Vascular endothelial growth factor, nitric oxide, and leptin follicular fluid levels correlate negatively with embryo quality in IVF patients

Objective(s): To measure vascular endothelial growth factor (VEGF), nitric oxide (NO) and leptin levels in individual ovarian follicles and to examine their relationships with perifollicular blood flow, follicular metabolic indices, and the developmental potential of the corresponding oocyte and embryo.

Design: Prospective study.

Setting: Academic, tertiary care institution.

Patient(s): Unselected IVF patients.

Intervention(s): Color-pulsed Doppler analysis of perifollicular blood flow; determination of partial pressure of oxygen (pO₂), partial pressure of carbon dioxide (pCO₂), and pH and VEGF, leptin and NO levels in follicular fluid.

Main Outcome Measure(s): Fertilization and day 3 embryo morphology and cleavage.

Result(s): Fifty-five follicular fluid samples from 16 patients were studied. Mean follicular fluid levels were as follows: VEGF, 1,046 ± 863.7 pg/mL (range, <63–3,332.7 pg/mL); NO₃/NO₂, 34.2 ± 12 μM (range, 16.4–76.1 μM); and leptin, 20.1 ± 12.1 ng/mL (range, 3.3–52.2 ng/mL). Vascular endothelial growth factor had a negative correlation with embryo morphology (r = −0.28, P=.01). Leptin demonstrated a negative correlation with follicular pO₂ (r = −0.42, P=.005) and a positive correlation with follicular pCO₂ (r = 0.36, P=.02). Follicular leptin levels correlated positively with VEGF levels (r = 0.46, P=.008) and with NO₃/NO₂ levels (r = 0.39, P=.006).

Conclusion(s): Vascular endothelial growth factor, NO and leptin appear to be markers of follicular hypoxia and suboptimal embryo development. Whether fluctuations of these regulatory factors determine or reflect changes in the follicular microenvironment affecting oocyte developmental potential remains to be elucidated.     

Fetal heart rate patterns in pregnancies complicated by maternal diabetes

Objective: To compare the fetal heart rate (FHR) pattern between fetuses of well controlled diabetic and non diabetic mothers using a computerized analysis of FHR. Study design: Weekly fetal surveillance was performed in 99 fetuses of mothers with diabetes class A, 21 fetuses of mothers with diabetes class B-R, and 55 fetuses of non-diabetic women, starting at 30 weeks' gestation. All diabetic patients were well controlled. Fetal surveillance included a computerized analysis of the FHR, umbilical and uterine Doppler velocimetry, and a biophysical profile. Changes of FHR variation, frequency of FHR accelerations, and umbilical and uterine Doppler velocimetry were calculated using a regression analysis for each patient. The average slopes and the intercept at 30, 34, and 38 weeks' gestation of these variables were compared among the three groups. Results: The slope of FHR variation and the frequency of accelerations had a lower rate of increase during the third trimester in fetuses of mothers with diabetes class A (0.84 ± 0.25 ms/week and 0.06 ± 0.02/20 min/week, respectively) compared with fetuses of non-diabetic mothers (1.34 ± 0.55 ms/week and 0.5 ± 0.1/20 min/week, respectively). In fetuses of mothers with diabetes class B-R, FHR variation did not change with gestation (−0.011 ± 0.2 ms/week) with a small increase in the frequency of accelerations (0.02 ± 0.004/20 min/week. While no differences were observed at 30 weeks' gestation, FHR variation and the frequency of accelerations were significantly reduced at 34 weeks' gestation in fetuses of mothers with diabetes class B-R compared with fetuses of non-diabetic mothers (P < 0.01). At 38 weeks' gestation, fetuses of mothers with diabetes class B-R and diabetes class A had both significantly reduced FHR variation as well as frequency of accelerations compared with fetuses of non-diabetic mothers (P < 0.01). The rate of decrease of the umbilical and uterine artery S/D ratios were similar among the three groups. Conclusions: The FHR pattern appears to be different in fetuses of well controlled diabetic mothers when related to fetuses of non-diabetic mothers. Disease specific standards should be considered for interpretation of FHR patterns in diabetic pregnancies.     

Immunosuppressive 30-kDa protein in urine of pregnant women and patients with trophoblastic diseases

Urine samples obtained from normal pregnant women and patients with trophoblastic diseases contain 30-kDa protein that suppresses phytohemagglutinin-induced T cell proliferation. The immunosuppressive protein was measured by a newly developed radioimmunoassay. The 30-kDa protein was demonstrated in almost all urine samples examined, fluid from hydatid vesicles and chorionic extracts, but not in any serum samples except at low levels in some sera from patients with choriocarcinoma. During pregnancy, the level of urinary 30-kDa protein was higher in the first (1625.5 ± 1212.0 ng/ml, mean ± S.D.) and second (1457.4 ± 1332.4 ng/ml) trimesters than in the third trimester (460.6 ± 419.0 ng/ml). The urinary 30-kDa protein/hCG ratios in patients with choriocarcinoma (8.3 ± 10.9) were significantly higher than those in patients with hydatidiform mole (0.67 ± 1.00, P < 0.01) and in all trimesters than those of normal pregnant women (0.54 ± 0.44 in the first trimester, P < 0.05; 0.63 ± 0.46 in the second trimester, P < 0.05; 0.24 ± 0.17 in the third trimester, P < 0.01). There is no significant difference between the ratios in hydatidiform mole and normal pregnancy. These findings and the fast disappearance of the 30-kDa protein from the circulation suggest that the 30-kDa protein plays a part in proliferation of trophoblastic cells in, or their invasion into the host by locally suppressing the immune reaction of the host and that the increase in the urinary 30-kDa protein level, in cases of choriocarcinoma, may be due to the malignant transformation of trophoblastic cells resulting in their rapid invasion.     

Dexamethasone compared with betamethasone for glucocorticoid treatment of postpartum HELLP syndrome

Objectives: To compare the efficacy of dexamethasone and betamethasone to ameliorate the course of postpartum hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. Methods: A prospective, mixed randomized/non-randomized clinical investigation of patients with postpartum HELLP syndrome. Treatment with either dexamethasone or betamethasone was continued until there was evidence of disease recovery. Results: Baseline characteristics of both the dexamethasone (n=18) and betamethasone (n=18) groups were similar. Although the time to discharge from the obstetrical recovery room was not statistically significant between groups, reduction in mean arterial blood pressure was more pronounced in the dexamethasone group as compared with the betamethasone group (−15.3±1.4 mmHg vs. −7.5±1.4 mmHg, respectively, P<0.01). Patients in the dexamethasone group required less antihypertensive treatment than the betamethasone group (6% vs. 50%, P=0.01) and also had a decreased need for readmission to the obstetrical recovery room (0% vs. 22%, P=0.03). Conclusion: This investigation supports the use of dexamethasone as the superior glucocorticoid to use for patients with postpartum HELLP syndrome.     

Transvaginal color Doppler ultrasonography for prediction of pre-cancerous endometrial lesions

Objective: To determine whether measurements of blood flow in endometrial and uterine vessels by transvaginal color Doppler ultrasonography was valuable in the diagnosis of a neoplastic endometrial pathology (hyperplasia and carcinoma) in women with abnormal bleeding. Methods: This is a prospective study and included 105 post-menopausal women and 33 pre-menopausal women with abnormal uterine bleeding. All subjects underwent transvaginal color Doppler ultrasonography. We investigated whether obtained results were correlated with histopathological findings. Results: There was no significant difference in the mean±S.D. RI of the left and the right uterine arteries, intramyometrial arteries and endometrial arteries between patients with neoplastic and non-neoplastic endometrium on histopathological examination. Doppler's velocity waveforms of small endometrial blood vessels could be detected in 9% of the women with non-neoplastic endometrium and in 42% of the women with neoplastic endometrium (P<0.05). The mean±S.D. of the endometrial thickness was significantly higher in the women with neoplastic endometrium than that of the women with non-neoplastic endometrium (16.6±6.1 mm vs. 9.5±4.7 mm, P<0.05). Conclusion: Doppler's velocity waveforms of uterine vessels coupled with transvaginal ultrasonography are not valuable enough to replace histopathological examination in the diagnosis of a neoplastic endometrial pathology. However, it may be helpful in cases in which invasive techniques are difficult to perform and in the differentiation of a certain group of patients at little risk of endometrial carcinoma.     

First trimester volumetric measurements: relation with hormone levels and fetal heart rate

Purpose

This study aimed to examine two-dimensional ultrasound (2D US) volumetric measurements of 1st trimester structures and their relationship with ??-hCG, progesterone, and fetal heart rate (FHR) in 6?C10?weeks healthy pregnant women.

Methods

Using conventional 2D transvaginal ultrasound imaging, the crown rump length (CRL), yolk sac (YS) and gestational sac (GS) were measured in 80 women. Volumetric measurements were done in 32 cases that were selected among 80 women, using a simplified formula for the volume of a prolate ellipsoid: V?=?0.523?×?length?×?height?×?width. The ??-hCG and progesterone levels were recorded. The heart rate was determined from M-mode tracings using electronic calipers.

Results

Moderately positive correlation was found between FHR versus CRL, embryo volume and GS volume. FHR increased linearly with CRL value, till CRL became 15?mm, after which it formed a plateau. ??-hCG increased linearly till CRL was 15?mm, and then it formed a plateau. Progesterone level was stable till CRL became 20?mm, embryo volume 2?cm³, after which it increased linearly.

Conlusion

Various ranges of relations are observed between FHR, obstetric, and hormonal measurements. The relationship between these parameters might be used for determination of abnormal growth and adverse outcomes in early pregnancy.     

Reproductive outcome before and after laparoscopic or abdominal myomectomy for subserous or intramural myomas

Objectives: To analyze the reproductive outcome before and after myomectomy in patients with subserous or intramural myomas, and to assess the factors influencing pregnancy rate after myomectomy. Study design: Out of 128 patients submitted to myomectomy, we considered eligible for this study only the 41 patients wishing to conceive after surgery and who did not present any plausible infertility factor, apart from the removed myomas. We have evaluated the pregnancy outcome prior to and following myomectomy, and analyzed the correlation between conception rate after surgery and patient’s age at the time of the surgery, type of surgery, number and size of the myomas, location of the largest fibroid and previous pregnancies. Results: Nineteen patients had been submitted to abdominal (group A) and 22 to laparoscopic myomectomy (group B). Prior to surgery, 28 pregnancies had occurred in 14 of the 41 patients, with a miscarriage rate of 57.1%. Following surgery 29 pregnancies occurred in 25 patients (60.9%), pregnancy rate being similar in both groups. The postoperative delivery rate was 86.2% whereas the miscarriage rate was reduced to 13.8% (P<0.001). Overall, 60% of deliveries were vaginal. No cases of ectopic pregnancy or uterine rupture occurred. Those patients who conceived after surgery were significantly younger (32.36±4.06 years versus 35.88±3.57 years; P=0.0073), and their removed myomas were significantly larger (5.80±2.69 cm versus 4.28±1.54 cm; P=0.0274). Furthermore, a multivariate analysis shows that, apart from age and diameter, the probability of conceiving after myomectomy is higher in case of intramural myomas (intramural versus subserosal: OR 12.382, 95% CI: 1.61–95.22) or laparoscopic surgery (laparoscopy versus laparotomy: OR 14.062, 95% CI: 1.40–141.15). Conclusions: Our results suggest that myomectomy significantly improves pregnancy outcome in patients with subserous or intramural fibroids, probably removing a plausible cause of altered uterine contractility or blood supply. The main determinants of pregnancy rate after surgery are patient age, diameter and intramural localization of the myomas and type of surgery.     

Postpartum hysterectomy

Objectives: To review cases of postpartum hysterectomy regarding indications, risk factors and complications and compare them with cases of emergency cesarean section. Methods: We conducted a retrospective chart review study of 20 cases of postpartum hysterectomy and 20 cases of emergency cesarean section performed at Sinai Samaritan Medical Center, Milwaukee, Wisconsin, between January 1984 and January 1994. Emergency postpartum hysterectomies were compared with emergency cesarean sections regarding obstetric history, placental location, operative time, blood loss, blood transfusion, intra- and postoperative complications and length of hospitalization. Emergency hysterectomies were reviewed according to their indications for the incidence of complications and length of hospitalization. Pathological diagnoses of the hysterectomy specimens were reviewed. Statistical analyses were performed using the two-tailed Student's t-test and Fisher's exact test. Results: Placenta accreta was the most common indication for emergency postpartum hysterectomy. Prior cesarean section and/or placenta previa were risk factors. Emergency hysterectomies were associated with longer operating times (P < 0.0001), greater blood loss (P < 0.0001), more transfusions (P < 0.001), postoperative complications (P < 0.01), secondary surgeries (P < 0.01) and longer hospitalizations (P < 0.0001) than cases of emergency cesarean section. Conclusions: Emergency postpartum hysterectomy is associated with significant blood loss, need for transfusion, postoperative complications and longer hospitalization partly because of its indications. The combination of prior cesarean section and current placenta previa should alert the obstetrician that an emergency postpartum hysterectomy may be needed.     

A comparison of crown-rump length measurements using a real-time scanner in an antenatal clinic and a conventional B-scanner.

In a series of 168 patients in the first trimester of pregnancy, fetal crown-rump length (CRL) measurements were attempted in the Antenatal Clinic using a linear-array real-time ultrasound scanner. The measurements could not be made in 23 of the patients; most of them had a gestational age of less than 10 weeks and the difficulty in obtaining measurements was usually due to an underfilled maternal bladder. When compared with CRL measurements obtained with a conventional B-scanner, a good correlation was obtained (r = 0.92); 80 per cent of the 'real-time' values fell within a range of +/- 5 mm of the conventional values. In all patients the estimates of gestational age using the two methods were within one week of each other.     

Reference ranges for the uterine arteries Doppler and cervical length measurement at 11–13(+6) weeks of gestation in a Brazilian population

Objective: To establish references ranges for the uterine arteries (UtA) Doppler and cervical length (CL) measurements at 11–13(+6) weeks of gestation in a Brazilian population.

Methods: We performed a retrospective cross-sectional study with singleton low-risk pregnant women who underwent first trimester ultrasound exams of fetuses with crown-rump length (CRL) ranging from 45 to 84?mm. The mean UtA Doppler and CL measurements were performed by transvaginal route. The mean pulsatility index (PI) of uterine arteries was obtained with color Doppler at the level of cervico-corporeal junction. The CL was obtained in a sagittal view using the cervical gland area as landmark. We determined mean?±?standard deviation (SD), ranges for mean PI of UtA and CL in each gestational age. Polynomial regression was performed to establish reference values.

Results: We have assessed 598 first-trimester pregnancies: the CL measurement was obtained from 497, while the mean PI UtA Doppler was available in 450 pregnant women. The mean CL ranged from 33.41 to 35.58?mm while the PI UtA Doppler ranged from 1.89 to 1.45. The best fit curves were: CL?=?30.790?+?0.057?×?CRL and UtA PI?=?2.411?0.011?×?CRL.

Conclusion: References ranges for the mean UtA PI Doppler and CL measurement at 11–13(+6) weeks of gestation in a Brazilian population were established.     

Reference range for the pulsatility index ductus venosus Doppler measurement between 11 and 13 + 6 weeks of gestation in a Brazilian population

Objective: To establish reference range for the pulsatility index (PI) ductus venosus (DV) Doppler measurement between 11 and 13?+?6 weeks of gestation in a Brazilian population.

Methods: A retrospective cross-sectional study was performed with 430 singleton pregnancies. The PI DV Doppler measurement was performed as routine during the first trimester screening. DV was identified by color Doppler and the pulsed Doppler gate was placed in the distal portion of the umbilical sinus. When at least three typical DV waveforms were obtained, PI DV was measured manually in one waveform. Polynomial regression was used to obtain the best fit using PI DV Doppler measurement and crown-rump length (CRL) with adjustments by the determination coefficient (R²). 5th, 50th and 95th percentiles for the PI DV Doppler measurements at each gestational were determined.

Results: The mean of PI DV Doppler measurement was 1.1?±?0.2 (range 0.8–3.7). The linear regression was the best fit: PI DV measurement?=?1.288–0.0034*CRL (R^2?=?0.03).

Conclusions: Reference range for the PI DV Doppler measurement between 11 and 13?+?6 weeks of gestation in a Brazilian population was established.     

A comparison of two methods of labor induction with vaginal misoprostol

Objectives: To evaluate if labor induction with 50 μg of vaginal misoprostol twice per day is as effective as and safer than 100 μg used once per day. Methods: Misoprostol was used to induce labor in 204 consecutive pregnant women assessed as needing labor induction, 104 at the University Hospital of the West Indies in Kingston, Jamaica, and 100 at the Victoria Jubilee Hospital, also in Kingston. At the former institution the women were administered 100 μg of misoprostol once per 24 h and at the latter 50 μg every 12 h. The doses were repeated if there was no cervical change or if the woman was not in labor. Bishop scores were determined before initiation of induction and again 12 h later. Women's records were reviewed after 24 h to determine delivery outcome. Results: The indications for labor induction were similar in each group. There was no significant difference in the group demographics. In the group given 50 μg of misoprostol twice per day the mean time±S.D. from insertion of misoprostol to delivery was significantly shorter than in the other group (560.14±269.20 min vs. 729.90±471.65 min; P<0.01), and the percentage of women who were delivered within 12 h was higher (75% vs. 56.8%; P<0.002). There was no significant difference between the two groups in the rate of cesarean births, the need for oxytocin, or blood loss. Only two patients experienced uterine hyperstimulation, both in the group that had received 100 μg of misoprostol per day. There was no significant difference between the two groups in the birthweight of the neonates and in the number of neonates with Apgar scores less than 7 at 1 min and 5 min. There were, however, significantly fewer neonates who needed resuscitation (6% vs. 14.7%; P=0.04) and admission to the special care nursery (7% vs. 17%; P=0.03) in the group that had received 50 μg of misoprostol twice per day. Conclusions: A dose of 50 μg of misoprostol twice per day appears to be more efficient and safer than a dose of 100 μg once per day, but this may partially be due to weaknesses in the study design.     

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 Spearman's 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.     

Reference intervals of embryos/fetuses heart rate between 6 and 14 weeks of pregnancy

Abstract

Objective: To determine reference intervals for the embryos/fetuses heart rate (HR) between 6 and 14 weeks of pregnancy.

Methods: A retrospective cross-sectional study was carried in a single center with singleton pregnancies of embryos/fetuses with a crown-rump length (CRL) between 5 and 85?mm. The HR was assessed by real time M-mode or spectrum Doppler ultrasound. To evaluate the correlation between embryo/fetal HR and CRL, polynomial equations were calculated, with adjustment by the determination coefficient (R²).

Results: A total of 5867 pregnancies were assessed. The mean gestational age was 10.37?±?2.12 weeks. The mean maternal age was 26.41?±?6.78 years. The mean embryo/fetal HR (bpm) for the CRL (mm) intervals 5├15; 15├25; 25├35; 35├45; 45├55; 55├65; 65├75; 75├85 was 145.1?±?18.7; 167.2?±?10.1; 166.9?±?8.7; 165.5?±?6.9; 162.2?±?6.8; 159.2?±?6.4; 157.1?±?6.4; 154.9?±?7.3; respectively. The following third-order equation best represented the correlation between embryo/fetal HR and CRL: HR?=?119.25?+?3.596*CRL-0.07954*CRL^2?+?0.00051*CRL³ (R^2?=?0.36).

Conclusion: Reference intervals of HR in embryos/fetuses in a large sample were determined. These reference intervals can be used in high-risk early pregnancy losses.     

Evolution of the amniotic sac and extracelomic space as seen by early ultrasound examination

OBJECTIVE: Amniotic sac and extracelomic space changes occurring from 5 to 14 weeks of pregnancy were observed with transvaginal ultrasound to gain new insights into their normal relationships during this time period. STUDY DESIGN: Ninety-seven women from 5 to 15 weeks' gestation were enrolled in the study. Gestational age was determined by measuring embryonic crown-rump length. The embryo, amniotic sac, and gestational sac areas were measured using the best-fitted computer-generated elliptical view. The embryonic heart rate was measured using the M-mode function of the ultrasound equipment. Associations were determined using the least-squares method and Pearson's correlation coefficient. RESULTS: Mean (range) gestational age calculated from CRL was 9.6 (5.3-14.6) weeks, embryonic heart rate 153 (100-188) beats per minute, embryonic surface 699.6 (5-2,199) mm(2), amniotic sac surface 1,383 (5-5,335) mm(2) and gestational sac surface was 1,517 (110-5,335) mm(2). Significant correlations between gestational sac surface, amniotic sac surface, embryonic surface, heart rate and gestational age were noted (p < 0.01). Changes in the amniotic sac surface correlated with embryonic surface but not with heart rate even when multiple regression analysis was attempted. CONCLUSION: These data describe the normal relationships between the embryonic, amniotic sac, extracelomic space, and gestational sac surface, suggesting that increases in embryonic surface area is a determining factor for early expansion of the amniotic sac at these gestational ages.     

Spine length measurement in the first trimester of pregnancy

OBJECTIVES: The aim of the study was to evaluate spine length as an indicator of skeletal growth in the first trimester of pregnancy and to provide a nomogram of spine length at the end of the first trimester of pregnancy. METHODS: The study was carried out on 420 single pregnancies, at gestational ages ranging from 11 to 14 weeks, using high-resolution transabdominal echography. Biparietal diameter and crown-rump length (CRL) were measured to date the pregnancy. Using the same scanning plane used to measure CRL, the whole spine length in antero-dorsal position can be visualized as a double hyperechoic line from 10 weeks of gestation onwards. Spine length was measured three times by one observer and the mean of the three measurements was considered as definitive. Forty fetuses had multiple measurements for interobserver and intraobserver error analysis. RESULTS: Linear relationship between spine length, and gestational age, biparietal diameter and CRL were demonstrated. Spine length (millimetres) as a function of gestational age (days) was expressed by the regression equation: spine length = 1.09 x (gestational age in days) -60.56, with a determination coefficient of R(2) = 0.744. Spine length ranged from 21.5 mm at 11 weeks to 41.9 mm at 14 weeks. CONCLUSION: The data obtained showed that spine length increased progressively from the end of the first trimester to the beginning of the second. A high correlation between spine length, gestational age, biparietal diameter, and CRL was observed. Spine length measurement could therefore be considered a good indicator of fetal growth.     

Acute reversible placental dysfunction and abnormal fetal heart rate at delivery

Acute placental dysfunction induced by malaria is characterized by umbilical artery resistance increase and cerebral artery resistance decrease during the crisis. The objective was to evaluate the sensitivity and specificity of fetal Doppler indices and crisis duration for predicting abnormal fetal heart rate (aFHR) at delivery several weeks after the crisis. Method: Every day during the crisis, the umbilical and cerebral resistance indices were measured by Doppler. These indices allowed evaluation of the amplitude of the fetal flow redistribution (C/U = cerebral resistance/umbilical resistance ratio), the duration of the flow redistribution period (i.e. crisis duration) and the Hypoxic index (HI) (mean %C/U change × crisis duration). Results: Population: 46 pregnancies. Mean duration of the flow redistribution period 8±3.2 days, mean C/U change −9%±6; Hypoxic index −86±75; prematures 48%; aFHR 30%). Hypoxic index >150 predicted occurrence of aFHR with high sensitivity and specificity (83%/88%). The presence of abnormal flow distribution (C/U<1.1) and the duration of the period with flow disturbance (>8 days) predicted aFHR at delivery with a sensitivity of 45 and 48% and a specificity of 82 and 84%. Conclusion: The Hypoxic index was more predictive of aFHR at delivery than the amplitude or the duration of the fetal flow redistribution triggered by placental insufficiency.     

Fetal echocardiography during routine first-trimester screening: a feasibility study in an unselected population

OBJECTIVE: To evaluate the feasibility of obtaining standard echocardiographic views of the fetal heart during routine first-trimester screening and construct reference ranges for cardiac biometry at 11 + 0 to 13 + 6 weeks of gestation. METHODS: A cross-sectional study of 584 fetuses in an unselected population. Viable pregnancies with a crown-rump length (CRL) of 41-78 mm were included. Echocardiography was performed by a single obstetrician using a 5 to 7.5 MHz vaginal transducer. The course and outcome of pregnancies were recorded and information on the babies was obtained in all cases. RESULTS: A completely satisfactory visualization of the fetal heart structures was possible in 58% (43%, 56% and 62% at 11, 12 and 13 weeks, respectively). Reference ranges were constructed from the measurements of cardiac ventricles, their outflow tracts, and cardiothoracic circumference ratio in relation to CRL. CONCLUSION: Standard echocardiograhic views of the fetal heart can be obtained at 11 + 0 to 13 + 6 weeks of gestation using the transvaginal approach. New reference ranges were established for fetal cardiac biometry at 11 + 0 to 13 + 6 weeks of gestation.     

Hyaluronan in follicular fluids and fertilization of oocytes

Objective: To determine the concentrations of hyaluronan, E₂, and progesterone in follicular fluids (FFs) and the incidence of apoptotic granulosa cells. Also, to examine the relationship between the concentration of hyaluronan and follicular steroids, the incidence of apoptotic cells, and the fertilizability of the oocyte in the same follicle.

Design: Samples of 130 follicles were retrospectively analyzed for hyaluronan and steroids and the incidence of apoptotic cells.

Setting: The reproductive center in Yamagata University Hospital.

Patient(s): Forty women infertile because of tubal damage or unknown causes undergoing IVF treatment were selected.

Intervention(s): The samples were collected from follicle aspirations.

Main Outcome Measurement(s): The concentrations of hyaluronan and steroids in FFs, the incidence of apoptotic granulosa cells, and oocyte fertilizability.

Result(s): The levels of hyaluronan in FF were found to correlate positively with P (r=0.444, P<0.0001) and the incidence of apoptotic cumulus granulosa cells (r=0.387, P=0.002) and inversely with E₂ (r = −0.601, P<0.0001) and free T (r = −0.344, P=0.001). The concentration of hyaluronan in FFs containing a subsequently fertilized oocyte after insemination was significantly lower than that in FFs containing a subsequently unfertilized oocyte (P=0.0005) (fertilized, 50.0 ± 2.6 ng/mL; triploidy, 59.1 ± 6.8; and unfertilized, 66.9 ± 5.9).

Conclusion(s): The concentration of hyaluronan in FF is an indicator for estimation of oocyte viability for fertilization.