RESUMEN

Objective: This study aimed to investigate the effects of the presence of subchorionic hematoma (SH) in early pregnancies with threatened miscarriage (TM) on levels of first-trimester maternal serum markers, pregnancy-associated plasma protein-A (PAPP-A), and free ß-human chorionic gonadotropin (ß-hCG) levels. Methods: The data of TM cases with SH in the first trimester between 2015 and 2021 were evaluated retrospectively. The data of age and gestational age-matched TM cases without SH were also assessed to constitute a control group. Demographic characteristics, obstetric histories, ultrasonographic findings, and free ß-hCG and PAPP-A levels of the groups were compared. Results: There were 119 cases in the study group and 153 cases in the control group. The median vertical and longitudinal lengths of the SH were 31 mm and 16 mm. The median age of both groups was similar (p=0.422). The MoM value of PAPP-A was 0.088 (.93) in the study group and 0.9 (0.63) in the control group (p=0.519). Similarly, the MoM value of free ß-hCG was 1.04 (0.78) in the study group and 0.99 (0.86) in the control group (p=0.66). No significant relationship was found in the multivariate analysis between free ß-hCG MoM, PAPP-A MoM, age, gravida, and vertical and longitudinal lengths of the hematoma (p>0.05). Conclusion: The level of PAPP-A and free ß-hCG were not affected by the SH. Therefore, these markers can be used reliably in TM cases with SH for the first-trimester fetal aneuploidy screening test.

Asunto(s)

RESUMEN

OBJECTIVE: To gather additional data on pregnancy outcome when a chorionic bump is detected at the time of the 11- to 13-week scan. METHODS: The presence of a chorionic bump was prospectively recorded in a database of women presenting for their first-trimester sonographic screening. Clinically relevant information was obtained by reviewing ultrasound reports and medical records or contacting the referring obstetrician or the parents themselves. RESULTS: During a 4.5-year study period from June 2014 to December 2018, a chorionic bump was identified in 23 out of 3375 pregnancies, for a prevalence of 1/147 or 0.7%. All women were asymptomatic at the time of evaluation. The chorionic bump was single in 21 (91%) cases, located in the central part of the placenta in 17 (74%) cases, and the median largest diameter was 20 mm (range, 10-43). Although the placenta was low-lying in 14 (61%) cases, all but one patient had a normally located placenta at the midtrimester anatomy scan. With the exception of one pregnancy complicated with trisomy 21, the outcome was universally good. CONCLUSION: Our experience suggests that a chorionic bump detected during the 11- to 13-week scan is usually a transient, is incidental finding, and probably has no clinical significance.

Asunto(s)

RESUMEN

BACKGROUNDS/AIMS: To assess the perinatal outcome of pregnancies with chorionic bump detected at the first trimester of pregnancy. METHODS: This was a nested case-control study of pregnancies with chorionic bump identified at the first trimester ultrasound that was performed from October 2014 and October 2016. The control group consisted of the following 5 unaffected pregnancies after each case. From the first trimester ultrasound, maternal and perinatal characteristics were obtained and stored in a dedicated database. The primary outcome was defined as the presence of an alive new-born. Secondary outcome was defined as the presence of a composite adverse obstetric outcome. RESULTS: Eleven first trimester pregnancies affected by a chorionic bump and 55 controls were identified. The primary outcome was observed in 72.7 and 89.1% of chorionic bump and controls respectively (p = 0.2). The secondary outcome was observed in 45.5% of pregnancies with a chorionic bump versus 12.7% in the unaffected group (p = 0.01). First trimester uterine artery Doppler demonstrated a non-significant trend to be higher in the chorionic bump group. CONCLUSIONS: The presence of a chorionic bump is associated with a significant higher risk of adverse perinatal outcome.

Asunto(s)

RESUMEN

RESUMEN La protuberancia coriónica (del inglés chorionic bump) es una condición que involucra al saco gestacional y que puede ser visualizada en la ecografía de primer trimestre. Ha sido descrita como una convexidad irregular que protruye hacia el saco gestacional y que probablemente corresponda a la formación de un hematoma en la superficie coriodecidual. Nosotros reportamos los hallazgos y el seguimiento ecográfico de un caso, junto con una revisión de la literatura.

SUMMARY Chorionic bump is a condition that involves the gestational sac and can be viewed during the first-trimester ultrasound scan. It has been described as an irregular convexity protruding into the gestational sac and probably corresponds to the formation of a hematoma within the choriodecidual surface. We reported both the sonographic findings and follow-up of a case, along with a review of the literature.

Asunto(s)

RESUMEN

BACKGROUND: Since the results of the Management of Myelomeningocele Study were published, maternal-fetal surgery for the in utero treatment of spina bifida has become accepted as a standard of care alternative. Despite promise with fetal management of myelomeningocele repair, there are significant complications to consider. Chorioamniotic membrane separation and preterm premature rupture of membranes are known complications of invasive fetal procedures. Despite their relative frequency associated with fetal procedures, few data exist regarding risk factors that may be attributed to their occurrence or the natural history of pregnancies that are affected with chorionic membrane separation or preterm premature rupture of membranes related to the procedure. OBJECTIVE: The objective of this study was to review chorioamniotic membrane separation and preterm premature rupture of membranes in a cohort of patients undergoing fetal management of myelomeningocele repair including identification of risk factors and outcomes. STUDY DESIGN: This was a retrospective review of patients undergoing fetal management of myelomeningocele repair and subsequent delivery from January 2011 through December 2013 at 1 institution. Patients were identified through the institutional fetal management of myelomeningocele repair database and chart review was performed. Perioperative factors and outcomes among patients with chorioamniotic membrane separation and preterm premature rupture of membranes were compared to those without. Risk factors associated with the development of chorioamniotic membrane separation and preterm premature rupture of membranes were determined. RESULTS: A total of 88 patients underwent fetal management of myelomeningocele repair and subsequently delivered during the study period. In all, 21 patients (23.9%) were diagnosed with chorioamniotic membrane separation by ultrasound and preterm premature rupture of membranes occurred in 27 (30.7%). Among the chorioamniotic membrane separation patients, 10 (47.6%) were diagnosed with global chorioamniotic membrane separation and 11 (52.4%) with local chorioamniotic membrane separation. Earlier gestational age at the time of fetal surgery was a significant risk factor for the development of chorioamniotic membrane separation (P = .01) and preterm premature rupture of membranes (P < 0.0001). Chorioamniotic membrane separation was significantly associated with preterm premature rupture of membranes (59.1% vs 21.2%, P = .008) and earlier gestational age at delivery (32.1 ± 4.2 vs 34.4 ± 3.5 weeks, P = .01). The average number of days from chorioamniotic membrane separation to preterm premature rupture of membranes was 11.0 ± 10.1 and from chorioamniotic membrane separation to delivery was 31.0 ± 22.5. The mean time interval between fetal management of myelomeningocele repair and preterm premature rupture of membranes was 47.9 days. Mean latency period from preterm premature rupture of membranes to delivery was 25 days. Gestational age at delivery was significantly lower in patients with preterm premature rupture of membranes (31.6 ± 3.4 vs 34.9 ± 3.5 weeks, P = .0001). Using logistic regression analysis, nulliparity, gestational age at fetal management of myelomeningocele repair, and membrane separation remained significant risk factors for preterm premature rupture of membranes. CONCLUSION: Chorioamniotic membrane separation after fetal management of myelomeningocele repair is a significant risk factor for subsequent development of preterm premature rupture of membranes and preterm delivery. Fetal management of myelomeningocele repair <23 weeks is associated with higher rates of preterm premature rupture of membranes and chorioamniotic membrane separation. Therefore fetal management of myelomeningocele repair should be deferred until ≥23 weeks to mitigate these complications. Nulliparity also appears to increase the risk for preterm premature rupture of membranes.

Asunto(s)

RESUMEN

La ecografía es uno de los métodos de diagnóstico gestacional más utilizados, que permite confirmar una gestación temprana y realizar seguimientos del desarrollo embrio-fetal. En este estudio se emplearon 10 gatas gestantes, entre 10 meses a 6 años de edad, con fecha de cruza conocida. Se realizaron exámenes ecográficos seriados en los días 15 (estadio 1), 18 (estadio 2), 21 (estadio 3), 38 (estadio 4), y 45 (estadio 5) de gestación para medir parámetros biométricos. Vesícula coriónica: diámetro transversal (DTVC), diámetro longitudinal (DLVC); Placenta: grosor (GP); Feto: longitud céfalo-caudal (LCC), diámetro toraco-abdominal (DTA), diámetro cefálico (DC), tomándose un registro fotográfico de cada estadio. En el estadio 1, no se logró visualizar el embrión. En el estadio 2, el embrión se observó cercano a la pared midiendo en promedio 4,7 milímetros de LCC, el tubo endocárdico se observó funcional. En el estadio 3, se observó el cordón umbilical, pero resultó difícil distinguir los diferentes órganos, excepto el corazón, debido al movimiento causado por sus latidos. En el estadio 4, el feto adquiere movimientos, se observó órganos como el encéfalo, pulmones, el tabicamiento del corazón, diafragma, hígado, estómago, asas intestinales, vejiga y la osificación de huesos. Se observó la flexión de los miembros. En los miembros anteriores se visualizaron los dedos separados, con garras y cojinetes plantares. En el estadio 5, además de las características observadas en el estadio anterior, los riñones muestran la corteza y médula, las cámaras del corazón se visualizaron claramente. Se realizó una correlación lineal entre los parámetros biométricos estudiados y los resultados dieron valor significativo (p<0,0001) para la mayoría de éstos. Se logró caracterizar los estadios gestacionales estudiados. Siete de las diez gatas presentaron una gestación normal, mientras que una de ellas presentó en uno de sus fetos una malformación congénita y en las otras dos gatas se presentó muerte embrio-fetal.

Ultrasound is one of the most widely used methods for gestational diagnosis, allowing the detection of early pregnancy and evaluation of fetal growth and development. Ten pregnant cats (aged 10 months to-6 years) were used in this study, with known dates of mating. Serial ultrasound testings were performed on days 15th (stage 1), 18th (stage 2), 21st (stage 3), 38th (stage 4) and 45th (stage 5) of gestation, to measure biometric parameters (Chorionic vesicle: transverse diameter (DTVC), longitudinal diameter (DLVC); Placenta: thickness (GP); Fetus: cephalocaudal length (LCC), thoraco-abdominal diameter (DTA), cephalic diameter (DC). Photographic records were made at each stage. In stage 1, it was impossible to visualize the embryo. In stage 2, the embryo was observed near the wall measuring 4.7 mm on average LCC, and the endocardial tube was functioning. In stage 3, the umbilical cord was observed, but it was difficult to distinguish different organs, with the exception of the heart, which was detected by heartbeat movements. In stage 4, the fetus begins to move. Organs, such as the brain, lungs, heart septation, diaphragm, liver, stomach, bowel, bladder and bone ossification were observed. In the forelimbs, fingers apart with claws and footpads were visualized. In stage 5, in addition to the features observed in the previous stage, the kidneys show the cortex and medulla, and the heart chambers are clearly visualize. A linear correlation analysis among the biometric parameters was performed. Results were statistically significant for most parameters studied (p<0.0001). We characterized the gestational stages studied. Out of the ten cats studied, seven cats had a normal pregnancy. One cat showed one congenitally malformed fetus, and one fetal death occurred in the other two cats.

Asunto(s)

Asunto(s)

RESUMEN

Twins, specially those of monochorionic and monoamniotic pregnancies, are exposed to many perinatal risks and complications. The objective of this study was to evaluate the usefulness of ultrasonographic determination of the chorionicity of human placental by counting the number of layers in amniotic membranes. Thirty-eight patients with twin pregnancies were studied prospectively. The ultrasonographic evaluation of membranes layers was made only once, between the weeks and 16 and 30 of pregnancy. When two layers were identified, the placentation was determined as monochorionic, and when four layers were seen, the diagnosis of bichorionic placentation was made. The type of chorionicity was confirmed by histologic study of the placenta. With ultrasound, the chorionicity was correctly determined in 36 out of 38 cases, for a total predictive value of 94.6%. The capacity for diagnosing bichorionic (4 layers) placentation was 100% (22/22) and 87.6% (14/16) for monochorionic (2 layers) placentation. The ultrasonographic evaluation of the amniotic membranes number is an efficient method to recognize the chorionicity of placenta and constitutes an useful and simple method giving important information in perinatal prognosis.

Asunto(s)