F. A. P. Vasques

Valores dos parâmetros da dopplerfluxometria do ducto venoso entre a 10ª e a 14ª semana de gestações normais

PURPOSE: to analyze the values of Doppler ultrasound for blood flow velocity in the ductus venosus between the 10th and the 14th week of gestation, during the different phases of the cardiac cycle: ventricular systole (wave S), ventricular diastole (wave D), atrial systole (wave a), and angle-independent indexes. METHODS: Doppler was used in this prospective cross-sectional study to examine 276 single pregnancies. Fetus malformations, abnormal nuchal translucency, and women with clinical pathologies were excluded. A Toshiba SSH-140 ultrasound equipment was used. The derivation of Doppler frequency spectra was carried out according to standardized measurement procedures: less than 30oinsonation angle and 50-70 Hz high-pass filter. The ductus venosus was identified in a median sagittal and ventral plane with the presence of color aliasing due to increase in blood flow velocity. The sample volume (1-2 mm3) was placed immediately at the origin of the ductus venosus. At least three clearly and subsequent waves were available for measurement of standard values. The Levene test and the Bonferroni method were used for statistical analysis. RESULTS: increase in blood flow velocity from 29 cm/s to 37 cm/s (p=0.013) was observed during ventricular systole between the 10th and the 14th week of gestation. Similarly, increase in blood flow velocity was recorded during the ventricular diastole (from 25 cm/s to 32 cm/s, p=0.026). There were no changes in wave a, pulsatility index, and S/a ratio in this period. CONCLUSION: the reference ranges established by this study may serve as the basis for Doppler ultrasound follow-up in a normal patient population. Further studies are required to determine the validity of these parameters and, in particular, for the fetus at risk.

Anatomopathological characterization of placentas from HIV+ patients associated with p24 expression

INTRODUCTION: The study of placentas from pregnant human immunodeficiency virus (HIV) positive women has become the subject of numerous studies in the literature. Morphological, viral, immune and inflammatory placental aspects have been analyzed in order to grasp the vertical transmission of the virus. OBJECTIVE: To identify the most frequent findings in the placentas by associating them with a viral antigen and correlating them with the infection of newborns. MATERIAL AND METHODS: Thirty-five placentas from HIV- positive pregnant women were pathologically and immunohistochemically analyzed with the use of p24 antibody in the period from 1992 to1997 in accordance with the routine laboratory testing from the Anatomopathological Department - Hospital Universitario Antonio Pedro - Universidade Federal Fluminense (APD/HUAP/UFF). RESULTS: The microscopic alterations detected in all cases, including those with vertical transmission, were arteriopathy in the fetal blood circulation, chorioamnionitis, perivillous fibrin deposition, syncytial knotting, villous edema and villous immaturity. No specific macroscopic or histopathological changes were found in these placentas. The neonatal infection was observed in five cases. Vertical transmission was identified in two out of five placentas that had low weight for the respective stage of pregnancy. Immunohistochemical analysis revealed 14 positive cases, two of which showed vertical transmission. The viral protein was not identified in 10 out of 14 placentas from patients who had been medicated with zidovudine (AZT). CONCLUSION: Our study has contributed to the anatomopathological investigation into placentas from HIV-positive patients, although p24 expression per se did not allow a definite and early diagnosis of the vertical transmission.

P01.13: Nuchal translucency in detection of aneuploidies

fetuses were submitted to ultrasound analysis for NT measurement, during routine ultrasound examinations. The Student’s t test and ANOVA were used in the statistical analysis. The regression test was used to adjust the better mathematical model to translate the NT behavior. Results: Maternal age varied between 14 to 49 years (mean 30.2%), and 22.1% were above 35 years of age. The NT measurement increased with gestational age and the crown-rump length (CRL). In 41 normal fetuses (2%) the NT was thicker than 2.5 mm. The better mathematical model was the linear correlation (NT = 0.414 + 0.020 × CRL) which allowed to establish the reference range (percentiles 5, 10, 25, 50, 75, 90 and 95). Conclusion: The NT measurement is a manageable method during the usual ultrasonography. NT measurements increase with gestational age during weeks 10 to 14 of pregnancy. The NT measurements seen in the population of the State of Espı́rito Santo were similar to other populations tested.

OC26.04: Screening for chromosomal abnormalities by ductus venosus Doppler in the first trimester

Over the last 10 years 655 fetuses with enlarged nuchal translucency (NT) were referred to our Prenatal Diagnosis department. The follow-up is known in 97% of cases. In 35% of cases a chromosomal anomaly was diagnosed by fetal karyotyping. The overall chance of an adverse outcome for the whole group was 55%. In case of normal chromosomes two standards ultrasound investigations were planned, the firts, shortly after karyotyping was known (13–16 weeks) and the second at 20–24 weeks. Of the remaining 428 fetuses a normal outcome was recorded in 81% of cases. Adverse outcome was subdivided into: spontaneous abortion or intra-uterine death (4%), structural anomalies (7%), genetic syndromes (5%) and termination of pregnancy on parents request (3%). Of the structural anomalies the most frequent were cardiac defects (54%). The chance of an adverse outcome increased progressively with the degree of NT enlargement, whereas the chance of a healthy baby followed the opposite trend. After a normal structural ultrasound investigation the overall chance of a normal outcome was 96%. Interestingly, the chance of a normal outcome after normal ultrasound findings was not anymore influenced by the initial degree of enlargement.

P236: The cylindrical shape of ductus venosus in the first trimester of gestation

Objective: To investigate the geometric shape of the ductus venosus between 10–13 weeks of gestation. Patients and methods: Ductus venosus measurements were performed in 64 normal human fetus using ultrasound color Doppler imaging. The geometrical measurements obtained were: length (n = 64), isthmic width (n = 34) and outlet width (n = 20). For statistical analysis, the analysis of variance, linear regression, Kruskal-Wallis terst and the Spearman correlation were used. Results: At 10–13 weeks of gestation, the ductus venosus length indicates a continuous growth and the width did not change. The measurements (median) were: length = 2 mm, isthimic inlet = 1.4 mm, and outlet width +1.4 mm. Conclusion: The new geometric shape of the ductus venosus between 10–13 weeks of gestation has a cylindrical and not a slender trumpet-like shape as defined previously in the literature.

P237: Reference values of Dopplerfluxometry of the ductus venosus at 10–14 weeks of gestation

Objective: To investigate the geometric shape of the ductus venosus between 10–13 weeks of gestation. Patients and methods: Ductus venosus measurements were performed in 64 normal human fetus using ultrasound color Doppler imaging. The geometrical measurements obtained were: length (n = 64), isthmic width (n = 34) and outlet width (n = 20). For statistical analysis, the analysis of variance, linear regression, Kruskal-Wallis terst and the Spearman correlation were used. Results: At 10–13 weeks of gestation, the ductus venosus length indicates a continuous growth and the width did not change. The measurements (median) were: length = 2 mm, isthimic inlet = 1.4 mm, and outlet width + 1.4 mm. Conclusion: The new geometric shape of the ductus venosus between 10–13 weeks of gestation has a cylindrical and not a slender trumpet-like shape as defined previously in the literature.

Correlation between the umbilical cord cross‐sectional area and fetal anthropometric parameters

A prospective cross‐sectional study was developed to determine the correlation between the umbilical cord cross‐sectional (UCCSA) and fetal anthropometric parameters during normal pregnancies (patients with known dates of LMP and an ultrasound examination before the 20th week, without any pathologic condition). The measurements of the umbilical cord cross‐sectional area were obtained in a plane adjacent to the insertion of the cord in the abdomen, as proposed by Raio et al., 1999, and compared to the biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) by the non‐parametric correlation of Spearman. The inclusion criteria were: (1) singleton pregnancy; (2) gestational week >20 weeks; (3) intact membranes; (4) normal umbilical Doppler flow velocimetry. The exclusion criteria, in the presence of any of those were: (1) congenital and/or chromosomal abnormalities; (2) pregnancy complications (any type); (3) inadequate size for gestational agent the time the ultrasound examination was performed, i.e. the weight below the 10th or above the 90th percentile; (4) abnormal AFI. The patients were examined and included only once. The statistical analysis was performed by the program called Statistical Package for Social Sciences (SPSS) and we used a Toshiba 140 with a transabdominal transducer of 3.5 MHz. Our results showed a strong correlation (Spearman rank = 0.610, significant at the level of P < 0.01) between the UCCSA and the estimated fetal weight by ultrasound examination and also with the fetal anthropometric parameters (UCCSA × BPD = 0.622; UCCSA × HC = 0.617; UCCSA × AC = 0.625; UCCSA × FL = 0.604, all of them significant at the level of P < 0.01). We concluded that the UCCSA is a parameter that can be included at the routine of obstetrical ultrasound examinations.

Ultrasonographically measured umbilical cord cross‐sectional area – reproducibility of the method

A prospective cross‐sectional study was developed in order to determine the reproducibility of the measurement of the umbilical cord cross‐sectional area (UCCSA) during normal pregnancies (patients with known dates of LMP and an ultrasound examination before the 20th week, without any pathologic condition), measured by different and trained examiners. The measurements of the umbilical cord cross‐sectional area were obtained in a plane adjacent to the insertion of the cord abdomen, as proposed by Raio et al. 1999, after the different examiners were trained by the author. The inclusion criteria were: (1) singleton pregnancy; (2) gestation age >20 weeks; (3) intact membranes (4) normal umbilical Doppler flow velocimetry. The exclusion criteria, in the presence of any of those were: (1) congenital and/or chromosomal abnormalities; (2) pregnancy complications (any type); (3) inadequate size for gestational age with when the examination was performed, i.e. the weight below the 10th percentile or above the 90th; (4) abnormal AFI for the gestational age. The patients were examined and included only once. During the period of the study (February 2000–May 2001), 545 patients were examined, after meeting the inclusion criteria determined for the present study. The age of the patients ranged from 15 to 42 years (mean = 26.7 ± 4.8), 242 patients (44.4%) had two gestations, 135 patients (28.1%) were at their first gestation, 129 patients (23.7%) were at their third gestation and 39 patients had four or more gestations (3.8%). The ultrasound machine used was the Synergy Multi Sync M 500. The statistical program used was the statistical package for social sciences (SPSS). The first examiner collected 22% of the data, the second examiner collected 45% of the data, the third examiner collected 24% of the data and the fourth one collected 9% of the data. According to the analysis of variance (anova), we performed, comparing the data obtained by the different examiners, no significance was found and this fact was also showed by the comparison of the data among them and verifying that the data had a dispersion inside tolerable limits. The anova showed the following data (example for 3 weeks): At 25 weeks, the F‐test showed a value of 0.930 and a P‐value of 0.454; at 32 weeks the values were 0.106 for the F‐test and 0.956 for the P‐value and for week 38 the values were 0.102 (F‐test) and 0.904 (P‐value). We conclude that the measurement of the UCCSA as proposed by Raio et al. 1999 is reproductible and can be adopted as a new obstetric ultrasound parameter.

A nomogram for the umbilical cord cross‐sectional area in normal pregnancies

A prospective cross‐sectional study was developed in order to determine reference ranges for the umbilical cord cross‐sectional area (UCCSA) during normal pregnancies (patients with known dates of LMP and an ultrasound examination before the 20th week, without any pathologic condition). The measurements of the UCCSA were obtained in a plane adjacent to the insertion of the cord abdomen, as proposed by Raio et al, 1999. The inclusion criteria were: (1) singleton pregnancy, (2) gestation age >20 weeks, (3) intact membranes, (4) normal umbilical Doppler flow velocimetry. The exclusion criteria, in the presence of any of those, were: (1) congenital and/or chromosomal abnormalities; (2) pregnancy complications (any type); (3) inadequate size for gestational age when the examination was performed, i.e. the weight below the 10th percentile or above the 90th; (4) abnormal AFI for the gestational age. The patients were examined and included only once. During the period of the study (February 2000–May 2001), 545 patients were examined, after meeting the inclusion criteria determined for the present study. The age of the patients ranged from 15 to 42 years (mean = 26.7 ± 4.8), 242 patients (44.4%) had two gestations, 135 patients (28.1%) were at their first gestation, 129 patients (23.7%) were at their third gestation and 39 patients had four or more gestations (3.8%). The ultrasound machine used was the Synergy Multi Sync M 500 and the statistical analysis was performed by the program called Statistical Package for Social Sciences (SPSS). Our data were considered normally by the Kolmogorov–Smirnov test and then we figured the nomogram by linear regression analysis. The analysis of variance obtained through the F‐test (value = 356.27) showed that our regression model was significant at the level of P < 0.001, showing that the curve represented well the studied population and that the confidence interval (95%) contained the real value of the UCCSA. The regression equation was: y = − 532.27 + 44.358x − 0.6555x2. We conclude that, there is a progressive increase in the UCCSA up to the 32nd week of gestation, followed by a stabilization until the 34th week and a fall of the values from the 35th week of gestation.