Tomiałowicz M

Quantitative assessment of placental vasculature and placental volume in normal pregnancies with the use of 3D Power Doppler

PURPOSE The aim of the study was to determine reference values for placental vascular indices and placental volume according to gestational age. MATERIAL/METHODS The assessment of placental vascular indices and placental volume using 3D Power Doppler and the Virtual Organ Computer-aided Analysis (VOCAL) technique was performed on 100 normal fetuses between 22 and 41 weeks of gestation. In this study the method of the individual setting of the power Doppler gain value was used. Only patients with entirely visualized placenta were included in the study. RESULTS No statistically relevant difference in the values of placental vascular indices and placental volume between different localizations of the placenta was detected. No statistically significant changes to placental vascular indices depending on gestational age were found. It enabled to determine the 10th, 50th and 90th percentile values for the vascularization index (VI), flow index (FI), vascularization-flow index (VFI), which are independent of gestational age. No correlation was found between placental volume and placental vascular indices. CONCLUSIONS The values of placental vascular indices are constant between the 22nd and 41st week of a normal pregnancy. Placental volume measured with the use of the VOCAL program increases between 22nd and 41st week of a normal pregnancy. In a normal pregnancy the placental vasculature increases adequately to the increase of its volume. The method of the individual setting of the power Doppler gain value makes it possible to achieve comparable values of placental vascular indices regardless of the distance between the probe and the placenta.

OC20.04: Ultrasonographic features of Cesarean scars in non-pregnant uterus after single and multiple Cesarean sections

Objectives: To assess the association between ultrasonographic parameters of the Cesarean scar in non-pregnant uterus and the number of previously performed Cesarean sections. Methods: The study group included 310 non-pregnant women with a history of low transverse Cesarean section with single-layer uterine closure. The transvaginal ultrasound was performed to assess the following parameters of the Cesarean section scar: the thickness of the knit tissue scar segment (G) and in case of visualization of a triangular shaped anechoic scar defect the basis (P) and height (W) of this triangle. G/P index and G/W index values were also calculated. Results: Transvaginal sonography enabled the visualization of the Cesarean section scar in 308/310 of the examined women (99.4%). In 55/310 cases (17.7%) the completely knit hysterotomy scar tissue was identified. In the remaining group of 255/310 women (82.2%) an anechoic triangle, defined as scar defect, was observed. The mean thickness of the knit tissue scar segment (G) after single, two and three Cesarean sections was: 9.9 mm, 8.0 mm and 4.1 mm, respectively. Statistically important decrease in the G values with the number of previous performed Cesarean sections was observed. The mean G/P index values after single, two and three Cesarean sections were as follows: 1.68, 1.53 and 0.8. The mean G/W index values were: 2.8, 1.9, 0. 9, respectively. No significant difference in the G/P index values was found between patients after one and two Cesarean sections. Statistically important decrease in G/P index values in the group of patients after three Cesarean sections comparing to the patients after one (0.80 vs. 1.68, P < 0.05) and two Cesarean sections (0.8 vs. 1.53, P < 0.05) was observed. Statistically important decrease in the G/W index values was found between the groups of women after one, two and three Cesarean sections. Conclusions: The thickness of the knit tissue scar segment (G) and the G/W index values decrease with the number of previous performed Cesarean sections.

Unilateral and unilocular adnexal cysts in postmenopausal women: a diagnostic and therapeutic problem

Wstęp: Jednostronne cysty proste przydatków stanowią istotny problem współczesnej ginekologii. W okresie menopauzalnym ok. 10% rozpoznawanych guzów przydatków ma charakter złośliwy. Istotna jest zatem odpowiedź na pytanie, czy stwierdzana w badaniu ultrasonograficznym (USG) torbiel prosta wymaga każdorazowo leczenia operacyjnego, czy też można przyjąć postawę wyczekującą. Cel pracy: Ocena częstości występowania nowotworów złośliwych jajnika w przypadku jednostronnych, jednokomorowych cyst prostych przydatków stwierdzanych w przezpochwowym badaniu USG u kobiet w wieku menopauzalnym. Materiał i metody: Badaniem objęto 90 pacjentek w okresie menopauzy, w wieku 50–81 lat, u których stwierdzono obecność zmian w obrębie przydatków, poddanych badaniu USG przezpochwowemu w skali szarości z zastosowaniem kolorowego dopplera, następnie leczonych chirurgicznie w Katedrze i Klinice Ginekologii i Położnictwa Uniwersytetu Medycznego we Wrocławiu. Wyniki: W materiale pooperacyjnym w 89 przypadkach (98,89%) rozpoznano zmiany o charakterze łagodnym. Najczęściej stwierdzano cystis serosa ovarii (65,6%). W jednym preparacie (1,1%) rozpoznano zmianę nowotworową o granicznej złośliwości cystadenofibroma papillare serosum ovarii casus limitans. Wnioski: Częstość występowania nowotworów o charakterze złośliwym w zmianach opisywanych w badaniu USG jako jednostronne cysty proste przydatków u kobiet w wieku menopauzalnym w badanej grupie była niska. Większość guzów okazała się zmianami łagodnymi. Pozwala to rozważać odstąpienie od leczenia chirurgicznego u kobiet w okresie menopauzalnym, zwłaszcza obciążonych internistycznie, u których stwierdzono w obrębie przydatków zmiany o charakterze jednostronnych cyst prostych, szczególnie gdy ich największy wymiar nie przekracza 50 mm. Słowa kluczowe: menopauza, cysty proste przydatków, rak jajnika.

Comment on the article "accuracy and reliability of fetal heart rate monitoring using maternal abdominal surface electrodes".

Sir, We found the article by Cohen et al. in the November issue of AOGS, regarding fetal heart function monitoring with electrodes placed on the abdomen of a pregnant woman during labor (fetal electrocardiography), very interesting (1). We are particularly interested in the ratio of cases in which achievement of an electric signal from the fetal heart was successful enough for it to be read, recorded and evaluated; and therefore satisfactory for application of the method for antelabor and intralabor monitoring of the fetal condition. In a study at our center we applied transabdominal monitoring to 612 women between 28 and 42 weeks of gestation in an uncomplicated pregnancy, and in 91 cases of a pregnancy complicated by fetal intrauterine growth restriction or pregnancy-induced hypertension, as well as in 84 cases complicated by imminent preterm delivery. Examinations were performed using the KOMPOREL system (ITAM, Zabrze, Poland), with an electrode placement scheme almost identical to the scheme applied in the Santa Monica system (2). The mean value of electric signal loss was 32%. This value is comparable with those reported by Cohen et al. and obtained during monitoring on the first stage of delivery, which may be assumed to be similar to the conditions for examination applied by our team. However, in many cases the loss was much more pronounced. From the practical point of view, a loss of fetal heart rate signals in between 20% and 30% of cases, results in a cardiotocography record quality that makes any interpretation of results of the examination impossible. FIGO recommendations mention 20% as an acceptable signal loss (3). In our material we did not find any correlation between the value of signal loss and body mass index of the pregnant women. A slightly better ratio of patients with loss below 20% during the first stage of the delivery has been presented by Reinhard et al.; however, there were only 144 patients included in the study (4). In our opinion, application of transcutaneous fetal electrocardiography as a method of fetal heart rate monitoring may be limited both before and during delivery, because of the impossibility of foreseeing the value of signal loss, which hinders or even makes impossible proper fetal supervision.