The ultrasound examination in the 3 rd trimester is of additional benefit and can detect previously unknown structural abnormalities. These findings are relevant for perinatal management and postnatal follow-up.
Pre-eclampsia is a pregnancy-associated disease of the second part of the pregnancy, occurring mainly after 20th weeks gestation. The prevalence of hypertension in pregnancy is between 5 to 11% and affects mainly women under 20 years of age. An inadequate invasion of trophoblasts with consequential placental ischemia as a result of insufficiently dilated uterine spiral arteries is thought to be an initial cause in the pathogenesis of pre-eclampsia. The clinical symptoms of pre-eclampsia, such as loss of intravascular volume and edema, are caused by generalized endothelial dysfunction. These symptoms are potentiated by hypertension and reduced colloid osmotic pressure in the plama. The organs being affected by pre-eclampsia are those of the vascular-, hepatic-, renal-, cerebral- and coagulatory systems. The prognosis is much more severe when pre-eclampsia develops very early in the pregnancy. The symptoms include elevated blood pressure (over 140 mmHg systolic, 90 mmHg diastolic) combined with proteinuria. Frequent symptoms are hyperreflexia and edema. The etiology of pre-eclampsia has not been clearly defined. Risk factors/triggers for the development of pre-eclampsia can include chronic hypertension, advanced maternal age at first pregnancy (over 35 y), nephropathy, thrombophilia (heterozygous factor V Leiden mutation, antiphospholipid syndrome, heterozygous prothrombin mutation and homozygous MTHFR), multiple gestation and prior pregnancy with preeclampsia. The incidence of preeclampsia is higher in nulliparous than multiparous women. In many countries pre-eclampsia is still most frequent cause of maternal perinatal mortality. HELLP-Syndrome (haemolysis-elevated liver enzyme- low platelets) is a severe progressive course of this disease. Eclampsia, characterized by generalized tonic-clonic convulsion, is the most dangerous complication of pre-eclampsia, and may develop before or after delivery. This form of pre-eclampsia is associated with higher maternal and fetal mortality. Constant maternal hypertension potentially alter vascular integrity of the placenta with further consequences in fetal blood supply leading to growth restriction or zero growth and subsequently resulting in low birth weight or fetal death. The sooner the disease is detected and confirmed, the better the maternal and fetal prognoses are. This is the reason why it is major importance, together with the employment of preventive measures, to identify patients with risk factors with pre-eclampsia though an adequate screening method, thereby detecting the disease earlier and ensuring better pregnancy outcomes for both mother and child.
Diastematomyelia is a rare form of occult spinal dysraphism. It is characterized by longitudinal clefting and separating of the spinal cord by a bony or fibrous spur. Diastematomyelia is associated with other anomalies, i. e. spina bifida, scoliosis, visceral malformations or anomalies of the overlying skin. Prenatal diagnosis is based on fetal ultrasound supplemented by fetal MRI. We present a case of diastematomyelia and prenatal diagnosis in the 23rd gestational week using routine ultrasound scanning and confirmation by fetal MRI. After vaginal delivery at term, the child's development is normal. Prenatal diagnosis of isolated diastematomyelia is challenging. Management and prognosis are still controversial as only few cases have been reported. Affected fetuses might benefit from early diagnosis enabling surgical intervention before the development of neurological sequelae.
A logistic regression model, based on the hCG ratio (hCG 48 hours/hCG 0 hours) has previously been developed in the Early Pregnancy Unit of an inner London Hospital, to predict the outcome of pregnancies of unknown location (PULs). The aim of this study was to validate this model in a new patient population. Methods: Serum hCG levels at 0 and 48 hours were collected on women classified as PULs presenting to the emergency gynecology service of a large Norwegian hospital. The final clinical outcomes of the pregnancies were recorded. Data was entered into the model and sensitivities, specificities, positive predictive values (PPV) and negative predictive values (NPV) calculated for each of the pregnancy outcomes (failing PUL, intra-uterine pregnancy (IUP) and ectopic pregnancy (EP). Results: Data was collected on 100 PULs presenting between 01.01.05 and 10.05.05. The model predicted that there were: 36 failing PULs, 15 IUPs and 49 EPs. The true pregnancy outcomes were: 61 failing PULs, 21 IUPs and 18 EPs. The sensitivity for the prediction of EP was 88.9% with a specificity of 56.1%, a PPV of 32.7% and a NPV of 90.2%. The sensitivity for the detection of an IUP was 61.9%, with a specificity of 62.0%, a PPV of 86.7% and a NPV of 57.7%. The sensitivity for the detection of a failing PUL was 54.1%, with a sensitivity of 74.4%, a PPV of 91.7% and a NPV of 45.3%. Conclusion: This logistic regression model based on the hCG ratio can be applied to other patient populations to predict EPs in women classified as PULs.
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