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Liu H, Zeng Z, Liao H, Hu Q, Yu H. Umbilical Artery Thrombosis After Selective Termination in Dichorionic Diamniotic Twin Pregnancy: A Case Report. Int J Womens Health 2023; 15:1327-1332. [PMID: 37583490 PMCID: PMC10424691 DOI: 10.2147/ijwh.s423242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/04/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Umbilical artery thrombosis is a rare complication associated with poor perinatal outcomes. The incidence of umbilical artery thrombosis in pregnancy is estimated from 0.0025% to 0.045%. Prenatal screening and diagnosis of umbilical artery thrombosis is usually performed by ultrasonography. Up to now, no treatment consensus has been achieved. Case Presentation We present a case of dichorionic diamniotic twin pregnancy complicated with selective termination of one twin with lymphoid cystic tumor at 14 weeks and 2 days of gestation and the alive twin occurred single umbilical artery thrombosis at 35 weeks and 6 days of gestation. The emergency cesarean section was performed after emergency admission. A healthy male baby was delivered weighing 2690g with Apgar scores of 10 and 10 at 1 and 5 minutes, respectively, whereas the dead fetus weighed 10 g. Thrombosis was observed throughout one of the umbilical artery of the alive fetus. The woman and the infant are followed up closely and both in good condition. Conclusion The number and morphology of umbilical arteries should be carefully observed during pregnancy. Individualized management of umbilical artery thrombosis should be based on clinical conditions. Timely termination of pregnancy if necessary could be suitable to improve adverse pregnancy outcomes.
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Affiliation(s)
- Hongyan Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Zhaomin Zeng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Hua Liao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Qing Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
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Dubetskyi BI, Makarchuk OM, Zhurakivska OY, Rymarchuk MI, Andriets OA, Lenchuk TL, Delva KM, Piron-Dumitrascu M, Bakun OV. Pregnancy and umbilical cord pathology: structural and functional parameters of the umbilical cord. J Med Life 2023; 16:1282-1291. [PMID: 38024812 PMCID: PMC10652671 DOI: 10.25122/jml-2023-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/03/2023] [Indexed: 12/01/2023] Open
Abstract
Scientific research in the field of physiology and pathology of the umbilical cord is quite limited and imperfect. The purpose of the study was to evaluate the histological architecture of the pathological umbilical cord and investigate the relationship between the main parameters and placental postnatal macromorphometric characteristics, which serve as a reflection of placental dysfunction. Four groups of patients were included, each undergoing a postnatal histological and topographic examination of the umbilical cord: Wharton's jelly edema (10 samples), velamentous cord insertion (10 samples), single umbilical artery (10 samples), and physiological pregnancy (10 samples). Compared to the control group, all newborn groups exhibited changes in umbilical vessel morphology, characterized by an increased Wagenworth index and a decreased Kernohan index. The functional indices of the umbilical vessels were found to be most severely affected in cases of Wharton's jelly edema. In cases of single umbilical artery, the changes in vascular functional parameters indicated their compensatory remodeling with the highest Wagenworth and Kernohan indices of the umbilical vein. Deviation from the normal average placental weight was observed in cases of Wharton's jelly volume pathology or velamentous cord insertion. However, in the case of a single umbilical artery, there were no significant deviations in the macromorphometry of the placenta.
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Affiliation(s)
- Bohdan Ihorovych Dubetskyi
- Department of Obstetrics and Gynecology named after I. Lanovyi, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Oksana Mykhailivna Makarchuk
- Department of Obstetrics and Gynecology named after I. Lanovyi, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | | | - Mariiana Ivanivna Rymarchuk
- Department of Obstetrics and Gynecology named after I. Lanovyi, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | | | - Tetiana Liubomyrivna Lenchuk
- Department of Radiology and Radiation Medicine, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | | | - Madalina Piron-Dumitrascu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Liu Z, Ruan J. The role of the absence of Hyrtl's anastomosis in monochorionic pregnancy: Friend or foe?: A case report. Medicine (Baltimore) 2023; 102:e33611. [PMID: 37144992 PMCID: PMC10158883 DOI: 10.1097/md.0000000000033611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Hyrtl's anastomosis, an intra-arterial shunt, plays a protective role when the placental territories supplied by the umbilical arteries are different in size. Its absence is associated with an increased risk of poor outcomes in singleton pregnancy. However, the literature and studies on the effect of absent Hyrtl's anastomosis in twin placentas are rare. CASE PRESENTATION We present a case of a monochorionic diamniotic twin pregnancy complicated with type I selective fetal growth restriction (SFGR). Despite discordance in placental territory and cord insertion sites, the patient had an overall good pregnancy process, suggesting that the absence of Hyrtl's anastomosis may have played a benign role. CONCLUSIONS The absence of Hyrtl's anastomosis in our case seemed to show a favorable effect, representing a finding of opposite effects in monochorionic placentas compared with singleton placentas.
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Affiliation(s)
- Ziling Liu
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases in Women and Children of Ministry of Education, West China Second Hospital, Sichuan University, Sichuan, China
| | - Jie Ruan
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases in Women and Children of Ministry of Education, West China Second Hospital, Sichuan University, Sichuan, China
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Siargkas A, Tsakiridis I, Pachi C, Mamopoulos A, Athanasiadis A, Dagklis T. Impact of velamentous cord insertion on perinatal outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100812. [PMID: 36379439 DOI: 10.1016/j.ajogmf.2022.100812] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/14/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Velamentous cord insertion may be identified prenatally, but the clinical implications of this diagnosis remain controversial. This meta-analysis aimed to quantitatively summarize current data on the association of velamentous cord insertion and adverse perinatal outcomes. DATA SOURCES A systematic search was performed in MEDLINE, Scopus, and the Cochrane Library from inception until May 22, 2022 to identify eligible studies. STUDY ELIGIBILITY CRITERIA Observational studies including singleton pregnancies with velamentous cord insertion, either prenatally or postnatally identified, and comparing them with those with central/eccentric cord insertion were considered eligible. METHODS The quality of the studies was assessed with the Newcastle-Ottawa scale and the risk of bias with the Quality In Prognosis Studies (QUIPS) tool. The main outcome was small-for-gestational-age neonates. Heterogeneity of the studies was evaluated using a Q test and an I2 index. Analyses were performed using a random-effects model, with outcome data reported as relative risk or mean difference with 95% confidence interval. RESULTS In total, 9 cohort and 2 case-control studies, of which 4 had prenatal and 7 had postnatal velamentous cord insertion diagnosis, were included. The overall prevalence of velamentous cord insertion was estimated to be 1.4% among singleton pregnancies. Compared with the central/eccentric cord insertion control group, pregnancies with velamentous cord insertion were at higher risk of several adverse perinatal outcomes, namely small-for-gestational-age neonates (relative risk, 1.93; 95% confidence interval, 1.54-2.41), preeclampsia (relative risk, 1.85; 95% confidence interval, 1.01-3.39), pregnancy-induced hypertension (relative risk, 1.58; 95% confidence interval, 1.46-1.70), stillbirth (relative risk, 4.12; 95% confidence interval, 1.92-8.87), placental abruption (relative risk, 2.94; 95% confidence interval, 1.72-5.03), preterm delivery (relative risk, 2.14; 95% confidence interval, 1.73-2.65), emergency cesarean delivery (relative risk, 2.03; 95% confidence interval, 1.22-3.38), 1-minute Apgar score <7 (relative risk, 1.53; 95% confidence interval, 1.14-2.05), 5-minute Apgar score <7 (relative risk, 1.97; 95% confidence interval, 1.43-2.71), and neonatal intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.32-2.02). In a subgroup analysis, prenatally diagnosed velamentous cord insertion was associated with small-for-gestational-age neonates (relative risk, 1.66; 95% confidence interval, 1.19-2.32), stillbirth (relative risk, 4.78; 95% confidence interval, 1.42-16.08), and preterm delivery (relative risk, 2.69; 95% confidence interval, 2.01-3.60). In a sensitivity analysis of studies excluding cases with vasa previa, velamentous cord insertion was associated with an increased risk of small-for-gestational-age neonates (relative risk, 2.69; 95% confidence interval, 1.73-4.17), pregnancy-induced hypertension (relative risk, 1.94; 95% confidence interval, 1.24-3.01), and stillbirth (relative risk, 9.42; 95% confidence interval, 3.19-27.76), but not preterm delivery (relative risk, 1.92; 95% confidence interval, 0.82-4.54). CONCLUSION Velamentous cord insertion is associated with several adverse perinatal outcomes, including stillbirth, and these associations persist when only prenatally diagnosed cases are considered and when vasa previa cases are excluded. According to these findings, the exact pathophysiology should be further investigated and an effective prenatal monitoring plan should be developed.
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Affiliation(s)
- Antonios Siargkas
- From the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsakiridis
- From the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Christina Pachi
- From the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- From the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- From the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- From the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Gu Y, Yu C, Zhang L, Weng Y, Zhou F, Yu Q, Zhang H. Abnormal umbilical cord insertion and birth weight discordancy in monochorionic diamniotic twins: A retrospective study. Medicine (Baltimore) 2022; 101:e32316. [PMID: 36550827 PMCID: PMC9771205 DOI: 10.1097/md.0000000000032316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To investigate the relationship between abnormal umbilical cord insertion and birthweight discordance in monochorionic diamnionic (MCDA) twins. A total of 137 pairs of MCDAs were retrospectively analyzed who delivered and survived in Hangzhou Women's Hospital from January 2016 to December 2021. According to different insertion methods, they were divided into normal cord insertion group (n = 57), marginal cord insertion (MCI) group (n = 34) and velamentous cord insertion (VCI) group (n = 46). The correlation was analyzed between different insertion methods of umbilical cord and the discordant birth weight of MCDAs. The gestational age of delivery with velamentous cord insertion was significantly earlier than those with normal and marginal insertion (P < .05). There were significant differences in birthweight between large fetus (F1) and small fetus (F2) with different umbilical insertion methods (P < .05). The birthweight of F1 and F2 in normal insertion group was significantly higher than those in MCI and VCI group (P < .05). Logistic regression analysis showed that VCI was significantly associated with birth weight in F1/F2, birthweight discordance ≥ 20%, and birthweight discordance ≥ 25%, however MCI and VCI were not an independent factor for discordance in birthweight of MCDAs (P > .05). Umbilical cord insertion method can lead to inconsistency in birthweight of MCDA twins, however they were not an independent factor for discordance in birthweight.
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Affiliation(s)
- Yunxia Gu
- Department of Ultrasound, Hangzhou Women’s Hospital, Hangzhou, Zhejiang, China
| | - Cheng Yu
- Department of Ultrasound, Hangzhou Women’s Hospital, Hangzhou, Zhejiang, China
| | - Lidan Zhang
- Department of Ultrasound, Hangzhou Women’s Hospital, Hangzhou, Zhejiang, China
| | - Yinan Weng
- Department of Ultrasound, Hangzhou Women’s Hospital, Hangzhou, Zhejiang, China
| | - Fangfang Zhou
- Department of Ultrasound, Hangzhou Women’s Hospital, Hangzhou, Zhejiang, China
| | - Qing Yu
- Department of Obstetrics, Hangzhou Women’s Hospital, Hangzhou, Zhejiang, China
| | - Hongyan Zhang
- Department of Reproductive Medicine Center, Hangzhou Women’s Hospital, Hangzhou, Zhejiang, China
- * Correspondence: Hongyan Zhang, Department of Reproductive Medicine Center, Hangzhou Women’s Hospital, Hangzhou, Zhejiang 310008, China (e-mail: )
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Placental and Umbilical Cord Anomalies Diagnosed by Two- and Three-Dimensional Ultrasound. Diagnostics (Basel) 2022; 12:diagnostics12112810. [PMID: 36428871 PMCID: PMC9689386 DOI: 10.3390/diagnostics12112810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of this review is to present a wide spectrum of placental and umbilical cord pathologies affecting the pregnancy. Placental and umbilical cord anomalies are highly associated with high-risk pregnancies and may jeopardize fetal well-being in utero as well as causing a predisposition towards poor perinatal outcome with increased fetal and neonatal mortality and morbidity. The permanent, computerized perinatology databases of different international centers have been searched and investigated to fulfil the aim of this manuscript. An extended gallery of prenatal imaging with autopsy correlation in specific cases will help to provide readers with a useful iconographic tool and will assist with the understanding and definition of this critical obstetrical and perinatological issue.
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Wu X, Wei C, Chen R, Yang L, Huang W, Huang L, Yan X, Deng X, Gou Z. Fetal umbilical artery thrombosis: prenatal diagnosis, treatment and follow-up. Orphanet J Rare Dis 2022; 17:414. [PMID: 36371215 PMCID: PMC9652808 DOI: 10.1186/s13023-022-02563-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To analyze the ultrasound imaging and clinical characteristics of fetuses with umbilical artery thrombosis (UAT), explore the potential causes of UAT and construct a prognostic prediction model to guide clinical practice. METHODS This was a retrospective cohort study of fetal UAT cases examined at two academic tertiary referral care centers from 2014 to 2020. The basic information of the participants was obtained by interview during follow-up, and data on clinical treatment, delivery conditions, diagnosis and confirmation were obtained through medical records. Probable causes of thrombosis were explored by comparative analysis of the UAT group to the control group and by further regression analysis. Multivariable logistic regression models were used to evaluate risk factors for adverse pregnancy outcomes. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic value of the prognostic prediction model. RESULTS Thirty fetuses with UAT were included in this study. UAT occurred mostly in the third trimester of pregnancy, and there was an obvious predominance of right UAT. An abnormal pregnancy history (53.3%) was the most common comorbidity, followed by gestational diabetes mellitus (GDM) (20.0%). GDM and umbilical cord (UC) abnormalities were found to be independent risk factors for the development of UAT. After comprehensive decision-making, over two-thirds of the patients with UAT received urgent treatment, and less than one-third received expectant management. Surprisingly, there were no significant differences in fetal outcomes between the urgent treatment and expectant management groups. Multivariate logistic regression analysis showed that gestational age (GA) at clinical diagnosis and UC abnormalities were independent risk factors for adverse pregnancy outcomes (OR 0.781, p = 0.042; OR 16.779, p = 0.023, respectively). Based on this, we constructed a comprehensive prognostic prediction model. The area under the ROC curve (AUC) was 0.877 (95% CI 0.698-0.970; p < 0.001), which suggested that the combination of GA and UC abnormalities was a better predictor for fetal outcomes in our setting. CONCLUSION In summary, maternal GDM and fetal UC abnormalities are independent risk factors for UAT. UAT is more frequently observed on the right side. Moreover, poor clinical outcomes for fetuses with UAT are ascribed mainly to GA and UC abnormalities, which should be comprehensively evaluated to choose the appropriate treatment.
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Affiliation(s)
- Xiafang Wu
- grid.469636.8Department of Ultrasonography, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang China
| | - Chenchen Wei
- grid.89957.3a0000 0000 9255 8984Center for Cardiovascular Disease, The Affiliated Suzhou Hospital of Nanjing Medical University, 242# Guangji Road, Suzhou, 215002 Jiangsu China
| | - Ruifeng Chen
- grid.452210.0Department of Ultrasonography, Affiliated Changsha Central Hospital of South China University, Changsha, Hunan China
| | - Linxian Yang
- grid.469636.8Department of Ultrasonography, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang China
| | - Weifei Huang
- grid.469636.8Department of Ultrasonography, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang China
| | - Liang Huang
- grid.513202.7Department of Ultrasonography, Tongren People’s Hospital, Tongren, Guizhou, China
| | - XinXin Yan
- grid.89957.3a0000 0000 9255 8984Department of Pharmacology, The Affiliated Suzhou Hospital of Nanjing Medical University, 242# Guangji Road, Suzhou, 215002 Jiangsu China
| | - Xuedong Deng
- grid.89957.3a0000 0000 9255 8984Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, 242# Guangji Road, Suzhou, 215002 Jiangsu China
| | - Zhongshan Gou
- grid.89957.3a0000 0000 9255 8984Center for Cardiovascular Disease, The Affiliated Suzhou Hospital of Nanjing Medical University, 242# Guangji Road, Suzhou, 215002 Jiangsu China
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Liu Q, Zhang Q, Liu P. The Diagnostic Accuracy of Transabdominal and Transvaginal Color Doppler Ultrasound for Pregnant Women with Vasa Previa and Velamentous Cord Insertion. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:1685783. [PMID: 36213044 PMCID: PMC9536888 DOI: 10.1155/2022/1685783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 11/21/2022]
Abstract
Objective The objective of this study is to evaluate feasibility and accuracy of transabdominal color Doppler ultrasound (TA-CDUS) and transvaginal color Doppler ultrasound (TV-CDUS) as screening methods for pregnant women with vasa previa (VP) and velamentous cord insertion (VCI). Methods A retrospective diagnostic accuracy study was performed on 5,434 pregnant women from 2018 to 2021, who underwent both TA-CDUS and TV-CDUS. Diagnostic performance of TA-CDUS and TV-CDUS was determined using specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and positive and negative likelihood ratios (LR+ and LR-), using the delivery information (gross examination) as the "Gold-standard". Patient records were reviewed for demographics and diagnosis. Results The combination of VP and VCI was diagnosed in 37/5434 (0.68%) women at delivery. The sensitivity, specificity, PPV, NPV, and overall test accuracy of TA-CDUS were 72.97%, 99.85%, 77.14%, 99.81%, and 99.67%, respectively, for diagnosing VP with VCI. The corresponding values for TV-CDUS were 89.19%, 99.87%, 82.50%, 99.93%, and 99.80%, respectively. Moreover, the sensitivity of combination of TA-CDUS and TA-CDUS in determining VP with VCI was 97.30%, specificity 99.98%, PPV 97.30%, NPV 99.98%, and accuracy 99.96%. No significant difference in the misdiagnosis and missed diagnosis was found between the examination by TA-CDUS and TV-CDUS. Conclusions Both TA-CDUS and TV-CDUS can be acceptable diagnostic tools for assessment of pregnant women with VP and VCI, with a better application of TV-CDUS with higher accuracy. The combination of TA-CDUS and TV-CDUS could provide an objective imaging basis for choosing clinical treatment strategies and predicting prognosis.
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Affiliation(s)
- Qing Liu
- Department of Ultrasound, Jingzhou Hospital Affiliated to Yangtze University, China
| | - Qiang Zhang
- Department of Ultrasound, Jingzhou Hospital Affiliated to Yangtze University, China
| | - Peiwu Liu
- Radiology Department, Jingzhou Hospital Affiliated to Yangtze University, China
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