bluuebunny/crossref_metadata_2025 huggingface dataset:
A Study of the Knowledge that People with Intellectual Disabilities have of their Prescribed Medication
Authors: Arscott K. , Stenfert Kroese B. , Dagnan D.
Published: March 2003

People with intellectual disability (ID) are frequently prescribed medication for psychiatric and medical conditions. Although knowledge of medication has been researched in other populations, few studies have addressed this issue in people with ID. A questionnaire was administered to 30 people with ID to ascertain the amount of knowledge that they had of their prescribed medication. The questions which appeared to be the most difficult to answer concerned side‐effects of medication, alternatives to medication and other medications which should not be taken in conjunction with the prescribed medication. The findings are discussed.
Evaluation of the Effect of an Open Learning Course on Staff Knowledge and Attitudes Towards the Sexual Abuse of Adults with Learning Disabilities
Authors: Hogg James , Campbell Martin , Cullen Chris , Hudson Wanda
Published: March 2003

An open learning course, ‘Approaches to Sexual Abuse of Adults with Learning Disabilities’, was undertaken with a range of staff working with adults with learning disabilities. Using a specially designed questionnaire based on the research and practice literature on sexual abuse, the present authors evaluated the impact of the course on staff knowledge of: (1) sexual abuse, and its antecedents and consequences; (2) the procedures to be followed once abuse is suspected; and (3) the practices most likely to minimize abuse. In addition, the effect of the course on attitudes was also assessed. Staff knowledge of sexual abuse was significantly increased following completion of the course. Staff attitudes at the outset of the course tended to be highly consistent with the values and practices reflected in the course material. However, changes in acceptance of formal practices to deal with abuse, confidence in having the skills to deal with incidents and awareness of the vulnerability of people with learning disabilities to abuse were all enhanced. The implication of sample attrition during the course is considered with respect to the nature of the environment in which staff work and the feasibility of the open learning model.
Healthy Ageing – Adults with Intellectual Disabilities: Biobehavioural Issues
Authors: Thorpe L. , Davidson P. , Janicki M.
Published: March 2003

This report has been prepared by the Ageing Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disabilities (IASSID) in collaboration with the Department of Mental Health and Substance Dependence and the Programme on Ageing and Health, World Health Organization (WHO), Geneva, Switzerland, and all rights are reserved by the above mentioned organization. The document may, however, be freely reviewed, abstracted, reproduced or translated in part, but not for sale or use in conjunction with commercial purposes. It may also be reproduced in full by non‐commercial entities for information or for educational purposes with prior permission from WHO/IASSID. The document is likely to be available in other languages also. For more information on this document, please visit the following websites:  and .
Social Support Networks and Psychological Well‐being of Mothers with Intellectual Disabilities
Authors: Stenfert Kroese Biza , Hussein Hanan , Clifford Clair , Ahmed Nazia
Published: March 2003

Background  The study aims to investigate the impact of social support networks of mothers with intellectual disabilities (N = 15) on their psychological well‐being and their views of parenting.

Methods  As part of a semi‐structured interview, mothers were asked about who helped them in their parenting role and how recent and how helpful this support had been. Adapted psychological questionnaires were presented which measured affect, assertiveness and self‐esteem. Mothers were also asked about the benefits, burdens and future expectations of parenthood. It was hypothesized that the larger, more recent and more helpful the support network was reported to be, the better the psychological well‐being and the more positive the views on parenthood. Data analysis included quantitative and qualitative methods.

Results  Significant associations were found between the number of reported social contacts and positive affect, the recency of reported social contacts and self‐esteem, and the lack of self‐esteem and reported burdens of parenting. The average number of social contacts reported was 6.8 persons, with only half of these being described as very helpful. Very few non‐family members were part of the support networks. Qualitative analysis of mothers' comments revealed a number of themes regarding helpful and unhelpful support.

Conclusions  These findings confirm the strong associations between supportive social networks, psychological well‐being and positive parenting experiences. The results are discussed with reference to previous research, service issues and future research directions.
Classification of tubal gestations by transvaginal sonography
Authors: Rottem S. , Thaler I. , Timor‐Tritsch I. E.
Published: March 2003

Transvaginal sonographic images of tubal pregnancies were correlated with the surgical findings in 191 patients having this condition. The sonographic appearance of the ectopic gestations was classified by the absence or presence of structures such as a ‘tubal ring’ containing the yolk sac, embryonic structures, heart activity, a sonolucent or irregularly echogenic gestational sac, dilated Fallopian tube with amorphous content, fluid in the pelvis and an empty uterus. The following classifications were made:

Type Ia (n = 43) A well‐defined ‘tubal ring’ and a beating heart with or without discrete embryonic or extra‐embryonic structures.

Type Ib (n = 48) A ‘tubal ring’ containing embryonic and/or extra‐embryonic structures without heart beats.

Type II (n = 64) An ill‐defined or thin tubal wall containing sonolucent or an irregularly echogenic core but not embryonic or extra‐embryonic structures.

Type III (n = 28) Free pelvic fluid and an empty uterus in patients with positive serum β‐hCG levels. The outline of the tube cannot be visualized.

Surgery revealed unruptured tubal pregnancies in 90 patients of the combined groups of Types Ia and Ib. In one additional patient, a tubal rupture was found. In the Type II patients, 26 tubal pregnancies with blood clots in the tube but no evidence of bleeding into the pelvis, and 38 tubal ruptures or abortions were diagnosed. All Type III patients had ruptured tubal pregnancies or bleeding tubal abortions. In eight patients (4.2%), the only sonographic finding was an empty uterus, and these cases were erroneously diagnosed as not having an ectopic pregnancy (false negatives). There were two false‐positive cases in which a tubal ring was detected, and this was related to an hemorrhagic corpus luteum. When used for diagnosing tubal pregnancy, the transvaginal scanning technique (together with β‐hCG in Type III cases) carries a sensitivity of 95.8% and specificity of 99.9%. It is an invaluable tool in the diagnostic work‐up and management of patients with suspected ectopic gestation. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Color Doppler studies in trophoblastic tumors: a preliminary report
Authors: Flam F. , Lindholm H. , Bui T.‐H. , Lundström‐Lindstedt V.
Published: March 2003

Ten women, referred because of a strong suspicion of gestational trophoblastic neoplasia, were examined by abdominal real‐time ultrasound and color Doppler. The results were compared to those of pelvic angiography. In all but one case color Doppler examination revealed areas of increased vascularity. In all cases the findings of color Doppler and pelvic angiography agreed. Real‐time ultrasound failed to detect abnormal uterine echoes in three of the patients where the other methods indicated tumor. The present study indicates that color Doppler could be of great value in a non‐invasive assessment of trophoblastic tumors. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Biparietal diameter and femur length discrepancies: are maternal characteristics important?
Authors: Jones T. B. , Wolfe H. M. , Zador I. E.
Published: March 2003

We examined whether gestational age, maternal race or height can be used to explain discrepancies between biparietal diameter‐ and femur length‐derived gestational ages by analyzing ultrasound scans from 8041 consecutively scanned, singleton pregnancies, using multiple regression analysis. While a consistent association was noted between differences of more than 3 weeks and less than 3 weeks and advancing gestational age, neither maternal height nor race were significantly related. We conclude that, first, discrepancies between gestational age by biparietal diameter and femur length are rare (5%) and, second, the presence of discrepancies should not be dismissed on the basis of maternal stature or race and should alert the clinician to possible abnormal fetal growth or development. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Paracetamol‐associated luteinized unruptured follicle syndrome: effect on intrafollicular blood flow
Authors: Bourne T. H. , Reynolds K. , Waterstone J. , Okokon E. , Jurkovic D. , Campbell S. , Collins W P.
Published: March 2003

We are using transvaginal ultrasonography with color Doppler imaging to study changes in intrafollicular blood flow over the periovulatory period. We report here the findings from one volunteer (subject 9), who took two tablets of paracetamol (1000 mg) twice daily (between 07.00 and 08.00, and 18.00 and 19.00) for 2 consecutive menstrual cycle days (12 and 13) to alleviate a headache, which was shown retrospectively to have occurred within the duration of the luteinizing hormone (LH) surge in peripheral plasma. The drug appeared to have a profound effect on peak systolic blood velocity within the preovulatory follicle. Color (an index of blood velocity) disappeared and flow velocity waveforms were not detectable for at least 4 h. Color then re‐appeared, but the peak systolic blood velocity had reduced by 69.8% (from 18.2 to 5.5 cm/s). The peak systolic blood velocity recovered subsequently to 16.3 cm/s, but the follicle did not rupture and continued to grow to a maximum diameter > 59 mm. There was no apparent effect of the drug on expected changes in the circulating levels of estradiol, LH, follicle stimulating hormone or progesterone. The secretory phase of the menstrual cycle lasted 13 days (i. e. day of LH peak to day of next menses minus one). We suggest that paracetamol taken at the time of the LH surge may affect intrafollicular peak systolic blood velocity and might inhibit ovulation. Possible molecular mechanisms are discussed. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Spontaneous remission of urinary tract obstruction and ascites in a fetus with posterior urethral valves
Authors: Hecher K. , Henning K. , Spernol R. , Szalay S.
Published: March 2003

We report a case of posterior urethral valves with its typical sonographic findings. The initial diagnosis of an infravesical obstruction was made at 18 weeks gestation based on the finding of an enlarged fetal bladder and bilateral dilated renal pelves. Weekly observations showed no change in bladder size until 27 weeks gestation. At this time there was a significant increase in dilatation, the bladder wall was thickened and at 28 weeks a large amount of fetal ascites was diagnosed, but there was no oligohydramnios. Fetal urine investigations following ultrasound‐guided puncture of the fetal bladder revealed hypotonic urine and adequate renal function. Hence no vesicoamniotic drainage was performed. At 32 weeks, spontaneous remission of ascites and reduction of the bladder dilatation were noted. The fetus was delivered vaginally at term. Follow‐up of the newborn during the 1st year of life is reported. At the age of 1 year the infant shows good renal function with a serum creatinine of 0.33 mg/dl. This case shows that spontaneous remission of fetal urinary tract obstruction as a consequence of posterior urethral valves is possible. The sequence of events leading to spontaneous remission and the favorable outcome is discussed. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
The natural history of oligohydramnios/polyhydramnios sequence in monochorionic diamniotic twins
Authors: Bromley B. , Frigoletto F. D. , Estroff J. A. , Benacerraf B. R.
Published: March 2003

Twelve patients with monochorionic diamniotic twin pregnancies complicated by oligohydramnios/polyhydramnios sequence were evaluated to determine the natural history of this syndrome. Nine patients elected to continue their pregnancies and three underwent elective termination. Six of the nine continuing pregnancies delivered viable fetuses. Four of the nine continuing pregnancies had evidence of a ‘stuck’ twin at less than 20 weeks' gestation, and only one yielded live newborns (25%). Three patients diagnosed with a mild case of oligohydramnios/polyhydramnios sequence underwent worsening of the syndrome with a ‘stuck’ twin seen only after 26 weeks: all neonates survived. Five pregnancies initially diagnosed as having a ‘stuck’ twin showed improvement in amniotic fluid volume, with one actually reversing, so that the previously ‘stuck’ twin developed polyhydramnios and the co‐twin became ‘stuck’.

In summary, among the nine non‐aborted pregnancies managed conservatively, 12 of 18 fetuses (67%) survived. When the diagnosis of ‘stuck’ twin was made at ≤ 20 weeks, only two of eight (25%) lived. These observations suggest that the oligohydramnios/polyhydramnios sequence is a dynamic process with wide and often unpredictable fluctuations in amniotic fluid volume. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Does the amniotic fluid index change over a short‐term time interval?
Authors: Schwartz D. B. , Daoud Y. , Schuchter K. , Freeman J. , McGirr K. , Campbell S.
Published: March 2003

The amniotic fluid index (AFI) is a rapid and simple technique that is commonly used to assess amniotic fluid volume. It is commonly used in conjunction with other tests of fetal well‐being that extend over a variable time interval. The data on interobserver and intraobserver variability have not stated the interval between measurements, although it is likely that they have been repeated immediately. In this study an AFI was repeated after a short time interval to assess whether a significant difference exists, as this may be clinically relevant. In 91 patients, the AFI was performed at the beginning and end of an ultrasound scan for either growth and development, or for Doppler velocimetry. The interval between the two measurements was 30–45 min, and the respective results were as follows: mean 18.4 vs. 18.7; standard deviation 4.2 vs. 3.9; minimum value 10.1 vs. 11.0 and maximum value 35.0 vs. 30.0. There were no significant differences between the two measurements (p > 0.133; d.f. = 90) and the correlation coefficient was 0.874 (p < 0.0001). These results validate the reproducibility of the AFI over a 30–45 min interval, during which time most adjunctive tests are usually completed. Therefore, the timing of the AFI in relation to the other tests is not critical. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
The minimum number of cardiac cycles necessary for calculation of renal blood flow velocity indices in pregnant and non‐pregnant women
Authors: Kublickas M. , Jogestrand T. , Lunell N.‐O. , Westgren M.
Published: March 2003

In this study Doppler ultrasound was used to measure the blood flow velocity in the main and segmental renal arteries in 16 healthy non‐pregnant women. There were no differences in blood flow indices between the right and left kidneys as well as between the main and segmental arteries. The variability of the indices in the main and segmental renal arteries in healthy non‐pregnant and in the segmental renal artery in normal pregnant women (32–37 weeks of gestation) was investigated. The within‐patient error standard deviations of ten cycles and two, and three to nine averaged cycles were compared. In non‐pregnant women, values for the error standard deviation comparable with those obtained from ten cycles for the systolic/diastolic ratio and pulsatility index from both main and segmental arteries were obtained by averaging from five to six consecutive cycles, while the error standard deviation for the resistance index stabilized when averaging only two to four cycles. In pregnant women, the error standard deviations for both the systolic/diastolic ratio and pulsatility index reached quite stable values after three cycle had been averaged as did the error standard deviation for the resistance index. We speculate that this difference between non‐pregnant and pregnant women is due to more favorable conditions for renal visualization and consequently higher quality Doppler signals during pregnancy. A knowledge about the number of cardiac cycles required for an accurate calculation of renal blood flow velocity indices may prevent time‐consuming calculations and inaccurate conclusions. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Characteristics of blood flow in cancer of the uterine cervix
Authors: Breyer B. , Despot A. , Predanic M. , Judin S.
Published: March 2003

Blood flow characteristics were measured in patients with histologically proved cervical cancer and compared to normal values. Flow parameters were derived by color and pulsed Doppler ultrasound. The results showed a significant difference in the mean values of resistance index and pulsatility index among the diseased patients and healthy controls. However, the method does not have the required sensitivity for screening purposes, so that its value may mainly be in the follow‐up of patients treated conservatively with radiation and chemotherapy. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Second‐trimester uterine artery flow velocity waveform and oral glucose tolerance test as a means of predicting intrauterine growth retardation
Authors: Valensise H. , Romanini C.
Published: March 2003

The absence of a rise in maternal serum glucose level during the course of a 3‐h glucose tolerance test was noted in pregnancies that resulted in growth‐retarded infants. It was postulated that this response to an oral glucose load, in association with increased impedence to uterine artery blood flow, as demonstrated by color flow Doppler waveforms, could select the pregnancies at greater risk of developing intrauterine growth retardation.

One hundred and four uncomplicated primigravidae and 88 multigravid women considered to be at high risk of developing intrauterine growth retardation were monitored longitudinally from the 24th week of gestation. The right and left uterine artery resistance indices (RI) were measured at 24 weeks by means of pulsed Doppler with color flow imaging, and the results were averaged. The following week, an oral glucose tolerance test (OGTT) was performed. Serum glucose was measured immediately prior to the ingestion of 100 g glucose, and again after 60, 120 and 180 min. The OGTT results were classified as normal, impaired glucose tolerance, gestational diabetes mellitus, and flat. This last result was indicated by a less than 20% rise in serum glucose compared to the fasting value.

A notch in the uterine artery waveform and/or an RI greater than 0.58 (> 2 SD above the mean) was found in 39 (20.3%) women. A flat response to the OGTT was seen in 31 (16.1%) cases. Of the 16 women in whom both a high RI and a flat OGTT response curve were demonstrated, 15 (93.7%) delivered low‐birth‐weight babies due to intrauterine growth retardation. Eight of these 16 women developed hypertension. In the group with a flat OGTT response curve but normal uterine artery RI, two of the 15 women (13.3%) had growth‐retarded babies. The positive predictive value of an increased RI with a flat OGTT response curve was 94%, while the predictive values of each individual method were 62% and 55%, respectively, for development of intrauterine growth retardation.

Increased resistance to blood flow in the uteroplacental circulation in conjunction with a flat response curve to an oral glucose load might identify a group of pregnant women at risk of having a growth‐retarded infant with or without the development of hypertension. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Fetal biometry at 14–40 weeks' gestation
Authors: Snijders R. J. M. , Nicolaides K. H.
Published: March 2003

Normal ranges for a wide variety of biometrical parameters were established from cross‐sectional data on 1040 normal singleton pregnancies resulting in livebirth at term of normal, and appropriately grown infants. Patients were selected so that the birth weight distribution was similar to that reported by Yudkin and colleagues' and the ranges can, therefore, be used for any population that has a simular birth weight distribution. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound in the follow‐up of young patients with malignant ovarian tumors after conservative surgery
Authors: Zanetta G. , Trio D. , Lissoni A. , Pittelli M. , Di Lelio A.
Published: March 2003

Ultrasound examinations were performed us a step in the follow‐up of 62 patients previously treated with conservative surgery for malignant ovarian tumors. With a minimal follow‐up period of 36 months (range 36–129) 12 recurrences of disease were observed in nine patients.

When compared to other routine follow‐up procedures, ultrasound examination proved to be the most effective procedure in the monitoring of these patients, correctly detecting ten recurrences. Physical and gynecological examinations detected seven, tumor marker measurements detected six and chest X‐rays detected one.

Ultrasound examination was 83% sensitive, 99% specific and 99% accurate in the detection of recurrent disease.

In four recurrences leading to death, the diameters of the tumors at first detection were 25, 50, 50 and 100 mm, significantly higher (p = 0.03) than in seven recurrences followed by complete response of the tumor (range 15–35 mm, median 30 mm).

Ultrasound appears to be superior to physical and gynecological examination in early detection of recurrence; considering that smaller burdens of tumor at the time of recurrence seem to imply a better prognosis, ultrasound should be considered us a useful additional procedure in the follow‐up of these patients. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Small hyperechoic ventricle: a benign foci of the fetal cardiac sonographic finding?
Authors: How H. Y. , Villafane J. , Parihus R. R. , Spinnato J. A.
Published: March 2003

The objective of our study was to determine the significance of antenatally detected, small hyperechoic foci in the fetal cardiac ventricle. In a 13‐month period, we identified 25 fetuses with such a finding, an incidence rate of 0.46%. The hyperechoic foci in 24/25 fetuses were seen during follow‐up serial scans. The size ranged from 1 to 6 mm. All had a normal fetal echocardiogram at 20–22 weeks' gestation. Eleven of the 24 neonates had a normal postnatal echocardiogram in the first 4 weeks of birth. One neonate had a previously undiagnosed transposition of the great vessels and no residual hyperechoic focus. Twelve had an echogenic focus located at the level of the chordae tendineae and papillary muscles in the left ventricle. In each of these 12 neonates, there was normal ventricular function determined by measuring the shortening fraction, and a competent atrioventricular valve.

When hyperechoic foci are identified, baseline antenatal echocardiography should be performed to confirm their benignity. With an otherwise normal fetal and clinical neonatal evaluation, serial antenatal and confirmatory postnatal echocardiography are unnecessary. A possible relationship to other cardiac anomalies or aneuploidies requires further study. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Fetal liver hemangioma and chorioangioma: two unusual cases of severe fetal anemia detected by ultrasonography and its perinatal management
Authors: Hubinont C. , Bernard P. , Khalil N. , Debauche C. , Gosseye S. , Jauniaux E. , Verellen G. , Van Lierde M.
Published: March 2003

Severe anemia was diagnosed by cordocentesis in two fetuses, one with a large chorioangioma, the other with a liver hemangioma. Despite the presence of a chronic fetotumoral shunt, both cases were partly treated by a fetal intravascular transfusion, followed by an elective Cesarean section. This ‘predelivery’ management of anemia should improve neonatal morbidity associated with severe hematological and acid‐base balance disorders.
Does gender have an impact on the sonographic detection of second‐trimester fetuses with Down's syndrome?
Authors: Benacerraf B. R. , Miller W. A. , Nadel A. , Pauker S. , Bromley B.
Published: March 2003

The biometric and structural sonographic features of 95 second‐trimester fetuses with Down's syndrome were evaluated to determine whether affected male fetuses differed from affected females. There were 54 male and 41 female fetuses with Down's syndrome studied. A shortened femur was identified in 28/54 (52%) males compared with 19/41 (46%) affected females (NS). A thickened nuchal fold was identified in 19/54 (35%) of males vs. 20/41 (49%) of females. Renal pyelectasis was seen in 7/54 (13%) males and 8/41 (19%) females. A heart defect was seen in 8/54 (15%) males and 7/41 (17%) females. Ventriculomegaly was identified in 6/54 (11%) males and 3/41 (7%) females with Down's syndrome. There were no statistically significant differences in the incidence of the sonographic findings when male and female Down's fetuses were compared. Our data show that the criteria for evaluation of sonographic markers for the identification of second‐trimester fetuses with Down's syndrome should be the same in male and female fetuses. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Clinical application of volume estimation based on three‐dimensional ultrasonography
Authors: Brunner M. , Obruca A. , Bauer P. , Feichtinger W.
Published: March 2003

The development of three‐dimensional sonography represents a milestone in the history of diagnostic ultrasound. It has become possible to evaluate a region of interest not only in the horizontal and vertical planes but also in a third, i.e. the frontal, plane. Among other possible applications, this technique greatly facilitates volume estimation. The objective of the present study was to evaluate the accuracy and precision of volumetry based on three‐dimensional sonography. The results demonstrate a good correlation between estimated volumes and the volumes measured by transvaginal needle‐guided follicle aspiration performed under sonographic visualization. Our findings confirm the conclusion of previous studies that three‐dimensional sonography is making a valuable contribution to imaging techniques. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Single uterine entry for genetic amniocentesis in twin pregnancies
Authors: Sebire N. J. , Noble P. L. , Odibo A. , Malligiannis P. , Nicolaides K. H.
Published: March 2003

In 176 diamniotic twin pregnancies at 10–20 weeks of gestation, amniotic fluid for cytogenetic studies was successfully obtained from both sacs by the use of a single uterine entry. There were no cases of discordancy between sex at amniocentesis and birth. There were six pregnancies with fetal unbalanced chromosomal defects; in one pregnancy both fetuses were abnormal and in five pregnancies only one fetus was abnormal. The total fetal loss rate was 5.7% (20 of 352 fetuses), including six (1.7%) terminations or selective fetocides and 14 (4.0%) spontaneous deaths. In the 176 pregnancies there were five (2.8%) with no survivors, including one termination and four (2.3%) spontaneous miscarriages or intrauterine deaths. There are only two (1.1%) pregnancies in which amniocentesis could have contributed directly to the losses and therefore the procedure‐related rate of fetal loss may be similar to that in singleton pregnancies. The median gestation at delivery was 37 (range 16–40) weeks and delivery before 32 weeks occurred in 9% of the pregnancies. The birth weight distribution was similar to that reported in singleton pregnancies. This study demonstrates that in twin pregnancies amniotic fluid for cytogenetic studies can be obtained successfully from both sacs by use of a single uterine entry. The risk of fetal loss from this procedure appears to be similar to that in singleton pregnancies. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Neuroectodermal cyst may be a rare differential diagnosis of fetal sacrococcygeal teratoma: first case report of a prenatally observed neuroectodermal cyst
Authors: Bloechle M. , Bollmann R. , Wit J. , Buttenberg S. , Kursawe R. , Guski H.
Published: March 2003

In spite of the fact that most anomalies can be accurately diagnosed prenatally, one may be confronted with an extremely rare fetal abnormality that has never been described before. We report a case of a neuroectodermal cyst arising from the posterior neuropore. After 21 weeks of gestation a fetal anechoic intra‐ and extra‐abdominal tumor was detected. The mass grew to 75 × 41 × 33 mm at 3.5 weeks. Initially it was believed to be a sacrococcygeal teratoma. Serial scans and Doppler ultrasound examinations were performed, which demonstrated fetal well being. Color Doppler imaging failed to demonstrate increased tumoral perfusion. After elective Cesarean section, the tumor was excised. The postoperative course was complicated by recurrent infections of the urinary tract due to neurological damage to the bladder. There was also impaired function of the anal sphincter. The histological finding of a monolayer of neuroepithelial cells and melanocytes led to the diagnosis of a neuroectodermal cyst. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Estimation of fetal shoulder width by measurement of the humerospinous distance by ultrasound
Authors: Riska A. , Laine H. , Voutilainen P. , Kariniem V.
Published: March 2003

The present study was undertaken to find a practical method for estimating the fetal shoulder width by ultrasound. Sixty pregnant women at term were included in the study. The distance between the lateral margin of the fetal cartilaginous caput humeri and the processus spinosus of the cervical vertebra C7 (humerospinous distance) was measured by ultrasound. The neonatal shoulder width was measured with a craniometer during the first postnatal day. Linear regression analysis was used to calculate the correlation between the humerospinous distance and the shoulder width, and a significant linear correlation (r = 0.612, p < 0.001) was shown. Although, in this small study, we could not show a relationship between humerospinous distance and dystocia, we feel a clinical study of humerospinous distance as a predictor of shoulder dystocia is indicated. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Vibroacoustic stimulation enhances visualization of the four‐chamber cardiac view in the third trimester
Authors: Lazebnik N. , Hill L. M. , Costantino J. P. , Many A. , Martin J. G.
Published: March 2003

The objective of this study was to determine whether vibroacoustic stimulation would improve the visualization rate of the four‐chamber cardiac view. Patients between 26 and 42 weeks' gestation were considered to be candidates for this study if the amniotic fluid index (AFI) was between 8.0 and 24.0 cm, no malformations were detected on a careful fetal anatomical survey and a four‐chamber cardiac view was not obtainable. Once a four‐chamber view was considered to be not obtainable due to fetal position, the patient was asked to withdraw a sealed envelope and was assigned to either the study or the control group. The 164 study patients received one to three 3‐s vibroacoustic stimulations. Five minutes later a second attempt was made to visualize the four‐chamber view adequately. The control group consisted of another 198 subjects in whom a four‐chamber view could not be obtained. The control group did not receive vibroacoustic stimulation. A similar 5‐min time interval was allowed to elapse before an attempt was made to visualize the four‐chamber view.

The study and control groups were similar with respect to fetal presentation, placental location, fetal weight category, biophysical profile score, gestational age, AFI and estimated fetal weight. The rate of the four‐chamber view was significantly higher among fetuses receiving vibroacoustic stimulation (20.1 %), in comparison to the control group (11.1 %) (p = 0.019). Successful repositioning was more likely among fetuses with estimated fetal weight between 2251 and 3050 g, and at a gestational age between 33.1 and 37.0 weeks.

We conclude that in a selected group of patients vibroacoustic stimulation can be used to enhance visualization of the four‐chamber view. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
45,X/46,XY mosaicism: the role of ultrasound in prenatal diagnosis and counselling
Authors: Lazebnik N. , Filkins K. A. , Jackson C. L. , Linn K. B. , Doshi N. N. , Hogge W. A.
Published: March 2003

The purpose of this study was to assess the benefit of ultrasound evaluation for fetuses with prenatally diagnosed 45,X/46,XY mosaicism. The charts of all patients who underwent chorionic villus sampling and/or amniocentesis between 1 March 1990 and 31 October 1995 were screened for 45,X/46,XY mosaicism. Cases were divided on the basis of the results of the confirmatory amniocentesis into two groups: (1) confined placental mosaicism (n = 4); and (2) true fetal 45,X/46,XY mosaicism (n = 4). All patients underwent high‐resolution detailed ultrasound study between 16 and 22 weeks. If the initial ultrasound study failed to visualize fetal genitalia, scanning was repeated in 2 weeks. Chromosome analysis was carried out on the newborn's skin to confirm the prenatal result. Six cases were found to have 45,X/46,XY mosaicism on chorionic villus sampling. Amniocentesis indicated a normal 46,XY male karyotype for three fetuses and true fetal 45,X/46,XY mosaicism for two cases. One patient declined follow‐up amniocentesis. At birth, this newborn was documented to have normal male genitalia and a 46,XY karyotype. An additional two cases underwent amniocentesis only and were documented to have 45,X/46,XY mosaicism. High‐resolution detailed ultrasound study between 16 and 22 weeks revealed seven fetuses with normal male genitalia and one fetus with ambiguous genitalia. Of the four neonates with true 45,X/46,XY mosaicism this was the only one found to have ambiguous genitalia. We conclude that the work‐up of patients with 45,X/46,XY mosaicism should include ultrasound study to look for ambiguous genitalia. This allows appropriate counselling regarding the natural history of the condition and aids in the planning for management in the postnatal period. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of type 2 Pfeiffer syndrome
Authors: Bernstein P. S. , Gross S. J. , Cohen D. J. , Tiller G. R. , Shanske A. L. , Bombard A. T. , Marion R. W.
Published: March 2003

Pfeiffer syndrome is an autosomal dominantly inherited disorder consisting of craniosynostosis, a flattened midface with a beaked nose and ocular proptosis, and broad and medially deviated thumbs and great toes. Recently, based on clinical findings, the disorder has been divided into three subtypes: type 1, characterized by mild expression; type 2, in which clover leaf skull deformity and multiple congenital anomalies are present at birth; and type 3, which is similar to type 2, but lacks the presence of the clover leaf skull at birth.

We describe a fetus in whom sonographic findings of clover leaf skull deformity, ocular hypertelorism, and varus deformity of the great toe led to the prenatal diagnosis of Pfeiffer syndrome type 2. We believe this is the second prenatal diagnosis of Pfeiffer syndrome, and the first time type 2 has been definitely identified in the second trimester of pregnancy. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Postnatal vesico‐ureteral reflux in a boy with urinary bladder dysfunction as the only prenatal sonographic sign
Authors: Fägerquist M. , Sillén U. , Blomberg S. G.
Published: March 2003

An antenatal ultrasonographic examination of a male fetus at 31, 33 and 36 weeks' gestation revealed grossly abnormal bladder function. The bladder cycle length, residual volumes and the degree of distention all markedly deviated from normal, although hydronephrosis which is indicative of vesico‐ureteral reflux could not be detected. Furthermore, postnatally no anatomical urethral obstruction was found to explain the high bladder volumes. Postnatal investigation revealed bilateral reflux and bladder dysfunction with detrusor instability, a reduced bladder capacity and a high voiding pressure similar to that observed in boys with anatomic obstruction of the urethra and/or posterior urethral valves. These findings add to the controversy concerning the genesis of vesico‐ureteral reflux and have implications for the prenatal assessment of bladder function in cases of suspected vesico‐ureteral reflux. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Computerized analysis of behavior in fetuses with congenital abnormalities
Authors: Vindla S. , Sahota D. S. , Coppens M. , James D. K.
Published: March 2003

An observational study was undertaken to evaluate a computerized fetal behavior program in a clinical setting. Behavior of normal fetuses was compared with that of fetuses with a variety of congenital abnormalities.

Forty‐three fetuses were studied at 28–36 weeks; 26 were normal (49 recordings) and 16 had congenital abnormalities (26 recordings; ten had structural abnormalities of the central nervous system, one had Down's syndrome and five had other abnormalities). Behavior was recorded with the use of Doppler ultrasound. The duration of each recording was 60 min or more in all but two instances. The behavioral criteria studied were (1) the relative percentage of time spent in low and high fetal heart rate (FHR) variation; and (2) the percentage of time fetal activity was detected in low and high FHR variation.

Fetuses with abnormalities exhibited varying patterns of behavior: only eight had patterns of FHR variation that were within the 10th and 90th centiles for normal fetuses and only one fetus exhibited a fetal activity pattern that was between the 10th and 90th centiles for the normal group. All the abnormal fetuses had a FHR pattern and/or fetal activity rate outside the 10th or 90th centiles.

This study suggests that such a computerized behavioral analysis program may serve as a functional adjunct to the evaluation of a fetus with structural abnormalities. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Reproducibility of transvaginal Doppler velocimetry measurements in the uterine arteries of postmenopausal women
Authors: Tekay A. , Järvelä I. , Jouppila P.
Published: March 2003

Intraobserver and interobserver reproducibility of transvaginal Doppler velocimetry measurements in uterine arteries were assessed by two observers in 20 postmenopausal women. In addition, the agreement between the observers regarding the detection of an ovary as well as the presence or absence of intraovarian arterial blood flow was documented.

Pulsatility index (PI), peak systolic velocity (PSV) and time‐averaged maximum velocity (TAMV) measurements in uterine arteries were made twice by the same investigator (IJ). Thereafter, the same measurements were made by the second investigator (AT). The agreement in categorical data was studied by using 2 × 2 tables and Cohen's κ‐coefficient. Reproducibility of the Doppler measurements was analyzed by using coefficient of variation, repeatability coefficient, intraclass correlation coefficient, mean differences and limits of agreement. In addition, the 95% confidence interval was calculated as appropriate.

There was agreement of 95–100% between the observers with respect to the detection of an ovary in transvaginal scanning. Agreement regarding the presence or absence of intraovarian arterial blood flow, however, was only 75–81%.

Intraobserver repeatability was (very good, the intraclass correlation coefficient being 0.98–0.99 and the coefficient of variation 6% in PI measurements. The PSV measurements showed an intraclass correlation coefficient of 0.94–0.96 and a coefficient of variation of 10–12%. The intraclass correlation coefficient for TAMV measurements was 0.94 and the coefficient of variation varied from 12 to 16%.

Interobserver agreement was good. There was no bias between the observers' measurements. The intraclass correlation coefficient for PI measurements was between 0.93 and 0.95, and the coefficient of variation was 11%. For PSV measurements, the intraclass correlation coefficient was 0.79–0.80 and the coefficient of variation was l8–29%. TAMV measurements showed an intraclass correlation coefficient of 0.83–0.84 and a coefficient of variation of 19–29%. When the limits of agreement for Doppler velocimetry measurements are considered, we expect the two observers to give PI measurements that differ by less than 0.7, with any discrepancy being equally likely in either direction.

In conclusion, based on the high intraclass correlation coefficients, the intraobserver repeatability of all Doppler parameters was very good, the most reliable measurement being the PI. Variation in PSV and TAMV measurements increased considerably, however, when Doppler velocimetry was carried out by two investigators instead of one. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Color Doppler energy imaging in the diagnosis of fetal intracranial hemorrhage in the second trimester
Authors: Guerriero S. , Ajossa S. , Mais V. , Risalvato A. , Angiolucci M. , Labate F. , P. Lai M. , Melis G. B.
Published: March 2003

Unlike conventional color Doppler imaging, color Doppler energy (or power Doppler) displays the intensity of the returning Doppler signal, is less dependent on the orientation of the blood vessel, and is therefore better able to detect low blood velocities. For these reasons it could be useful in some investigations which are difficult to perform, such as transvaginal evaluation of fetal brain vessels. We report a case of a fetal intracranial hyperechoic lesion detected at 26 weeks by transabdominal sonography in a severely growth‐retarded fetus. There was absence of diastolic flow in the umbilical artery and low impedance to diastolic flow in the middle cerebral arteries. The fetus was further investigated by transvaginal sonograpy for the evaluation of the nature and localization of the lesion and an intraventricular hemorrhage in the right brain parenchyma with disorganized supratentorial brain structure was observed. As color Doppler energy imaging is more sensitive to slow flow, it was more reliable than conventional Doppler imaging in confirming the absence of flow within and around the hyperechoic lesion in contrast to the normal vascularity of the contralateral ventricular system. After informed parental counselling, the mother, for psychological reasons, asked to be delivered by Cesarean section. The fetus died 24 h after birth. The autopsy corroborated the ultrasonographic diagnosis. This case report confirms the accuracy of transvaginal ultrasonography in the diagnosis of intracranial hemorrhage and suggests a specific role for color Doppler energy imaging. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic measurement of the fetal rib cage perimeter to thoracic circumference ratio: application to prenatal diagnosis of skeletal dysplasias
Authors: Dugoff L. , Coffin C. T. , Hobbins J. C.
Published: March 2003

The object of this study was to establish new normative data for the fetal rib cage perimeter to thoracic circumference ratio, and to evaluate the potential application of this measurement in the diagnosis of short rib and other skeletal dysplasias. Rib cage perimeter (RCP) and thoracic circumference (TC) were measured in a prospective, cross‐sectional sample of 88 patients with normal pregnancies between 14 and 39 weeks of gestation. The RCP and TC were both measured in cross‐section, at a level of the four‐chamber view of the fetal heart. RCE and TC measurements were also obtained from eight cases known to have skeletal dysplasias.

The mean (± SE) RCP : TC ratio in normal pregnancies, regardless of gestational age, was 0.670 ± 0.004. In five of eight cases with skeletal dysplasias the RCP : TC ratio was significantly decreased, and in one case it was increased.

The RCP : TC ratio in normal fetuses is independent of gestational age. In this small series the ratio was abnormal in fetuses with certain skeletal dysplasias, and particularly decreased in the fetus with a short rib‐polydactyly syndrome. After further evaluation, this technique may prove to be of clinical significance in helping to diagnose skeletal dysplasias, particularly in cases where the gestational age is uncertain. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal ultrasonographic characterization of ovarian masses: comparison of five scoring systems in a multicentric study
Authors: Ferrazzi E , Zanetta G , Dordoni D , Berlanda N , Mezzopane R , Lissoni A A
Published: March 2003

This paper was originally published in Ultrasound Obstet Gynecol 1997; 10:192–7.
The initials of the name of Dr Andrea A Lissoni were wrongly given as G. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
In utero ultrasonographic measurements of fetal aortic and pulmonary artery diameters during the first half of gestation
Authors: Achiron R. , Golan‐Porat N. , Gabbay U. , Rotstein Z. , Heggesh J. , Mashiach S. , Lipitz S.
Published: March 2003

The study was conducted to construct a normal range for the diameters of the aortic root and pulmonary artery during the first half of gestation. With the use of transvaginal and transabdominal high‐resolution ultrasound techniques, a prospective, cross‐sectional study was performed on 139 normal singleton pregnancies at between 14 and 26 weeks. Great vessel diameters were measured by transvaginal ultrasonography until 17 weeks, and by transabdominal ultrasound between 18 and 26 weeks' gestation. The results showed that the aortic diameter (AD) as a function of gestational age (GA) was expressed by the regression equation AD = −16.0331 + 2.2563 × GA, and the pulmonary artery diameter (PD) by PD = −14.7637 + 2.4026 × GA; AD and PD are expressed in millimeters and GA in weeks. The correlation r2 = 0.94 was found to be highly statistically significant (p < 0.0001) for both great vessels. The normal mean of aortic and pulmonary artery diameter per week and the 95% prediction limits were also defined. During the study period we evaluated two cases with arterial diameters outside the 95% confidence limits; one had aortic coarctation and the other tetralogy of Fallot. The normative data established by us may be helpful in the prenatal diagnosis of congenital heart defects that include, among their manifestations, discordant diameters of the great vessels. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology