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OBJECTIVES: The objectives of this study is to compare ductus venosus (DV) and cerebral transverse sinus (CTS) Doppler velocimetry for predicting acidemia at birth in pregnancies complicated by placental insufficiency. METHODS: A prospective cross-sectional study involving 69 cases. Doppler assessment of the DV and CTS was carried out in the last 24 hours prior to delivery. The sensitivity, specificity, positive and negative predictive values, and the accuracy and false-positive and false-negative rates were calculated for those parameters considered to be good predictors of acidemia. The McNemar test was used to compare the various parameters. RESULTS: The DV pulsatility index(PI), S/A, and (S - A)/S ratios as well as the CTS PI and the (S - A)/S ratio were good predictors of acidemia. The comparison between DV and CTS showed that for pulsatility index for veins, the sensitivity was 52.4% versus 66.7%, p = 0.508; the specificity was 81.2% versus 77.1%, p = 0.774; and the accuracy was 72.5% versus 73.9%, p = 1.00. For the (S - A)/S ratio the sensitivity was 52.4% versus 52.4%, p = 1.00; the specificity was 85.4% versus 79.2%, p = 0.508; and the accuracy was 75.4% versus 71%, p = 0.647. CONCLUSIONS: In pregnancies with placental insufficiency, the PI and the (S - A)/S ratio of both DV and CTS were equally effective in predicting acidemia at birth.

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OBJETIVO: estudar o valor da dopplervelocimetria do ducto venoso (DV) entre a 11º e a 14º semanas de gestação, associado à medida da translucência nucal (TN), na detecção de resultado fetal adverso. MÉTODOS: foram estudados 1.268 fetos consecutivamente. Em 56 casos, realizou-se estudo citogenético no material obtido, por meio de biópsia de vilosidade coriônica e, em 1.181 casos, o resultado teve como base o fenótipo do recém-nascido. Todos os fetos foram submetidos, além da ultra-sonografia de rotina, à medida da TN e à dopplervelocimetria do DV. Trata-se de um estudo transversal e prospectivo. Foram calculados e analisados, para fins de prevalência e índices de acurácia: sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN), probabilidade de falso-positivo (PFP), probabilidade de falso-negativo (PFN), razão de probabilidade positiva e razão de probabilidade negativa. RESULTADOS: do total de 1.268 fetos, foram selecionados para análise 1.183 casos. Deste total, 1.170 fetos eram normais (98,9 por cento) e 13 fetos tiveram resultado fetal adverso ao nascimento (1,1 por cento) - incluindo morte fetal (trissomia 21 e 22) em dois casos, síndrome genética (Nooman) em um caso, fetos polimalformados em dois casos, cardiopatia em três casos e outros defeitos estruturais em cinco casos. A prevalência do DV alterado (onda A zero/reversa) na população estudada foi de 14 casos (1,2 por cento), com taxa de falso-positivo de 0,7 por cento. CONCLUSÕES: há correlação significativa entre alteração da dopplervelocimetria do DV e a medida da TN, como marcadores ultra-sonográficos de primeiro trimestre, na detecção de resultado fetal adverso, especialmente para malformações graves. O Doppler do DV foi capaz de diminuir o resultado falso-positivo, comparativamente ao uso isolado da TN, melhorando consideravelmente o VPP do teste.

PURPOSE: to study the value of Doppler velocimetry of the ductus venosus, between the 11th and 14th weeks of pregnancy, associated to the nuchal translucency thickness measurement, in the detection of adverse fetal outcome. METHODS: a transversal and prospective study in which a total of 1,268 fetuses were studied consecutively. In 56 cases, a cytogenetic study was performed on material obtained from a biopsy of the chorionic villus and, in 1,181 cases, the postnatal phenotype was used as a basis for the result. In addition to the routine ultrasonographic examination, all the fetuses were submitted to measurement of the nuchal translucency thickness and to Doppler velocimetry of the ductus venosus. Aiming at prevalence and accuracy indices, sensitivity, specificity, positive predictive value, negative predictive value, probability of false-positive, probability of false-negative, reason of positive probability and reason of negative probability were calculated and analyzed. RESULTS: from the total of 1,268 fetuses, 1,183 cases were selected for analysis. From this number, 1,170 fetuses were normal (98.9 percent) and 13 fetuses presented adverse outcome at birth (1.1 percent), including fetal death (trisomy 21 and 22) in two cases; genetic syndrome (Nooman) in one case; two cases of polymalformed fetuses; cardiopathy in three cases; and other structural defects in five cases. The prevalence of the modified ductus venosus (wave A zero/reverse) in the studied population was of 14 cases (1.2 percent), with a false-positive rate of 0.7 percent. CONCLUSIONS: there is a significant correlation between the alteration of the ductus venosus Doppler velocimetry and the thickness of the nuchal translucency as an ultrasonographic marker for the first trimester of gestation, in the detection of adverse fetal outcome, especially serious malformations. The ductus venosus was able to diminish the false-positive result in comparison to the isolated use of the nuchal translucency thickness, improving considerably the positive predictive value of the test.

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PURPOSE: to study the value of Doppler velocimetry of the ductus venosus, between the 11th and 14th weeks of pregnancy, associated to the nuchal translucency thickness measurement, in the detection of adverse fetal outcome. METHODS: a transversal and prospective study in which a total of 1,268 fetuses were studied consecutively. In 56 cases, a cytogenetic study was performed on material obtained from a biopsy of the chorionic villus and, in 1,181 cases, the postnatal phenotype was used as a basis for the result. In addition to the routine ultrasonographic examination, all the fetuses were submitted to measurement of the nuchal translucency thickness and to Doppler velocimetry of the ductus venosus. Aiming at prevalence and accuracy indices, sensitivity, specificity, positive predictive value, negative predictive value, probability of false-positive, probability of false-negative, reason of positive probability and reason of negative probability were calculated and analyzed. RESULTS: from the total of 1,268 fetuses, 1,183 cases were selected for analysis. From this number, 1,170 fetuses were normal (98.9%) and 13 fetuses presented adverse outcome at birth (1.1%), including fetal death (trisomy 21 and 22) in two cases; genetic syndrome (Nooman) in one case; two cases of polymalformed fetuses; cardiopathy in three cases; and other structural defects in five cases. The prevalence of the modified ductus venosus (wave A zero/reverse) in the studied population was of 14 cases (1.2%), with a false-positive rate of 0.7%. CONCLUSIONS: there is a significant correlation between the alteration of the ductus venosus Doppler velocimetry and the thickness of the nuchal translucency as an ultrasonographic marker for the first trimester of gestation, in the detection of adverse fetal outcome, especially serious malformations. The ductus venosus was able to diminish the false-positive result in comparison to the isolated use of the nuchal translucency thickness, improving considerably the positive predictive value of the test.

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Estudo retrospectivo de seis casos em que houve discrepância entre cariótipo pré-natal e achados pós-natais. Em cinco deles as anomalias cromossômicas que foram encontradas inicialmente pela biópsia de vilosidades coriônicas ou amniocentese não foram compatíveis com resultados posteriores. Já em um caso, o cariótipo inicial normal pela biópsia de vilosidades coriônicas necessitou de novo controle devido ao aparecimento de sinais ultra-sonográficos pré-natais e sinais clínicos pós-natais. Na maioria dos casos a evolução favorável ultra-sonográfica foi o que levantou a dúvida sobre o cariótipo inicial anormal. Quando os achados ultra-sonográficos são discordantes do cariótipo encontrado inicialmente, muita cautela é necessária na interpretação dos resultados e no aconselhamento genético desses casais. O mosaicismo confinado à placenta é uma das principais causas de resultados discordantes. Desta forma, a interpretação do cariótipo fetal depende da correlação com os achados clínicos/ultra-sonográficos pré-natais.

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OBJECTIVE: Assess the accuracy of the nuchal translucency (NT) measurement between 11 and 13 weeks and 6 days of gestation as a sonographic marker to screen for congenital heart defects (CHD). METHODS: This is a multi-center retrospective study in which singleton gestations of euploid fetuses were analyzed. NT measurement was performed in the first trimester examination when the fetal crown-rump length (CRL) was 45 to 84 mm, according to the criteria established by the Fetal Medicine Foundation. The cases were followed up to one month postpartum to assess the presence of CHD. RESULTS: Three thousand six hundred and sixty four gestations were analyzed, of which twenty newborn infants had some congenital heart defect up to the first month of life (prevalence of 0.55%). The median NT in fetuses with CHD was 1.70 mm, and 1.60 mm in fetuses without CHD. However no statistically significant difference was observed between the two medians (Mann-Whitney test, p > 0.05). The NT sensitivity to detect CHD ranged from 15% to 20%, with a probability of false positive cases of 86.4% to 97.9%, depending on the cut-off point used. Odds ratio for CHD was high when compared to the classical indications for fetal echocardiography, ranging from 4.7 to 33.7, according to the cut-off point used. CONCLUSION: Despite the low sensitivity of the test, increased NT is an important risk factor for CHD, and should be included in the strategy of prenatal screening for these diseases.

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OBJETIVO: Avaliar a acurácia da medida da translucência nucal (TN) entre onze e treze semanas e seis dias como marcador ultra-sonográfico para rastreamento de cardiopatias congênitas (CC). MÉTODOS: Estudo multicêntrico retrospectivo, no qual foram analisadas gestações únicas de fetos euplóides. A medida da TN foi realizada no exame de primeiro trimestre quando os fetos tinham entre 45 e 84 mm de comprimento cabeça-nádega (CCN), segundo os critérios estabelecidos pela Fetal Medicine Foundation. Os casos foram seguidos até um mês após o parto para avaliar a presença de CC. RESULTADOS: Foram analisadas 3.664 gestações, das quais vinte recém-nascidos apresentaram alguma cardiopatia congênita até o primeiro mês de vida (prevalência de 0,55 por cento). A mediana da TN nos fetos com CC foi de 1,70 mm e nos fetos sem CC foi de 1,60 mm; entretanto, não houve diferença significativa entre as duas medianas (Teste de Mann-Whitney, p>0,05). A sensibilidade da TN na detecção de CC variou de 15 por cento a 20 por cento, com probabilidade de falso-positivos de 86,4 por cento a 97,9 por cento, dependendo do ponto de corte utilizado. A razão de chance para CC foi alta, quando comparada com as indicações clássicas de ecocardiografia fetal, variando de 4,7 a 33,7, de acordo com o ponto de corte utilizado. CONCLUSÃO: Apesar da baixa sensibilidade do teste, a TN aumentada é um importante fator de risco para CC, devendo ser incluída na estratégia do seu rastreamento pré-natal.

OBJECTIVE: Assess the accuracy of the nuchal translucency (NT) measurement between 11 and 13 weeks and 6 days of gestation as a sonographic marker to screen for congenital heart defects (CHD). METHODS: Multicentric retrospective study, analyzing single pregnancies from euploid fetuses. NT measurement was performed in the first trimester, when fetuses had from 45 to 84 mm of crown-rump length (CRL), according to the criteria established by the Fetal Medicine Foundation. Cases were followed until 1 month after delivery to verify the presence of CHD. RESULTS: 3,664 pregnancies were analyzed and 20 newborns had CHD diagnosed until the first month of life (prevalence of 0.55 percent). The median NT of the fetuses with CHD was 1.70 mm and 1.60 mm for fetuses without CHD, however no significant difference was found (Mann-Whitney test, p > 0.05). The sensitivity of NT in detection of CHD varied from 15 percent to 20 percent, with a range of false positive probability from 86.4 percent to 97.9 percent, depending on the cut-off point used. However, the odds ratio was high, compared to the classic indications of echocardiography, ranging from 4.7 to 33.7 according to the cutt-off point. CONCLUSION: In spite of the low sensitivity of the test, enlarged NT is an important risk factor for CHD and should be used in prenatal screening for CHD.

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A medida do comprimento cervical por ultra-sonografia transvaginal é útil no rastreamento do parto prematuro, sendo o encurtamento do colo fator preditor do trabalho de parto pré-termo. Os métodos tradicionais para avaliar a cérvice na gestação são limitados e insatisfatórios. O exame de toque digital, considerado método padrão, demonstra variação entre diferentes examinadores, entretanto, a ultra-sonografia transvaginal é exame eficiente durante a gravidez. Recentemente, o exame ultra-sonográfico tridimensional tem sido utilizado na prática clínica, incluindo o estudo do colo. Grande volume de informações pode ser obtido e armazenado utilizando-se a tecnologia tridimensional. A informação armazenada permite ser manipulada e analisada por número infinito de planos. O exame ultra-sonográfico transvaginal tridimensional é o único capaz de obter o plano coronal pela visualização da imagem em organização multiplanar. Este método aparenta oferecer potencial diagnóstico no aumento da acurácia da ultra-sonografia cervical.

The measurement of cervical length utilizing transvaginal ultrasound is of help for pregnant women screening for premature labor, the shortening of the cervix being a predictor of higher risk of preterm delivery. Traditional methods for evaluating the uterine cervix during pregnancy are limited and unsatisfactory. Digital examination of cervix, considered as the standard method, demonstrates large variation among different examiners; on the other hand, transvaginal sonography is an effective method of examination during pregnancy. Recently, three-dimensional ultrasound has been used in the clinical practice including the study of uterine cervix. The three-dimensional technology allows acquisition and storage of a large volume of data. Such stored information can be reformatted and analyzed through an unlimited number of planes. The three-dimensional transvaginal ultrasound is the unique imaging method capable of obtaining a true coronal plane by direct correlation of the views in a multiplanar display. This method seems to offer a diagnostic potential because of the cervical ultrasonography increased accuracy.

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OBJETIVO: comparar as medidas do comprimento da cérvice e afunilamento, obtidas por ultra-sonografia transvaginal bidimensional e tridimensional na gestação. MÉTODOS: estudo descritivo, prospectivo, com comparação de grupos realizado no período de abril de 2004 a fevereiro de 2005. Foram incluídas 74 gestantes com idade gestacional entre a 19ª e a 24ª semana, independente da presença ou não de fatores de risco para parto prematuro. O exame ultra-sonográfico da cérvice foi efetuado uma única vez na mesma paciente e por único observador. As medidas aferidas por ultra-sonografia bidimensional foram feitas no momento da realização dos exames, e pela tridimensional, com intervalo de 7 a 15 dias do exame bidimensional. A medição do comprimento da cérvice, diâmetro e comprimento do funil cervical foi realizada por ultra-sonografia bidimensional no plano sagital e tridimensional nos planos sagital e coronal. Para testar a diferença estatística entre os resultados médios das medidas do comprimento cervical obtidas nos exames bi e tridimensional, foi utilizado o teste t pareado. Também foi calculado para essas medidas o coeficiente de correlação de Pearson. RESULTADOS: objetivando-se determinar associação linear entre elas encontramos diferença significante entre as medidas aferidas no plano sagital por meio da ultra-sonografia bidimensional e plano coronal da USG 3D (p=0,009), e na ultra-sonografia tridimensional entre os cortes sagital e coronal (p=0,001), sendo as médias das medidas do comprimento cervical (±desvio padrão) de 3,9±0,92c; 4,1±0,97 e 3,9±0,88 cm, respectivamente. O número de afunilamento em nossa casuística foi de 9/74 exames (12,1 por cento). As ultra-sonogafias bi- e tridimensional visualizaram o mesmo número de afunilamento (8/9). Na ultra-sonografia tridimensional, o corte coronal detectou número maior de funil cervical que o corte sagital (8/9). Não houve diferença significativa entre as médias...

PURPOSE: to compare the uterine cervix measurements and funneling obtained by two- and three-dimensional transvaginal sonography during pregnancy. METHODS: a prospective, descriptive study, with group comparison, was carried out between April 2004 and February 2005 in 74 pregnant women, who were between the 19th and 24th week of pregnancy, regardless of risk factors for premature delivery. The ultrasound examination of the cervix was carried out only once in the same patient and by only one observer. The measurements of the cervix by two-dimensional ultrasound were made at the time of the test and by three-dimensional ultrasound at intervals of 7 to 15 days after the two-dimensional ultrasound. The measurements of cervical length, funnel width and length were taken by two-dimensional ultrasound in the sagittal plane and by three-dimensional in the sagittal plane as well as in coronal plane. RESULTS: there was no significant difference between the averages of the measurements of the cervix obtained by two- and three-dimensional ultrasound in the sagittal plane (p=0.23); however, there was a difference in the averages of the measurements of the cervix obtained by two-dimensional ultrasound in sagittal plane and three-dimensional ultrasound in the coronal plane (p=0.009) and between three-dimensional ultrasound in the sagittal and coronal planes (p=0.001). The kappa test (0.86) showed no superiority of either the two-dimensional and three-dimensional ultrasound in the visualization of the cervical funnel. No statistically significant difference was observed between the methods when the average of the measurements of funneling was compared (p>0.05). CONCLUSION: there were differences between two-dimensional and three-dimensional ultrasound of cervical length, only using the coronal plane of the three-dimensional ultrasound.

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OBJECTIVES: To evaluate the prediction of acidemia at birth using ductus venosus Doppler velocimetry and to determine the best parameter and cut-off values for this prediction in pregnancies complicated with placental insufficiency. METHODS: Prospective cross-sectional study. Forty-seven patients with placental insufficiency managed in two Brazilian hospitals were submitted to ductus venosus Doppler velocimetry in the last 24 h before delivery. All pregnancies were singleton, at least 26 weeks of age and without structural or chromosomal anomalies. A ROC curve was calculated for each ductus venosus parameter (independent variable) and acidemia (dependent variable). A cut-off value was established. The McNemar test was used to compare the various parameters. RESULTS: The ductus venosus S, D and A peak velocities were not good predictors of acidemia at birth. Pulsatility Index for Veins (PIV) was a good predictor of acidemia (ROC curve area 0.79, p = 0.003), as well as S/A and (S - A)/S ratios (ROC curve area 0.818, p = 0.001). The cut-off values were PIV = 0.76, S/A = 2.67 and (S - A)/S = 0.63. CONCLUSIONS: In this high-risk population, angle-independent ductus venosus Doppler indexes were good predictors of birth acidemia. The S/A and (S - A)/S ratios and the ductus venosus PIV were statistically equivalent in this prediction.

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