摘要:

Purpose of reviewThree-dimensional (3D) ultrasound is a natural development of the imaging technology. Fast computers are essential to enable 3D and four-dimensional (4D) ultrasound pictures. A short review of the technical points and clinical aspects is presented. Our purpose is to acquaint the reader with the possibilities of this new technology and to increase awareness of its present clinical usefulness. A short review of technical information is provided.Recent findingsThe advantages of 3D and 4D ultrasound in certain areas are unequivocal. Its use in the workup of fetal anomalies involving the face, limbs, thorax, spine and the central nervous system are already applied by most centers.The use of this technology in applying color Doppler, in guiding needles for different puncture procedures as well in evaluating the fetal heart are under close research scrutiny. The bonding effect between the parents and their future offspring is becoming evident as 3D ultrasound is used. Consulting specialists understand fetal pathology better and can better plan postnatal interventions. 4D or real time 3D ultrasound was developed and is expected to achieve new meaning with the planned introduction of electronic transducer multilinear arrays.Summary3D ultrasound is an extremely promising imaging tool to image the fetus. In spite of the scant outcome studies the potential of 3D ultrasound is understood by a large number of obstetricians, maternal fetal specialists and imaging specialists.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose of reviewAn update of findings from studies on first trimester nuchal translucency screening.Recent findingsNew first trimester markers can substantially improve efficacy of screening. When fully informed, preliminary data indicate that women prefer first trimester above second trimester testing.SummaryRecent reports on nuchal translucency screening reiiterate the importance of standardization of technique and quality control as proposed by the Fetal Medicine Foundation in London. Effective quality control can be achieved through quantitative analysis of operator specific data. Three-dimensional ultrasound does not provide substantially higher success rates in obtaining reliable nuchal translucency measurements than two-dimensional ultrasound. New data confirm the previously reported association between increaed nuchal translucency and increased rate of spontaneous fetal loss, genetic syndromes and a high prevalence (15%) of anomalies, among which cardiac defects are the commonest. Researchers agree that increased nuchal translucency ought to be an indication for specialized echocardiography. Promising data have become available on new markers that can enhance first trimester screening. It is estimated that when assessment of nasal bone and maternal serum analytes are taken into account, first trimester screening can identify 97.5% of trisomy 21 pregnancies for a 5% false-positive rate. It is stressed that parents need to be informed about the possible implications of screening before testing. Preliminary data indicate that when appropriately informed, women prefer first trimester above second trimester testing. Furthermore, the uptake of screening is likely to be relatively low among younger women.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose of reviewOur review on Doppler ultrasound in obstetrics aims to identify which vessels have a definite clinical role in obstetrics.Recent findingsThe use of Doppler ultrasonography in the diagnosis and management of the intrauterine growth-restricted fetus improves the perinatal morbidity and mortality. However, the timing of delivery of the intrauterine growth-restricted fetus, based on Doppler ultrasonography, remains the subject of investigation. Robust data exist on the management of fetuses at risk for anemia because of red cell alloimmunization by using the middle cerebral artery peak systolic velocity. Appropriate training for the correct assessment of this vessel is fundamental. Doppler ultrasonography of the umbilical artery is useful in the counseling of patients with pregnancies complicated by twin-twin transfusion syndrome.SummaryRecently, Doppler ultrasonography has been shown to be helpful to the obstetricians in the diagnosis of the IUGR fetus, diagnosis of fetal anemia, twin-twin transfusion syndrome. These are the basis for timing the delivery of the IUGR fetus. However, more data are necessary. Doppler ultrasonography should be used to assess the fetal ductus arteriosus in patients treated with prostaglandin inhibitors. Doppler is also an important part of the fetal echocardiogram.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose of reviewThis brief review will focus exclusively on very recent developments and controversial aspects of vaginal birth after cesarean. Only papers published in 2001 or 2002 are included.Recent findingsRecent studies have addressed the intrapartum management of vaginal birth after cesarean patients and the safety of trial of labor compared with elective repeat cesarean.SummaryThe recent trend has been towards a more cautious approach to vaginal birth after cesarean. Some are concerned that this trend may limit childbirth options for those women who wish to avoid repeat cesarean operations.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose of reviewThe rates of obesity are increasing rapidly in the United States and other countries. Because obesity is a major factor in the development of many chronic diseases, it is an important individual and public health issue. This review focuses on the pregnancy complications associated with maternal obesity.Recent findingsMaternal obesity adversely impacts pregnancy outcome primarily through increased rates of hypertensive disease (chronic hypertension and pre-eclampsia), diabetes (pregestational and gestational), cesarean section and infections. It is associated with a higher rate of venous thromboembolic disease and respiratory complications, and may be an independent risk factor for neural tube defects, fetal mortality and preterm delivery. Maternal obesity also increases the risk of delivering a large for gestational age or macrosomic neonate, who is in turn at an increased risk of subsequent childhood obesity and its associated morbidity.SummaryRecommendations regarding the counselling of obese pregnant women and specific guidelines for the obstetrician, family physician, or midwife managing the pregnancy are presented. Cultural and political changes with the potential to decrease the epidemic of obesity in our society are discussed.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose of reviewThe purpose of this review was to summarize recently published clinical and animal-based studies of antenatal corticosteroids, describe current recommendations for practice, and suggest priority areas for future research.Recent findingsA single course of antenatal corticosteroids is known to improve newborn lung function after preterm birth and to reduce the risk of newborn death. Current evidence from animal and clinical studies suggests that additional numbers of courses do not further improve lung function and are associated with risks of adverse consequences. These risks principally include restricted intrauterine growth, altered brain development, postnatal insulin resistance and changes to the hypothalamic-pituitary-adrenal axis.SummaryThe research challenges in this field are now centred on uncovering the mechanisms by which cortisol is involved in programming the fetus for its future metabolic life, and discovering ways in which the effectiveness and safety of antenatal glucocorticoids can be enhanced.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose of reviewBreast carcinoma, cervical dysplasia and cervical carcinoma are some of the most common forms of precancerous and malignant changes seen in pregnancy due to their prevalence in reproductive age women. The impact of pregnancy on these diseases is complex and needs to be carefully considered for appropriate clinical management.Recent findingsRecent studies indicate a relationship between hormone levels during pregnancy and subsequent breast cancer risk. For women who have already been diagnosed with breast cancer, retrospective studies show no adverse outcomes on maternal mortality with subsequent pregnancy. Prospective studies are needed to further elucidate these relationships. Recent research evaluating human papilloma virus in pregnant women indicates a similar prevalence of disease among pregnant and nonpregnant patients. Increased rates of human papilloma virus clearance postpartum may be related to an increased immune response within the cervix secondary to the trauma of labor. For women with early stage cervical cancer desiring to preserve future fertility, new trends in treatment allow for preservation of reproductive function. Few recent studies have been conducted regarding the use of chemotherapy during pregnancy, but one study reports increased rates of prematurity after the use of chemotherapy.SummaryContinued research is needed regarding the management of breast and cervical cancer during pregnancy in order to optimize treatments and to further our understanding of these disease processes.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID