Walter Plasencia

Comparative Study of Transabdominal and Transvaginal Uterine Artery Doppler Pulsatility Indices at 11–13 + 6 Weeks

Objective. The objective of this study was to compare two approaches to determine the uterine artery pulsatility index (PI) as a screening measure for preeclampsia. Methods. Comparative analysis of the PI values obtained from transabdominal and transvaginal Doppler ultrasound in 351 women with singleton pregnancies who were examined between May and June 2009 during routine morphological study and risk calculation of chromosome anomalies at 11–13 + 6 weeks of gestation. Results. The mean PI measured transabdominally was 1.83 [95% confidence interval (CI) 1.78–1.89], but when measured transvaginally it was 1.98 (95% CI 1.93–2.08) (p < 0.05). Transabdominal mean PI was observed to decrease as the crown-rump length (CRL) increased: 1.96 (95% CI 1.80–2.12) for CRL <60 mm and 1.71 (95% CI 1.56–1.87) for CRL ≥70 mm (p < 0.05). The transvaginally measured indices were 2.09 (95% CI 1.93–2.26) and 1.78 (95% CI 1.64–1.92), respectively, for the same CRL groups (p < 0.05). A weak correlation was found between the mean PI and the mean CRL using Spearmans rho correlation (–0.20 for abdominal measures and –0.21 for vaginal measures, p < 0.001). Conclusions. Transabdominal and transvaginal Doppler ultrasound measurements of the uterine artery PI were significantly different. The latter approach yielded significantly higher values than the first.

First‐trimester screening for large‐for‐gestational‐age infants

To examine the relationship between newborn birth weight and first‐trimester uterine artery (UtA) pulsatility index (PI), maternal characteristics, serum pregnancy‐associated plasma protein‐A (PAPP‐A), free β‐human chorionic gonadotropin (β‐hCG) and fetal nuchal translucency (NT) thickness. We also examined the results of screening for large‐for‐gestational‐age (LGA) neonates by an integrated first‐trimester approach incorporating these parameters.

Effect of pregestational diabetes mellitus on first trimester placental characteristics: Three-dimensional placental volume and power Doppler indices

OBJECTIVE To investigate whether pregestational diabetes mellitus (DM) induces changes in vascular placental development detectable at first trimester. METHODS This was a prospective case-control study in 69 women with pregestational DM and 94 controls undergoing first-trimester combined screening for aneuploidies. Maternal characteristics, fetal nuchal translucency thickness, maternal serum pregnancy-associated plasma protein A (PAPP-A) and free β human chorionic gonadotrophin (β-hCG) were evaluated. Three-dimensional ultrasound was used to measure placental volume and three dimensional power Doppler (3D-PD) placental vascular indices including: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Pregnancy-associated hypertensive complications (PAHC) and perinatal outcomes were analyzed. The total group of diabetic women and the group of diabetic women without PAHC were compared separately with the control group. RESULTS 3D-PD placental vascular indexes were significantly lower in women with DM than in controls (VI p = 0.007, FI p = 0.003 and VFI p = 0.04). These differences remained on excluding cases with PAHC in the DM group. No differences were found in placental volumes between the DM group and controls. Serum PAPP-A levels were also lower in diabetic women (p < 0.02) and negatively correlated with the degree of maternal metabolic control at first trimester. CONCLUSIONS Pregestational DM induces demonstrable alterations in first trimester placental development, with significantly reduced placental vascularization indices and PAPP-A values. This effect is independent of the later development of PAHC.

First trimester placental volume and vascular indices in pregnancies complicated by preeclampsia

To analyze placental volume and vascularization at first trimester in women with pre‐eclampsia, and secondarily, the effect of maternal characteristics on placental development and perinatal outcomes.

The effect of customized growth charts on the identification of large for gestational age newborns

Objective: To determine the effect of using customized vs. standard population birthweight curves to define large for gestational age (LGA) infants. Methods: We analyzed data obtained from 2,097 singleton pregnancies using three different methods of classifying newborn birthweight: standard population curves, British or Spanish customized curves. We recorded maternal characteristics, proportion of LGA newborns when using each method, percentage of LGA according to one method but not for the others, and concordance between the different methods. Results: The proportion of LGA newborns according to Spanish customized curves was significantly lower than that calculated using either standard general population birthweight curves or British curves (p < 0.001). A third (33.9%) of the infants classified as LGA according to the general population method were adequate for gestational age (AGA) when the Spanish customized curves were used, and 18.5% of non-LGA were LGA according to customized curves (p < 0.001). Concordance between the different models high, but on excluding AGA the concordance coefficient was low (Cohen’s κ <0.4). Conclusions: The use of customized curves allows differentiation between constitutional LGA and cases of fetal overgrowth, leading to a decrease in the rate of both false-positives and negatives as well as the overall proportion of LGA babies.

Role of ultrasound in the labor ward.

Intrapartum ultrasound is commonly used to evaluate fetal vitality, presentation and status as well as placental location. Health professionals are increasingly using intrapartum ultrasound for advanced applications that have not yet been shown to be effective by controlled research studies, using advanced ultrasound technologies such as bi-dimensional ultrasound, color ultrasound, pulsed Doppler ultrasound and three-dimensional ultrasound. This article reviews the current applications of intrapartum ultrasound and considers which advanced technologies can add to the standard of care in the delivery ward.

Prenatal diagnosis and tridimensional ultrasound features of bilateral femoral hypoplasia--unusual facies syndrome.

The femoral hypoplasia – unusual facies syndrome is a rare disorder, which was described first three decades ago. It is characterised by the occurrence of short femurs with certain associated alterations mainly affecting the face, of which micrognathia is the most frequently found. Although the etiology of this condition is unknown, clear relationship with maternal insulin-dependent diabetes has often been reported, which suggests some sort of inherited component. Nevertheless, most cases occur sporadically. This entity is usually diagnosed after birth because prenatal ultrasound detection is rather difficult. Here, we report a case of prospective detection. So far, such cases have been seldom described in the literature.

Tratamiento laparoscópico de la endometriosis vesical

Resumen Presentamos dos casos de endometriosis vesical, que se resolvieron favorablemente y sin complicaciones mediante un abordaje laparoscopico. Se hace una revision amplia del tema en la bibliografia, que permite proponer la laparoscopia como el tratamiento de eleccion ante esta localizacion

Intracranial fetal hemorrhage due to choroid plexus papilloma.

Various pathologies may trigger cerebral hemorrhage during the fetal period. Intracranial hemorrhages (ICH) are very rare occurrences and intracranial papilloma can be a cause of ICH. This case concerns a 34-year-old healthy pregnant woman who had no significant medical history and whose initial ultrasound exams revealed normal fetal anatomy and growth. An ultrasound scan at 36 weeks revealed a 35×22 mm tumor in the interior of the right posterior horn (Fig. 1). The tumor was hyperechogenic with an irregular surface and perilesional vascularization. No obstruction to the ventricular system was found. The peak flow speed from the medium cerebral artery was 1.5 MoM for the age of gestation. A diagnosis of an intraventricular tumor was made, compatible with choroid plexus papilloma. Consensus was reached to end gestation via cesarean delivery to prevent a secondary hemorrhage during natural childbirth. At 37 weeks of pregnancy a male neonate was delivered weighing 2885 g, with an Apgar score of 9/10 and an arterial pH of 7.29. The newborn was admitted to the neonatal intensive care unit where cranial MRI and cranial ultrasound were carried out. This revealed a large mass in the right lateral ventricle and associated cysts that had displaced the cerebral parenchyma to the frontal region (Figs. 2 and 3). Cerebral arteriography was carried out, followed by embolization and a right temporal craniotomy and complete removal of the mass. The infant currently has normal neurologic development and is progressing well. ICH is observed in utero as hyperechogenic cerebral images on ultrasound [1]. It is usually associated with various maternal medical histories such as thrombocytopenia, hemorrhagic diathesis, or hypertension in pregnancy [2]. ICH caused by a choroid plexus papilloma is rare [2,3]. Diagnosis is made during ultrasound examinations and various manifestations can be identified, such as encephalic parenchyma, hyperechogenic lesions, ventriculomegaly, and periventricular leucomalacia, which may lead to development of severe hydrocephalus and seriously impact neurological development [1,2,4]. This wide range of ultrasoundmanifestations of the damage caused by ICH is an indication of the number of possible prognoses. Nuclear magnetic resonance imaging is the next step in diagnosing these lesions. In cases of ICH, the intensity of the image in T1 is increased compared with the healthy brain tissue, which can contribute to the diagnosis [1].

A rare cause of polyhydramnios: Neu–Laxova syndrome

Neu–Laxova syndrome is a rare group of congenital malformations including intrauterine growth retardation (IUGR), microcephaly, central nervous system alterations, facial abnormalities, ichthyosis, limb abnormalities, generalized edema, polyhydramnios, and perinatal death. Thirty cases have been identified since the publication of the first two cases and only five of them had a prenatal diagnosis. The earliest diagnosis in a published case was at week 32 of gestation. This study illustrates that the detection of the syndrome during the second trimester of gestation is possible, with emphasis on the detection of the early appearance of polyhydramnios and the association of the syndrome with the Arabic ethnic group.