Ultrasound Markers Research Articles

Analysis of the clinical diagnosis and treatment of fetal meconium peritonitis

Background The purpose of this study was to improve diagnostic and therapeutic standards by examining the clinical features, treatment, and prognosis of fetal meconium peritonitis (FMP), as well as the diagnostic efficacy of ultrasound for FMP. Methods The clinical data of 41 infants and pregnant women diagnosed with meconium peritonitis (MP) and treated at the Fujian Maternal and Child Health Hospital from January 2013 to January 2020 were analyzed retrospectively. Clinical data, imaging data, complications, treatment strategies, pregnancy outcomes, neonatal prognoses, and follow-up outcomes were all analyzed. Results The MP prenatal diagnosis rate was 56.1% (23/41), the neonatal surgery rate was 53.7% (22/41), and the survival rate was 85.4% (35/41). Intraperitoneal calcification (23 pregnant women, 56.1%), intestinal dilatation (13 pregnant women, 31.7%), peritoneal effusion (22 pregnant women, 53.7%), intraperitoneal pseudocyst (7 pregnant women, 17.1%), and polyhydramnios were diagnosed via prenatal ultrasound (18 pregnant women, 43.9%). Twenty-two pregnant women were assigned to the surgical treatment (operation) group, while 18 were assigned to the conservative treatment group. In the operation group, there were 9 cases of ileal atresia (40.9%), 7 cases of jejunal atresia (31.8%), 2 cases of atresia at the jejunum-ileum junction (9.1%), 2 cases of ileal perforation (9.1%), 1 case of ileal necrosis (4.5%), and 1 case of adhesive obstruction (4.5%). There was no statistically significant difference (p > .05) in the occurrence of various prenatal ultrasound findings by etiology. Conclusion Multiple prenatal ultrasound markers have been identified for MP. To improve the efficacy of newborn treatment for FMP and reduce neonatal mortality, dynamic monitoring of ultrasound image alterations and strengthened integrated perinatal management are necessary.

Chromosomal Microarray Analysis in Fetuses with Ultrasound Abnormalities.

To explore and evaluate the value of chromosomal microarray analysis (CMA) in prenatal diagnosis of fetuses with ultrasound abnormalities. A retrospective analysis was performed on 370 fetuses with ultrasound abnormalities received invasive prenatal diagnosis at Meizhou People's Hospital from October 2022 to December 2023. Fetal specimens were analyzed by CMA, and the detection rates of aneuploidy and pathogenic (P)/likely pathogenic (LP) copy number variations (CNVs) in ultrasound structural abnormalities (malformations of fetal anatomy) and non-structural abnormalities (abnormalities of fetal nonanatomical structure) were analyzed. There were 114 (30.8%) cases with isolated ultrasound structural abnormalities, 226 (61.1%) cases with isolated non-structural abnormalities (182 isolated ultrasound soft markers abnormalities, 30 isolated fetal growth restriction (FGR), and 8 isolated abnormalities of amniotic fluid volume), and 30 (8.1%) cases with both structural and non-structural abnormalities. The overall detection rate of aneuploidy and P/LP CNVs in isolated ultrasonic structural abnormalities was 5.3%, among which cardiovascular system abnormalities were the highest. In addition, the largest number of fetuses with non-structural abnormalities was nuchal translucency (NT) thickening (n = 81), followed by ventriculomegaly (n = 29), and nasal bone dysplasia (n = 24). The detection rate of chromosomal abnormalities of fetuses with abnormal ultrasound soft markers was 9.9%, and the detection rate in single abnormal ultrasound soft marker, and multiple ultrasound soft markers abnormalities was 9.7% (16/165) and 11.8% (2/17), respectively. Moreover, the detection rate of chromosomal abnormalities of fetuses with FGR and structural abnormalities combined with non-structural abnormalities was 6.7% (2/30), and 13.3% (4/30), respectively. The incidence of chromosomal abnormalities (aneuploidy and P/LP CNVs) varies among different fetal ultrasound abnormalities.

Multimodal ultrasound plus tumor markers demonstrates a high value in enhanced diagnosis of breast cancer.

To determine the diagnostic value of multimodal ultrasound combined with tumor markers in breast cancer (BC). A retrospective analysis was conducted on 198 patients with breast lesions treated at the Affiliated Wuxi People's Hospital of Nanjing Medical University between May 2020 and May 2023. All patients underwent multimodal ultrasound and tumor marker testing. Among the 198 patients, 88 patients were pathologically diagnosed with benign disease (benign group) and 110 patients were pathologically diagnosed with malignant disease (malignant group). With the pathological results as the gold standard, the benign and malignant results from different diagnostic methods were compared, focusing on specificity, sensitivity and accuracy. The areas under the curves (AUCs) of carbohydrate antigen 153 (CA153), CA125, and carcinoembryonic antigen (CEA) for diagnosing BC were 0.810, 0.812, and 0.790, respectively. When these tumor markers were used in combination for diagnosing BC, the AUC increased to 0.928. The AUC of multimodal ultrasound alone in diagnosing BC was 0.845. Additionally, the AUC of multimodal ultrasound combined with tumor markers in diagnosing BC reached 0.971, with the corresponding specificity, sensitivity and accuracy of 90.00%, 94.43% and 91.92%, respectively. In patients with early BC, the combination of multimodal ultrasound and tumor marker detection significantly improves the accuracy of diagnosing benign and malignant breast lesions compared to using either modality alone.

93 Reliability of “lethal” ultrasound markers in identifying fetuses with truly life-limiting skeletal dysplasia

93 Reliability of “lethal” ultrasound markers in identifying fetuses with truly life-limiting skeletal dysplasia

Diagnostic and prognostic role of soft ultrasound markers in prenatal detection and assessment of foetal abnormalities.

Various soft markers can be detected in the ultrasonography of foetuses, which can be related to chromosomal abnormalities and increases the risk of abnormalities, or they can be considered as normal variations that can disappear due to the pregnancy progress. There are different tools to detect chromosomal abnormalities like conventional karyotyping, chromosomal microarray analysis (CMA), single nucleotide polymorphism (SNP) array, non-invasive prenatal test (NIPT), and non-invasive prenatal screening (NIPS). Therefore, in the present study, we aim to assess the accuracy of ultrasonic soft markers in the diagnosis of chromosomal abnormalities such as chromosomal structural abnormalities, aneuploidy, and triploidy, especially Trisomy 21 and Trisomy 18. A systemic literature search was performed using PubMed, Scopus, Google Scholar, and Web of Science. We gathered all articles published before August 2023. We selected English studies such as retrospective and cross-sectional ones that assessed the relationship between ultrasonic soft markers and foetal chromosomal abnormalities. A total of 10 articles with 18,580 cases were included in our systematic review article that assessed the foetal abnormalities and aneuploidies by using conventional karyotyping, SNP array, CMA, and NIPT (or NIPS). Trisomy 21, Trisomy 18, and chromosomal structural abnormalities were the most common abnormalities related to ultrasonic soft markers by karyotyping; however, Trisomy 13, 47, XXY, 45, X, and mosaic chromosomal abnormalities were other abnormalities detected. Results by CMA showed Trisomy 21 and Trisomy 18 as the most common abnormalities in the foetuses also with ultrasonic soft markers, and other abnormalities were pathogenic copy-number variations, Turner (XO), polyploidy, 22q11.2deletion, and Trisomy13, respectively. It was discovered that there is a greater possibility of having pathogenic copy number variations (CNVs) in the groups with multiple ultrasonic soft markers, while foetuses with ultrasonic soft markers have a decreased prevalence of CMA abnormality compared to those who had significant abnormalities or abnormal nuchal translucency. Trisomy 21 was the only abnormality found by NIPT in the groups with 1 and 2 soft markers, while groups with multiple soft markers were all normal. By using SNP array, it was identified that the rate of chromosomal abnormalities such as aneuploidy and triploidy, LOH, and CNVs was lower in the group with a single ultrasonic soft marker compared to the group with structural abnormalities in multiple systems. Trisomy 21, Trisomy 18, and chromosomal structural abnormalities were the most common chromosomal abnormalities that ultrasound soft markers could diagnose. Therefore, it is recommended to employ soft markers besides CMA, SNP array, and NIPS (or NIPT) for greater accuracy in detecting foetus abnormalities.

Effect of physical activity breaks during prolonged sitting on vascular outcomes: A scoping review.

Emerging evidence claims the vascular benefits of varied frequency and duration of physical activity (PA) breaks, whereas the efficacy of varied intensity remains unexplored. We aimed to collate and summate the studies investigating the PA breaks at various intensities on vascular protection. Seven electronic databases were searched for potential studies till Jan 31, 2022. The eligible studies should have administered PA breaks of differing intensities in prolonged sitting postures and explored regional vascular changes [flow mediated dilation (FMD), shear stress, diameter, and blood flow] using ultrasound and novel outcome markers. Two independent reviewers assessed the studies for eligibility after abstract and full-text screen, and appropriate data were extracted to summarise vascular protective effects with PA breaks. Our findings reveal adverse regional vascular outcomes with prolonged sitting (FMD ≈ -1.5%, diameter ≈ -0.06 mm), whereas PA breaks of any intensity were found to improve endothelial functions (FMD ≈ +0.5%, diameter ≈ +0.1 mm, shear ≈ +13 s-1) and mitigate the adverse effects associated with prolonged sitting. Compared with high-intensity activity, low-intensity PA breaks alleviate arterial stiffness and endothelial dysfunction risks.

146 A novel first-trimester ultrasound marker for cesarean scar pregnancy: the tadpole sign

146 A novel first-trimester ultrasound marker for cesarean scar pregnancy: the tadpole sign

Measurement of atherosclerosis markers in individuals with periodontitis.

The inflammatory response due to inflammatory cytokines, bacterial pathogens, and the altered lipoprotein metabolism in patients with periodontitis indicates that infection with periodontal anaerobic bacteria may influence atherogenesis in vitro and in vivo. We aimed to explore the effect of periodontitis concerning clinical and ultrasound markers of early atherosclerosis. In this case-control study, a total of 30 systemically healthy adults (15 with periodontitis and 15 without periodontitis) over 40 years of age were studied. Periodontitis was determined by measuring the clinical attachment level (CAL) and radiographic bone loss (RBL). Conventional cardiovascular risk factors, including body mass index, serum levels of total cholesterol (TCH), triglycerides (TG), and high-density and low-density lipoprotein (HDL and LDL, respectively) cholesterol were evaluated. Carotid artery intima-media thickness (IMT) was measured using ultrasonography. The mean values of the CAL and carotid IMT were 5.02±0.9 mm and 0.084±0.01 cm vs. 1.6±0.61 mm and 0.072±0.02 cm in the periodontitis and healthy groups, respectively, reflecting statistically significant differences (P=0.001 and P=0.037, respectively). There were statistically significant differences in the serum levels of TCH, TG, and LDL between the 2 groups (P=0.017). The CAL and RBL were positively associated with carotid IMT and serum cholesterol levels, except for HDL, whereas tooth loss was not associated with any markers (P<0.05). Compared to the healthy group, participants with periodontitis exhibited 2.09 times higher odds (95% confidence interval, 1.22-3.59) of having subclinical atherosclerosis. The presence of periodontitis increased the risk of atherosclerosis.

Prospective Study of Ultrasound Markers of Organ Congestion in Critically Ill Patients With Acute Kidney Injury

Organ congestion may be a mediator of adverse outcomes in critically ill patients with severe acute kidney injury (AKI). The presence of abnormal venous Doppler waveforms could identify patients with clinically significant organ congestion who may benefit from a decongestive strategy. This prospective multicenter cohort study enrolled patients with severe AKI defined as Kidney Disease: Improving Global Outcomes stage 2 or higher. Patients were not eligible if they received renal replacement therapy (RRT) for more than 72 hours at the time of screening. Participants underwent serial Doppler ultrasound examinations of the portal, hepatic and intrarenal veins during the week following enrolment. We calculated the venous excess ultrasound (VExUS) score based on these data. The primary outcome studied was major adverse kidney events at 30 days (MAKE30) defined as death, RRT dependence, or a persistent decrease in kidney function. A total of 125 patients were included for whom 291 ultrasound assessments were performed. Severely abnormal venous waveforms were documented in 14.4% of portal vein assessments, 6.5% of intrarenal venous assessments, and 14.4% of hepatic vein assessments. The individual ultrasound markers were not associated with MAKE30. The VExUS score (grade 0-1: reference; grade 2: adjusted hazard ratio [aHR]: 4.03, confidence interval [CI]: 1.81-8.99; grade 3: aHR: 2.70, CI: 1.10-6.65; P= 0.03), as well as severely abnormal portal, hepatic and intrarenal vein Doppler were each independently associated with mortality. Although not significantly associated with MAKE30, venous Doppler abnormalities suggestive of venous congestion were associated with higher mortality in critically ill patients with severe AKI.

A comprehensive review of recent advances in chronic pancreatitis

Chronic pancreatitis (CP) is a multifaceted disorder influenced by environmental and genetic factors, with smoking and alcohol consumption being major contributors. Recent developments encompass the advent of innovative transgenic models and the identification of susceptibility genes, shedding light on the genetic aspect of CP. The pathogenesis of this disease involves a complex interplay of pancreatic acinar cell dysfunction, inflammatory reactions, and fibrosis. Current research delves into understanding these molecular mechanisms. Pain, a pivotal symptom of CP, has been increasingly studied to develop effective therapeutic interventions. Diagnostic advancements, including endoscopic ultrasound, radiomics, and blood-based markers, have shown potential in enhancing early CP detection. Moreover, recent clinical trials have optimized treatment approaches, such as pancreatic stone fragmentation, stent placement, and decision-making between endoscopic and surgical procedures. Emerging therapies, including chemical pancreatectomy and gene therapy, present promising opportunities for improved CP management.

Prenatal screening after preimplantation genetic testing for aneuploidy: time to evaluate old strategies

Research questionWhat is the performance of the first-trimester aneuploidy screening in pregnancies achieved after in vitro fertilization (IVF) and preimplantation genetic testing for aneuploidy (PGT-A) transferred embryos in our medical setting? DesignRetrospective cohort study in a single tertiary care centre between January 2013 and June 2022. A total of 20,237 women have had a prenatal follow-ups in our clinical centre and were included in our study. Three groups were included: singleton pregnancies conceived after the transfer of a PGT-A screened euploid-embryo (n=511), singleton pregnancies conceived after IVF without PGT-A (n= 3,291), and singleton naturally conceived pregnancies (n= 16,436). ResultsThe conventional combined test for PGT-A pregnancies had a specificity of 91% and the sensitivity could not be calculated since there were no cases of fetal aneuploidy in this group. In 89.1% of pregnancies conceived after IVF with PGT-A with a high-risk for T21, 18, or 13, the result was related to advanced maternal age. ConclusionsThe current screening strategy for T21, T18, and T13 can generate unnecessary tests in pregnancies achieved by IVF-PGT-A. A new protocol is needed for these patients with a greater weight on ultrasound markers.

Markers of heart failure with preserved ejection fraction in patients with unexplained dyspnea

Aim. To evaluate the prevalence of clinical, history, laboratory and ultrasound markers of heart failure with preserved ejection fraction (HFpEF) in patients with unexplained dyspnea, as well as to identify markers of structural myocardial remodeling in this group of patients.Material and methods. This retrospective study included 504 patients aged 18 to 84 years who were hospitalized from July 1, 2022 to March 31, 2023. Patients were divided into two groups depending on the presence of dyspnea. A comparative analysis of ultrasound parameters was carried out in order to identify myocardial structural remodeling.Results. A number of associated conditions and metabolic disorders, which are known to be risk factors for HFpEF, were detected more often in patients with unexplained dyspnea and myocardial remodeling. A model to determine the probability of structural remodeling was developed. Two most significant indicators were dyspnea and diabetes.Conclusion. This study demonstrated the relationship between unexplained dyspnea and structural myocardial remodeling. Identification of certain clinical and morphological signs of HFpEF in such patients requires apprehensive attitude and in-depth examination in order to rule out it.

Diagnostic Performance of Magnetic Resonance Imaging for Pediatric Ovarian Neoplasms: A Multi-Institutional Review

Study ObjectiveTo assess diagnostic performance of MRI to predict ovarian malignancy alone and compared to other diagnostic studies. MethodsRetrospective analysis of patients aged 2 to 21 years who underwent ovarian mass resection between 2009-2021 at eleven pediatric hospitals. Sociodemographic information, clinical and imaging findings, tumor markers, and operative and pathology details were collected. Diagnostic performance for detecting malignancy was assessed by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for MRI with other diagnostic modalities. Results1,053 patients underwent resection of an ovarian mass with a median age of 14.6 years; 10% (110/1053) had malignant disease on pathology and 13% (136/1053) underwent preoperative MRI. MRI sensitivity, specificity, PPV, and NPV were 60%, 94%, 60%, 94%. Ultrasound sensitivity, specificity, PPV, and NPV were 31%, 99%, 73%, 95%. Tumor marker sensitivity, specificity, PPV, and NPV were 90%, 46%, 22%, 96%. MRI and ultrasound concordance was 88% with sensitivity, specificity, PPV, and NPV of 33%, 99%, 75%, 94%. MRI sensitivity in ultrasound-discordant cases was 100%. MRI and tumor marker concordance was 88% with sensitivity, specificity, PPV, and NPV of 100%, 86%, 64%, 100%. MRI specificity in tumor marker-discordant cases was 100%. ConclusionDiagnostic modalities used to assess ovarian neoplasms in pediatric patients typically agree. In cases of disagreement, MRI is more sensitive for malignancy than ultrasound and more specific than tumor markers. Selective use of MRI with preoperative ultrasound and tumor markers may be beneficial when the risk of malignancy is uncertain. Concise AbstractThis retrospective review of 1053 patients age 2-21 years who underwent ovarian mass resection between 2009-2021 at 11 pediatric hospitals found that ultrasound, tumor markers, and MRI tend to agree on benign vs malignant but in cases of disagreement, MRI is more sensitive for malignancy than US.

Application of Copy Number Variation Sequencing Technology in 422 Foetuses with Abnormal Ultrasound Soft Markers.

The application value of ultrasound soft indicators in prenatal diagnosis was evaluated by copy number variation sequencing (CNV-seq). The authors conducted a retrospective analysis of 422 pregnant women who underwent CNV-seq testing at Luoyang Maternal and Child Health Hospital between January 2020 and November 2021. The women had presented with abnormal ultrasound soft markers; those identified as high-risk through non-invasive prenatal screening were excluded. A total of 43 abnormal cases were detected in 422 pregnant women, including 24 aneuploidy (including chimerism) and 19 pathogenic or likely pathogenic copy number variations (CNVs). Based on the characteristics of ultrasound soft indicators, pregnant women were divided into five groups: isolated nuchal translucency (NT) group, combined NT group, isolated soft indicators group, combined soft indicators group and combined non-NT group. The abnormality detection rates in the five groups were 12.38% (13/105), 36.11% (13/36), 3.74% (4/103), 3.08% (2/63) and 10.09% (11/109), respectively. Statistical tests showed that the detection rate in the NT thickening combined with other abnormalities group was significantly higher than the other four groups, while there was no statistical difference in the detection rate among the other four groups. When NT thickening is combined with other abnormalities, it is more likely to indicate chromosome abnormalities or CNVs, so it should be regarded seriously upon finding, and pregnant women should be referred for prenatal diagnosis according to the examination results. In addition, NT thickening is an important indicator for prenatal diagnosis and should be considered regardless of whether it occurs independently. The authors recommend CNV-seq for prenatal diagnosis to prevent missing small fragments of CNVs during traditional karyotyping.

Prenatal diagnosis of fetal digestive system malformations and pregnancy outcomes at a tertiary referral center in Fujian, China: A retrospective study

Fetal digestive system malformations (DSMs) are correlated with chromosomal anomalies. The prenatal diagnosis of DSMs allows for timely treatment and reduces perinatal morbidity and mortality. However, genetic screening for fetal DSMs is rarely reported. This study aimed to investigate genetic etiology and pregnancy outcomes in cases of fetal DSM by analyzing correlations between DSM types and chromosomal anomalies. This retrospective single-center study included 126 fetuses in whom DSMs were detected via prenatal ultrasonography. Genetic etiology was investigated using conventional karyotyping, chromosome microarray analysis (CMA), and whole-exome sequencing (WES). DSMs were categorized as simple DSM (Group A), DSM combined with abnormal ultrasound soft markers (Group B), and DSM combined with comorbidities of other systems (Group C). Abnormal karyotypes were detected in 11/126 (8.7 %) fetuses. Four more pathogenic copy number variants (CNVs) were detected using CMA, increasing the detection rate to 11.9 %. The detection rates significantly differed between the three DSM types (1.78 %, 8.11 %, and 33.33 % in Groups A, B, and C, respectively). The overall adverse pregnancy outcome rate was 33.9 %, and 11.5 %, 23.5 %, and 81.3 %, (P < 0.001), respectively, in Groups A, B, and C. Out of 83 live births, three neonates died, 26 underwent postnatal surgery with 24 favorable outcomes, and 54 did not undergo surgery and were basically normal. Two neonates who underwent WES were diagnosed with CHD7-associated Charge syndrome and JAG1-associated Alagille syndrome, respectively. Our findings demonstrate that fetal DSM is closely related to chromosome aneuploidies, CNVs, and point mutations. The prognoses of most fetuses with simple DSM and those with comorbid abnormal ultrasound soft markers were favorable in the absence of chromosomal anomalies and severe structural malformations, provided they underwent timely surgery as neonates. These findings provide guidance for the prenatal diagnosis and clinical management of fetal DSMs and the genetic counseling of parents.

Association between Ultrasound Soft Markers of Endometriosis and Pathologically Confirmed Positivity Rates of Endometriosis Lesions

Association between Ultrasound Soft Markers of Endometriosis and Pathologically Confirmed Positivity Rates of Endometriosis Lesions

OP03.08: Improving pregnancy outcome prediction in women with recurrent miscarriages by taking early ultrasound markers into account

OP03.08: Improving pregnancy outcome prediction in women with recurrent miscarriages by taking early ultrasound markers into account

Uterocervical angle versus cervical length in the prediction of spontaneous preterm birth in women with history of spontaneous preterm birth: a prospective observational study

BackgroundPreterm delivery is a leading cause of neonatal mortality and morbidity. History of spontaneous preterm birth is the greatest risk factor for another preterm delivery. So, every effort should be made to prevent the recurrence of preterm delivery in this vulnerable group. This study aimed to evaluate the predictive ability of the anterior uterocervical angle and cervical length in preterm birth.Patients and MethodsThis was a prospective cohort study that included 70 patients with a history of spontaneous preterm birth. Ultrasound measurements of cervical length and anterior uterocervical angle were set to be measured for each patient at three visits; first between 16 0/7 and 24 0/7 weeks, second between 24 1/7 and 32 0/7 weeks, and the third was between 32 1/7 and 36 6/7 weeks. The correlation between both measures and the prediction of preterm birth among study participants was the primary outcome of the study. Neonatal outcome among the study patients was a secondary measure of outcome.ResultsThe incidence of preterm birth among study participants was 31.41%. Cervical length and uterocervical angle showed progressive decrease and increase respectively throughout pregnancy. At the 2nd visit, the two measures were significantly different between those who delivered at term and those with preterm delivery with the cervical length being significantly shorter in the preterm arm (3.0 ± 0.49 versus 3.38 ± 0.36, p < 0.001) and uterocervical angle being significantly bigger among the same arm (110.1 ± 18.48 versus 84.42 ± 12.24, p < 0.001). A uterocervical angle > 89.8° at the second visit predicted preterm birth with 81.8% sensitivity and 70.8% specificity while cervical length ≤ 3.22 cm at the second visit predicted preterm birth with 68.1% sensitivity and 62.5% specificity. Multivariant logistic regression analysis showed that uterocervical angle > 89.8° at the second visit increased the odds ratio for preterm birth by 9.ConclusionUterocervical angle can be a useful ultrasound marker for the prediction of preterm birth among high risk patients. A cutoff value of 89.8° can be used as a threshold above which prophylactic measures such as cervical cerclage or progesterone therapy can be provided.Trial registrationNCT05632003 (First posted date: 30/11/2022).

THE ROLE OF UTEROCERVICAL ANGLE IN DETERMINING THE THREAT OF PRETERM BIRTH

Europäische Wissenschaftliche Gesellschaft Home About the Journal Peer Review Editorial Board For Authors Reviewer Recognition Archive Contact Impressum EWG e.V. Crossref Member Badge Erfolgreich durch internationale Zusammenarbeit OBSTETRICS DOI 10.35630/2023/13/4.817 Received 11 July 2023; Accepted 19 July 2023, Published 15 August 2023 THE ROLE OF UTEROCERVICAL ANGLE IN DETERMINING THE THREAT OF PRETERM BIRTH Ufuk Atlıhan orcid id logo , Umit Derundere orcid id logo Private Karatas Hospital, Izmir, Turkey download article (pdf) cfl.ufuk@gmail.com ABSTRACT Preterm labor is one of the leading causes of perinatal morbidity and mortality and is thought to complicate approximately 10-12% of pregnancies. Defined as birth before 37 weeks of gestation, preterm labor is one of the most common obstetric complications worldwide. Although the pathogenesis of preterm labor is not fully understood, intraamniotic infection or hemorrhage, uteroplacental ischemia, uterine overstretching and immunologic processes have been proposed in its etiology. However, there is still no definitive prediction tool. Sonographic assessment of the cervical structure by measuring cervical length (CL) has been used as a popular prediction tool to predict preterm labor. The uterocervical angle (UCA) is defined as the angle between the lower anterior uterine segment and the endocervical canal. Recently, UCA has been proposed as an alternative to CL for predicting preterm labor. In recent years, several studies have investigated the potential impact of UCA for preterm labor prediction. Our study aimed to determine whether the uterocervical angle, a new ultrasonographic marker for predicting preterm labor, is associated with the risk of spontaneous preterm delivery. The present study included 186 singleton pregnant women who gave birth in our hospital between January 2018 and December 2022. The data of the included patients were retrospectively evaluated from the hospital database and patient files. Regarding the primary outcome of our study, we found that there was a statistically significant difference in UCA and cervical length between women who delivered spontaneously preterm and women who delivered at term (p&lt;0.05). In the second trimester ultrasonography evaluation, the mean UCA was wider and the mean cervical length was shorter in the preterm group. Contrary to other studies in the literature, smoking and history of preterm delivery as risk factors were not included in our study. The exact reasons for some of the differences between our findings and the studies reported in the literature are not clear, but may be attributed to several factors. First, the patient type was heterogeneously selected in the cited studies. There are large differences in terms of sample size and studies that may be attributed to such heterogeneity. In conclusion, wider UCA and shorter cervical length in the second trimester are associated with spontaneous preterm delivery. Measurement of UCA is a reproducible technique and the UCA value was found to increase from the first trimester to the second trimester. We recommend the inclusion of UCA in current clinical practice in addition to cervical length measurement as a predictive factor that can be used in decision-making regarding the management of women at risk of preterm delivery. However, future studies are needed to assess the diagnostic accuracy of this index and should specifically consider the use of thresholds and related outcomes (preterm birth rates based on specific gestational weeks).

Retrospective analysis of cases of transient global amnesia admitted to the hospital

Introduction. Transient global amnesia (TGA) is a clinical syndrome, the main clinical manifestation of which is sudden development of anterograde and retrograde amnesia, lasting not more than 24 hours, without other general cerebral or focal neurological symptoms.The aim of the work was to reveal the peculiarities of clinical manifestations and data of additional methods of examination of patients with TGA syndrome referred to the primary vascular department with suspected acute cerebral circulation disorder (ACCD).Materials and methods. The study included 16 patients with transient global amnesia diagnosed according to the diagnostic criteria of Hodges and Warlow (1990). All patients underwent a detailed neurological and general medical examination. Electrocardiography, multispiral computer tomography of the head, echocardiography, ultrasound duplex scanning of the main arteries of the head and neck, laboratory examination (lipid spectrum) were performed. The Brief Mental Status Rating Scale was used to assess cognitive impairment.Results. The majority of patients had elevated blood pressure (BP). The leading trigger factor of transient global amnesia was stress. The duration of amnesia ranged from 1.5 to 5 hours. There was a significant impairment of short-term memory. On the first and second days of hospitalization, 50% of patients had normal cognitive functions on a brief mental status assessment scale, but by the 5th−7th day only 12.5 % of patients had abnormalities. Ultrasound markers of atherosclerosis in the form of intima-media complex thickening and dyslipidemia were found in 6 patients. Signs of left ventricular hypertrophy were found in the majority of patients. Discussion TGA is a relatively rare condition and an understudied syndrome. Due to its suddenness of clinical manifestation, TGA requires differential diagnostics with acute cerebral circulatory disorders, epilepsy, acute hypertensive encephalopathy and psychogenic amnesia.Conclusion. The clinical features of TGA identified in the patients were a history of arterial hypertension, elevated BP during an episode of TGA. The leading provoking factor was stress. TGA episode occurred predominantly in the first half of the day. The majority of patients had complaints of headache on admission. Cognitive disorders detected in patients on the first and second days of the disease quickly regressed to normal. Left ventricular hypertrophy was detected in most patients.