Objectives: To determine accuracy of ultrasound (US) in classifying placental cord insertion (PCI) site in multiple gestations at a tertiary care center. Methods: A retrospective study of multiple gestations delivered from 2/2003 to 7/2009 was performed. Data included gestational age (GA) at PCI identification, use of in-vitro fertilization (IVF), and PCI characterization by both US and pathology. The distance from PCI to placental edge was measured. To correlate US with pathology data, PCI was classified as central/eccentric, marginal (≤ 1 cm from placental edge), or velamentous (into membranes). Statistical analysis was performed with Chi-square comparison amongst categorical variables. US images were reviewed in discordant cases to determine causality. Results: Twins and triplets were analyzed. 638 fetuses (302 pregnancies) met criteria. Mean GA at PCI evaluation was 20.9 wks, median 19.0. Using pathology results as gold standard, US correctly identified PCI as central/eccentric, marginal, or velamentous in 69.3% (P < 0.01). US was more accurate for diamniotic-dichorionic twins (73.8% of 382) than diamniotic-monochorionic (59.4% of 155, P = 0.002). US correctly classified 97.5% of central/eccentric, 8.5% of marginal, and 6.1% of velamentous PCIs (438, 118, and 82 cases). Conversely, pathology confirmed US diagnosis of central/eccentric in 71.4%, marginal in 32.3%, and velamentous in 11.1% (of 598, 31, and 9). Comparing normal (central/eccentric) to abnormal (marginal/velamentous), US was less accurate in identifying abnormal (7.5% of 200) than normal (97.5% of 438) PCIs (P < 0.01); no difference was seen for twins (71.9% of 549) vs. triplets (73.5% of 89, P > 0.05). No difference was found in occurrence of velamentous PCI in IVF vs. non-IVF cases (12.5% for both). Conclusions: US classification of PCI was often inconsistent with pathological results in multiple gestations. Discrepant cases were evaluated and suggest evolution/peripheral infarction of the placenta with apparent evolution of the PCI in many instances.
Objectives:To assess the efficacy of prenasal thickness measurements on second trimester ultrasound examination in prenatal prediction of Down syndrome fetuses. Methods: Prenasal thickness was measured from stored fetal profile images during 16-24 week second trimester scans. Images from 115 women with normal fetuses and 15 women with Down syndrome were included. Prenasal thickness was measured as the shortest distance from the anterior edge of the lowest part of the frontal bone to the skin. Delta values for each gestational week for prenasal thickness were calculated for statistical analysis. Results: In the normal group prenasal thickness increased with gestation (prenasal thickness = −28.747 + (2.254 × GA, R2, P < 0.01). There was a statistically significant increase in the mean prenasal thickness measurement in Down syndrome fetuses. The prenasal thickness measurement was above the 95 th centile in 66.7% (10/15) of all Down syndrome cases, including 4 of 5 with an absent nasal bone and 6 of 10 with a nasal bone length above 2.5 mm. Conclusions: Prenasal thickness is increased in fetuses with Down syndrome as compared to normal fetuses. Prenasal thickness may be an additional predictor for Down syndrome on the second trimester ultrasound. Objectives: To determine if sonographic dimensions of the facial profile on a population of fetuses with absent nasal bone, differs from the normal population. Methods: 16 fetuses with absent nasal bone and with an adequate volume dataset of the fetal profile where included in the study. After a multi-planar manipulation to obtain a mid sagittal plane of the profile, 3 different operator measured the distance between the tip of the nose and the mouth (A), between the mouth and the gnathion (B), between the upper philtrum and the mouth (a) and between the mouth and the upper concavity of the chin (b), as recently reported by Goldstein et al, 2010. The values were plotted between the reported confidence limits, analyzing its percentage of distribution when it was corresponding or not to trisomy 21 (T21). Prenasal thickness was also measured. Wilcoxon non parametric test was used to determine differences between groups of measurement. Results: 2 cases were excluded (gestational age more than 26+6 weeks). The mean gestational age of the remaining was 21+3 (range, 18+2-26+5). 10/14 (71.5%) were carriers of T21 and the remaining were fetuses with normal karyotype. The A, B and (a) measurements were registered between the reported intervals of confidence, without statistical differences between both groups of fetuses with/without nasal bone. 60% of the fetuses with T21 had (b) measurement below the interval of confidence. The same measurement, on normal karyotype/absent nasal bone fetuses, were in the normal interval. Concordance between the three operators was found for the measurements, particularly (b). Mean prenatal thickness was 6.26 (T21) and 3.9 mm (non T21). OP09.06 Conclusions:Although the sample is small and ideally must be compared with our own population of healthy fet...
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