This study was conducted to try to achieve the success rate to detect fetal cardiac malformations and/or tricuspid regurgitation with color Doppler during first trimester ultrasound scan within a short period (less than 3 minutes) in a general low-risk population. For this purpose, we started a prospective study, evaluating 240 consecutive single pregnancies, by a single examiner, during the first trimester ultrasound scan (crown to rump length between 45 and 84 mm) using a Voluson E8 system (GE Healthcare, Zipf, Austria) with a 2- to 8-MHz RAB 4-8-D transabdominal probe. Pulsed-wave and color Doppler flow mapping was used to assess the blood flow through the tricuspid valve. In addition, color Doppler was used to evaluate the 4-chamber view, the great vessels ("V sign"), and the right subclavian artery. Blood flow in the tricuspid valve could be examined in 206 cases (85.8%). Of these, tricuspid regurgitation was detected in 17 cases (7.1%) with both pulsed-wave and color Doppler. The 4-chamber view, the V sign, and the right subclavian artery could be evaluated in 188 cases (78.3%). One case of aberrant right subclavian artery and 2 suspicious of cardiac malformations were detected. In our opinion, using color Doppler during first trimester ultrasound scan, even for a short period (<3 minutes), probably adds important information about the fetal heart.
Objectives: To assess the specificity of the novel 'separation sign' as a positive predictive of normal placental separation in women referred to a tertiary specialist placenta clinic due to an increased risk of placenta accreta spectrum (PAS). Methods: This sign utilises the difference in elasticity between the placenta and myometrium to emphasise the clear zone seen in normal placentation but not in PAS. Pressure is applied with an ultrasound probe, to distend the placental bed. On rapidly releasing this pressure, a differential rate of rebound is observed between the placenta and myometrium, with the placenta appearing to bounce off the myometrium. Placental separation was assessed at delivery using the IS-PAS stepwise diagnostic strategy and the FIGO PAS clinical classification. The value of the sign as a predictor for normal separation was assessed. Results: 191 women between 22 and 38 weeks of gestation were recruited. Of these, 161 had a positive separation sign, and 100% of these went on to have normal placental separation at delivery. Of the 24 women with a negative separation sign, 3 (12.5%) had normal placental separation at delivery, and 21 (87.5%) were diagnosed with PAS at delivery. This generates a specificity value of 100% [95% CI: 83.9%, 100.0%] and a sensitivity of 98.17% [95% CI: 94.8%, 99.6%]. In the particularly high-risk cohort (placenta previa or anterior low-lying placenta and ≥1 prior Caesarean delivery: n=35), a positive separation sign remained a confident predictor of normal placental separation with positive predictive value of 100%, with 100% [95% CI: 80.5%, 100.0%] specificity, and 90.0% [95% CI: 68.3%, 98.8%] sensitivity. Conclusions:The separation sign could be used when assessing women considered at risk for PAS, to improve prediction of normal placental separation. This improved risk stratification will prevent over treatment and decrease the risks of iatrogenic morbidity.
This prospective multicentric study aiming to determine the incidence of complications (malignant transformation, torsion or rupture) during conservative management of adnexal masses was performed in two Portuguese tertiary referral hospitals. It included ≥18-year-old, non-pregnant patients with asymptomatic adnexal masses (associated IOTA ADNEX risk of malignancy < 10%) sonographically diagnosed between January 2016 and December 2020. Conservative patient management consisted of serial clinical and ultrasound assessment up to 60 months of follow-up, spontaneous resolution of the formation or surgical excision (median follow-up: 17.8; range 9–48 months). From the 573 masses monitored (328 premenopausal and 245 postmenopausal adnexal masses), no complications were observed in 99.5%. The annual lesion growth rates and increases in morphological complexity were similar in the premenopausal and postmenopausal patients. Spontaneous resolution, evidenced in 16.4% of the patients, was more common in the premenopausal group (p < 0.05). Surgical intervention was performed in 18.4% of the cases; one borderline and one invasive FIGO IA stage cancer were diagnosed. There was an isolated case of ovary torsion (0.17%). These data support conservative management as a safe option for sonographically benign, stable and asymptomatic adnexal masses before and after menopause and highlight the need for expedite treatment of symptomatic or increased-morphological-complexity lesions.
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