bluuebunny/crossref_metadata_2025 huggingface dataset:
P156Teaching in ultrasound – new methods in training
Authors: Heer I. , Fuchshuber S. , Strauss A.
Published: March 2003

Introduction

The purpose of this study was to evaluate a new training system for transvaginal ultrasound.

Methods

We used a software‐based 3D‐ultrasound which allows offline re‐evaluation of structures recorded in a 3D‐voxelcube during an actual exam. The software assigns a specific plane to each possible position of the transducer within the 3D‐cube. This allows virtual ‘re‐scanning’ of recorded exams. In the teaching model, an vaginal ultrasound transducer is used to examine a life‐size model pelvis. The transducer is linked to a computer which displays the virtual ultrasound scan. We tested the system on 30 Munich‐University 3rd year medical students. None had previous ultrasound experience. All were shown an 8 minute teaching video. Each student was allowed a 1 minute practice period, then asked to find a proper plane and measure the endometrial thickness.

Results

All students were able to find a proper plane for measurement within 30 s. The results of measurments varried between 5 and 9 mm (actual thickness 8 mm). All rated the session as an excellent theoretical introduction into the field of transvaginal ultrasound, and as extremely valuable skill‐training.

Conclusion

In this software based re‐evaluation model, we believe to have found an optimal new training tool for transvaginal ultrasonound. As a consequence, we intend to establish a case‐library for the future basic training of younger doctors.
P16Office ultrasonography in obstetrics: an eight year experience
Authors: Assimakopoulos E. A.
Published: March 2003

Background

We present an eighth year experience (1991–98) of ultrasonography in a private office, using a portable ultrasound unit, Aloca SSD‐500.

Method

Each pregnant woman underwent transvaginal ultrasound examination 7–8w in order to date pregnancy, to confirm fetal viability and the number of fetuses. At 17 weeks, a second trimester screening for Down syndrome was ordered by using BPD, maternal age and maternal serum AFP and free β‐HCG. Later, at 20–22w a detailed scan was performed to all pregnant women in order to exclude fetal anomalies.

Results

In 1019 consecutive pregnant women, 22 could not recall the date of their LMP and 59 had irregular cycles. By measuring the CRL, the expected date of delivery was accurately calculated. One hundred and seventy‐six women underwent amniocentesis with no complications, and from these, there was only 1 case with trisomy 18. All pregnant women had level II scan. There were 5 cases with abnormalities (1 cystic hygroma, 1 diaphragmatic hernia, 1 with talipes, 1 anencephalic and two with hydrops). We couldn't diagnose prenataly 1 case with coarctation of the aorta, 1 anorectal atresia, 1 microcephaly and 3 with Down Syndrome. All the other women delivered babies with normal anatomy. As far as the cost is concerned, there was no extra charge for ultrasound examinations.

Conclusion

Office ultrasonography is feasible after long‐term training and experience.

Acknowledgements

W. R. Lees and J. C. Hobbins.
P23Ultrasonographic weight estimation of the macrosomic fetus: the benefit of two examiners
Authors: Gull I. , Wolman I. , Har‐Toov J. , Fait G. , Amster R. , Lessing J. B. , Jaffa A. J.
Published: March 2003

Background

Using two examiners to obtain more accurate estimation of fetal weight (EFW) in suspected macrosomy is commonly accepted. However, the real benefit of such routine has not been validated.

Aim

To validate and calculate the benefit of using two examiners for increasing the accuracy and decreasing errors of more than 10% in EFW of macrosomic fetuses.

Methods

Fifty term fetuses suspected for macrosomy were examined by two examiners. The accuracy and the number of errors of EFW of more than 10% were calculated for each examiner, and compared to an average estimation of both examiners.

Results

The average birth weight was 4140gr. The estimation accuracy of the examiners was 5.83% and 6.18% (N.S.). Using an average estimation of both examiners the accuracy increased to 5.75% (N.S.). However, using two examiners decrease the number of errors of more than 10%. Twelve fetuses were estimated erroneously by at least one examiner. Only 6 fetuses were estimated erroneously when the EFW was based upon the average of the two examiners.

Conclusion

Although the use of two examiners for EFW in macrosomic fetus doesn't increase the accuracy, it decreases errors of more than 10%.
P27Unusual fetal infection leading to early IUGR and hydrocephaly: case report
Authors: Pedreira D. A. L. , Jasinowodolinsk D. , Rocha A. J. , Schultz R. , Zerbini M. C. N. , Cha S. C.
Published: March 2003

LRK, 34 years‐old, primigravida, had first scan done at 10 weeks 1 day with CRL compatible with 9 weeks + 5 days. At 12 weeks 2 days, nucal translucency measured 1.0 mm, Doppler velocimetry of ductus venosus (positive A wave) showed posite A wave and CRL measured 46 mm (11 weeks 4 days). At 21 weeks + 6 days the anomaly scan revealed dilatation of cerebral ventricles, asymmetric IUGR (measurement compatible for 17w + 6d), oligohydramnios and severe placentomegaly. Amniocentesis showed normal karyotipe (46XX). MRI was performed at 22 weeks, using T2 sequence and single shot fast spin echo (SSFSE) without maternal or fetal sedation. Global dilatation of cerebral ventricles, without signs of obstruction or other CNS malformations. Delivery was induced after spontaneous fetal death at 23 weeks, a female stillborn weighting 240g showed no other malformation then those described in CNS. Anatomo pathologic evaluation of the brain revealed encephalitis and periventriculitis and placenta showed severe vilositis. Immuno‐histochemistry of the brain/placenta was negative for herpesvirus and CMV, but adenovirus was positive in both tissues. Maternal serology from the begining of pregnancy showed no antibodies against toxoplasmosis, HIV or syphilis and acquired antibodies to rubella, CMV, Hepatitis B. At delivery all this serologies were repeated and results remained the same. Maternal serology for adenovirus in a stored sample collected at 18 weeks showed a 1/8 titre.

Discussion

Besides the usual torch infection, other infections can severely affect otherwise normal pregnancies. The identification of other possible infection agents may help to elucidate the so‐called ‘idiophatic’ causes of spontaneous fetal death. We suggest the inclusion of adenovirus in the infection screening of such cases.
P35Duodenal atresia: prenatal diagnosis and perinatal outcome of 27 fetuses
Authors: Has R. , Batukan C. E. M. , Ermiş H. , Başaran S. , Yüksel A. , Ibrahimoglu
Published: March 2003

Objective

To discuss the prenatal diagnosis, obstetrical management, and perinatal outcome of duodenal atresia, and investigate the incidence of associated malformations and chromosomal anomalies.

Materials and methods

The data about 27 fetuses with duodenal atresia which were diagnosed on prenatal sonographic evaluation, and confirmed postnatally, among 20401 high risk pregnancies who were referred to Prenatal Diagnosis Unit of Obstetrics and Gynecology Department of Istanbul Medical Faculty between 1988 and 1999, are analyzed. Presence of polihydramnios, gestational week at diagnosis, associated malformations and chromosomal abnormalities, and perinatal outcomes were evaluated. Fisher's exact test is used for statistical analysis.

Results

Duodenal atresia was diagnosed in 43 fetuses, but postnatal outcomes of 38 fetuses could be obtained. Ten of the fetuses had additional abnormalities in 27 cases whom diagnosis was confirmed. Nine chromosomal abnormalities (33.3%) including seven trisomy 21 (29.6%), one deletion, one translocation anomaly detected. The perinatal mortality of duodenal atresia is found 44.4% with 12 pre and postnatal deaths. Fifteen infants discharged in a healthy condition after operations.

Conclusion

Duodenal atresia, especially in the presence of associated abnormalities has a high perinatal mortality. Establishment of diagnosis in prenatal period, even in the late stages of gestation, may contribute the obstetrical and neonatal management.
P36Prenatally diagnosed duodenal obstruction: a report of 16 cases
Authors: Galindo A. , Arbues J. , Puente J. M. , Villar O. , Cano I. , Grañeras A. , De La Fuente P.
Published: March 2003

Aim

To evaluate main ultrasound findings, associated anomalies and perinatal outcome of fetuses with duodenal obstruction (DO).

Methods

Retrospective review from January 1990 to October 1998 of 16 fetuses with DO.

Results

The incidence was 1 in 2771 deliveries. DO accounted for 53% (16/30) of all the small bowel obstructions. Sensitivity was 76%. Mean gestational age at diagnosis was 32.6 weeks. Associated anomalies were diagnosed prenatally in 5 cases (31.3%) and postnatally in 3 more cases, so associated anomalies were present in 50%. DO was an isolated finding in 11 cases (68.7%) and no chromosomal anomalies were observed in this group. These were diagnosed in 4 out of the 5 cases with associated anomalies. Polyhydramnios was quite common (93.7%). Taking into account also cases postnatally diagnosed, chromosomal defects rate was 33.3% (trisomy 21 represents 86% of all). Mean gestational age at delivery was 35.1 weeks. Mean weight at birth was 2315 g. Perinatal mortality rate for prenatally diagnosed DO cases was 31.2%, but this rate rose up to 62.5% in those cases with associated anomalies. No deaths were seen in isolated cases. DO resulted from atresia in 6 cases (37.5%), from web in 5 (31.2%) and from annular pancreas in 5 (31.2%).

Conclusion

DO is most prevalent type of small bowel obstruction. Associated anomalies and chromosomal defects (Tr.21) are common and should always be ruled out. While isolated cases have good prognosis, outcome is worse with associated anomalies, the latter being the major prognostic factor.
P39Recurrent non inmune hydrops fetalis in parents with shared HLA DR and DQ
Authors: Pérez Fernández R. , De León J. A. , Pintado P. , Orera M. , Carbone J. , Ortiz L.
Published: March 2003

Introduction

Non immune hydrops fetalis (NIHF) is defined as the extra cellular accumulation of fluid in tissues and serous cavities, without evidence of circulating antibodies against red blood cell antigens. NIHF is the result of a heterogeneous group of conditions including cardiovascular, pulmonary, chromosomal, haematology, infectious disorders and deposit disease.

A 34‐year‐old pregnant woman with obstetrical history of two prior perinatal deaths between 29th and 30th weeks of gestation, all associated with foetal hydrops. In the prior pregnancy we made a exhaustive study of the foetal blood, obtained by cordocentesis, and the parents' blood. This study included haematology, infectious serology, hormonal and immune disorders and it was detected a shared HLA DR and DQ. In the current pregnancy, the foetus has developed hydrops at the 20th week of gestation which has been diagnosticated by ultrasound. Once again the results of the research has been normal and we have tried to correct the hypoproteinemia with albumen infusion by cordocentesis. The following up has showed the increase of the hydrops concluding with cardiovascular failure and foetal death.

Discussion

The mortality rate of recurrent NIHF is over the 80% of the cases and depends on the ethiology. The epidemiological studies had demonstrated the association between abortions and parents who shared HLA DR and DQ but the association with recurrent NIHF is not a proved fact.

The diagnosis of hydrop fetalis is by ultrasound on detection of skin thickness greater than 5 mm with fluid accumulation in at least one of the serous cavities. It is also necessary to obtain a detailed ultrasound scan for structural defects, echocardiography and Doppler blood flow studies of mayor foetal vessels. Ultrasound is an important tool used in the following up of NIHF and it makes possible the use of the cordocentesis therapy in some cases.
P42Hydrops fetalis and hepatosplenomegaly in the second half of pregnancy as a sign of myeloproliferative disorder in fetuses with trisomy 21
Authors: Smrcek J. , Germer U. , Baschat A. , Gembruch U.
Published: March 2003

Background

Fetal hydrops and/or hepatosplenomegaly in the second half of pregnancy may be a sign of myeloproliferative disorder in fetuses with trisomy 21.

Methods

In order to search for fetuses with myeloproliferative disorder a retrospective study was performed in fetuses with trisomy 21 and hydrops diagnosed in our prenatal unit. Three of these fetuses presented hepatosplenomegaly and myeloproliferative disorder. In addition, one fetus with sonographic signs of trisomy 21, where karyotyping was unfortunately unsuccessful, presented with hepatosplenomegaly, hydrops and myeloproliferative disorder.

Results

The four fetuses reported presented with fetal hepatosplenomegaly and hydrops in the second and third trimester. Infectious serology was negative. The characteristics of blast cells in the peripheral blood smear revealed a myeloproliferative disorder. The diagnosis was confirmed by postmortem examination, since all four cases ended up in fetal demise.

Conclusion

Fetal hydrops and/or hepatosplenomegaly in the second half of pregnancy, although suggestive of infectious aetiology, may be a sign of myeloproliferative disorder in fetuses with trisomy 21 or mosaic trisomy 21. It seems to be possible, that a myeloproliferative disorder is the most common cause of hydrops in cases of trisomy 21, at least during late second and third trimester. Furthermore, the incidence of myeloproliferative disorder in utero may be more frequent than realized.
P43Endocardial fibroelastosis associated with nonimmune hydrops fetalis – case report
Authors: Dimcev P. , Stojkovski J. , Kapusevski M. , Sopova A. , Janevska V.
Published: March 2003

Over 30% of cases with nonimmune hidrops fetalis remain with idiopathic etiology. In cases with known origin, cardiovascular failure is on the first place with over 20%. We report case of 29‐year‐old primigravida, no previous risk factors, 32 second week of gestation. At her first admit to our Hospital, ultrasound examination (performed on SIEMENS Sonoline Versa Pro, 3.5 MHz abdominal probe) revealed obvious signs of severe nonimmune hidrops fetalis: ascites, hepatosplenomegaly, cardiomegaly, pleural and pericard effusion. Prenatal evaluation excludes immune, chromosomal, diabetic, urinary, gastrointestinal, metabolic origin and infection. As there was obvious sign of extreme fetal tahicardia, over 230 hbpm, we conclude that cardiovascular etiology is the main in patogenesis. Because we can not find any big cardiac anomaly, we tried to menage this condition with intravenous administration of digoxin to the mother. Unfortunately, after 3 days there was no proper answer of the therapy and baby died in utero after extreme tahiarithmia, 250 hbpm. Autopsy report maintain our prenatal diagnosis – endocardial fibroelastosis. The conclusion is that early diagnosis and proper investigations in corresponding institution are very important for menagement of nonimmune hydrops fetalis.
P46Differential diagnosis in fetal obstructive uropathy
Authors: Paternoster D. M. , Stella A.
Published: March 2003

Case report

A healthy 24‐year‐old secundigravida presented for a routine ultrasound examination at the 11th week of gestation. The scan showed a singleton pregnancy and the crown‐rump length (43.8 mm) was compatible with the gestation calculated from the last menstrual period. The foetal abdomen was distended by the presence of one only cyst (12 × 7.4 mm), compatible with distension of the bladder. There was no other evident abnormality. Amniotic fluid volume was normal for the first trimester despite total urethral obstruction. At 14 weeks still birth was found and the patient delivered three days later. Diagnosis was confirmed at autopsy. Post mortem examination confirmed a phenotypically normal male foetus consistent with 14 weeks gestation and weighing 70 gr. The abdomen was distended and the abdominal wall was thin. Internal examination confirmed the presence of an enlarged bladder. There was urethral atresia, with associated dilatation of the bladder but the ureter and kidneys were normal. Internal genitals were male with normal testicles and penis. Chromosome analysis was performed on foetal skin and karyotype was 46, XY.

Discussion

Cloacal dysgenesis sequence (CDS) is a rare cause of fetal obstructive uropathy (FOU). The prenatal differentition of CDS from other FOU is important because CDS is not amenable to in utero surgical intervention in the form of vescicoamniotic shounts. Differential diagnosis must be made with pathologies capable of determining cystic lesions localised in the inferior foetal abdomen, such as ovarian cysts, intestinal duplications, Hirschsprung disease, colic dilatation, imperforate hymen with hydrometracolps and megacystes–microcolon syndrome. Accurate prenatal diagnosis can be difficult and requires prolonged serial observations. The above‐mentioned pathologies have characteristics of relative ‘fixity’, while typical imaging of cloaca undegoes variations due to sequential filling in, or repletion, of the liquid contained in the urinary, genital and digestive components of the malformation. Moreover, intestinal obstruction is generally associated with polyhydramnios. In the first trimester diagnosis of cloaca anomalies are very difficult because there are no great changes in amniotic fluid volume and ascites rarely is present; serial examinations are required for enable definition of diagnosis.
P47The functionality of renal kidneys. Can amniotic markers be used to diagnose renal pathologies?
Authors: Troyano J. M. , Clavijo M. T. , Feo C. M. , Marco Y. , Laynez E.
Published: March 2003

Background and method

Fetal urine was analysed for differences in renal functionality between physiological cases and pathological cases featuring dilatation of the excretory channels (hydronephrosis). Kidney samples were taken by means of aspirative nephrostomy under echographic monitoring, and 4 parameters were assessed in both amniotic fluid and urine, namely osmolarity, [Na+], [Cl−], [nag] and [β2 microglobuline].

Results

A total of 51 cases (healthy group) presented hypotonic urine, medium osmolarity (200 mosm), low levels of Na+(< 100 mEq/ml), Cl− (< 90 mEq/ml), nag (< 2 U/l) and β microglobuline (< 5 ml/l), and a healthy postnatal evolution. In contrast, the remaining 19 cases (pathological group) had hypertonic urine, nag and β2 microglobuline levels over 18 U/l and 26 ml/l, respectively, and evolved towards heavy renal disfunctionality after delivery. In the pathological group the concentration of nag and β2 microglobuline in the amniotic fluid was significantly larger than in the physiological group, but no differences in amniotic Na+, Cl− and osmolarity were observed between both groups.

Conclusion

The concentration of liposomial proteins (nag and β2 microglobuline) from the amniotic fluid is a sound indicator of heavy proximal tubulopathy. Invasive techniques such as puncturing can thus be avoided to diagnose fetal disfunctionality.
P55Large yolk sac preceding increased nuchal translucency in skeletal malformations: report of two cases
Authors: Odeh M. , Kais M. , Wolfson M. , Ophir E. , Oettinger M.
Published: March 2003

Case 1

A 20‐year‐old secondegravida was screened at 20 weeks due to consanguinity. The fetus had extreme shortening of the limbs, cystic hygronia, hydrocephalus and tetralogy of fallout. The pregnancy was terminated. Missed abortion was diagnosed in her third pregnancy at 18 weeks. The fetus had extreme shortening of the limbs, spina bifida and cystic hygroma. In her fourth and fifth pregnancies she was first scanned at 7–8 weeks. A large yolk sac was detected (10 mm) and later the fetuses developed increased nuchal translucency short limbs and ascites. Both pregnancies were terminated. Twins were diagnosed in her sixth pregnancy. At 8 weeks one fetus had large yolk sac and this fetus developed the same features, including spina bifida and ascites and at 17 weeks heart activity was not detected. She delivered a healthy term female.

Case 2

A primigravida was scanned due to consanguinity at 22 weeks. The fetus had fixed extension of four limbs and bilateral club feet the parents refused termination and a newborn with congenital arthrogriposis died a few days after delivery. In her second pregnancy she was first seen at 9 weeks and a large yolk sac was found and 2 weeks later increased nuchal translucency developed. Deformities of the limbs were first detected at 16 weeks and this pregnancy was terminated. The third and fourth pregnancies were normal. In her fifth pregnancy the same features developed. The parents refused termination and the baby died a few days after delivery.
P07Fetal gender determination in the first trimester using the transverse view: the importance of the third point
Authors: Pedreira D. A. L. , Yamasaki A. , Czeresnia C.
Published: March 2003

Aim

To determine the accuracy of fetal gender determination between 11–13 weeks of pregnancy.

Material and methods

Retrospective evaluation from October 1997 to July 1999. Transabdominal sonography using 3.5–5.0 MHz curvilinear probes. Fetal gender was evaluated at the transverse view of genital region. Male gender was considered when three hiperecogenic points, triangular in shape (probably corresponding to the escrotum (‘two points’) and falus (‘third point’) were visible. Female gender was considered when only two parallel white lines were observed (probably corresponding to the falus pointing to the caudal fetal region.

Results

166 singleton pregnancies had fetal sex determined after birth and/or after cytogenetic results. Total accuracy in determining fetal sex was 82.1%. The most frequent error was evaluating as female the male fetuses.

GA (weeks)
CRL (mm)
n
Correct

N
%

11–11 + 6
43.8–55.3
46
35
76.1

12–12 + 6
55.4–67.9
74
60
81.1

13–13 + 6
68.0–81.7
46
43
93.5

Total

166
134
80.7

Conclusions

Recent studies on fetal sex determination in the first trimester used mainly the longitudinal view of the fetus to this evaluation. In this study, we describe the presence of the ‘third point’ as an important sign in the characterization of fetal gender, in the transverse view, during the first trimester.
P88Cardiotocography predicting buffer base deficit (> 10 mM) at birth in pregnancies with absent or reversed end‐diastolic velocity in the umbilical artery Doppler studies
Authors: Yamamoto R. M. , Francisco R. P. V. , Okatani D. , Miyadahira S. , Zugaib M.
Published: March 2003

Background

A study of cardiotocographic (CTG) variables and buffer base deficit at birth in fetuses with AREDV.

Methods

The last CTGs of 127 AREDV cases were correlated to buffer base deficits above 10 mM. The variables selected by the Logistic Regression model were: baseline, accelerations, variability (variab.), sinusoidal pattern, bradycardia, late and variable (var.) decelerations (mild, moderate and severe).

Results

The maximum likelihood estimates are shown with the variables:

Variable
Parameter  estimate
Standard  error
P
Odds  ratio

Intercept
−0.4976
1.8374
0.7865

GA (weeks)
−0.0195
0.0590
0.7407
0.981

variab. 5–9 bpm
0.5330
0.4431
0.2290
1.704

Variab. < 5 bpm
2.5275
0.5804
0.0001
12.522

Conclusion

The analysis of cardiotocographic variables makes it possible to estimate the probability of a base deficit above 10 mM at birth, i.e. buffer base depletion. Low placental permeability to bicarbonate and buffer base is an advantage for studying these results, which are less influenced by acute events.
Gestational age in pregnancies conceived after in vitro fertilization: a comparison between age assessed from oocyte retrieval, crown‐rump length and biparietal diameter
Authors: Tunón K. , Eik‐Nes S.H. , Grøttum P. , Von Düring V. , Kahn J.A.
Published: March 2003

Objective 
To compare gestational age (GA) and day of delivery estimated from the time of in vitro fertilization (IVF) (oocyte retrieval + 14 days), the ultrasonic measurement of the crown–rump length (CRL) and the biparietal diameter (BPD) in pregnancies conceived in an IVF setting.

Design 
Included were 208 singletons and 72 twin pregnancies conceived after IVF. GA estimated from the time of IVF was compared with the GA estimated from the ultrasonic measurement of the CRL in the first trimester and the BPD in the second trimester.

Results 
In singletons the mean difference in gestational age was 0.9 days between IVF and CRL estimates and 2.1 days between IVF and BPD estimates. The gestational age as estimated from CRL or BPD was shorter than the GA estimated from IVF. There was no systematic variation in the mean differences in GA between the methods. In three pregnancies there was a difference of more than 7 days between the gestational age estimated from IVF and CRL and in 22 pregnancies between gestational age estimated from IVF and BPD. A difference of > 14 days for any of the estimates was not found in any case. In singletons there was a high correlation in the gestational age at birth assessed from the time of IVF and from CRL, from the time of IVF and from BPD.

Conclusion 
Assessment of gestational age from the time of IVF, CRL and BPD in pregnancies conceived after IVF shows equally high agreement between the three methods. This supports the use of ultrasound as a reliable method for estimation of gestational age.
WS17‐05Placentation studied by three dimensional power Doppler sonography
Authors: Hafner T.
Published: March 2003

Objective

The aim of this study is to investigate processes of placentation by the use of three‐dimensional sonography.

Methods

A group of 25 pregnant women in gestational age ranging six to 10 weeks underwent a detailed assessment. The ultrasound device was Voluson 530D MT, by Kretztechnik, Zipf, Austria. Measurements in three‐dimensional B‐mode were gestational sac volume, chorion volume, and embryonic volume. Volumes were measured by the use of an integrated software. Structures were outlined manually in multiple parallel sections. The machine integrated and calculated the volume. The hemodynamical changes correlated to the process of placentation were assessed by the use of three‐dimensional power Doppler (angio mode). Three‐dimensional imaging of vascular changes was expressed and quantified by the use of volume flow index (VFI). The analysis of the results included correlation of morphological and hemodynamical parameters obtained by measurements.

Results

The volume of gestational sac, chorion and embryo increases during the weeks of gestation under investigation. The amount of vascular spaces in the chorion and surrounding myometrium increase with gestational age and correlates with the gestational sac and chorion volume.

Conclusion

3D power Doppler sonography is a valuable tool for assessment and quantification of hemodynamic changes involved in placentation.
WS17‐10Sonographic evaluation of the umbilical cord throughout gestation
Authors: Di Naro E. , Raio L. , Ghezzi F. , Franchi  , Bolla D. , D'addario V. , Schneider H.
Published: March 2003

Traditionally, the prenatal assessment of the umbilical cord (UC) is limited to the assessment of the number of vessels and to the evaluation of umbilical artery blood flow parameters. Morphologic aspects of the UC have usually been studied by pathologists and retrospectively correlated with the perinatal outcome. The introduction of more sophisticated imaging techniques have offered the possibility to investigate the UC characteristics during fetal life from early to late gestation. A number of investigations have demonstrated that an altered structure of the UC can be associated with pathologic conditions (i.e. preeclampsia, fetal growth restriction, diabetes, fetal demise). Nomograms of the various UC components have been generated and allow the identification of lean or large umbilical cords, entities frequently associated with fetal growth abnormalities and diabetes, respectively. Of note, lean UC in the second and third trimester differs from normal UC not only from a structural point of view but also in the umbilical vein blood flow characteristics. On the other hand a thin UC in the first trimester seems to be a marker for identifying a subset of fetuses at risk for spontaneous abortion and pre‐eclampsia. A Wharton's jelly reduction has also been invoked as a possible cause of fetal death in the presence of single umbilical artery. Prenatal morphometric and morphologic UC characteristics as well as UC arterial and venous blood flow parameters in normal and pathologic conditions will be presented and discussed.
WS03: Infertility WS03‐01Selection of candidates for IVF based on color Doppler findings
Authors: Biljan M. M.
Published: March 2003

In the last 20 years there have been numerous improvements in IVF techniques leading to an exponetial increase in pregnancy rates. In spite of these improvements the patients undergoing IVF procedure still have more chance of failure than success. This presentation will address the areas in IVF treatment in which the use of color Doppler ultrasound could improve the results of IVF. Discussion will include the appropriate assessment of ovarian reserve as well as why the determination of the initial dose of gonadotropins based solely upon the patient's chronological age or serum FSH or E2 concentrations is imprecise. Recently, baseline ultrasound scans to assess for the presence of polycystic ovaries, and the use of color Doppler sonography to assess stromal perfusion have emerged as valuable tools in the assessment of the optimal dose selection of gonadotropins required for IVF ovarian stimulation. The issue of the assessment of oocyte maturity will additionally be discussed. Traditionally, follicular size has been used to assess oocyte maturity. However, frequently very poor oocytes are obtained from optimally grown follicles. It has been suggested that the assessment of peri‐follicular flow could potentially distinguish oocyte maturity in a superior manner than size of follicles. Finally, the value of measurement of endometrial thickness and its structure, as well as uterine and subendometrial flow in the assessment of endometrial receptivity will be discussed.
WS03‐02Doppler assessment of the ovarian blood flow
Authors: Mercé L. T.
Published: March 2003

Background

The aim of this study was to evaluate arterial and venous intraovarian blood flow in infertile patients.

Methods

Seventy‐six FSH stimulated cycles in 39 patients participating in a timed intercourse or iui program were studied. Transvaginal color and pulsed Doppler measurement of the dominant follicle and corpus luteum resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), maximum venous velocity (MVV) and serum p levels during mesoluteal phase were recorded. Velocimetric parameters were established and then used to classify ovarian function in normal ovulatory cycle (NOV; n = 52), luteal phase defect (LPD; n = 15) and luteinized unruptured follicle (LUF; n = 9).

Results

The luteal PSV and MVV in the nov and LPD cycles were significantly higher (NOV: 24.3 ± 12.2 vs. 13.1 ± 6.5 and 8.1 ± 3.30 vs. 3.6 ± 1.1; LPD: 29.8 ± 10.3 vs. 14.4 ± 4.8 and 5.7 ± 1.5 vs. 4.3 ± 1.2) and luteal RI and PI were significantly lower (NOV: 0.45 ± 0.06 vs. 0.55 ± 0.08 and 0.62 ± 0.15 vs. 0.83 ± 0.22; LPD: 0.46 ± 0.05 vs. 0.54 ± 0.06 and 0.62 ± 0.10 vs. 0.81 ± 0.15) than follicular ones. LUF cycles did not show significant changes during the ovarian cycle (follicular vs. luteal PSV; MVV; RI and PI: 14.4 ± 4.8 vs. 14.9 ± 7.3; 4.3 ± 1.2 vs. 4.2 ± 2.1; 0.47 ± 0.07 vs. 0.58 ± 0.12 and 0.66 ± 0.12 vs. 0.89 ± 0.29) and no ‘luteal conversion’ of the Doppler signal was identified. There was significant correlation between luteal MVV and serum p (r = 0.36).

Conclusions

Arterial and venous intraovarian blood flow remain unaltered during LUF cycles and P levels correlate with luteal MVV. This makes Doppler an effective noninvasive test to assess ovulation and luteal function.
WS03‐03Three‐dimensional digital imaging for assessing oogenesis and follicular development as well as live 3D follicle aspirations
Authors: Feichtinger W.
Published: March 2003

The purpose of the first study was to evaluate whether number and size of antral follicles can predict the outcome of IVF‐ET. A total of 113 patients was prospectively included into this study. After 19 days of downregulation number and size of follicles were determined by using recent three dimensional transvaginal ultrasound (3‐D) technology. We demonstrated that patients with a higher number of follicles between 5 and 10 mm showed a significantly higher pregnancy rate (PR), whereas patients with antral follicles > 11 mm have a higher cancellation rate due to ovarian low‐response.

Ultrasound visualization of the cumulus has been demonstrated years ago as an occasional finding during follicle scanning. It has never been proven, however, that cumulus‐like intrafollicular structures as seen on ultrasound correlated with the recovery of mature oocytes. It was therefore our aim to investigate this possibility by using recent three‐dimensional ultrasound (3‐D) technology: Cumulus visualization by 3D ultrasound seems to be an indicator for mature oocytes and the fertilization rate. Follicles without visualization of the cumulus in all three planes are unlikely to contain mature, fertilizable oocytes.

In the third part we wanted to evaluate the possibility of puncturing procedures under three‐dimensional ultrasound control in close to real time using a new commercially available system, and to describe the technique.

It will be demonstrated for follicle punctures that recent technology enables the carrying out of three‐dimensional puncture procedures in real time; but this will be of more importance in other fields, e.g. in fetal medicine, oncology, and surgery.
WS03‐04Three‐dimentional‐ultrasound in IVF cycles
Authors: Schild R. L. , Knobloch C. , Van Der Ven H. , Hansmann M.
Published: March 2003

Aim

To investigate the role of 3D‐ultrasound in estimating the likelihood of conception in an IVF programme.

Materials and methods

We studied a total of 152 women during their stimulation cycle. Apart from conventional 2D‐parameters we assessed endometrial and uterine volume (sub‐)endometrial blood flow (sub‐)endometrial vessel density and ovarian volume by 3D‐ultrasound.

Results

With regard to subendometrial blood flow on day 1 of the stimulation cycle, all 3D‐indices were significantly lower in the conception vs. non‐conception group. On the day of oocyte retrieval, any difference between the two groups failed to reach statistical significance. The same applied to endometrial volumes. The latter showed a significant corrrelation with uterine size. Ovarian volumes ≤ 3 mm (1 SD below the mean) on day 1 of the stimulation cycle were associated with a nonsignificant lower conception rate.

Conclusion

Quantitative assessment of spiral artery blood flow and vessel density may be an early predictor of IVF success.
WS03‐08Diagnosis and treatment of PCO syndrome – what is the place of ultrasound
Authors: Šimunic V.
Published: March 2003

Ultrasound characterization of ovarian morphology and vascularisation has become an important part of gynaecological endocrinology. PCO syndrome is the most prevalent endocrinological problem in women during reproductive period of life. The us diagnostic accuracy has advanced from recognition of ovarian size (volume), characteristic follicular distribution and volume of dense ovarian stroma, to blood flow changes in the uterine and ovarian stromal vessels. Improvement has been made by using innovations such as 3D US, colour and pulsed Doppler US, which allows US quantitative analysis of the ovarian stroma. In the PCOS the ovarian stroma is the source of hyperandrogenemia.

One hundred and thirty‐two patients with PCOS, diagnosed by us and endocrinological findings, underwent further clinical, US and endocrine evolution during various kinds of therapy (metformine, ovarian drilling, oral contraception, flutamide and finasteride treatment). Mean age of the PCO patients was 25.5 years (range 15–48), 59.3% were obese (BMI = 28), 75.6% had signs of hirsutism, 43.02% presented with acne and 88.5% have had irregular menstrual cycle. Ultrasound findings (TVUS, colour and pulsed Doppler, 3D US) and hormonal evaluation (FSH, LH Androstendion, DHEA‐a, T, Free T, SHBG, 3 α diol) were performed prior, during and at the end of the therapy.

Comparison has been made between these five groups of patients.
WS03‐10Vasoactive substances and infertility
Authors: Battaglia C. , Regnani G. , Volpe A.
Published: March 2003

The regulation and significance of ovarian and uterine haemodynamics in human reproductive pathophysiology has been largely studied. In women, ovarian vascularization seems to be responsible for the selection and maturation of follicles both in spontaneous and stimulated IVF cycles while endometrial receptivity is related to uterine blood flow and implicated in the achievement of pregnancy. In patients who underwent to IVF cycles, the PI of both uterine and spiral arteries is significantly lower in patients who became pregnant in comparison with nonpregnant and is associated with significantly lower endometrial cell thromboxane concentrations than non pregnant patients. In poor responders women it has been demonstrated the role of l‐arginine in improving uterine and follicular Doppler flow and in increasing ovarian response to gonadotrophin. Recently, in a total of 41 patients undergoing to assisted reproduction, an higher number of oocytes collected and embryos transferred was observed in normo‐responders than in poor‐responders patients. Furthermore follicular vascular endothelial growth factor (VEGF) resulted inversely correlated with retrieved oocytes (r = −0.942; p = 0.0017). In addition significant higher uterine and perifollicular Doppler flow resistances were observed in poor‐responders women. The pregnancy rate/cycle was significantly higher in normo‐responders (26%) than poor‐responders (6%; p = 0.037) patients.

In conclusion, vasoactive substances improve ovarian response to gonadotrophin and allow a better management of ovarian stimulation in infertile patients.
WS04‐02Should all unilocular ovarian cysts be removed in postmenopausal women?
Authors: Granberg S. , Ekerhovd E. , Wienerroith H. , Staudach A.
Published: March 2003

Objectives

Our purpose was to evaluate the risks of malignancy in surgically removed ovarian cysts that preoperatively were characterized as unilocular by transvaginal sonography.

Study design

This prospective analysis included 1307 women operated at two European university Hospitals between January 1992 and December 1997. Based on ultrasonographic findings the cysts were characterized either as echo‐free, without solid parts or papillary formations (group I) or cysts with solid parts/papillary formations or echogenic cyst content (group II). Ultrasonographic and macroscopic appearance of the cysts were compared with histopathological diagnosis.

Results

In group I seven of 670 (1.1%) proved to be borderline or malignant, and all measured ≥ 75 mm in diameter. The corresponding figures for cysts in group II were 24 of 634 (3.8%). The frequency of borderline/malignant cysts increased significantly with the size of the cysts.

Conclusion

Unilocular, echo‐free cysts (group I) with a mean diameter above 50 mm and all unilocular cysts with solid parts/papillary formations should be removed surgically. Serial ultrasound follow‐up should be the standard procedure of unilocular, echo‐free cysts less than 50 mm.
WS04‐05Doppler ultrasound and hormonal replacement therapy (HRT)
Authors: Zalud I.
Published: March 2003

Hormonal replacement therapy (HRT) offers multiple benefits and some risks to many postmenopausal women, especially to those whose menopause occurred before age 45. Improvements of image resolution by transvaginal sonography allow the investigation of very delicate anatomical structures such as the endometrium. Various diagnostic criteria including thickness and volume of endometrium, internal structure and myometrial involvement help to identify endometrial abnormality. The benefits of technologies such as sonohysterography, Doppler and 3D ultrasound are being assessed. In the postmenopausal patient without hormonal substitution, endometrial pathology may be diagnosed by measuring endometrial thickness alone. In women with postmenopausal bleeding, endometrial atrophy as the must common cause has been differentiated from endometrial cancer with a high success rate. Considering that the majority of diagnostic endometrial biopsies reveal a benign pathology, Doppler ultrasound may significantly reduce the number of these procedures. In patients with HRT, the measurement of endometrial thickness is not reliable to predict pathology. In this situation, ultrasound examination of the endometrial/myometrial border or endometrial blood flow is advantageous. Transvaginal ultrasound and Doppler blood flow analysis could prove helpful in selection and follow up of patients on HRT and maybe to prevent some unwanted endometrial effects.
WS01‐03The posterior fossa: a useful landmark in the evaluation of the fetal ventriculomegaly
Authors: D′addario V. , Pinto V. , Di Naro E. , Di Cagno L.
Published: March 2003

Objective

The objective of this study was to obtain a nomogram of the clivus‐suvraocciput angle as a basis for the diagnosis of Chiari II malformation in fetuses with ventriculomegaly.

Design

A cross‐sectional study was undertaken on 310 normal pregnant women of 16–34 weeks' gestation. A mid‐sagittal section of the fetal skull was obtained and the angle between the clivus and the supraocciput was measured. 44 fetuses with ventriculomegaly due to different causes (13 Chiari II malformation, 12 dysgenesis of the corpus callosum, 7 aqueductal stenosis, 6 borderline ventriculomegaly, 3 Dandy‐Walker malformation, 2 porencephaly, 1 schizencephaly) were also included into the study and the values of the angle found in the pathological cases were compared with that found in the normal population.

Results

The clivus‐supraocciput angle did not change during gestation and was almost constant with an average value of 79,3° ± 6°. All cases of Chiari II malformation showed a value below the 10th centile of our nomogram; all the remaining cases of ventriculomegaly showed normal values of the angle.

Conclusions

The evaluation of the posterior fossa and particularly the measurement of the clivus‐supraocciput angle is a useful parameter to differentiate the various causes of fetal ventriculomegaly and particularly to recognize Chiari II malformation. The measurement of the angle could be also useful to screen for spina bifida which is almost constantely associated to Chiari II malformation.
WS05‐05A role of ultrasound in follow‐up of tamoxifen patients
Authors: Predanic M
Published: March 2003

Recently suggested role of tamoxifen as a preventive agent in women at high risk of breast cancer has a potential to increase significantly the number of women treated with tamoxifen agent. By the fact that tamoxifen is beneficial in taming the breast cancer, but detrimental to the uterus by increasing the risk of endometrial carcinoma, hyperplasia, and development of endometrial polyps, surveillance of endometrial changes in patients on tamoxifen is needed. However, no cost‐effective method has been found for screening for the rare occurrence of endometrial carcinoma. Therefore, the ACOG does not recommend routine endometrial screening of tamoxifen‐treated breast cancer patients. Regardless of aforementioned recommendation, ultrasound (US) is very helpful as a first line for diagnosis of endometrial pathology in symptomatic or asymptomatic patients with previous endometrial pathology. Endometrial thickness < 5 mm is reassuring, > 5–8 mm calls for further investigation such as sonohysterography to rule out polyps. If it fails to demonstrate polyps, but cystic structures still present and letter on endometrial biopsy (or D & C) shows atrophic changes of the endometrium or material is insufficient for analysis, likely diagnosis is Cystic Endometrial Atrophy. Additionally, Color Doppler flow measurement helps in differentiation between atrophic cystic endometria and polyps, hyperplasia or even cancer in terms that atrophic endometrial are mainly avascular, whereas endometrial polyps and carcinomas are richly vascularized within the endometrium as well as in surrounding myometrial tissue.

How and how often endometrial surveillance should be done?

1. Recommend us or endometrial biopsy evaluation prior to tamoxifen treatment;

2. Follow up with endometrial biopsy/D & C if symptomatic; or

3. If asymptomatic but patient at high risk (history of previous endometrial disorders, obesity, long duration of tamoxifen treatment), recommend us 6 months.

US findings

1. If endometrial thickness > 5–8 mm, exclude endometrial polyps by sonohysterography; and add color doppler to evaluate vascularity pattern;

2. If no polyps with thick endometrium on sonohysterography and avascular pattern present, perform blind or hysteroscopic guided endometrial biopsy;

3. If findings are atrophic endometrium or insufficient material for diagnosis, assume atrophic (± cystic) endometrial changes and continue annual/semiannual endometrial evaluation (± US);

4. If (+) simple hyperplasia, consider progestin and/or D & C treatment;

5. Consider hysterectomy as final option if endometrial pathology persists.
WS01‐06Fetal obstructive uropathies: management and outcome
Authors: Sen C.
Published: March 2003

Background

Urinary tract anomalies are among the most common sonographically identified anomalies in utero with the incidence about 1/250–1/1000 pregnancies. The obstruction can be unilateral or bilateral at the level of urethra, ureteropelvic junction (UPJ), ureterovesical junction (UVJ).

Method

Obstructive uropathy cases diagnosed antenatally have been retrospectively evaluated in terms of short and long‐term outcome. It is important to make early diagnosis and intervention in order to save organ function as possible.

Results

During last 7 years in our Department, 58 cases with fetal obstructive uropathy were examined and performed 12 interventions. They were diagnosed antenatally with different type of obstruction including posterior urethral valve syndrome, unilateral and bilateral hydronephrosis, ureteropelvic junction obstruction, multicystic kidney. Intervention was performed in 12 cases at different stage of gestation including needling, vesico‐amniotic shunting and pelvic shunting. Out of 12 procedures, there was mortality in 5 cases antenatally or neonatally.

Conclusion

Early diagnosis of the obstruction is very important before the kidney becomes dysplastic. The type of anomalies, level and starting time of pathology and duration of severe obstruction are the main factors for prognosis. Early diagnosis and referral to tertiary center is to be encouraged in order to have early management and intervention in the case of severe obstruction and to save kidney function as early as possible.