Blog dedicated to the continuous education in Gynecology and Endocrinology

 

SCREENING FOR TWIN-TWIN TRANSFUSION SYNDROME AT 11-14 WEEKS OF PREGNANCY: THE KEY ROLE OF DUCTUS VENOSUS BLOOD FLOW ASSESSMENT.

5) Ultrasound Obstet Gynecol. 2010 Feb;35(2):142-8.

Matias A, Montenegro N, Loureiro T, Cunha M, Duarte S, Freitas D, Severo M.

OBJECTIVES: A discrepancy in crown-rump length (CRL) and/or nuchal translucency thickness (NT) between monochorionic twins has been found to be associated with an increased risk of twin-twin transfusion syndrome (TTTS). As one of the most plausible mechanisms for increased NT is hemodynamic imbalance and cardiac dysfunction, indirectly manifested by abnormal blood flow in the ductus venosus (DV), we aimed to clarify the role of DV blood flow assessment in identifying those monochorionic twins more prone to develop TTTS. METHODS: We present 99 cases of monochorionic diamniotic twin pregnancies in which CRL, NT and DV blood flow were evaluated at 11-14 weeks’ gestation. RESULTS: Discrepant values of CRL were not predictive of TTTS development. Intertwin NT discrepancy >or= 0.6 mm had a sensitivity of 50.0% and a specificity of 92.0%. The presence of at least one abnormal blood flow waveform in the DV was associated with a relative risk for developing TTTS of 11.86 (95% CI, 3.05-57.45), with a sensitivity of 75.0% and a specificity of 92.0%. The combination of abnormal DV blood flow with NT discrepancy >or= 0.6 mm yielded a relative risk for the development of TTTS of 21 (95% CI, 5.47-98.33). CONCLUSIONS: Both intertwin discrepancy in NT and abnormal flow in the DV in monochorionic twins may represent early manifestations of hemodynamic imbalance between donor and recipient. In these pregnancies, in addition to NT measurement at 11-14 weeks, the Doppler assessment of DV blood flow significantly increases the performance of screening for those at risk of developing TTTS.

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AUTOMATED ASSAYS FOR SVEGF R1 AND PLGF AS AN AID IN THE DIAGNOSIS OF PRETERM PREECLAMPSIA: A PROSPECTIVE CLINICAL STUDY.

3) Am J Obstet Gynecol. 2010 Jan;202(1):40.e1-7.

Sunderji S, Gaziano E, Wothe D, Rogers LC, Sibai B, Karumanchi SA, Hodges-Savola C.

OBJECTIVE: The purpose of this study was to assess the utility of soluble vascular endothelial growth factor 1 (sVEGF R1) and placental growth factor (PlGF) levels in the clinical diagnosis of preeclampsia. STUDY DESIGN: Plasma was collected prospectively from 457 subjects (n = 409 without preeclampsia, n = 48 with preeclampsia) at 20-36 weeks’ gestation. Automated immunoassays were used to measure free sVEGF R1 and free PlGF. RESULTS: Clinical sensitivities of 0.96 and specificities of 0.96 and 0.95 were calculated for sVEGF R1 and PlGF, respectively, for aiding in the diagnosis of preeclampsia. Among subjects with chronic hypertension, sVEGFR1 was dramatically elevated and PlGF decreased in those with superimposed preeclampsia (P < .001 for superimposed preeclampsia vs chronic hypertension for both biomarkers). The ratio of sVEGFR1/PlGF provided a better test to aid in the diagnosis of preeclampsia than either analyte alone (3% false positive rate). CONCLUSION: Free sVEGF R1 and PlGF were useful in differentiating women with preterm preeclampsia from normotensive and hypertensive subjects.

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AMNIOVACUCENTESIS VS STANDARD SYRINGE TECHNIQUE FOR AMNIOCENTESIS: EXPERIENCE WITH 1219 CASES

6) Am J Obstet Gynecol. 2009 Dec;201(6):593.e1-3.

Calda P, Brestak M.

OBJECTIVE: The aim of the study was to compare amniovacucentesis to the usual syringe use for amniotic fluid aspiration.

STUDY DESIGN: We compared 2 groups of procedures: 1117 amniocenteses performed with the usual syringe technique and 1219 amniovacucenteses. more

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Pregnancy outcome following genetic maternal cryiopreservation

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Pregnancy outcome following genetic maternal cryiopreservation
Schenker J.

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DOPPLER VELOCIMETRY OF THE UTERINE, UMBILICAL AND FETAL MIDDLE CEREBRAL ARTERIES IN PREGNANT WOMEN UNDERGOING TOCOLYSIS WITH ORAL NIFEDIPINE

7) Ultrasound Obstet Gynecol. 2009 Sep;34(3):311-5

Lima MM, Souza AS, Diniz C, Porto AM, Amorim MM, Moron AF.

OBJECTIVES: To evaluate Doppler velocimetry (resistance index (RI) and peak systolic velocity (PSV)) in the maternal-fetal circulation before and 5 and 24 h after tocolysis with oral nifedipine.

METHODS: This was a prospective, observational, analytic cohort study performed in 47 pregnant women undergoing nifedipine tocolysis, each subject acting as her own control. Doppler assessment of uterine, umbilical and fetal middle cerebral (MCA) arteries was performed before and 5 and 24 h after an initial 20-mg sublingual dose, which was repeated twice at 20-min intervals if contractions failed to diminish. The maintenance dose consisted of 20 mg orally every 6 h for 24 h up to a total of 100-120 mg nifedipine. We analyzed whether there was a time effect and compared values at the different time-points. more

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