bluuebunny/crossref_metadata_2025 huggingface dataset:
Arteriovenous fistulas of the placenta in a singleton fetus with large atrial septal defect and anomalous connection of the umbilical veins
Authors: Chiappa E. , Viora E. , Botta G. , Abbruzzese P. A. , Ciriotti G. , Campogrande M.
Published: March 2003

Arteriovenous fistulas of the placenta rarely occur in single‐ton pregnancies. This report describes the fetal and neo‐natal hemodynamic pattern in a singleton gestation in which multiple placental artery‐to‐vein anastomoses were associated with a large atrial septal defect and a single umbilical artery with an anomalous connection of the persistent right and left umbilical veins. Possible links between the extracardiac vascular malformation and the congenital heart defect are discussed. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic diagnosis of a retroperitoneal dermoid cyst in a young girl
Authors: Kanizsai B. , Turi Z. , Örley J. , Szigetvári I. , Doszpod J.
Published: March 2003

We describe the detection and management of a retroperitoneal dermoid cyst in a young girl. Transabdominal ultrasound revealed in the pelvis a complex mass with anechogenic and echogenic components characteristic of a dermoid cyst. Initially, it was presumed to be of ovarian origin, because extragonadal dermoid cysts are very rare in adolescence; however, the findings on physical examination were normal. Laparoscopy was performed but failed to identify a cyst. Ultrasound examination was repeated intraoperatively and confirmed the presence of the cyst, which was then removed by laparotomy from the retroperitoneum. This case illustrates the significance of ultrasonography in the diagnosis of a rare condition in adolescent gynecology and demonstrates the possibility of performing ultrasound scanning intraoperatively to confirm the presence of a mass which was not identified by laparoscopy. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Myocardial motion imaging: a new application of power color flow and frequency‐based color flow Doppler in fetal echocardiography
Authors: Twining P
Published: March 2003

Objective

Myocardial motion imaging is a new way of looking at the fetal heart using power color flow and frequency‐based color flow Doppler to demonstrate heart wall movement in color. This study set out to assess the value of myocardial motion imaging in fetal echocardiography in a routine clinical setting.

Design

In our hospital, all patients at high risk of carrying a fetus with a cardiac abnormality are offered detailed ultrasound scanning, including fetal echocardiography, at 20 weeks' gestation. A prospective study was carried out over a 2‐month period and, in addition to conventional fetal echocardiography, myocardial motion imaging was also carried out on all patients, by means of both power color flow and frequency‐based color flow Doppler ultrasound.

Results

Myocardial motion imaging demonstrated fetal heart wall movement in 26 of the 27 patients. Myocardial motion imaging using power color flow gave a global view of fetal heart wall movement, demonstrating both atrial and ventricular contraction simultaneously. Myocardial motion imaging using frequency‐based color flow Doppler demonstrated atrial and ventricular contractions separately.

In addition, as the direction of fetal heart wall motion can be color coded, atrial contractions, ventricular relaxation and ventricular contraction were demonstrated, providing a functional assessment of fetal heart wall movement. Two cases of cardiac abnormality were also studied, one case of hypoplastic left heart syndrome and one case of atrioventricular septal defect. In both cases functional information was obtained using myocardial motion imaging, and the technique also highlighted the anatomical defect.

Conclusions

Myocardial motion imaging produces both a global view of fetal cardiac anatomy and a functional assessment of individual chamber contraction in the normal and abnormal heart. It may prove to be a useful adjunct to conventional color flow Doppler assessment of the fetal heart. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Fetal cataract in congenital toxoplasmosis
Authors: Pedreira D. A. L. , Diniz E. M. A. , Schultz R. , Faro L. B. , Zugaib M.
Published: March 2003

We report a case of the prenatal diagnosis of fetal cataract due to congenital toxoplasmosis. To the best of our knowledge, this is the first report of such case. We discuss the long‐term ocular sequelae of the condition and how they should affect prenatal counselling Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal sonographic diagnosis of epignathus at 15 weeks of pregnancy
Authors: Gull I. , Wolman I. , Har‐Toov J. , Amster R. , Schreiber L. , Lessing J. B. , Jaffa A.
Published: March 2003

Epignathus is a rare, benign, congenital teratoma of the hard palate. Most of these teratomas are unidirectional and protrude through the mouth. Hence, the prognosis depends on the size of the tumor and the degree of face distortion and airway obstruction that it causes. However, some epignathi protrude bidirectionally, involving and destroying the brain tissue, resulting in a poor prognosis. This report presents a case of ultrasonographic detection of a bidirectional epignathus at 15 weeks of pregnancy. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal salpingosonography for assessing tubal patency in women previously treated for pelvic inflammatory disease and benign ovarian tumors
Authors: Spalding H. , Martikainen H. , Tekay A. , Jouppila P.
Published: March 2003

Objective

The aim of this study was to evaluate the role of transvaginal salpingosonography in the assessment of tubal patency among women previously treated conservatively for pelvic inflammatory disease and surgically for a benign ovarian tumor.

Design

Twenty‐two women were recruited for this study at the University Hospital of Oulu. Transvaginal salpingosonography was scheduled to be performed twice within a 3‐month interval. X‐ray hysterosalpingography was chosen as a reference method and was performed within 2 days of the second salpingosonography examination during the same menstrual cycle. Altogether, 31 Fallopian tubes were assessed with the second salpingosonography examination and X‐ray hysterosalpingography.

Results

Twenty‐nine Fallopian tubes were observed by both methods to be patent (i.e. 29 tubes by each method, but not necessarily the same tubes). An occlusion was diagnosed by each method in two tubes only, of which one appeared occluded by both methods, while one tube from each method appearing to be occluded was demonstrated to be patent using the other method. The agreement of transvaginal salpingosonography compared with X‐ray hysterosalpingography was 94%, the sensitivity 50%, the specificity 97%, the positive predictive value 50% and the negative predictive value 97%. Two successive transvaginal salpingosonography examinations were performed in 18 patients with 27 Fallopian tubes. Disagreement was observed for only one tube. The agreement between these two examinations was 96%, the sensitivity 100%, the specificity 96%, the positive predictive value 67% and the negative predictive value 100%. The kappa coefficient was 0.78 (95% confidence interval 0.75–0.81).

Conclusions

In conclusion, transvaginal salpingosonography can be used in patients with previous pelvic inflammatory disease and adnexal surgery due to its ease of use, reliability and low costs on an out‐patient basis. Among these patients, tubal patency was a common finding. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Uterine anomalies and failed surgical termination of pregnancy: the role of routine preoperative transvaginal sonography
Authors: Jermy K. , Oyelese O. , Bourne T.
Published: March 2003

Although used extensively in the assessment of many gynecological conditions, transvaginal ultrasonography is not performed routinely prior to termination of pregnancy in the UK.

We describe a case in which surgical evacuation of the uterus failed. Postoperatively, transvaginal ultrasonography demonstrated a bicornuate uterus with a viable pregnancy within the left horn. Subsequent medical termination of pregnancy was successful.

This case shows the potential value of transvaginal ultrasonography prior to termination of pregnancy. A prospective trial is needed to assess whether its routine introduction into clinical practice will lead to a reduction in morbidity resulting from termination. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
P10Development of cardiac size in early pregnancy
Authors: Rosati P. , Guariglia L.
Published: March 2003

Background

The relationships between measurement of cardiac circumference, obtained by transvaginal sonography in early pregnancy, and other sonar fetal parameters – crown rump length, biparietal diameter, head, toracic and abdominal circumference, femur, humerus and foot length – were analysed in order to assess the role of these variables for the identification of fetuses at risk of abnormal cardiac development.

Methods

Study population consists of 1435 euploid fetuses at 9–16 weeks of gestation. Ultrasound examinations were performed using high‐resolution apparatus (model SSA‐270 A and SSA‐340 A; Toshiba Medical Corporation, Tokyo, Japan) equipped with 5.0–7.0 MHz transvaginal probes with a maximal angle of vision of 86° and 121°, respectively. au scans were performed by the authors. Nomograms were established for cardiac circumference vs. eight sonographic parameters.

Results

Cardiac circumference demonstrates to be highly correlated with abdominal circumference (r2of 0.65) with narrow confidence interval of cardiac circumference ranging from 6 to 19%.

Conclusion

Our results showed also a good correlation between cardiac circumference and the other variables suggesting that cardiac measurement in early pregnancy could be a screening tool for identifying fetuses at risk of disorders affecting heart growth.
P112Early fetal echocardiography at 13–16 weeks of gestation
Authors: Martinez J.M. , Puerto B. , Borrell A. , Cararach V. , Fortuny A.
Published: March 2003

Objective

Our aim was to determine the potential value of fetal echocardiography at 13–16 weeks of gestation for early reassurance of normality or a prenatal diagnosis of congenital heart disease in high‐risk pregnant women.

Methodology

92 pregnant women from 13 to 16 weeks with singleton pregnancies underwent fetal echocardiography because of a high risk of congenital heart disease. The main indications were: nuchal translucency > 95th centile, pregestational diabetes, family history, suspected cardiac anomaly at screening ultrasound, woman at risk of chromosomal abnormality declining invasive testing and fetus affected by a chromosomal abnormality. All the examinations were performed combining either the transvaginal or the transabdominal route, and were considered as complete when the four chamber view, and the origin and double crossing of the great arteries were correctly identified. Colour and pulsed Doppler examination were used to detect regurgitation or very high velocities suggesting valve stenosis. A further conventional transabdominal echocardiography at 20–22 weeks of gestation was performed in all aparently normal cases.

Results

We were able to reassure normality in 84 of the cases and eight congenital heart anomalies were diagnosed.

Conclusion

Fetal echocardiography at 13–16 weeks' is feasible and can be offered to high risk pregnants. It should be supplemented with the conventional 20–22 weeks' examination whenever normality is diagnosed in the early scan. Postmortem examination is essential to confirm its accuracy.
P113Prenatal diagnosis of congenital heart defects: report of 263 cases
Authors: Galindo A. , Carrera M. , Salvador M. , Gutiérrez‐Larraya F. , Gómez E. , De La Fuente P.
Published: March 2003

Aim

To evaluate the main characteristics of prenatally diagnosed congenital heart defects (CHD).

Methods

Retrospective study of 263 fetuses with CHD diagnosed between January 1993–September 1999. In this period 133 more cases were born with a CHD not identified prenatally.

Results

The incidence in the period reviewed was 1/148 deliveries (7‰). 161 patients (61%) were referred from other Hospitals. Mean gestational age at diagnosis was 27.1 weeks (range: 13–41). 103 were diagnosed before 22 weeks (39%). Most common CHD were complete atrioventricular canal (CAVC) (49 cases, 18%), hypoplastic left heart syndrome (HLHS) (37,14%) and conotruncal anomalies (CTA) (31, 12%). Postnatally, most common CHD were ventricular septal defects (VSD) (70, 29%). Overall sensitivity was 66%, improving from 1993 (60%) to 1999 (80%). Sensitivity was higher for CAVC (86%), HLHS (90%), tricuspid atresia (93%). Sensitivity was poor in VSD (26%). Associated anomalies were seen in 105 cases (40%) more common in CAVC (37/49, 75%), VSD (16/22, 73%) and CTA (14/31, 45.2%). In 85 cases (32%) termination of pregnancy (top) was performed. This represents 82.5% of 103 cases diagnosed < 22 weeks' gestation. tops were more common in CAVC (39%) and HLHS (46%).

Conclusion

Fetal echocardiography enables the diagnosis of a high number of CHD in the first half of pregnancy. Changes in the monographic visualization of the CHD over the pregnancy with potential progression of the lesion in utero, the small size of the defect and difficulties in monographic work‐up are explanations for late diagnosis and false negative cases. The distribution of the different CHD differs from that observed postnatally. Associated anomalies should be ruled out because of their high frequency, mainly in some specific heart defects.
P120Prenatal demonstration of polyvalvular disease in a fetus with trisomy 18
Authors: Gembruch U. , Germer U. , Denzel S. , Gloeckner‐Hofmann K.
Published: March 2003

A polyvalvular disease of cardiac valves is a common finding in early trimester fetuses with trisomy 18 at autopsy (Hyett et al. Am J Med Genet 1997; 69: 207). Prenatal diagnosis of this disease, however, is very rare.

Case report

Nuchal translucency screening was performed in a 26‐year‐old gravida 1 at 13 + 5 weeks. IUGR (CRL 65 mm) with nuchal translucency thickness of 3.0 mm, retrogenia and cardiomegaly (CTR > 0.5) was shown. Umbilical artery Doppler indices were normal (PI 1.44), but in the ductus venosus a reversed blood flow during atrial systole was demonstrated (PIV 4.18, PVIV 2.9). Echocardiography showed ‘doming’ of the pulmonary and aortic valves with poststenotic dilatation. Doppler echocardiography demonstrated severe stenoses of the pulmonary and aortic valves (maximal velocities: 1.8 m/s and 2.13 m/s, respectively) and holosystolic insufficiencies of tricuspid and mitral valves (maximal velocities: 2.12 m/s and 2.04 m/s, respectively). The CVS revealed trisomy 18 (47,XY, + 18). 6 days later, fetal demise was diagnosed. Abortion was induced by an intra‐amnial injection of Rivanol. Autopsy confirmed the severe stenoses of both great arteries without additional cardiac malformation.

Conclusions

The case reports the option of Doppler echocardiography in early pregnancy to diagnosed severe stenosis of the great arteries and confirmed the data of autopsy studies, that fetuses with trisomy 18 in early pregnancy have polyvalvular diseases, presumably being a lethal factor.
P134Uterus sonographic volume evaluation in post menopausal women and its variation
Authors: Santos F. F. A. , Machado M. R. M. , Dertkigil M. S. J. , Marussi E. F.
Published: March 2003

Background

The aim of this study was evaluate the uterine volume in postmenopausal women considering parity, years since the last menstrual bleeding, abnormal vaginal bleeding and hormonal replacement therapy (HRT).

Method

Uterine size was measured in 100 postmenopausal women by pelvic and/or transvaginal US, that had gone to routine examinations.

Results

The mean age was 61.5 years (± 9.3) and the mean menopausal age was 48 years (± 5). Forty percent was under HTR and the mean parity was 4.0 (± 3). Abnormal vaginal bleeding was present in 13% of the patients. The patients were divided into three groups: I (nullipara), II (1 or 2 deliveries), III (3 or more deliveries). The uterine volume was, respectively, 39, 45 and 47 cm3. Patients under HTR had the mean uterine volume 51 cm3 and the others 42 cm3. Patients with 5 or less years since menopause had a mean uterine volume of 51 cm3 and the women with 6 or more years had 44 cm3. The mean uterine volume in patients with abnormal vaginal bleeding was 62 cm3 (± 35) and in the assynthomatic ones was 43 cm3(± 21).

Conclusions

The uterine volume had a tendency to be smaller in patients without HTR, low parity and more years since last menstrual period, but have no statistical significance. However the volume was significantly bigger in women with abnormal vaginal bleeding.
P14Sonographic features of the cervix in the midtrimester as a predictor of preterm delivery
Authors: Fukami T. , Sekiya T. , Yoshimatsu K. , Otabe T. , Tsukada K. , Ishihara K. , Araki T.
Published: March 2003

Background

The purpose of this study was to predict preterm delivery by transvaginal ultrasound in the midtrimester.

Method

This prospective study was conducted on 568 outpatients with normal pregnancy up to 16 gestational weeks. After the patient's consent was obtained, serial transvaginal ultrasound scanning (TVS) was planned at 2–4 weekly intervals from 16 to 27 gestational weeks, and used to assess cervical length, cervical gland area and internal os dilatation.

Results

(1) The preterm delivery (37 weeks gestation) rate of the patients was 3.0% (17/568). (2) Of the three predictive factors of preterm delivery namely shortened cervical length (30 mm), absence of cervical gland area, and internal os dilatation, the most useful monographic feature of the cervix was absence of cervical gland area examined at 16–19 weeks gestation. (3) The combination of these factors at 16–19 weeks gestation improved the predictive value (sensitivity 35%, specificity 99%, positive predictive value 88%, negative predictive value 96%).

Conclusion

For the prediction of preterm delivery by TVS in the midtrimester, the most appropriate gestational period was at 16–19 weeks, and the best predictive factor was a combination of the absence of cervical gland area with shortened cervix and internal osdilatation.
P141Benign mucinous ovarian cysts: transvaginal sonography with color Doppler features
Authors: Pascual Ma.A. , Tresserra F. , Ubeda A. , Grases P.J. , Hereter L. , Labastida R.
Published: March 2003

Aim

To evaluate the accuracy of transvaginal sonography with color Doppler (TVSCD) in identifying mucinous ovarian cysts.

Material and methods

Five hundred 18 adnexal masses were diagnosed by TVSCD before surgery. We identified those adnexal masses in which an ultrasonographic diagnosis of mucinous ovarian cyst was done. This diagnosis was based on the presence of a cystic lesion with thin, grape‐like appearing septa and diffuse internal echoes. This diagnosis was compared with the pathological features.

Results

A total of 49 mucinous cysts were diagnosed by TVSCD, 26 of them were histologically confirmed. Twenty‐three cysts were misdiagnosed (9 were serous, 4 were interpreted as malignant and one was an endometrioma). TVSCD was unable to diagnose 14 out of 40 mucinous cysts confirmed by histology. The ultrasonographic features most frequently seen as suspicious of malignancy were thin, grape‐like appearing septa (84.6%) and diffuse internal echoes (53.8%). The sensitivity, specificity, and positive and negative predictive values and accuracy of TVSCD were 65%, 95.2%, 53.1%, 97%, and 92%, respectively.

Conclusions

The accuracy of TVCD for the diagnosis of benign mucinous cysts is very high, being the most frequently cause of confusion simple serous cysts.

Acknowledgements

The authors are grateful to the Càtedra d'Investigació en Obstetrícia i Ginecologia (Universitat Autónoma de Barcelona).
P142Endometrioma simulating ovarian cancer in a postmenopausal woman – report of one case
Authors: Kavak Z. N. , Başgül A.
Published: March 2003

Background

External endometriosis is principally a disease of active reproductive life which is seldom found during postmenopausal years because of estrogen deprivation. Endometriosis is a great mimicker of other pelvic pathologies especially in postmenopausal years. We report here, a case of ovarian endometrioma in a postmenopausal woman simulating ovarian cancer. Ultrasonographic features, clinical presentation, differential diagnosis and treatment modalities of this rare case are presented and discussed.

Case

76‐year‐old woman gravida 3 para 2 presented with an asymptomatic pelvic mass discovered on gynecologic examination. An ultrasound examination was requested to investigate the nature of this mass. She was otherwise symptom‐free surprisingly except for occasionally occuring bilateral pelvic pain. Longitidunal sonograms showed an irregular, partially solid and cystic mass in the right adnexal region. A transverse scan showed the presence of a complex right adnexal mass measuring 6 × 7 × 7 cm in diameter which was considered most likely to be malignant. CA‐125 level of her was slightly elevated. Urgent laparatomy revealed no evidence of malignancy and the mass proved to be an endometrioma histologically. Most possibly, the presence of old blood within the tumor simulated a solid component. The patient was vigorously reassured and hormone replacement therapy was given in the postoperative follow up period.
P143Primary bilateral fallopian tube cancer – case report
Authors: Wojcieszyn M. , Błaszczyk K. , Biernat M. , Krzystyniak M. , Poreba R.
Published: March 2003

Introduction

Fallopian tube cancer is one of the rarest neoplasm of female reproductive tract. Primary, bilateral presence of the cancer is especially rare. Diagnostic difficulties cause, that it is often found in very advanced state. The authors have presented the case of primary bilateral cancer of the fallopian tube, qualified to surgical treatment on the base of sonographic examination.

57 years‐old women was examined using transvaginal ultrasound due to increasing pain in the lower part of the abdomen and abnormal discharge out of the vagina. During the examination fluid in the uterus cavity and cystic, oblong, winding structures in both adnexa, looking like distended oviducts were found. Typical ovary tissue wasn't visible. On the base of history and examination laparotomy was ordered. During the surgery multiple adhesions in the pelvis and extended fluid filled fallopian tubes were found. The hysterectomy and bilateral adnexectomy was performed. Pathological examination revealed presence of bilateral papillary adenocarcinoma of the fallopian tubes. Out of the oviduct no neoplastic cells was found.

Conclusion

Extended fluid filled oviducts found during sonographic examination may be the first sign of fallopian tube cancer.
148Blood flow changes after uterine artery embolization in the treatment of adenomyosis and myomis: preliminary report
Authors: Lee E.‐H. , Sunwoo T. W. , Ahn C. S. , Lee M.‐H. , Lee W. H.
Published: March 2003

Background

The aim of this study was to evaluate prospectively the changes of blood flow following permanent embolization of uterine arteries using polyvinyl alcohol in the treatment of uterine adenomyosis or myomas.

Methods

From August 1998 to May 1999, 114 cases of uterine artery embolization were performed for the patients having symptomatic adenomyosis (n = 63) or myomas (n = 51). They were underwent baseline (n = 114) and follow‐up ultrasound on 1 week (n = 106), 3 (n = 102) and 6 months (n = 23) after embolization. The peak systolic velocity (PSV) and resistive index (RI) were calculated in the isthmic portion of uterine arteries and intratumoral vessels.

Results

One week after embolization, uterine blood flow was markedly decreased comparing with pre‐embolization status. After 3 months, blood flow was recovered up to 56% of pre‐embolization state but not increased significantly on 6 months examination. Color flow was not detected within the myomas after embolization.

Changes in PSV and RI

Pre
1 week
3 month
6 month

PSV (cm s−1)
54.7
23.0
30.5
32.0

RI
0.76
0.84
0.80
0.79

Conclusion

Uterine blood flow was markedly decreased immediately after embolization and increased up to the half level of pre‐embolization status on 3 months examination.
P155The pathological breast in gestation‐puerperal period
Authors: Machado M. R. M. , Santos F. F. A. , Marussi E. F. , Pereira S. L. , Vissotto S. L.
Published: March 2003

Background

The aim of this study was to describe the appearance of breast tissue in a breast inflammatory disease and in the inflammatory breast tumour during gestational‐puerperal period using ultrasound and to evaluate the contribution of this exam in differential diagnosis.

Method

We will describe two cases with increase of volume breast, analysed by two‐dimensional ultrasound, performed on an ACUSON XP4A using a 7,5 MHz linear, focused probe with Colour Doppler.

Results

The two patients showed typical inflammatory characteristics, similar symptoms and the same appearance of breast tissue in ultrasound. The two exams appears as parenquymal disorganisation breast tissue, increase width skin, hypoechoic ill undefined masses with some internal echoes, thick walls and septations.

Conclusions

In some cases, the differential diagnosis between breast tumours associated to inflammatory appearance and inflammatory diseases, during pregnancy and puerperal period are very difficult. The Doppler evaluation is helpful as well as clinical history and epidemiology. Sometimes, only the hystological aspects will provide the right diagnosis.
P158The representation of obstetric ultrasound scan among obstetricians and ultra‐sonographers: a descriptive exploratory study
Authors: Quayle J. , Wojciechowski V. , Ueno L. S. , Bunduki V. , Miyadahira S. , De Lucia M. C. S. , Zugaib M.
Published: March 2003

Background

Ultrasound is one of the most known exams performed during prenatal period for diagnosis and screening, but little is known about obstetricians' perceptions associated to the exam. The aim of this study was to assess psychological representations related to obstetric ultrasound scan among obstetricians who were also ultrasonographists and those who were not.

Method

Psychological interview with 54 obstetricians of our Institution with different level of specialization.

Results

55% believe that only a specific training is necessary to be an ultrasonographist, while 35% consider a title essential to perform the exam. Most of the subjects (98%) believe the exam has influences on the pregnant woman bonding with her baby, due to fetal visualization and the proximity feeling it favors. Almost all (93%) consider the possibility of early diagnosis the main feature of the exam while 20% mention the possibility of diagnostic mistakes and their repercussion. When asked to produce projective associations, content analysis points out to aspects associated to the qualities of the exam, particularly ‘fidelity’, precision and power.

Conclusion

There is a massive idealization of the exam and little difference between ultrasonographists and obstetricians. This should be approached during professional training to help them deal with the bonding aspects they themselves consider important.
P22The efficacy of IUGR treatment with arginin—the ultrasound assessment: preliminary report
Authors: Sieroszewski P. , Suzin J. , Surkont G. , Karowicz‐Bilińiska A.
Published: March 2003

Objective

To study the efficacy of IUGR treatment with arginin with the use of ultrasound biometry measurements.

Design and methods

A pilot study was performed on 45 pregnant women with IUGR fetuses (EFW < 10%ile). 30 patients were treated with arginin 2 g daily po during 20 days (I group). 15 patients were not treated (control‐II group). After 3 weeks ultrasound measurements were repeated.

Results

The increase in EFW was greater in I group (587 g vs. 321 g, P < 0.005). After delivery we noticed differences in weight between both groups, but they were not statistically significant (2753 g vs. 2495 g, NS). Percentage of IUGR newborns was higher in 11 group (29% vs. 73%, P < 0.005).

Conclusions

1. EFW (ultrasound assessment) is useful to supervise IUGR fetuses treated with arginin. 2. Arginin treatment of IUGR fetuses is often skuteczne. The project is ongoing. (KBN 4 P05E 01616).
P26Congenital Rubella syndrome and fetal exencephaly – case report
Authors: Andrade J. Q. , Miyadahira S. , Curtis S. P. , Figueiredo C. A. , Yamamoto R. M. , Zugaib
Published: March 2003

Exencephaly is characterized by a complete or partial absence of the skull'cap, follwed by abnormal development of the cerebral tissue.

We report a case of a 31‐year‐old, white patient, on the 9th. week of her second gestation who presented with fever, coryza and myalgia. The gestational period was calculated based on the first ultrasonography, and the maternal sorology for rubella was positive (IgG and IgM).

The patient was send to the department of Fetal Medicine‐HCFMUSP for evaluation. Morphologic ultrasonography and another sorology for rubella were performed. On the 12th gestation week, ultrasonography revealed absence of the skullcap and the presence of cerebral tissue floating in the amniotic fluid. Maternal sorology still showed positive (IgG and IgM). The patient suffered a miscarriage and the maternal (fetus and placenta) was analyzed at the Virology Department of Adolfo Lutz Institute. The virus of rubella was isolated in all the examined organs, and the presence of congenital rubella was confirmed.

Considering that the etiology of this malformation is still umknown and is associated with a severe congenital infection we speculate that is coul be a consequence of the massive fetal compromise caused by the rubella virus.
P34Mechanical ileus diagnosed with transvaginal ultrasonography
Authors: Klarić P. , Grubisic G. , Zovak M. , Tuèkar N.
Published: March 2003

Background

The aim of this work is to present a rare case of mechanical ileus diagnosed with ultrasound and confirmed on radiology.

Thirty‐six years old women underwent an operation because of an endometric cyst and left adnexectomy was done. Mechanical ileus occurred on the fifth postoperative day. A level of liquid in bowel was seen at radiology. At ultrasound we saw on left hemiabdomen distended bowel and a thin, wire‐like hyperechogenic structure with no vascularization, thick about 5 mm. This structure was surrounded by the bowel. Laparotomy detected the bowel surrounded by a wire‐like thin fibrinoid structure which was extended from uterus corn to the left pelvic wall and caused mechanical ileus. After release of this tissue the bowel was in normal condition and peristaltics was restored next day.

Conclusion

It is possible to observe a localization of mechanical ileus with vaginal sonography.
P37Ileal atresia and thrombo‐embolic liver calcifications, a possible complication after treatment with intrauterine laser coagulation therapy for twin to twin transfusion syndrome
Authors: Van Zalen‐Sprock R. M. , Schaap A. H. P. , Van Wijngaarden W. J. , Schnater J. M. , Aronson D. C. , Bleker O. P.
Published: March 2003

Background

Two fetuses with complications after laser coagulation therapy for twin to twin transfusion syndrome (TTTS) are described.

Case 1

In this patient laser coagulation of the connecting placental vessels was performed at 21 weeks of gestation. Two weeks after this treatment the donor twin had died. Sonography of the survivor showed progressive intestinal distension from 24 weeks onwards. After birth a laparotomy was performed and an ileal atresia was found.

Case 2

In this patient laser coagulation was performed at 19 weeks of gestation. Premature rupture of membranes occurred at 21 weeks and both fetuses died. At autopsy thrombo‐embolic calcifications were found in the liver of the smallest, donor twin.

Discussion

Whereas duodenum atresia is considered a ‘true’ congenital anomaly, jejuno/ileal atresia is thought to be caused by a mesenteric vascular accident during fetal life, which leads to necrosis. Intra‐uterine laser coagulation therapy seems promising in the treatment of TTTS. Although it cannot be proven, this therapy must be regarded as one of the possible causes for the thrombo‐embolic processes described in the two cases.
P49Prenatal diagnosis of myelocystocele‐cloacal exstrophy in a male neonate with a abnormal penis and urethra
Authors: De León J. A , Pintado P. , Viñuela M. , Herrero E. , García F. , Aguarón A. , Pérez Fernández R.
Published: March 2003

Introduction

Cloacal exstrophy results from a migration failure of the lateral mesodermal folds of the infraumbilical anterior abdominal wall, and rupture of the resulting enlarged, persistent cloacal membrane before the eighth week of gestation. Myelocystocele is a defect of the medular channel characterizased by a cystic that contain dural and arachnoid layer and the ependymal lining layer, respectively. The association of persistent cloaca and caudal spinal anomalies is thought to be related to cell loss in the caudal cell mass, which affects caudal spinal column formation and cleavage of the cloaca by the urorectal septum. Cloacal malformation occurs in approximately 1 in 65 000 live male births. Prenatal ultrasound may lead to the diagnosis in selected cases.

Case report

We report an unusual case of prenatally detected with a myelocystocele and cloacal malformation. Additional anomalies included an omphalocele and malformations of the upper urogenital tract, skeleton, and vertebral column. Labor was induced at 34 weeks' estimated gestational age. It finish by eutocical delivery. A 2154‐g male was born, Apgar 6/8, pH 7.32. The newborn was taken to NCIU and the neonatal outcome was favourable.
P57Twin pregnancy with a hemiacardiac fetus
Authors: Košec V. , Hodek B.
Published: March 2003

Background

Fetal acardia is a rare anomaly occuring exclusively in monozygotic multiple pregnancies with an incidence of 1:35000 deliveries or in 1% of monozygotic twins. Since 1920, rudimentary developed heart of an acardiac twin, mostly called ‘hemiacardius’ or ‘pseudoacardius’, has been recognized in eigth cases. Four of them have been discovered during autopsy.

We are showing a twin pregnancy of a 25‐year‐old woman with a hemiacardiac and a normal fetus, which was conducted in our Maternity Hospital. In the 22nd week of amenorea a suspicion of acardia of a deceased fetus with multiple malformations was expressed for the first time by ultrasound. With help of amniocenthesis we defined a normal male kariotype of a live twin and by ultrasound we carefully observed its morphology and growth. Furthermore, in the course of the pregnancy, mother's coagulation parameters were controlled weekly. In the 33rd week of gestation an extreme polyhydramnios developed, so amniodrainage was performed twice. The pregnancy was finished in the 36th week of gestation with a caesarian section: a live male child – 2330/46 and a hemiacardiac fetus – 2800 g with multiple malformations were born. The live twin was discharged from hospital three weeks later as a healthy baby.
P58Fetal anemia, thrombocytopenia, dilatated umbilical vein and cardiomegally due to voluminous placental chorioangioma: a case report
Authors: Calda P. , Mára M. , Eretová V. , Žižka Z. , Binder T. , Pavlišta D. , Sebron V.
Published: March 2003

We present a rare case of voluminous placental chorioangioma diagnosed by ultrasound and color Doppler imaging at 20 weeks of gestation. The tumor size enlarged progressively up to 10 cm at 32 weeks. Further pathological findings, showing fetal intrauterine volume overload and blood cells consumption were observed (cardiomegally, umbilical vein dilatation, polyhydramnion, anemia and thrombocytopenia of the fetus). At 32 weeks of gestation the signs of uteroplacental insufficiency and fetal hypoxia appeared. Pregnancy was terminated by sectio Caesarea. The newborn, a girl, with birthweight 1870 g was dismissed in good condition after 48 days. Histopatological examination of placental tumor showed benign, vascular‐type chorioangioma.
P59Prenatal diagnosis of fetal rubella infection by ultrasound‐guided cordocentesis
Authors: Park J. S. , Roh J. W. , Moon J. B. , Jun J. K. , Yoon B. H. , Moon S. Y. , Syn H. C. , Lee H. P.
Published: March 2003

Objective

Our purpose was to compare the accuracy between rubella‐specific IgM and polymerase chain reaction (PCR) for the diagnosis of fetal rubella infection by ultrasound‐guided cordocentesis.

Method

30 pregnant women with the evidences of rubella infection were enrolled. Fetal rubella infection was diagnosed by rubella‐specific IgM using microparticle enzyme immunoassay (MEIA) and rubella virus PCR with the blood obtained by ultrasound‐guided cordocentesis after 21 weeks of gestation. Neonatal outcomes were evaluated by physical examination at birth and rubella‐specific IgM if possible.

Results

20 cases were evaluated by IgM and PCR, and 10 cases only IgM. No fetus showed positive IgM antibody, and 8 of 20 cases showed positive PCR in cord blood, and 6 in amniotic fluid. One infant with negative rubella‐specific IgM by cordocentesis before completed 22 weeks resulted in positive IgM at birth, low birth weight, strabismus and developmental delay. These findings were compatible with congenital rubella syndrome. No case showed congenital rubella syndrome in the fetuses with positive rubella PCR.

Conclusion

(1) The incidence of fetal rubella infection may be very low in mothers with rubella infection. It is suggested that prenatal diagnosis should be performed even if maternal infection occurs in early pregnancy; (2) Cord blood rubella‐specific IgM is more accurate than PCR for the prenatal diagnosis of congenital rubella syndrome; (3) Cordocentesis for rubella‐specific IgM detection should be done after 22 weeks of gestation for accurate diagnosis.
P64The newly calculated equations of nuchal skinfold thickness measurement in mid‐trimester
Authors: Won H. S. , Kim M. K. , Lee P. R. , Lee I. S. , Kim A. , Nam J. H.
Published: March 2003

Background

Use of nuchal skinfold thickness (NT) measurement as an ultrasound marker for Down syndrome has been limited due to a high false positive rate. We suggested that some variables, which influence on NT have been presented. The purpose of our study was to identify the variables that have effects on measured values of NT, and to make a regression equation based on those variables.

Method

The data on gestational age (GA), cephalic index (CI), presentation (Pr; vertex or breech) and the presence or absence of nuchal cord (NC) were collected prospectively on 548 normal singleton fetuses between 16 and 24 weeks' gestation. We calculated independent correlation of those variables with NT by multiple regression analysis and made a regression equation based on GA, CI, Pr, and NC.

Results

GA has positive correlation and CI has negative correlation with NT significantly. The nuchal skinfold was thicker among fetuses with breech presentation rather than those of vertex presentation and increased in the presence of nuchal cord. The all four variables (GA, CI, Pr, and NC) were independent factors to NT by multiple regression analysis.

We calculated the expected NT through these observations; for fetuses presenting vertex, NT = 5.608 + 0.243GA − 0.066CI + NC* and for breech, NT = 2.803 + 0.392GA − 0.066CI + NC* (*if no NC, NC* equals −0.785 and zero for the other).

Conclusion

This is the first report, which takes GA, CI, Pr and NC for correlation factors with NT as a whole. These equations may be considered as a screening method for the detection of aneuploidies.
P68Chorionic villus sampling for prenatal diagnosis in Zagreb: experience with 3000 cases
Authors: Podgajski M. , Podobnik M. , Duic Z. , Cigiar S. , Gebauer B.
Published: March 2003

Objectives

This study comprises data from 3000 women allocated to transcervical CVS (TC‐CVS), transabdominal CVS (TA‐CVS) and transvaginal CVS (TV‐CVS). We have assessed the efficacy of transabdominal CVS compared with transcervical CVS and transvaginal CVS, and examined factors that have been implicated in causing spontaneous abortion.

Method

Over a 10‐year period, 3000 women underwent chorionic villus sampling at 9–12 weeks of gestation, by transcervical (500 patients), transabdominal (2400 patients) and transvaginal technique (100 patients). Transvaginal color Doppler was used to investigate the uteroplacental and fetal vessels in 500 pregnancies between 11 and 12 weeks of gestation (400 TA‐CVS and 100 TC‐CVS) before and after CVS procedures.

Results

Five hundred (16.7%) patients underwent transcervical CVS (TC‐CVS) and spontaneous abortion after TC‐CVS occurred in five cases (1.0%). Some 2400 (80.0%) patients underwent transabdominal CVS (TA‐CVS) using a 20 gauge spinal needle and abortion after TA‐CVS occurred in 10 cases (0.4%). One hundred (3.7%) patients underwent transvaginal CVS (TV‐CVS) using a 20‐gauge needle and abortion after TV‐CVS occurred in three cases (3.0%). The spontaneous abortion rate after CVS procedures was 0.6%. Some 120 (4.0%) cases showed chromosomal aberration. The spontaneous abortion rate was lower among cases allocated to TA‐CVS after 11 weeks of gestation. There were no significant differences in mean pulsatility indices (PI) between maternal, fetal and intraplacental circulation, before and after CVS procedures.

Conclusions

Transabdominal CVS has lower fetal loss rate than transcervical and transvaginal CVS.
P73The value of sequential screening in avoiding invasive procedures when maternal age is considered advanced
Authors: Pedreira D. A. L. , Cha S. C. , Czeresnia C.
Published: March 2003

Aim

To evaluate the importance of sequential screening in the diagnosis of aneuploidies when maternal age is advanced, but invasive procedure is wanted only if screening tests are altered.

Material and methods

We retrospectively analysed all pregnant patients aged 35 years or more at estimated data of delivery, from July 1996 to June 2000. For those in doubt about having an invasive procedure, we offered an alternative strategy of screening. Starting with nucal translucency (NT) (11–14 weeks), if altered we offer CVS, if normal, we offer an anomaly scan at 16–18 weeks targeted to soft markers of chromosomal abnormalities and major malformations. If altered, we then offer amniocentesis, if normal we repeat the anomaly scan at 22–24 weeks, targeting for other malformations (especially in the heart), uterine artery screening and cervical screening.

Results

We evaluated 296 fetuses (280 pregnancies) patients mean maternal age 37.4 years‐old (range 35–45). 39.9% patients (118) had invasive procedures (IP) with 3 abnormal karyotipe result (1 case T21, 2 cases 47XXY). One missed abortion detected at NT revealed T21. 122 fetuses (114 patients) had NT performed with Likelyhood Ratio increased in 11 cases (9.1%): 2 fetal malformation (skeletal dysplasia and acrania), 5 normal karyotipe after IP and 4 normal live‐born babies. Among this 114 patients, 52 had one or two reassuring anomaly scans after NT and did not had an IP done. 17 pregnancies are still ongoing and all live‐born babies so far were normal (94.8% follow‐up).

Conclusion

New studies about the psychological impact of later gestational age termination vs. early ones, showed no significant difference. We believe that sequential screening is a valid alternative for older pregnant patients, especially after IVF. The choice of having a later termination vs. the possible loss of a normal pregnancy after an IP must be given to patients.
P81Predicting delivery before 30 weeks in pregnancies with absent or reversed end‐diastolic velocity (ARED) flow in the umbilical artery
Authors: Francisco R. P. V. , Yamamoto R. M. , Chuba C. C. , Miyadahira S. , Zugaib M.
Published: March 2003

Background

A study of the relation between methods for assessment of fetal well‐being and the occurrence of delivery before 30 weeks of gestational age in fetuses with ARED.

Methods

A prospective study was conducted to assess the fetal well‐being in 30 singleton pregnancies with ARED. The results of these methods were compared with the occurrence of delivery before 30 weeks of gestational age (GA). All data were analyzed and compared using logistic regression.

Conclusion

The probability of delivery before 30 weeks in AREDV fetuses was predicted by the ti between AREDV diagnosis and delivery and by the gravity of placental lesion estimated by the PI in the umbilical artery.
P86Assessment of fetal well‐being in patients with poor obstetric history: comparison between cases of absent or reversed end‐diastolic velocity in the umbilical artery
Authors: Francisco R. P. V. , Yamamoto R. M. , Leite C. C. , Miyadahira S. , Zugaib M.
Published: March 2003

Background

A study of the assessment of fetal well‐being and perinatal results in patients with poor obstetric history and absent or reversed end‐diastolic velocity flow (AREDV).

Methods

Between 1997 and 2000, 36 high risk pregnant women with poor obstetric history and AREDV were followed by the Fetal Surveillance Unit. Ten cases presented reversed end‐diastolic velocity waveforms.

Results

The results are shown in the table:

AEDV n = 26
REDV n = 10
P

fhr with deceleration
13/19(68.4%)
5/7(71.4%)
NS

BPS below 6
1/26(3.8%)
5/7(71.4%)
0.004

Amniotic fluid index ≤ 5
6/26(23.1%)
7/10(70.0%)
0.025

MCA PI < 5th p
23/24(95.8%)
8/10(80.0%)
NS

Perinatal death
6/26(23.1%)
6/10(60.0%)
0.04

Birth weight < 1000g
10/26(36.5%)
6/10(60.0%)
NS

Conclusions

The results show a higher incidence of abnormal BPS and AFI in red cases, with a high rate of perinatal death.
P09Flow velocity waveforms in the spiral artery versus AFP and BHCG maternal serum concentration in pregnancy complicated by threatened abortion
Authors: Persona‐Sliwiñska A. , Brazert J. , Biczysko R.
Published: March 2003

Objectives

The aim of the study was to determine the values of resistance index (RI) and pulsatility index (PI) in the spiral arteries and to evaluate the maternal serum concentration of AFP and β‐hCG trying to find correlation between these parameters in the patients in early pregnancy complicated by threatened abortion.

Study methods

We have analysed 32 pregnant women between 5th and 12th weeks of pregnancy diagnosed as threatened abortion. In all patients TV ultrasound with pulsed color doppler was performed. The RI and PI were calculated for blood flow obtained from the spiral arteries. The concentration of AFP and β‐hCG in maternal serum was evaluated by immunoassays.

Results

32 velocity waveforms from spiral arteries were analysed and blood flow indices were calculated. We have found statistically significant negative correlation between the values of both blood flow parameters (RI & PI) and successive weeks of pregnancy. In the tested group in 37.5% of patients the level of β‐hCG was low. There was statistically significant correlation between serum β‐hCG, AFP concentrations and blood flow parameters.

Conclusions

Only the combination of Doppler blood flow analysis in spiral arteries and evaluation of AFP and β‐hCG in the maternal serum performed in first trimester may be useful for the intensive fetal monitoring of high risk pregnancies.