Wiley

To evaluate our experience with the diagnosis and treatment of Cesarean scar pregnancy.

During a 6‐year period, 12 cases of Cesarean scar pregnancy were diagnosed using transvaginal color Doppler sonography and treated conservatively to preserve fertility. Incidence, gestational age, sonographic findings, β‐human chorionic gonadotropin ( β‐hCG) levels, flow profiles of transvaginal color Doppler ultrasound, and methods of treatment were recorded.

The incidence of Cesarean scar pregnancy was 1:2216 and its rate was 6.1% in women with an ectopic pregnancy and at least one previous Cesarean section. Gestational age at diagnosis ranged from 5 + 0 to 12 + 4 weeks. The time interval from the last Cesarean section to the diagnosis of Cesarean scar pregnancy ranged from 6 months to 12 years. High‐velocity and low‐impedance subtrophoblastic flow (resistance index, 0.38) persisted until β‐hCG declined to normal. Patients were treated as follows: transvaginal ultrasound‐guided injection of methotrexate into the embryo or gestational sac (n = 3), transabdominal ultrasound‐guided injection of methotrexate (n = 2), transabdominal ultrasound‐guided injection of methotrexate followed by systemic methotrexate administration (n = 2), systemic methotrexate administration alone (n = 2), dilatation and curettage (n = 2), or local resection of the gestation mass (n = 1). Eleven of the 12 patients preserved their reproductive capacity; the remaining patient, treated by dilatation and curettage, underwent a hysterectomy because of profuse vaginal bleeding. The Cesarean scar mass regressed from 2 months to as long as 1 year after treatment. Uterine rupture occurred in one patient during the following pregnancy at 38 + 3 weeks' gestational age.

Ultrasound‐guided methotrexate injection emerges as the treatment of choice to terminate Cesarean scar pregnancy. Surgical or invasive techniques, including dilatation and curettage are not recommended for Cesarean scar pregnancy due to high morbidity and poor prognosis. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

Khảo sát ảnh hưởng tiềm năng của việc kết hợp độ tuổi của mẹ với độ mờ da gáy của thai nhi và β‐hCG tự do trong huyết thanh mẹ cũng như protein-A huyết tương liên quan đến thai kỳ (PAPP-A) trong việc sàng lọc trisomy 21 từ tuần thứ 10 đến 14 của thai kỳ.

β‐hCG tự do trong huyết thanh mẹ và PAPP-A được đo bằng công nghệ Kryptor, một máy phân tích miễn dịch tiếp cận ngẫu nhiên sử dụng phát xạ cryptate khuếch đại theo thời gian, trên 210 thai đơn mắc trisomy 21 và 946 mẫu đối chứng bình thường về nhiễm sắc thể, phù hợp về độ tuổi của mẹ, thời điểm mang thai và thời gian lưu trữ mẫu. Trong tất cả các trường hợp, chiều dài đầu-mông của thai nhi và độ mờ da gáy đã được đo bằng siêu âm ở tuần thứ 10–14 của thai kỳ và máu của mẹ đã được thu thập ngay khi siêu âm. Phân bố (dưới dạng bội số của trung vị; MoM) của β‐hCG tự do và PAPP-A (đã điều chỉnh theo trọng lượng của mẹ) và độ mờ da gáy của thai nhi được xác định trong nhóm trisomy 21 và nhóm đối chứng. Các tỷ lệ khả năng cho các tổ hợp dấu hiệu khác nhau đã được tính toán và chúng được sử dụng cùng với rủi ro liên quan đến tuổi để tính tỷ lệ phát hiện dự kiến của các trường hợp mang thai ảnh hưởng, ở một tỷ lệ dương tính giả cố định, trong một quần thể có phân bố tuổi mang thai của mẹ như ở Anh và Wales.

Trong một quần thể có phân bố tuổi mang thai của mẹ như ở Anh và Wales, ước tính rằng, việc sử dụng kết hợp độ tuổi của mẹ, độ mờ da gáy của thai nhi và β‐hCG tự do trong huyết thanh mẹ và PAPP-A, sẽ giúp phát hiện 89% trường hợp mang thai trisomy 21 ở tỷ lệ dương tính giả cố định 5%. Ngoài ra, ở tỷ lệ phát hiện cố định 70%, tỷ lệ dương tính giả sẽ là 1%. Việc bao gồm các tham số sinh hóa đã nâng cao thêm 16% tỷ lệ phát hiện so với việc chỉ sử dụng độ mờ da gáy và tuổi của mẹ.

Công nghệ chẩn đoán nhanh như Kryptor, có khả năng cung cấp các phép đo sinh hóa tự động có thể lặp lại trong vòng 30 phút sau khi lấy mẫu máu, sẽ cho phép phát triển các phòng khám liên ngành một lần cho việc đánh giá thai nhi sớm. Các phòng khám như vậy sẽ có thể cung cấp độ nhạy sàng lọc cao hơn, nhanh chóng và hiệu quả hơn, giúp giảm sự lo lắng và căng thẳng cho bệnh nhân. Bản quyền © 1999 Hiệp hội quốc tế siêu âm trong sản phụ khoa.

Few data exist for counseling and perinatal management of women after an antenatal diagnosis of early‐onset fetal growth restriction. Yet, the consequences of preterm delivery and its attendant morbidity for both mother and baby are far reaching. The objective of this study was to describe perinatal morbidity and mortality following early‐onset fetal growth restriction based on time of antenatal diagnosis and delivery.

We report cohort outcomes for a prospective multicenter randomized management study of fetal growth restriction (Trial of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE)) performed in 20 European perinatal centers between 2005 and 2010. Women with a singleton fetus at 26–32 weeks of gestation, with abdominal circumference < 10^th percentile and umbilical artery Doppler pulsatility index > 95^th percentile, were recruited. The main outcome measure was a composite of fetal or neonatal death or severe morbidity: survival to discharge with severe brain injury, bronchopulmonary dysplasia, proven neonatal sepsis or necrotizing enterocolitis.

Five‐hundred and three of 542 eligible women formed the study group. Mean ± SD gestational age at diagnosis was 29 ± 1.6 weeks and mean ± SD estimated fetal weight was 881 ± 217 g; 12 (2.4%) babies died in utero. Gestational age at delivery was 30.7 ± 2.3 weeks, and birth weight was 1013 ± 321 g. Overall, 81% of deliveries were indicated by fetal condition and 97% were by Cesarean section. Of 491 liveborn babies, outcomes were available for 490 amongst whom there were 27 (5.5%) deaths and 118 (24%) babies suffered severe morbidity. These babies were smaller at birth (867 ± 251 g) and born earlier (29.6 ± 2.0 weeks). Death and severe morbidity were significantly related to gestational age, both at study entry and delivery and also with the presence of maternal hypertensive morbidity. The median time to delivery was 13 days for women without hypertension, 8 days for those with gestational hypertension, 4 days for pre‐eclampsia and 3 days for HELLP syndrome.

Fetal outcome in this study was better than expected from contemporary reports: perinatal death was uncommon (8%) and 70% survived without severe neonatal morbidity. The intervals to delivery, death and severe morbidity were related to the presence and severity of maternal hypertensive conditions. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

To examine the association between maternal age and a wide range of adverse pregnancy outcomes after adjustment for confounding factors in obstetric history and maternal characteristics.

This was a retrospective study in women with singleton pregnancies attending the first routine hospital visit at 11 + 0 to 13 + 6 weeks' gestation. Data on maternal characteristics, and medical and obstetric history were collected and pregnancy outcomes ascertained. Maternal age was studied, both as a continuous and as a categorical variable. Regression analysis was performed to examine the association between maternal age and adverse pregnancy outcome including pre‐eclampsia, gestational hypertension, gestational diabetes mellitus (GDM), preterm delivery, small‐for‐gestational age (SGA) neonate, large‐for‐gestational age (LGA) neonate, miscarriage, stillbirth and elective and emergency Cesarean section.

The study population included 76 158 singleton pregnancies with a live fetus at 11 + 0 to 13 + 6 weeks. After adjusting for potential maternal and pregnancy confounding variables, advanced maternal age (defined as ≥ 40 years) was associated with increased risk of miscarriage (odds ratio (OR), 2.32 (95% CI, 1.83–2.93); P < 0.001), pre‐eclampsia (OR, 1.49 (95% CI, 1.22–1.82); P < 0.001), GDM (OR, 1.88 (95% CI, 1.55–2.29); P < 0.001), SGA (OR, 1.46 (95% CI, 1.27–1.69); P < 0.001) and Cesarean section (OR, 1.95 (95% CI, 1.77–2.14); P < 0.001), but not with stillbirth, gestational hypertension, spontaneous preterm delivery or LGA.

Maternal age should be combined with other maternal characteristics and obstetric history when calculating an individualized adjusted risk for adverse pregnancy complications. Advanced maternal age is a risk factor for miscarriage, pre‐eclampsia, SGA, GDM and Cesarean section, but not for stillbirth, gestational hypertension, spontaneous preterm delivery or LGA. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

To compare early vs late administration of low‐dose aspirin on the risk of perinatal death and adverse perinatal outcome.

Databases were searched for keywords related to aspirin and pregnancy. Only randomized controlled trials that evaluated the prophylactic use of low‐dose aspirin (50–150 mg/day) during pregnancy were included. The primary outcome combined fetal and neonatal death. Pooled relative risks (RR) with their 95% CIs were compared according to gestational age at initiation of low‐dose aspirin (≤ 16 vs > 16 weeks of gestation).

Out of 8377 citations, 42 studies (27 222 women) were included. Inclusion criteria were risk factors for pre‐eclampsia, including: nulliparity, multiple pregnancy, chronic hypertension, cardiovascular or endocrine disease, prior gestational hypertension or fetal growth restriction, and/or abnormal uterine artery Doppler. When compared with controls, low‐dose aspirin started at ≤ 16 weeks' gestation compared with low‐dose aspirin started at >16 weeks' gestation was associated with a greater reduction of perinatal death (RR = 0.41 (95% CI, 0.19–0.92) vs 0.93 (95% CI, 0.73–1.19), P = 0.02), pre‐eclampsia (RR = 0.47 (95% CI, 0.36–0.62) vs 0.78 (95% CI, 0.61–0.99), P < 0.01), severe pre‐eclampsia (RR = 0.18 (95% CI, 0.08–0.41) vs 0.65 (95% CI, 0.40–1.07), P < 0.01), fetal growth restriction (RR = 0.46 (95% CI, 0.33–0.64) vs 0.98 (95% CI, 0.88–1.08), P < 0.001) and preterm birth (RR = 0.35 (95% CI, 0.22–0.57) vs 0.90 (95% CI, 0.83–0.97), P < 0.001).

Low‐dose aspirin initiated at ≤ 16 weeks of gestation is associated with a greater reduction of perinatal death and other adverse perinatal outcomes than when initiated at >16 weeks. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.