Reuven Mashiach

Sonographic Fetal Weight Estimation Which Model Should Be Used

Objective. The purpose of this study was to compare the accuracy of different sonographic models for fetal weight estimation. Methods. We evaluated 26 different models using 3705 sonographic weight estimations performed less than 3 days before delivery. Models were ranked on the basis of systematic and random errors and were grouped according to the combination of biometric indices in each model. Cluster analysis was used to compare the accuracy of the different model groups. Results. A considerable variation in the accuracy of the different models was found. For birth weights (BWs) in the range of 1000 to 4500 g, models based on 3 or 4 fetal biometric indices were significantly more accurate than models that incorporated only 1 or 2 indices. The accuracy of weight estimation decreased at the extremes of BWs, leading to overestimation in low‐BW categories as opposed to underestimation when the BW exceeded 4000 g. The precision of most models was lowest in the low‐BW groups. Conclusions. To improve the accuracy of fetal weight estimation, sonographic models that are based on 3 or 4 fetal biometric indices should be preferred. Recognizing the accuracy and the tendency for underestimation or overestimation of each of the available models is important for the judicious interpretation of fetal weight estimations, especially at the extremes of fetal weight.

The relationship between sperm ultrastructural features and fertilizing capacity in vitro

OBJECTIVE To evaluate the relationship between ultramorphological features of the human sperm and its fertilizing capacity in vitro. DESIGN The study was performed retrospectively. Ultrastructural features were assessed using scanning and transmission electron microscopes in sperm samples of individuals who underwent an in vitro fertilization (IVF) treatment cycle no more than 6 months before the study. SETTING Institutional clinical care. PATIENTS Fifty-six infertile couples in whom mechanical infertility was diagnosed in the female partner. Patients were categorized as fertilizing when fertilization of at least 30% of the oocytes occurred (n = 27) and nonfertilizing when none of the oocytes fertilized in at least two consecutive IVF treatment cycles (n = 29). RESULTS The two groups differed significantly only in ultramorphological parameters of the sperm head and acrosome (head, F(8,36) = 2.8, P less than 0.02; acrosome, F(4,40) = 2.8, P less than 0.04), and especially in the following malformation patterns: hyperelongated head, acrosome deficiency, and acrosome damage. The suggested score based on these findings was able to predict 90% and 76% of the cases with and without fertilizing potential, respectively. CONCLUSION The ultrastructural morphology of the sperm head components is a key parameter for assessing the sperm fertilizing capacity in vitro.

Sonographic prediction of fetal macrosomia: the consequences of false diagnosis.

Objective. The purpose of this study was to determine the effect of false diagnosis of macrosomia (<4500 g) on maternal/perinatal outcomes. Methods. We conducted a case‐control study of women (n = 1938) in whom sonographically estimated fetal weight (EFW) was determined up to 3 days before delivery and actual birth weight (BW) was 3500 to 4499 g. Women with false‐positive and ‐negative findings for macrosomia were compared, respectively, with women with true‐negative and ‐positive findings for outcome variables. Results. The cesarean delivery (CD) rate was 2 to 2.5 times higher when EFW was 4000 to 4499 g, regardless of actual BW. Failure to detect macrosomia was associated with higher rates of perineal trauma, 5‐minute Apgar scores less than 7, and neonatal trauma, mostly related to the higher rate of surgical vaginal deliveries. The use of another sonographic model with a lower false‐positive rate could theoretically reduce the CD rate by approximately 5%. Conclusions. False diagnosis of macrosomia substantially increases the CD rate and leads to maternal/neonatal complications.

Sonographic Diagnosis of Ovarian Torsion Accuracy and Predictive Factors

The purpose of this study was to determine the accuracy of sonographic diagnosis of ovarian torsion and the predictive value of typical sonographic signs.

Fetal Sex and Intrauterine Growth Patterns

To analyze the effect of fetal sex on intrauterine growth patterns during the second and third trimesters.

The Contribution of Prenatal Sonographic Diagnosis of Clubfoot to Preventive Medicine

From 1995 through 1997, clubfoot was detected by transabdominal sonography in 13 fetuses of 12 women, in nine bilaterally and in four unilaterally (total, 22 clubfeet). The average menstrual age at diagnosis was 23.6 weeks (range, 17-36). Three fetuses had associated malformations: two were therapeutically aborted and one died 2 weeks after birth. Proper understanding of the significance of prenatal ultrasound findings of clubfoot will assist both the orthopaedist and the parents in reaching a decision concerning future management of their pregnancy.

Subtorsion of the ovary: sonographic features and clinical management.

To define the sonographic imaging criteria of ovarian subtorsion.

Accuracy of sonographic estimation of fetal weight before induction of labor in diabetic pregnancies and pregnancies with suspected fetal macrosomia

Abstract Aims: To evaluate the accuracy of sonographic estimation of fetal weight (EFW) in diabetic pregnancies and pregnancies with suspected fetal macrosomia. Methods: 63 women with diabetic pregnancies, 74 nondiabetic women with suspected largeforgestationalage (LGA) infants, and 161 controls underwent ultrasound assessment prior to induction of labor. EFW was compared to the weight at birth, 1–3 days later. Results: EFW was highly correlated to birth weight. Absolute or actual weight differences between the birth weight and the EFW, and the rate of EFW within 10% of birth weight were not different between the groups.A linear regression model controlling for maternal and gestational age, diagnosis of gestational or pregestational diabetes, birth weight, gravidity, parity, nulliparity, placental location and AFI was not significantly correlated to the absolute or actual weight differences. In pregnancies with suspected LGA, higher birth weight was an independent and significant predictor of high weight difference inaccuracy. Conclusions: The ultrasonographic EFW 1–3 days before delivery is highly correlated with birth weight, reaffirming the clinical use of abdominal circumference and femur length in estimating fetal weight near labor at term. In pregnancies with suspected LGA fetuses and higher prevalence of macrosomia, ultrasound has higher sensitivity but lower specificity than the controls.

Use of the Amniotic Fluid Index Combined With Estimated Fetal Weight Within 10 Days of Delivery for Prediction of Macrosomia at Birth

Objective. The purpose of this study was to assess the value of combining the sonographically estimated fetal weight (EFW) and amniotic fluid index (AFI) measured within 10 days of term delivery for prediction of macrosomia at birth. Methods. Prospective sonographic fetal biometric measurements and delivery ward data of a single center, uploaded separately over a 4‐year period, were retrospectively linked to yield an unselected sample of nondiabetic pregnancies with live‐born term neonates. Results. Of the 1925 pregnancies evaluated, 140 (7.2%) were macrosomic (birth weight ≥4000 g). The AFI was significantly higher in the macrosomic group (P < .001). On receiver operating characteristic curve analysis, the area under the curve was larger for predictions based on the EFW alone than on the AFI. An EFW of 4000 g or higher had a positive predictive value of 46.6% for macrosomia at birth. Use of the previously suggested combined EFW and AFI cutoffs of 3689 g and 119 mm, respectively, yielded a positive predictive value of 30.3%. Conclusions. Combined use of the EFW and AFI rather than the EFW alone does not improve prediction of macrosomia at birth.

Psychological response to multifetal reduction and pregnancy termination due to fetal abnormality

Objective: To investigate the emotional response in cases of multifetal reduction and pregnancy termination and to compare the psychological response between these two groups. Methods: A prospective study in a tertiary-care, university-affiliated medical center. The study group included 65 women who had been advised to terminate pregnancy because of a finding of a severe fetal abnormality on ultrasound screening (pregnancy termination group) and 41 women advised to undergo reduction because of the presence of multiple fetuses (multifetal reduction group). All women underwent psychological testing using validated questionnaires addressing perinatal grief and anxiety levels. Results: Women in both the multifetal reduction and the pregnancy termination groups reported significant degree of grief and anxiety before and after the procedure, although the levels of anxiety on the day of procedure and anxiety and grief at follow up were higher in the pregnancy termination group (t = 2.438, p = 0.016; t = 2.441, p = 0.017; and t = 3.111, p = 0.03, respectively). In both groups there was a gradual decrease in the state anxiety with time (48.01 ± 8.26 to 37.59 ± 9.23; t = −9.931; p < 0.001). Several factors affected the emotional response in the cases, including marital status, level of education, employment status, and gestational age. There was no association between a history of prior perinatal loss and emotional response. Conclusion: There is need for a continuing psychosocial support of women undergoing multifetal reduction and pregnancy termination for fetal abnormalities.