Re: Umbilical cord diameter at 11-14 weeks of gestation: relationship to nuchal translucency, ductus venous blood flow and chromosomal defects.
Explore the source record for details and available documents.
Chromosome Aberrations↗
Biomedical subjects
Nuno Montenegro
Publications and source records attributed to Nuno Montenegro.
Evolving indications for the EXIT procedure: the usefulness of combining ultrasound and fetal MRI.
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.
Adult↗
[Transvaginal ultrasound assessment of the cervix and digital examination before labor induction].
OBJECTIVE: To examine the relationship between sonographic measurement of cervical length and Bishop score with duration of labour induction. METHODS: A prospective, blinded, observational study was performed in 191 pregnant women undergoing labor induction. Ultrasound measurement of cervical length and determination of Bishop score were performed. Induction was based exclusively on the Bishop score according to Obstetric Unit protocol. The criteria for considering the cervix unripe were either Bishop score < 6 or a cervical length = 26 mm. Duration of induction is defined like the induction-to-delivery interval. The main outcomes assessed were the duration of induction, the delivery within 24 h of induction and type of delivery. RESULTS: The duration of induction was between 2 h 27 min and 61 h 30 min. We found an association between cervical length and Bishop score with duration of induction. The duration of induction was significantly increased in nulliparous (median 18 h 38 min vs. 9 h 18 min). There was no correlation of age or weight of pregnant women with the duration of induction. Comparison between Bishop score and cervical length in predicting delivery within the first 24 hours showed that the pregnant women with low Bishop score had a higher risk of deliver after 24 hours of induction (OR = 21.16), as the ones with cervical length longer than 26 mm (OR = 5.06). Analyzing the relation of these two parameters with type of delivery we realize that low Bishop score has a higher risk of cesarean section (OR = 2.67) and that there wasn't any relation between type of delivery and cervical length. DISCUSSION: In this study we verified a statistically significant relation between Bishop score, US cervical length and previous vaginal birth with induction duration. Pregnant woman's age and weight didn't have influence on the duration of induction. The study showed that both Bishop score and US cervical length are useful in predicting delivery within the first 24 hours. Bishop score was also related with type of delivery.
Adolescent↗
Critical evaluation of elective termination of pregnancy in a tertiary fetal medicine center during 43 months: correlation of prenatal diagnosis findings and postmortem examination.
OBJECTIVES: 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. MATERIAL AND METHODS: 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. RESULTS: 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. DISCUSSION: 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.
Abortion, Eugenic↗
Down syndrome screening in multiple pregnancies.
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.
Biomarkers↗
Search for hemodynamic compromise at 11-14 weeks in monochorionic twin pregnancy: is abnormal flow in the ductus venosus predictive of twin-twin transfusion syndrome?
BACKGROUND AND OBJECTIVES: 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. DESIGN: 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. RESULTS: 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. CONCLUSIONS: 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.
Adolescent↗
[Influence of three organisational measures on the cesarean section rate in a tertiary care University Hospital].
OBJECTIVE: To evaluate the influence of three organizational measures on the cesarean section rate over two consecutive years, in the Department of Obstetrics and Gynaecology of a tertiary care University Hospital. MATERIAL AND METHODS: Clinical records of births occurring in the years 2001 and 2002 were retrospectively evaluated, in order to identify the annual rate of emergency and elective cesarean sections. Other data recorded were the type of deliveries in each on-call team, newborn 1-min and 5-min Apgar scores, neonatal intensive care unit admissions, principal motive for emergency cesareans, time of day and week-day of emergency cesareans. In the first week of 2002, the results of the first year's evaluation were presented to all staff at the Department. At that time, an information pamphlet was distributed to all health care professionals, reminding them of the risks associated with cesarean section. From then on, all emergency cesareans were discussed on the following work-day, in a clinical meeting involving all obstetrical staff. Statistical analysis was carried out using the chi-squared test, with the level of significance being established at 0.05. RESULTS: In 2001 there were 3009 births, overall cesarean section rate was 36.5%, and emergency cesarean rate was 30.5%. Cesarean section rates varied between 23.3% and 43.4%, amongst the eight on-call teams. In 2002 there were 2959 births, overall cesarean section rate was 27.6%, and emergency cesarean rate was 20.4%. Cesarean section rates in on-call teams varied between 14.3% and 31.5%. Over the two years, a reduction of 8.9 percentage points (p<0.001) in overall cesarean section rate, and of 10.1 points (p<0.001) in emergency cesareans were observed. During the same period elective cesareans increased 1.2 percentage points (p=0.052) and instrumental deliveries increased 3.2 points (p=0.002). There were less cesarean sections due to arrested labour (154 cases) and non-reassuring fetal state (46 cases), although these motives remained preponderant. The number of newborns with low 1-min Apgar decreased significantly, while those with low 5-min Apgar and intensive care unit admission remained constant. CONCLUSIONS: The introduction of three relatively simple organizational measures enabled a significant reduction in the cesarean section rate over a one-year period, without changing the incidence of the main neonatal outcome indicators.
Cesarean Section↗
Non-viable cervico-isthmic pregnancy: the importance of an accurate sonographic diagnosis to preserve fertility.
BACKGROUND: Cervico-isthmic pregnancy is a rare occurrence and until the use of current ultrasonographic techniques was associated with a disastrous outcome for women desiring to maintain their fertility. CASE REPORT: A 39-year-old woman was diagnosed at 12 weeks of amenorrhoea with an intra-uterine non-viable pregnancy and a low implantation of the gestational sac. Medical management of this situation with a regimen of intravaginal misoprostol was unsuccessful. At introduction of a cervical expander severe vaginal bleeding ensued, leading to an emergency curettage followed by a life-saving hysterectomy. Pathologic examination confirmed the peroperative impression of an isthmic implantation of the gestational sac. CONCLUSION: Early ultrasonographic diagnosis is essential to make conservative management of cervico-isthmic pregnancy possible.
Adult↗
Nuchal translucency and ductus venosus blood flow as early sonographic markers of thanatophoric dysplasia. A case report.
Thanatophoric dysplasia (TD) is the most frequent form of lethal osteochondrodysplasias. Prenatal diagnosis is commonly accomplished in the second-trimester scan, but occasionally TD may not be clearly distinguished from the other osteochondrodysplasias, with consequent important prognostic implications. However, in order to confirm the diagnosis, complementary radiological, pathological and molecular studies are mandatory. We present a case of TD diagnosed in the late first trimester with the contribution of nuchal translucency combined with ductus venosus blood flow assessment.
Abortion, Induced↗
[Calculation of gestational age. Methods and problems].
Gestational age assignment is one of the most important issues in perinatal medicine. Nowadays, the first day of the last menstrual period, when available, is still used as the basis for calculation of gestational age and expected day of confinement. However, most frequently this date is uncertain or even unknown, and thereby gestational age can be confidently estimated by ultrasonographic biometry until 22 weeks of gestation. There is no uniform dating policy when both a valid last menstrual period and ultrasonographic dates are available in determining the date of confinement. When both methods are compared, there are obvious advantages of routine scanning in the first half of pregnancy.
Female↗
[Clinical impact of ultrasonography between the 10th and the 13th week of pregnancy].
The authors aimed to assess the impact of a routine ultrasound examination performed between 10 and 13 weeks of pregnancy. During a thirty month period, 778 ultrasound examinations between 10 and 13 weeks of pregnancy were performed, in women referred to our hospital. Transvaginal ultrasound was systematically adopted and the parameters obtained were introduced in a computerized data base. Biographic data, first day of menses (whenever possible), menstrual cycle characteristics, eventual use of hormonal contraception in the three months before last menses, antecedents of chromosomal abnormalities, number of foetuses and chorionicity, foetal vitality, crown-rump length, nuchal translucency and foetal heart rate were registered in all examinations. The median gestational age at the time of examination was 12.5 weeks (9-14.3). The median of maternal age was 29 years (14-44), maternal age prevalence higher or equal to 35 years was 17%. Fifty two per cent of women had usually regular menstrual cycles and 11% ignored last menses. In 74% of cases discrepancy between amenorrhea and ultrasound derived gestational age was inferior to one week and in 19% superior. The median of nuchal translucency was 1.4 mm (0.5-10), 7% of all cases had a nuchal translucency higher or equal to 2.5 mm. If maternal age criteria had been decisive for diagnostic invasive procedures, they would have been made in 135 cases. Considering nuchal translucency value combined with maternal age, it should have been done in 63 cases. In our series, invasive testing was performed in 31 (5%) cases. Eight women with fetuses with abnormal karyotypes decided for termination of pregnancy. The importance of ultrasound examination between 10 and 13 weeks seems unquestionable, allowing the correction of gestational age, multiple pregnancy characterisation and chromosomal abnormalities screening.
Adolescent↗