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Biomedical subjects

A Monteagudo

Publications and source records attributed to A Monteagudo.

At least 55 records · Page 3Linked to original sources
PubMed1995

Sonographic neuroembryology of the central nervous system.

In the last decade, strong emphasis has been placed on the structural evaluation of the fetus. Central nervous system anomalies are among the most common malformations affecting the developing fetus. As ultrasound equipment has improved, our demand for more resolute pictures has increased. The high-frequency, transvaginal ultrasound probe allows us to access the fetal fontanel and produce high-resolution fetal brain images. When such transducer probes are aligned with the fetal anterior fontanel (much like neonatal brain scans), clear and clinically useful images in the sagittal and coronal planes are generated. In this article, we review the technique of transvaginal transfontanel scanning, discuss pertinent neuroembryology, and apply this information to the sonographic diagnosis of neural tube defects.

Central Nervous System↗
PubMed1994

An approach to multifetal pregnancy reduction in a pregnancy of grand order (12 fetuses).

Our objective was to determine the best method to approach a multifetal pregnancy reduction of a patient with a multiple pregnancy of grand order (12 fetuses). Transvaginal ultrasound-guided reduction was performed in three stages. Successful outcome was achieved. The patient delivered twins at 37 weeks' gestation. The published and unpublished literature is reviewed and discussed in the light of this case. Our conclusion is that a multifetal pregnancy reduction of grand order can be performed in stages to achieve the desired number of fetuses.

Journal Article↗
PubMed1994

In utero detection of ventriculomegaly during the second and third trimesters by transvaginal sonography.

The purpose of this study was two-fold. The first was to extend the previously developed and published nomograms of the fetal lateral ventricles from 18 weeks back to 14 weeks of gestation using transvaginal sonography, and, second, to test the performance of the nomograms by plotting the measurements of 36 fetuses whose transabdominal and/or qualitative transvaginal scans were suspicious for ventriculomegaly. In all the cases in which postnatal confirmation of the diagnosis was possible, prenatal ultrasound correctly identified the lesion. Although a total of nine nomograms was created, the clinically meaningful measurements were: the height of the occipital horn on the parasagittal plane, and the two ratios derived from the measurements performed on the parasagittal plane. In conclusion, the transvaginally generated nomograms were useful for the correct identification of fetuses with ventriculomegaly.

Journal Article↗
PubMed1994

Successful management of viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography.

We evaluated the feasibility of transvaginal methotrexate injection of viable cervical pregnancies to avoid complications of the "classic" surgical procedures in use and to preserve future fertility. Five viable cervical pregnancies, at 6 to 8 weeks, were treated. In three patients a spring-loaded automated puncture device and in two a manually operated simple needle guide mated to and guided by a transvaginal ultrasonography probe were used with 21-gauge needles. The puncture and injection treatment was successful and without complications in all five cases presented. This procedure may become a useful alternative to other, more radical or complex surgical approaches.

Cervix Uteri↗
PubMed1994

Early and simple determination of chorionic and amniotic type in multifetal gestations in the first fourteen weeks by high-frequency transvaginal ultrasonography.

OBJECTIVE: Our aim was to determine the chorionic and amniotic types in multifetal pregnancies with transvaginal ultrasonography at > or = 14 weeks' gestation. STUDY DESIGN: Two hundred twelve multifetal pregnancies were scanned transvaginally at or before 14 weeks' gestation. The number of fetuses and the chorionic and amniotic type were determined ultrasonographically. Of the 212 patients, 54 were delivered at our institution, and 43 of these 54 had pathologic evaluation of the placenta. Ultrasonographic and pathologic correlation of the chorionic and amniotic type was assessed in this group. RESULTS: Ultrasonographic evaluation of the 212 pregnancies demonstrated 64 twin, 87 triplet, 41 quadruplet, 18 quintuplet, 1 sextuplet, and 1 septuplet gestation. Nine of the twin pregnancies were monochorionic-diamniotic; two of the triplets were dichorionic-triamniotic, and four of the quadruplets were trichorionic-quadraamniotic. In the 43 patients with both ultrasonographic and pathologic assessment, there were 40 twins, five of which were monochoronic diamniotic type. All three triplets were trichorionic-triamniotic type. In all 43 transvaginal ultrasonography correctly predicted the chorionic and amniotic type as determined by the pathologic findings. CONCLUSIONS: Transvaginal ultrasonography at < or = 14 weeks can easily and accurately determine the chorionic and amniotic type in multifetal pregnancies.

Amnion↗
PubMed1993

The use of the transvaginal automated spring-loaded puncture device transabdominally.

Transabdominal use of a software integrated, automated, spring-loaded transvaginal puncture device is described. This device allows accurate, high-velocity needle placement into sonographically targeted areas under continuous direct vision without the use of local anesthesia. Successful use of the device in seven cases is described.

Journal Article↗
PubMed1993

Multifetal pregnancy reduction by transvaginal puncture: evaluation of the technique used in 134 cases.

OBJECTIVE: This report reviews multifetal pregnancy reductions performed transvaginally and tests the feasibility and associated pregnancy loss rates with this technique. STUDY DESIGN: One hundred thirty-four consecutive multifetal pregnancy reductions were analyzed regarding different aspects of total pregnancy losses and complications. The first 40 manually performed were compared with the last 94 procedures performed with an automated puncture device and a thin needle. The losses were also analyzed as a comparison of the reduction of the lower-lying with the higher-lying fetuses located in relation to the internal os. RESULTS: A total uncorrected total pregnancy loss rate of 12.6% and a corrected loss rate of 10.6% was observed. Of the 112 pregnancies in which the lower-lying fetus was reduced, 11 losses were seen. The loss rate in the group reducing the upper fetus was three of 22. The manual versus the puncture device groups showed the same loss rate (10%); however, the manual group had a larger number of subchorionic hematomas after the procedure. CONCLUSIONS: The data are indicative of a very low maternal complication rate (infection) and an acceptable loss rate of the entire pregnancy. The loss rates compare favorable with those for multifetal pregnancy reduction performed transabdominally.

Abortion, Induced↗
PubMed1993

Transvaginal ultrasonographic characterization of ovarian masses by means of color flow-directed Doppler measurements and a morphologic scoring system.

OBJECTIVE: The aim of the study was to test the hypothesis that a combination of a previously devised morphologic scoring system and color flow-directed Doppler measurements would afford better discrimination between benign and malignant ovarian masses. STUDY DESIGN: The scoring system and color flow-directed Doppler measurements for 115 masses were prospectively analyzed and correlated with histopathologic surgical findings. RESULTS: In 21 masses (18 patients) no flow was obtained. Seventy-eight masses in 70 patients were benign, and 16 masses in 12 patients were malignant. The mean total score for the benign masses was 6.7 and for the malignant masses 11.7. The resistance index was 0.64 for the benign lesions and 0.39 for the malignant masses (range 0.2 to 0.98). The mean pulsatility index of the benign masses was 1.17 and 0.52 for the malignancies (range 0.2 to 2.6). There were no malignancies in the group with no flow obtained. The sensitivity and specificity of score alone was 94% and 87%, respectively, with a 60% positive predictive value. By means of resistance index or pulsatility index the sensitivity was 94%, the specificity 99%, and the positive predictive value 94%. CONCLUSION: These results suggest that Doppler flow measurements alone and in conjunction with a scoring system help differentiate benign from malignant masses.

Adenocarcinoma↗
PubMed1993

Transvaginal multifetal pregnancy reduction: Which? When? How many?

This report contains the experience of our centre, using the transvaginally guided puncture procedure, to reduce the number of fetuses in a multifetal pregnancy to a lower number. The aim of the procedure was to improve perinatal outcome and/or to meet the personal desires of patients and their families. We surveyed 148 multifetal pregnancy reductions. The fetus or fetuses overlying the internal os was most commonly reduced. The total uncorrected loss of the entire pregnancy was 13.4%. The corrected pregnancy loss was 11%. Of the 63 twins left after the reduction, 33 delivered preterm. Of the 36 singletons, two delivered preterm. Our conclusion was that multifetal pregnancy reduction is a safe procedure for the mother and has an acceptable loss rate of the entire pregnancy. The reduction of a fetus overlying the internal os by the transvaginal puncture procedure seems to yield results at least as good as the transabdominally performed puncture procedures for multifetal pregnancy reduction.

Abortion, Induced↗
PubMed1993

Diagnosis of placenta previa by transvaginal sonography.

The evolution of the sonographic diagnosis of placenta previa is reviewed with special emphasis on transvaginal sonography (TVS), which has been proved accurate at diagnosing different degrees of placenta previa, such as complete, partial, marginal and low-lying. Bleeding tendency and the need for Caesarean delivery increases when the placental edge is within 3 cm of the internal os. There is no association between bleeding and use of transvaginal probes. The early diagnosis of addition abnormalities of implantation (e.g. placenta accreta) using transvaginal colour flow Doppler widens the prospects for carefully planned patient management. In conclusion, TVS should be the principal diagnostic modality used in the work-up of an obstetric patient with vaginal bleeding. The ease of performance and the clarity and accuracy of method and the additional information about implantation that it can provide will soon make TVS the 'golden standard' in the diagnostic process of placenta previa.

Cervix Uteri↗
PubMed1993

Nomograms of the fetal lateral ventricles using transvaginal sonography.

Nomograms of the fetal lateral ventricles were obtained by the transvaginal approach. Three hundred low-risk women with no sonographically apparent fetal anomalies were scanned prospectively in a cross-sectional study. Three measurements in the parasagittal plane, three in the midline coronal plane, and two in the posterior coronal plane were used to generate seven nomograms. Two additional nomograms reflecting two calculated ratios also were created. A mean regression line and the 5th and 95th confidence intervals were determined. We concluded that transvaginal sonography of the fetal brain generates images of both hemispheres of good enough resolution to allow several precise and reproducible measurements.

Anthropometry↗
PubMed1992

High-frequency transvaginal sonographic examination for the potential malformation assessment of the 9-week to 14-week fetus.

A study was undertaken to evaluate the ability of the high-frequency transvaginal scanning method to consistently image first- and early second-trimester fetal structures, such as body contours, long bones, fingers, face, palate, feet, toes, and the four-chamber view. Ninety-seven low-risk pregnancies were scanned from 9 weeks to 14 menstrual weeks inclusive. Accurate dating was ascertained. The results showed that consistent detection of the respective structures was achieved at the following menstrual ages: sagittal contours at 9 weeks to 10 weeks, long bones at 10 weeks to 11 weeks, fingers at 12 weeks, face and palate at 12 weeks, feet and toes at 13 weeks, and the four-chamber view at 14 weeks. The organs and structures examined could be detected at 9 weeks to 14 weeks inclusive. An increasing number of structure were detected consistently with the increasing menstrual age. The study supports the possibility of searching for specific malformations at or after the menstrual ages mentioned, or performing a more comprehensive malformation evaluation after 13 weeks.

Female↗
PubMed1992

Sonographic evolution of cornual pregnancies treated without surgery.

Transvaginal sonography allows early and accurate diagnosis of cornual pregnancy, as well as providing a means for puncture injection treatment of certain ectopic pregnancies. We describe four cases of cornual pregnancy managed nonsurgically and followed with transvaginal sonography for 47-64 weeks. Sonographic evidence of cornual pregnancy persisted throughout the period of follow-up, despite resumption of normal menstrual cyclicity. We conclude that some early live cornual pregnancies can be managed by puncture injection, and cornual pregnancies in which the embryo has died can be followed conservatively.

Female↗
PubMed1991

Puncture procedures utilizing transvaginal ultrasonic guidance.

The introduction of transvaginal sonography has enabled the use of this scanning method for guided puncture procedures. A total of 102 puncture procedures are described: 63 fetal reductions, eight punctures of ectopic pregnancies, 19 drainages of pelvic contents, seven punctures of ovarian cysts, four diagnostic culdocenteses and one injection of a cervical pregnancy. Every procedure is discussed in detail. There was only one procedure-related complication. The advantages of the ultrasound-guided vaginal puncture procedure are its performance under real-time imaging, a low complication rate, a better pregnancy outcome when considering the reduction of multifetal gestations, and, most importantly, the fact that abdominal surgery can be avoided in several cases.

Journal Article↗
PubMed1991

Transvaginal ultrasonographic definition of the central nervous system in the first and early second trimesters.

A 6.5 MHz transvaginal sector scanner was used to describe the fetal central nervous system anatomy from 6 to 14 weeks. One hundred thirty-three pregnant patients were scanned after the crown-rump measurements were found to be within a range of less than or equal to 4 days from menstrual age. The number of possible ultrasonographic sections ("slices"), as well as the number of successful views in the axial, coronal, and sagittal sections, was tabulated. A detailed list of central nervous system structures that are seen at each gestational age is presented. The results showed that a significant number of brain structures could be imaged. The number and the clarity of the structures and the number of successful views in the three scanning planes increased with gestational age. We concluded that transvaginal scanning for central nervous system maldevelopment can be started in the late first and early second trimesters.

Central Nervous System↗
PubMed1991

Imaging the fetal brain in the second and third trimesters using transvaginal sonography.

High-frequency transvaginal probes were used at 20-40 weeks' gestation to develop a systematic examination of the fetal brain. Modeling the procedure after the standard neonatal neurosonographic examination, we attempted to obtain three coronal sections (anterior, midline, posterior) and two sagittal sections (midsagittal, right or left parasagittal). In 70 normal patients, all planes were imaged with a similar frequency (74-76%) except for the posterior coronal plane, which was imaged 59% of the time. Among the first 35 cases, 17% had a complete study, compared with 71% of the second 35 cases. Transvaginal sonography established or changed the diagnosis in five of the 13 cases with central nervous system or other abnormalities. We recommend that a complete fetal neurosonographic examination include transvaginal sonography to complement and enhance the transabdominal examination, especially for cases in which a fetal abnormality is suspected.

Brain Diseases↗
PubMed1990

Mitochondrial myopathy and preeclampsia associated with pregnancy.

Mitochondrial myopathy is characterized by weakness, exercise intolerance, and acidosis. Pregnancy has been reported to accelerate the disease process. This report discusses pregnancy and management of labor complicated by mitochondrial myopathy and the therapeutic dilemmas that arise when preeclampsia is diagnosed.

Female↗