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Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(6):356-367
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Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(6):356-367
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Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(11):596-601
To investigate the clinical and sonographic parameters associated with adverse fetal outcomes in patients with congenital parvovirus B19 infection managed by intrauterine transfusion.
This was a single-center retrospective study conducted from January 2005 to December 2016 that assessed patients with singleton pregnancies with fetal parvovirus infection confirmed by a polymerase chain reaction of the amniotic fluid or fetal blood samples who underwent at least one intrauterine transfusion. The maternal characteristics, sonographic findings and parameters related to intrauterine transfusion were compared between the two groups (recovery/non-recovery), who were categorized based on fetal response after in-utero transfusions. Progression to fetal death or delivery without fetal recovery after the transfusions was considered nonrecovery and categorized as an adverse outcome.
The final analysis included ten singleton pregnancies: seven of which were categorized into the recovery group and three of which into the non-recovery group. The baseline characteristics were similar between the groups. All fetuses were hydropic at the time of diagnosis. No significant differences related to sonographic or intrauterine transfusion parameters were identified between the groups; however, the nonrecovery group tended to have an increased number of sonographic markers and lower fetal hemoglobin and platelet levels before the transfusion.
We were unable to firmly establish the clinical or sonographic parameters associated with adverse fetal outcomes in patients with parvovirus infection managed with intrauterine transfusions; however, edema, placental thickening and oligohydramnios may indicate greater fetal compromise and, subsequently, adverse outcomes. However, further studies are necessary, mainly due to the small number of cases analyzed in the present study.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(11):596-601
To investigate the clinical and sonographic parameters associated with adverse fetal outcomes in patients with congenital parvovirus B19 infection managed by intrauterine transfusion.
This was a single-center retrospective study conducted from January 2005 to December 2016 that assessed patients with singleton pregnancies with fetal parvovirus infection confirmed by a polymerase chain reaction of the amniotic fluid or fetal blood samples who underwent at least one intrauterine transfusion. The maternal characteristics, sonographic findings and parameters related to intrauterine transfusion were compared between the two groups (recovery/non-recovery), who were categorized based on fetal response after in-utero transfusions. Progression to fetal death or delivery without fetal recovery after the transfusions was considered nonrecovery and categorized as an adverse outcome.
The final analysis included ten singleton pregnancies: seven of which were categorized into the recovery group and three of which into the non-recovery group. The baseline characteristics were similar between the groups. All fetuses were hydropic at the time of diagnosis. No significant differences related to sonographic or intrauterine transfusion parameters were identified between the groups; however, the nonrecovery group tended to have an increased number of sonographic markers and lower fetal hemoglobin and platelet levels before the transfusion.
We were unable to firmly establish the clinical or sonographic parameters associated with adverse fetal outcomes in patients with parvovirus infection managed with intrauterine transfusions; however, edema, placental thickening and oligohydramnios may indicate greater fetal compromise and, subsequently, adverse outcomes. However, further studies are necessary, mainly due to the small number of cases analyzed in the present study.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(8):599-603
DOI 10.1590/S0100-72032003000800009
PURPOSE: the aim was to study Rh-alloimmunized pregnant women and describe the gasometric abnormalities and the fetal acid-base changes before and after intrauterine transfusion. METHODS: between June 2001 and October 2001, before and after intrauterine transfusion in the alloimunized fetuses, gasometric data and acid-base parameters were prospectively studied in the umbilical vein blood. The measurements were performed in 8 samples of 5 fetuses. The fetal blood was obtained by cordocentesis before and after the intrauterine transfusion. The results were compared to the volemic expansion, the gestational age at procedure, the estimated fetal weight and the hemoglobin values (g/dL). RESULTS: all the cases showed pH value reduction, mean of 0.09 (SD=0.02). The fetal hemoglobin value showed a mean improvement of 8.4 g/dL (SD=2.9 g/dL). The pO2 and HCO3- concentrations showed negative variation (mean deltapO2 = -1.28 mmHg, mean deltaHCO3- = -2.25 mEq/L). pCO2 showed improvement (mean deltapCO2 = 3.2 mmHg) and reduced values of base excess occurred (mean = -3.75). CONCLUSION: the gasometric analysis allows to conclude that intrauterine transfusion is followed by pH reduction in the umbilical vein, with relative fetal acidemia after the procedure.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(8):599-603
DOI 10.1590/S0100-72032003000800009
PURPOSE: the aim was to study Rh-alloimmunized pregnant women and describe the gasometric abnormalities and the fetal acid-base changes before and after intrauterine transfusion. METHODS: between June 2001 and October 2001, before and after intrauterine transfusion in the alloimunized fetuses, gasometric data and acid-base parameters were prospectively studied in the umbilical vein blood. The measurements were performed in 8 samples of 5 fetuses. The fetal blood was obtained by cordocentesis before and after the intrauterine transfusion. The results were compared to the volemic expansion, the gestational age at procedure, the estimated fetal weight and the hemoglobin values (g/dL). RESULTS: all the cases showed pH value reduction, mean of 0.09 (SD=0.02). The fetal hemoglobin value showed a mean improvement of 8.4 g/dL (SD=2.9 g/dL). The pO2 and HCO3- concentrations showed negative variation (mean deltapO2 = -1.28 mmHg, mean deltaHCO3- = -2.25 mEq/L). pCO2 showed improvement (mean deltapCO2 = 3.2 mmHg) and reduced values of base excess occurred (mean = -3.75). CONCLUSION: the gasometric analysis allows to conclude that intrauterine transfusion is followed by pH reduction in the umbilical vein, with relative fetal acidemia after the procedure.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(7):421-428
DOI 10.1590/S0100-72032000000700004
Purpose: to evaluate 24 cases of gastroschisis, in relation to the prognostic factors that interfered with postnatal outcome. Patients and Method: twenty-four pregnancies with fetal prenatal ultrasound diagnosis of gastroschisis, during an 8-year period, were analyzed. Gastroschisis was classified into isolated, when there were no other structural abnormalities, or associated, when other abnormalities were present. For both groups the following parameters were examined: ultrasound bowel dilatation (>18 mm), obstetric complications and postnatal outcome. Nonparametric Mann-Whitney and exact Fisher's tests were used for statistical analyses. Results: in 9 cases (37.5%) gastroschisis was associated with other abnormalities, and in 15 cases it was isolated (62.5%). All cases of associated gastroschisis had a letal prognosis, therefore the overall mortality rate was 60.8%. In the group of isolated gastroschisis, all were born alive and were submitted to surgery, but the survival rate after surgical correction was 60%. The median gestational age at birth was 35 weeks and birth weight 2,365 grams. Premature delivery was observed in 10 cases, mainly as a consequence of obstetric complication. Two newborns were small for gestational age, and only 3 had birth weight >2,500 grams. Oligohydramnios was found in 46.6% and it was more frequent in the group of postnatal death (66.7%). Ultrasound assessment of bowel showed bowel dilatation in 86.6%, however, without relation to the prognosis and postnatal bowel findings. There was no significant difference between gestational age at birth and birth weight comparing the survivor and postnatal death groups. Conclusions: isolated gastroschisis had a better prognosis when compared to associated, therefore this prenatal differentiation is important. Isolated gastroschisis was often associated with prematurity, small birth weight and obstetric complications. Prenatal diagnosis allows better monitoring of fetal and obstetric conditions. Delivery should be at term, unless presenting with obstetric complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(7):421-428
DOI 10.1590/S0100-72032000000700004
Purpose: to evaluate 24 cases of gastroschisis, in relation to the prognostic factors that interfered with postnatal outcome. Patients and Method: twenty-four pregnancies with fetal prenatal ultrasound diagnosis of gastroschisis, during an 8-year period, were analyzed. Gastroschisis was classified into isolated, when there were no other structural abnormalities, or associated, when other abnormalities were present. For both groups the following parameters were examined: ultrasound bowel dilatation (>18 mm), obstetric complications and postnatal outcome. Nonparametric Mann-Whitney and exact Fisher's tests were used for statistical analyses. Results: in 9 cases (37.5%) gastroschisis was associated with other abnormalities, and in 15 cases it was isolated (62.5%). All cases of associated gastroschisis had a letal prognosis, therefore the overall mortality rate was 60.8%. In the group of isolated gastroschisis, all were born alive and were submitted to surgery, but the survival rate after surgical correction was 60%. The median gestational age at birth was 35 weeks and birth weight 2,365 grams. Premature delivery was observed in 10 cases, mainly as a consequence of obstetric complication. Two newborns were small for gestational age, and only 3 had birth weight >2,500 grams. Oligohydramnios was found in 46.6% and it was more frequent in the group of postnatal death (66.7%). Ultrasound assessment of bowel showed bowel dilatation in 86.6%, however, without relation to the prognosis and postnatal bowel findings. There was no significant difference between gestational age at birth and birth weight comparing the survivor and postnatal death groups. Conclusions: isolated gastroschisis had a better prognosis when compared to associated, therefore this prenatal differentiation is important. Isolated gastroschisis was often associated with prematurity, small birth weight and obstetric complications. Prenatal diagnosis allows better monitoring of fetal and obstetric conditions. Delivery should be at term, unless presenting with obstetric complications.