A. F. Moron

Ophthalmic artery Doppler as a measure of severe pre-eclampsia

To identify differences in orbital flow behavior in mild and severe pre‐eclamptic women compared with healthy pregnant women, demonstrated by ophthalmic artery Doppler indexes.

The cross-sectional area of umbilical cord components in normal pregnancy

Objective: To determine the normal cross‐sectional areas of the umbilical vein, umbilical artery, and Wharton jelly in healthy pregnancies, and correlate the obtained values with fetal anthropometric parameters. Methods: A cross‐sectional study was performed with 312 women between the 24th and 39th weeks of a normal pregnancy. The cross‐sectional areas of umbilical cord vessels were measured at the junction of the cord and fetal abdomen, and the values were subtracted from the total cord cross‐sectional area to assess the cross‐sectional area of the Wharton jelly. The anthropometric parameters analyzed were biparietal diameter, head circumference, femur length, and estimated fetal weight, and the Spearman correlation was used to assess the correlation between the cross‐sectional areas of umbilical cord components and fetal anthropometric parameters. A polynomial regression analysis was performed to identify the curves that best adjusted to mean and standard deviation according to gestational age. Results: A statistically significant correlation was observed between the cross‐sectional areas of cord components and fetal anthropometric parameters (P < 0.001) as well as gestational age (P < 0.001). Conclusions: Reference measurements of the cross‐sectional areas of umbilical cord components are important tools in the assessment of fetal growth.

Doppler assessment of uterine blood flow in recurrent pregnancy loss

Objective: To compare uterine artery pulsatility index (PI) and flow velocity wave (FVW) patterns between women with no history of abortion and women with recurrent pregnancy loss of unexplained cause. Method: A cross‐sectional study was conducted with 43 women with recurrent pregnancy loss and 43 women with no history of abortion and at least 1 child born at term (control group). Transvaginal ultrasonography with uterine artery Doppler evaluation was performed in the second phase of the menstrual cycle to calculate the PI and analyze the FVW pattern. Results: The women with recurrent pregnancy loss had a significantly higher uterine artery PI than those in the control group (2.71 ± 0.54 and 2.30 ± 0.44, respectively), as well as a higher incidence of FVWs of the A and B types. Conclusion: Compared with the control group, a higher PI and a higher incidence of FVW of the A and B types—and thus a higher uterine artery impedance—were found among women with recurrent pregnancy loss.

Evaluation of Placental Volume at 7–10 + 6 Weeks of Pregnancy by 3D-Sonography

The aim of the study was to establish normative data for placental volume (PV) at 7-10+6 weeks of gestation using three-dimensional ultrasound (3DUS). The cross-sectional study involved 70 healthy pregnancies between 7 and 11 weeks. The VOCAL (Virtual Organ Computer-aided Analysis) method with a 30 degrees rotation angle and six planes was used for volumetric calculations. Regression models were constructed to assess the correlation between PV and crown-rump length (CRL) adjusted by the determination coefficient (R2). The method proposed by Royston and Wright was used to establish the 2.5th; 10th; 50th; 90th and 97.5th percentiles (percentile=mean+KxSD). The intraclass correlation coefficient (ICC), Bland-Altman graphs and Students paired t-tests were used to assess intra- and interobserver variability. PV ranged from 1.7 to 42.6 cm3, with a mean of 13.6cm3 (+/-9.4cm3). There was a strong correlation between PV and CRL; the exponential equation was the model that best expressed the correlation between them (R2=0.76). For CRL between 9 and 40 mm, the mean PV increased 10.5 times, while CRL increased only 4.4 times. Inter- and intraobserver correlation were excellent (ICC=0.979 and 0.971, respectively). Bland-Altman graphs indicated a good reproducibility with a mean intraobserver and interobserver difference of 0.2 cm3 (95% CI: -0.7-1.2cm3) and -0.2cm3 (95% CI: -1.3-0.9cm3), respectively. Reference limits were generated for first trimester PV assessed by 3DUS using the VOCAL method. There is a strong correlation between PV and CRL. Placental volume obtained through this method was highly reproducible.

Reversible constriction of the fetal ductus arteriosus after maternal use of topical diclofenac and methyl salicylate

A 33-year-old physician in her second pregnancy underwent fetal echocardiography at 35 weeks’ gestation. She decided to present at this late gestational age due to anxiety. Cardiac anatomy was normal, as were color Doppler velocimetry assessments of the foramen ovale, mitral valve, pulmonary artery and aortic arch. Slight tricuspid regurgitation was observed (Figure 1) and systolic and diastolic ductal velocities were 2.2 m/s and 0.42 m/s, respectively (Figure 2), indicating ductal constriction (normal values being < 1.40 m/s and 0.35 m/s). The patient did not smoke, had no history of preterm labor requiring prostaglandin inhibitors or steroids and denied use of any medication throughout her pregnancy. However, she did mention that for the last two nights, due to severe musculoskeletal pain, she had been massaging her shoulders and neck with a diclofenac gel (Cataflam Emulgel @ Novartis, São Paulo, Brazil). After rubbing in the gel she covered the painful area overnight with an adhesive patch containing methyl salicylate, l-menthol and dl-camphor (Salonpas @ Hisamitsu, São Paulo, Brazil). On the second night she repeated both topical treatments and also took a 50-mg tablet of tramadol (Tramal @ Searle, São Paulo, Brazil), a centrally acting synthetic analgesic, analogous to codeine. All medication was self-prescribed and purchased by the patient, without the knowledge of her obstetrician. She was advised to discontinue all medication and return within a week. Five days later repeat echocardiography (Figure 3) revealed normal ductal velocities (systolic, 1.1 m/s; diastolic, 0.27 m/s). An uneventful delivery occurred 1 month later and, after a neonatal echocardiogram showed no abnormalities, the infant was discharged on the 3rd day. The fetal ductus arteriosus is patent throughout gestation due to low oxygen tension and circulating prostaglandins. This patency allows the majority of right ventricular output to bypass the high-resistance pulmonary vessels. Rare cases of spontaneous ductus arteriosus constriction have been reported and some have been attributed to an anatomical distortion of the ductal arch2. More frequently, ductal constriction is caused by maternal use of non-steroidal anti-inflammatory drugs (NSAIDs) that enter the fetal circulation, block cyclooxygenase enzymes and inhibit prostaglandin synthesis. Fetuses become more susceptible to NSAIDs with advancing gestational age. Individual susceptibility also influences fetal response. Demandt et al.3 reported a case in which only one twin developed ductal constriction after maternal exposure to indomethacin. Although specific Figure 1 Echocardiography at 35 weeks’ gestation revealed slight tricuspid regurgitation (TR). RA, right atrium; RV, right ventricle.

Doppler velocimetry of the uterine, umbilical and fetal middle cerebral arteries in pregnant women undergoing tocolysis with oral nifedipine

To evaluate Doppler velocimetry (resistance index (RI) and peak systolic velocity (PSV)) in the maternal–fetal circulation before and 5 and 24 h after tocolysis with oral nifedipine.

Cervical gland area as an ultrasonographic marker for preterm delivery

Objective: To assess the association between spontaneous preterm delivery (SPTD) in the general population and the measurement of the cervix length, cervical funneling, and absence of the cervical gland area (CGA).

Chromosomal and cardiac anomalies in fetuses with intracardiac echogenic foci.

Objective: To evaluate the prevalence of intracardiac echogenic foci (ICEF) and the association between ICEF and chromosomal and cardiac anomalies in Brazilian women.

True hermaphroditism—the importance of ultrasonic assessment

Intersex states are associated with rare syndromes within a wide clinical spectrum, true hermaphroditism being the rarest of them all. It is a condition that is characterized by ovotestis, i.e. the presence of ovarian and testicular tissues in the same individual, either in separate gonads or in the same gonad. Diagnostic investigation of hermaphroditism involves ultrasound examination of the gonads, karyotype analysis and histological studies. We report the case of a 21‐year‐old individual with true hermaphroditism, in whom ovotestis was diagnosed on ultrasonography and which was later confirmed by anatomopathological study of the gonads. The role of ultrasound in the initial diagnostic investigation of intersex states, especially true hermaphroditism, is discussed. Copyright

Prediction of acidemia at birth by Doppler assessment of fetal cerebral transverse sinus in pregnancies with placental insufficiency.

To evaluate the prediction of acidemia at birth using cerebral transverse sinus (CTS) Doppler velocimetry and to determine the best parameter and cut‐off values for its prediction in pregnancies complicated with placental insufficiency.