Transcript of video
You are also an expert in the prevention of preterm birth. You published important research and using transvaginal ultrasound examination to measure cervical length. And this can predict the risk of premature rupture of membranes, premature birth, and some serious complications for the mother and the child. Please discuss your work in the prevention of preterm labor and premature birth. Right. You know, obstetrics for centuries, thousands of years is based on digital examination of the cervix, which is the worst thing that we could come up with. It’s useless during pregnancy. It is less used in the Anglo-Saxon world. And that’s a very good thing. I think no pregnant woman should ever be examined digitally during the pregnancy. The only advantage of a digital examination of the cervix is when a woman is in labor. Outside this situation, this is full of false positive and false negative information. Digital examination of the cervix increases the risk of infection. It increases the risk of infection because a long cervix can be entirely open and colonized by the membranes from inside, and your digital examination will be normal. A cervix can seem short with your fingers and belong by ultrasound with an internal os [entry] that is very high up. And once a woman has delivered once in our life, a cervix is never closed again. Therefore, saying that, oh yeah, I can’t put my finger in. Certainly don’t do that. And if you do that, it doesn’t prove anything. So ultrasound came up as the most objective examination about the risk of prematurity. Short cervix or cervix that is open, it is called a funneling from the inside, although it’s long, can be high risk. Ultrasound is very accurate for that. Also, and most importantly, in a high-risk situation, women with a previous history of prematurity, women with twins or triplets, if the cervix on ultrasound is long, then the negative predictive value of during prematurely is extremely high. So ultrasound is proven in many clinical studies (1) to be superior to digital examination, (2) to have an excellent negative predictive value. It’s only when a cervix is short, and there are contractions. Medical second opinion. If the service is short with ultrasound, although it’s better than digital examination, the positive predictive value is still not that high. So people have worked on a complementary diagnostic test for that. Fibronectin and other things to try and improve the positive predictive value for premature labor. Dr. Yves Ville, MD. But the negative predictive value of ultrasound is excellent. So ultrasound in obstetrics has become a clinical tool. Even if it’s an oxymoron because it’s a device. It’s not clinical. It is the best clinical examination is vaginal ultrasound in obstetrics. Thank you, that’s a very important information. You’re also a leading expert on MRI in the diagnosis of problems during pregnancy, both an unborn mother and developing child, an MRI of the placenta can identify important risk factors for developing fetus for mother and the future child. How can MRI be used for the diagnosing of problems in the placenta? Dr. Anton Titov, MD. And what is the future for MRI use in diagnosing problems during pregnancy? Dr. Anton Titov, MD. Schematically, there are two kinds of expectations for MRI. One expectation is about morphology. The other one is about function. For morphology, MRI is an extremely accurate tool. Both for the fetal anatomy and especially the brain MRI is unbeatable, much better than ultrasound, especially late in the pregnancy. And if you look at function, today ultrasound is much more accurate than MRI in predicting functional problems with the placenta, for example, by using Doppler, umbilical and fetal Doppler. MRI is currently developing in exploring the function of the brain, function of certain organs, and function of the placenta. Dr. Yves Ville, MD. But to date, MRI has not achieved a clinical level of performance. Although if you look at, again, the anatomy, the anatomy of the brain, the fetal brain in a high-risk situation, we mentioned infections earlier on, MRI as the best negative predictive value. Clearly. Now, MRI of the placenta is extremely useful and accurate if you suspect placenta accreta or if you have risk factors for placenta accreta. So, placenta accreta is a placenta inserted not on the surface of the uterus with a cleavage plane, represented by the endometrium. It is going through the endometrium, at a different level of penetration of the uterus, sometimes down to the serosa. So you got placenta accreta, placenta increta, placenta percreta. Especially when the placenta is posterior, ultrasound is not the best tool for diagnosing placenta accreta. Dr. Yves Ville, MD. But MRI is pristine to show you either placenta accreta, increta, or percreta. You can look at the invasion of the nearby vessels in the pregnant woman, which is a very important prognostic factor for the management and mainly to exclude placenta aaccreta, actually. You can say no, don’t worry, this placenta looks odd on ultrasound, but there is no placenta accreta.