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הצגת עבודות יום ה', 18.2.2010 - תכנית ותקצירים

הכנס הדו שנתי

של החברה הישראלית לאולטרה-סאונד במיילדות וגינקולוגיה

כפר המכביה, 17-18 בפברואר 2010

 

הצגת עבודות יום ה', 18.2.2010

15:00 – 13:35

יושבי ראש:   פרופ' י. שלו, ד"ר מ. עודה, ד"ר מ. תמרקין

 

יש ללחוץ על הלינק כדי לצפות בתקציר

התקצירים מופיעים בהמשך דף זה ולא יודפסו בתכנית שתחולק הכנס

תכנית:

1

 

 

 

13:35-13:42

Evaluation of the curvature of fetal corpus callosum using MRI

Tepper R1, Gonen L, Ben Sira L2, Shklyar R3, Goldstein D3, Hershkovitz R4

Ultrasound units, ObGyn, Sapir Medical Center1, MRI Unit, Tel Aviv Medical Center2, Holon Institute of Technology3, Soroka University Medical Center4

2

 

 

13:42-13:49

The Prenatal Diagnosis of Syndromic Macrocephaly

Gustavo Malinger, Dorit Lev, Tally Lerman-Sagie.

Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv.

3

 

 

 

 

13:49-13:56

הערך הפרוגנוסטי של בדיקות אולטרסאונד ו-MRI טרום לידתיות בהריונות עם הדבקה ודאית של העובר ב-CMV

שלמה ליפיץ, חן הופמן, בני חן, ברוך פלדמן, יואב ינון, רבקה פלץ, מיכל טפרברג, אייל שיף, בועז ווייס

אגף נשים ויולדות, מחלקת הדמיה, מעבדה מרכזית לנגיפים, ביה"ח ע"ש שיבא, תל-השומר.

4

 

 

 

 

 

 

 

13:56-14:03

Ultrasound demonstration of the fetal palate - the accuracy of prenatal diagnosis and fetal outcome.

Gindes Liat1, Zajicek Michal1, Weissmann-Brenner Alina1, Weisz Boaz1, Shrim Alon1 , Tzadikevitch Geffen Keren1, Mendes David2, Kuint Jaccob3,Achiron Reuven1

1Department of Obstetrics and Gynecology, 2Department of Plastic surgery, 3NICU, The Chaim Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University.

5

 

 

 

 

 

14:03-14:10

Normal fetal salivary glands at 14 to 16 weeks of gestation as observed by transvaginal ultrasound

Marwan Odeh1, Ella Ophir 1, Leon Ardekian 2, Jacob Bornstein 1

Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya1, Department of Oral & Maxillofacial Surgery, Rambam Medical Centre, Haifa2,Rappaport Faculty of Medicine, Technion, Haifa, Israel

6

 

14:10-14:17

Prenatal diagnosis of oral cyst caused by foregut duplication

Rami Aviram, Dvora Kidron, Ronnie Tepper, Rivka Regev

Meir Medical Center, Kfar Sava

7

 

 

 

14:17-14:24

Three-dimensional ultrasonography (3D-US) and power Doppler angiography (PDA) measurements to predict ovarian response

Yinon Gilboa, Tamar Borkowski, Liat Gindes, ,Ariel Horowitz, Shuki Dor and Reuven Achiron.

Department of Obstetrics Gynecology, Sheba Medical Center, Tel-Hashomer.

8

 

 

 

14:24-14:31

Endometrial vascularization after intrauterine ozonated water irrigation (OWI) -computerized power Doppler analysis and histological studies.

Cohen M., Leibovitz Z., Volkov N., Calderon I., Artzi O.,Degani S., Shapiro I., Ohel G.

Bnai-Zion Medical Center; Technion-Israel Institute of Technology, Haifa.

9

 

 

 

14:31-14:38

הערכת השינוי בעובי הסגמנט התחתון של הרחם לאורך שבועות ההיריון – קביעת עקומות ייחוס

ד"ר יובל גינסברג, פרופ' ישראל גולדשטיין, ד"ר ארגז אודי, ד"ר לבנשטיין ליאור, פרופ ויינר זאב

מחלקת האולטרסאונד החטיבה לגניקולוגיה ומיילדות מרכז רפואי רמב"ם חיפה.

10

 

 

 

 

 

 

14:38-14:45

Pregnancy-related Uterine Vascular Malformations: A Rising Complication?

Zvi Vaknin1, Dana Sadeh-Mefpechkin1, Reuvit Halperin1, Alexander Altshuler2, Peer Amir2, Arie Herman1 and Ron Maymon1

Department of 1Obstetrics and Gynecology and the Department of 2Interventional Radiology, Assaf Harofe Medical Center, Zerifin, affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv

11

 

 

 

 

 

14:45-14:52

Clinical significance of Sub chorionic hematoma: comparison between diagnosis in the first and second trimester

Reli Hershkovitz1, Moshe Dahan1, Michael Frieger2, Moshe Mazor1

Ultrasound Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center1, Department of Epidemiology2, Ben Gurion University of the Negev , Beer Sheva.

12

14:52-15:00

Long term follow-up of women with 3rd and 4th degree perineal tears using transperineal ultrasound

Vered Eisenberg, Menachem Alcalay, Genady Bitman, Reuven Achiron, Eyal Schiff

Sheba Medical Center, Ramat Gan.

 התקצירים:

 

1

13:35-13:42

 

Evaluation of the curvature of fetal corpus callosum using MRI

Tepper R1, Gonen L, Ben Sira L2, Shklyar R3, Goldstein D3, Hershkovitz R4

Ultrasound units, ObGyn, Sapir Medical Center1, MRI Unit, Tel Aviv Medical Center2, Holon Institute of Technology3, Soroka University Medical Center4

 

Purpose: 1) To assess normal curvature of the upper and lower boundaries of the corpus callosum (CC) during pregnancy and to present a reference curve. 2) To assess curvature of CC among fetuses with abnormal US and MRI findings.

 

Materials and Methods: A retrospective study was designed and two groups of fetuses were included. The first group included 77 normal fetuses between 28-36 weeks gestation. These fetuses had normal US and MRI results and were divided into 3 sub groups according to gestational age: 28-30 weeks (16 fetuses), 31-33 weeks (43 fetuses) and 34-36 (18 fetuses). Neurological examination was performed in 14/77 children at 4-5 years age old, and normal results were obtained. The second groupincluded 29 fetuses with abnormal brain US and MRI findings. Curvature of the CC was studied with a soft tool designed for this purpose enabled to translate the digital mark of the CC to mathematical model. Mean curvature and standard deviation at 51 points along the upper and lower boundary of the CC were calculated and reference curve was performed.In order to compare curvature changes during gestational age and among fetuses with abnormal brain findings, 14 different points in the CC were evaluated.

 

Results: In 12 out of 14 points used to compare CC between different age groups, no significant differences were found. Only 2 points were significantly different between fetuses at 28-30 weeks gestation and the other 2 groups. These differences were demonstrated at the curvature at the upper boundary area of the middle callosal body and at the inferior part of the anterior callosal body. No other differences were also found in the CC with brain anomalies.

 

Conclusions: Curvature of the CC is described here for the first time in the literature. The curvature was found to be steady during 28-36 weeks gestation. No differences were found between the normal fetuses and the fetuses with brain pathologies such as ventriculomegaly.

 

בחזרה לתוכנית

2

13:42-13:49

 

The Prenatal Diagnosis of Syndromic Macrocephaly

Gustavo Malinger, Dorit Lev, Tally Lerman-Sagie.

Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv.

 

Objective. To present the prenatal findings and postnatal diagnoses in fetuses with suspected syndromic macrocephaly.

Methods. We reviewed the files of all patients with fetal macrocephaly defined as a HC>2SD. All the patients were contacted and their development was evaluated. Autopsy records were reviewed when available.

Results. Adequate data was available for 96 patients, in 83 patients the macrocephaly was considered isolated, mean HC Z score 2.4 (range 2-3.6); 1 patient had suspected MRI findings that were later considered as normal and in 12 patients associated anomalies were identified, mean HC Z score 3.17 (range 2.3-4.5). The mean GA at the initial examination was 29.5 (20.0-38.4). CNS associated findings included mild ventriculomegaly (6), callosal abnormalities (5), overdeveloped sulcation (3), malformations of cortical development (2), large CSP (2), large subarachnoid space (2); and asymmetric hemispheres, large 3rd ventricle, periventricular pseudocyst, open operculum, vermian dysgenesis and mega cisterna magna (1 each). Non-CNS anomalies included frontal bossing (4), nephromegaly (2) and micrognathia, polydactyly, short rhizomelic bones, bilateral club feet, ascites and bilateral hydronephrosis (1 each). A prenatal diagnosis was reached in 5 fetuses: hemimegalencephaly, achondroplasia, macrocephaly polydactyly polymicrogyria, hydrocephalus syndrome, familial vermian hypoplasia and chromosomal aberration. These pregnancies were terminated. In 3 fetuses an association between macrocephaly and a thick CC was observed, and in 3 the cortex was considered abnormal. One fetus with a HC of +4.5 SD was diagnosed after delivery as suffering from Macrocephaly-Capillary Malformation syndrome.

Conclusion: Fetuses with syndromic macrocephaly had a significantly larger HC compared to fetuses with isolated macrocephaly. Most fetuses with syndromic macrocephaly had associated brain abnormalities. Accurate counseling in cases with fetal macrocephaly can be achieved when considering these factors.

בחזרה לתוכנית

3

13:49-13:56

 

הערך הפרוגנוסטי של בדיקות אולטרסאונד ו-MRI טרום לידתיות בהריונות עם הדבקה ודאית של העובר ב-CMV

שלמה ליפיץ, חן הופמן, בני חן, ברוך פלדמן, יואב ינון, רבקה פלץ, מיכל טפרברג, אייל שיף, בועז ווייס

אגף נשים ויולדות, מחלקת הדמיה, מעבדה מרכזית לנגיפים, ביה"ח ע"ש שיבא, תל-השומר.

 

מטרה: בדיקת תוצאות הריונותעם הדבקה עובריתב-CMV ראשוני, במקרים בהם מועד ההדבקה האימהית ידוע ובוצעו בדיקות אולטרסאונד ו MRI טרום לידתית.

שיטות: הריונות עם עובר יחיד והדבקה ודאית של העוברב-CMV אשר החליטו להמשיך בהריון תוך מעקב של בדיקות אולטרסאונד ו MRI (47 נשים) הם הקבוצה הנבדקת. המחקר הנו פרוספקטיבי כאשר הושם דגש על מועד ההדבקה האימהית, בדיקות ההדמיה בהריון,ועל תוצאות הילודים. כל הילודים הפרישו CMV בשתן בשבוע הראשון לחייהם. כל הילודים עברו בדיקות ראיה, שמיעה, ואולטרסאונד מוח ומעקב ע"י מומחה בהתפתחות ילדים.

תוצאות: זיהום ראשוני ב CMV התרחש בטרימסטר הראשון, השני והשלישי להריון ב 12, 26, ו 9 הרות, בהתאמה. ב 28/38 נשים שנדבקו בשליש הראשון או השני להריון, המעקב האולטרסוני היה תקין לחלוטין.26/28 מהנשים המשיכו את ההריון וכולן ילדו ילודים בריאים (2 נשים בחרו לבצע הפסקת הריון - אחת עם MRI פתלוגי, ואחת עם MRI תקין).בדיקת ה MRI הייתה תקינה ב 18/26 (69%) מהעוברים.ב4/26 מהעוברים היו ממצאי MRI לא תקינים (בעיקר סיגנלים היפראקוגנים באונות הטמפורליות) ו-4/26 לא ביצעו MRI בהריון.

ב10/38 נשים שנדבקו בשליש ראשון או שני להריון, היו ממצאים אולטרסונוגרפיים במהלך המעקב בהריון. 3/10 בחרו לבצע הפסקת הריון (לשלשת העוברים היו בדיקות MRI פתלוגיות). 7/10 נשים ילדו במועד. בשתי נשים התגלה נזק קבוע למערכת השמיעה (בשתיהן ההדבקה בשליש ראשון) למרות שלשתיהן היו בדיקות MRI תקינות. שתי נשים אלו הן היחידות עם נזק קבוע לילודים. ארבע נשים ילדו ילדים בריאים (למרות שאצל שניים מהעוברים היו ממצאים ב (MRI. אצל היולדת השביעית היו ממצאים חמורים בבדיקת מוח העובר באולטרסאונד, היא סירבה להפסיק ההריון. הילוד נולד עם מחלה סמפטומטית קשה ונפטר בפגיה.

אף אחד מהילדים עם הדבקה בשליש השלישי להריון לא נפגע.

מסקנות: תוצאות ההריונות עם הדבקה עוברית ראשונית ב CMV, בנוכחות אולטרסאונד ו MRI טרום לידתיים תקינים, הן טובות מאוד. הערך הפרוגנוסטי של ממצאי MRI "רכים" כנראה מוגבל וכממצא בודד כנראה ואין הצדקה להפסיק את ההריון.

 

בחזרה לתוכנית

4

13:56-14:03

 

Ultrasound demonstration of the fetal palate - the accuracy of prenatal diagnosis and fetal outcome.

Gindes Liat1, Zajicek Michal1, Weissmann-Brenner Alina1, Weisz Boaz1, Shrim Alon1 , Tzadikevitch Geffen Keren1, Mendes David2, Kuint Jaccob3,Achiron Reuven1

1Department of Obstetrics and Gynecology, 2Department of Plastic surgery, 3NICU, The Chaim Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University.

 

Objectives: To evaluate the feasibility of ultrasound in demonstration of fetal palate in high-risk pregnancies.

Methods: Data regarding anomaly scans of patients at high risk for fetal cleft palate, performed between June 2006 and February 2009, were collected retrospectively. In all cases palate was visualized by 2-Dimensioanl or 3-Dimensional ultrasound in the axial plane, and swallow movements were demonstrated by Doppler in mid sagittal plane.

Results: During that period 11,443 fetuses were evaluated at the Sheba Medical Center. A directed examination of fetal palate was performed in 57 cases.

Mean gestational age at the first visit was 27w6d (range 12w3d to 40w4d). Normal palate was demonstrated in 37 patients (64.9%), in 13 (22.8%) cleft palate was suspected, and in seven fetuses (12.3%) palate could not be visualized. Information regarding outcome was obtained from all patients.Seven out of 53 women chose termination of pregnancy, and 46 infants were born alive and were examined by a neonatologist. In 5/46 neonates (10.8%) physical examination did not match prenatal diagnosis. Two fetuses with suspected cleft palate were born with intact palate, three cleft palates were missed, one of which was a cleft of the soft palate. Sensitivity, specificity, positive predictive value and negative predictive value of detection of palatal clefts were 78.5%, 94.9%, 84.6%, 92.5%, respectively.

Conclusion: In 90.2% of pregnancies at high risk for cleft palate prenatal sonographic evaluation of fetal palate is accurate. Directed examination should be performed in selected cases.

 

בחזרה לתוכנית

5

14:03-14:10

 

Normal fetal salivary glands at 14 to 16 weeks of gestation as observed by transvaginal ultrasound

Marwan Odeh1, Ella Ophir 1, Leon Ardekian 2, Jacob Bornstein 1

Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya1, Department of Oral & Maxillofacial Surgery, Rambam Medical Centre, Haifa2,Rappaport Faculty of Medicine, Technion, Haifa.

 

Objective: Absence or congenital anomalies of the parotid glands are serious congenital defects, with significant long-term morbidity. To date there are no published data on ultrasonographic detection of these defects in early pregnancy. We set out to demonstrate and measure the fetal parotid and submandibular salivary glands at 14 to 16 weeks using transvaginal ultrasound.

Methods: In thirty consecutive patients, during routine fetal anomaly detection scan, an attempt was made to examine the fetal parotid and submandibular glands.The fetal head was scanned in transverse sections just below the fetal ears and the area of the parotid and submandibular glands was inspected. The examination time was not prolonged for the purpose of measuring the salivary glands. The fetal biparietal diameter and the femur length were also documented.

Results: The median gestational age was 15.4 weeks (range: 14.4-16.5). In all 30 patients examined, at least one pair of parotid and submandibular glands was clearly visualized and measured. In seven patients the parotid and the submandibular glands were visualized on both sides. The median length of the parotid gland was 7.5mm (range: 5.5-11.5) and the submandibular gland 5.4mm (range: 3.7-8.5).

Conclusion: The fetal salivary glands can be easily demonstrated by transvaginal ultrasound at 14 to 16 weeks of gestation. This is the first reported study presenting the normal values of the salivary gland measurements, which may be important in detecting fetuses with congenital absence or other congenital malformations of the glands.

 

בחזרה לתוכנית

6

14:10-14:17

 

Prenatal diagnosis of oral cyst caused by foregut duplication

Rami Aviram, Dvora Kidron, Ronnie Tepper, Rivka Regev

Meir Medical Center, Kfar Sava

 

Prenatal diagnosis of oral cystic lesions is rare but is reported more frequently. The diagnosis of sublingual cyst is important because of the potential for airway obstruction. A rare case of a foregut duplication cyst associated with unilateral sclerocorneal microphthalmia is reported. The differential diagnosis and the limitations of the prenatal ultrasound and the postnatal MRI are discussed.

 

בחזרה לתוכנית

7

14:17-14:24

 

Three-dimensional ultrasonography (3D-US) and power Doppler angiography (PDA) measurements to predict ovarian response

Yinon Gilboa, Tamar Borkowski, Liat Gindes, ,Ariel Horowitz, Shuki Dor and Reuven Achiron.

Department of Obstetrics Gynecology, Sheba Medical Center, Tel-Hashomer.

 

The purpose of this study was to try to predict poor or good ovarian response by three- dimensional ultrasonography (3D-US) and Power Doppler Angiography (PDA) in patients who are on IVF program.

Methods:

A prospective clinical studyof 46 women who underwentIVF treatment by a short protocol. 3D-US parameters included ovarian volume and antral follicular count (AFC) while PDA included: vascularisation index (VI), flow index (FI), and vascularization flow index (VFI). All ultrasound examination were performed in early proliferative phase of the cycle.

 

Results:

Thirty one women with normal response and 15 women with poor response were analyzed. We have found that age, AFC, number of eggs derived and fertilized, number of embryos frozen andlevel of E2in the day of HCG administration, differs significantly in the poor comparing to good responders. The levels of FSH, ovarian indexes (VI, FI, VFI), ovarian volume and pregnancy rate did not differ between the two groups.

Conclusion:

3D-US and power Doppler angiography indexes could not be used for predicting poor or good ovarian response. The antral follicular count was the only parameter that statistically distinguished low ovarian response and control.

 

בחזרה לתוכנית

8

14:24-14:31

 

Endometrial vascularization after intrauterine ozonated water irrigation (OWI) -computerized power Doppler analysis and histological studies.

Cohen M., Leibovitz Z., Volkov N., Calderon I., Artzi O.,Degani S., Shapiro I., Ohel G.

Bnai-Zion Medical Center; Technion-Israel Institute of Technology, Haifa.

 

Objective: This study addressed the effect of OWI on the sonographic and histological characteristics of the endometrial vascularization.

Methods: Twelve healthy volunteers with regular menstruation and normal hormonal profile completed 3 consecutive ovulatory cycles: normal saline irrigation, rest and OWI. The endometrial irrigation was done on the 10th day of the cycle. Pipelle endometrial biopsy was performed 48 hours after the irrigation. Just before the biopsy, the mid-sagittal and axial 2D power Doppler uterine images (at peak systolic vascular filling) were obtained under standard sonographic preset. The endometrial region of interest (ROI) was defined in the images. Mean endometrial color intensity (CI) and endometrial vascular ratio (VR) (color /total pixels in the ROI) were calculated by a special computer program. The histological parameter of endometrial vascularization was the number of blood vessels per a magnified field (x40).

Results: A significant increase in number of endometrial blood vessels was found after OWI compared to normal saline irrigation (30.5±11.4 per field and 19.1±8.7 per field, correspondingly), p-value<0.05.In the axial images VR and CI showed no significant changes in normal saline cycles vs. OWI cycles: 12.4±6.9 vs.17.5±16.3 for VR and 64.8±3.8 vs. 64.5±4.7 for CI. Also, there was no significant difference in these parameters between normal saline and OWI cycles in the sagittal images. There was no significant correlation between the sonographic and histological parameters of endometrial vascularization.

Conclusions:In contrast to the significant increase in the histological endometrial blood vessels count, the power Doppler parameters of the endometrial vascularization did not increase significantly in the OWI cycles compared to the normal saline irrigation cycles.

 

בחזרה לתוכנית

9

14:31-14:38

 

הערכת השינוי בעובי הסגמנט התחתון של הרחם לאורך שבועות ההיריון – קביעת עקומות ייחוס

ד"ר יובל גינסברג, פרופ' ישראל גולדשטיין, ד"ר ארגז אודי, ד"ר לבנשטיין ליאור, פרופ ויינר זאב

מחלקת האולטרסאונד החטיבה לגניקולוגיה ומיילדות מרכז רפואי רמב"ם חיפה.

 

מטרות: מחקרים קודמים הדגימו עיבוי של קירות הרחם בחודשי ההיריון הראשונים על רקע היפרפלסיה והיפרטרופיה של סיבי השריר, ובהמשך עם התקדמות ההיריון וגדילת העובר מתחילים קירות הרחם להימתח ולהפוך לדקים יותר. בסקירה ממוחשבת באתרים נבחרים לא נמצאו מחקרים סונוגרפיים רבים שהתייחסו לעובי הסגמנט התחתון בנשים ללא ניתוח קיסרי קודם. מטרתו של מחקר זה הייתה להעריך את השינוי בעובי הסגמנט התחתון לאורך חודשי ההיריון וניסיון לקביעת עקומות ייחוס.

חומרים ושיטות: במסגרת מחקר פרוספקטיבי שבוצע במכוני האולטרסאונד בבית החולים רמב"ם ובמרכז חורבנכללו150 נשים בין שבועות היריון 14-42. כל הנשים שנבדקו הביעו אתהסכמתן להשתתף במחקר (אושר ע"י וועדת הלסינקי).מדידות עובי הסגמנט התחתון בוצעו באמצעות מתמר נרתיקי, בחתך סגיטלי, באזור שלפוחית השתן מייד לאחר ריקון השלפוחית. בנוסף בוצעה הערכה סונוגרפית של משקל העובר.לאחר איסוף הנתונים השונים בוצעו מבחנים סטטיסטיים בכדי לבחון את הקשר בין עובי הסגמנט לשבוע ההיריון ומשקל העובר. בנוסף הוחל בקביעת ערכי ייחוס של עובי הסגמנט לאורך הריונות נורמאליים.

תוצאות: נמצא קשר ישיר בין עובי הסגמנט התחתון (R=0.58 p<0.0001) לגיל ההיריון. נמצא קשר ישיר בין עובי הסגמנט התחתון (R=0.55 p<0.0001) למשקלי העובר. בנוסף יוצגו ערכים נורמאליים של עובי הסגמנט לאורך ההיריון.

סיכום: הוכח הקשר בין עובי הסגמנט התחתון לגיל ההריון. כמו כן נקבעו ערכים נורמאליים של עובי הסגמנט התחתון לאורך ההיריון היכולים לשמש כערכי ייחוס למקרים פתולוגיים.

 

בחזרה לתוכנית

10

14:38-14:45

 

Pregnancy-related Uterine Vascular Malformations: A Rising Complication?

Zvi Vaknin1, Dana Sadeh-Mefpechkin1, Reuvit Halperin1, Alexander Altshuler2, Peer Amir2, Arie Herman1 and Ron Maymon1

Department of 1Obstetrics and Gynecology and the Department of 2Interventional Radiology, Assaf Harofe Medical Center, Zerifin, affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv

 

Objective: The objectives of this article were to investigate clinical, ultrasonographic findings and outcomes of post-pregnancy patients with acquired uterine vascular abnormalities including arteriovenous malformations (AVMs).

Methods:We have used a computerized database search for all patients with ultrasonographic findings of a vascular abnormality including AVM in our referral center between 2000-2008. Ultrasound finding of vascular abnormality was defined as an area of strong hypervascularity within the myometrium and the presence of marked turbulence. Inclusion criteria for angiography were abnormal vaginal bleeding in a hemodynamically stable patient, bhC serum levels £30 mIU/ml, and ultrasound demonstration of large size (≥15 mm on the larger side of the vessel) or multiple vascular lesions.

Results:Of the 16 women identified, 11 were found to have true AVMs. Ten patients (63%) underwent uterine embolization which was a primary treatment option in nine of them, and one had an emergency uterine artery ligation Angiography confirmed the pre-interventional ultrasound diagnosis of AVM in all cases. AVM feeding arteries were on the left side of the uterus in 80% of the cases. Residual tissue was ultrasonographically detected in five patients: two underwent hysteroscopy and guided curettage following embolization and three received methotrexate. All tissue samples were benign. One small vascular abnormality resolved spontaneously.

Conclusion: Acquired uterine vascular abnormality including AVM should be considered in the work up of post-pregnancy vaginal bleeding.

 

בחזרה לתוכנית

11

14:45-14:52

 

Clinical significance of Sub chorionic hematoma: comparison between diagnosis in the first and second trimester

Reli Hershkovitz1, Moshe Dahan1, Michael Frieger2, Moshe Mazor1

Ultrasound Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center1, Department of Epidemiology2, Ben Gurion University of the Negev , Beer Sheva.

 

Purpose: To investigate pregnancy outcome among pregnant patients with subchorionic hematomas diagnosed during first trimester in comparison to those diagnosed at second trimester.

Material and Methods: Three hundred eleven consecutive singleton pregnancies with subchorionic hematomas examined at the ultrasound unit at the Soroka University Medical Center were included. Two groups were defined. Group 1: patients with subchorionic hematoma diagnosed at first trimester (n-193). Group 2: patients with subchorionic hematoma diagnosed at second trimester (n-118). Exclusion criteria were: multiple pregnancies, congenital anomalies and uncertain dates.

Results: Patients among group 2 had statistically significantly higher rates of: intrauterine growth restricted fetuses (12.7% vs. 2.6%; p<0.001), oligohydramnios (13.6% vs. 2.5%, p<0.001) and cesarean sections (33.1% vs. 15.5%; p<0.001). Gestational age at delivery was significantly lower in group 2 in comparison as compared to group 1 (36.5 weeks vs. 38.2 weeks'; p<0.001).Apgar scores were also lower at 1 and 5 min at group. No differences were found in the rates of abortions, preeclampsia, premature rupture of membranes between the groups. Using multiple logistic regression analysis (after inserting into the model,gestational age at delivery, IUGR, cesarean section, oligohydramnios and PROM) revealed that subchorionic hematoma is associated with increased rates ofIUGR, oligohydramnios and cesarean sections and lower gestational age at delivery in group 2.

Conclusions:Subchorionic hematomas diagnosed during second trimester were associated with adverse pregnancy outcome that those cases diagnosed at first trimester.

 

בחזרה לתוכנית

12

14:52-15:00

 

Long term follow-up of women with 3rd and 4th degree perineal tears using transperineal ultrasound

Vered Eisenberg, Menachem Alcalay, Genady Bitman, Reuven Achiron, Eyal Schiff

Sheba Medical Center, Ramat Gan.

 

Objective: To prospectively assess long term changes in symptoms and transperineal ultrasound findings in women with 3rd and 4th degree perineal tears.

Methods: 44 women with 3rd and 4th degree tears in a prospective observational study underwent transperineal ultrasound (GE Kretz Voluson 730), an interview, standardized pelvic floor questionnaire, and a Cleveland Clinics Incontinence Score questionnaire (CCIS). Current data was compared with the enrollment questionnaires and ultrasound examination (blinded offline analysis 4DView). Statistical analysis was performed with SPSS, with p<0.05 considered statistically significant.

Results: Mean time from the delivery with a tear to the latest follow up examination was 845 days (range 342-1314), and mean time from enrollment to latest exam was 602 days (range 367-753). 14 women (31.8%) had a repeat delivery during the follow up time (11 elective cesarean sections and 3 spontaneous vaginal births). 9 women (20.5%) were pregnant at the time of the latest visit. At follow up there was more stress incontinence, urinary urgency and voiding dysfunction. Flatus incontinence was more common and the CCIS was higher, but did not reach statistical significance. On ultrasound, bladder neck mobility was significantly increased with a higher rate of cystocele and rectocele. There was a decrease in defect size and some improvement in descriptive sphincter characteristics. In longitudinal section the sphincter was shorter, and measurements in the transverse section showed significantly thicker external anal sphincter and thinner internal anal sphincter (IAS) widths. A thinner IAS at the follow up visit was found to correlate significantly with fecal incontinence, urgency, flatus incontinence and the total CCIS (Spearman's rho -4.4—5, all p<0.05).

Conclusion: Women who have had 3rd and 4th degree perineal tears continue to endure long term debilitating symptoms and to have abnormal sphincter findings on transperineal ultrasound, especially a thin IAS.


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