- Email: [email protected]
Diffuse myometrium hemangioma — Case report
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complained of mild abdominal discomfort. Recidives occurred in 3 cases. Conclusions: Ultrasonically guided puncture of ovarian cysts indicates a safe and effective procedure in diagnosis and treatment concerning this pathology.
P2.18.03 DOPPLER FLOW VELOCIMETRY OF THE UMBILICAL ARTERY AND MIDDLE CEREBRAL ARTERY IN PREGNANCIES COMPLICATED BY INSULIN-DEPENDENT DIABETES MELLITUS A.Havalda, M. Korbel, M. Borovsky, Z. Niznanska, Dept. OB/GYN, Comenius University Hospital, Bratislava, Slovakia. Objectives: The aim of this study was to compare changes in Doppler ultrasound studies of the fetal circulation in normal pregnancies with a group of pregnancies complicated by insulin-dependent diabetes mellitus. Study Methods: In addition to the non-stress test, fetal biophysical profile, Doppler measurements of the fetal circulation included the umbilical artery (UA) resistance index (RI) and the fetal middle cerebral artery (MCA) resistance index (RI). Altogether 86 pregnancies complicated by insulin-dependent diabetes mellitus constituted the study group. 86 uncomplicated pregnancies with a term delivery of an appropriately grown baby were used to define normal range. 23 pregnancies with diabetes mellitus type I were complicated by preeclampsia. Doppler studies of umbilical artery and fetal middle cerebral artery velocity waveforms and biophysical profile were performed at 30-40 weeks of gestation. Data were analyzed with regard to asphyxia and otherwise complicated fetal outcome. Results: Fetuses of diabetic women displayed changes in umbilical artery flow and fetal middle cerebral artery flow in 1.5 cases complicated with preeclampsia and in 4 cases with intrauterine growth retardation. Conclusions: Doppler flow velocimetry of the fetal middle cerebral artery and umbilical artery together with biophysical profile and nonstress test has a high significance in predicting adverse fetal outcome, especially in the growth-retarded fetus.
P2.18.04 DIFFUSE MYOMETRIUM HEMANGIOM.4 - CASE REPORT L. Saleueiro, M.J. Bernardo, F. Omar, .I. Bugalho, Dept. OB/GYN, Dona Estefsnia Hospital, Lisbon, Portugal. Diffuse myometrium hemangioma is a rare lesion which belongs to the uterine vascular tumors. Although the diagnosis is histological, it can be suspected by ultrasonographic examination. The authors report a case of a 46.year-old woman with post-partum progressive dysmenorrhea (eight years). Physical examination detected only a little enlarged uterus. Ultrasonography with color-Doppler revealed the uterine anterior wall enlarged containing a great amount of vascular channels, some of them with low resistance blood flow. Hypothetical diagnosis of uterine vascular tumor versus angiosarcoma was made. Total hysterectomy with bilateral salpingo-oophorectomy was decided and performed with success. The final pathological diagnosis revealed a rare case: a diffuse myometrium hemangioma. One year after surgery the patient had no complaints. The authors revised the literature concerning this clinic case.
P2.18.05 PRENATAL DIAGNOSIS AND MANAGEMENT OF FETAL OVARIAN CYSTS: REPORT OF THREE CASES. E.Vardaki, S.Sifakis, E.Angelakis, E.Kolibianakis, G.Froudarakis, K.Giannadakis, E.Koumantakis. Dept.of Obstetrics-Gynecology, University Hospital of He&lion, Crete, Greece Objectives: Technical refinement of routine antenatal ultrasound scanning has led to an increase in the diagnosis of ovarian cysts in female fetuses. Three cases of fetuses with simple ovarian cysts diagnosed by USS at 30-32 weeks of gestation are reported. Study methods: A simple cyst (4cm diameter) was diagnosed in the first
TUESDAY,
SEPTEMBER
5
fetus, two in the second fetus (5 and 3.5 cm diameter) and one simple cyst (4cm diameter) in the third. All of the cysts were anechoic and had smooth walls. Normal anatomy of the gastrointestinal and urinary tract in all cases led to the suggestion that the cysts were of ovarian origin. Serial ultrasound scans were performed weekly in all fetuses In addition fetal cardiotocography and Doppler velocimetry of the umbilical artery were performed biweekly and remained within normal limits throughout gestation. Amniotic fluid index, placental grade as well as HCG and E2 were within normal limits. Results: Two fetuses were delivered vaginally by spontaneous and induced labour at 39 and 38+5 weeks respectively. A caesarean section in the third case was performed because of changes in the USS characteristics of the fetal cyst suggesting an intrauterine ovarian cyst torsion. The ovarian cysts observed antenatally regressed in all fetuses within 10 weeks following delivery, as confirmed by serial USS. Conclusion: It seems that close surveillance of fetuses with simple ovarian cysts not accompanied with other USS findings during intrauterine life can lead to a successful fetal outcome.
P2.18.06 REVERSED DIASTOLIC UMBILICAL ARTERY FLOW IN THE FIRST TRIMESTER ASSOCIATED WITH CHROMOSOMAL FETAL ABNORMALITIES OR CARDIAC DEFECTS C. G. V. Murta, A. F. Moron and A. A. P, Avila Department of Obstetrics and Gynecology, Federal University of Sfo Paula, UNIFESP/EPM, Sfo Paula, Brazil. Email:[email protected] Background: There are six cases reported of reversed end-diastolic umbilical artery blood flow at lo-14 weeks’ gestation. Four of those were associated with chromosomal anomalies and one showed congenital heart disease. This report describes two new cases. Case 1: A 41.year-old gravida 4, para 2, presented at 10 weeks for ultrasound, which showed a single fetus with crown-rump length of 42 mm and increased nuchal translucency (5 mm). The fetal heart rate (FHR) was 149 beats/minute, and Doppler showed reversed end-diastolic umbilical artery velocity. Cytogenetic analysis by chorionic villus sampling diagnosed 69,xXx karyotype. The fetus died 1 week later. The uterus was evacuated by D&C and triploidy was confirmed by karyotyping of the fetal tissue. Case 2: A 30.year-old primigravida with an unremarkable medical history presented at 12 weeks’ gestation for ultrasound, which showed a fetal crown-rump length of 57 mm, increased nuchal translucency (9.1 mm) and FHR of 147 beats/minute. A interventricular septal defect was identified by a 6-MHz tramvaginal transducer. Doppler examination showed reversed end-diastolic umbilical artery velocity. Chromosome analysis by chorionic villus sampling indicated trisomy 9. Ten days later the fetus died. The uterus was evacuated by D&C, and complete trisomy 9 was confirmed by cytogenetic examination of the fetal tissue. The ventricular septal defect was confirmed by autopsy. Conclusion: The reversed end-diastolic umbilical artery flow in the first trimester might be an important sign in early pregnancy of chromosomal abnormalities. In addition, it might be useful as an alarm sign for earlier diagnosis of structural cardiac defects.
P2.18.07 SECOND TRIMESTER LOW-LYING PLACENTA: RISK FOR VASA PREVIA K.O.Ovelese’. R.MacLaren’,K.M.Lewis’, S.Campbellz, J.T.Queenan’, ‘Dept.Ob/Gyn, Georgetown University Medical Center, Washington DC, USA ‘Dept Ob/Gyn, St George’s Hospital, London,United Kingdom Objective: The aim of this study was to determine if there are any risk factors that predispose to development of vasa previa in pregnancy. Study Method: We reviewed the medical records of all women with a diagnosis of vasa previa over the past 5 years in two major teaching hospitals. We identified 5 cases. We sought to determine if there were any common features to all the cases. Results: In all the cases a sonogram performed in the second trimester had shown a low-lying placenta. In only two was the placenta still low-lying at term. In addition, two of the cases had a succenturiate lobed placenta that was diagnosed prenatally by sonography. Two of the five pregnancies were conceived by in-vitro fertilization. Conclusion: A second trimester low-lying placenta appears to be a risk for
complained of mild abdominal discomfort. Recidives occurred in 3 cases. Conclusions: Ultrasonically guided puncture of ovarian cysts indicates a safe and effective procedure in diagnosis and treatment concerning this pathology.
P2.18.03 DOPPLER FLOW VELOCIMETRY OF THE UMBILICAL ARTERY AND MIDDLE CEREBRAL ARTERY IN PREGNANCIES COMPLICATED BY INSULIN-DEPENDENT DIABETES MELLITUS A.Havalda, M. Korbel, M. Borovsky, Z. Niznanska, Dept. OB/GYN, Comenius University Hospital, Bratislava, Slovakia. Objectives: The aim of this study was to compare changes in Doppler ultrasound studies of the fetal circulation in normal pregnancies with a group of pregnancies complicated by insulin-dependent diabetes mellitus. Study Methods: In addition to the non-stress test, fetal biophysical profile, Doppler measurements of the fetal circulation included the umbilical artery (UA) resistance index (RI) and the fetal middle cerebral artery (MCA) resistance index (RI). Altogether 86 pregnancies complicated by insulin-dependent diabetes mellitus constituted the study group. 86 uncomplicated pregnancies with a term delivery of an appropriately grown baby were used to define normal range. 23 pregnancies with diabetes mellitus type I were complicated by preeclampsia. Doppler studies of umbilical artery and fetal middle cerebral artery velocity waveforms and biophysical profile were performed at 30-40 weeks of gestation. Data were analyzed with regard to asphyxia and otherwise complicated fetal outcome. Results: Fetuses of diabetic women displayed changes in umbilical artery flow and fetal middle cerebral artery flow in 1.5 cases complicated with preeclampsia and in 4 cases with intrauterine growth retardation. Conclusions: Doppler flow velocimetry of the fetal middle cerebral artery and umbilical artery together with biophysical profile and nonstress test has a high significance in predicting adverse fetal outcome, especially in the growth-retarded fetus.
P2.18.04 DIFFUSE MYOMETRIUM HEMANGIOM.4 - CASE REPORT L. Saleueiro, M.J. Bernardo, F. Omar, .I. Bugalho, Dept. OB/GYN, Dona Estefsnia Hospital, Lisbon, Portugal. Diffuse myometrium hemangioma is a rare lesion which belongs to the uterine vascular tumors. Although the diagnosis is histological, it can be suspected by ultrasonographic examination. The authors report a case of a 46.year-old woman with post-partum progressive dysmenorrhea (eight years). Physical examination detected only a little enlarged uterus. Ultrasonography with color-Doppler revealed the uterine anterior wall enlarged containing a great amount of vascular channels, some of them with low resistance blood flow. Hypothetical diagnosis of uterine vascular tumor versus angiosarcoma was made. Total hysterectomy with bilateral salpingo-oophorectomy was decided and performed with success. The final pathological diagnosis revealed a rare case: a diffuse myometrium hemangioma. One year after surgery the patient had no complaints. The authors revised the literature concerning this clinic case.
P2.18.05 PRENATAL DIAGNOSIS AND MANAGEMENT OF FETAL OVARIAN CYSTS: REPORT OF THREE CASES. E.Vardaki, S.Sifakis, E.Angelakis, E.Kolibianakis, G.Froudarakis, K.Giannadakis, E.Koumantakis. Dept.of Obstetrics-Gynecology, University Hospital of He&lion, Crete, Greece Objectives: Technical refinement of routine antenatal ultrasound scanning has led to an increase in the diagnosis of ovarian cysts in female fetuses. Three cases of fetuses with simple ovarian cysts diagnosed by USS at 30-32 weeks of gestation are reported. Study methods: A simple cyst (4cm diameter) was diagnosed in the first
TUESDAY,
SEPTEMBER
5
fetus, two in the second fetus (5 and 3.5 cm diameter) and one simple cyst (4cm diameter) in the third. All of the cysts were anechoic and had smooth walls. Normal anatomy of the gastrointestinal and urinary tract in all cases led to the suggestion that the cysts were of ovarian origin. Serial ultrasound scans were performed weekly in all fetuses In addition fetal cardiotocography and Doppler velocimetry of the umbilical artery were performed biweekly and remained within normal limits throughout gestation. Amniotic fluid index, placental grade as well as HCG and E2 were within normal limits. Results: Two fetuses were delivered vaginally by spontaneous and induced labour at 39 and 38+5 weeks respectively. A caesarean section in the third case was performed because of changes in the USS characteristics of the fetal cyst suggesting an intrauterine ovarian cyst torsion. The ovarian cysts observed antenatally regressed in all fetuses within 10 weeks following delivery, as confirmed by serial USS. Conclusion: It seems that close surveillance of fetuses with simple ovarian cysts not accompanied with other USS findings during intrauterine life can lead to a successful fetal outcome.
P2.18.06 REVERSED DIASTOLIC UMBILICAL ARTERY FLOW IN THE FIRST TRIMESTER ASSOCIATED WITH CHROMOSOMAL FETAL ABNORMALITIES OR CARDIAC DEFECTS C. G. V. Murta, A. F. Moron and A. A. P, Avila Department of Obstetrics and Gynecology, Federal University of Sfo Paula, UNIFESP/EPM, Sfo Paula, Brazil. Email:[email protected] Background: There are six cases reported of reversed end-diastolic umbilical artery blood flow at lo-14 weeks’ gestation. Four of those were associated with chromosomal anomalies and one showed congenital heart disease. This report describes two new cases. Case 1: A 41.year-old gravida 4, para 2, presented at 10 weeks for ultrasound, which showed a single fetus with crown-rump length of 42 mm and increased nuchal translucency (5 mm). The fetal heart rate (FHR) was 149 beats/minute, and Doppler showed reversed end-diastolic umbilical artery velocity. Cytogenetic analysis by chorionic villus sampling diagnosed 69,xXx karyotype. The fetus died 1 week later. The uterus was evacuated by D&C and triploidy was confirmed by karyotyping of the fetal tissue. Case 2: A 30.year-old primigravida with an unremarkable medical history presented at 12 weeks’ gestation for ultrasound, which showed a fetal crown-rump length of 57 mm, increased nuchal translucency (9.1 mm) and FHR of 147 beats/minute. A interventricular septal defect was identified by a 6-MHz tramvaginal transducer. Doppler examination showed reversed end-diastolic umbilical artery velocity. Chromosome analysis by chorionic villus sampling indicated trisomy 9. Ten days later the fetus died. The uterus was evacuated by D&C, and complete trisomy 9 was confirmed by cytogenetic examination of the fetal tissue. The ventricular septal defect was confirmed by autopsy. Conclusion: The reversed end-diastolic umbilical artery flow in the first trimester might be an important sign in early pregnancy of chromosomal abnormalities. In addition, it might be useful as an alarm sign for earlier diagnosis of structural cardiac defects.
P2.18.07 SECOND TRIMESTER LOW-LYING PLACENTA: RISK FOR VASA PREVIA K.O.Ovelese’. R.MacLaren’,K.M.Lewis’, S.Campbellz, J.T.Queenan’, ‘Dept.Ob/Gyn, Georgetown University Medical Center, Washington DC, USA ‘Dept Ob/Gyn, St George’s Hospital, London,United Kingdom Objective: The aim of this study was to determine if there are any risk factors that predispose to development of vasa previa in pregnancy. Study Method: We reviewed the medical records of all women with a diagnosis of vasa previa over the past 5 years in two major teaching hospitals. We identified 5 cases. We sought to determine if there were any common features to all the cases. Results: In all the cases a sonogram performed in the second trimester had shown a low-lying placenta. In only two was the placenta still low-lying at term. In addition, two of the cases had a succenturiate lobed placenta that was diagnosed prenatally by sonography. Two of the five pregnancies were conceived by in-vitro fertilization. Conclusion: A second trimester low-lying placenta appears to be a risk for