Objective: The aim of this study was to investigate the role of the 'angle of progression' (AOP) in the prediction of vaginal delivery and establish a cut-off value.Method: 101 pregnant women were included in this prospective study. They were admitted in labor to our hospital and had singleton cephalic presentations and full-term pregnancies. AOP was measured at admission time. We analyzed the results of all the women included but also a subgroup of 66 singleton pregnant women whose assessment of the AOP was performed at the beginning of the second stage of labor.Results: Ninety-one patients had a vaginal delivery (90%) and 19 a cesarean section (10%).The area under the curve was 0.85 (95% confidence interval [CI], 0.77-0.92)and the value of the AOP that optimizes the curve was 125º (S 67.1% E 100%). In the subgroup that was assessed at the second stage of labor, the area under the curve was 0.97 (95%CI,0.90-0.99) and a value of the AOP that optimizes the curve was also 125º (S 91.38% E 100%). Conclusions:The angle of progression is a simple and reliable intrapartum ultrasound parameter for the evaluation of fetal head descent. Transperineal ultrasound assessment could help to decide the method of delivery. In our experience, the sensitivity of the ultrasound measurement increases when this is taken in the second stage of childbirth.
Background: Multiple factors have been associated with an increased risk of fetal growth restriction. The risk of genetic syndromes in these cases is not well established. The aim of this study was to determine the relationship between chromosomal abnormalities and early fetal growth restriction and to assess the incremental yield of genomic microarray over conventional karyotyping in fetuses with early growth restriction.Methods: A prospective observational study of early fetal growth restriction diagnosed between 2013 and 2016 in our hospital. Chromosomal microarray analysis was performed in fetuses with early growth restriction defined as a fetal weight below the 3rd percentile estimated from 19 to 28 weeks of gestation, and a normal conventional karyotype result. We performed a descriptive analysis of the mean, the interval and the standard deviation for continuous variables and an analysis of absolute frequency and percentages for the categorical variables.Results: Among 28 enrolled pregnant women, the incidence of early fetal growth restriction was 0.30%. We diagnosed 18.5 % of pathological results by arrays, but only one case (3.7%) were diagnosed by conventional karyotype too. Incremental yield of chromosomal microarray analysis over karyotyping was 16%. We detected a 20% incremental yield of chromosomal microarray analysis over karyotyping in fetus with structural anomalies, and a 17.6% incremental yield in isolated early fetal growth restriction. Conclusions:The use of chromosomal microarray analysis provided a 16% incremental yield of detecting copy number variations in fetuses with early growth restriction and normal karyotype. Prenatal array should be part of the usual study of these fetuses, especially if there have ultrasound malformations associated.
Objetivos. Correlacionar la ecografía prequirúrgica de las masas anexiales aplicando los criterios IOTA y el diagnóstico anatomopatológico tras intervención quirúrgica. Valorar la utilidad de los marcadores tumorales bioquímicos. Método. Estudio observacional prospectivo en 102 pacientes con diagnóstico ecográfico de tumoración anexial, intervenidas quirúrgicamente entre enero 2017 y febrero 2020. El análisis estadístico se realizó con SPSS 17.0. Las variables categóricas se analizaron mediante pruebas de Fisher y chi-cuadrado, las variables cuantitativasmediante prueba t-student. La concordancia entre la valoración de la ecografía transvaginal mediante criterios IOTA y el resultado anatomopatológico, se estudió con el coeficiente de contingencia y el índice kappa. Resultados. Según criterios IOTA, se clasificó como benignas a 48% de las tumoraciones, como malignas 24,5%, y 27,5% resultaron no clasificables. La anatomía patológica confirmó que 68,1% de las benignas y 72,8% de las malignas fueron correctamente filiadas por la ecografía. La concordancia entre la ecografía transvaginal prequirúrgica y la anatomía patológica fue significativa, con coeficiente de contingencia 0,58, índice kappa 0,47, p <0,05 y con sensibilidad 94,1% y especificidad 92,1%. Los valores de la proteína epididimal humana 4 (HE4) y el antígeno del cáncer 125 (CA 125) tuvieron correlación con la anatomía patológica, también con significación estadística, siendo mayor en las pacientes menopáusicas. Conclusiones. Los criterios IOTA discriminaron de forma satisfactoria las masas benignas de las malignas. La proteína HE4 resultó mejor marcador bioquímico que el CA125.
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