Screening for morbidly adherent placenta in early pregnancy

OBJECTIVE

To estimate the diagnostic accuracy of a two-stage strategy for early prediction of morbidly adherent placenta (MAP). In the first stage, at 11-13 weeks' gestation, women with low-lying placenta and history of uterine surgery are classified as being at high risk for MAP and, in the second stage, at 12-16 weeks, these high-risk pregnancies are assessed at a specialist MAP clinic.

METHODS

This was a prospective study in women having an ultrasound scan at 11-13 weeks' gestation as a part of routine pregnancy care. Women with low-lying placenta and a history of uterine surgery were followed up at a specialist MAP clinic at 12-16 weeks' gestation, 20-24 weeks and 28-34 weeks. At each visit to the MAP clinic, an ultrasound scan was carried out and the following features suggestive of MAP were recorded: non-visible Cesarean section scar; bladder wall interruption; thin retroplacental myometrium; presence of intraplacental lacunar spaces; presence of retroplacental arterial-trophoblastic blood flow; and irregular placental vascularization demonstrated by three-dimensional power Doppler.

RESULTS

Screening at 11-13 weeks was carried out in 22 604 singleton pregnancies, 1298 (6%) of which were considered to be at high risk of MAP because they had previous uterine surgery and low-lying placenta. At the MAP clinic at 12-16 weeks, the diagnosis of MAP was suspected in 14 cases and this was confirmed at delivery in 13. In the rest of the population, there were no cases of MAP.

CONCLUSION

Accurate prediction of MAP can be achieved by ultrasound examination at 12-16 weeks' gestation. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

[ULTRASOUND OF THE PLACENTA. NORMAL FINDINGS AND PLACENTAL ABNORMALITIES: A REVIEW.]

The placenta has a fundamental role for fetal growth and health throughout pregnancy. Normal placental function is essential for a healthy pregnancy outcome. A complete ultrasound survey at any stage of the pregnancy should include full assessment of the fetus and placenta. Timely detection of placental abnormalities cbn give the clinician the opportunity to make important management decisions. The primary aim is healthy pregnancy outcome. Prenatal diagnosis and correct obstetric managment reduce fetal and maternal morbidity and mortality. Familiarity with the normal and abnormal imaging appearance of the placenta is therefore necessary for the obstetrician. Despite the fundamental role of the placenta for the pregnancy outcome, ultrasound examination of the placenta is often considered secondary to the fetus. Location, size, shape and architecture are easily ascertained with two-dimensional techniques. Three-dimensional techniques and Doppler techniques are more detailed methods for evaluation uteroplacental structure and function.

Prediction of small-for-gestational-age neonates: screening by fetal biometry at 19-24 weeks

OBJECTIVE

To investigate the value of fetal biometry at 19-24 weeks' gestation in the prediction of delivery of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE), and examine the potential value of such assessment in deciding whether the third-trimester scan should be at 32 and/or 36 weeks' gestation.

METHODS

This was a screening study in 88,187 singleton pregnancies, including 5003 (5.7%) that delivered SGA neonates with birth weight < 5(th) percentile (SGA < 5(th)). Multivariable logistic regression analysis was used to determine if screening by a combination of maternal characteristics and medical history and Z-scores of fetal head circumference (HC), abdominal circumference (AC) and femur length (FL) had significant contribution in predicting SGA neonates. A model was developed for selecting the gestational age for third-trimester assessment, at 32 and/or 36 weeks, based on the results of screening at 19-24 weeks.

RESULTS

Combined screening by maternal factors and fetal biometry at 19-24 weeks, predicted 76%, 58% and 44% of SGA < 5(th) delivering < 32, 32-36 and ≥ 37 weeks' gestation, respectively, at a false-positive rate (FPR) of 10%. The detection rate (DR) of SGA < 5(th) delivering at 32-36 weeks improved from 58% to 82% with screening at 32 weeks rather than at 19-24 weeks. Similarly, the DR of SGA < 5(th) delivering ≥ 37 weeks improved from 44% with screening at 19-24 weeks to 61% and 76% with screening at 32 and 36 weeks, respectively. In a hypothetical model, it was estimated that if the desired objective of prenatal screening is to predict about 80% of the cases of SGA < 5(th), it would be necessary to select 28% of the population at the 19-24-week assessment to be reassessed at 32 weeks and 41% to be reassessed at 36 weeks; in 59% of pregnancies there would be no need for a third-trimester scan.

CONCLUSION

Prenatal prediction of a high proportion of SGA neonates necessitates the undertaking of screening in the third trimester of pregnancy, in addition to assessment in the second trimester, and the timing of such screening, either at 32 and/or 36 weeks, should be contingent on the results of the assessment at 19-24 weeks.

[CASE REPORT OF FETAL ASCITES CAUSED BY PRENATAL PERFORATION OF BOWEL]

The detection of isolated ascites is a rare ultrasound finding. A precise examination should be undertaken in all cases fetal ascites. This include following a systematic protocol for diagnosis. The prognosis of the newborn in case of prenatal diagnosed ascites, depends on the etiology of the ascites. This is a case report of 40 years old pregnant women, at 34 weeks of gestation. During routine ultrasound examination at 33 weeks of gestation fetal ascites, has been diagnosed. The aim of our team was to examine the etiology of the ascites. We performed systematic diagnostic test and series of ultrasound examination, which helped us to diagnose fetal ascites, caused by bowel perforation. The good timing of delivery and postnatal surgical treatment were associated with good neonatal outcome. In cases of prenatal diagnosed ascites, the desirable good neonatal outcome requires multidisciplinary approach and team work of obstetric consultant, fetal medicine consultants, neonatologists and pediatric surgeons. However the parents should be counselled that not all of the associated anomalies could be diagnosed prenatally.