Ilan Gull

Anaerobic glycolysis. The metabolism of the preovulatory human oocyte.

OBJECTIVESnThe aim of the study was to investigate the process of glycolysis in gonadotropic, hyperstimulated, human ovarian follicles.nnnSTUDY DESIGNnFollicular fluid (FF) lactate and glucose concentrations were measured in 26 patients with tubal factor infertility undergoing in vitro fertilization treatment.nnnRESULTSnThe mean FF lactate and glucose concentrations were 3.17+/-0.90 mM with positive, and 3.39+/-0.91 mM with negative correlations to follicular size. FF lactate concentration correlated negatively to glucose levels.nnnCONCLUSIONSnOur study confirms in vivo the anaerobic glycolysis in gonadotropic, hyperstimulated human ovarian follicles.

Reproducibility of Transvaginal Ultrasonographic Measurements of Endometrial Thickness in Patients with Postmenopausal Bleeding

The aim of the study was to establish the reproducibility of transvaginal sonographic measurements of endometrial thickness in patients with postmenopausal bleeding (PMB). In a prospective blind study, two examiners measured the endometrial thickness in 48 patients presenting with PMB by transvaginal sonography on two separate occasions, 30 min apart. The analysis of variance performed at each endometrial thickness measured by the two examiners revealed no statistical difference. However, it was shown that the most accurate measurements are up to the level of 4 mm (mean deviation of 0.1 ± 0.2 mm, range 0.7). Once the endometrial thickness reaches 5–6 mm the mean deviation becomes 0.3 ± 1.2 mm with a range of variation of 4 mm. In conclusion, measurements of endometrial thickness in patients presenting with PMB can be repeated quite accurately up to a level of 4 mm thickness.

Nomograms for the Sonographic Measurement of the Fetal Philtrum and Chin

Objective: To generate nomograms for the sonographic measurement of the fetal philtrum and chin during pregnancy. Design: A prospective, cross-sectional study in normal singleton pregnancies. Subjects: One hundred and fifty-three fetuses between 13 and 42 weeks of gestation were studied. Methods: The philtrum was measured from the base of the columella to the upper lip. The chin was measured from the tip of the lower lip to the skin under the lower tip of the mandible. Predictive models were evaluated to generate graphic description of the 5th, 50th and 95th centiles for the fetal philtrum and chin. Results: Fetal philtrum length increased with gestational age. The regression equation for the philtrum length (y) according to gestational age in weeks (x) is best predicted by the S-curve (Gompertz) model, as described by the following equation: y = exp(a + b/x), where a = 2.778577, and b = –23.476723 (R2 = 85.3%, p < 0.0001). The fetal chin length increased with gestational age. The regression equation for the mean chin length (y) according to gestational age in weeks (x) is best predicted by the S-curve model as described in the following equation. y = exp(a + b/x), where a = 3.7922, b = –28.043, (R2 = 89.0%, p < 0.0001). Conclusions: The nomograms generated in this study for the fetal philtrum and chin during pregnancy can be used in confirming subjective impression of facial dysmorphism.

Acid accumulation during end‐stage bradycardia in term fetuses: how long is too long?

Objective To estimate the existence and degree of fetal accumulation of acid during end‐stage bradycardia as reflected by the base deficit. This may set a criterion for proper intervention during labour.

Combined clinical and ultrasonographic work-up for the diagnosis of retained products of conception

Retained products of conception (RPOC) present a major clinical challenge. We assessed the accuracy of an evaluation protocol based on clinical management and transvaginal ultrasonographic evaluation for the detection of retained products of conception. This combined clinical and sonographic evaluation protocol offers a high sensitivity for the accurate diagnosis of RPOC.

Feasibility of Nuchal Translucency in Triplet Pregnancies

Objective. To assess the feasibility of nuchal translucency in triplets compared with singletons. Methods. Nuchal translucency thickness as part of routine first‐trimester screening in the general population was compared between 3128 singleton pregnancies and 51 triplets (153 fetuses). Crown‐rump length was also noted. The 5th, 50th, and 95th percentiles were determined and compared between the 2 groups, and regression curves of nuchal translucency measurements plotted against crown‐rump length were drawn. Results. The mean nuchal translucency thickness was 1.23 mm for singletons and triplets. The 5th and 95th percentiles were also the same between the 2 studied groups. The regression curves of 5th, 50th, and 95th percentiles of nuchal translucency plotted against crown‐rump length of triplets and singletons overlapped. Conclusions. Nuchal translucency values and distribution are the same in triplets and singletons, validating the utility of the cutoff values.

Sonographic detection of undescended testes in the third trimester.

Objective. To assess the sonographic detection rate of fetal undescended testes among a low‐risk population during the third trimester. Methods. A sonographic evaluation, which included biometric studies and a detailed examination of the fetal genitalia, was performed prospectively on 332 male fetuses of singleton pregnancies between 34 and 40 weeks gestation. A qualified neonatologist examined the presence of the testes within the scrotum within 3 days after birth. Results. The scrotum was visible in 294 (89%) of the 332 fetuses who were examined. It was visible in all fetuses evaluated between 34 and 36 weeks gestation. Nine cases of undescended testes were detected (3%). Of these, the diagnosis of 1 case, examined at 34 weeks gestation, was revealed after birth to be false‐positive. There were no false‐negative results. Conclusions. Sonographic examination during the late third trimester of pregnancy appears to allow accurate diacknowledgmentagnosis of undescended testes prenatally. This early identification will alert the neonatologist of the possibility of cryptorchidism and will permit early postnatal identification and treatment.

Revealed versus concealed criteria for placental insufficiency in an unselected obstetric population in late pregnancy (RATIO37): randomised controlled trial study protocol

Introduction Fetal growth restriction (FGR) affects 5%–10% of all pregnancies, contributing to 30%–50% of stillbirths. Unfortunately, growth restriction often is not detected antenatally. The last weeks of pregnancy are critical for preventing stillbirth among babies with FGR because there is a pronounced increase in stillbirths among growth-restricted fetuses after 37u2009weeks of pregnancy. Here we present a protocol (V.1, 23 May 2016) for the RATIO37 trial, which evaluates an integrated strategy for accurately selecting at-risk fetuses for delivery at term. The protocol is based on the combination of fetal biometry and cerebroplacental ratio (CPR). The primary objective is to reduce stillbirth rates. The secondary aims are to detect low birth weights and adverse perinatal outcomes. Methods and analysis The study is designed as multicentre (Spain, Chile, Mexico,Czech Republic and Israel), open-label, randomised trial with parallel groups. Singleton pregnancies will be invited to participate after routine second-trimester ultrasound scan (19+0–22+6 weeks of gestation), and participants will be randomly allocated to receive revealed or concealed CPR evaluation. Then, a routine ultrasound and Doppler scan will be performed at 36+0–37+6 weeks. Sociodemographic and clinical data will be collected at enrolment. Ultrasound and Doppler variables will be recorded at 36+0–37+6 weeks of pregnancy. Perinatal outcomes will be recorded after delivery. Univariate (with estimated effect size and its 95% CI) and multivariate (mixed-effects logistic regression) comparisons between groups will be performed. Ethics and dissemination The study will be conducted in accordance with the principles of Good Clinical Practice. This study was accepted by the Clinical Research Ethics Committee of Hospital Clinic Barcelona on 23May 2016. Subsequent approval by individual ethical committees and competent authorities was granted. The study results will be published in peer-reviewed journals and disseminated at international conferences. Trial registration number NCT02907242; pre-results.

Evacuating retained products of conception in the setting of an ultrasound unit

Women who have retained products of conception are usually referred for curettage or hysteroscopy, both performed in most cases under general anesthesia in an operating theater and sometimes requiring hospitalization. We propose that for most of these patients the procedure can be just as safely and effectively carried out in an obstetric ultrasound unit.

Torsion of the pregnant uterus at term

Torsion of a pregnant uterus is an unusual complication of pregnancy. Abnormal presentation, myomatous uterus, uterine malformations and pelvic adhesions are the main abnormalities associated with uterine torsion. Maternal age, parity and gestational age are not significant factors in torsion pathogenesis [l]. Although uterine torsion may be asymptomatic, it is usually characterized by pain, intestinal or urinary complaints and even circulatory shock. At term, obstructed labor occurs in almost all cases [2]. The diagnosis is usually established only after opening of the abdomen, or even after closure of the uterine incision [3,4]. We present a 40-year-old woman, gravida 6, para 4. History of her previous pregnancies (all