Umbilical cord cyst detected in the first trimester by two- and three-dimensional sonography

A case of umbilical cord cyst was identified via 2-dimensional and 3-dimensional sonographic examination at 8 weeks' menstrual age. The cyst was solitary, measuring 18.0 mm, and it was located close to the placental insertion on the umbilical cord. The gestational sac and yolk sac diameters and the fetal heart rate were within normal ranges for menstrual age. Follow-up 3-Dimensional sonographic examination in the second trimester showed complete resolution of the cyst. Amniocentesis revealed a normal karyotype, and a normal infant was delivered at term.     

Velamentous insertion of the umbilical cord: a first-trimester sonographic screening study.

OBJECTIVE: The purpose of this study was to determine the feasibility of prenatal sonography for detecting velamentous insertion of the umbilical cord in singleton pregnancies at the 11- to 14-week scan. METHODS: The placental umbilical cord insertion site was prospectively examined at the time of the routine first-trimester scan between 11 and 14 weeks as part of ongoing first-trimester sonographic screening for chromosomal abnormalities. RESULTS: Over a 1-year period, 533 consecutive singleton pregnancies were examined by a fetal medicine specialist at a median gestational age of 12 weeks. In 5 cases, a velamentous umbilical cord insertion was diagnosed, with a prevalence rate of 1 (0.9%) per 107. The diagnosis was further confirmed at the second-trimester scan and at the time of delivery in all cases. CONCLUSIONS: The placental umbilical cord insertion site can be readily determined by sonography at the time of the 11- to 14-week scan. Sonographic examination at this early gestational age provides the opportunity for screening for velamentous insertion of the umbilical cord in the first trimester, allowing close surveillance of the pregnancy for potential complications associated with this condition.     

Single and multiple umbilical cord cysts in early gestation: two different entities.

OBJECTIVE: To investigate the prevalence of single and multiple umbilical cord cysts in the first trimester and to assess whether there is a difference in the pregnancy outcome between them. METHODS: A targeted sonographic morphological and morphometric evaluation of the umbilical cord was performed in consecutive patients between 7 and 14 weeks of gestation. Crown-rump length and umbilical cord diameter were measured in all cases. Nuchal translucency thickness was measured between 11 and 14 weeks' gestation. In pregnancies at very early gestational ages (7-10 weeks) an additional scan was performed between 11 and 14 weeks. RESULTS: A total of 1159 patients was screened. The prevalence of umbilical cord cysts was 2.1% (24/1159). The cysts were single and multiple in 18 and six cases, respectively. The median (range) largest umbilical cord cyst diameter was no different between multiple and single umbilical cord cysts (3.8 (2.1-18) mm vs. 3.05 (2.0-7.8) mm; P = 0.386). All women with a single umbilical cord cyst delivered an infant without structural abnormalities and without features suggestive of chromosomal abnormalities. Among the women with multiple umbilical cord cysts, four had a missed miscarriage and one had a fetus with obstructive uropathy. CONCLUSION: Single and multiple umbilical cord cysts in the first trimester of gestation represent two different entities. While single cysts in the first trimester are associated with a favorable pregnancy outcome, the presence of multiple umbilical cord cysts is associated with an increased risk of miscarriage and aneuploidy.     

Second-trimester ultrasonographic assessment of the umbilical coiling index.

OBJECTIVE: To determine the relationship between gestational age and the ultrasonic measurement of umbilical coiling index (UCI), and to assess the ability of second-trimester ultrasonic measurements of UCI to predict the true UCI, determined at birth. SUBJECTS/METHODS: Five hundred and thirty-one consecutive women with uncomplicated pregnancies, booking for delivery with a singleton pregnancy, were recruited during a routine second-trimester fetal morphology scan. Multiple ultrasonographic measurements of the intercoil distance were performed between two to three coils of the umbilical cord, along its entire visible length. Three hundred and seventy-four patients (70%) were followed until delivery when the true UCI was measured. RESULTS: An adequate portion of umbilical cord for assessment of coiling was visualized in 99% of cases. Adequate ultrasonographic visibility rates for the fetal, middle and placental regions of the cord were different. All three regions of the umbilical cord could only be visualized adequately in 10% of cases, and two regions were visible in 75%. The UCI progressively decreased along the cord from the fetal insertion to the placental insertion. The mean decrease in UCI with increasing gestational age was similar in all parts of the cord before the 23rd week (160 days) of pregnancy, and plateaued off after this point, except in measurements performed near the fetal insertion. The sensitivity of second-trimester ultrasound examination for predicting hypercoiling at birth was 17.3% and for predicting hypocoiling was 9.1%. DISCUSSION: Whilst UCI can be measured easily and reliably in the second trimester these estimates do not accurately reflect the UCI at term. Our original assumption that umbilical coiling does not alter after the initial formation of coils in the first trimester is incorrect; mixed patterns occurred in about 25% of cases. These patterns develop during the second and third trimesters, presumably due to snarls in the cord, and influence the final coiling number and therefore the relationship between the two measurements of UCI.     

Absence of a relationship between umbilical cord thickness and coiling patterns.

OBJECTIVE: The purpose of this study was to evaluate a relationship between the umbilical cord thickness and cord coiling patterns during the fetal sonographic anatomic survey in the second trimester of pregnancy. METHODS: This was a prospective study of 470 patients with singleton pregnancies who had a fetal anatomic survey with recorded umbilical coiling patterns between 18 and 23 weeks' gestation. The umbilical cord thickness was assessed as an umbilical diameter at the level of the fetal abdominal cord insertion and compared with the antenatal umbilical coiling index (aUCI), calculated as a reciprocal value of the distance between a pair of umbilical cord coils. RESULTS: Three hundred twenty-one patients had adequate sonographic umbilical cord images and maternal demographic, antenatal, and labor data to meet inclusion criteria. The mean aUCI was 0.41 with 10th and 90th percentiles of 0.21 and 0.60, respectively. A total of 10.6% (34/321) and 9.3% (30/321) of patients were categorized as having hypocoiled and hypercoiled umbilical cords, respectively. The mean cord diameter +/- SD was 9.48 +/- 0.97 mm (range 7.0-12.5 mm). There was no statistically significant correlation between aUCI and umbilical cord thickness (P = .1164). CONCLUSIONS: An aUCI, or umbilical coiling pattern, does not correlate with umbilical cord thickness. It appears that a lesser amount of the umbilical supportive tissue, mainly Wharton jelly, is not related to an increased umbilical cord coiling pattern.     

Megacystis Associated With an Umbilical Cord Cyst

Objective. The purpose of this series was to report the first‐trimester sonographic findings, antenatal course, and outcome in fetuses with a patent urachus. Methods. We conducted a review of ultrasound reports and medical charts from 3 pregnancies complicated by a congenital patent urachus detected in the first trimester. Results. All 3 fetuses had megacystis and an umbilical cord cyst close to the fetal abdominal insertion that was detected in the first trimester. In 2 cases, the megacystis resolved spontaneously while the umbilical cord cyst worsened in appearance; among them, massive edema of the umbilical cord was documented in 1, and evidence of partial bladder exstrophy was detected in the third trimester in the other. Both cases required neonatal surgery with no complications. In the remaining case, the fetus died in the early second trimester. Postmortem examination confirmed the diagnosis of a patent urachus, an allantoic cyst, and thrombosis of the umbilical vessels. Conclusions. Megacystis is a warning sign of a patent urachus in the first trimester. The prognosis of this condition is generally good; however, fetal death can occur secondary to compression of umbilical vessels due to the expanding allantoic cyst.     

HD-FLOW技术在11-13+6周胎儿脐带帆状附着的筛查应用

【】目的：探讨多普勒超声高分辨率血流 (high definition-flow, HD-FLOW)成像在11-13+6周帆状脐带胎盘入口筛查中的准确性。方法：选取2141例于我院进行早孕、中孕筛查并在我院分娩的孕妇 (共2296个胎儿) 作为研究对象。依据11-13+6周脐带胎盘入口位置的不同分为三组：A组：经超声HD-FLOW检查显示胎儿脐带胎盘入口位置位于胎膜上,被认定为帆状胎盘;B组：超声HD-FLOW检查显示胎儿脐带胎盘入口位置在胎盘边缘处,难以确定插入点在胎膜或胎盘实质;C组：超声HD-FLOW检查显示胎儿脐带胎盘入口位置为胎盘实质,认定该组为正常胎盘。将检查结果与中孕期和胎儿出生后的检查结果进行比较。结果：早孕期超声HD-FLOW检查相对于中孕期检查来说对胎儿附着位置的一次检查显示率以及单胎、双胎的一次检查显示率来说要高且其差异具有统计学意义 (P<0.05) 。于11-13+6周时对胎儿进行检查发现,A组共21例,B组32例,C组2243例。中孕期检查显示29例帆状胎盘,23例球拍状胎盘,正常胎盘2244例。胎儿出生后检查显示28例帆状胎盘,23例球拍状胎盘,正常胎盘2245例。11-13+6周诊断准确率为98.26% (2256/2296) 。结论：HD-FLOW技术在11-13+6周帆状脐带胎盘入口筛查中具有一定价值,能够对部分帆状胎盘做出准确诊断。     

Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre-eclamptic pregnancies.

OBJECTIVES: To calculate the normal range for the fetal middle cerebral artery (MCA)/uterine artery pulsatility index (PI) ratio in the third trimester of pregnancy and to assess its value, compared with that of the MCA/umbilical artery PI ratio, in predicting an unfavorable outcome of pregnancies complicated by pre-eclampsia. METHODS: Doppler blood flow velocimetry of the uterine and umbilical arteries and fetal MCA was performed. We calculated the ratios between 1) the PI of the MCA and the mean PI value of both uterine arteries and 2) the PI of the MCA and the PI of the umbilical artery. All women were examined at or beyond 26 weeks of gestation. A cross-sectional study of 231 normal pregnancies was conducted to construct the reference range. Values below the 5th percentile or an MCA/umbilical artery PI ratio lower than 1.08 were defined as brain-sparing. A further 115 pregnancies with pre-eclampsia (50 mild and 65 severe) were assessed prospectively and the results were related to perinatal outcome. The accuracy of MCA/uterine artery and MCA/umbilical artery PI ratios for prediction of unfavorable pregnancy outcome was compared. RESULTS: Normal MCA/uterine artery PI ratios decreased with advancing gestational age. Redistribution of the fetal circulation indicated by a low MCA/uterine artery PI ratio was seen in 30% of the mild (n=15) and 46% of the severe (n=30) pre-eclamptic cases. There was a significant difference between those without and those with signs of brain-sparing, respectively, in mean birth weight (2456.0 vs. 1424.5 g), gestational age at delivery (35.6 vs. 31.3 weeks) and gestational age at the time of examination (34.9 vs. 30.9 weeks). Furthermore, there was a significantly higher rate of small-for-gestational-age (SGA) neonates (57.8% vs. 25.7%), preterm delivery (100% vs. 81.8%) and Cesarean section (90.7% vs. 66.7%) in cases with an MCA/uterine artery PI ratio below the 5th percentile. However, there was no difference between the groups in the rate of low 5-min Apgar scores, admission to the neonatal intensive care unit, or deliveries before 34 weeks. The MCA/uterine artery and MCA/umbilical artery PI ratios were similar in the prediction of adverse perinatal outcome. Both ratios were better at predicting the outcome of pregnancy than were signs of increased vascular impedance in either the umbilical or uterine arteries. CONCLUSIONS: Normal MCA/uterine artery PI ratio decreases with gestational age. Abnormally low MCA/ uterine artery PI ratios are related to unfavorable pregnancy outcome. The predictive value of the MCA/uterine artery PI ratio is similar to that of the MCA/umbilical artery PI ratio.     

Early prenatal diagnosis of cord entanglement in monoamniotic multiple pregnancies.

OBJECTIVES: Cord entanglement is a severe complication in monoamniotic multiple pregnancies. Three cases were reviewed to determine how early ultrasound diagnosis might improve counselling and management. METHODS: In two monoamniotic twin and one dichorionic diamniotic triplet pregnancies, cord entanglement was detected between 10 and 18 gestational weeks by color Doppler and pulsed Doppler velocimetry. Pregnancies were followed up on a weekly basis with special observation of fetal behavior and use of color Doppler velocimetry. RESULTS: In Case 1, a monoamniotic twin pregnancy with cord entanglement close to the umbilical insertions was diagnosed at 10 weeks. Longitudinal follow-up showed intrauterine death of both twins at 15 weeks. In Case 2, entanglement of the umbilical cords of two monoamniotic triplets within a dichorionic diamniotic triplet pregnancy was diagnosed at 10 weeks. The pregnancy continued uneventfully until 35 weeks when cord entanglement was confirmed at Cesarean section. All triplets have since developed normally. In Case 3, monoamniotic twins were diagnosed at 18 weeks. Color Doppler detected side-by-side insertion of the umbilical cords and Doppler velocimetry suggested an entanglement at the chorionic plate. The pregnancy was complicated by polyhydramnios. Cesarean section at 36 weeks confirmed cord entanglement at the chorionic plate. Postnatal computer angiography and morphological examination of the placenta showed the presence of superficial artery-to-artery and vein-to-vein anastomoses and of deep arteriovenous shunts. The development of the twins was uneventful. CONCLUSIONS: Diagnosis of cord entanglement is feasible early in gestation. Future protocols are proposed to document the gestational age at detection, the location, and the Doppler flow patterns and to facilitate the assessment of short- and long-term development.     

Early second-trimester low umbilical coiling index predicts small-for-gestational-age fetuses.

OBJECTIVE: To evaluate the role of the early second-trimester Doppler velocimetric studies of the umbilical coiling index and umbilical cord cross-sectional area as tests for the prediction of small-for-gestational age infants. METHODS: Doppler blood flow studies in 147 singleton pregnancies at risk for delivery of a small-for-gestational-age neonate were performed at 15 +/- 1 (SD) weeks' gestation from the uterine artery, umbilical artery, middle cerebral artery, inferior vena cava, and ductus venosus. Pulsatility index values were calculated for the arteries, and preload index values and systolic-atrial contraction ratios were calculated for the veins. The sonographic cross-sectional area of the umbilical cord was measured in a plane adjacent to the insertion into the fetal abdomen. The umbilical coiling index was calculated by using sonographic longitudinal views of cord vessels from several segments antenatally and by dividing the total number of helices by cord length (centimeters) postnatally. Small-for-gestational-age neonates were identified when the birth weight was below the 10th percentile for gestational age. RESULTS: Among 147 pregnancies studied, 124 fulfilled the study criteria. Thirty-nine of the neonates were small for gestational age at birth (31.5%). The mean +/- SD gestational age at delivery of the appropriate-for-gestational-age neonates was 39.7 +/- 1.28 weeks, and that of the small-for-gestational-age neonates was 36.4 +/- 2.9 weeks (range, 28-40 weeks). The best single predictor of a small-for-gestational-age infant was the coiling index, with sensitivity of 79%, specificity of 86%, a positive predictive value of 72%, and a negative predictive value of 90%. CONCLUSIONS: The umbilical coiling index measured in the second trimester is useful in predicting the birth of a small-for-gestational-age infant and may serve as a marker for subsequent growth restriction.     

Gestational sac diameter in very early pregnancy as a predictor of fetal outcome.

OBJECTIVE: To determine whether transvaginal sonographic measurement of gestational sac diameter in pregnancies 28-42 days from the last menstrual period can predict whether a pregnancy results in a normal term birth or a spontaneous miscarriage. DESIGN: Gestational sac diameter was measured during the 4th and 5th weeks of gestation from the last menstrual period in 67 women who had a total of 102 ultrasound scans. These pregnancies were followed until one of two outcomes occurred: term gestation (n = 32) or spontaneous miscarriage (n = 35). Gestational sac diameter as a function of gestational age was compared in each of the groups. RESULTS: The mean diameter of the gestational sac at 28-35 days from the last menstrual period among normal pregnancies did not differ significantly from that in those that subsequently miscarried (2.6 mm vs. 2.7 mm; P = 1.00). In pregnancies 36-42 days from the last menstrual period, the mean sac diameter was significantly different between the two groups (normal group, mean sac diameter, 8.2 mm and miscarriage group, mean sac diameter, 4.5 mm; P < 0.001). CONCLUSION: There is no difference in gestational sac diameter at 28-35 days from the last menstrual period in normal and abnormal pregnancies. However, smaller than expected sac diameter in pregnancies 36-42 days from the last menstrual period is predictive of spontaneous miscarriage.     

产前超声对胎儿脐动脉栓塞的诊断价值

目的:探讨产前超声诊断胎儿脐动脉栓塞的临床意义。方法:对2015年1月-2019年5月在本院超声检查发现一支脐动脉栓塞,并于本院分娩或引产共7例胎儿的超声图像及妊娠结局等进行回顾性分析。结果: 7例胎儿20-24周超声检查均为双脐动脉,均于28周后（28-30周）发现一支脐动脉栓塞,并于分娩后诊断脐动脉血栓,4例于分娩后诊断脐带过度扭转。超声表现其中4例为一支脐动脉内可见实性回声改变。1例为一支脐动脉内径减小继发脐动脉栓塞, 2例28周后超声诊断为单脐动脉,未显示脐动脉内血栓。5例活产,其中3例早产;2例胎死宫内。4例胎儿宫内生长受限,3例胎儿大小符合孕周。结论:脐动脉栓塞胎儿并发症和病死率高,严重影响胎儿预后,与不良妊娠结局密切相关,孕晚期超声检查应高度警惕有无脐动脉栓塞的发生,一经确诊,密切监测胎儿情况,及时终止妊娠,能有效地降低围产儿的死亡率并改善预后 。     

Yolk sac and umbilicoplacental hemodynamics during early human embryonic development.

OBJECTIVES: To determine the relationship between the yolk sac and umbilicoplacental circulations during the first trimester of pregnancy. DESIGN: Sixteen normal singleton pregnancies were included in this longitudinal study. Transvaginal ultrasonography with color and pulsed Doppler was performed at 5+, 7+, 8+ and 10+ gestational weeks. Fetal heart rate and blood velocity waveforms of yolk sac, umbilical and chorionic arteries were obtained. RESULTS: The detection rate of arterial blood flow in the yolk sac increased significantly from 5+ (2/16) to 7+ gestational weeks (12/16). Thereafter, it declined significantly and no arterial blood flow was detected at 10+ weeks. When the arterial blood flow was observable in the yolk sac, all waveforms consisted of continuous diastolic blood flow. There were no significant changes in peak systolic velocity (PSV), time-averaged maximum velocity (TAMXV), pulsatility index (PI) or resistance index (RI) values of the yolk sac arteries during the study period. In umbilical arteries, blood flow was detected in two of 16 patients at 5+ weeks and in all cases thereafter. The mean umbilical artery PSV (SD) increased from 7.2 cm/s (3.7) at 8+ weeks to 13.0 cm/s (2.9) at 10+ weeks (p = 0.001). No changes in PI values were found and the absence of diastolic flow was typical of the umbilical artery during the study period. In chorionic arteries, blood flow was detected in six out of 16 subjects at the 5+ week, in 14 out of 16 patients at the 7+ week and in every case thereafter. No changes in PSV or TAMXV values were found. CONCLUSIONS: Our results showed that the arterial signals in the yolk sac circulation disappeared and the umbilicoplacental circulation increased between 8+ and 10+ weeks of gestation. This indicates that the placenta replaces the yolk sac as an essential source of blood supply to the embryo at that time.     

First trimester bleeding evaluation

First trimester bleeding is a common presentation in the emergency room. Ultrasound evaluation of patients with first trimester bleeding is the mainstay of the examination. The important causes of first trimester bleeding include spontaneous abortion, ectopic pregnancy, and gestational trophoblastic disease; 50% to 70% of spontaneous abortions are due to genetic abnormalities. In normal pregnancy, the serum beta hCG doubles or increases by at least 66% in 48 hours. The intrauterine GS should be visualized by TVUS with beta hCG levels between 1000 to 2000 mIU/mL IRP. Visualization of the yolk sac within the gestational sac is definitive evidence of intrauterine pregnancy. Embryonic cardiac activity can be identified with CRL of >5 mm. A GS with a mean sac diameter (MSD) of 8 mm or more without a yolk sac and a GS with an MSD of 16 mm or more without an embryo, are important predictors of a nonviable gestation. A GS with a mean sac diameter of 16 mm or more (TVUS) without an embryo is a sonographic sign of anembryonic gestation. A difference of <5 mm between the mean sac diameter and the CRL carries an 80% risk of spontaneous abortion. Approximately 20% of women with first trimester bleeding have a subchorionic hematoma. The presence of an extra ovarian adnexal mass is the most common sonographic finding in ectopic pregnancy. Other findings include the tubal ring sign and hemorrhage. About 26% of ectopic pregnancies have normal pelvic sonograms on TVUS. Complete hydatidiform mole presents with a complex intrauterine mass with multiple anechoic areas of varying sizes (Snowstorm appearance). Twenty-five percent to 65% of molar pregnancies have associated theca-leutin cysts. Arteriovenous malformation of the uterus is a rare but life-threatening cause of vaginal bleeding in the first trimester. The sonographic findings in a patient with first trimester bleeding should be correlated with serum beta hCG levels to arrive at an appropriate clinical diagnosis.     

Color Doppler sonographic assessment of placental circulation in the first trimester of normal pregnancy.

Our aim was to study placental circulation during the first trimester of normal pregnancy. For this purpose, 108 single pregnancies from 4 to 15 gestational weeks were evaluated through conventional Doppler ultrasonography. The flow velocity waveforms from the retrochorionic arteries (spiral-radial arteries) and the umbilical artery were assessed using the peak systolic velocity, resistive index, and pulsatility index). Intervillous flow velocity waveform was evaluated from the maximum velocity. The earliest color signal from the retrochorionic circulation was registered at 4.5 weeks along with gestational sac visualization. The venous Doppler signal from the intervillous space and the Doppler signal from the umbilical artery were recorded with an embryo visible from the end of week 5 onward. The retrochorionic, intervillous, and umbilical peak systolic velocities increase, whereas the resistive and pulsatility indices decrease progressively during early pregnancy with a significant correlation with gestational age. Similarly, intervillous maximum velocity gradually increases throughout the first trimester of pregnancy. Despite some methodologic problems related to Doppler technology and the vessels studied color Doppler sonography appears to be an adequate tool to assess the physiologic changes in the placental circulation during early pregnancy.     

Fetal cerebral venous Doppler velocimetry in normal and high-risk pregnancy.

OBJECTIVE: In previous pilot studies, fetal vein of Galen (GV) blood velocity has been shown to be non-pulsatile in normal pregnancies. A pulsating pattern in high-risk pregnancies has been related to adverse outcome of pregnancy. The aim of this study was to establish reference ranges for fetal cerebral venous blood flow and compare them to the recordings in high-risk pregnancies in terms of predicting adverse perinatal outcome. METHODS: The GV, straight sinus (SS) and transverse sinus (TS) were located by color Doppler ultrasound in 189 normal pregnancies between 23 and 43 weeks of gestation. Recordings were also made in 102 pregnancies complicated by pregnancy-induced hypertension and/or intrauterine growth restriction. The following parameters were measured: peak systolic velocity, minimum diastolic velocity, time-averaged maximum velocity, pulsatility index for veins (PIV) and preload index (PLI). GV pulsations were noted. In high-risk pregnancies, Doppler measurements were correlated to pregnancy outcome, including emergency operative intervention and/or neonatal distress. Umbilical vein and umbilical, uterine and middle cerebral artery blood velocities were also recorded at the same time. RESULTS: In normal pregnancy, pulsating venous blood velocity was observed in GV in 8% of cases, in SS in 79% of cases and in TS in 100% of cases. GV and SS maximum velocity increased with gestational age and TS-PIV showed linear decreasing values and TS-PLI showed increasing values with gestational age. In high-risk pregnancies, pulsating blood velocity in the GV was found in 59 (58%) cases and was related to adverse outcome of pregnancy including mortality. Abnormal values for TS-PIV and PLI and SS maximum velocity were found in nine, six and five cases, respectively and were only related to perinatal mortality. GV pulsations were more frequent than umbilical venous pulsations. CONCLUSIONS: Of the fetal cerebral veins studied, the presence of pulsations in the GV seems to be the best predictor of adverse outcome of high-risk pregnancy. Pulsations in the GV are more frequent than in the umbilical vein and might therefore appear earlier during worsening fetal condition, and thus be of potential value for fetal surveillance in high-risk pregnancies.     

Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography.

OBJECTIVE: To assess the prevalence and natural history of ovarian pathology in pregnancy. METHODS: Three thousand consecutive pregnant women presenting before 14 weeks' gestation at the early pregnancy unit at St George's Hospital, London, underwent ultrasound examination during which both ovaries were visualized. Women found to have a simple ovarian cyst with a minimum diameter > or =25 mm or a complex ovarian cyst of any size were included in the study. They were followed up with ultrasound scans every 4-6 weeks until either resolution of the ovarian cyst occurred, intervention was required or the pregnancy was concluded. If the cyst persisted at 20 weeks' gestation, these women were rescanned 6 weeks after conclusion of the pregnancy. Women were managed expectantly throughout their pregnancy. RESULTS: One hundred and sixty one women with a total of 166 cysts were included for analysis. At presentation, 43.7% of the women were asymptomatic and 56.3% had pain and/or vaginal bleeding. The mean gestational age at presentation was 53 (range, 28-98) days, the mean maternal age was 30 (range, 17-42) years, and the mean ovarian cyst diameter was 48 (range, 12-115) mm. The first-trimester pregnancy diagnoses were 106 intrauterine pregnancies, 40 miscarriages, five ectopic pregnancies, three pregnancies of unknown location and seven terminations of pregnancy. The sonographic features of the ovarian cysts included: 117 simple and anechoic, 21 hemorrhagic, 16 with mixed echogenicity, seven with a ground-glass appearance, three solid/cystic with papillary projections and two with low-level echoes. One hundred and nineteen (71.7%) of the cysts resolved spontaneously and were presumed to be physiological, 40 (24.1%) persisted and seven (4.2%) required intervention, four of these as an emergency because of pain. There was one case of borderline malignancy and no cases of malignancy. Five (3.0%) of the cysts underwent torsion. Only 0.13% (4/3000) of all women who initially presented to our unit required acute intervention during their pregnancy. CONCLUSIONS: The majority of cysts detected in early pregnancy are physiological and resolve. Very few persist and intervention during the pregnancy is rarely indicated. The expectant management of ovarian cysts detected in the first trimester is safe and should be encouraged. Examining the ovaries in the first trimester is of limited value.     

The empty amnion: a sign of early pregnancy failure.

Between 6.5 to 10 weeks of gestation, the length of the amniotic cavity is similar to that of the embryo. It follows that by the time an amniotic sac is detectable sonographically, an embryo of equal length should also be visualized. Retrospective review of case records at our institution revealed 15 patients in whom the amnion was visualized in the absence of an embryonic pole during first trimester sonography (endovaginal and transvesical). Indications for sonographic examination included gestational age estimation, discrepant size and dates, or vaginal bleeding. The mean sac diameter for the 15 gestations ranged from 14 to 36 mm, corresponding to gestational ages of 6.1 to 9.5 weeks. Ages based on the last menstrual period ranged from 6.1 to 11 weeks. A yolk sac was identified in all cases in addition to the amniotic sac, but neither an embryo nor cardiac pulsations were observed. In 12 of the 15 cases the size of the gestational sac was greater than 16 mm, such that the absence of an embryo also met an accepted criterion for a failed pregnancy. Follow-up in all cases confirmed early pregnancy failure. In this series the demonstration of an "empty amnion" (visualization of an amnion but no identifiable embryonic pole) was always associated with pregnancy loss. The "empty amnion" sign is helpful as an additional finding confirming early pregnancy failure.     

Varix of the fetal intra-abdominal umbilical vein: comparison with normal.

To compare the normal extrahepatic portion of the fetal intra-abdominal umbilical vein (FIUV) with varix of the FIUX, we prospectively measured the diameter of the FIUV in 150 uncomplicated second and third trimester pregnancies and compared these results with retrospective review of nine fetuses with varix of the FIUV as an isolated prenatal sonographic finding. The diameter of the normal FIUV increases linearly from approximately 3 mm at 15 menstrual weeks to approximately 8 mm at term (R = 0.92). The nine fetuses with FIUV varix had a FIUV diameter 6 to 12 standard deviations above the mean for age. Four (44%) of the nine fetuses with FIUV varix subsequently died, including one with trisomy 21. One of the remaining fetuses developed severe hydrops 2 weeks after the initial detection of the FIUV varix. FIUV varix appears to carry an increased risk of adverse fetal outcome, including fetal demise.     

超声测量晚孕期正常双胎生长参数的初步分析

目的拟初步建立孕28-34周的双胎胎儿生长参数超声测量值的正常范围,比较晚孕期单、双胎妊娠胎儿的宫内生长发育模式。方法对2009年5月一2010年4月超声诊断为正常宫内双活胎、单活胎孕妇,采用超声测量胎儿相关生长发育指标,包括双顶径、头围、腹围、股骨长等,测量其中部分双胎的小脑横径并应用虚拟器官计算机辅助分析技术测量其小脑容积,比较晚孕期单、双胎胎儿生长发育的差异。结果①自妊娠30周以后,双胎胎儿的双顶径发育速度比单胎胎儿延缓,单、双胎胎儿平均每周增长分别约2．3、1．7mini②自妊娠32周以后,双胎胎儿的头围的发育速度比单胎胎儿延缓,单、双胎胎儿平均每周增长分别约6．7、5．8Inrn;③自妊娠30周以后,双胎胎儿的腹围的发育速度比单胎胎儿延缓,单、双胎胎儿平均每周增长分别约6．9、5．3mm;④双胎胎儿股骨长从孕28～34周发育速度均较单胎胎儿缓慢,单、双胎胎儿平均每周增长分别约2．0、1．7mml⑤多元分析孕28－34周的双胎胎儿双顶径、头围、腹围和股骨长,相对于单胎胎儿而言,自28周起,双胎妊娠胎儿的生长发育较延缓;⑥自孕28～34周,双胎胎儿小脑横径、小脑容积与单胎胎儿无明显差异。结论双胎妊娠胎儿与单胎妊娠胎儿在晚孕期有着不同的生长发育规律。