Daniele Spagnolo

Transvaginal sonography for fetal measurement in early pregnancy

Objective To establish reference ranges for fetal size by gestation in the first trimester as indicated by cephalic, abdominal and limb measurements using trans‐vaginal sonography.

Accuracy of the umbilical arteries Doppler flow velocity waveforms in detecting adverse perinatal outcomes in a high-risk population

Objective. To define the accuracy of the umbilical artery Doppler flow velocity waveforms, according to different cut‐off values, in predicting adverse perinatal outcomes among fetuses at high risk of hypoxic complications.

Transvaginal ultrasonography in persistent trophoblastic tumor

OBJECTIVE We assessed the reliability of transvaginal ultrasonography in the detection of uterine involvement in cases of gestational trophoblastic tumor, to establish a possible role of this procedure in the management of such neoplasia. STUDY DESIGN Transvaginal ultrasonography was performed in six women with gestational trophoblastic tumor at initial diagnosis, during the cytotoxic course when negative beta-human chorionic gonadotrophin levels were obtained, and within 3 to 6 months after the end of chemotherapy. RESULTS In all cases in which metastatic disease was absent intrauterine localization was easily detected by transvaginal ultrasonography; it appeared as endometrial hypoechoic areas and intramyometrial nodules. Favorable response to chemotherapy was determined by a negative serum beta-human chorionic gonadotropin determination accompanied by the finding of regression of nodules at transvaginal ultrasonography. CONCLUSION Our data support the introduction of transvaginal ultrasonography in the management of gestational trophoblastic tumor.

Ultrasound imaging after evacuation as an adjunct to β-hCG monitoring in posthydatidiform molar gestational trophoblastic neoplasia

OBJECTIVE The purpose of this study was to identify prognostic factors associated with development of gestational trophoblastic neoplasia (GTN) after hydatidiform mole (HM). STUDY DESIGN A retrospective analysis of 189 patients with HM was performed. We recorded features such as maternal age, HM history, blood group, gestational age, uterine volume at evacuation, presence of theca lutein cysts, vaginal bleeding, and transvaginal ultrasonography with color Doppler imaging. We considered risk predictors to be the presence of nodules and hypervascularization within the myometrium or endometrium (positive ultrasound imaging). An univariate and multivariate analysis, with the COX nominal logistic model, was performed. RESULTS Fourteen patients experienced GTN (7.4%). After univariate analysis, uterine size (P = .0139) and positive ultrasound results (P < .0001) were associated significantly with GTN development. At multivariate analysis, only positive ultrasound results maintained significance (likelihood ratio test: chi(2) = 0.0000). CONCLUSION The risk of GTN is increased in patients with uterine involvement that is assessed by ultrasound imaging. None of the other prognostic factors that were evaluated was predictive of GTN development.

Transvaginal ultrasound predicts delayed response to chemotherapy and drug resistance in Stage I low-risk trophoblastic neoplasia

Methotrexate (MTX) resistance is defined on the basis of the human chorionic gonadotropin (hCG) curve. The aim of this study was to identify low‐risk non‐metastatic patients with gestational trophoblastic neoplasia (GTN) who can achieve resolution by continuing MTX treatment despite a transient hCG plateau.

Prenatal sonographic monitoring of idiopathic megacystis.

This case report is of a female fetus diagnosed with severe idiopathic megacystis at 21 weeks of pregnancy. Sonographic monitoring demonstrated normal amniotic fluid volume and renal structures, absence of hydronephrosis, ureteral dilation, and associated abnormalities. Conservative management was chosen with postnatal confirmation of diagnosis. The neonate presented seizures, and subsequent magnetic resonance imaging demonstrated transverse sinus thrombosis with adjacent ischemic damage. At present, the infant is 2 years old, and she is thriving normally and maintains urinary continence with spontaneous voidings.

Prenatal diagnosis by 3D ultrasound and MRI of an unusual malformation of cortical development with brain-in-brain appearance.

A 31‐year‐old pregnant woman was referred for isolated mild ventriculomegaly and failure to visualize the left lateral ventricles anterior horn on second trimester sonography (US). Three‐dimensional US suspected a frontal lesion deviating the midline. MRI revealed a mass compressing the ventricle. Follow‐up MRI described a “brain‐in‐brain” malformation: infolded microgyric cortex and white matter in frontal lobe extending to frontal horn and midline, irrorated by hypertophic Heubner artery. Conservative approach was chosen. Neurodevelopment at 1 year is normal.

Percutaneous transvesical chorionic villus sampling: a safe alternative method for difficult procedures?

Chorionic villus sampling (CVS) is a safe and effective procedure for invasive prenatal diagnosis in the first trimester, with a 1% risk of miscarriage as a result of patientor procedure-related variables, including operator experience1–3. CVS is an ultrasound-guided procedure generally performed transabdominally. Occasionally, transabdominal CVS is difficult because of an axial-retroverted uterus, a posterior low-lying placenta (interposed bowel) or the presence of uterine myomas, and so alternative approaches are required: transvaginal transcervical CVS or percutaneous transvesical CVS3,4. We retrospectively analyzed our series of difficult CVS procedures to evaluate

OP06.01: Ultrasound imaging after hydatidiform mole surgical evacuation as a prognostic factor for gestational trophoblastic neoplasia

Results: From 121 fetuses the median gestational age was at first examination 30 wk and at birth 31 1/7 wk, the median birth weight was 1318g. General movements were normal, suspect and abnormal in 42%, 17% and 41%, respectively. Echogenicity changes of the brain were absent, mildly or moderately abnormal in 28%, 41% and 31%, respectively. The sensitivity of general movements for moderate echogenicity changes (periventricular ≥ IB: brighter than choroid plexus, intraventricular grade II, III filling <, ≥ 50%, in basal ganglia/thalamus locally increased) per brain area and the three areas together was 0.53–0.85, specificity 0.40–0.44, positive predictive value 0.13–0.35, negative predictive value of general movements was 0.81–0.96. Conclusions: Qualitative abnormal general movements predict moderate echogenicity changes in the brain especially in the periventricular area in fetuses of pregnancies complicated by hypertensive disorders or preterm labour. Normal general movements predict absence of moderate echogenicity changes.

P26.18: Prenatal diagnosis of bladder exstrophy by 2D and 3D ultrasound

due to an enlarged uterus. A male fetus was noted to have a 4 cm × 5 cm solid tumor in the right retroperitoneal space. By 28 weeks, the mass had increased to 8 cm × 6 cm with extreme polyhydramnios. The mass originated in the renal fossa and extended to the level of the diaphragm and across the midline. The mass replaced the fetal right kidney. The left kidney appeared normal. Premature labor initiated hospitalization. A series of drainage amniocentesis were performed due to uterine overdistention and preterm labor. Chromosome analysis showed normal male karyotype. The patient delivered at 33w1d by Cesarean section due to sudden labor and dilitation with breech positioning. The mass measured 10 cm × 10 cm at birth. Surgical resection was performed on day 5. The diagnosis of mesoblastic nephroma was confirmed by histopathology. Cytogenetic studies of the tumor showed a hyperdiploid male karyotype with extra copies of chromosomes 7, 8, 11, 16, and 17. Trisomy 16 was observed in two cells from one isolated area. Parental origin of the extra copy of 11 was confirmed. The combination of three-dimensional ultrasound, pathology and genetic studies confirms diagnosis, treatment and further investigation of this congenital renal tumor.