Reference measurements of the cross-sectional areas of umbilical cord components are important tools in the assessment of fetal growth.

The reference values of the cross-sectional area of umbilical cord increased according to gestational age until the 33rd week and are related to parameters of fetal growth.

Introduction: The study of placentas from pregnant human immunodeficiency virus (HIV) positive women has become the subject of numerous studies in the literature. Morphological, viral, immune and inflammatory placental aspects have been analyzed in order to grasp the vertical transmission of the virus. Objective: To identify the most frequent findings in the placentas by associating them with a viral antigen and correlating them with the infection of newborns. Material and methods: Thirty-five placentas from HIV-positive pregnant women were pathologically and immunohistochemically analyzed with the use of p24 antibody in the period from 1992 to1997 in accordance with the routine laboratory testing from the

In this high-risk population, angle-independent ductus venosus Doppler indexes were good predictors of birth acidemia. The S/A and (S - A)/S ratios and the ductus venosus PIV were statistically equivalent in this prediction.

IntroduçãoÉ aceito que a velocidade sanguínea no ducto venoso (DV) pode refletir alterações na hemodinâ-mica venosa central ou no retorno venoso umbilical. Existe estreita correlação entre a velocidade e a pressão no fluxo sangüíneo . A avaliação da mecânica do fluxo neste vaso apresenta, portanto, informações vitais sobre a distribuição do sangue umbilical oxigenado no feto e pode oferecer novas possibilidades de aplicação como método diagnóstico na compreensão da hemodinâmica fetal.Fetos com restrição ao crescimento apresentam fluxo sanguíneo venoso umbilical diminuído e volume de sangue reduzido a ser distribuído no fí-gado e DV 1 . Durante hipoxemia, a proporção de sangue umbilical direcionado ao DV aumenta e mantém um fluxo preferencial através do forame oval 2,3 . Outra possível causa de modificação na velocidade de fluxo no DV é falência cardíaca devido a malformações estruturais ou alterações funcio-

OBJETIVO: Este objetivou aferir a área de secção transversa do cordão umbilical (ASTCU) em gestações normais, com idade gestacional entre 20 e 40 semanas, para a construção de uma curva de valores normais para tal parâmetro. MATERIAIS E MÉTODOS: Foi realizado estudo transversal para determinar os valores de referência para a ASTCU em gestações normais (pacientes com datas precisas da última menstruação e exame ultra-sonográfico realizado antes da 20ª semana, sem qualquer doença conhecida). As medidas da ASTCU foram obtidas em plano adjacente à inserção do cordão umbilical no abdome. Os aparelhos de ultra-som utilizados foram da marca Synergy Multi Sync M500, Toshiba 140 e Toshiba Corevision, todos com transdutores transabdominais de 3,5 MHz. A análise estatística foi realizada pelo programa SPSS (Statistical Package for Social Sciences). RESULTADOS: Os dados obtidos foram considerados normais pelo teste de Kolmogorov-Smirnov e a curva de normalidade foi calculada por regressão linear. A análise de variância obtida pelo teste F (F = 356,27) mostrou que o modelo de regressão foi significativo ao nível de p < 0,01, mostrando que a curva estudou corretamente a população recrutada e que o intervalo de confiança (95%) continha o valor real da ASTCU. A equação de regressão encontrada para a ASTCU (y), de acordo com a idade gestacional (x), foi: y = -532,27 + 44,358x - 0,655x². CONCLUSÃO: Obtivemos uma curva de valores normais da ASTCU que mostra um crescimento progressivo de seus valores até a 32ª semana, seguida por um período de estabilização até a 34ª semana e uma queda de seus valores a partir da 35ª semana.

Purpose: To evaluate the efficiency of transvaginal ultrasound in the early diagnosis of ovarian cancer. Methods: Screening transvaginal ultrasound has been annually performed during the last 2 years in asymptomatic women without familial history of ovarian cancer. When abnormalities were detected, the procedure was repeated after 4-6 weeks. If the findings disappeared, the study was repeated after 1 year. If the abnormality persisted, study was complemented with tumor markers, computed tomography and laparoscopic surgery. The findings were compared with a control group of women in whom ovarian transvaginal ultrasonography was formally indicated. Results: A total of 26007 transvaginal ultrasound were performed: 8813 (33.8%) belonged to the screening group and 17194 (66.2%) to the control group. In 14 patients of the screening group, a malignant tumor was diagnosed and histologically confirmed. The mean age of these patients was 45 years old (SD 12). Eleven of these tumors were stage I (seven Ia, and four Ic), two stage IIIc and one was a metastatic melanoma in both ovaries. Six lesions were borderline tumors (five serous and one mucinous). In the control group, 27 ovarian cancers were diagnosed in patients with a mean age of 48 years (SD 17). In this group, 11 tumors were in stage I, and six were borderline. Conclusions: Although consensus about the benefits of using transvaginal ultrasound as a screening procedure is not conclusive, our data reveals that tumors detected in patients screened with transvaginal ultrasound are in earlier stages when compared with those diagnosed in the control group. No differences were found in age and number of borderline tumors between both groups. Additional studies are needed to support this preliminary findings. P02Endometrial sampling during sonohysterography (SHGes) E. Ferrazzi, C. Lanzani, N. Ciminera & V. Conserva Purpose: To assess the diagnostic accuracy of sonohysterography (SHG) and endometrial sampling during SHG (SHGes) compared to traditional hysteroscopy and biopsy. Methods: Seventy-two consecutive patients with irregular bleeding and/or intracavitary abnormalities underwent transvaginal sonography (TVS) and SHG. SHG was performed with a 4.7-mm intrauterine catheter. In all patients, an endometrial biopsy was performed by a syringe vacuum aspiration at the end of SHG. Procedure-related pain was assessed. Sonographic findings at SHG were defined as normal, focal lesions or diffuse endometrial abnormality. In patients with diffuse endometrial abnormality, hysteroscopy and hysteroscopic guided biopsy were performed. In patients with focal lesions, an operative hysteroscopy was performed. Pathologic report was the gold standard. Results: Mean age was 48 years (interquartile range 38-54). At SHG, no pain, mild, and severe discomfort was reported by 75, 18 and 7% of patients, respectively. Fifty patients underwent hysteroscopic guided biopsy, 22 operative hysteroscopy. Hysteroscopic findings were compared to SHG-SHGes finding. (A) Benign lesions: in 56 cases SHG and SHG...

Objectives: Investigate the prediction of birth acidemia in pregnancies with placental insufficiency using two newly created venous-arterial Doppler ratios: pulsatility index (PI) of the ductus venosus (DV) over PI of the middle cerebral artery (MCA) and PI of the DV over PI of the umbilical artery and establish cut-off values for this prediction. Methods: This was a prospective cross-sectional study involving 47 patients with placental insufficiency managed in two Brazilian hospitals. All pregnancies were singleton, over 26 weeks of age and without structural or chromosome anomalies. A ROC curve was calculated for the venous-arterial ratios (independent variable) and acidemia (dependent variable). Results: The DV/AU PI ratio was not a good predictor of acidemia at birth. The DV/MCA PI ratio was related to fetal acidemia (area under the ROC curve 0.785, p = 0.004). The cut-off value was 0.582, sensibility 66.7%, specificity 77.1% and accuracy 74.5%. Conclusions: The DV/MCA PI ratio is adequate for the diagnosis of acidemia at birth in pregnancies with placental insufficiency. The cut-off value was 0.582.