Andrea Surányi

Fetal renal hyperechogenicity in intrauterine growth retardation : importance and outcome.

Abstract The object of the study was to investigate the outcome in growth-retarded newborns who were diagnosed with fetal renal hyperechogenicity without anatomical abnormality during any stage of pregnancy. Depending on the fetal renal ultrasonography result, the cases were divided into two study groups. There was an intrauterine growth-retarded group with fetal renal medullary hyperechogenicity and another group without fetal renal medullary hyperechogenicity. The renal parenchyma was observed after birth, within the first 5 days of life, and several times until the 14thpostpartum day in positive cases. Hyperechogenic renal medullae were detected in 25 of 90 cases with intrauterine growth retardation during the 8-month study period. This may be an in utero cause of subsequent intrauterine and neonatal complications, such as cesarean section because of fetal distress (36%), perinatal infection (24%), treatment in a neonatal intensive care unit (52%), or increased perinatal mortality (8%). The results demonstrate that fetuses with hyperechoic medullae had 1.5 times the risk of an abnormal outcome compared with fetuses with normal echoic kidneys and intrauterine growth retardation. Detailed ultrasound examinations of renal parenchyma appear to be useful for the prenatal diagnosis of intrauterine hypoxia, allowing the detection of possible pathological fetal conditions in utero.

Placental three-dimensional power Doppler indices in mid-pregnancy and late pregnancy complicated by gestational diabetes mellitus

The aim of our study was to evaluate placental three‐dimensional power Doppler indices in diabetic pregnancies in the second and third trimesters and to compare them with those of the normal controls.

Postnatal outcome and placental blood flow after plasmapheresis during pregnancy

Abstract Purpose: Plasmapheresis in pregnancy adversely affects maternal hemodynamics, however there are studies suggesting it to reduce pregnancy loss in immunological diseases when medication is more harmful to the fetus. The overall optimal plasmapheresis treatment protocol remains unknown. Materials and methods: A pregnant with neuromyelitis optica was followed up after receiving six volumes of fresh frozen plasma via plasmapheresis. Results: The placenta compensated the hemodynamic change until the 33rd week of gestation, resulting a small for gestational age, otherwise healthy girl. Conclusions: More research is needed on plasma exchange during pregnancy because in our observation placental circulation can adapt to the change in blood pressure.

Examination of placental three-dimensional power Doppler indices and perinatal outcome in pregnancies complicated by intrauterine growth restriction.

To examine placental vascularization using three‐dimensional power Doppler (3DPD) ultrasonography in pregnancies complicated by intrauterine growth restriction (IUGR).

Placental Volumes Measured by 3-Dimensional Ultrasonography in Normal Pregnancies From 12 to 40 Weeks' Gestation

To the Editor: We read with interest the article “Placental Volumes Measured by 3-Dimensional Ultrasonography in Normal Pregnancies From 12 to 40 Weeks’ Gestation” by de Paula et al.1 An increasing amount of data demonstrates the importance of placental volume because it correlates with several characteristics of pregnancy and the fetus.2,3 It is obvious that placental weight at birth is different in cases of some pathologic pregnancies compared to nonpathologic pregnancies, which leads to the rationale of estimating placental volume during pregnancy. The quantitative assessment of placental volume by means of the 3-dimensional virtual organ computer-aided analysis (VOCAL) technique is an adjunctive modality for differentiation between normal and pathologic (ie, intrauterine growth restriction and diabetes) pregnancies.2–4 Nomograms of placental volumes plotted against the gestational age (between 12 and 40 weeks’ gestation) and estimated fetal weight illustrate a selected normal population. However, a statistical curve analysis5 of placental volume data has not been performed so far; only a nomogram of the linear regression correlation was created,1 but we suggest that the results must be taken with caution. A prospective study on a total of 374 pregnant women (gestational ages between 5 weeks 2 days and 40 weeks 2 days) has been performed at the Department of Obstetrics and Gynecology of the University of Szeged. The selection criteria were exactly the same as listed in the published article.1 A rotational multiplanar technique was applied (Voluson 730 system, RAB 2-5 MHz probe, and 4D View version 10.4 program; GE Healthcare, Kretztechnik, Zipf, Austria) to acquire the placental volume, as described in the published article.1 However, only patients with entirely visualized placentas were included in the study, which was described in detail in the article.1 Regression curve analyses were performed concerning both firstand second-trimester placental volume data by SPSS (Chicago, IL) software to optimize the fitting of curves to our plot. Curve estimation models were as follows: linear, logarithmic, inverse, quadratic, power, compound, S-shaped curve, logistic, growth, and exponential relationships.5 Based on our experience with the VOCAL technique, the placenta can be visualized entirely until 24 weeks’ gestation in all cases, but after mid pregnancy, only a smaller proportion can be detected, but these limitations were not detailed in the article.1 The multiplanar technique and the VOCAL technique have no notable differences in volume measurement. Placental volumes were plotted against gestational age (Figure 1). The regression curve analyses revealed that all of the above-mentioned curves can significantly fit into the plotted data, but the placental volumes were related most significantly to gestational age by the S-shaped curve in the first trimester (P < .001; r2 = 0.749). In addition, the exponential (P < .001; r2 = 0.733) and the logistic (P < .001; r2 = 0.733) regressions also provided LETTERS TO THE EDITOR

Use of placental vascularization indices and uterine artery peak systolic velocity in early detection of pregnancies complicated by gestational diabetes, chronic or gestational hypertension, and preeclampsia at risk

Aim We aimed to investigate correlations between uterine artery peak systolic velocity (AUtPSV), and placental vascularization in groups of normal blood pressure (NBP) and hypertensive disorders of pregnancy (chronic hypertension (CHT), gestational hypertension (GHT) and preeclampsia (PE)) alone or in combination with gestational diabetes mellitus (GDM), and hypothesized that AUtPSV rises when GDM complicates pregnancy hypertension. Methods Placental 3-dimensional power Doppler indices, such as vascularization index (VI), flow index (FI), and vascularization-flow index (VFI), and uterine artery peak systolic velocity (AUtPSV) were measured in CHT (N = 43), CHT+GDM (N = 15), GHT (N = 57), GHT+GDM (N = 23) and PE (N = 17) pregnancies, and compared to NBP (N = 109). Correlations were analyzed between vascularization indices, AUtPSV, pregestational BMI and adverse pregnancy outcome rates. Results In our results VI was higher in CHT (P = 0.010), while FI was lower in CHT (P = 0.009), GHT and PE (P = 0.001) compared to NBP. In case of VFI, significant difference was found between CHT and GHT (P = 0.002), and NBP and PE (P = 0.001). FI was found prognostic for umbilical pH and neonatal birth weight. Pre-gestational BMI was significantly higher in GHT+GDM compared to GHT, and in CHT+GDM compared to the CHT group. As for AUtPSV, significant difference was found between NBP and CHT (P = 0.012), NBP and CHT+GDM (P = 0.045), NBP and GHT+GDM (P = 0.007), NBP and PE (P = 0.032), and GHT and GHT+GDM (P = 0.048) groups. Conclusion Our study revealed that vascularization indices and AUtPSV show significant differences due to gestational pathology, and can be useful in detection of pregnancies at risk.

Unusual Clinical History of a Male Infant with Edwards Syndrome

Edwards syndrome (trisomy of chromosome 18) is generally characterized by the disorders of central nervous system, as well as the musculoskeletal and genitourinary systems. In majority of the cases with trisomy 18 the following malformations can be found: ventricular septal defect, horseshoe kidneys, oesophageal atresia, omphalocele, facial clefts, diaphragmatic hernias and genital hypoplasia. We report a male patient with Edwards syndrome. The boy had a partial agenesis of corpus callosum, oesophageal atresia with tracheo-oesophageal fistula, renal agenesis, ventricular septal defect, Dandy-Walker cyst and low-set malformed ears. The first three features are unique based on previous literature reports on trisomy 18. This report allows a further delineation of the trisomy 18 syndrome.

Evaluation of placental vascularization indices in monochorionic diamniotic and dichorionic diamniotic twin pregnancies

OBJECTIVES We aimed to investigate and compare placental vascularization indices between monochorionic-diamniotic, dichorionic-diamniotic normal twin pregnancies, and normal singular pregnancies. We hypothesized that there is correlation between placental three-dimensional power Doppler vascularization indices and birth weight in case of twin pregnancies, and that normal singular pregnancies have higher placental vascularization indices than normal twin pregnancies. STUDY DESIGN Placental three-dimensional power Doppler vascularization indices, such as vascularization index, flow index, and vascularization-flow index were measured in monochorionic-diamniotic (N = 15) and dichorionic-diamniotic (N = 36) normal twin pregnancies, and in normal singular (N = 109) pregnancies. Correlations were analyzed between vascularization indices, and birth weight, APGAR score, umbilical pH, umbilical venous bicarbonate, lactate, and base excess. RESULTS Vascularization indices and birth weight were significantly (p < 0.01) higher in normal singular gestations (vascularization index = 10.36, flow index = 46.08, vascularization-flow index = 4.08, average birth weight = 3377 g at 38.2 weeks average gestational age) compared to monochorionic-diamniotic and dichorionic-diamniotic normal twin pregnancies. No significant differences were found in vascularization indices between monochorionic-diamniotic and dichorionic-diamniotic normal twins. There were no significant differences in APGAR score, umbilical pH, umbilical venous bicarbonate, lactate, and base excess between groups examined (p < 0.01). We found strong linear correlations between placental vascularization indices and birth weight in both twin groups. CONCLUSION Placental three-dimensional power Doppler vascularization indices seem appropriate for predicting birth weight in monochorionic-diamniotic and dichorionic-diamniotic normal twin pregnancies. Our pilot study revealed reference values for vascularization indices in case of twin pregnancies examined.

P05.03: Correlation between placental vascularisation indices and histological findings of placentas in pregnancy hypertension

males. (Mean fetal weight: 0,65g vs 0,84g, p<.001 at ED17,5 and 1,01g vs 1,14g, p=.02 at ED18,5). Measured by ultrasounds, uterine artery resistance index (RI) was higher in late gestation in transgenic group. (mean RI: 0,63 vs 0,58, p= .029). In 29 mice studied by BOLD MRI, change in T2* differed significantly between STOX 1 and wild type in placental inner layer (8.2 msec vs 5.8 msec; p < .025), placental outer layer (6.1 msec vs 3.07msec; p < .005), and fetal brain (5.29 msec vs 9.09 msec; P = .004). There was no significant difference in the fetal liver (2.42 msec vs 2.5 msec; P = .25). Conclusions: STOX1-overexpressing mice constitute a reliable model of PE. BOLD MRI has the potential to pick up placental changes in such mice pre-eclamptic pregnancies as compared to normal ones.

EP14.25: Placental weight and volume related to birthweight and third trimester maternal blood sample in normal and IUGR pregnancies

Objectives: To investigate human long bone development in fetuses with intrauterine growth restriction (IUGR) by analysing distal femoral epimetaphyseal structures and bone morphometrics on prenatal MR imaging. Methods: This retrospective study included 14 fetuses (mean gestational age, 26 weeks 2 days; range, 21 weeks 3 days to 33 weeks) with IUGR caused by placental insufficiency, without other brain or body abnormalities, as well as a total of 192 age-matched normal fetuses. On 1.5-T echo-planar MR images, diaphyseal and epiphyseal morphometric measurements were assessed, and, using a grading system, the cartilaginous epiphyseal and metaphyseal shape, secondary ossification, and the perichondrium were qualitatively analysed. Student’s t-testing was used to compare the morphometric measurements of IUGR fetuses with normal fetuses, and descriptive statistics were used to compare the qualitative bone characteristics. Results: The morphometric measurements of the IUGR fetuses did not exceed the minimum normative measurements at any gestational age (diaphyseal length: p <0.0001 0.0053; epiphyseal length: p <0.0001 0.0022; epiphyseal width: p <0.0001 0.0032). Overall, the same grading for cartilaginous epiphyseal shape as observed in IUGR fetuses was found in 28.6% 100% of normal fetuses, for the metaphyseal shape in 7.1% 94.4%, for secondary ossification in 16.7% 100%, and for the perichondrium in 12.5%91.7%. Conclusions: On prenatal MR imaging, fetuses with placental-based IUGR exhibit long bone shortening, whereas their qualitative bone characteristics appear within normal limits. Consequently, the presence of qualitative bone abnormalities should include the differential diagnosis of various fetal skeletal disorders.