Jerry Martin

Sonographic determination of first trimester twin chorionicity and amnionicity

To determine the reliability of first trimester sonography in the detection of twin chorionicity and amnionicity.

Comparative estimates of neonatal gestational maturity by electrographic and fetal ultrasonographic criteria

We previously reported a high correlation between electrographic and postmortem neuroanatomic (i.e., sulcal-gyral) estimates of maturity in sick preterm neonates who were clinically abnormal because of neonatal medical illnesses. Electroencephalographic studies have not yet been compared with ultrasonographic measurements in healthy fetuses who subsequently had normal neurodevelopmental outcome. Twenty-five EEG recordings on healthy neonates (28-43 weeks postconceptional age) had EEG estimates of gestational maturity without knowledge of obstetric, neonatal, or ultrasonographic criteria. Thirteen recordings from this cohort were obtained on very premature neonates (i.e., < 32 weeks estimated gestational age). Fetal ultrasonographic determinations of gestational maturity for these 13 subjects were also obtained prior to birth. Ultrasonographic estimates were assigned without knowledge of other clinical data. Gestational age estimates based on electroencephalographic analyses were compared with 5 ultrasonographic estimates of gestational age maturity using multivariate regression (i.e., biparietal diameter, abdominal circumference, femur length, transcerebellar diameter, and head circumference), as well as the mothers last menstrual period. No significant differences were detected between the electrographic and obstetric/ultrasonographic estimates of gestational maturity. An electroencephalographers assessment of gestational age is as accurate as the fetal ultrasonographic estimates in the asymptomatic preterm neonate whose gestational age is < 32 weeks at birth.

Severity of polyhydramnios does not affect the prevalence of large-for-gestational-age newborn infants.

The purpose of this study was to evaluate the relationship between the severity of polyhydramnios with or without maternal diabetes and the prevalence of large‐for‐gestational‐age newborn infants. A case control design was used. The study group consisted of 275 singleton pregnancies with an amniotic fluid index > or = 25.0 cm. An equal number of controls was matched for maternal age, gravidity, parity, and gestational age. Polyhydramnios was categorized into three groups by severity: mild (amniotic fluid index 25 to 30 cm.); moderate (amniotic fluid index, 30.1 to 35.0 cm); and severe (amniotic fluid index > or = 35.1 cm). Among our study group, 72.7%, 19.7%, and 7.6% of cases had mild, moderate, and severe polyhydramnios, respectively. Patients with polyhydramnios had a significantly higher prevalence of large‐for‐gestational‐age neonates (27%) than did controls (10%) (P < 0.001). No correlation was seen between the severity of polyhydramnios and neonatal delivery weight. The prevalence of gestational and class > or = B diabetes mellitus was significantly higher among patients with polyhydramnios (17.7%) than among controls (7%) (P < 0.003). Once polyhydramnios was diagnosed sonographically, however, maternal diabetic status did not affect the prevalence of large‐for‐gestational‐age newborn infants. We conclude that the prevalence of large‐for‐gestational‐age neonates is 2.7 times greater when polyhydramnios is present than when the amniotic fluid volume is normal. Neither the severity of polyhydramnios nor the presence of maternal diabetes mellitus strengthens the relationship between polyhydramnios and large‐for‐gestational‐age newborn infants.

Ovarian pregnancy resulting in a surviving neonate. Ultrasound findings.

Ovarian pregnancy complicates 1 out of 6970 deliveries and 13% of all ectopic gestations.• In primary ovarian pregnancy, the ovum remains in the follicle where it is fertilized. The fertilized ovum subsequently implants in the corpus luteum. In a secondary ovarian pregnancy, the fertilized ovum is aborted through the tube and secondarily implants on the ovary. Accurate preoperative diagnosis of ovarian pregnancy is very difficult. In the first trimester, ovarian pregnancy is usually confused with a ruptured corpus luteum cyst. Advanced ovarian pregnancy is extremely unusual and rarely considered as a preoperative diag· nosis. If the extrauterine location of an advanced gestation is recognized, a diagnosis of abdominal pregnancy is more likely to be made than one of ovarian pregnancy. We report a case of a primary ovarian pregnancy resulting in a viable neonate. The correct diagnosis was made only at laparotomy. The ultrasound findings of this case are also reported.

The role of the transcerebellar view in the detection of fetal central nervous system anomaly

The current resolution of antenatal ultrasonography permits the sonologist to visualize and critically evaluate the cerebellum and cisterna magna. Abnormalities in the size and shape of these structures will assist the sonologist in the detection of the majority of central nervous system malformations.

Sonographic imaging of the fetal azygous vein. Normal and pathologic appearance.

Sonologists should be familiar with the frequency of resolution and the ultrasonic appearance of the normal fetal azygous vein. In this study, 66 consecutive uncomplicated pregnancies were scanned to determine the frequency of imaging the fetal thoracic azygous vein. Between 21.7 and 30 gestational weeks, the azygous vein could be imaged in 50% of the cases and measured 1‐2 mm in caliber. In the last 10 weeks of pregnancy, the azygous vein could be imaged in 98% of the cases and measured 2‐4 mm. A case of fetal azygous continuation of the inferior vena cava is shown where the vein was abnormally dilated to a caliber of 8 mm.

Endometrial thickness and risk of breast and endometrial carcinomas in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

Postmenopausal women with higher circulating estrogen levels are at increased risk of developing breast and endometrial carcinomas. In the endometrium, excess estrogen relative to progesterone produces a net proliferative stimulus, which may result in endometrial thickening. Therefore, the hypothesis that endometrial thickness is a biological marker of excess estrogen stimulation that is associated with risk of breast and endometrial carcinomas was tested. Endometrial thickness was measured in 1,272 postmenopausal women, aged 55–74 years, who underwent transvaginal ultrasound (TVU) screening as part of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Serial endometrial thickness measurements were available for a subset of women at 1 year (n = 1,018), 2 years (n = 869) and 3 years (n = 641) after baseline. The associations between endometrial thickness and breast (n = 91) and endometrial (n = 14) carcinoma were evaluated by estimating relative risks (RRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression with age as the time metric. Models incorporating baseline endometrial thickness and as a time‐varying covariate using all measurements were examined. Median follow‐up among study participants was 12.5 years (range: 0.3–13.8 years). Compared to baseline endometrial thickness of 1.0–2.99 mm, women with baseline endometrial thickness greater than or equal to 5.0 mm had an increased risk of breast (RR = 2.00, 95% CI = 1.15–3.48) and endometrial (RR = 5.02, 95% CI = 0.96–26.36) carcinomas in models adjusted for menopausal hormone use and BMI. These data suggest that increased endometrial thickness as assessed by TVU was associated with increased risk of breast and endometrial carcinomas.

Correlation Between Pathologic and Ultrasound Findings in First Trimester Spontaneous Abortions

We compared the pathologic and ultrasonographic findings of 31 first trimester spontaneous abortions to determine the benefits of such studies. The ultrasound diagnoses included empty gestational sac (n = 11), intrauterine fetal death (n = 11), abortion in progress or incomplete abortion (n = 8), and live embryo (n = 1). Two subgroups of empty sacs were identified by pathologic examination. Embryonic development appeared to be more advanced in one group as indicated by the presence of embryonic red blood cells (RBCs) in the placental vessels. Although an embryo or fetus was identified more frequently by sonar than by pathologic examination, we were able to diagnose developmental anomalies in small embryos that current ultrasound equipment cannot resolve. Such anomalies were identified even in the presence of fetal heart activity. Pathologic examination was also informative when heavy bleeding obscured the contents of the uterine cavity to sonar and was thus supplementary of a suboptimal ultrasound examination. Placental examination proved to be reliable in assessing gestational age at the time of embryonic/fetal death. There was a good correlation between RBC morphology and sonographic measurement of crown-rump length. First trimester ultrasound and pathologic examination of the embryo and placenta are informative and complement each other.

Destructive Brain Lesions of Presumed Fetal Onset: Antepartum Causes of Cerebral Palsy

Antepartum events have been associated with fetal brain injury and may contribute to later neurological sequelae. However, children with these injuries may be asymptomatic or exhibit few clinical signs during the neonatal period. Six neonates are presented with destructive brain lesions of fetal onset based on radiological and neurophysiological studies at birth. No intrapartum difficulties were noted in any of the cases. Two maternal histories were significant for either placental bleeding or toxemia during the second or third trimesters of pregnancy. Fetal porencephaly from presumed intraventricular hemorrhage was documented by serial abdominal sonography for these two children. No causes could be assigned for the remaining four patients with destructive brain lesions. All six children had normal results on neurological examinations at birth, although four neonates later presented with isolated seizures at 8 to 30 hours of life which resolved after administration of anti-epileptic medication. In all cases initial neonatal electroencephalographic records showed abnormalities consisting of major background asymmetries or seizures. Initial documentation of cerebral lesions was made by fetal sonography (two patients) and computed tomography scan (four patients) during the initial 30 hours of life, timing the lesions to the antepartum period. Cerebral palsy has been documented in all children; one child had resolution of her deficits by 6 months of age. Better surveillance of events during the antepartum period may help identify specific pathophysiological conditions that contribute to cerebral palsy. Neurophysiological and imaging studies should be used during the immediate new-born period for neonates believed to have cerebral lesions based on maternal sonography or isolated seizures.