Objective: To evaluate the indications, intraoperative diagnoses, and complication rates of both diagnostic and operative hysteroscopic procedures. Materials and Methods: Five thousand four hundred seventy-four (5474) hysteroscopic procedures performed in the department of gynecologic endoscopy unit between May 2005 and December 2012 were retrospectively analyzed from the archives. Indications, intraoperative diagnosis, and complications of all gynecological endoscopic procedures are recorded. Results: Abnormal uterine bleeding in premenopausal and postmenopausal women was the most frequent indication for diagnostic hysteroscopies in 1,887 (40%) cases. The most common preoperative indication for operative hysteroscopy was endometrial polyps in 469 (55.7%) cases and submucous leiomyomas in 151 (17.9%) cases. In this series, the most common complication was uterine perforation which occured in 15 (0.27%) out of 5,474 cases and the rate for diagnostic hysteroscopy and operative hysteroscopy was 0.06% and 1%, respectively. Conclusion: Hysteroscopy is a safe and effective minimally invasive procedure with very low complication rate.
Aim: Fetal growth restriction (FGR) has significant consequences on cardiac functions. This study aims to evaluate cardiac functional parameters in late-onset (FGR) fetuses and compare those appropriate for gestational age (AGA) fetuses. Material and Methods: Fifty-six singleton pregnancies were involved in this prospective case-control study. Delphi consensus was used to define late-onset FGR. We compared the E/A ratio, left myocardial performance index (MPI) and tricuspid annular plane systolic excursion (TAPSE) in late-onset FGR cases and gestational age-matched AGA fetuses. Results: Twenty-eight late-onset FGR and 28 AGA fetuses were enrolled. The mean gestational age in the late-onset FGR group was 34.1 AE 2.3 weeks and 34.4 AE 2.1 in controls. The E/A ratio was 0.88 AE 0.09 in AGA fetuses, 0.79 AE 0.11 in the late-onset FGR group, and significantly lower in late-onset FGR fetuses (p: 0.012). Left MPI was 0.51 AE 0.09 in AGA and 0.62 AE 0.11 in the late-onset FGR group. Left MPI was markedly higher in late-onset FGR fetuses (p: 0.024). TAPSE was 7.4 AE 2.9 mm in controls and 5.2 AE 1.8 in the late-onset FGR group, and it was significantly shorter in the late-onset FGR fetuses (p: 0.016). Conclusion: Late-onset FGR is associated with cardiac remodeling and dysfunction. Fetal echocardiography may be beneficial to detect those subtle cardiac changes.
Hydrometrocolpos is a pelvic cystic mass representing the distension of the vagina and uterus due to a lower genital tract obstruction causing accumulation of utero‐cervical‐vaginal secretions or urine in the vagina and endometrial cavity. Prenatal diagnosis is uncommon and differential diagnosis of the underlying etiologies is quite challenging in the prenatal period. We present three cases of female fetuses with hydrometrocolpos and discuss the prenatal differential diagnoses in the light of ultrasound findings along with postnatal diagnoses and outcomes.
Objectives:The Solomon technique has been suggested to reduce post-operative complications and thus improve twin survival following fetoscopic laser coagulation of chorionic vessels for Twin-twin transfusion syndrome (TTTS). We aimed to evaluate the benefit of this technique on perinatal outcome compared to selective ablation of anastomoses. Methods: We conducted a monocentric retrospective study comparing selective laser coagulation to coagulation of the vascular equator, from April 1999 to august 2020. To evaluate the impact of the technique on perinatal outcome, we used a propensity score matching based on gestational age at laser therapy, placenta localisation and Quintero stage. Results: A total of 798 pregnancies were included in the analysis. Compared with selective ablation, Solomon technique was associated with higher survival rates at discharge (Overall fetal survival of 70 % vs 79%, p < 0.001 at delivery, and of 66% vs 75%, p < 0.001 at discharge), higher double twin survival (49% vs 65%, p < 0.001), and fewer in utero fetal death (18% vs 12%, p < 0.001). We observed a reduction in post-operative complications such as TAPS (11% vs 4%, p < 0.001) and recurrences (7.9% vs 2.5%, p = 0.003), leading to fewer rescue secondary surgeries (18% vs 7.3%, p < 0.001) and less cord occlusions for neurological damage (8.3% vs 3%, p = 0.002). However, the Solomon technique was associated with an increasing risk of PROM, especially in early gestational age (3.3% vs 11%, p < 0.001 for PROM<24 weeks). Among the survivors at delivery, both groups had similar gestational age at birth. However, the Solomon group was associated with an increasing risk of acute respiratory distress (12% vs 29%, p < 0.001) and of bronchopulmonary dysplasia (3.2% vs 12%, p < 0.001). Neonatal mortality was similar in both groups. Conclusions: Although the risk of PPROM has increased, the introduction of the Solomon technique has significantly improved the perinatal outcome in pregnancies affected with TTTS.
Objectives This study aims to assess the diagnostic accuracy of targeted ultrasound examination in prenatal diagnosis of hypospadias and to evaluate the predictive values of defined ultrasonographic findings of hypospadias. Methods The cases diagnosed with hypospadias in our fetal medicine center were identified on an electronic database. The ultrasound reports, images and hospital records were reviewed retrospectively. The predictive value of prenatal ultrasound diagnosis and the predictive values of each sonographic finding were assessed according to the postnatal clinical examinations. Results Thirty-nine cases were diagnosed with hypospadias on ultrasound during the 6 years. Nine fetuses with missing postnatal examination records were excluded. Twentytwo of the remaining fetuses had their prenatal diagnosis of hypospadias confirmed in postnatal examinations, indicating a 73.3 % positive predictive value. Normal external genitalia was detected in postnatal examinations of three fetuses. Five fetuses were diagnosed with other external genital abnormalities, including micropenis (n=2), clitoromegaly (n=2), and buried penis with bifid scrotum (n=1) in postnatal examinations. The positive predictive value of prenatal ultrasound for any external genital abnormality was 90 %. Conclusions Although the positive predictive value of ultrasound for genital anomalies is satisfying, it is slightly lower for the specific diagnosis of hypospadias. This reflects overlapping ultrasound findings of different external genitalia anomalies. Standardized, systematic evaluation of the internal and external genital organs, karyotyping and genetic sex determination are essential to achieve a precise prenatal diagnosis of hypospadias.
Objective: To assess the accuracy of prenatal echocardiography in defining pulmonary vasculature in pulmonary atresia with VSD (PAVSD). The second aim is to compare the perinatal and postnatal outcomes of different pulmonary blood supply types. Design:The cases prenatally diagnosed with PAVSD between January 2017- October 2022 in a single tertiary fetal medicine center were identified on the electronic database. Fetal echocardiography reports and images were reviewed retrospectively. Postnatal outcomes and images were acquired from the hospital records of relevant pediatric cardiology and cardiovascular surgery clinics. Fetal echocardiography results were compared with postnatal results. Perinatal and postnatal outcomes were compared between the pulmonary vascular supply types. Results: Among the 24 PAVSD cases, six were diagnosed with major aortopulmonary collateral arteries (MAPCA) dependent, eleven were diagnosed with ductus arteriosus (DA) dependent pulmonary vascular supply, and seven were diagnosed with double pulmonary supply (MAPCA + DA) on prenatal echocardiography. Seventeen cases were live-born and have undergone postnatal investigations. Fetal echocardiography was 88.2% accurate about the type of pulmonary vascular supply. The accuracy of fetal echocardiography regarding pulmonary vascular anatomy was 82.3%. Four cases were demised before surgical interventions. Postoperative survival was 69.2%. Mortality and postoperative survival did not differ between pulmonary supply groups. Survival was disrupted with extracardiac anomalies. The need for early surgical interventions was significantly higher in the DA group. Conclusion:The anatomy of pulmonary vascularization in PAVSD can be defined precisely on fetal echocardiography. The source of pulmonary blood supply does not impact postnatal short-term outcomes significantly; however, it affects the postnatal management. The associated anomalies highly contribute to postnatal mortality. Therefore, MAPCAs, the anatomy of the pulmonary arteries, and accompanying abnormalities should be intensely searched on fetal ultrasonography.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.