Zvi Leibovitz

Decidualization of Ovarian Endometriosis During Pregnancy Mimicking Malignancy

The purpose of this series is to present deciduosis (the formation of extrauterine decidua) as one of the differential diagnoses of a malignant tumor during pregnancy.

Myometrial thickness in pregnancy: longitudinal sonographic study.

The purpose of this study was to evaluate in vivo the changes in myometrial thickness throughout pregnancy. Myometrial thickness was measured in 25 singleton uncomplicated pregnancies. Ultrasonographic sagittal and transverse sections were used to measure uterine wall thickness from the low anterior wall (lower segment) and the anterior, posterior, right, and left walls of the upper segment and from the fundus. In each case four measurements were made in the second and third trimesters. Myometrial thickness of the upper uterine segment remains fairly constant in the first and second trimesters of pregnancy, whereas a significant linear trend was found between a decreasing thickness of the lower uterine segment and advancing gestational age. Myometrial thickness is significantly increased behind the placental insertion site as compared to other portions of the uterine wall. These data may serve as baseline reference values for further studies in the antepartum fetal surveillance of high‐risk pregnancies.

Cervical varices complicated by thrombosis in pregnancy

We present a case of a 36‐year‐old pregnant woman with varicose veins of the uterine cervix diagnosed during the second trimester. The cervical tissue was completely replaced with dilated venous plexus. Therapeutic decisions were further complicated by the presence of blood clots within the dilated vessels. Pregnancy proceeded uneventfully, no bleeding occurred and the patient underwent a planned Cesarean delivery. This is the first reported case in the medical literature where the rare phenomenon of cervical varices was accompanied by thrombosis. Copyright

Endometrium-to-Myometrium Relative Echogenicity Coefficient

A computer program was developed to assess the endometrial echogenicity relative to the myometrial one, based on the gray-level processing of the midsagittal uterine image. The endometrial region of interest was specified within the upper part of the uterine cavity. The adjacent area of the myometrium was used to determine the reference brightness. The endometrial region of interest was analyzed along the anteroposterior uterine axis, as a set of thin strips directed parallelly to the midcavitary line. The endometrial/myometrial relative echogenicity coefficient (E/M REC) was computed for each strip and displayed graphically as a function of the distance from the midcavitary line. The area under the E/M REC curve within the limits of the total endometrial width was defined as total area (TA) and was used as a measure of the endometrial echogenicity. This parameter was assessed in 9 patients during their normal ovulatory cycles and in 29 IVF-treated patients with mechanical infertility. TA has a significant linear increase during the days of the ovulatory cycles. TA was found in high correlation with log(estradiol). TA can be used reliably for sonographic endometrial dating in ovulatory cycles.

OP33.01: Effect of harmonic imaging, SRI-II, CRI, FFC and coded excitation B-mode features on fetal bowel echogenicity, studied by computerized image analysis

aimed to explore quantifiable sonographic approaches to evaluate uterine involution after vaginal birth. Methods: Eighty-one women who vaginally delivered a singleton at term were recruited. Weekly uterine examinations were performed until 7 weeks after the delivery. Uterine volumes were assessed manually, followed by twoand three-dimensional sonographies. Doppler studies of uterine and arcuate arteries were also carried out. Results: Analysis was achieved in 71 women with uncomplicated postpartum course and complete follow ups. Longitudinal normogram of uterine volumes was created from 497 observations. It demonstrated a steady involution from week 1 to 7 after the delivery. The volume measured by two and three-dimensional sonographies are well correlated (r > 0.7), but not with the manual estimation (r < 0.3). Continuous thinning of endometrial stripes and gradual elevation of uterine artery resistance indices were not correlated with the uterine volume (r < 0.1, and < 0.2, respectively). Resistance indices of the intramural arcuate artery were unchanged for the whole postpartum course. Involution was not affected by parity (r < 0.2). Conclusions: In contrast with traditional belief, the involution process may not be completed yet at 7 weeks after delivery. Uterine involution normogram might facilitate the diagnosis of postpartum uterine complications. Broader applications are expected with the normogram created from two-dimensional data. Additional predictive claims could be achieved with endometrial stripe and uterine artery Doppler indices, since their sequential changes are independent to that of uterine volume.

Primary ovarian ectopic pregnancy misdiagnosed as first-trimester missed abortion.

Primary ovarian ectopic pregnancy is an uncommon ectopic gestation. It accounts for 0.5% to 1% of all ectopic gestations, and its incidence ranges from 1 in 7000 to 1 in 40,000 deliveries. 1 , 2 The clinical appearance varies. It is known to mimic an ovarian tumor or a tubal ectopic pregnancy 3 - 8 but to be misdiagnosed as an asymptomatic 8-week missed abortion is uncommon and makes this an interesting case. In the literature, there have been sparse case reports of primary ovarian ectopic pregnancy mistaken for intrauterine gestation, some of which progressed to the third trimester. 9 - 1 2 We present this case as an example of a misdiagnosed missed abortion and discuss sonographic examination methods to diagnose ovarian ectopic pregnancy.

OC04: Fetal weight estimation for prediction of fetal macrosomia: does additional clinical and demographic data using a pattern recognition algorithm improve detection?

OBJECTIVE The aim of this study was to test whether pattern recognition classifiers with multiple clinical and sonographic variables could improve ultrasound prediction of fetal macrosomia over prediction which relies on the commonly used formulas for the sonographic estimation of fetal weight. METHODS THE SVM ALGORITHM WAS USED FOR BINARY CLASSIFICATION BETWEEN TWO CATEGORIES OF WEIGHT ESTIMATION: >4000gr and <4000gr. Clinical and sononographic input variables of 100 pregnancies suspected of having LGA fetuses were tested. RESULTS Thirteen out of 38 features were selected as contributing variables that distinguish birth weights of below 4000gr and of 4000gr and above. Considering 4000gr. as a cutoff weight the pattern recognition algorithm predicted macrosomia with a sensitivity of 81%, specificity of 73%, positive predictive value of 81% and negative predictive value of 73%. The comparative figures according to the combined criteria based on two commonly used formulas generated from regression analysis were 88.1%, 34%, 65.8%, 66.7%. CONCLUSIONS The SVM algorithm provides a comparable prediction of LGA fetuses as other commonly used formulas generated from regression analysis. The better specificity and better positive predictive value suggest potential value for this method and further accumulation of data may improve the reliability of this approach.

Dizygotic Twin Pregnancy Discordant for Sirenomelia

win pregnancies pose a real challenge to caregivers for several reasons.Maternal and perinatal complications are higher in twins than in singletonpregnancies. Preterm deliveries, a higher rate of structural malformations,and perinatal mortality place twin pregnancies at greater risk. Likewise, theanatomic survey in twin pregnancies is more difficult, and rare malformations mightbe masked by more common conditions. Amniotic fluid volume and fetal growth dis-cordancy may appear either in twin-twin transfusion syndrome (TTTS) or in placen-tal, structural, and genetic disorders of one of the twins. Twin-twin transfusionsyndrome is a complication of monochorionic multiple pregnancies; therefore, adetermination of chorionicity and a thorough scanning for fetal anomalies are nec-essary for proper diagnosis and optimal pregnancy management.We report a case of dizygotic twin pregnancy discordant for sirenomelia referred assuspected TTTS. The diagnostic and management aspects of sirenomelia in twin preg-nancies are discussed.

Prenatal sonographic features of triploidy at 12–16 weeks

The purpose of our study was to describe the sonographic appearance of triploidy in early pregnancy.

Fetal Escape From the Amniotic Sac Follow-up From First Trimester to Delivery

upture of the amniotic membrane with its subsequent disintegration may cause the fetus to appear in the chorionic cavity. This has been described previously as occurring after amniocentesis and fetal surgical procedures1–3; however, the spontaneous escape of the fetus through a defect in the amniotic membrane in the early second trimester is an extremely rare event. In this report, such an “amniotic escape” is presented with its sonographic follow-up and postpartum findings. The clinical importance of this peculiar disorder is discussed.