Three-dimensional power Doppler ultrasound in ovarian cancer and its correlation with histology

Purpose  

The aim of this study was to evaluate and quantify intraovarian blood flow with 3D power Doppler histogram analysis before surgical intervention in women suspected of having ovarian carcinoma and to determine the correlation with histology findings.     

Term and preterm (<34 and <37 weeks gestation) placental pathologies associated with fetal growth restriction

Objective  

The present study was aimed to compare term versus preterm placental pathologies associated with fetal growth restriction (FGR).     

Nitrofurantoin transport by placental choriocarcinoma JAr cells: involvement of BCRP, OATP2B1 and other MDR transporters

Objective  

To determine the role of BCRP in nitrofurantoin (NF) transport in JAr cells and the possible contribution of OATP2B1, P-gp and MRPs to this transport.     

Carrier-mediated uptake of Levofloxacin by BeWo cells, a human trophoblast cell line

Objective  

Placental transfer of Levofloxacin (LF), a broad spectrum fluoroquinolone antibiotic, and its inhibition was investigated in BeWo cells, a human trophoblast cell line.     

Progesterone levels in cesarean and normal delivered term placentas

Background  

One of the most important hormones synthesized by the placenta during pregnancy is progesterone. The regulating mechanisms of progesterone synthesis and the mechanism responsible for the spontaneous onset of labor in women are still not fully understood. Progesterone is thought to have been involved in human parturition. The objective of this study was to compare the levels of progesterone in the human placentas, at the end of the gestation (37–41 weeks) in vaginal versus cesarean deliveries, and to evaluate the pattern of progesterone accumulation, instantly following its synthesis by the human placenta at the end of the pregnancy.     

Neonatal outcome in preterm deliveries between 23 and 27 weeks’ gestation with and without preterm premature rupture of membranes

Objectives  To characterize neonatal morbidity and mortality rates in extreme preterm deliveries (between 23 and 27 weeks’ gestation) with and without PPROM, and to evaluate the association between PPROM and chorioamnionitis. Methods  A retrospective population-based study was conducted on preterm singleton pregnancies delivered between 23 and 27 weeks’ gestation from 1988 to 2007. Immediate neonatal morbidity and mortality rates in pregnancies complicated by PPROM were compared to pregnancies with intact membranes. A multivariate analysis was conducted in order to determine the independent association between PPROM and chorioamnionitis. Results  Out of 1,437 preterm deliveries, 236 (16.4%) were complicated with PPROM. There were more neonates with low 1 min (61.0 vs. 42.5%; P = 0.001) and low 5 min (30.1 vs. 23.8%; P = 0.042) Apgar scores (of less than 7) in pregnancies complicated by PPROM than in the comparison group. There were more cases of chorioamnionitis in the PPROM group born at 23–24 weeks’ gestation (33.8 vs. 17.0%; P < 0.001), and in the PPROM group born at 25–27 weeks (42.0 vs. 15.5%; P < 0.001). In the group born at 23–24 weeks’ gestation, there were more postpartum deaths (PPD) in the PPROM group (70.0 vs. 54.8%; P = 0.013); however, there was no significant difference in PPD in the groups born at 25–27 weeks. In the group born at 23–24 weeks, as well as at 25–27 weeks, there were fewer antepartum deaths (APD) in the PPROM group as compared to the control group (16.3 vs. 32.6%; P = 0.002, and 5.3 vs. 36.3%; P < 0.001; respectively). After adjusting for gestational age and gender, using a multivariate analysis, the association between PPROM and chorioamnionitis remained significant (OR = 3.32; 95% CI 2.43–4.51, P < 0.001). Conclusions  PPROM is associated with adverse perinatal outcome in deliveries between 23 and 27 weeks’ gestation. Moreover, PPROM is an independent risk factor for chorioamnionitis.     

Is oligohydramnios more common during the summer season?

Objective  The main objective of the present study was to determine whether the summer season is a risk factor for oligohydramnios, by comparing the frequency of oligohydramnios during the summer months versus its frequency during the rest of the year. Methods  A retrospective population-based study including all pregnancies of patients with oligohydramnios that delivered during the years 1988–2007 in a tertiary medical center was performed. All non-idiopathic causes for oligohydramnios were excluded from the analysis. Summer months were defined as May to August. A multiple logistic regression model was performed in order to control for confounders. Results  During the study period, there were 191,558 deliveries of which 4,335 were diagnosed with oligohydramnios. Of these, 1,553 deliveries occurred during the summer months and 2,782 deliveries occurred during the rest of the year. Higher rates of oligohydramnios were found in the summer months as compared to the rest of the year: 2.5 versus 2.1%, odds ratio (OR) = 1.18, 95% confidence interval (CI) 1.1–1.3; P < 0.001. Using a multiple logistic regression model, controlling for confounding variables such as ethnicity, the summer season was noted as an independent risk factor for oligohydramnios (OR = 1.1, 95% CI 1.02–1.21; P < 0.001). Another independent risk factor for oligohydramnios was Bedouin ethnicity (OR = 1.3, 95% CI 1.2–1.4; P = 0.015). Conclusions  Oligohydramnios is significantly more common during the summer months versus the rest of the year. Moreover, the summer season is an independent risk factor for oligohydramnios.     

Evidence for abnormal middle cerebral artery values in patients with idiopathic hydramnios.

OBJECTIVE: Idiopathic hydramnios is an independent risk factor for perinatal morbidity and mortality, although the precise mechanism is unknown. Hydramnios may alter oxygen delivery to the human fetus. The middle cerebral artery (MCA) pulsatility index (PI) is a sensitive parameter for detection of blood flow redistribution or centralization. The aim of this study was to determine whether idiopathic hydramnios is associated with changes in the PI of the MCA and the umbilical artery (UA). DESIGN: The PI of the MCA and UA were determined prospectively in 113 consecutive pregnant women with singleton pregnancies and idiopathic hydramnios (study group) and in 113 matched control patients with normal amniotic fluid (AF) volume (control group). The control group was matched for maternal age, gravidity, parity and gestational age at examination. Hydramnios was defined as an AF index above 24 cm. Patients with fetal structural or chromosomal anomalies and with diabetes mellitus were excluded. A PI below the 5th centile for the MCA was considered abnormal. RESULTS: The rate of abnormal MCA PI was significantly higher in the study group than in the control group (30.9% (35/113) vs. 5.3% (6/113), respectively, OR 8.0; p < 0.0001; 95% CI 3.3-22.1). A significant inverse correlation was found between MCA PI and increasing AF index among patients with hydramnios (p = 0.008, r = 0.46). In contrast, there were no significant differences between the UA PI (0.93 (0.57-2.06) vs. 1.0 (0.49-1.48), (p = 0.20)) and MCA/UA (1.86 (0.77-2.01) vs. 2.15 (0.86-4.11), (p = 0.14)) in both groups. CONCLUSIONS: Our observations provide evidence of cerebral blood flow redistribution in fetuses with idiopathic hydramnios.     

Ultrasound of the placenta: a systematic approach. Part II: functional assessment (Doppler)

Doppler velocimetry is the ideal clinical tool to assess placental performance in high-risk pregnancies. It also has value in predicting later complications and outcome in pregnancies which appear uncomplicated. All three circulations (fetal, placental and maternal) may be interrogated by Doppler technology. In the following review, we present basic physics aspects of Doppler and discuss mainly Doppler investigation of the fetal-placental circulation (umbilical artery, intraplacental circulation) as well as the uterine arteries. The assessment of umbilical blood flow provides information on blood perfusion of the fetal-placental unit. The diastolic blood flow velocity component in umbilical artery increases with advancing gestation. In pregnancies complicated by placental dysfunction, there may be a reduction in the number of functional villi and/or small blood vessels with, as a result, increased impedance, reflected, mainly, by a decrease in end-diastolic velocity. When the resistance increases even more, there is no diastolic forward velocity (absent end-diastolic velocity). Further increase in the resistance causes reversed end-diastolic velocity, which is considered a late step in the cascade of events leading to intrauterine fetal demise. Doppler assessment of the umbilical arteries was found to improve outcome of high-risk pregnancies, and reduce hospital admissions. On the contrary, routine Doppler ultrasound in low risk or unselected populations does not seem to confer benefit on mother or newborn. Uterine artery Doppler is a useful test in predicting pregnancies at high risk of developing complications related to uteroplacental insufficiency. It identifies women who may benefit from increased antenatal surveillance or prophylactic therapy. Three-dimensional power Doppler sonography can provide new insights into placental pathophysiology.