Isolated mild fetal pyelectasis detected by transvaginal sonography in advanced maternal age

OBJECTIVE

To evaluate the importance and evolution of isolated, mild fetal pyelectasis, detected in early pregnancy by high-resolution transvaginal sonography, and to determine its association with abnormal fetal karyotypes.

METHODS

Transvaginal scan at 11-16 weeks' gestation and transabdominal ultrasound examinations at the time of amniocentesis (16-18 weeks) were performed in 1093 pregnant women undergoing genetic amniocentesis because of advanced maternal age. In 795 cases, transabdominal scans were repeated at 22-24 weeks. Women were excluded if they had a spontaneous abortion, chose to terminate their pregnancy, or declined amniocentesis. Each patient was screened for fetal pyelectasis, defined as an increase in anteroposterior renal pelvic diameter, using cutoff values related to various stages of pregnancy.

RESULTS

Isolated fetal pyelectasis was detected at the first ultrasound examination in 56 women (5.1%) in early pregnancy, in 32 (2.9%) at the time of amniocentesis, and in 23 (2.9%) at 22-24 weeks' gestation. Two fetuses with diagnoses of mild pyelectasis at the first transvaginal ultrasound demonstrated abnormal karyotypes at amniocentesis. In one case, the pyelectasis disappeared at 22-24 weeks' gestation.

CONCLUSION

This retrospective study shows that pyelectasis is more frequently detectable by high-resolution transvaginal sonography in the first half of pregnancy than in the second half. When detected in early pregnancy, the finding is frequently transient and not associated with an increased risk of abnormal fetal karyotypes.

Early transvaginal measurement of transcerebellar diameter in Down syndrome

OBJECTIVE

To evaluate the screening utility of early transvaginal measurement of the transverse cerebellar diameter for identification of Down syndrome fetuses.

METHOD

Measurements of the transverse cerebellar diameter were obtained by transvaginal sonography between 11 and 16 weeks of gestation in 544 fetuses with a normal karyotype and in 37 Down syndrome fetuses.

RESULTS

The transverse cerebellar diameter was found to show a fairly constant increment of values throughout the period evaluated with a linear relationship to the gestational age. The measurements obtained in Down syndrome fetuses are within the normal range for gestational age.

CONCLUSION

The transverse cerebellar diameter cannot be considered a useful tool in the detection of Down syndrome in early pregnancy.

Transvaginal sonographic fetal biparietal diameter/kidney length ratio in early pregnancy as a screening tool for renal malformations

OBJECTIVE

The aim of the study was to produce by 7.0 MHz high resolution transvaginal scan early in pregnancy normal values of biparietal diameter/kidney length ratio that can be used as reference ranges.

METHODS

In this prospective cross-sectional study, a transvaginal high-resolution sonography was performed between 11 and 16 weeks' gestation in 807 pregnant women with a history of regular cycles, singleton pregnancies and absence of fetal malformations. Measurements of kidney length and biparietal diameter were obtained in all cases and biparietal diameter/kidney length ratio was plotted against gestational age.

RESULTS

The values of biparietal diameter/kidney length ratio were found to be fairly constant throughout the period evaluated.

CONCLUSION

Our results indicate that this new age-independent ratio can be useful in the early detection of some fetal kidney malformations affecting normal growth.

[Early prognostic ultrasonographic indices in pregnancy with fetal cystic hygroma]

OBJECTIVE

Aim of this study was the correlation of same early ultrasonographic signs with fetal karyotype, prognosis of pregnancy and neonatal outcome.

EXPERIMENTAL DESIGN

Volume of cystic hygroma and presence of septations are correlated with fetal karyotype and an ultrasonographic follow-up was carried out during pregnancy. Details concerning neonatal outcome were recorded at delivery.

PATIENTS

Diagnosis was performed in 13 patients between 8.3 to 16.5 weeks' gestation referred to our center for prenatal diagnosis or for obstetric reasons.

METHOD

Ultrasonographic examinations were performed using 5.0 and 6.0 MHz endovaginal convex probes.

SURVEYS

Hygroma was diagnosed as a cystic dilatation in the nuchal region larger than 3 mm in diameter in the anterolateral aspects. The volume was calculated considering the lesion as spherical and using the standard formula for an ellipsoid volume; the presence of septations was considered.

RESULTS

A volume greater than 70 cc3 and the presence of septations demonstrated a strictly correlation with fetal karyotype, evolution of the features, pregnancy and neonatal outcome.

CONCLUSIONS

Prognosis varies depending on fetal karyotype, volume, presence of septations and other associated malformations. The volume of the hygroma and the presence of septa are associated with higher incidence of chromosomal diseases and a poorer fetal prognosis.

[Echographic markers of fetal chromosomopathies. Diagnostic possibilities with transvaginal ultrasonography and our experience]

OBJECTIVE

Aim of this study was to evaluate, during early pregnancy, the correlation of some anomalies and malformations with fetal chromosomopathies.

EXPERIMENTAL DESIGN

Morphostructural and biometric anomalies in chromosomopathic fetuses were evaluated.

PATIENTS

1331 pregnancies at high risk for genetic disease and malformations referred to our center for prenatal diagnosis.

METHOD

Scans were performed using endovaginal convex probes (5.0 to 7.0 MHz).

SURVEYS

Urinary, cardiac and cerebral malformations as well as alterations of bone growth were evaluated.

RESULTS

With respect to the other malformations, cystic hygroma is more frequently associated with an abnormal fetal karyotype.

CONCLUSIONS

The majority of morphostructural abnormalities diagnosed during first trimester by transvaginal sonography cannot, in according to personal experience, be used as markers of chromosomopathies.

Transvaginal fetal biometry in early pregnancy

OBJECTIVE

To produce reference charts for fetal size with transvaginal sonography that are potentially helpful in evaluating normal and abnormal early pregnancies.

DESIGN

A prospective cross-sectional study.

SUBJECTS

1081 normal singleton pregnancies with a normal fetal karyotype or normal healthy baby at delivery, at 9-16 weeks' gestation. Measurements included crown rump length, biparietal diameter, transverse cerebellar diameter, head and abdominal circumference, mean abdominal diameter, thoracic circumference, femur length, humerus length and foot length.

RESULTS

The best description of the relationship between single ultrasonographic parameters and gestational age was achieved by polynomial regression analysis. All fetal biometric parameters correlated closely with gestational age. Biparietal diameter maintained the closest correlation with gestational age (r2 = 97.15, p < 0.001; y = -0.545 - 0.06x + 0.15x2); transverse cerebellar diameter showed the poorest correlation with gestational age (r2 = 88.17, p < 0.001). Reference ranges (5 degrees and 95 degrees percentile intervals) were constructed for all biometric parameters in relation to gestational age. Mean residuals are similar for all parameters with a very low range.

CONCLUSIONS

These data provide normograms for first and early second trimester fetal measurements which may be of aid in the dating of pregnancies and can be useful in the early detection of genetic disorders affecting the growth of fetal structures.

[Embryo-fetal development in the early stages of pregnancy]

The introduction of high resolution transvaginal US in obstetrical clinical practice permits earlier and more detailed visualization of embryo-fetal structures in early pregnancy. A transvaginal US examination with a high-resolution probe (5.0-6.0 MHz) was performed in 1246 pregnant patients between 9 and 16 weeks of gestation and known gestational age. Ten embryo-fetal biometric parameters were measured (crown-rump length, biparietal diameter, head circumference, transverse cerebellar diameter, thoracic circumference, mean abdominal diameter, abdominal circumference, femur length, humerus length and foot length). Reference ranges with 5 degrees and 95 degrees percentile intervals were constructed for all biometric parameters in relation to gestational age. Only one scan per patient was considered for this study. All the parameters evaluated demonstrated a high correlation with gestational age at polynomial regression analysis. The mean coefficient of determination (r2) ranged from 97.15 for biparietal diameter to 88.17 for transverse cerebellar diameter. The data are useful as reference range for the assessment of normal embryofetal development by transvaginal US in the early stages of pregnancy.

Transvaginal ultrasound detection of septated and non-septated cystic hygroma in early pregnancy

OBJECTIVE

To evaluate the correlation of sonographic transvaginal signs of cystic hygroma and fetal outcome.

METHOD

Diagnosis was made in 11 cases at 9.1-13.4 weeks of gestation. Fetal karyotype, presence of septations and other associated malformations were considered. The volume of septated and non-septated cystic hygromas was compared by a t test with a statistical significance of p < 0.01.

RESULTS

Septation of the hygroma was found in 4 cases and fetal death occurred in 3 of these with an abnormal karyotype. Five fetuses demonstrated regression of the hygroma within the 19th week. The volume of septated and non-septated cystic hygromas are statistically different (p < 0.01).

CONCLUSIONS

Diagnosis of cystic hygromas is possible in early pregnancy by transvaginal scan. Prognosis varies depending on fetal karyotype, volume, presence of septations and other associated malformations. The volume of the hygroma and the presence of septa are associated with a higher incidence of chromosomopathies and a poorer fetal prognosis.

Fetal biometric ratios by transvaginal sonography as a marker for aneuploidies in early pregnancy

The aim of this study was to obtain by transvaginal sonography in early pregnancy normal biometric charts of some fetal ratios and to evaluate the utility of these ultrasonographic indices as biometric markers for the identification of fetal chromosome abnormalities. The study population included 1054 normal euploid fetuses and 30 fetuses with an abnormal karyotype. We obtained six standard ultrasound measurements by transvaginal sonography at 11-16 weeks' gestation before genetic amniocentesis in patients at risk for genetic disorders. Seven biometric ratios (biparietal diameter/femur length, biparietal diameter/humerus length, head circumference/abdominal circumference, abdominal circumference/femur length, abdominal circumference/humerus length, femur length/foot length, and humerus length/foot length) were calculated and reference curves were plotted. The ratios from aneuploid fetuses showed no differences from reference ranges. Only in trisomy 13 fetuses were abnormal values of head circumference/abdominal circumference, biparietal diameter/humerus length, and biparietal diameter/femur length ratios detected, probably due to the high incidence of microcephaly and central nervous system malformations in these fetuses. The normal values of sonographic ratios obtained by transvaginal sonography in the first and early second trimester of pregnancy cannot generally be considered a useful tool for the detection of chromosomal abnormalities. Only ratios involving cephalic measurements can be used in early pregnancy as screening markers in the detection of trisomy 13 fetuses.

[Early diagnosis of embryo-fetal malformations by transvaginal echography in a high-risk population]

BACKGROUND

High resolution transvaginal sonography permits, in respect of traditional transabdominal scan, an earlier diagnosis of some fetal anomalies and malformations.

METHODS

In our prospective study, between 11th to 16th weeks gestation, 820 pregnant patients at high risk for chromosomopathies and for fetal malformations were scanned in order to obtain a detailed survey of embryofetal structures and organs and an earlier diagnosis of fetal malformations.

RESULTS

Thirty-two fetal anomalies and malformations (3.9%) were detected, and in 4 cases (0.49%) the diagnosis was obtained later in pregnancy. Fetuses with structural malformations were scanned during pregnancy and, if possible, postnatally. We reconsidered the pitfalls in relation to the time of transvaginal scan and the fetal pathology.

CONCLUSIONS

En early prenatal diagnosis of fetal anomalies by transvaginal sonography is related to the knowledge of normal embryofetal development and the pathogenesis of malformations.

[Embryo-fetal ultrasonographic diagnosis in the early pregnancy using transvaginal echography]

The diagnostic capability of high resolution transvaginal sonography in early pregnancy is described. Transvaginal sonography allows for the visualisation of some fetal organs and structures one to four weeks earlier than transabdominal ultrasound thus permitting evaluation of several embryofetal parameters early in pregnancy. This technique permits formulation of fetal measurement charts and detection of embryo-fetal malformations during the initial stages of pregnancy. Knowledge of the transvaginal sonographic appearance of embryonal and fetal biometric and structural anatomy enables us to determine the appearance of the normal fetus. Transvaginal scan may be employed as a screening tool for the identification of fetal anomalies in early stages of pregnancy. An increasing number of case reports and documented records of cases of malformations and anomalies diagnosed during the first trimester of pregnancy using this technique have been reported in the literature. The most frequent embryo-fetal malformations and anomalies detected at transvaginal scan and the earliest gestational age of diagnosis are described. At present a limited number of anomalies can be diagnosed because only a part of the potentially recognizable anomalies have been described using this technique. The importance of this new imaging technique as well as the necessity of a through knowledge of embryology are evident. Transvaginal sonography allows for biometric evaluation, for a clearer visualization of embryo-fetal morphology and for detection of several malformations and anomalies during early pregnancy.

[Visualization of the fetus in early pregnancy with transvaginal sonography]

The aim of this prospective study is to define in early pregnancy the time and percentage of visualization of embryo-fetal structures and organs. 820 patients at high risk for fetal genetic anomalies and/or malformations were scanned by high resolution transvaginal probe between 10 and 16 weeks' gestational age. Criteria for exclusion were: fetal malformations, multiple pregnancies and loss of pregnancy. We determined percentage of visualization in the different weeks of: orbits, face, cerebellum, cisterna magna, cardiac chambers, abdomen, diaphragm, stomach, kidneys and bladder. The percentage of visualization of fetal organs and structures investigated increased with gestational age and at 13 weeks ranged from 80% to 100%. With the introduction of high-frequency transvaginal probes in early pregnancy embryo-fetal structures and organs can be imaged and studied in great detail and more accurately identified than with traditional abdominal ultrasound, up to 4 weeks earlier. Another important advantage is the fact that some fetal malformations can be detected earlier.

Transvaginal sonographic measurement of cisterna magna in fetuses with abnormal karyotype

The fetal cisterna magna was measured by transvaginal sonography in early pregnancy in 525 pregnant women at increased genetic risk in order to test whether the measurements thus obtained afforded a sonographic marker for abnormal fetal karyotype. The measurements of the cisterna magna increased as pregnancy progressed and showed a good linear correlation with gestational age (r = 0.616; p < 0.001). Chromosome abnormalities were found in 23 fetuses. In all these cases, the cisterna magna measurements were normal, and no differences were observed between fetuses with normal and abnormal karyotype in the different periods tested. While transvaginal sonographic measurement of the cisterna magna is easy to perform in early pregnancy, it is a poor screening test for the detection of abnormal fetal karyotypes.

Transvaginal sonographic assessment of the fetal urinary tract in early pregnancy

Fetal renal size in the first trimester and the early second trimester of pregnancy was evaluated by high-frequency transvaginal sonography in 537 singleton fetuses at risk for cytogenetic abnormality but not at risk for congenital kidney disease. The percentage of visualization of both kidneys and bladder at different menstrual ages (11-16 weeks) is presented, and centile reference charts for evaluating kidney growth have been compiled. All kidney measurements were found to increase as pregnancy progressed. At 13 weeks, fetal kidneys and fetal urinary bladder were visualized in 92% of the cases screened. The incidence of pyelectasis was high in our population (4.5%), and this pathology was studied by other sonographic scans during pregnancy and postnatally. All fetuses had normal karyotypes. The results presented provide a reference for the assessment of normal renal morphology and growth in early pregnancy.

Preoperative ultrasound assessment of omental spread in ovarian cancer

The accuracy of high-resolution ultrasound in the detection of macroscopic omental metastases was evaluated in 50 consecutive patients undergoing surgery for ovarian cancer. Ultrasound provided an overall diagnostic accuracy of 83.7%, with a sensitivity of 76.6% and a specificity of 100%. The sensitivity in the diagnosis of diffuse omental involvement was 93.3%. Moreover, the overall diagnostic accuracy, sensitivity and positive predictive value of the method increased as the study progressed. In the last 25 cases examined, in fact, these values were 94.7, 90, and 90%, respectively.

A novel inositol mono-phosphatase inhibitor from Memnoniella echinata. Producing organism, fermentation, isolation, physicochemical and in vitro biological properties

A novel inositol mono-phosphatase inhibitor, L-671,776 (1), was discovered from a culture of the hyphomycete, Memnoniella echinata (ATCC 20928). 1 has a molecular weight of 388 and a molecular formula of C23H32O5. The mode of inhibition is non-competitive, with a Ki of 450 microM. It shows no inhibition of myo-inositol 1,4-bisphosphate 1-phosphatase or myo-inositol 1,4,5-triphosphate 5-phosphatase, although it weakly inhibits myo-inositol 1,4,5-triphosphate 3-kinase (IC50 = 3 mM). It elevates inositol monophosphates in rat parotid slices (EC50 approximately 3 mM), but abolishes agonist effects. It also produces short-lived contraction of guinea pig trachea at 300 microM.

Ovarian fibrothecoma: sonographic and histologic findings

The sonographic and histologic findings observed in 11 cases of ovarian fibrothecoma were compared, and an attempt was made to find a correlation between each histologic type of the tumor (pure thecoma, predominantly fibrous fibrothecoma, mixed fibrothecoma) and its sonographic appearance. The presence of a homogeneous echogenic pattern, with marked posterior acoustic shadowing, in the absence of any calcification, was highly suggestive of a predominantly fibrous ovarian fibrothecoma; the presence of a diffusely hypoechoic ovarian mass, with no posterior echo enhancement, was strikingly correlated with pure thecomas; mixed fibrothecomas were characterized by the presence of an echogenic pattern with no posterior acoustic shadowing. Sonographic findings, even though nonspecific, can provide the clinician with useful information which permits to detect these rare neoplasms preoperatively.

Pelvic lymphocele following radical para-aortic and pelvic lymphadenectomy for cervical carcinoma: incidence rate and percutaneous management

Thirty-six women, treated with radical hysterectomy (Piver types III-IV) plus systematic para-aortic and pelvic lymphadenectomy for cervical carcinoma, underwent serial postoperative ultrasound examinations to determine the incidence of lymphocele and the therapeutic efficacy of percutaneous catheter drainage. Pelvic lymphoceles, ranging in volume from 46-300 mL, occurred in eight patients (22.2%) between the 12-24th postoperative day. Percutaneous catheter drainage, inserted under local anesthesia, was used for a mean time of 14.5 days (range 4-32), resulting in a mean daily drainage of 92.2 mL and a mean total volume of 1727.5 mL per patient. Catheter drainage allowed complete clinical and sonographic remission in all cases, and only one asymptomatic recurrence was observed at 3-month and 6-month follow-up. Ultrasound-guided percutaneous catheter drainage has proved to be a well-tolerated, safe, and effective technique in the management of lymphocele that obviates the need for more invasive surgical procedures.

Transvaginal ultrasound evaluation of myometrial invasion in endometrial carcinoma

In 20 cases of histologically proved endometrial cancer the depth of myometrial invasion was ascertained by means of transvaginal ultrasound, using a high-frequency endocavitary probe. The sonographic findings were confirmed by histologic examination in 18 of the 20 patients evaluated (90.0%). Transvaginal ultrasound provides a fuller preoperative clinical picture and supplies additional diagnostic information which is invaluable in the choice of therapeutic approach.

Effects of intra-amniotic isoxsuprine on amino acid placental transfer in rats

Direct administration of isoxsuprine to the rat fetus increases placental transfer of 35S-methionine and this increase is statistically significant on day 17 as compared with intraperitoneal administration and controls (p less than 0.01; p less than 0.05). In contrast, no statistically significant differences were found between the groups on day 16.