Three-dimensional ultrasound diagnosis of ruptured subcapsular liver hematoma caused by HELLP syndrome

Early detection of embryonic malformations by transvaginal and color Doppler sonography.

A total of 834 women with uneventful pregnancies were followed prospectively until the 15th week of gestation by TVS to screen for early embryonic malformations. Twenty-eight embryonic anomalies were detected in this series (3.3%). The median gestational age at diagnosis was 11 (range, 8 to 15) weeks. Two neural tube defects were missed by early TVS screening. Two suspected abdominal wall defects were not confirmed by repeat mid-second trimester abdominal sonography representing 6.7% of all fetal malformations evident by 24 weeks of gestation. The sensitivity and specificity of TVS screening for fetal malformations in this series were 93.3 and 99.7%, respectively. In addition, the role of T…

Morphological assessment of the umbilical cord with three-dimensional ultrasonography

ABSTRACTThe long cylindrical cord covered by a layer of amnion that extends from the umbilicus of the fetus to the fetal surface of the placenta is known as the umbilical cord, or, in older medical textbooks, as funiculis umbilicalis. The two umbilical arteries extend as branches of the internal iliac arteries that emerge from the fetal body at the umbilicus, and run a helical course through the umbilical cord carrying venous blood to the placenta. In most normal placentas, the umbilical arteries anastomose within 2 cm of insertion into the placenta. The fetal umbilical vein emerges from the placenta and carries oxygenated blood to the fetus. The cord vessels are supported by a matrix of my…

Umbilical cord cysts: evaluation with different 3-dimensional sonographic modes.

Objective. The purpose of this series was to determine whether the use of different 3-dimensional (3D) sonographic modes allows better definition of umbilical cord cysts and pseudocysts in utero. Methods. Two cases of umbilical cord cysts and 1 of a pseudocyst were analyzed and compared with 2-dimensional (2D), 3D, angiopower Doppler, tomographic ultrasound imaging (TUI), virtual organ computer-aided analysis (VOCAL), and automatic volume calculation (AVC) sonographic modes. All cases were followed during pregnancy. A karyotype analysis was also obtained. Results. Three-dimensional sonography, TUI, and VOCAL allowed clear visualization and evaluation of the sizes, locations, and numbers of …

Gonadotropin-releasing hormone (GnRH)-I regulation of interleukin (IL)-1b and IL-1 receptor antagonist expression in cultured human endometrial stromal cells

Aim:  Human endometrium is an active site of cytokine production and action. Among these cytokines, the interleukin-1 (IL-1) system seems to be relevant to the embryonic implantation process. We have previously reported the production of GnRH-I by human blastocyst, as well as the presence of GnRH-I receptor in human endometrium. This suggests a close interaction between the immune and endocrine systems through these cytokine mediators in embryonic implantation. Methods:  To test the relevance of this interaction during embryonic implantation, we investigated GnRH-I regulation of IL-1b and IL-1ra mRNA and protein expression in human endometrial stromal cells using quantitative competitive po…

Alta definición ecográfica en tiempo real (HDLive US) en Obstetricia y Ginecología / High real time ultrasound definition (HDLive US) in Obstetrics and Gynecology

Los ultrasonidos de alta definición en tiempo real (HDLive US) incorporan un software que calcula la propagación de la luz a través de superficies y en relación con la dirección de la misma. Esta fuente de luz puede ser posicionada libremente con el fin de iluminar las áreas de interés deseadas, permitiendo así imágenes de mejor calidad, una mayor sensación de profundidad y una visión más sencilla de superficies fetales. Mostramos casos de embriones y fetos normales, así como algunas malformaciones para señalar las posibilidades de esta nueva tecnología. El auténtico potencial de esta nueva tecnología esta aún por revelar. La HDLive representa, en nuestra opinión, una verdadera innovación y…

Control of intrauterine device insertion with three-dimensional ultrasound: is it the future?

A comparative study was designed to determine whether three-dimensional transvaginal sonography (3D-TVS) offered advantages over two-dimensional transvaginal sonography (2D-TVS) for the identification and location of IUDs in 66 asymptomatic women. Hysteroscopy was performed in cases in which there was a discrepancy between the information obtained by both methods (n = 14). In eight cases (12.2%) the IUD was misidentified with 2D-TVS. In six cases (9.1%) it was not possible to identify the device model with 2D-TVS. In two cases (3.0%) 2D-TVS failed to identify the position of the device. In contrast, all IUDs were identified and located accurately with 3D-TVS. © 1996 John Wiley & Sons, Inc.

First-trimester neck abnormalities: three-dimensional evaluation.

In order to study the first trimester ultrasonographic differences between nuchal translucency and hygroma colli, we rescanned 25 fetuses (13 with nuchal translucency and 12 with hygroma colli) using transvaginal and three-dimensional ultrasonography, after obtaining a fetal karyotype report. Our objective was to test the premise that the different physiopathologic mechanisms of both processes would be reflected in detectable sonographic differences. Our retrospective analysis showed that the most striking ultrasonographic difference was the presence of bullae as well as greater irregularity, extent, and amplitude of the membrane in cases of hygroma colli. Fetuses with simple nuchal translu…

Recombinant follicle stimulating hormone stimulation in poor responders with normal basal concentrations of follicle stimulating hormone and oestradiol: improved reproductive outcome

A total of 30 young infertile patients who exhibited a poor response in two previous consecutive cycles, despite having normal basal follicle stimulating hormone (FSH) and oestradiol concentrations, were invited to participate in a prospective randomized study comparing the clinical efficacy of recombinant (rFSH) and urinary (uFSH) follicle stimulating hormone. An evaluation of the total dose used (3800 IU versus 4600 IU, P < 0.05) and duration of treatment (10.2 days versus 13.2 days, P < 0.05) showed a significantly shorter treatment period as well as a significantly lower total dose of FSH required to induce ovulation successfully in the group of patients treated with rFSH. Significantly…

Is avoidance of surgery possible in patients with perimenopausal ovarian tumors using transvaginal ultrasound and duplex color Doppler sonography?

A total of 108 cases of small perimenopausal ovarian tumors (largest diameter, less than 7 cm) were evaluated by transvaginal sonography and duplex color Doppler sonography; 101 had criteria for benignity and 7 for malignancy. All cysts were punctured and aspirated to avoid unnecessary surgery (benign cases) and establish the cytologic diagnosis as well as to avoid the risk of leakage (malignant cases). Recurrence rate of benign punctured cysts was 25% within 1 year of follow up. No difference in recurrent rate was seen between pre- and postmenopausal patients (19 of 56 cases in the premenopausal group, and five of 28 cases in the postmenopausal group). The larger the cyst, the greater the …

Does transvaginal color Doppler sonography differentiate between developing and involuting ectopic pregnancies?

The objective of this study was to assess the addition of transvaginal color Doppler imaging to transvaginal ultrasonography and beta-human chorionic gonadotropin values to differentiate between developin and involuting ectopic pregnancies. Forty surgically confirmed ectopic pregnancies were classified into developing or involuting according to histopathologic findings. Results were compared retrospectively with the plasma beta-human chorionic gonadotropin values as well as the resistive index and pulsatility index obtained in corpora lutea and peritrophoblastic flow in serial examinations. Student's t-test was used for comparison of means. Logistic regression analysis was applied to predic…

Cystic degeneration of uterine leiomyoma during ulipristal acetate treatment

Degenerative cyst formation  is a rare phenomenon in-between uterine leiomyomas, however, both patients and physicians have to be aware of this possibility when using ullipristal acetate as this event may guide to the inaccurate diagnosis of an adnexal malignant pathology.

Three-dimensional inversion mode rendering in molar pregnancy

Three-dimensional hysterosonography for the study of endometrial tumors: comparison with conventional transvaginal sonography, hysterosalpingography, and hysteroscopy.

We studied endometrial thickness and homogeneity in 36 patients with postmenopausal bleeding using three-dimensional ultrasound following distention of the uterine cavity with a sterile saline solution (3D-SHSG). Results with 3D-SHSG were compared with findings using transvaginal sonography, transvaginal sonohysterography, transvaginal color Doppler, and hysteroscopy. Sixteen patients (including three on tamoxifen) were undergoing hormone therapy at the time when they were studied. Visualization of the uterine cavity and of endometrial thickness was better with 3D-SHSG than with any of the other ultrasound techniques. The results with 3D-SHSG corresponded to the findings observed with hyste…

Útero septo con duplicación cervical: una anomalía mülleriana infrecuente

Resumen En el presente caso hemos descrito una variante mulleriana infrecuente (utero septo y cervix doble), que resulta inconsistente con la embriologia clasica. Asimismo, hemos realizado un diagnostico correcto mediante el empleo de ecografia tridimensional, que representa el primer caso de la bibliografia mundial descrito mediante esta tecnica ecografica. Por ultimo, hemos repasado las opciones terapeuticas y discutido su inclusion futura en la clasificacion de las malformaciones uterinas

Three-dimensional ultrasound evaluation of ovarian masses.

Seventy-six women with ovarian masses first detected with two-dimensional (2D) ultrasound were then evaluated with three-dimensional (3D) ultrasound. Two-dimensional ultrasound detected four of five ovarian malignancies. One additional ovarian carcinoma was diagnosed by 3D scanning. Observation of papillary projections, characteristics of cystic walls, and the extent of capsular infiltration of tumors was superior with 3D ultrasound as was the calculation of ovarian volume. Fifty-seven of the women studied underwent surgery within 7 days of 3D ultrasound evaluation. Histologic examination of surgical specimens confirmed the 3D sonographic diagnoses. There was one false positive and one fals…

Three-dimensional ultrasound radiance mode imaging of a uterine lipoleiomyoma.

In this case report the diagnosis of a uterine lipoleiomyoma is depicted by means of a three-dimensional radiance mode. The advent of radiance or silhouette mode as a new tool in ultrasound diagnosis is intended to assist by generating additional realistic image visualization and a better distinction among different tissues.

Endometrial receptivity: evaluation with ultrasound.

An adequate endometrial receptivity is a crucial factor for embryo implantation. We describe endometrial morphology (endometrial appearance or pattern, endometrial thickness, volume, and delimitation), based on the concepts and possibilities of the new ultrasound modalities (3-dimensional/4-dimensional ultrasound, automatic volume calculation, virtual organ computer-aided analysis, tomographic ultrasound image, inverse mode, and 3-dimensional Doppler angiography) as markers of endometrial receptivity.

Two-dimensional and three-dimensional sonography of conjoined twins.

Purpose The aim of this study was to evaluate and compare the diagnostic capabilities of 2-dimensional (2D) and 3-dimensional (3D) sonography for the study of conjoined twins. Methods Four pregnant women with an initial 2D sonographic diagnosis of conjoined twins were examined with color Doppler sonography, 3D multiplanar sonography, and orthogonal plane imaging and 3D surface rendering. Results All 4 cases of conjoined twins were initially diagnosed with either transvaginal or transabdominal 2D sonography. 3D sonography afforded more realistic views and demonstrated more clearly the linking areas and surface anomalies, but 2D and color Doppler sonography provided more definitive and specif…

Use of three-dimensional ultrasonography for the study of normal and pathologic morphology of the human embryo and fetus: preliminary report.

Our objective was to determine whether three-dimensional ultrasonography offers advantages over two-dimensional sonography for the evaluation of normal and pathologic morphology of human embryos and fetuses at various stages of pregnancy. Our studies suggest that small fetal and embryonic malformations are better defined with 3D sonography. Our experience indicates that 3D sonography allows more detailed visualization of fetal internal structures. We believe that with technical improvements 3D sonography will permit a more complete evaluation of fetuses earlier in gestation than is possible with current 2D sonographic instruments.

Assessment of endometrial volume by three-dimensional ultrasound prior to embryo transfer: clues to endometrial receptivity

The aim of the present prospective study was to obtain quantitative data on endometrial volume by three-dimensional (3D) ultrasound at the time of embryo transfer in an in-vitro fertilization programme and to assess its value in predicting endometrial receptivity. The cycles (n = 72) were classified according to endometrial volume: group A2 ml, group B 2-4 ml, and group C4 ml. Comparisons of the groups showed that pregnancy and implantation rates were significantly lower (P0.05) in the group of patients with an endometrial volume2 ml. Furthermore, no pregnancy was achieved with an endometrial volume1 ml. It is concluded that endometrial volume by 3D transvaginal ultrasound may become a new …

Expression of vascular endothelial growth factor receptors in the endometrium of septate uterus.

Objective To compare the messenger RNA (mRNA) expression of vascular endothelial growth factor (VEGF) receptors (KDR, Flt-1, and sflt) in the different endometrial locations of septate uterus and normal uterus. Design Prospective, observational study. Setting University teaching hospital. Patient(s) Twelve women with complete septate uterus undergoing hysteroscopic metroplasty and 12 women with normal uterus. Intervention(s) Endometrial tissue samples were obtained from the endometrium covering the septum and the endometrium lining the lateral wall of the uterus. Moreover, endometrial samples were obtained from patients with normal uterus. Main Outcome Measure(s) Differences in the mRNA exp…

3D sonographic prenatal diagnosis of lobar holoprosencephaly associated with cebocephaly. Assessment and diagnosis with multiplanar reconstruction

Prenatal diagnosis of congenital cystic adenomatoid malformation using three-dimensional inversion rendering: A case report

We report a case of a congenital cystic adenomatoid malformation of the lung (CCAM). At 12 weeks of gestation, an echogenic lung associated to a hydrothorax was detected. Despite the results of the combined test that informed of a high risk of chromosomopathy, normal karyotype was confirmed after an amniocentesis. The three-dimensional ultrasound inversion mode depicted all the cysts within the fetal lungs as opaque areas that were seen concurrently together, which was compatible with CCAM. After parental counseling, the patient opted to terminate the pregnancy at 18 weeks. Pathological analysis of the lungs confirmed the diagnosis of a CCAM type II. The recent advent of the three-dimension…

Empleo prenatal de esteroides: riesgos y beneficios

Resumen El empleo de corticoides ante la posibilidad de un parto prematuro ha disminuido la incidencia de distress respiratorio, hemorragia intraventricular y muerte neonatal. En aquellas mujeres en que el parto se pospone mas alla de una semana, el empleo de nuevas dosis semanales ha sido empleado en la practica obstetrica pese a que hay poca evidencia de su eficacia. Nuevos estudios sugieren en estas pautas repetidas ocos beneficios y riesgos potenciales, por lo que sugieren las dosis unicas.

Ecografía tridimensional en uroginecología

Resumen La ecografia 3D permite observar, en tres planos y sistema volumetrico, el suelo pelvico, la uretra, el rabdoesfinter y el cuello vesical. Los estudios existentes muestran una excelente correlacion entre los hallazgos 3D de esta nueva tecnologia y los estudios de presiones. La ecografia 3D se convertira, con toda probabilidad, en una nueva y excelente ayuda para el estudio de la disfuncion pelvica y la incontinencia urinaria.

SonoAVC: a new tool in early diagnosis of patent urachus with bladder prolapse

Polycystic ovarian syndrome: assessment with color Doppler angiography and three-dimensional ultrasonography.

We conducted a three-dimensional ultrasonographic evaluation of the size and structure of the ovaries of women who had clinical and biochemical findings suggestive of polycystic ovary syndrome. We carried out a comparative color Doppler frequency and color Doppler amplitude study of the vascular patterns of these ovaries. This study involved 65 women of reproductive age with polycystic ovary syndrome and 25 eumenorrheic women who were not taking hormonal contraceptives and who had a body mass index below 25 kg/m2. Compared to controls, women with polycystic ovary syndrome had larger ovaries and thicker stroma, increased impedance in the uterine arteries, increased stromal vascularity with d…

Rotura hepática espontánea en el síndrome HELLP: tratamiento mediante packing

Resumen La rotura hepatica espontanea asociada a sindrome de HELLP (hemolisis, elevacion de enzimas hepaticas y plaquetopenia) es extremadamente rara y se acompana de una elevada tasa de complicaciones y mortalidad maternofetal. Es necesario un tratamiento urgente basado en la finalizacion del embarazo, reposicion de hemoderivados y hemostasia hepatica. Presentamos el caso de una paciente con sindrome HELLP y rotura hepatica espontanea tratada mediante cesarea urgente y packing hepatico.

Fetus acardius: two- and three-dimensional ultrasonographic diagnoses.

Objective. To determine whether ultrasonographic detection of acardiac fetuses and diagnostic accuracy of related malformations improve with complementary use of two-dimensional ultrasonography, three-dimensional ultrasonography, and Doppler scanning. Methods. Three pregnant women with multifetal gestations who were found to have discordant fetuses on initial two-dimensional ultrasonographic scanning were subsequently scanned with three-dimensional ultrasonography and color Doppler ultrasonography. Results. Although the possibility of acardiac fetuses was entertained in all cases after two-dimensional ultrasonographic scanning, the diagnosis was confirmed, and the accuracy and extent of fet…

Prenatal diagnosis of sacrococcygeal teratomas by two- and three-dimensional ultrasound

We suspected two fetuses of having sacrococcygeal teratomas following initial two-dimensional ultrasound scanning at 18 and 22 weeks' gestation. The fetuses were then scanned with three-dimensional multiplanar surface and three-dimensional orthogonal planar ultrasound to establish a definitive diagnosis. Although we made a presumptive diagnosis in both cases after initial two-dimensional scanning, with three-dimensional ultrasound we were better able to define the degree of involvement of the sacrum and other pelvic structures of prognostic importance. Copyright © 2002 ISUOG

Quilotórax antenatal en feto euploide con translucencia nucal aumentada en el primer trimestre

Resumen Gestacion en que el feto presento una translucencia nucal aumentada en el primer trimestre; el cariotipo normal fue tras la amniocentesis. A las 33 semanas se observo un derrame pleural derecho que desplazaba el mediastino, asociado a polihidramnios. Se produjo un parto prematuro a las 33,4 semanas; se obtuvo un recien nacido que presento distres respiratorio y requirio colocacion de un drenaje toracico. La presencia de linfocitos en el liquido pleural oriento el diagnostico hacia un quilotorax. Aunque es conocida la asociacion entre translucencia nucal aumentada con cariotipo normal y resultados perinatales desfavorables, la asociacion con quilotorax es infrecuente.

Congenital Müllerian anomalies: diagnostic accuracy of three-dimensional ultrasound

Objective To determine whether it is possible to identify and diagnose accurately Mullerian anomalies with three-dimensional (3-D) ultrasound (US). Design Controlled blinded clinical study. Setting Normal human volunteers undergoing infertility evaluation in a university hospital. Patients Forty-two patients who underwent laparoscopy and hysterosalpingography as part of their work up for infertility and were found to have either a normal uterus (30 patients) or a Mullerian abnormality (12 patients) consented to be evaluated with 3-D US by sonographers who were unaware of their infertility history or of their laparoscopy and hysterosalpingography diagnoses. Interventions Transvaginal 3-D US …

HDlive imaging of cystic uterine leiomyoma degeneration

Multimodality 3-dimensional volumetric ultrasound in obstetrics and gynecology with an emphasis in HDlive technique.

HDlive (high-definition live or real-time US), a new ultrasound software, combines a movable virtual adjustable light source in a software that calculates the proportion of light reflecting through surface structures, depending on light direction. The light source can be manually positioned to illuminate the desired area of interest. The ultrasound technician can control light intensity to create shadows that enhance image quality. HDlive is an innovation that will render even more realistic images of fetal anatomy and of gynecologic lesions. The full potential of this new technology is yet to be determined and deserves scientific evaluation.

Human Oviductal Gonadotropin-Releasing Hormone: Possible Implications in Fertilization, Early Embryonic Development, and Implantation1

The oviduct is host to gametes and early embryos at a critical point in their lives. It is clear that the interactions of gametes/early embryo with the maternal oviduct in an autocrine and paracrine manner provide a microenvironment that enhances fertilization, early embryonic development, and implantation. Moreover, there is considerable evidence that an extrahypothalamic GnRH may play a substantial role as a molecular autocrine/paracrine regulator in these events. Gametes and preimplantation embryos express GnRH and GnRH receptor at both messenger ribonucleic acid (mRNA) and protein levels. However, whether GnRH is produced by the human oviduct has not yet been demonstrated. We used RT-PC…

Abdominale, perineale und vaginale sonographische Diagnose der Zervikalinsuffizienz

In patients with cervical incompetence, the diagnostic efficiency of abdominal, perineal and vaginal sonography was compared. 73 patients, who were divided into three groups, were examined: Group A (n = 50) control group, Group B (n = 11) normal pregnancies, Group C (n = 12) pregnancies with demonstrated cervical incompetence. According to our results, using vaginal sonography, only the incompetent pregnancies showed significant shortening of the cervical length. Characteristic scans were also obtained (membrane herniation) which were useful in diagnosis and control in the performance of cerclage.

Prenatally detected double trisomy: Klinefelter and Down syndrome

Double trisomies are a rare occurrence. We report the first case of a Down and Klinefelter's syndrome (48,XXY,+21) in a fetus that was prenatally diagnosed during the 15th week of pregnancy. Even though the nasal bone was present, and the color-Doppler study of the ductus venosus and the nuchal thickness were normal, the maternal serum test results indicated an increased risk of Down syndrome and consequentially a genetic amniocentesis was performed. A 48,XXY,+21 karyotype was observed and the patient decided to terminate the pregnancy. In this case, we did not find the typical ultrasound (US) signs that would have led us to the chromosomopathy; furthermore, we emphasize the advantages of u…

HDlive ultrasound images in assisted reproduction treatment.

Abstract The volume ultrasound technology software known as the HDlive technique represents an innovative tool, a step towards an even more realistic anatomical visualization of pelvic organ structures. HDlive can help improve physician–patient communication with the aid of life-like images and might prove useful in the field of assisted reproduction treatment. The clinical application of this novel ultrasound technology in assisted reproduction treatment deserves scientific evaluation.

Abdominal wall defects: two- versus three-dimensional ultrasonographic diagnosis.

We diagnosed 12 cases of abdominal wall defects. The cases diagnosed occurred in 6 fetuses with omphalocele, 3 with gastroschisis, 2 with prune-belly syndrome, and 1 with pentalogy of Cantrell. Except for 1 case of gastroschisis first diagnosed on the basis of three-dimensional ultrasonography at 14 weeks' gestation, all cases were first detected by two-dimensional transabdominal ultrasonography and then reevaluated with three-dimensional ultrasonography using multiplanar and orthogonal plane modes. Although the original diagnosis was accurate on the basis of two-dimensional ultrasonography in 11 of 12 cases, additional information was obtained by three-dimensional scanning in all cases. Ou…

The role of gonadotropin-releasing hormone in murine preimplantation embryonic development.

Previous studies have established the presence of an extrahypothalamic GnRH in a variety of tissues. GnRH receptor is known to be present in the placenta, which produces and secretes the decapeptide from the very early stages of placentation. We hypothesized that GnRH may play a role in the preimplantation development of embryos. To examine this hypothesis, we assessed GnRH and GnRH receptor messenger RNA (mRNA; RT-PCR) and protein expression (Immunohistochemistry) in preimplantation murine embryos at various developmental stages. Furthermore, preimplantation murine embryos were cultured with GnRH agonist and antagonist in vitro to assess the influence of GnRH analogs on embryo development.…

Tumor de Krukenberg secundario a adenocarcinoide apendicular

Resumen Las metastasis ovaricas de tumores apendiculares son excepcionales. Presentamos el caso de una mujer de 38 anos con una tumoracion ovarica bilateral sometida a histerectomia total con salpingo-ooforectomia bilateral, apendicectomia y omentectomia. El estudio anatomopatologico revelo la presencia de un tumor de Krukenberg secundario a un adenocarcinoide oculto de apendice. Asimismo, se realiza una actualizacion de estos casos.