Speciality
Spotlight

 




 

Obstetric & Gynaecology

 

 




Ultrasonography

   

  • Sonia S Hassan, Roberto Romero, et al (Detroit, Michigan)

    Patients with an ultrasonographic cervical length £15mm have nearly a 50% risk of early spontaneous preterm delivery.

    Am J Obstet Gynecol, vol.182

        


    Objective: the aim of this study was to determine the value in the prediction of spontaneous preterm delivery of ultrasonographically measured cervical length measured between 14 and 24 weeks’ gestation. 

        


    Study Design: A retrospective cohort study examined cervical length by means of a two-stage procedure, transabdominal ultrasonography followed by transvaginal ultrasonography if cervical length was <30mm.

        


    Results: A total of 6877 patients met inclusion criteria. Mean cervical length was 37.5mm. Odds ratios for early preterm delivery (£32 weeks’ gestation) for patients with cervical lengths £10, £15, £20, £25, and £30mm were, respectively, 29.3 (95% confidence interval, 11.3-75.8)< 24.3(95% confidence interval, 12.9-45.9), 18.3 (95% confidence interval, 10.8-31.0), 13.4 (95% confidence interval, 8.8-20.6), and 3.2 (95% confidence interval, 2.4-4.4). For early preterm delivery a cervical length of £15mm had a positive predictive value of 47.6%, a negative predictive value of 96.7%, a sensitivity of 8.2% and a specificity of 99.7%.

         


    Conclusions: A short cervix seen on a second-trimester sonogram was a powerful predictor of early spontaneous preterm delivery (£ 32 weeks’ gestation). Nearly 50% of patients with a cervical length £ 15mm had an early spontaneous preterm delivery, which suggests that clinical trials of interventions (eg. cerclage) in this population are urgently needed.

        

  • E F Magann, S P Chauhan, et al (Jackson, Mississippi, South Carolina)

    Determination of amniotic fluid volume in twin pregnancies: Ultrasonographic evaluation versus operator estimation.

    Am J Obstet Gynecol, vol.182, June 2000, p.1606-9

        


    Objective: To determine the accuracy of amniotic fluid volume estimation (visually) in diamniotic twin pregnancy versus ultrasonography technques.

         


    Study Design: In this prospective study the volume of each sac in 23 sets of diamniotic twin pregnancies was subjectively and objectively estimated by a second year obstetric resident, nurse sonographer, maternal-fetal medicine fellow, and maternal-fetal medicine staff. The actual volume was confirmed by amniocentesis and a dye-dilution technique.

        


    Results : There was no difference in the total number of correct estimates of volume by level of operator experience (P=.98), ultrasonography technique (P=.87), or combined subjective versus objective correct estimates (P-.87). Identification of low volume was not different among the four evaluators (P=.48), but the percentage of correct estimates was poor (7%-29%). The 2-diameter pocket was a better predictor of oligohydramnios (57%) than the amniotic fluid index or the largest vertical pocket 912.5%; P=.002)

        


    Conclusion : The extremes of volume (low or high) are poorly identified by the subjective or objective assessment of volume.

        

  • J Bornstein, R Auslender, et al (Haifa, Isreal)


    Increased endometrial thickness in women with hypertension


    Am J Obstet Gynecol, 183: Sept.2000: 583-7

       


    Objective : The authors noticed an increase in endometrial thickness in women with hypertension who were treated with a combination of medications, including b-blockers. The purpose of this study was to examine whether the endometrium of hypertensive women is thicker than that of healthy women and to determine whether endometrial thickening in hypertensive women is directly related to the antihypertensive b-blocker treatment.

       


    Study Design: The authors compared 3 groups of postmenopausal patients as follows: (1) women with a history of essential hypertension treated with a combination of medications, including b-blockers; (2) women with a history of hypertension treated with a combination of medications that did not include b-blockers; and (3) healthy women without hypertension. All patients were interviewed and examined, blood tests were performed, and endometrial thickness in the anterior -posterior diameter was measured by vaginal ultrasonography. Among the exclusion criteria were diabetes or an abnormal fasting blood glucose level, obesity, hormonal medication or replacement hormonal therapy during the previous 6 months, and a history of hormonal disturbances, infertility or polycystic ovary syndrome.

       


    Results: Of 45 hypertensive women enrolled in the study, 22 were treated with a b-blocker combination medication and 23 were treated with other antihypertensive medications. They were compared with 25 healthy women. There was no statistically significant difference in endometrial thickness between women treated with medications, including b-blockers, and those who were treated with other hypotensive agents. Twenty percent of women with hypertension and none of the healthy women had endometrium >5mm thick (P<.017; odds ratio, 8.22; 95% confidence interval, 1.22)

       


    Conclusion: Twenty percent of hypertensive postmenopausal women were found to have increased endometrial thickness. However, we were unable to substantiate an association between the type of treatment administered, whether b-blockers were included, and the increase in endometrial thickness.

       

  • D S Walsh, A M Hubbard, et al (Philadelphia, Pennslyvania)

    Assessment of fetal lung volumes and liver herniation with magnetic resonance imaging in congenital diaphragmatic hernia.

    Am J Obstet Gynecol, Nov.2000; 183: 1067-9





    Objective : Authors evaluated the use of fetal magnetic resonance imaging in predicting outcomes after ultrasonographic diagnosis of left-sided congenital diaphragmatic hernia.



    Study Design: Forty-one pregnant women carrying fetuses with congenital diaphragmatic hernia underwent 43 magnetic resonance imaging scans. Lung volumes were calculated by summing the areas on 6-mm axial sections. The presence or absence of liver herniation was noted. A liver/diaphragm ratio was obtained by using the distances from the superior aspect of the liver and the diaphragmatic remnant to the apex of the chest.



    Results: Mean gestational age was 26 weeks and overall survival was 59%. Neither right, left, nor total lung volume measurements were predictive of survival. Liver herniation into the left side of the chest was predictive of outcome at P <.05. The liver/diaphragm ratio was predictive of outcome at P=.03.



    Conclusion: Fetal magnetic resonance imaging permits calculation of lung volumes, but these volumes are not predictive of outcome. However, both the presence of liver herniation and the volume of liver within the chest, as reflected by the liver/diaphragm ratio, help predict outcome in left-sided congenital diaphragmatic hernia.

       

  • E R Guzman, C Walters, et al (New Brunswick, New Jersey and New York)

    Use of cervical ultrasonography in prediction of spontaneous preterm birth in twin gestations.

    Am J Obstet Gynecol, Nov.2000; 183: 1103-7


      


    Objective: This study was undertaken to compare various ultrasonograpic cervical parameters with respect to ability to predict spontaneous preterm birth in twin gestations.

       


    Study Design: This prospective study involved 131 women carrying twins who were longitudinally evaluated on 524 occasions between 15 and 28 weeks’ gestation with transvaginal cervical ultrasonography and transfundal pressure. The following cervical parameters were obtained: funnel width and length, cervical length, percentage of funneling, and cervical index. Receiver operating characteristic curve analysis was used to determine the ultrasonographic cervical parameter evaluated at 15 to 20 weeks’ gestation, 21 to 24 weeks’ gestation, and 25 to 28 weeks’ gestation, and <34 weeks’ gestation.

       


    Conclusion: In twin gestations a cervical length of £ 2.0 cm measured between 15 and 28 weeks’ gestation was at least as good as other ultrasonogrpahic cervical parameters at predicting spontaneous preterm birth. The high specificities indicate that cervical length was better at predicting the absence than the presence of various degrees of spontaneous
    prematurity.

         

      



 

 

Speciality Spotlight

 

 

Ultrasonography
   

  • Sonia S Hassan, Roberto Romero, et al (Detroit, Michigan)
    Patients with an ultrasonographic cervical length £15mm have nearly a 50% risk of early spontaneous preterm delivery.
    Am J Obstet Gynecol, vol.182
        

    Objective: the aim of this study was to determine the value in the prediction of spontaneous preterm delivery of ultrasonographically measured cervical length measured between 14 and 24 weeks’ gestation. 
        
    Study Design: A retrospective cohort study examined cervical length by means of a two-stage procedure, transabdominal ultrasonography followed by transvaginal ultrasonography if cervical length was <30mm.
        
    Results: A total of 6877 patients met inclusion criteria. Mean cervical length was 37.5mm. Odds ratios for early preterm delivery (£32 weeks’ gestation) for patients with cervical lengths £10, £15, £20, £25, and £30mm were, respectively, 29.3 (95% confidence interval, 11.3-75.8)< 24.3(95% confidence interval, 12.9-45.9), 18.3 (95% confidence interval, 10.8-31.0), 13.4 (95% confidence interval, 8.8-20.6), and 3.2 (95% confidence interval, 2.4-4.4). For early preterm delivery a cervical length of £15mm had a positive predictive value of 47.6%, a negative predictive value of 96.7%, a sensitivity of 8.2% and a specificity of 99.7%.
         
    Conclusions: A short cervix seen on a second-trimester sonogram was a powerful predictor of early spontaneous preterm delivery (£ 32 weeks’ gestation). Nearly 50% of patients with a cervical length £ 15mm had an early spontaneous preterm delivery, which suggests that clinical trials of interventions (eg. cerclage) in this population are urgently needed.
        

  • E F Magann, S P Chauhan, et al (Jackson, Mississippi, South Carolina)
    Determination of amniotic fluid volume in twin pregnancies: Ultrasonographic evaluation versus operator estimation.
    Am J Obstet Gynecol, vol.182, June 2000, p.1606-9
        

    Objective: To determine the accuracy of amniotic fluid volume estimation (visually) in diamniotic twin pregnancy versus ultrasonography technques.
         
    Study Design: In this prospective study the volume of each sac in 23 sets of diamniotic twin pregnancies was subjectively and objectively estimated by a second year obstetric resident, nurse sonographer, maternal-fetal medicine fellow, and maternal-fetal medicine staff. The actual volume was confirmed by amniocentesis and a dye-dilution technique.
        
    Results : There was no difference in the total number of correct estimates of volume by level of operator experience (P=.98), ultrasonography technique (P=.87), or combined subjective versus objective correct estimates (P-.87). Identification of low volume was not different among the four evaluators (P=.48), but the percentage of correct estimates was poor (7%-29%). The 2-diameter pocket was a better predictor of oligohydramnios (57%) than the amniotic fluid index or the largest vertical pocket 912.5%; P=.002)
        
    Conclusion : The extremes of volume (low or high) are poorly identified by the subjective or objective assessment of volume.
        

  • J Bornstein, R Auslender, et al (Haifa, Isreal)
    Increased endometrial thickness in women with hypertension
    Am J Obstet Gynecol, 183: Sept.2000: 583-7
       
    Objective : The authors noticed an increase in endometrial thickness in women with hypertension who were treated with a combination of medications, including b-blockers. The purpose of this study was to examine whether the endometrium of hypertensive women is thicker than that of healthy women and to determine whether endometrial thickening in hypertensive women is directly related to the antihypertensive b-blocker treatment.
       
    Study Design: The authors compared 3 groups of postmenopausal patients as follows: (1) women with a history of essential hypertension treated with a combination of medications, including b-blockers; (2) women with a history of hypertension treated with a combination of medications that did not include b-blockers; and (3) healthy women without hypertension. All patients were interviewed and examined, blood tests were performed, and endometrial thickness in the anterior -posterior diameter was measured by vaginal ultrasonography. Among the exclusion criteria were diabetes or an abnormal fasting blood glucose level, obesity, hormonal medication or replacement hormonal therapy during the previous 6 months, and a history of hormonal disturbances, infertility or polycystic ovary syndrome.
       
    Results: Of 45 hypertensive women enrolled in the study, 22 were treated with a b-blocker combination medication and 23 were treated with other antihypertensive medications. They were compared with 25 healthy women. There was no statistically significant difference in endometrial thickness between women treated with medications, including b-blockers, and those who were treated with other hypotensive agents. Twenty percent of women with hypertension and none of the healthy women had endometrium >5mm thick (P<.017; odds ratio, 8.22; 95% confidence interval, 1.22)
       
    Conclusion: Twenty percent of hypertensive postmenopausal women were found to have increased endometrial thickness. However, we were unable to substantiate an association between the type of treatment administered, whether b-blockers were included, and the increase in endometrial thickness.
       

  • D S Walsh, A M Hubbard, et al (Philadelphia, Pennslyvania)
    Assessment of fetal lung volumes and liver herniation with magnetic resonance imaging in congenital diaphragmatic hernia.
    Am J Obstet Gynecol, Nov.2000; 183: 1067-9


    Objective : Authors evaluated the use of fetal magnetic resonance imaging in predicting outcomes after ultrasonographic diagnosis of left-sided congenital diaphragmatic hernia.

    Study Design: Forty-one pregnant women carrying fetuses with congenital diaphragmatic hernia underwent 43 magnetic resonance imaging scans. Lung volumes were calculated by summing the areas on 6-mm axial sections. The presence or absence of liver herniation was noted. A liver/diaphragm ratio was obtained by using the distances from the superior aspect of the liver and the diaphragmatic remnant to the apex of the chest.

    Results: Mean gestational age was 26 weeks and overall survival was 59%. Neither right, left, nor total lung volume measurements were predictive of survival. Liver herniation into the left side of the chest was predictive of outcome at P <.05. The liver/diaphragm ratio was predictive of outcome at P=.03.

    Conclusion: Fetal magnetic resonance imaging permits calculation of lung volumes, but these volumes are not predictive of outcome. However, both the presence of liver herniation and the volume of liver within the chest, as reflected by the liver/diaphragm ratio, help predict outcome in left-sided congenital diaphragmatic hernia.
       

  • E R Guzman, C Walters, et al (New Brunswick, New Jersey and New York)
    Use of cervical ultrasonography in prediction of spontaneous preterm birth in twin gestations.
    Am J Obstet Gynecol, Nov.2000; 183: 1103-7

      
    Objective: This study was undertaken to compare various ultrasonograpic cervical parameters with respect to ability to predict spontaneous preterm birth in twin gestations.
       
    Study Design: This prospective study involved 131 women carrying twins who were longitudinally evaluated on 524 occasions between 15 and 28 weeks’ gestation with transvaginal cervical ultrasonography and transfundal pressure. The following cervical parameters were obtained: funnel width and length, cervical length, percentage of funneling, and cervical index. Receiver operating characteristic curve analysis was used to determine the ultrasonographic cervical parameter evaluated at 15 to 20 weeks’ gestation, 21 to 24 weeks’ gestation, and 25 to 28 weeks’ gestation, and <34 weeks’ gestation.
       
    Conclusion: In twin gestations a cervical length of £ 2.0 cm measured between 15 and 28 weeks’ gestation was at least as good as other ultrasonogrpahic cervical parameters at predicting spontaneous preterm birth. The high specificities indicate that cervical length was better at predicting the absence than the presence of various degrees of spontaneous prematurity.
         

      

 

By |2022-07-20T16:43:00+00:00July 20, 2022|Uncategorized|Comments Off on Ultrasonography

About the Author: