Fetal maxillary and mandibular length in normal pregnancies from 11 weeks' to 13+6 weeks' gestation: A Taiwanese study

ObjectivesThis study aims to establish the normal range of maxillary and mandibular lengths within the Taiwanese population at 11⁺⁰ weeks to 13⁺⁶ weeks of gestation in normal singleton pregnancy as a reference value for prenatal ultrasonographic examinations.Materials and methodsWe examined nuchal translucency in 269 normal singleton pregnancies, with the gestational age ranging from 11 weeks to 13⁺⁶ weeks in this study. Fetal biometric measurements, with an emphasis on maxillary and mandibular lengths, were obtained from the patients during consecutive routine prenatal ultrasonographic examinations.ResultsMaxillary and mandibular lengths were recorded successfully in 191 patients and 179 patients, respectively. The mean maternal age was 31 years (range 19–45 years), with a corresponding gestational age of 12 + 4 weeks (range, 11⁺⁰–13⁺⁶ weeks). A first-degree correlation was found to exist between the gestational age and maxillary length (r = 0.596; p < 0.0001; y = 1.491 × GA − 10.523) as well as mandibular length (r = 0.465; p < 0.0001; y = 1.050 × GA − 6.50).ConclusionNormative data for ultrasonographic measurements of maxillary and mandibular lengths within the Taiwanese population were presented. Our data can serve as a reference value in congenital anomaly screening during prenatal examination.     

The effect of glucose tolerance test on fetoplacental circulation

ObjectiveAcute hyperglycemia affects the fetoplacental circulation. This study aims to investigate the possible effect of acute hyperglycemia induced by 50 g oral glucose tolerance test (OGTT) on fetoplacental circulation in women between 24 and 28 weeks of gestation.Materials and methodsBetween January 2019 and April 2019, a total of 29 women who were between 24 and 28 weeks of gestation with a singleton gestation and were in low-risk group were included in this prospective study. All patients underwent fetal biometric measurements using ultrasonography (USG) and were administered 50 g OGTT. Before and 1 h after the test, Doppler USG was used to measure uterine artery, umbilical artery (UA), middle cerebral artery (MCA), pulsatility index (PI), resistance index (RI), and systolic/diastolic (S/D) ratio. The cerebroplacental ratio (CPR) was calculated as the ratio of the MCA-PI/UA-PI.ResultsThere was a decline in the MCA-RI (p = 0.008) and UA-PI (p = 0.021) at 1 h after the administration of 50 g OGTT. Z-scores of the mean UA-PI, MCA-PI, and CPR were calculated and a statistically significant increase in the Z-scores of the mean UA-PI was observed (p = 0.028).ConclusionOur study results show that acute hyperglycemia induced by OGTT significantly increases the Z-scores of the UA-PI, affecting the fetoplacental circulation.     

Maternal hemodynamics influence fetal hemodynamics in normal and hypertensive pregnancy

ObjectivesThis observational case-control study aims to test whether there is a relationship between maternal systemic hemodynamics, maternal renin-angiotensin system and fetal hemodynamics in normal and hypertensive pregnancy.Study designFour groups of non-pregnant women (n = 18), pregnant controls (n = 25), women with gestational hypertension (n = 21) and preeclampsia (n = 10) were included.Main outcome measuresMaternal echocardiography parameters, plasma renin and aldosterone were correlated with fetal Doppler parameters in third trimester pregnancy.ResultsHigher maternal mean arterial pressure and total peripheral vascular resistance were associated with lower fetal middle cerebral artery pulsatility index (PI) (r = ?.51, p < 0.01 and r = ?.49, p < 0.01, respectively); mean arterial pressure correlated negatively with ductus venosus PI (r = ?.35, p = 0.01); higher maternal plasma aldosterone levels were associated with lower maternal uterine artery resistance (r = ?0.33, p = 0.03).ConclusionsIt seems that maternal hemodynamics influence fetal hemodynamics with protective adaptation in fetal cerebral and ductus venosus blood flow observed as maternal blood pressure and vascular resistance increase.     

Prediction of fetal anemia by middle cerebral artery Doppler

ObjectivesTo assess the value of peak systolic velocity in the middle cerebral artery (MCA) in prediction of fetal anemia as a non invasive method in non hydropic fetuses.MethodsThe study included 30 pregnant women with non hydropic fetuses and with known red cell antibodies. Full ultrasound examination was done and peak velocity of systolic cerebral blood flow in MCA was measured. If severe anemia was suspected, fetal blood sampling by cordocentesis was performed.ResultsThirty fetuses were examined, 22 were anemic and eight had a hemoglobin value within a normal range. The mean MCA peak systolic velocity for fetus with the normal hemoglobin (Hb) was 48.98 ± 13.94 while that for the anemic fetus was 64.79 ± 11.97 and P = 0.004.Sensitivity of increased peak velocity of systolic blood flow in MCA for prediction of fetal anemia was 90.5% and specificity was 78.6%.ConclusionDoppler of peak velocity of systolic blood flow in MCA can be reliable in predicting anemia so delaying invasive methods until treatment (blood transfusion) is expected to be necessary.     

Two-year neurological outcome of very-low-birth-weight children with prenatal absent or reversed end-diastolic flow velocity in the umbilical artery

ObjectiveThe aim of this study was to investigate the 2-year neurological outcome of very-low-birth-weight (VLBW) children who had abnormal umbilical blood flow velocity prenatally.Materials and MethodsWe performed a prospective collection of infants prenatally diagnosed with abnormal umbilical blood flow velocity at a tertiary referral center from January 1, 2001 to September 30, 2005. VLBW children with prenatal absent or reversed end-diastolic flow velocity (AREDV) in the umbilical artery were investigated and compared with two similar demographic control groups of VLBW children without AREDV: one group with fetal growth restriction and the other without it. A follow-up study at 2 years of age for Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) of the Bayley Scales among the three groups was analyzed.ResultsTwenty-four VLBW children were identified to have AREDV prenatally, of whom four died during the neonatal period. After 2 years, five children were lost to follow-up and 15 were rescued, of whom 11 had absent end-diastolic velocity and four reversed end-diastolic velocity. We compared the remaining 15 children with the two control groups [28 children in the matched control group with intrauterine fetal growth restriction (IUGR), and 38 children in the matched control group without IUGR], and no significant differences were found in MDI (p = 0.938) and PDI (p = 0.496) scores at 2 years of age. However, we also surveyed the children with a gestational age of ≤29 weeks and found a significant difference in MDI scores (p = 0.048), but not in PDI scores (p = 0.219), among the three groups.ConclusionVLBW children delivered earlier than 29 gestational weeks with abnormal umbilical blood flow velocity prenatally have greater mental developmental delay at 2 years of age.     

Exploring sexual dimorphism in placental circulation at 22–24 weeks of gestation: A cross-sectional observational study

IntroductionPlacental blood flow is closely associated with fetal growth and wellbeing. Recent studies suggest that there are differences in blood flow between male and female fetuses. We hypothesized that sexual dimorphism exists in fetal and placental blood flow at 22–24 weeks of gestation.MethodsThis was a prospective cross-sectional study of 520 healthy pregnant women. Blood flow velocities of the middle cerebral artery (MCA), umbilical artery (UA), umbilical vein (UV) and the uterine arteries (UtA) were measured using Doppler ultrasonography. UV and UtA diameters were measured using two-dimensional ultrasonography and power Doppler angiography. Volume blood flows (Q) of the UV and UtA were calculated. Maternal haemodynamics was assessed with impedance cardiography. UtA resistance (R_uta) was computed as MAP/Q_uta.ResultsUA PI was significantly (p = 0.008) higher in female fetuses (1.19 ± 0.15) compared with male fetuses (1.15 ± 0.14). MCA PI, cerebro-placental ratio (MCA PI/UA PI), Q_uv, UtA PI, Q_uta and R_uta were not significantly different between groups. At delivery, the mean birth weight and placental weight of female infants (3504 g and 610 g) were significantly (p = 0.0005 and p = 0.039) lower than that of the male infants (3642 g and 634 g).DiscussionWe have demonstrated sexual dimorphism in UA PI, a surrogate for placental vascular resistance, at 22–24 weeks of gestation. Therefore, it would be useful to know when this difference emerges and whether it translates into blood flow differences that may impact upon the fetal growth trajectory.     

Are there any relationships between umbilical artery Pulsatility Index and macrosomia in fetuses of type I diabetic mothers?

Abstract

Objective: To establish whether there are relationships between umbilical artery Pulsatility Index (PI) and fetal macrosomia in pregnancies complicated by type I diabetes.

Methods: In a retrospective observational study, 102 singleton pregnant women with type I diabetes were considered. Umbilical artery PI was measured by Doppler ultrasonography within one week from delivery and related to neonatal weight. Pregnancies were grouped according to birtweight in macrosomic group (≥4000?g) and normal growth group (<4000?g). Relationships between umbilical artery PI and birth weight and birth weight centile were tested by Pearson’s correlation analysis. Further umbilical artery PI values were compared between macrosomic and normally grown fetuses.

Results: Birth weight was ≥4000?g in 24 pregnancies (23.5%). A significant relationship was found between umbilical artery PI and neonatal weight (r?=?0.512; p?<?0.01) and neonatal weight centile (r?=?0.400; p?<?0.01). Umbilical artery PI were significantly lower (t?=??6.013; p?<?0.001) in the macrosomic group (0.78; 95% confidence interval (CI) 0.73–0.84) than in the normal growth group (1.00; 95% CI 0.97–1.04).

Conclusions: In pregnancies complicated by type I diabetes there is a significant relationship between umbilical artery PI value before delivery and absolute birth weight and birth weight centile. Macrosomic fetuses show a significant reduction in umbilical artery PI when compared with diabetic pregnancies without fetal overgrowth.     

Three-dimensional ultrasonography using the VOCAL technique for estimation of reference range between 7 and 11 weeks embryonic volume

ObjectiveAccurate estimation of gestational age (GA) is the basis of vital decisions in pregnancy and hence its importance in obstetric management. This study tries estimating a reference range of 3D embryonic volume using the VOCAL technique for pregnancies between 7 and 11 weeks.Materials and methodsThis cross-sectional study included 62 singleton normal uneventful pregnancies. All women were essentially sure of the date of last menstrual period. All women were submitted to 3D ultrasonographic examination with VOCAL technique to determine the embryonic volume. In addition the crown-rump length was measured. Regression analysis was performed to predict the gestational age from the fetal volume.ResultsThere was a strong positive correlation between embryonic volume and menstrual age, gestational age and crown-rump length (r = 0.919, 0.938 and 0.941, respectively). Power regression model produced R² value of 0.838 with a regression equation (y = 52.22 + 6.5 x).ConclusionThis study demonstrated that embryonic/fetal volume is a good predictor of gestational age with a power regression equation (y = 52.22 + 6.5 x) for the period from 7 to 10 weeks + 6 days. We suggest using the embryo volume as an early evidence of growth restriction in high risk pregnancy.     

Dynamic changes in maternal decidual leukocyte populations from first to second trimester gestation

IntroductionDecidual leukocytes are critical to the development of the fetomaternal interface, regulating tolerance to the semi-allogeneic fetus and vascular transformation of the uterine spiral arteries. Despite the continuation of these processes beyond the first trimester of pregnancy, the second trimester has largely been unstudied, with investigation focusing on early gestation and term tissues. We sought to characterize changes in decidual leukocyte populations from first to second trimester.MethodsMulticolor flow cytometry was performed on isolated decidual leukocytes from elective terminations of pregnancy between 6 and 20 weeks of gestation for study of first (6–12 weeks) and second trimesters (13–20 weeks). Specific subpopulations were identified by comparison to isotype and fluorescent-minus-one (FMO) controls.ResultsDecidual natural killer cells (CD56⁺CD16⁻CD3⁻) did not change in number, although a population of dNK with decreased CD56 brightness was observed in second trimester decidua. CD14⁺HLA-DR⁺ macrophage numbers declined from first to second trimester (p = 0.031), yet a CD163⁺CD206⁺ subset designating alternatively activated M2-like macrophages increased during the same period (p = 0.015). Intermediate CD205⁺ dendritic cells demonstrated significant decline (p = 0.022), but immature CD209⁺ and mature CD83⁺ dendritic cells did not differ between trimesters. Total CD3⁺ and CD3⁺CD4⁺ T lymphocytes increased (p = 0.0079, p = 0.0028); CD3⁺CD8⁺ T cells trended towards increase but did not differ significantly.ConclusionSeveral changes in leukocyte subsets are observed in the second trimester that promote a tolerogenic and angiogenic decidual microenvironment through mid-gestation.     

Circulating CD34+KDR+ Endothelial Progenitor Cells Correlate with Erectile Function and Endothelial Function in Overweight Men

IntroductionBone marrow-derived endothelial progenitor cells (EPCs) circulate in the peripheral blood and are involved in endothelial homeostasis and repair.AimThe aim of this study was to assess the circulating levels of different EPC phenotypes in overweight men with or without erectile dysfunction (ED). As endothelial dysfunction is considered a necessary link with ED, endothelium-dependent vasodilation and its relation with EPCs were also investigated.MethodsWe studied 30, otherwise healthy, overweight subjects with symptomatic ED for at least 6 months, and 30 age- and weight-matched subjects without ED. Erectile function was assessed by completing the International Index of Erectile Function (IIEF-5), which consists of items 5, 15, 4, 2, and 7 from the full-scale IIEF-15.Main Outcome MeasuresSeven subpopulations of EPCs were determined by flow cytometry on the basis of the surface expression of CD34, CD133, and KDR antigens: CD34⁺, CD133⁺, KDR⁺, CD34⁺CD133⁺, CD34⁺KDR⁺, CD133⁺KDR⁺, and CD34⁺CD133⁺KDR⁺. Endothelium-dependent flow-mediated dilation (FMD) was evaluated in the right brachial artery with a high-resolution ultrasound machine following reactive hyperemia.ResultsCD34⁺KDR⁺ cell count was significantly lower in men with ED as compared with men without ED (63.1 ± 4 vs. 92.4 ± 6 cells/10⁶ events, mean ± standard error, P < 0.01). There was a significant direct correlation between circulating CD34⁺KDR⁺ cells and the IIEF score (r = 0.44; P = 0.01): men with the severe form of ED presented the lowest level of circulating EPC CD34⁺KDR⁺ cells. No significant correlation was found between the circulating levels of the other EPC phenotypes and the IIEF score. There was a significant correlation between CD34⁺KDR⁺ cell count and FMD (r = 0.45; P = 0.01), but not between FMD and the other phenotypes.ConclusionsCirculating levels of CD34⁺KDR⁺ EPC are reduced in overweight subjects with ED and correlate with the severity of ED. Other EPC phenotypes are not related to ED, suggesting that the CD34⁺KDR⁺ phenotype of EPCs may be preferred in future studies. Esposito K, Ciotola M, Maiorino MI, Giugliano F, Autorino R, De Sio M, Jannini E, Lenzi A, and Giugliano D. Circulating CD34⁺KDR⁺ endothelial progenitor cells correlate with erectile function and endothelial function in overweight men.     

Detection of endometrial and subendometrial vasculature on the day of embryo transfer and prediction of pregnancy during fresh in vitro fertilization cycles

ObjectivesSuccessful implantation depends on interaction between a blastocyst and a receptive endometrium. Endometrial vasculature is important in the early endometrial response to blastocyst implantation, and vascular changes can affect uterine receptivity. This study aims to investigate whether vascular parameters measured using three-dimensional power Doppler ultrasound (3D PD-US) could predict pregnancy following fresh in vitro fertilization and embryo transfer (IVF–ET) using a gonadotropin releasing hormone (GnRH) agonist long protocol.Materials and methodsThis prospective observational study enrolled 236 nulliparous women who underwent a first IVF–ET using a GnRH long protocol with stimulation by recombinant FSH (rFSH) from May 2009 to April 2012. After excluding two cases of tubal pregnancy, 234 women were in either a pregnant group (n = 113) or a nonpregnant group (n = 121). Color Doppler ultrasound and 3D PD-US examinations were performed on the day of embryo transfer. Main outcomes were pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) of the uterine artery, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of the endometrium and subendometrial region. Measurements were analyzed relative to IVF–ET outcome (pregnant vs. nonpregnant).ResultsNo significant differences were observed in patient age, infertility duration, body mass index (BMI), basal FSH levels, number of retrieved oocytes or good quality embryos, or endometrial thickness or volume between the two groups. The pregnant group had higher endometrial VI, FI, and VFI scores than the nonpregnant group (p = 0.001, p = 0.000, p = 0.021, respectively). By contrast, neither subendometrial region VI, FI, and VFI scores (p = 0.770, p = 0.252, p = 0.451), nor uterine artery PI, RI, or S/D scores (p = 0.256, p = 0.527, p = 0.365) differed between groups. Cut-off values of endometrial VI, FI, and VFI scores were 0.95, 12.94, and 0.15 for pregnancy achievement.ConclusionThree dimensional PD-US was a useful and effective method for assessing endometrial blood flow in IVF cycles. Good endometrial blood flow on the day of embryo transfer might be associated with high pregnancy success with a GnRH long protocol, because this is indicative of endometrial receptivity in fresh IVF cycles.     

OS088. First trimester triple vascular test for pre-eclampsia prediction

IntroductionAlthough PE represents a major cause of maternal and fetal morbidity and mortality, the vascular mechanisms underlying this disorder have not been clearly identified. During the past three decades, while numerous clinical, biophysical, and biochemical screening tests have been proposed for the early detection of preeclampsia, maternal circulation changes during early pregnancy have yet to be fully evaluated for their contribution to PE prediction.ObjectivesThe aim of this study was to examine a combination of maternal risk factors, mean arterial blood pressure, uterine artery Doppler, brachial artery flow-mediated dilatation (FMD), and ophthalmic artery Doppler for pre-eclampsia prediction during the first trimester of pregnancy.MethodsProspective study with singleton pregnancies examined at 11–14 weeks of gestation, presenting consecutively for antenatal care in a tertiary Brazilian hospital. The base-cohort population constituted of 487 singleton pregnancies, including 9 case subjects who developed pre-eclampsia (PE) requiring delivery before 34 weeks (early PE) and 22 with late PE, 47 with gestational hypertension, and 409 cases subjects (84%) who were unaffected by PE or gestational hypertension. Maternal history (nulliparity, previous and family history of PE), body mass index (BMI), mean arterial pressure (MAP), uterine artery pulsatility index, brachial artery FMD and ophthalmic artery Doppler were recorded in all of the cases. Univariate and logistic regression analysis was used to derive algorithms for the prediction of hypertensive disorders.ResultsUterine artery percentile of mean PI was higher in the PE than in the control group (p < 0.01). The mean brachial artery FMD was 7.4% ± 8.2% in the control group and 7.3% ± 8.2% in the PE group. Logistic regression analysis determined that FDM was not a predictor of PE (OR = 0.99, CI 95% 0.94–1.04; p = 0.90) and this test was withdrawn from the predictive model. The average of the first diastolic peak velocity in the ophthalmic artery was higher in the PE group compared with controls (24.56 cm/s × 21.13 cm/s; p < 0.01).It was estimated that, with the prediction algorithm for PE, a combination of maternal factors + MAP + uterine artery Doppler or ophthalmic artery Doppler can detect 78% of early-onset PE with 10% false-positive rate.ConclusionMaternal ophthalmic artery Doppler in the first trimester of pregnancy is a novel predictive parameter for PE (especially early-onset PE), it has the same detection rate contribution in a multi-parameter predictive model as would be the case uterine artery Doppler was used instead.     

Placenta-bound and Body Fluid PP13 and its mRNA in Normal Pregnancy Compared to Preeclampsia,HELLP and Preterm Delivery

ObjectivesTo compare the distribution of placental protein 13 (PP13) in fetal and maternal blood and amnionic fluid and to correlate it with PP13 protein and mRNA in the placenta.MethodsUmbilical arterial serum, amnionic fluid, maternal venous serum and placental tissues were collected from normal outcome pregnancies (N = 63) (GA>37), early onset preeclampsia (PE) (N = 12, GA: 26–33), and HELLP syndrome (N = 5, GA: 27–29). Because PE and HELLP cases delivered preterm, cases of preterm delivery (PTD) (N = 6, GA: 31–36) served as additional control. PP13 was determined by ELISA, Western blot, and immunohistochemistry. PP13 mRNA was measured by PCR (RT-PCR). Continuous parameters were compared by t-test, P < 0.05 was considered significant.ResultsIn women with normal pregnancy outcome significantly higher PP13 levels were found in maternal serum compared to amnionic fluid and negligible amount was found in fetal serum. A similar pattern was identified in cases of PTD with concentrations similar to term control. In PE and HELLP cases PP13 levels in amnionic fluid level were more than twice compared to maternal serum (P < 0.001). Umbilical cord level was negligible in PE but high in HELLP corresponding to the much higher level of PP13 in this patient group compared to all others. In the placenta PP13 level in term controls was higher compared to PTD. In PE and HELLP (similar early delivery time as PTD) the level was significantly higher (P < 0.01) compared to PTD or term controls. PP13 mRNA levels in term control and PTD were similar while PP13 mRNA levels in PE and HELLP placentas were significantly lower compared to term controls or PTD or the two combined. Syncytiotrophoblast labeling appeared stronger in PE and HELLP compared to term controls and PTD.ConclusionsIn all cases but HELLP, PP13 in fetal blood is very low indicating that routing of PP13 to fetal blood is limited and that the fetus is unlikely to generate PP13. PP13 mRNA is lower in the third trimester at the time of disease while protein level accumulates and become higher creating an unparallel change in the level of the mRNA and the corresponding protein.     

Sonographic evaluation of fetal abdominal circumference and cerebroplacental Doppler indices for the prediction of fetal macrosomia in full term pregnant women. Cohort study

ObjectivesThe aim of the study was to explore the relationship between cerebroplacental Doppler ratio and birth weight in cases of suspected fetal macrosomia.MethodsThe pulsatility indices of the umbilical (UA-PI) and middle cerebral (MCA-PI) arteries, the cerebroplacental pulsatility index ratio (CPR) and the estimated fetal weight (EFW) were obtained in a cohort of 150 ultrasound-dated pregnancies at ⩾ 37 weeks’ gestation divided into two groups as follows; large for gestational age (LGA, n = 50) and average for gestational age (AGA, n = 100).ResultsThere is a significant difference between groups in abdominal circumference (AC), head circumference (HC), biparital diameter (BPD), estimated fetal weight (EFW) and actual fetal weight with a mean difference of 92.7 g in the LGA group and 84 g in the AGA group. MCA-RI and PI were significantly lower in the LGA group with no difference in UA-RI, PI and CPR-PI between both groups.ConclusionsCPR-PI could not differentiate between LGA and AGA.     

The influence of placental perfusion on birthweight in women with gestational diabetes

Objective: To evaluate the influence of both uterine and umbilical arteries Doppler pulsatility indexes (PI) and metabolic control on birthweight in pregnant women with gestational diabetes mellitus.

Methods: One hundred sixty-nine women with gestational diabetes were evaluated. Doppler measurements of umbilical artery and mean uterine arteries PI were recorded and the corresponding Z-score values by gestational age calculated. Maternal pregestational body mass index (BMI) and the levels of glycosylated hemoglobin were also recorded. The relationships between these studied variables and customised birthweight centiles according to sex and gestational age were analyzed using Spearman’s correlation coefficient and linear regression.

Results: There was a significant correlation between birthweight centiles and Z-score values of the umbilical artery PI (r?=??0.25, p?=?0.001), but not with the Z-score values of the uterine artery PI (r?=??0.12, p?=?0.43). Third trimester maternal glycosylated hemoglobin was also positively correlated to birthweight (r?=?0.29, p?=?0.01). When using stepwise linear regression both maternal glycosylated hemoglobin and the Z-score of umbilical artery PI were included as independent variables in the predictive model of birthweight centile (p?=?0.0002, p?=?0.001 respectively, R^2?=?0.27).

Conclusions: Umbilical artery PI predicts birthweight in women with gestational diabetes. However, metabolic control is the only important determinant of fetal macrosomia in these mothers.     

Umbilical artery blood flow velocity waveforms in pregnancy complicated by diabetes mellitus

Summary Umbilical artery blood velocity waveforms were recorded by a pulsed Doppler system in the third trimester of pregnancy in 16 diabetic women (12 class B, 1 class C, 3 class D) and the waveforms were analysed for resistance index (RI = peak systolic velocity minus end diastolic velocity/peak systolic velocity). There was no significant correlation between the RI values and either serum glucose (r=0.385) or fructosamine levels (r=0.380). However, the RI values were raised in two cases with serum glucose levels of over 300 mg/dl. With a fall in serum glucose levels, the RI values returned to the normal range. No abnormal umbilical artery velocity waveforms were found when the serum glucose level was below 200 mg/dl.     

Influence de l’indice de masse corporelle sur la prise en charge et le pronostic des patientes avec carcinome endométrial

ObjectiveThe aim of this study was to evaluate the outcome of surgery, postoperative morbidity and prognosis of patients with endometrial cancer in function of the body mass index (BMI).Patients and methodsThe study cohort consisted of consecutive women undergoing surgery for endometrial cancer in our institution between January 2000, and September 2012. Individual records of all patients were reviewed and analyzed. Patient BMI was categorized as underweight, normal, overweight and obese.ResultsA total of 192 patients were evaluated. Patients were followed for one to 153 months with a mean of 52.56 months. The mean BMI and the range of each of the BMI categories were 16.97 kg/m² (14–18), 22.97 kg/m² (20–24.9), 27.61 kg/m² (25.7–29.4), 37.34 kg/m² (30–71). Women with higher BMI were more frequently affected by hypertension (8.3%, 31.43%, 58.13% and 59.7% respectively, P < 0.0001) and diabetes (16.67%, 4.3%, 13.9% and 29.85% respectively, P = 0.02). Women with normal BMI had more frequently postmenopausal replacement therapy than the other categories (P = 0.0004). Surgical operative time, mean length of hospitalization in days were not significantly different among the 4 groups. In the obese group there were significantly higher peroperative blood loss (P = 0.01), more wound abces (P = 0.05), more eventration (P = 0.02) and more reinterventions for complications (P = 0.03). Patients had the same protocols of treatment (surgery and adjuvant treatment) and histological characteristics were the same between groups but obese patients had much less positive lymph nodes (P = 0.03). There were no statistically significant difference in overall 5-years survival between groups (P = 0.54)Discussion and conclusionsOur study demonstrate a survival equivalency for obese and non-obese women even though obese women showed less positive lymph nodes.     

A Modification of the Uterine Artery Restriction Technique in the Guinea Pig Fetus Produces Asymmetrical Ultrasound Growth

AimsTo evaluate the use of diathermy ablation of branches of the uterine artery to produce growth restriction in the fetal guinea pig, and to compare this new approach with the more conventional use of uterine artery ligation. The development of growth restriction was documented by measuring fetal biparietal diameter (BPD) and the resistance index (RI) of the umbilical artery blood flow velocity waveform.MethodsAt 30–35 days of gestation (term = 70 days), one uterine artery was ligated in 29 sows. In another 16 sows, branches of one uterine artery were ablated using diathermy. Fetuses in contralateral horns were used as controls. Ultrasound measurements were made weekly, and at 59–69 days of gestation animals were euthanased to determine fetal position in utero as well as fetal and placental weights. In some fetuses, brain and liver weights were also recorded.ResultsBoth surgical techniques resulted in similar reductions in fetal body and placental weights. The number of fetuses surviving to term was greater in the diathermy group (53%) compared to the ligation group (22%) (P < 0.05). Results from these two groups were combined and referred to as “treated” fetuses. The brain/liver weight ratio was increased by 245% in the treated fetuses compared to control fetuses. Ultrasound measures of BPD in the treated fetuses were within the normal range. The mean RI of the treated group showed a slight but significant increase near term compared to the mean RI of the normal range.ConclusionWe have shown that the diathermy technique produces asymmetrical fetal growth restriction (with normal head size) in the guinea pig to the same extent as the conventional ligation technique. It is associated with a lower fetal mortality rate and therefore should be the preferred method. The minimal increase in umbilical artery resistance index only at the end of gestation amongst the intrauterine growth restriction (IUGR) fetuses suggests that an obliterative vasculopathy in the umbilical circulation is not the cause of growth failure when there is maternal uteroplacental restriction.     

CIN Extension at Colposcopy: Relation to Treatment and Blood Parameters

ObjectiveTo determine the colposcopic lesion size that predicts the presence of residual lesion in patients with cervical intraepithelial neoplasia (CIN) 2/3, to aid gynaecologists in selecting conservative management.MethodsData from 51 patients with low- and high-grade squamous intraepithelial lesions were evaluated. Colposcopic images were captured and lesion areas were calculated. Polymerase chain reaction (PCR) for human papillomavirus was performed. Laboratory parameters were evaluated. Receiver operating characteristic (ROC) curves were used to obtain cut-off values for lesion area. The performance of PCR in the detection of high-grade CIN was assessed. A flowchart was created to compare the costs of related procedures in the Brazilian health system.ResultsFor CIN 2/3 treated with excisional surgery, the best cut-off value for lesion area below which no residual lesion was present was 21 019 pixels² (58.87 mm²). The cut-off value that predicted compromised surgical margins was 155 577.65 pixels² (435.75 mm²). Among all patients with CIN, lesion area correlated inversely with neutrophil/lymphocyte ratio (NLR; r = –0.446, P = 0.001), platelet/lymphocyte ratio (PLR; r = –0.438, P = 0.001), and absolute number of leukocytes (r = –0.351, P = 0.011). Conservative clinical management with semi-annual clinical follow-up was found to reduce direct costs to the Brazilian Health System by R $909.82 (US $169.42).ConclusionCIN reflects systemic alteration, leading to altered NLRs, PLRs, and absolute numbers of leukocytes. Patients with high-grade CIN and colposcopic lesion areas <21 019 pixels² could benefit from conservative management, which would result in cost savings for the Brazilian health system.