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Rev Bras Ginecol Obstet. 2001;23(2):101-105
DOI 10.1590/S0100-72032001000200007
Purpose: to study the changes in amniotic fluid index (AFI) measured by ultrasonography, mean arterial pressure (MAP) and pulse rate in normal pregnant women submitted to subtotal body immersion in water for different periods of time, and to standardize the technique. Methods: AFI values were studied as recommended by Phelan et al.¹ in a group of 52 pregnant women with gestational age of 28 weeks or more considered to be clinically normal, before and after exposure to subtotal immersion in water heated to 32 to 34ºC for 30, 45 and 60 min. The patients were seen at the Ultrasonography and Medical Updating School of Ribeirão Preto and in the Department of Gynecology and Obstetrics of the Faculty of Medicine of Ribeirão Preto, University of São Paulo. Results: before and after immersion, the average of MAP was 87.8 and 87.1 in the group of 30 min, 76.7 and 66.6 in the group of 45 min and 77.4 and 60.7 in the group of 60 min, with statistical significance. Before and after immersion, the means of pulse rates were 74.9 and 78.7 in the group of 30 min, 83.6 and 85.2 in the group of 45 min and 84.9 and 90.6 in the group of 60 min, with statistical significance. The mean of AFI also showed statistical significance. When submitted to 30-min immersion the means of AFI were 11.7 cm before and 16.8 cm after. In the group of 45 min, the averages were 9.7 cm before and 13.8 cm after immersion. In the group of 60 min, the averages were 9.5 cm before and 13.6 cm after immersion. The time of immersion of 30-min was as effective and ample as 45 or 60 min. Conclusions: subtotal immersion in water is a safe and practical procedure that can mobilize fluids during pregnancy, increasing amniotic fluid volume.
Summary
Rev Bras Ginecol Obstet. 2001;23(2):101-105
DOI 10.1590/S0100-72032001000200007
Purpose: to study the changes in amniotic fluid index (AFI) measured by ultrasonography, mean arterial pressure (MAP) and pulse rate in normal pregnant women submitted to subtotal body immersion in water for different periods of time, and to standardize the technique. Methods: AFI values were studied as recommended by Phelan et al.¹ in a group of 52 pregnant women with gestational age of 28 weeks or more considered to be clinically normal, before and after exposure to subtotal immersion in water heated to 32 to 34ºC for 30, 45 and 60 min. The patients were seen at the Ultrasonography and Medical Updating School of Ribeirão Preto and in the Department of Gynecology and Obstetrics of the Faculty of Medicine of Ribeirão Preto, University of São Paulo. Results: before and after immersion, the average of MAP was 87.8 and 87.1 in the group of 30 min, 76.7 and 66.6 in the group of 45 min and 77.4 and 60.7 in the group of 60 min, with statistical significance. Before and after immersion, the means of pulse rates were 74.9 and 78.7 in the group of 30 min, 83.6 and 85.2 in the group of 45 min and 84.9 and 90.6 in the group of 60 min, with statistical significance. The mean of AFI also showed statistical significance. When submitted to 30-min immersion the means of AFI were 11.7 cm before and 16.8 cm after. In the group of 45 min, the averages were 9.7 cm before and 13.8 cm after immersion. In the group of 60 min, the averages were 9.5 cm before and 13.6 cm after immersion. The time of immersion of 30-min was as effective and ample as 45 or 60 min. Conclusions: subtotal immersion in water is a safe and practical procedure that can mobilize fluids during pregnancy, increasing amniotic fluid volume.
Summary
Rev Bras Ginecol Obstet. 2003;25(2):115-121
DOI 10.1590/S0100-72032003000200007
PURPOSE: to establish a normality curve of cervical length during pregnancy measured by transvaginal ultrasonography. METHODS: we conducted a prospective, longitudinal study on 82 healthy pregnant women who were followed up from the beginning of pregnancy to delivery at four-week intervals, of whom 49 concluded the study. Patients were divided according to parity into nulliparous women and women with one or more previous deliveries. Cervical length was measured in a sagittal view by transvaginal ultrasonography, as the linear distance between internal and external cervical os. RESULTS: no significant difference was observed in mean cervical length or the 5th, 25, 50th, 75th, or 95th percentile according to gestational age between groups (p>0.05). Between the 20thand 24th gestacional week, the 5th, 50th and 95th percentiles of cervical length were 28, 35 and 47.2 mm, respectively. Cervical length decreased progressively during normal pregnancy, with a significant shortening observed after 20 weeks of gestation and being more marked after 28 weeks (p<0.05). CONCLUSION: the pattern of cervical length behavior does not seem to differ between nulliparous women and women with one or more previous deliveries. The numerical values of the normality curve of cervical length according to gestational age reflect the variability in the peculiar characteristics of the studied sample, thus emphasizing the value of the parameters established for different populations.
Summary
Rev Bras Ginecol Obstet. 2003;25(2):115-121
DOI 10.1590/S0100-72032003000200007
PURPOSE: to establish a normality curve of cervical length during pregnancy measured by transvaginal ultrasonography. METHODS: we conducted a prospective, longitudinal study on 82 healthy pregnant women who were followed up from the beginning of pregnancy to delivery at four-week intervals, of whom 49 concluded the study. Patients were divided according to parity into nulliparous women and women with one or more previous deliveries. Cervical length was measured in a sagittal view by transvaginal ultrasonography, as the linear distance between internal and external cervical os. RESULTS: no significant difference was observed in mean cervical length or the 5th, 25, 50th, 75th, or 95th percentile according to gestational age between groups (p>0.05). Between the 20thand 24th gestacional week, the 5th, 50th and 95th percentiles of cervical length were 28, 35 and 47.2 mm, respectively. Cervical length decreased progressively during normal pregnancy, with a significant shortening observed after 20 weeks of gestation and being more marked after 28 weeks (p<0.05). CONCLUSION: the pattern of cervical length behavior does not seem to differ between nulliparous women and women with one or more previous deliveries. The numerical values of the normality curve of cervical length according to gestational age reflect the variability in the peculiar characteristics of the studied sample, thus emphasizing the value of the parameters established for different populations.
Summary
Rev Bras Ginecol Obstet. 2004;26(2):147-151
DOI 10.1590/S0100-72032004000200010
PURPOSE: to assess the length of the uterine cervix by transvaginal ultrasonography in pregnant women with preterm premature rupture of membranes. METHODS: the study group (Ge) consisted of 26 pregnant women with gestational age between 24 and 36 weeks and the control group (Gc) of 49 clinically normal patients at the same gestational age. The patients were evaluated between the 24th to 28th, 28th to 32th and 32th to 36th weeks. The groups were divided into subgroups Ge24-28, Ge28-32, Ge32-36 and Gc24-28, Gc28-32, Gc32-36, according to the study or control group. The cervix length was measured by transvaginal ultrasonography as the linear distance between the internal and external cervical os. RESULTS: we observed significant differences in cervix length between Ge24-28 and Gc24-28 groups whose values were, respectively, 24.3 and 33.0 mm (p=0.04), and between Ge32-36 and Gc32-36, 20.1 and 28.0 mm, respectively (p=0.005). The latency periods of Ge24-28, Ge28-32 and Ge32-36 were, respectively, seven, five and three days, showing a positive correlation with cervix length (r=0.66) and a negative correlation with gestational age (r=-0.27). CONCLUSIONS: the length of the uterine cervix varied with the gestational age when premature preterm rupture of the membranes was detected, with the length being shorter in the study group than in the control group betweeen the 24th and 28th and 32th and 36th weeks. In addition, it was demonstrated that, the shorter the cervix length, the shorter the latency time, with a reduction in the latency period with increasing gestational age at the time of rupture.
Summary
Rev Bras Ginecol Obstet. 2004;26(2):147-151
DOI 10.1590/S0100-72032004000200010
PURPOSE: to assess the length of the uterine cervix by transvaginal ultrasonography in pregnant women with preterm premature rupture of membranes. METHODS: the study group (Ge) consisted of 26 pregnant women with gestational age between 24 and 36 weeks and the control group (Gc) of 49 clinically normal patients at the same gestational age. The patients were evaluated between the 24th to 28th, 28th to 32th and 32th to 36th weeks. The groups were divided into subgroups Ge24-28, Ge28-32, Ge32-36 and Gc24-28, Gc28-32, Gc32-36, according to the study or control group. The cervix length was measured by transvaginal ultrasonography as the linear distance between the internal and external cervical os. RESULTS: we observed significant differences in cervix length between Ge24-28 and Gc24-28 groups whose values were, respectively, 24.3 and 33.0 mm (p=0.04), and between Ge32-36 and Gc32-36, 20.1 and 28.0 mm, respectively (p=0.005). The latency periods of Ge24-28, Ge28-32 and Ge32-36 were, respectively, seven, five and three days, showing a positive correlation with cervix length (r=0.66) and a negative correlation with gestational age (r=-0.27). CONCLUSIONS: the length of the uterine cervix varied with the gestational age when premature preterm rupture of the membranes was detected, with the length being shorter in the study group than in the control group betweeen the 24th and 28th and 32th and 36th weeks. In addition, it was demonstrated that, the shorter the cervix length, the shorter the latency time, with a reduction in the latency period with increasing gestational age at the time of rupture.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):175-179
DOI 10.1590/S0100-72032001000300007
Purpose: to determine the accuracy of transabdominal ultrasound (TAUS) in revealing physiological and pathological changes in uterine volume, and to compare uterine volume detected by TAUS and by transvaginal ultrasound (TVUS) in an attempt to determine the relationship between the two methods. Methods: a total of 1,186 pelvic echographic examinations (TAUS and TVUS) were first reviewed retrospectively in terms of the major diseases and indications for the examinations. A total of 480 TAUS examinations without uterine disease were then selected and uterine volume was correlated with age and parity. Finally, a retrospective study was conducted to compare the uterine volume of 50 women obtained by TAUS and TVUS. Data were analyzed statistically by Student's t-test and Spearman and Pearson correlation. Results: correlating with parity, volume was 44.4 cm³ for P = 0 (n = 99), 58.5 cm³ for P = 1 (n = 72), 75.8 cm³ for P = 2-3 (n = 137), 88cm³ for P = 4-5 (n = 56), and 105cm³ for P = 6 or more (n = 26), showing a positive correlation between parity and uterine volume. Calculation of Spearman's correlation coefficient yielded r = 0.59 and p = 0.001 and calculation of Pearson's correlation coefficient yielded r = 0.55 and the same p value. There were no significant differences between the uterine volumes detected by TAUS and TVUS. Conclusions: the volume increases with parity and changes with age, and these modifications are detected by TAUS. The two methods (TAUS and TVUS) are equivalent in determining the uterine volume; however, when TAUS is used, bladder filling allows a better evaluation of the uterine length.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):175-179
DOI 10.1590/S0100-72032001000300007
Purpose: to determine the accuracy of transabdominal ultrasound (TAUS) in revealing physiological and pathological changes in uterine volume, and to compare uterine volume detected by TAUS and by transvaginal ultrasound (TVUS) in an attempt to determine the relationship between the two methods. Methods: a total of 1,186 pelvic echographic examinations (TAUS and TVUS) were first reviewed retrospectively in terms of the major diseases and indications for the examinations. A total of 480 TAUS examinations without uterine disease were then selected and uterine volume was correlated with age and parity. Finally, a retrospective study was conducted to compare the uterine volume of 50 women obtained by TAUS and TVUS. Data were analyzed statistically by Student's t-test and Spearman and Pearson correlation. Results: correlating with parity, volume was 44.4 cm³ for P = 0 (n = 99), 58.5 cm³ for P = 1 (n = 72), 75.8 cm³ for P = 2-3 (n = 137), 88cm³ for P = 4-5 (n = 56), and 105cm³ for P = 6 or more (n = 26), showing a positive correlation between parity and uterine volume. Calculation of Spearman's correlation coefficient yielded r = 0.59 and p = 0.001 and calculation of Pearson's correlation coefficient yielded r = 0.55 and the same p value. There were no significant differences between the uterine volumes detected by TAUS and TVUS. Conclusions: the volume increases with parity and changes with age, and these modifications are detected by TAUS. The two methods (TAUS and TVUS) are equivalent in determining the uterine volume; however, when TAUS is used, bladder filling allows a better evaluation of the uterine length.
Summary
Rev Bras Ginecol Obstet. 2017;39(6):309-314
To describe the prenatal diagnosis of Galen vein aneurysm (GVA) based on ultrasonography and magnetic resonance imaging (MRI) in a series of cases, as well as its postnatal outcomes and follow-up until 4 years of age.
A retrospective longitudinal study was performed, analyzing a database comprising seven cases of prenatal diagnosis of GVA at two Brazilian institutions from February of 2000 to May of 2012. The following data were evaluated: gestational age at diagnosis, GVA dimensions on ultrasonography, associated fetal changes, findings on fetal echocardiography, gestational age at delivery, type of delivery, birth weight, Apgar score at the 1st and 5th minutes, neonatal outcomes, and survival with follow-up until 4 years of age.
The mean gestational age ± standard deviation on the prenatal diagnosis of GVA based on ultrasonography was 25±4.9 weeks. The mean length of GVA was 3.2±0.4 cm. The mean gestational age at birth was 37.5±0.7 weeks, and a cesarean section was performed in 85.7% of the cases (6/7). The mean birth weight was 3,070±240.4 g. The total survival rate was 42.8% (4/7), with three neonatal deaths. Of the four survivors, three presented with normal neuropsychomotor development until 4 years of age and only one showed serious neurological sequelae. Ultrasonography and MRI showed similar findings for all seven cases.
Galen Vein Aneurysm is associated with a high neonatal death rate. Therefore, its prenatal diagnosis is essential for parent counseling and follow-up at tertiary care institutions.
Summary
Rev Bras Ginecol Obstet. 2017;39(6):309-314
To describe the prenatal diagnosis of Galen vein aneurysm (GVA) based on ultrasonography and magnetic resonance imaging (MRI) in a series of cases, as well as its postnatal outcomes and follow-up until 4 years of age.
A retrospective longitudinal study was performed, analyzing a database comprising seven cases of prenatal diagnosis of GVA at two Brazilian institutions from February of 2000 to May of 2012. The following data were evaluated: gestational age at diagnosis, GVA dimensions on ultrasonography, associated fetal changes, findings on fetal echocardiography, gestational age at delivery, type of delivery, birth weight, Apgar score at the 1st and 5th minutes, neonatal outcomes, and survival with follow-up until 4 years of age.
The mean gestational age ± standard deviation on the prenatal diagnosis of GVA based on ultrasonography was 25±4.9 weeks. The mean length of GVA was 3.2±0.4 cm. The mean gestational age at birth was 37.5±0.7 weeks, and a cesarean section was performed in 85.7% of the cases (6/7). The mean birth weight was 3,070±240.4 g. The total survival rate was 42.8% (4/7), with three neonatal deaths. Of the four survivors, three presented with normal neuropsychomotor development until 4 years of age and only one showed serious neurological sequelae. Ultrasonography and MRI showed similar findings for all seven cases.
Galen Vein Aneurysm is associated with a high neonatal death rate. Therefore, its prenatal diagnosis is essential for parent counseling and follow-up at tertiary care institutions.
Summary
Rev Bras Ginecol Obstet. 2006;28(1):38-43
DOI 10.1590/S0100-72032006000100007
PURPOSE: to determine the intraobserver and interobserver reproducibility of endometrial volume measurements using the VOCAL®-imaging program (Virtual Organ Computer-aided AnaLysis). METHODS: one three-dimensional (3-D) ultrasound dataset of the endometrium was obtained from each of five infertile women with different endometrial volumes. For each 3-D dataset, the endometrial volume was calculated by two different observers using the manual mode in four different rotational steps (30º, 15º, 9º and 6º). Ten measurements were obtained with each method and observer from each 3-D dataset. We have used one-way ANOVA and the Tukey post-test to verify the differences among means and the intraclass correlation coefficient to test reliability. RESULTS: rotational methods employing a rotation step of 30º were associated with lower endometrial volume readings in 3 of the 5 patients. There were no significant differences between the means obtained by the 15º, 9º or 6º step rotation. No significant difference was found between the means obtained by the two different observers. The intraclass correlation coefficients were significantly lower with 30º (all under 0.984) than with the other step rotations (all above 0.996). CONCLUSIONS: the use of a rotational step of 15º or less provides reliable readings of endometrial volume: there were no significant differences between the means calculated by the two observers, associated with highintraclass correlation coefficient (>0.996). We recommend the 15º step rotation because it is quicker to be performed than 6º and 9º.
Summary
Rev Bras Ginecol Obstet. 2006;28(1):38-43
DOI 10.1590/S0100-72032006000100007
PURPOSE: to determine the intraobserver and interobserver reproducibility of endometrial volume measurements using the VOCAL®-imaging program (Virtual Organ Computer-aided AnaLysis). METHODS: one three-dimensional (3-D) ultrasound dataset of the endometrium was obtained from each of five infertile women with different endometrial volumes. For each 3-D dataset, the endometrial volume was calculated by two different observers using the manual mode in four different rotational steps (30º, 15º, 9º and 6º). Ten measurements were obtained with each method and observer from each 3-D dataset. We have used one-way ANOVA and the Tukey post-test to verify the differences among means and the intraclass correlation coefficient to test reliability. RESULTS: rotational methods employing a rotation step of 30º were associated with lower endometrial volume readings in 3 of the 5 patients. There were no significant differences between the means obtained by the 15º, 9º or 6º step rotation. No significant difference was found between the means obtained by the two different observers. The intraclass correlation coefficients were significantly lower with 30º (all under 0.984) than with the other step rotations (all above 0.996). CONCLUSIONS: the use of a rotational step of 15º or less provides reliable readings of endometrial volume: there were no significant differences between the means calculated by the two observers, associated with highintraclass correlation coefficient (>0.996). We recommend the 15º step rotation because it is quicker to be performed than 6º and 9º.
Summary
Rev Bras Ginecol Obstet. 2003;25(6):437-442
DOI 10.1590/S0100-72032003000600009
PURPOSE: to study the evolution of the resistance and pulsatility indices, maximum velocity, final diastolic velocity and time of acceleration of the middle cerebral artery of fetuses between 22 and 38 weeks of gestation. METHODS: a prospective and longitudinal observational study was conducted on 33 fetuses of normal pregnant women evaluated between 22 and 38 weeks of pregnancy. The gestational age was determined on the basis of the date of the last menstruation and/or by ultrasound examination during the first trimester. Doppler ultrasound examination was performed by a single observer using an Image Point 1800 (Hewlett Packard) apparatus equipped with a multiple frequency transducer. For the acquisition of the Doppler tracing of the middle cerebral artery, the sample indicator was calibrated for a sample volume of 1 mm³ and placed on the anterior middle cerebral artery as close as possible to the skullcap. The insonation angle was kept between 5º and 19º and the filter was adjusted to a frequency of 50-100 Hz. The newborn infants were evaluated in order to confirm that the fetuses were vigorous and adequate for gestational age. RESULTS: the results obtained for the resistance and pulsatility indices revealed a 2nd-degree equation, representing a parabola whose values for the resistance index were 0.81 during the 22nd week and 0.75 during the 38th week. The pulsatility index was 1.59 during the 22nd week and 1.45 during the 38th week. Maximum systolic velocity increased progressively along pregnancy, with values of 26.3 cm/s during the 22nd week and 57.7 cm/s during the 38th week. Final diastolic velocity increased progressively from the 26th week (5.21 cm/s) to term (14.6 cm/s). Acceleration time increased significantly only between 26 and 30 weeks, with values of 0.04 s during the 26th week and 0.05 s during the 30th week. CONCLUSION: it was concluded that the evolution of the resistance and pulsatility indices and of maximum systolic velocity were similar to those of most studies described in the literature. Acceleration time presented few modifications during the evaluated gestational weeks.
Summary
Rev Bras Ginecol Obstet. 2003;25(6):437-442
DOI 10.1590/S0100-72032003000600009
PURPOSE: to study the evolution of the resistance and pulsatility indices, maximum velocity, final diastolic velocity and time of acceleration of the middle cerebral artery of fetuses between 22 and 38 weeks of gestation. METHODS: a prospective and longitudinal observational study was conducted on 33 fetuses of normal pregnant women evaluated between 22 and 38 weeks of pregnancy. The gestational age was determined on the basis of the date of the last menstruation and/or by ultrasound examination during the first trimester. Doppler ultrasound examination was performed by a single observer using an Image Point 1800 (Hewlett Packard) apparatus equipped with a multiple frequency transducer. For the acquisition of the Doppler tracing of the middle cerebral artery, the sample indicator was calibrated for a sample volume of 1 mm³ and placed on the anterior middle cerebral artery as close as possible to the skullcap. The insonation angle was kept between 5º and 19º and the filter was adjusted to a frequency of 50-100 Hz. The newborn infants were evaluated in order to confirm that the fetuses were vigorous and adequate for gestational age. RESULTS: the results obtained for the resistance and pulsatility indices revealed a 2nd-degree equation, representing a parabola whose values for the resistance index were 0.81 during the 22nd week and 0.75 during the 38th week. The pulsatility index was 1.59 during the 22nd week and 1.45 during the 38th week. Maximum systolic velocity increased progressively along pregnancy, with values of 26.3 cm/s during the 22nd week and 57.7 cm/s during the 38th week. Final diastolic velocity increased progressively from the 26th week (5.21 cm/s) to term (14.6 cm/s). Acceleration time increased significantly only between 26 and 30 weeks, with values of 0.04 s during the 26th week and 0.05 s during the 30th week. CONCLUSION: it was concluded that the evolution of the resistance and pulsatility indices and of maximum systolic velocity were similar to those of most studies described in the literature. Acceleration time presented few modifications during the evaluated gestational weeks.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):443-448
DOI 10.1590/S0100-72031998000800003
Purpose: to demonstrate the interobserver variation existing in the ultrasonographic measurement of amniotic fluid index (AFI) and in the measurement of pocket area, and to compare these two methods. In addition, an attempt was made to establish the intraobserver variation in the measurement of this index. Methods: values of AFI, described by Phelan et al.18, were studied in a group of 80 pregnant women considered to be clinically normal, seen at the Ultrasonography and Medical Updating School of Ribeirão Preto and in the Department of Gynecology and Obstetrics of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP). All pregnant women had a gestational age of more than 24 weeks. Fifty of these patients were submitted to AFI evaluation by 5 different ultrasonographists using the same equipment and during the same period of time, in order to determine the interobserver variation of this index. In addition, planimetric measurement of the area was performed by 2 of these 5 ultrasonographists, selected at random, in an attempt to determine interobserver variation in area measurement. Another group of 30 pregnant women was evaluated by the same ultrasonographist in an attempt to evaluate intraobserver variation in terms of AFI measurement. Results: There was a significant interobserver variation in AFI measurement and a significant variation in area measurement. However, the intraobserver variation in AFI measurement was nonsignificant. There was a correlation between AFI and area measurements. Conclusions: we emphasize the obstetrical applicability of this index and the easier execution of this method compared to area measurement, despite the importance of both procedures.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):443-448
DOI 10.1590/S0100-72031998000800003
Purpose: to demonstrate the interobserver variation existing in the ultrasonographic measurement of amniotic fluid index (AFI) and in the measurement of pocket area, and to compare these two methods. In addition, an attempt was made to establish the intraobserver variation in the measurement of this index. Methods: values of AFI, described by Phelan et al.18, were studied in a group of 80 pregnant women considered to be clinically normal, seen at the Ultrasonography and Medical Updating School of Ribeirão Preto and in the Department of Gynecology and Obstetrics of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP). All pregnant women had a gestational age of more than 24 weeks. Fifty of these patients were submitted to AFI evaluation by 5 different ultrasonographists using the same equipment and during the same period of time, in order to determine the interobserver variation of this index. In addition, planimetric measurement of the area was performed by 2 of these 5 ultrasonographists, selected at random, in an attempt to determine interobserver variation in area measurement. Another group of 30 pregnant women was evaluated by the same ultrasonographist in an attempt to evaluate intraobserver variation in terms of AFI measurement. Results: There was a significant interobserver variation in AFI measurement and a significant variation in area measurement. However, the intraobserver variation in AFI measurement was nonsignificant. There was a correlation between AFI and area measurements. Conclusions: we emphasize the obstetrical applicability of this index and the easier execution of this method compared to area measurement, despite the importance of both procedures.
