
PubMed1997

Duration of pregnancy after carbon dioxide laser conization of the cervix: influence of cone height.

OBJECTIVE: To determine if carbon dioxide laser conization of the cervix is a risk factor for preterm delivery in subsequent gestations and to evaluate whether there is any relationship between cone height and duration of pregnancy. METHODS: Patients of fertile age who had carbon dioxide laser conization were followed for reproductive events. Cases were matched one-to-one with controls for known risk factors for preterm delivery. Pregnancy duration, rate of preterm birth, and mode of delivery were studied. Parametric and nonparametric tests were used for statistical analysis. Logistic regression analysis and Cox proportional hazard modeling were used to investigate the relationship between cone height and subsequent preterm delivery. RESULTS: Sixty-four women with singleton pregnancies after carbon dioxide laser conization and 64 controls were included in the study. Overall, no difference was found in the rate of preterm delivery and duration of pregnancy. However, women with cone height of at least 10 mm had a higher rate of preterm delivery than either those with cone height less than 10 mm (five of 23 versus one of 41, P = .01) or the controls (five of 23 versus three of 64, P < .05). Cone height of at least 10 mm remained significant in predicting the occurrence of preterm delivery and the duration of pregnancy after adjusting for known risk factors (odds ratio 11.1, P < .05). CONCLUSION: Cone height of at least 10 mm is an independent risk factor for the duration of pregnancy and for the occurrence of preterm delivery in the subsequent gestation.

Adult↗
PubMed1997

[Discordant umbilical cord arteries: prenatal diagnosis and significance].

Prenatal Diagnosis and Consequences. Prenatal diagnosis of discordant umbilical arteries is possible with ultrasound. Different umbilical artery flow waveforms may result in discordancy of umbilical arteries. Discordancy of size between the umbilical arteries is considered to be an incomplete form of the single umbilical artery syndrome, caused by abnormal placentation or insertion of the umbilical cord. To rule out fetal malformation detailed ultrasound examinations and fetal surveillance are mandatory.

Abnormalities, Multiple↗
PubMedDate not supplied

[Shorter delivery time after induction with misoprostol].

INTRODUCTION: Increasing evidence has demonstrated that intravaginal misoprostol (PGE1) is more effective in labor induction than dinoprostone (PGE2). Several studies have demonstrated that the administration of PGE1 instead of PGE2 reduces the induction-to-delivery interval. However, it has not been fully investigated on which phase of birth the activity of PGE1 is stronger than that of PGE2. We undertook this study to investigate whether the activity of the two prostaglandins are different over time during the induction-to-delivery interval. MATERIAL AND METHODS: 155 patients undergoing induction of labor with 50 micrograms intravaginal PGE1 were compared with 174 patients treated with 3 mg PGE2. In both groups the procedure was repeated 6, and 24 hours after the first dose until labor was achieved. Induction-to-initiation of labor time, duration of labor stages, induction-to-delivery time, mode of delivery, maternal and neonatal morbidity and changes in Bishop score were compared. RESULTS: Demographic characteristics, indications for induction, mode of delivery, fetal weight, maternal and neonatal morbidity and duration of the labor stages were similar between the groups. A significant difference was found in terms of: induction-to-initiation of labor interval (7.37 h [1-68] vs. 11.25 h [1-74], p < 0.01) and induction-to-delivery interval (11.5 h [2.5-89] vs. 14.4 h [2.7-94], p < 0.05). The Bishop score at the time of the second administration was significantly different from that at admission in the PGE1 group compared to the PGE2 group [PGE1: 4.8 +/- 2/5.6 +/- 1.9, p < 0.0005; PGE2: 3.9 +/- 2/4.2 +/- 1.4, p = 0.09]. This effect of PGE1 remained significant after correction for various explanatory variables. CONCLUSIONS: The stronger effect of PGE1 is the consequence of a faster cervical ripening, which in turn leads to a quicker achievement of active labor. DISCUSSION: Intravaginal PGE1 compared to PGE2 reduces significantly the induction-to-delivery time.

Administration, Intravaginal↗
PubMedDate not supplied

[Postpartum pelvic vein and vena cava thrombosis after water immersion delivery].

A 26-years old primipara experienced a laparotomy with thrombectomy because of pelvic vein thrombophlebitis and cavathrombosis 18 days after ambulant water-birth. The pelvic vein thrombophlebitis is a potentially life-threatening complication in puerperium and to our knowledge, this is the first case reported after water-birth. Even after ambulant childbirth those rather rare complications are able to appear. To think of such events makes professional help possible in time.

Adult↗