Miguel Branco

The role of ultrasound in the prediction of birth weight discordance in twin pregnancies: are we there yet?

Abstract Objective: To analyze the accuracy of ultrasound prediction of birth weight discordance (BWD) and the influence of chorionicity and fetal growth restriction (FGR) on ultrasound performance. Methods: Retrospective analysis of 176 twin pregnancies at a Portuguese tertiary center, between 2008 and 2014. Last ultrasound biometry was recorded. Cases with delivery before 24 weeks, fetal malformations, interval between last ultrasound and deliver >3 weeks, twin-to-twin transfusion syndrome and monoamniotic pregnancies were excluded. The accuracy of prediction of BWD was assessed using the area under the receiver-operating characteristics curve (AUC). Results: BWD ≥20% was present in 21.6% of twin pregnancies. EBW had the best predictive performance for BWD (AUC 0.838, 95%CI 0.760–0.916), with a negative predictive value of 86.9% and a positive predictive value of 51.3%. Chorionicity did not influence ultrasound performance. None of the biometric variables analyzed was predictive of BWD in pregnancies without FGR. Conclusion: The accuracy of ultrasound in the prediction of BWD is limited, particularly in pregnancies without fetal growth restriction. Clinical decisions should not rely on BWD alone.

Interstitial ectopic pregnancy managed with local methotrexate

A 38-year-old woman, 7 weeks and 4 days pregnant as assessed by her last menstrual period, presented to our emergency department with non-painful vaginal bleeding for 2 days. She was a gravida 2, para 1 with a history of caesarean section 12 years before. Her serum β human chorionic gonadotropin level (β-HCG) was 2776 mIU/mL. Other laboratory results, including full blood count and liver function tests, were normal. Ultrasonography showed an empty uterine cavity and a gestational sac implanted adjacent …

Congenital dacryocystocoele with prenatal diagnosis

A male term infant was born to a 32-year-old primigravida after conception induced by in vitro fertilisation. The mother had experienced an uneventful prenatal course until the routine third trimester ultrasound screening, at the 35th-week of gestation, revealed a hypoechogenic cystic 12×12 mm mass on the right inferior medial orbital wall of the fetus, with no blood flow detected on Doppler ultrasound (figure 1). These initial findings suggested a dacryocystocoele. An infant boy was delivered vaginally with a birth weight of 3060 g. Apgar scores were 10 at 1 and 5 min. No initial respiratory nor feeding difficulties were perceived. Physical examination revealed only a …

Lesão vascular da placenta condicionando RCIU e hidropisia fetal não imune em gestação gemelar

Placenta vascular lesions are a group of distinct yet related entities that include chorangiomas and diffuse multifocal chorangiomatosis. Chorangioma is an expansive nodular lesion with an incidence of about 1%. Diffuse multifocal chorangiomatosis is rare (0.2%) and mostly seen in placentas before the 32nd gestational week. The authors present a case of a monochorionic/biamniotic twin pregnancy, in which, at the 26th gestational week, one fetus developed intrauterine growth restriction (IUGR), hydrops, and anemia associated with a tumor of the placenta with increased vascularization in the Doppler study. Pathological examination of the placenta diagnosed diffuse multifocal chorangiomatosis. This rare case report of diffuse multifocal chorangiomatosis with prenatal manifestations resembling those of a chorangioma proves that prenatal ultrasound detection of a placenta tumor, with increased vascularization at Doppler study, must raise other diagnostic possibilities beside chorangioma.