BACKGROUND: The prevalence of congenital abnormalities in general populations is approximately 3-5%. One of the most important applications of obstetric ultrasound is in detection of fetal structural defects. OBJECTIVE: To assess fetal structural anomalies diagnosed using ultrasound in the three trimesters of pregnancy. DESIGN AND SETTING: Retrospective cohort study at the Mário Palmério University Hospital of the University of Uberaba (Universidade de Uberaba, UNIUBE), from March 2014 to December 2016. METHODS: Ultrasound data at gestational weeks 11-13 + 6, 20-24 and 32-36 were recorded to identify fetal anomalies in each trimester and in the postnatal period. The primary outcome measurements were sensitivity, specificity, positive predictive value and negative predictive value for detection of fetal anomalies and their prevalence. RESULTS: The prevalence of anomalies detected using ultrasound was 2.95% in the prenatal period and 7.24% in the postnatal period. The fetal anomalies most frequently diagnosed using ultrasound in the three trimesters were genitourinary tract anomalies, with a prevalence of 27.8%. Cardiac anomalies were diagnosed more often in the postnatal period, accounting for 51.0% of all cases. High specificity, negative predictive value and accuracy of ultrasound were observed in all three trimesters of pregnancy. CONCLUSION: Ultrasound is safe and has utility for detecting fetal anomalies that are associated with high rates of morbidity and mortality. However, the low sensitivity of ultrasound for detecting fetal anomalies in unselected populations limits its utility for providing reassurance to examiners and to pregnant women with normal results.

PurposeThe aim of this study was to evaluate whether the presence of an intrauterine hematoma (IUH) on an early pregnancy ultrasound scan showing a live fetus was related to adverse perinatal outcomes.MethodsWe performed a retrospective cohort study to evaluate pregnant women who underwent an ultrasound examination in early pregnancy, between 6 weeks 0 days and 10 weeks 6 days. We compared the perinatal outcomes between women with and without firsttrimester IUH using the Mann-Whitney and Fisher exact tests. Furthermore, we performed a stepwise regression analysis to identify possible predictors of miscarriage among maternal characteristics, ultrasound parameters, and IUH.ResultsDuring the study period, data from 783 pregnancies were included, and the incidence of IUH was 4.5% (35 of 783). We observed a higher proportion of miscarriage following the scan (28.6% vs. 10%, P=0.003) and a larger yolk sac diameter during the scan (4.8 mm vs. 3.8 mm, P<0.001) in the pregnant women with first-trimester IUH. There was no significant difference regard the prevalence of low birth weight (LBW; P=0.091), very LBW (P=0.370), or extremely LBW (P=0.600) between cases with IUH and without IUH, the cesarean section rate (68% vs. 81%, P=0.130), preterm delivery (16% vs. 16%, P>0.999), or the incidence of first-trimester vaginal bleeding (31% vs. 20%, P=0.130). Moreover, heart rate (HR) was the only variable that predicted miscarriage with statistical significance (P=0.017).ConclusionWomen with first-trimester IUH had a higher risk of miscarriage after the ultrasound scan. HR was the only variable that predicted miscarriage with statistical significance.

Reference values for the AFI measurement between 26w0d and 41w6d of gestation in a low-risk Brazilian population were established.

ObjectiveTo assess the predictive capacity of cervical length (CL) measurement underwent during the second trimester ultrasound for prediction preterm birth <32, 34, and 37 weeks of gestation in an unselected risk population.MethodsA retrospective cohort study was performed with 751 singleton pregnancies between 20 and 24+6 weeks of gestation. The CL measurement (mm) using the transvaginal route was obtained in a sagittal view and the calipers positioned to measure the linear distance between the triangular area of echodensity at the external os and the internal os. To compare the preterm (<37 weeks) and term births (≥37 weeks), we used unpaired t test. We assessed whether the CL measurement was dependent of gestational age by performing a linear regression and assessing the coefficient of determination (R2). We additionally assessed the accuracy of CL measurement to predict preterm birth by assessing the area under receiver operating characteristics curves with its respective confidence intervals (CIs) 95%.ResultsPreterm birth <37 weeks was found in 13.6% (102/751) of pregnant women. Short cervix (≤25 mm) was found in 2.7% (20/751) of pregnancies. Only 30% (6/20) of pregnant women with short cervix have used progesterone to prevent preterm birth. There was a weak correlation between CL measurement and gestational age at delivery (R2=0.01, P=0.002). Receiver operating characteristics curve analysis of the ability of CL measurement to predict preterm birth <32, 34, and 37 weeks, showed an area under the curve of 0.693 (95% CI, 0.512 to 0.874), 0.472 (95% CI, 0.353 to 0.591), 0.490 (95% CI, 0.426 to 0.555), respectively.ConclusionThere was a weak correlation between CL measurement and gestational age at delivery. In an unselected population, CL measurement screening at 20 to 24+6 weeks of gestation does not seem to be a good predictor of preterm birth.

To establish reference values for the cervical length (CL) measurement by transvaginal ultrasound between 20 and 24+6 weeks of gestation in a large Brazilian population. A retrospective cross-sectional study was performed with 996 singleton pregnancies. The CL measurement (mm) using the transvaginal ultrasound was obtained in a sagittal view and the calipers positioned to measure the linear distance between the triangular area of echodensity at the external os and the internal os. The median±standard deviation and ranges for the CL measurement (mm) was 37.0±10.7 (range, 8 to 51). CL measurement did not modify significantly with gestational age. The observed percentiles for the CL measurement (mm) considering all number case were the following: 5th, 28 mm; 50th, 37 mm; and 95th, 45 mm. Reference values for the CL measurement by transvaginal ultrasound between 20 and 24+6 weeks of gestation in a large heterogeneous Brazilian population were established.