Pertti Kirkinen

Perinatal diagnostic evaluation of velamentous umbilical cord insertion : Clinical, doppler, and ultrasonic findings

Objective To evaluate the association between velamentous cord insertion and adverse pregnancy outcome in singleton pregnancies, and to assess the diagnostic usefulness of nonstress testing (NST) and Doppler ultrasound in this condition. Methods We retrospectively reviewed 12,750 consecutive singleton, chromosmally normal pregnancies from July 1989 through December 1993 at the University Hospital of Kuopio, Finland. Of these, 216 were complicated by velamentous umbilical cord insertion, whereas the remaining 12,534 were normal controls. Using multiple regression analysis, we evaluated the risks by noting adverse infant outcomes: low birth weight (LBW), small for gestational age (SGA), preterm delivery, fetal death, admission to a specific infant care unit, low Apgar scores, neonatal acidemia, and abnormal intrapartum fetal heart rate (FHR) patterns. At prenatal visits NST and Doppler ultrasound examinations were carried out as a routine part of obstetric care. Results Even after we controlled for confounding factor, velamentous umbilical cord insertion was associated with higher risk of LBW (odds ratio [OR] 2.32), SGA (OR 1.54), preterm delivery (OR 2.12), low Apgar scores at 1 and 5 minutes (ORs 1.76 and 2.47, respectively), and abnormal intrapartum FHR pattern (OR 1.59). Only 5% of the patients with abnormal insertion showed pathologic NST results at prenatal visits. Ultrasonographic examination was carried out on 80 patients with velamentous umbilical cord insertion as a routine part of obstetric care, and in only one case was direct visualization of the abnormal insertion successfull. After we excluded pregnancies with preeclampsia, abnormalumbilical artery Doppler velocimetry was found in none of the cases examined (n = 48). Conclusion There were substantial differences in pregnancy outcome measures between the subjects with velamentous umbilical cord insertion and controls. Current antepartum methods of tracing uteroplacental problems are not effective in the prenatal detection of abnormal insertion. Therefore, in future studies, the use of other diagnostic tools, such as color Doppler imaging of cord insertion, should be evaluated in high-risk pregnancies followed-up because of fetal growth restriction.

Pregnancy outcome with Intrahepatic cholestasis

OBJECTIVE To determine the risk of adverse pregnancy outcomes resulting from intrahepatic cholestasis. METHODS We analyzed 91 women with singleton pregnancies complicated by cholestasis who gave birth at Kuopio University Hospital from January 1990 to December 1996. Logistic regression analysis was used to compare pregnancy outcomes of this group with those of the general obstetric population (n = 16,818). RESULTS Women of relatively advanced age (over 35 years) were at increased risk of developing intrahepatic cholestasis. Affected pregnant women delivered by cesarean significantly more often (25.3%) than the general obstetric population (15.8%). Intrahepatic cholestasis increased the low basic risk of preterm delivery and the need for neonatal care in the general population (odds ratio [OR] 2.73; 95% confidence interval [CI] 1.50, 4.95 and OR 2.15; 95% CI 1.21, 3.83, respectively). Otherwise, the courses of pregnancy were comparable in both groups. CONCLUSION Intrahepatic cholestasis has an adverse effect on fetal development, and affected pregnancies merit closer surveillance. Delivery of infants when maturity is reached may minimize the risk of adverse outcomes.

Diagnosing fetal urinary tract abnormalities: benefits of MRI compared to ultrasonography

Background. To compare antepartum ultrasonography with magnetic resonance imaging for prenatal diagnosis of malformations in the fetal urinary tract in high risk patients during the last trimester.

Etiology and outcome of second trimester non‐immunologic fetal hydrops

Background. This investigation was undertaken to study the conditions resulting in midtrimester fetal hydrops and to evaluate its overall prognosis as regards counseling purposes.

Intrapartum reflectance pulse oximetry: effects of sensor location and fixation duration on oxygen saturation readings

Objective. To determine the effects of sensor location and suction fixation duration on measurements of intrapartum fetal oxygen saturation (SpO2) with a new reflectance pulse oximetry system. Design. Fetal SpO2 values (n = 18) were determined in the first stage of labor before and after moving the sensor to another part of the fetal head. Results. Mean fetal SpO2 values did not differ with sensor location (95% CI: −3.59 to 1.48). The duration of measurement period 1, before moving the sensor, was 104 ± 44 (range 30–240) min. No time-dependent changes in SpO2 values were seen (r = 0.17). Conclusion. Suction is an effective and noninvasive method of securing the reflectance pulse oximetry sensor to the fetal head in the first stage of labor and does not interfere with reproducible SpO2 values over several hours.

Ultrasonic and magnetic resonance imaging of fetal sacrococcygeal teratoma.

Objective. To evaluate ultrasonic and magnetic resonance imaging (MRI) and Doppler examination in fetal sacrococcygeal teratoma (SCT), in respect to the postnatal findings and histological type of the tumor.

Placenta accreta: imaging by gray-scale and contrast-enhanced color Doppler sonography and magnetic resonance imaging.

Antepartum diagnosis of placenta accreta on the scarred myometrium of the isthmus uteri after previous cesarean section was made in 2 pregnancies. Antepartum sonographic examination revealed abnormal bulging of placental tissue toward the bladder cavity and arcuate arteries within the bladder wall. Magnetic resonance imaging revealed the depth and extent of placental invasion into the myometrium of the isthmus and the bladder muscular layer. Low‐resistance pulsatile intervillous flow was recorded within the placenta in 1 case. Both magnetic resonance imaging and contrast‐enhanced color Doppler sonography were informative in the other of these cases, in which the patient was conservatively managed during pregnancy and after delivery.

Contrast-enhanced sonography in the examination of benign and malignant adnexal masses.

Our objective was to characterize the properties of an intravascular ultrasonographic contrast agent in examination of adnexal masses and to compare contrast agent properties between benign and malignant adnexal tumors. Fifty‐eight consecutively examined women with suspected ovarian tumors were examined preoperatively by power Doppler ultrasonography, first without and then with contrast agent enhancement (Levovist). Fourteen women had ovarian cancer, 3 had borderline ovarian tumors, 18 had benign ovarian neoplasms, and 23 had functional adnexal cystic masses or endometriomas. The effect of the contrast agent was evaluated visually and by using computerized power Doppler signal intensity measurements. In visual evaluation, the brightness of the power Doppler signal and the amount of recognizable vascular areas increased in each tumor after contrast agent administration. The number of vessels in power Doppler ultrasonograms, both before and after contrast agent enhancement, was significantly higher in malignant than in benign adnexal masses, as also was the increase in the number of recognizable vessels after contrast agent administration. Contrast agent uptake time was significantly shorter in malignant than in benign tumors. No significant differences were found in the power Doppler signal intensities or their changes between benign and malignant tumors. In conclusion, use of sonographic contrast agent facilitates imaging of tumor vessels. For differentiation of benign and malignant tumors, the kinetic properties of the contrast agent, such as uptake and washout times, may have more potential than the use of the contrast agent in anatomic imaging of the tumor vessels.

The clinical outcome in pregnancies of grand grand multiparous women

Objective. To longitudinally evaluate maternal and neonatal complications with relation to birth order, with specific emphasis on grand grand multiparity (at least 10th para).

OBSTETRIC PROGNOSIS IN SECOND PREGNANCY AFTER PREECLAMPSIA IN FIRST PREGNANCY

Objective To assess obstetric outcomes in women in their second pregnancy after preeclampsia in the first pregnancy.Methods We utilized population-based birth registry data of Kuopio University Hospital to investigate pregnancy outcome measures in 123 non-preeclamptic parous women with prior preeclampsia and 21 women with repeat preeclampsia in their second pregnancy. The general obstetric population was used as a reference group in logistic regression.Results The development of recurrent preeclampsia in 15% of women is associated with adverse neonatal outcomes. A first preeclamptic pregnancy may offer protection against disease recurrence and a history of preeclampsia has no significant effects on birth weight, fetal distress, or prematurity rate. However, they have a higher rate of pregnancy-induced hypertension and abdominal deliveries, and, therefore, a greater proportion of newborns are referred to neonatal units for observation.Conclusions Women in whom preeclampsia does not recur have good obstetric outcomes in their second delivery, almost comparable to that in the general obstetric population. A genetic susceptibility to preeclampsia alone has minor effects on pregnancy outcome in a second pregnancy if the disease does not recur.