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Rev Bras Ginecol Obstet. 2011;33(5):211-218
DOI 10.1590/S0100-72032011000500002
PURPOSE: the aim of this study was to analyze conjoined twins in terms of antenatal, delivery and postnatal aspects. METHODS: a retrospective descriptive analysis of prenatally diagnosed conjoined twins. Prenatal ultrasound and echocardiography, delivery details, postnatal follow-up, surgical separation and post mortem data were reviewed. The twins were classified according to the type of fusion between fetal structures. The following data were analyzed: ultrasound and echocardiographic findings, antenatal lethality and possibility of surgical separation, delivery details and survival rates. RESULTS: forty cases of conjoined twins were included in the study. There were 72.5% cases of thoracophagus, 12.5% of paraphagus, 7.5% of omphalo-ischiophagus, 5.0% of omphalophagus, and 2.5% of cephalophagus. Judicial termination of pregnancy was requested in 58.8% of the cases. Cesarean section was performed in all cases in which pregnancy was not terminated. The mean gestational age at delivery was 35 weeks; all twins were live births with a mean birth weight of 3,860 g and 88% died postnatally. Ten percent of the live borns were submitted to surgical separation with a 60% survival rate. The total survival rate was 7.5% and postnatal survival was 12%. Antenatal evaluation of lethality and possibility of surgical separation were precise. There were no maternal complications related to delivery. CONCLUSION: conjoined twins present a dismal prognosis mainly related to the complex cardiac fusion present in the majority of cases with thoracic sharing. At referring centers, prenatal ultrasound and echocardiographic evaluation accurately delineate fetal prognosis and the possibility of postnatal surgical separation.
Summary
Rev Bras Ginecol Obstet. 2011;33(5):211-218
DOI 10.1590/S0100-72032011000500002
PURPOSE: the aim of this study was to analyze conjoined twins in terms of antenatal, delivery and postnatal aspects. METHODS: a retrospective descriptive analysis of prenatally diagnosed conjoined twins. Prenatal ultrasound and echocardiography, delivery details, postnatal follow-up, surgical separation and post mortem data were reviewed. The twins were classified according to the type of fusion between fetal structures. The following data were analyzed: ultrasound and echocardiographic findings, antenatal lethality and possibility of surgical separation, delivery details and survival rates. RESULTS: forty cases of conjoined twins were included in the study. There were 72.5% cases of thoracophagus, 12.5% of paraphagus, 7.5% of omphalo-ischiophagus, 5.0% of omphalophagus, and 2.5% of cephalophagus. Judicial termination of pregnancy was requested in 58.8% of the cases. Cesarean section was performed in all cases in which pregnancy was not terminated. The mean gestational age at delivery was 35 weeks; all twins were live births with a mean birth weight of 3,860 g and 88% died postnatally. Ten percent of the live borns were submitted to surgical separation with a 60% survival rate. The total survival rate was 7.5% and postnatal survival was 12%. Antenatal evaluation of lethality and possibility of surgical separation were precise. There were no maternal complications related to delivery. CONCLUSION: conjoined twins present a dismal prognosis mainly related to the complex cardiac fusion present in the majority of cases with thoracic sharing. At referring centers, prenatal ultrasound and echocardiographic evaluation accurately delineate fetal prognosis and the possibility of postnatal surgical separation.
Summary
Rev Bras Ginecol Obstet. 2011;33(9):240-245
DOI 10.1590/S0100-72032011000900004
PURPOSE: To determine the accuracy of ultrasound in fetal weight estimation and to evaluate maternal and/or fetal factors that could interfere in the result. METHODS: This was a transverse prospective study, involving 106 patients, with 212 fetal weight evaluations, by two observers, within 24 h to delivery. The following parameters were measured: biparietal diameter, head circumference, abdominal circumference, and femoral length. Fetal weight was estimated using the Hadlock formula and the results were compared to birth weight. The maternal factors examined were: weight, BMI, and skin to uterus distance measured by ultrasound, and the fetal factors were: presentation, position, placental localization and thickness, fetal weight, and amniotic fluid index (AFI). RESULTS: There was good correlation between estimated fetal weight and birth weight (R=0.97). In 79.2% and in 92.4% of cases the estimated fetal weight was within 10% and 15% of birth weight, respectively. The only maternal factor that presented a positive correlation with percent error in the estimate of fetal weight was the skin to uterus distance (R³0.56). Fetal weight showed negative correlation with percent error (R>-0.36; p<0.001), with a significant tendency to overestimate fetal weight in the group of very low weight - <1000 g (p<0.05). The AFI showed a low negative correlation with percent error (R=-0.21; p<0.001) with no difference between AFI groups (p=0.516). CONCLUSION: Ultrasound presented good accuracy in the estimation of fetal weight. The error of weight estimate was directly proportional to the skin to uterus distance and inversely proportional to fetal weight. AFI did not interfere significantly in the ultrasound prediction of fetal weight.
Summary
Rev Bras Ginecol Obstet. 2011;33(9):240-245
DOI 10.1590/S0100-72032011000900004
PURPOSE: To determine the accuracy of ultrasound in fetal weight estimation and to evaluate maternal and/or fetal factors that could interfere in the result. METHODS: This was a transverse prospective study, involving 106 patients, with 212 fetal weight evaluations, by two observers, within 24 h to delivery. The following parameters were measured: biparietal diameter, head circumference, abdominal circumference, and femoral length. Fetal weight was estimated using the Hadlock formula and the results were compared to birth weight. The maternal factors examined were: weight, BMI, and skin to uterus distance measured by ultrasound, and the fetal factors were: presentation, position, placental localization and thickness, fetal weight, and amniotic fluid index (AFI). RESULTS: There was good correlation between estimated fetal weight and birth weight (R=0.97). In 79.2% and in 92.4% of cases the estimated fetal weight was within 10% and 15% of birth weight, respectively. The only maternal factor that presented a positive correlation with percent error in the estimate of fetal weight was the skin to uterus distance (R³0.56). Fetal weight showed negative correlation with percent error (R>-0.36; p<0.001), with a significant tendency to overestimate fetal weight in the group of very low weight - <1000 g (p<0.05). The AFI showed a low negative correlation with percent error (R=-0.21; p<0.001) with no difference between AFI groups (p=0.516). CONCLUSION: Ultrasound presented good accuracy in the estimation of fetal weight. The error of weight estimate was directly proportional to the skin to uterus distance and inversely proportional to fetal weight. AFI did not interfere significantly in the ultrasound prediction of fetal weight.
Summary
Rev Bras Ginecol Obstet. 2002;24(4):247-251
DOI 10.1590/S0100-72032002000400006
Purpose: to compare cervical length measurements in twin pregnancies obtained by transvaginal ultrasound examination in the recumbent and standing positions. Methods: fifty twin pregnancies underwent transvaginal ultrasound examinations to measure the cervical length with the women in recumbent and standing positions. The study was carried out between May 1999 and December 2000. The scans were repeated every 4 weeks and the total number of evaluations was 136. Two groups were analyzed: one included only the first ultrasound examinations carried out in each woman and the second group included all evaluations. Results: in the first group, cervical length measurements in the standing and recumbent positions correlated inversely with the gestational age (recumbent: r=-0.60; p<0.001; standing: r=-0.46; p=0.008). The mean measure in the recumbent position was 35.2 mm (SD=9.9 mm) and 33.4 mm (SD=9.5 mm) in the standing position. When the difference between the measure obtained in the standing and recumbent positions was expressed as percentage of the measure in the recumbent position, there was no significant association with gestational age (p=0.07). When all evaluations were considered, there was a significant association between cervical length in the recumbent and standing positions (r=0.79; p<0.001). The measures in recumbent and standing positions were inversely correlated with gestational age (recumbent: p<0.0001; standing: p<0.0001). The mean cervical length in the recumbent position was 33.5 mm (SD=10.8 mm) and 31.8 mm (SD=9.6 mm) in the standing position. There was no significant association between cervical length difference expressed as percentage of the measure in the recumbent position and gestation. Conclusion: cervical length measure obtained with the patients in the recumbent and standing positions provided similar information.
Summary
Rev Bras Ginecol Obstet. 2002;24(4):247-251
DOI 10.1590/S0100-72032002000400006
Purpose: to compare cervical length measurements in twin pregnancies obtained by transvaginal ultrasound examination in the recumbent and standing positions. Methods: fifty twin pregnancies underwent transvaginal ultrasound examinations to measure the cervical length with the women in recumbent and standing positions. The study was carried out between May 1999 and December 2000. The scans were repeated every 4 weeks and the total number of evaluations was 136. Two groups were analyzed: one included only the first ultrasound examinations carried out in each woman and the second group included all evaluations. Results: in the first group, cervical length measurements in the standing and recumbent positions correlated inversely with the gestational age (recumbent: r=-0.60; p<0.001; standing: r=-0.46; p=0.008). The mean measure in the recumbent position was 35.2 mm (SD=9.9 mm) and 33.4 mm (SD=9.5 mm) in the standing position. When the difference between the measure obtained in the standing and recumbent positions was expressed as percentage of the measure in the recumbent position, there was no significant association with gestational age (p=0.07). When all evaluations were considered, there was a significant association between cervical length in the recumbent and standing positions (r=0.79; p<0.001). The measures in recumbent and standing positions were inversely correlated with gestational age (recumbent: p<0.0001; standing: p<0.0001). The mean cervical length in the recumbent position was 33.5 mm (SD=10.8 mm) and 31.8 mm (SD=9.6 mm) in the standing position. There was no significant association between cervical length difference expressed as percentage of the measure in the recumbent position and gestation. Conclusion: cervical length measure obtained with the patients in the recumbent and standing positions provided similar information.
Summary
Rev Bras Ginecol Obstet. 2001;23(4):247-251
DOI 10.1590/S0100-72032001000400008
Purpose: to determine the feasibility of early ultrasonographic identification of fetal gender. Methods: a prospective study in a University Department of Obstetrics and Gynecology. A total of 592 women underwent ultrasonography at 11-14 weeks of gestation. Fetal gender was identified according to genital tubercle position (vertical or horizontal) at sagittal plane and confirmed at birth or by karyotype analysis. Results: the overall accuracy of correctly assigning fetal gender was 84%. The success of identification increased with gestational age, being 72%, 85% and 89% at 11, 12 and 13 weeks, respectively. The accuracy of correctly identifying fetal sex significantly changed with operator training, being 83.5% at the beginning and 93.6% at the end of the study. Conclusion: ultrasound determination of fetal gender is feasible, with good accuracy and may be of potential use to avoid invasive testing in family histories of X-linked disorders.
Summary
Rev Bras Ginecol Obstet. 2001;23(4):247-251
DOI 10.1590/S0100-72032001000400008
Purpose: to determine the feasibility of early ultrasonographic identification of fetal gender. Methods: a prospective study in a University Department of Obstetrics and Gynecology. A total of 592 women underwent ultrasonography at 11-14 weeks of gestation. Fetal gender was identified according to genital tubercle position (vertical or horizontal) at sagittal plane and confirmed at birth or by karyotype analysis. Results: the overall accuracy of correctly assigning fetal gender was 84%. The success of identification increased with gestational age, being 72%, 85% and 89% at 11, 12 and 13 weeks, respectively. The accuracy of correctly identifying fetal sex significantly changed with operator training, being 83.5% at the beginning and 93.6% at the end of the study. Conclusion: ultrasound determination of fetal gender is feasible, with good accuracy and may be of potential use to avoid invasive testing in family histories of X-linked disorders.
Summary
Rev Bras Ginecol Obstet. 2000;22(5):275-279
DOI 10.1590/S0100-72032000000500004
Objective: to evaluate ultrasound findings in pregnant women with threatened abortion in the first trimester of pregnancy. Methods: transabdominal and transvaginal ultrasound scans were performed in patients with vaginal bleeding with previous positive pregnancy test. Patients with 6-14-week gestation (by the last menstrual period or ultrasound scan), with closed cervix on clinical evaluation were included. Multiple pregnancies and those patients who have tried abortion by using abortive drugs or manipulation were excluded. Results: in 132 of 247 (53.4%) the pregnancy was viable and in 46.6% (115/247) the pregnancy was nonviable. Incomplete miscarriage was found in 19% (47/247), complete miscarriage in 8.5% (21/247), missed abortion in 7.7% (19/247), anembryonic pregnancy in 6.1% (15/247), ectopic pregnancy in 4.5% (11/247) and hydatidiform mole in 0.8% (2/247). Conclusion: almost half (46.6%) of the pregnancies with threatened abortion in the first trimester were diagnosed as a nonviable pregnancy. The ultrasound scan can help to define this condition and the management of the pregnancy.
Summary
Rev Bras Ginecol Obstet. 2000;22(5):275-279
DOI 10.1590/S0100-72032000000500004
Objective: to evaluate ultrasound findings in pregnant women with threatened abortion in the first trimester of pregnancy. Methods: transabdominal and transvaginal ultrasound scans were performed in patients with vaginal bleeding with previous positive pregnancy test. Patients with 6-14-week gestation (by the last menstrual period or ultrasound scan), with closed cervix on clinical evaluation were included. Multiple pregnancies and those patients who have tried abortion by using abortive drugs or manipulation were excluded. Results: in 132 of 247 (53.4%) the pregnancy was viable and in 46.6% (115/247) the pregnancy was nonviable. Incomplete miscarriage was found in 19% (47/247), complete miscarriage in 8.5% (21/247), missed abortion in 7.7% (19/247), anembryonic pregnancy in 6.1% (15/247), ectopic pregnancy in 4.5% (11/247) and hydatidiform mole in 0.8% (2/247). Conclusion: almost half (46.6%) of the pregnancies with threatened abortion in the first trimester were diagnosed as a nonviable pregnancy. The ultrasound scan can help to define this condition and the management of the pregnancy.
Summary
Rev Bras Ginecol Obstet. 2002;24(5):301-306
DOI 10.1590/S0100-72032002000500003
Purpose: to compare the outcome of pregnancies with and without threatened abortion presenting alive embryo/fetus between 6 and 13 weeks at sonographic evaluation. Method: this was a retrospective case-control study, carried out from February 1998 to December 1999. Criteria for inclusion were: topic and single pregnancy; embryo/fetus cardiac activity present in the ultrasound scan; gestational age between 6 weeks and 13 weeks and 6 days, absence of fetal anomalies, absence of attempt of abortion by drugs or manipulation, absence of maternal disease, known pregnancy result. A total of 1531 pregnancies were examined, of which 258 with threatened abortion (case group) and 1273 without threatened abortion (control group). The two groups were compared regarding outcome such as: abortion, stillbirth, prematurity and intrauterine growth restriction. Results: the percentage of abortion (11,7%) and prematurity (17,8%) were higher in the group with threatened abortion (p<0.001 and p=0.026, respectively). The frequency of stillbirth and intrauterine growth restriction did not differ significantly between the groups.Conclusion: threatened abortion with alive embryo/fetus in 6- to 13- week gestation presented a higher abortion risk and subsequent prematurity.
Summary
Rev Bras Ginecol Obstet. 2002;24(5):301-306
DOI 10.1590/S0100-72032002000500003
Purpose: to compare the outcome of pregnancies with and without threatened abortion presenting alive embryo/fetus between 6 and 13 weeks at sonographic evaluation. Method: this was a retrospective case-control study, carried out from February 1998 to December 1999. Criteria for inclusion were: topic and single pregnancy; embryo/fetus cardiac activity present in the ultrasound scan; gestational age between 6 weeks and 13 weeks and 6 days, absence of fetal anomalies, absence of attempt of abortion by drugs or manipulation, absence of maternal disease, known pregnancy result. A total of 1531 pregnancies were examined, of which 258 with threatened abortion (case group) and 1273 without threatened abortion (control group). The two groups were compared regarding outcome such as: abortion, stillbirth, prematurity and intrauterine growth restriction. Results: the percentage of abortion (11,7%) and prematurity (17,8%) were higher in the group with threatened abortion (p<0.001 and p=0.026, respectively). The frequency of stillbirth and intrauterine growth restriction did not differ significantly between the groups.Conclusion: threatened abortion with alive embryo/fetus in 6- to 13- week gestation presented a higher abortion risk and subsequent prematurity.
Summary
Rev Bras Ginecol Obstet. 2001;23(1):31-37
DOI 10.1590/S0100-72032001000100005
Purpose: to evaluate the prognosis of fetal omphalocele after prenatal diagnosis. Methods: fifty-one cases with prenatal diagnosis of fetal omphalocele were divided into three groups: group 1, isolated omphalocele; group 2, omphalocele associated with structural abnormalities and normal karyotype; group 3, omphalocele with abnormal karyotype. The data were analyzed for overall survival rate and postsurgery survival, considering associated malformations, gestational age at delivery, birth weight and size of omphalocele. Results: group 1 corresponded to 21% (n = 11), group 2, 55% (n = 28) and group 3,24% (n = 12). All of Group 3 died, and trisomy 18 was the most frequent chromosomal abnormality. The survival rate was 80% for group 1 and 25% for group 2. Sixteen cases underwent surgery (10 isolated and 6 associated), 81% survived (8 isolated and 5 associated). The median birth weight was 3,140 g and 2,000 g for survivals and non-survivals after surgery, respectively (p = 0.148), and the corresponding gestational age at delivery was 37 and 36 weeks (p = 0.836). The ratio of omphalocele/abdominal circumference decreased with gestation, 0.88 between 25-29 weeks and 0.65 between 30-35 weeks (p = 0.043). The size of omphalocele was not significantly different between the 3 groups (p = 0.988), and it was not associated to postsurgery prognosis (p = 0.553). Conclusion: the overall and postsurgery survival rates were 25 and 81%, respectively. Associated malformations were the main prognostic factor in prenatally diagnosed omphaloceles, since they are associated with prematurity and low birth weight.
Summary
Rev Bras Ginecol Obstet. 2001;23(1):31-37
DOI 10.1590/S0100-72032001000100005
Purpose: to evaluate the prognosis of fetal omphalocele after prenatal diagnosis. Methods: fifty-one cases with prenatal diagnosis of fetal omphalocele were divided into three groups: group 1, isolated omphalocele; group 2, omphalocele associated with structural abnormalities and normal karyotype; group 3, omphalocele with abnormal karyotype. The data were analyzed for overall survival rate and postsurgery survival, considering associated malformations, gestational age at delivery, birth weight and size of omphalocele. Results: group 1 corresponded to 21% (n = 11), group 2, 55% (n = 28) and group 3,24% (n = 12). All of Group 3 died, and trisomy 18 was the most frequent chromosomal abnormality. The survival rate was 80% for group 1 and 25% for group 2. Sixteen cases underwent surgery (10 isolated and 6 associated), 81% survived (8 isolated and 5 associated). The median birth weight was 3,140 g and 2,000 g for survivals and non-survivals after surgery, respectively (p = 0.148), and the corresponding gestational age at delivery was 37 and 36 weeks (p = 0.836). The ratio of omphalocele/abdominal circumference decreased with gestation, 0.88 between 25-29 weeks and 0.65 between 30-35 weeks (p = 0.043). The size of omphalocele was not significantly different between the 3 groups (p = 0.988), and it was not associated to postsurgery prognosis (p = 0.553). Conclusion: the overall and postsurgery survival rates were 25 and 81%, respectively. Associated malformations were the main prognostic factor in prenatally diagnosed omphaloceles, since they are associated with prematurity and low birth weight.
Summary
Rev Bras Ginecol Obstet. 2005;27(6):310-315
DOI 10.1590/S0100-72032005000600004
PURPOSE: to evaluate the accuracy of fetal gender prediction at 11 to 13 weeks and 6 days by measuring the anterior and posterior genital tubercle angles. MESTHODS: the anterior and posterior genital tubercle angles were measured in a midsagittal plane in 455 fetuses from 11 to 13 weeks and 6 days. The probability of a correct fetal sex prediction (confirmed after birth) was categorized in accordance with the angle measurements, gestational age and crump-rump length. The optimal accuracy cutoffs were derived from a ROC-plot. The interobserver variability was evaluated by a Bland-Altman plot. RESULTS: the correct fetal sex prediction rate increased with gestational age and crump-rump length. Using a 42-degree anterior angle as a cutoff, a correct fetal sex prediction occurred in 72% of the fetuses from 11 to 11 weeks and 6 days, 86% from 12 to 12 weeks and 6 days and 88% from 13 to 13 weeks and 6 days. Using a 24-degree posterior angle as a cutoff, a correct fetal gender prediction occurred in 70, 87 and 87%, respectively. The interobserver variability evaluation revealed a mean difference between paired measurements of 15.7 and 9 degrees for the posterior and anterior angles, respectively. CONCLUSION: the measurement of the genital tubercle angles showed a high accuracy in correctly predicting the fetal sex from the 12th week of gestation on. However, accuracy was still not high enough for clinical use in pregnancies at risk of serious X-linked diseases.
Summary
Rev Bras Ginecol Obstet. 2005;27(6):310-315
DOI 10.1590/S0100-72032005000600004
PURPOSE: to evaluate the accuracy of fetal gender prediction at 11 to 13 weeks and 6 days by measuring the anterior and posterior genital tubercle angles. MESTHODS: the anterior and posterior genital tubercle angles were measured in a midsagittal plane in 455 fetuses from 11 to 13 weeks and 6 days. The probability of a correct fetal sex prediction (confirmed after birth) was categorized in accordance with the angle measurements, gestational age and crump-rump length. The optimal accuracy cutoffs were derived from a ROC-plot. The interobserver variability was evaluated by a Bland-Altman plot. RESULTS: the correct fetal sex prediction rate increased with gestational age and crump-rump length. Using a 42-degree anterior angle as a cutoff, a correct fetal sex prediction occurred in 72% of the fetuses from 11 to 11 weeks and 6 days, 86% from 12 to 12 weeks and 6 days and 88% from 13 to 13 weeks and 6 days. Using a 24-degree posterior angle as a cutoff, a correct fetal gender prediction occurred in 70, 87 and 87%, respectively. The interobserver variability evaluation revealed a mean difference between paired measurements of 15.7 and 9 degrees for the posterior and anterior angles, respectively. CONCLUSION: the measurement of the genital tubercle angles showed a high accuracy in correctly predicting the fetal sex from the 12th week of gestation on. However, accuracy was still not high enough for clinical use in pregnancies at risk of serious X-linked diseases.
