Showing papers by "Elisenda Eixarch published in 2006"

Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome

Abstract: Objective To describe sequential changes in uterine artery waveform between the first and second trimesters of gestation and to analyze their association with the subsequent risk of hypertensive disorders and fetal growth restriction (IUGR). Methods Sequential uterine artery Doppler recordings were obtained in a final cohort of 870 singleton pregnancies over two gestational age intervals: 11–14 weeks and 19–22 weeks. The left and right uterine arteries were examined by color and pulsed Doppler and the mean pulsatility index (PI) as well as the presence of a bilateral protodiastolic notch were recorded during both intervals. Pregnancies were followed for occurrence of hypertensive disorders and IUGR. Results Mean uterine artery PI showed a significant linear decrease within each of the two intervals considered, while the prevalence of a bilateral notch showed decreasing values only throughout 11–14 weeks of gestation. Sixty-four (7.3%) pregnancies developed a hypertensive disorder and/or IUGR, including three (0.34%) cases of gestational hypertension, 24 cases of pre-eclampsia (2.75%) and 37 (4.25%) of IUGR. Compared with pregnancies with a normal outcome, complicated pregnancies showed a significantly higher prevalence of a bilateral notch and a higher mean PI in each of the two intervals studied. Compared with normal pregnancies, complicated pregnancies had a significantly higher persistence of a bilateral notch (30% vs. 8%), a higher proportion of women with an abnormal first-trimester uterine artery PI shifting to normal in the second trimester (14% vs. 4%) and a higher incidence of a normal first-trimester mean PI that shifted to abnormal in the second trimester (13% vs. 4%). Persistence of an abnormal mean PI from the first to the second trimester identified the group with the greatest risk for adverse perinatal outcome (OR, 10.7; 95% CI, 3.7–30.9). In addition, women in whom the uterine artery mean PI shifted from abnormal to normal between the two trimesters and women in whom the reverse shift occurred showed a similar intermediate risk (OR, 5; 95% CI, 2.1–10.6), comparable to that in women with persistence of a bilateral notch (OR, 5.6; 95% CI, 2.9–10.7). Conclusions The sequence of changes in uterine flow between the first and second trimesters correlates with the subsequent development of hypertensive disorders and IUGR. Women with a persistent abnormal mean PI represent the group with the greatest risk for adverse perinatal outcome. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.

Middle cerebral artery pulsatility index: reliability at different sampling sites

Abstract: Objectives To analyze the interobserver reliability of measurement of the middle cerebral artery (MCA) pulsatility index (PI) at two different sampling sites. Methods This study included 100 consecutive singleton pregnancies between 24 and 40 weeks with normal fetal growth. The PI was calculated by two independent operators at proximal and distal sampling sites of the near-field MCA. Reliability analyses were performed between observers at each sampling site by means of the intraclass correlation coefficient (ICC) for agreement. Differences between observers were explored and agreement limits calculated by means of the Bland–Altman test. Results Satisfactory flow velocity waveforms were obtained successfully in each fetus at both sampling sites. Peak systolic, end-diastolic and time-averaged maximum velocities were significantly higher at the proximal compared with the distal sampling site. Conversely, PI was significantly higher at the distal compared with the proximal site. ICCs for PI were 0.3 and 0.33 at the proximal and the distal sampling sites, respectively. The 95% interval of the PI differences between observers were + 0.91 and − 1.14 at the proximal and + 1.03 and − 1.08 at the distal sampling sites. In about 30% of the cases the PI difference between observers was greater than 0.5 at both sampling sites. Conclusions Moderate interobserver reliability in the measurement of end-diastolic and time-averaged maximum MCA flow velocities results in limited agreement of the PI calculation at both proximal and distal sampling sites. These results may preclude its clinical applicability. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.

Umbilical artery pulsatility index: reliability at different sampling sites.

Abstract: Objectives: To analyse the inter-observer and inter-artery reliability of the umbilical artery (UA) pulsatility index (PI) at different sampling sites. Methods: One hundred consecutive singleton pregnancies between 24 and 40 weeks were included. The PI was calculated by two independent operators from both umbilical arteries at the placental end, at a free-floating loop and at the perivesical segment. Reliability analyses were performed between observers and between arteries at each sampling site. Results: The mean percentage of PI difference between arteries was 15.2, 14.5 and 22% at the placental end, free-loop and perivesical site, respectively. The Intraclass correlation coefficients at each site were 0.51, 0.59 and 0.67, respectively. Whereas about 20% of cases showed a percentage of PI difference between arteries greater than 20% at free-loop and placental end sites, and at the perivesical site this figure was 45%. Conclusions: The perivesical sampling site for UA PI calculation is more reliable than at a free-floating loop, albeit without significance, and is significantly more reliable than at the placental end of the umbilical cord. Since discordances in PI between both arteries are more pronounced at the perivesical site, it seems mandatory to evaluate both arteries in this segment.

Leiomyomatosis peritonealis disseminata (2006: 9b).

Abstract: A 35-year-old woman with regular periods and no history of pregnancy or use of oral contraceptive presented with a 3-week history of abdominal pain and a hypogastric mass. Previous medical history is uneventful other than a previous laparoscopic myomectomy for isolated uterine leiomyoma 3 years previously. There was no asthenia or anorexia. Physical examination revealed two firm hypogastric masses of approximately 4-cm diameter. On gynaecological examination the uterus was prominent and there was a nonfixed tender mass in the right adnexa. She underwent transabdominal ultrasonography (US), which showed the presence of multiple hypoechoic small nodules in the pelvis, abdomen and subhepatic space with moderate ascites (Fig. 1a,b). During transvaginal ultrasonography, many abdominal nodules (30–70 mm) were identified, with a normal uterus and right ovary and moderate ascites. The left ovary could not be demonstrated. CT demonstrated a multinodular well-demarcated mass arising from the pelvis extending to the right side of the abdomen and subhepatic space. Portal phase imaging revealed multiple nodules that show heterogeneous enhancement with central hypodense areas. Subtle enhancement was identified in the right parietal peritoneum with ascites. No abnormal retroperitoneal lymph nodes were identified Magnetic resonance (MR) imaging was performed to gain further information; this also demonstrated a multilobular mass on T1and T2weighted images, which enhanced after administration of intravenous gadolinium DTPA (Figs. 3a,b, 4) (Fig. 2a,b). Diagnostic laparoscopy was performed. Multiple vascularized nodules resembling leiomyomata were seen along the abdominal cavity with ascites. A biopsy of one of the nodules was performed. Histological examination indicated leiomyomatosis peritonealis disseminata (LPD) without any evidence of malignancy. The oestrogen receptors were negative and progesterone receptors were positive. During subsequent laparotomy for conservative treatment, more than 20 nodules varying in size from 5 to 10 cm were removed from the surface of the uterus, large intestine, right broad ligament, posterior parietal peritoneum and parietal peritoneum of the right side of the abdomen (Fig. 5a,b). Histological examination of the nodules confirmed benign LPD.