bluuebunny/crossref_metadata_2025 huggingface dataset:
Microcalcifications of non‐palpable breast lesions detected by ultrasonography: correlation with mammography and histopathology
Authors: Huang C.‐S. , Wu C.‐Y. , Chu J.‐S. , Lin J.‐H. , Hsu S.‐M. , Chang K.‐J.
Published: March 2003

Objectives

Microcalcifications are generally not demonstrated well on ultrasonography. In this study, we attempted to demonstrate the usefulness of high‐resolution ultrasonography in the detection of microcalcifications associated with non‐palpable breast cancers.

Design

Fourteen patients with non‐palpable breast lesions in whom microcalcifications were detected or suspected by ultrasonography and one patient in whom microcalcifications were detected on mammography only were included in the study. Mammography and analysis of biopsy specimens were performed in each patient and the findings were correlated with the ultrasonographic findings. Ultrasonography and mammography were performed independently by different physicians at different times.

Results

In three patients ≤ 30 years of age, who were not at high risk of breast cancer and who had no evidence of cancer on palpation, high‐resolution ultrasonography clearly showed microcalcifications but no mass. Two of these patients had ductal carcinoma in situ and one had small invasive carcinoma with extensive comedocarcinoma. Among the other 12 patients with non‐palpable breast lesions, ultrasonography detected microcalcifications accurately in six and suggested possible microcalcifications in a further four. Microcalcifications in all of these ten patients were confirmed by mammography thereafter. Four of these ten patients had ductal carcinoma in situ, with or without invasive carcinoma. Of the remaining two patients, one demonstrated false‐positive findings and one false‐negative findings on ultrasound. On high‐resolution ultrasonography, microcalcifications produced the appearance of twinkling stars (bright dots in different planes) in a dark sky (contrasted against ill‐defined hypoechoic patches), corresponding on histopathology to groups of expanded ducts with increased cell density with or without necrosis.

Conclusion

High‐resolution ultrasonography may be used for detection of microcalcifications in non‐palpable breast lesions. Ultrasonography is helpful in screening for early breast cancers, especially in young patients who are at risk for breast cancer and in whom mammography is not usually carried out. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
P41Prenatal diagnosis of chorioangioma of the placentae: case report
Authors:   Nurwansyah, Murti K. , Taufik E.
Published: March 2003

Background

Chorioangioma of the placentae are the most common primary tumors of the placentae, occurring in 1% of all pregnancies. In the past, the majority of patients' diagnosis is made after the delivery of the placenta. But, with the increasing use of ultrasound, prenatal diagnosis of these tumors is should become more common. Clinical implications of placental chorioangioma have been associated with adverse perinatal and maternal outcomes such as polyhydramnios, premature labor, fetal hydrops, fetal disseminated intravascular coagulopathy, fetal anemia, fetal cardiomegaly, fetal growth retardation, abruptio placentae, gestosis and maternal hemolysis.

Case

A 25‐year‐old primigravid was admitted to the hospital in 35th week of gestation with premature rupture of the membrane (PROM). Ultrasound examinations were performed on two occasions. First, at 28 weeks gestation, ultrasound revealed placental tumor and no fetal abnormality. The second one, at admission, ultrasound revealed olygohydramnios caused by PROM, intrauterine growth retardation and large placental echogenic mass with anechoic parts. Diagnosis was made as placental chorioangioma.

Conclusion

Demonstrating well‐circumscribed placental mass with or without anechoic area and its clinical implications makes prenatal diagnosis of placental chorioangioma.
Fetal transverse cerebellar diameter measurements in normal and reduced fetal growth
Authors: Vinkesteijn A.S.M. , Mulder P.G.H. , Wladimiroff J.W.
Published: March 2003

Objectives 
To establish the increase in fetal transverse cerebellar diameter (TCD) relative to gestational age during normal and restricted fetal growth; to determine the significance of TCD and TCD/AC relationship in predicting fetal outcome as expressed by perinatal mortality.

Design 
A retrospective cross‐sectional study.

Subjects 
Three hundred and sixty normally developing fetuses between 17 and 34 weeks of gestation and 73 growth‐restricted fetuses between 24 and 34 weeks of gestation.

Methods 
Ultrasonographic measurements included head circumference (mm), abdominal circumference (mm) and transverse cerebellar diameter (mm). A gestational age‐related normal reference chart was produced for TCD.

Results 
Statistically significant relationships between transverse cerebellar diameter and gestational age, abdominal circumference and head circumference were found. The normal fetal TCD exhibited a more than twofold increase in size during the second half of pregnancy. Twenty‐six per cent of the small‐for‐gestational age (SGA) fetuses displayed a reduced TCD and 82% of the SGA fetuses demonstrated raised TCD/AC values. No statistically significant difference in perinatal mortality or birth weight was found between the subsets of growth‐restricted fetuses with reduced or normal TCD; or between the subsets with normal or raised TCD/AC values.

Conclusions 
In the normally developing fetus the TCD increases with advancing gestational age. Increased TCD/AC values are suspicious of fetal growth restriction. The perinatal mortality in growth‐restricted fetuses with a small cerebellum is increased twofold over that of other fetuses.
Striking findings concerning the variability in the measurement of the fetal renal collecting system
Authors: Persutte W.H. , Hussey M. , Chyu J. , Hobbins J.C.
Published: March 2003

Objective Using strict thresholds of normality, investigators have reported associations between fetal pyelectasis and aneuploidy, obstructive uropathy, postnatal pyeloplasty and vesicoureteral reflux. Although evidence continues to mount regarding the importance of fetal pyelectasis, little is known of the variability of collecting system measurements. To investigate the short‐term variability and its relationship to bladder dilatation, the following study was conducted.

Design During May and June 1996, 20 mid‐ and late‐trimester patients with varying degrees of fetal pyelectasis were recruited into this study. Each consented to undergo periodic (every 15 min for 2 h) ultrasound measurements of the fetal renal collecting systems and bladder. To account for anatomic and technical variability in measurement, we used both the sum of the transverse and anterior–posterior (AP) measurements of the collecting systems, and AP measurement alone for comparison. The variability of the collecting system measurements was assessed based upon gestational age, magnitude of pyelectasis and fetal bladder size.

Results We investigated 38 renal units in 20 patients (eight in the second trimester and 12 in the third). The mean(SE) AP diameter of all kidneys was 5.89(2.49) mm (range 15 (2–17) mm), and the sum of transverse and AP renal collecting system diameters was 13.91(5.73) mm (range 26 (4–31) mm). These data were normally distributed. When assessing the variability in individual kidneys over time, we found the mean variation (minimum to maximum) for the sum of the AP and transverse measurement to be 7.61(4.26) mm and for the AP measurement alone to be 3.80(2.49) mm. No relationship was found between variability of dilatation, magnitude of dilatation or fetal bladder size. Cyclic dilatation of the fetal bladder was observed in all cases. The mean time from maximal to minimal dilatation was 20 min (1.34 observations; range 12–30 min).

Conclusions We found the size of the fetal renal collecting system to be highly variable over the course of a 2‐h period. Seventy per cent of cases (14 of 20) had both normal (< 4 mm) and abnormal values (≥ 4 mm) during the 2‐h study period. Significant caution should be used when considering the implications of renal collecting system dilatation based upon a single AP measurement.
Gray scale and color Doppler sonography in the third stage of labor for early detection of failed placental separation
Authors: Krapp M. , Baschat A.A. , Hankeln M. , Gembruch U.
Published: March 2003

Objective The purpose of this study was the characterization of normal and abnormal third stage placental separation using gray scale and color Doppler sonography.

Methods The third stage of labor was examined in 62 patients using gray scale and color Doppler sonography. After identification of placental basal plate vessels by color Doppler sonography, the placentation site was examined throughout the third stage with combined gray scale and color Doppler mode. Placental separation from the myometrium was defined clinically and correlated to cessation of color Doppler detected blood flow in basal plate vessels.

Results Three sonographic phases of placental separation were: (1) latent = interval between delivery of the fetus and beginning placental separation; (2) detachment = mono‐ or multiphasic shearing off of the placenta and (3) expulsion = interval between completed separation and vaginal delivery of the placenta. In 57 cases with clinically normal placental separation blood flow between placenta and myometrium ceased immediately after delivery of the fetus during the latent period. In five cases manual or instrumental removal was necessary because of placenta adhaerens in one case and placenta accreta in four cases. The latter showed maternal blood flow from the myometrium deep into the placenta beyond the latent phase.

Conclusion Cessation of blood flow between the basal placenta and myometrium following delivery of the baby is the sonographic hallmark of normal placental separation. Persistent blood flow demonstrated by color Doppler sonography is suggestive of placenta accreta.
Maternal cardiac systolic and diastolic function: relationship with uteroplacental resistances. A Doppler and echocardiographic longitudinal study
Authors: Valensise H. , Novelli G. P. , Vasapollo B. , Borzi M. , Arduini D. , Galante A. , Romanini C.
Published: March 2003

Objective

To test the hypothesis of the existence of a relationship between central and peripheral hemodynamic parameters by the longitudinal evaluation of maternal echocardiographic and uteroplacental resistance modifications during normal pregnancy.

Methods

Forty‐three healthy normotensive primigravidae were evaluated at 12 ± 1, 21 ± 1, and 33 ± 1 weeks of gestation with uterine artery color Doppler and maternal echocardiographic examinations to identify morphologic, systolic, and diastolic variables.

Results

Cardiac output and stroke volume significantly increased during pregnancy. Uterine resistance index (RI) decreased from the first to the second trimesters (0.72 ± 0.10 versus 0.54 ± 0.09, P < 0.001). Left atrial dimensions increased during pregnancy (33.8 ± 1.9 cm, 38.1 ± 1.8 cm, 39.3 ± 2.1 cm, P < 0.001). Left atrial function also increased. Left ventricular mass increased (132 ± 18 g, 162 ± 16 g, 174 ± 27 g, P < 0.001). Diastolic function parameters showed significant modifications: E wave velocity and E/A ratio decreased; A wave velocity and deceleration time of the E wave (DtE) increased; the left ventricular isovolumetric relaxation time (IVRT) decreased significantly (88.7 ± 6.7 ms, 75.6 ± 7.7 ms, 71.1 ± 5.0 ms, P < 0.001) showing a correlation with left atrial dimensions and RI (r = −0.38, r = 0.47, respectively; P < 0.001).

Conclusions

Diastolic cardiac function varies during pregnancy. A relationship between preload (left atrial enlargement), afterload (RI reduction), morphologic, and diastolic function modifications (IVRT reduction, DtE prolongation) appears to exist as a consequence of the hemodynamic modifications which occur during physiologic pregnancy. Diastolic function analysis maybe useful to identify women who fully adapt to pregnancy, and to understand the mechanisms that might be involved in women who show abnormal uterine artery Doppler waveforms. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The frequency of the detection of fetal echogenic intracardiac foci with respect to maternal race
Authors: Shipp T. D. , Bromley B. , Lieberman E. , Benacerraf B. R.
Published: March 2003

Objective

To determine if there is a racial difference in the frequency of identification of echogenic intracardiac foci (EIF) seen sonographically in the hearts of second‐trimester fetuses.

Methods

Over a 2‐month period (June 1998–August 1998), all fetuses scanned between 15 and 20 completed weeks' gestation were evaluated prospectively for the presence or absence of EIF. Pregnancies specifically referred for the presence of EIF were excluded. The sonographer performing the scan indicated maternal race as Asian, black, white, or (if maternal race was not clear) unknown. Maternal race, gestational age, and the presence or absence of EIF were prospectively documented. Follow‐up of those fetuses with EIF was obtained from the referring physicians' offices. The groups were compared with respect to maternal race and presence or absence of EIF.

Results

There were 46, 34, 400, and nine fetuses of the Asian, black, white, and unknown mothers, respectively. The mean gestational age ± 1 SD at examination was 18.2 ± 1.6, 17.5 ± 1.4, 17.7 ± 1.5, and 17.8 ± 1.1 weeks, for the Asian, black, white, and unknown mothers, respectively. The incidence of sonographically detected EIF was 30.4, 5.9, 10.5 and 11.1% for the Asian, black, white, and unknown mothers, respectively, P = 0.001. In a multivariate logistic regression model, Asian mothers had an odds ratio of 3.8 (95% CI, 1.8, 7.6) for having a fetus identified as having EIF, as compared with white mothers.

Conclusions

The Asian patient is more likely than patients of other races to have a fetus with identified EIF. The counseling implications for Asian mothers undergoing midtrimester sonography when EIF is identified should be tempered, due to the increased frequency of EIF as a normal finding in the Asian population. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic appearance of first trimester complete hydatidiform moles
Authors: Benson C. B. , Genest D. R. , Bernstein M. R. , Soto‐Wright V. , Goldstein D. P. , Berkowitz R. S.
Published: March 2003

Objective

Complete hydatidiform moles are now being diagnosed earlier in gestation, thus the clinical presentation and pathologic findings of complete molar pregnancy have changed. We studied the sonographic appearance of first trimester moles and the ability of ultrasound to detect them.

Methods

We reviewed the sonographic interpretation and sonograms, when available, from all patients with first trimester complete moles diagnosed at our institution from January 1988 to March 1996.

Results

Of the 24 patients in our study, the mean gestational age at time of the sonogram was 8.7 ± 2.0 weeks (mean ± SD) with a range of 5.7–12.3 weeks. The initial sonographic interpretation was a complete mole in 17 (71%) cases, partial mole versus failed pregnancy in two (8%), and failed pregnancy in five (21%) cases. Of the 22 patients with sonograms available for review, interpretation on review of the images was a complete mole in 18 (82%) cases, partial mole versus failed pregnancy in one (5%), and failed pregnancy in three (14%) cases. The typical sonographic appearance of a first trimester complete mole was a complex, echogenic, intra‐uterine mass containing many small cystic spaces.

Conclusion

The majority of first trimester complete moles demonstrate a typical ultrasound appearance such that the diagnosis can be made with ultrasound in most cases. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
A malformed fetus in a rudimentary uterine horn pregnancy
Authors: Has R. , Ermis H. , Yildirim A.
Published: March 2003

We present a case of a 13‐week pregnancy with a malformed fetus in a ruptured, non‐communicating rudimentary horn. The patient, a 21‐year‐old woman with pelvic and right‐sided abdominal pain, was admitted to the gynecology clinic of our institution. A ruptured rudimentary horn pregnancy was diagnosed by ultrasonography. The fetus in the gestation sac showed evisceration of the liver and intestines and an absent left femur. There was an amniotic band extending across the body of the fetus. The ruptured horn was excised by laparotomy. The factors associated with rudimentary horn pregnancy and related fetal abnormalities are discussed. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Classification of discordant fetal growth may contribute to risk stratification in monochorionic twin pregnancies
Authors: Van Gemert M. J. C. , Vandenbussche F. P. H. A. , Schaap A. H. P. , Zondervan H. A. , Nikkels P. G. J. , Van Wijngaarden W. J. , Van Zalen‐Sprock R. M. , Sollie‐Szarynska K. M. , Stoutenbeek P. H.
Published: March 2003

Objectives

To determine whether classification of discordant growth between fetal twins allows risk stratification in monochorionic twin pregnancies.

Methods

In 12 twin‐to‐twin transfusion syndrome (TTTS) pregnancies and 12 cases that were suspected of developing the syndrome, fetal growth was determined by serial standard sonography. Fetal growth was expressed as the difference‐average‐ratio (DAR), defined as the difference in estimated fetal weight between both twins divided by their average weight. In each case, we determined the maximum value of DAR and the rate of change of DAR using a least squares linear fit of the estimated fetal weights.

Results

For the TTTS cases the maximum value of DAR was 0.44 ± 0.21 versus 0.52 ± 0.13 for the suspected TTTS cases (P = 0.25). The rate of change of DAR was 0.052 ± 0.034 per week for the TTTS versus 0.0055 ± 0.0092 for the suspected TTTS cases (P = 0.0004). After laser therapy, DAR decreased in four successful cases, with a rate of change of −0.0146 ± 0.0093 per week, but increased further in one unsuccessful case, due to patent anastomoses. In the seven TTTS cases treated with amnioreduction, DAR did not decrease; in one of two suspected TTTS cases the DAR decreased slightly. In the nine amnioreduction cases, the average rate of change of DAR was 0.067 ± 0.083 per week. This was significantly different from the four successful laser cases (P = 0.01).

Conclusions

The rate of change of DAR, but not DAR itself, has prognostic value for the development of suspected TTTS pregnancies, for the onset and severity of TTTS and for the efficacy of therapy. This parameter is derived from routine sonography examination and may contribute to risk stratification in monochorionic twin pregnancies. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Does local anesthesia at mid‐trimester amniocentesis decrease pain experience? A randomized trial in 220 patients
Authors: Van Schoubroeck D. , Verhaeghe J.
Published: March 2003

Objectives

To evaluate whether local anesthesia decreases patients' pain experience during mid‐trimester amniocentesis.

Methods

In a randomized trial, one group did not receive local anesthesia while, in another group, lignocaine 1% was injected subcutanously prior to amniocentesis. Five different scoring systems were used to evaluate patients' pain experience.

Results

Two hundred and twenty women entered the study: 114 received local anesthesia, while 106 did not. The mean (SD) Visual Analog Scale was 1.4 (1.5) on a 0–10 scale (range 0–7.6). Some 97% of patients described the procedure as not painful or bearable, 79% had expected the procedure to be more painful and 59% reported the amniocentesis to have a comparable discomfort as venous blood sampling; 98% of women declared they would undergo an amniocentesis again if indicated. There were no statistical differences between both randomization groups.

Conclusions

Mid‐trimester amniocentesis is not a painful procedure. Local anesthesia does not affect pain experience during amniocentesis. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Uterine artery Doppler perfusion in the first and second pregnancies
Authors: Hafner E. , Schuchter K. , Metzenbauer M. , Philipp K.
Published: March 2003

Objective

To compare blood perfusion expressed as pulsatility index (PI) and ‘notching’ of the left and right uterine arteries measured in the same woman in her first and second pregnancies.

Methods

Data from 1102 women's uterine perfusion in their first and second pregnancies were evaluated. Bilateral data, PI and early diastolic notch in both pregnancies were collected. A notch and a PI ≥ 1 were deemed to be pathologic. Statistical mean and standard deviation together with the frequency of pathological uterine perfusion in the first and second pregnancies were compared (t‐test, χ2‐test).

Results

PI values did not differ significantly in the first and second pregnancies whereas there was a small but marked difference in the right uterine artery compared to the left. Early diastolic notch behaved differently, being more frequently found in the first pregnancy. This discrepancy was highly significant. However in subsequent pregnancies a notch was found more frequently on the left than on the right side. Women with pathologic flow patterns in the first pregnancy were significantly more likely to develop pathologic flow patterns in their second pregnancy.

Conclusion

Although uterine perfusion in the same woman is similar in the first and second pregnancies, ‘notching’ appears much more frequently in the first pregnancy reflecting the fact that the decidual embedding of the trophoblast is less problematic in the second pregnancy. Nevertheless the subgroup with an early diastolic notch in their first pregnancy is four times more likely to develop a notch in a second pregnancy. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of Bardet–Biedl syndrome by targeted second‐trimester sonography
Authors: Dar P. , Sachs G. S. , Carter S. M. , Ferreira J. C. , Nitowsky H. M. , Gross S. J.
Published: March 2003

Bardet–Biedl syndrome (BBS) is an autosomal recessive disorder characterized by mental retardation, obesity, retinal degeneration, polydactyly and syndactyly, diabetes mellitus, hypogenitalism, renal dysplasia and short stature.

Definitive molecular diagnosis for BBS is not currently available and counseling of affected families is based on the 25% recurrence risk consistent with autosomal recessive inheritance.

Our case presents the first successful use of second trimester targeted sonographic anatomy scanning to prospectively identify a fetus affected with BBS, and indicates that ultrasound can be of critical importance in providing precise as well as timely prenatal diagnosis for families at risk for this serious disorder. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
The significance of crown–rump length measurement for predicting adverse pregnancy outcome of threatened abortion
Authors: Reljič M.
Published: March 2003

Objectives

To determine if in women with threatened miscarriage the measurement of fetal crown–rump length (CRL) is a useful predictor of spontaneous miscarriage and small for gestational age (SGA) infants.

Methods

Fetal CRL was measured in 310 singleton pregnancies with live fetuses, presenting with threatened miscarriage before 13 weeks of gestation. The relationship between fetal CRL and pregnancy outcome was investigated.

Results

In fetuses with CRL < 18 mm there was a significant positive association between the deficit in CRL for gestation and the incidence of subsequent spontaneous miscarriage. In those cases with CRL deficit more than 2 standard deriations (SDs) the incidence of miscarriage was 13.7%, whereas if the CRL was between the mean and −2 SDs the incidence of miscarriage was 8.3%. In fetuses with CRL ≥ 18 mm there was a significant positive association between the deficit in CRL for gestation and the incidence of SGA. In those cases with CRL deficit of more than 2 SD the incidence of SGA was 27.3%, whereas if the CRL was between the mean and −2 SDs the incidence of SGA was 18.9%.

Conclusions

The findings of this study suggest that the measurement of fetal CRL may be a useful predictor of spontaneous miscarriage and SGA in pregnancies with threatened miscarriage. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Changes in fetal hemodynamics with ritodrine tocolysis
Authors: Gokay Z. , Ozcan T. , Copel J. A.
Published: March 2003

Objective

To evaluate the effect of ritodrine on the fetal cardiovascular system.

Methods

Cardiac and extracardiac Doppler waveforms were recorded in 12 fetuses prior to and during ritodrine therapy used for preterm labor. Maternal and fetal heart rates, the Doppler pulsatility indices of the umbilical artery, middle cerebral artery, descending thoracic aorta and renal artery, and time velocity integrals of the atrioventricular valves and the ductus arteriosus, were measured.

Results

Ritodrine infusion caused an increase in maternal and fetal heart rates, the left cardiac output as measured by the product of time velocity integral and heart rate, and the pulsatility index of the middle cerebral artery, and a decrease in the pulsatility index of the umbilical artery.

Conclusions

Ritodrine infusion may alter placental and cerebral blood flow and may have a selective effect on the left side of the heart. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Nomogram of Wharton's jelly as depicted in the sonographic cross section of the umbilical cord
Authors: Ghezzi F. , Raio L. , Di Naro E. , Franchi M. , Balestreri D. , D'Addario V.
Published: March 2003

Objectives

To generate a nomogram for the sonographic measurement of Wharton's jelly area (WJA) during gestation and to investigate whether WJA is related to fetal biometric parameters.

Method

The sonographic cross‐sectional area of the umbilical cord and of its vessels was measured in 659 fetuses between 15 and 42 weeks of gestation. The WJA was calculated by subtracting the vascular area from the umbilical cord area. The conventional biometric parameters were measured and correlated with the WJA. Polynomial regression analysis was utilized for statistical purposes.

Results

The WJA increased as a function of gestational age (r = 0.63, P < 0.001). The regression equation for the mean WJA (y) according to gestational age (x) was y = −114.7 + 4.142x − 0.01x2 and for the standard deviation (y′) was y′ = −7.567 + 1.319x. There was a strong correlation between the WJA and the umbilical cord area (r = 0.97, P < 0.001). A significant correlation was also found between the WJA and fetal biometric parameters before 32 weeks of gestation (WJA and biparietal diameter: r = 0.82, P < 0.001; WJA and abdominal circumference: r = 0.79, P < 0.001; WJA and femur length: r = 0.81, P < 0.001) while after 32 weeks of gestation no correlations were found between WJA and fetal anthropometric parameters.

Conclusion

A nomogram for the WJA has been generated. The WJA increases as a function of gestational age and it is correlated with fetal size up to 32 weeks of gestation. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Down–up sequential separation of the placenta
Authors: Herman A. , Zimerman A. , Arieli S. , Tovbin Y. , Bezer M. , Bukovsky I. , Panski M.
Published: March 2003

Objective

To characterize the patterns of placental separation during the third stage of labor.

Methods

Continuous real‐time ultrasound was performed during the third stage of labor in 101 normal deliveries. The sequence of placental separation was recorded for determining whether the process was multiphasic, the site from which separation commenced and the mode of its progression.

Results

Separation in 97 cases was multiphasic. Monophasic separation in which all parts of the placenta appeared to separate simultaneously occurred in two cases only. Pathological prolongation of the third stage precluded determination of separation in two cases. Ninety‐two cases had a uterine wall placenta (anterior or posterior); the separation commenced at one pole and progressed sequentially towards the opposite side in 89 of them. The process started at the lower pole (down–up separation) in 83/92 cases (90.2%) and began from the upper pole (up–down separation) in only 6/92 cases (6.5%). Nine cases had a fundal placenta; of these the separation was also multiphasic but began sequentially from either the anterior or posterior pole, or simultaneously from both, in 8 (88.9%) cases so that the fundal part was separated last (bipolar separation).

Conclusions

Placental separation is usually an orderly multiphasic phenomenon that begins mostly from the lower pole of the placenta and propagates sequentially upwards. Fundal placentae, however, separate first at their poles with the fundal part being separated last. Recognition of the sequence of events and understanding of the mechanism of placental separation may aid in detecting cases prone to third‐stage complications and in managing pathological ones. Copyright © 2002 ISUOG
Cerebral hemodynamics and fetal behavioral states
Authors: Clerici G. , Luzietti R. , Cutuli A. , Di Renzo G. C.
Published: March 2003

Objective

This study aimed to evaluate the hemodynamic patterns of the proximal (M1) and distal (M2) portions of the middle cerebral artery, during different fetal behavioral states.

Design

The study included 20 normal singleton pregnancies at between 36 and 40 weeks of gestation. After identification of the fetal behavioral state (FBS), flow velocity evaluation was performed on the proximal and distal segments of the middle cerebral artery during ‘quiescence’ (FBS‐1F) and ‘activity’ (FBS‐2F).

Results

A statistically significant decrease of pulsatility index, reflecting a decrease of impedance to flow values, was identified in both segments of the middle cerebral artery (MCA) during ‘activity’, with a more marked decrease in the MCA‐M2 than in MCA‐M1 (M1, P = 0.0028; M2, P = 0.00000085). The mean fetal heart rate during ‘quiescence’ was significantly lower than during ‘activity’ (P = 0.0047). However, there was no significant correlation between the pulsatility index of both segments of the middle cerebral artery and the fetal heart rate during different fetal behavioral states.

Conclusions

The results of this study provide evidence of the influence of different fetal behavioral states on fetal cerebral hemodynamic patterns. We believe it is better to sample the proximal segment in clinical practice because it is less influenced by fetal behavioral state. This information should be considered when evaluating fetal cerebral hemodynamics. Copyright © 2002 ISUOG
Antenatal prediction of intraventricular hemorrhage in fetal growth restriction: what is the role of Doppler?
Authors: Baschat A. A. , Gembruch U. , Viscardi R. M. , Gortner L. , Harman C. R.
Published: March 2003

Objective

To evaluate relationships between neonatal intraventricular hemorrhage and altered brain blood flow in preterm growth‐restricted fetuses.

Methods

One hundred and thirteen growth‐restricted fetuses (birth weight <10th centile and umbilical artery pulsatility index > two standard deviations above gestational age mean) which delivered prematurely (<34.0 weeks) were studied. Three expressions of altered brain blood flow were defined: ‘brain sparing’ = middle cerebral artery pulsatility index > two standard deviations below the gestational age mean, ‘centralization’ = ratio of middle cerebral artery/umbilical artery pulsatility indices (cerebroplacental ratio) > two standard deviations below the gestational age mean, and ‘redistribution’ = absent or reversed umbilical artery end‐diastolic velocity. Intraventricular hemorrhage was graded after Papile (I–IV) by cranial ultrasound performed within 7 days of delivery.

Results

Sixty‐seven (59.3%) fetuses had brain sparing, 84 (74.3%) had centralization and 51 (45.1%) had redistribution. Fifteen (13.3%) neonates had intraventricular hemorrhage and were more likely to have a biophysical profile <6, earlier delivery for fetal indications, lower cord artery pH, HCO3, hemoglobin, and platelets, a 10‐min Apgar score <7 and high perinatal mortality (5/15; 33.3%). No associations between intraventricular hemorrhage and brain sparing or centralization were identified. However, neonates with intraventricular hemorrhage had significantly higher umbilical artery pulsatility index deviations from the gestational age mean and a relative risk of 4.9‐fold for intraventricular hemorrhage with redistribution (95% confidence interval, 1.5–16.3; P < 0.005). Multiple logistic regression revealed significant associations between intraventricular hemorrhage and a low 10‐min Apgar score (r = 0.30, P < 0.005) and low hemoglobin (r = 0.28), gestational age at delivery (r = 0.25) and birth‐weight centiles (r = 0.23) (P < 0.05). No Doppler parameter was identified as an independent contributor to intraventricular hemorrhage.

Conclusion

While loss of umbilical artery end‐diastolic velocity early in gestation significantly increases the risk for neonatal intraventricular hemorrhage, prematurity and difficult transition to extrauterine life remain the most important determinants of intraventricular hemorrhage. Copyright © 2002 ISUOG
Ultrasound imaging of paravaginal defects in women with stress incontinence before and after paravaginal defect repair
Authors: Martan A. , Mašata J. , Halaška M. , Otčenášek M. , Svabik K.
Published: March 2003

Objective

The aim of our study was to analyze whether transabdominal and introital sonography can identify paravaginal defects and to determine changes that occur following paravaginal defect repair and Burch colposuspension.

Methods

Twenty women with genuine stress incontinence took part in this prospective study. The mobility of the bladder neck was assessed transperineally with a curved array probe following instillation of 300 mL saline. The same probe was used transabdominally to determine the presence of paravaginal defects. Introital examination using a transvaginal probe was then performed to determine the presence of paravaginal defects. The same measurements were performed following Burch colposuspension and paravaginal defect repair.

Results

There were significant differences in bladder neck position and mobility before and after surgical intervention. In 18 women before surgery, transabdominal ultrasound identified unilateral or bilateral paravaginal defects. Eight unilateral defects were found on the right side but only two were found on the left side. In eight women, the defect was bilateral. The introital approach obtained similar results apart from in two patients with a bilateral defect in whom it indicated a unilateral right defect. Between the first and second weeks following the operation transabdominal ultrasound found no paravaginal defects in 16 women and introital ultrasound found no paravaginal defects in 18 women. We were unable to visualize the region of the paravaginal defect in two women using transabdominal ultrasound because the abdominal wall was edematous after surgery. Five to 6 weeks after the operation, our results were confirmed by abdominal and introital ultrasound in all cases. No paravaginal defects were found in any of the patients after paravaginal defect repair.

Conclusion

Our clinical study suggests that ultrasound scanning should be performed to confirm the presence of paravaginal defects and that paravaginal defect repair may be added to Burch colposuspension for the treatment of genuine stress incontinence, as an operation to correct cystourethrocele and the posterior urethrovesical angle. Copyright © 2002 ISUOG
Prenatal diagnosis of parasitic twins using three‐dimensional ultrasound: a case report
Authors: Tan A. , Lee S.‐L.
Published: March 2003

Parasitic twins are a rare form of monochorionic, monoamniotic conjoined twins. Early prenatal ultrasound is essential for their diagnosis and assists in determining their eventual outcome; the use of three‐dimensional ultrasound may enhance diagnostic capabilities in the presence of this severe condition. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Two‐dimensional and M‐mode echocardiography of the fetal coronary sinus
Authors: Abello K. C. , Stewart P. A. , Baschat A. A.
Published: March 2003

Objective

To document fetal coronary sinus dimensions in normal pregnancy.

Methods

Two hundred and sixty‐five normal fetuses in which congenital cardiac defects had been excluded were examined cross‐sectionally between 21 and 38 weeks of gestation. From the apical or basal four‐chamber view the transducer was tilted towards the inferior cardiac surface in order to visualize the coronary sinus by real‐time ultrasound. Maximum systolic and diastolic diameters were measured using M‐mode. Reference ranges were constructed and the ratio of systolic and diastolic diameters calculated. Data from two fetuses, one with supraventricular tachycardia and a second one with hydrops secondary to anemia, were also compared.

Results

Visualization and measurement of the coronary sinus were successful in 258 (97.4%) patients. The coronary sinus systolic and diastolic diameters increased significantly with gestational age (maximum systolic diameter, 1.6 mm at 21 weeks to 4 mm at 38 weeks; maximum diastolic diameter, 0.9 mm at 20 weeks to 2.2 mm at 38 weeks). The ratio of systolic to diastolic diameters remained relatively constant (range, 1.7–2.1) and therefore was unrelated to gestational age. In the fetuses with supraventricular tachycardia and hydrops, both diameters of the coronary sinus were increased and diminished fluctuation in size during the cardiac cycle was observed.

Conclusions

The described sonographic approach provides an effective method for measurement of coronary sinus dimensions. The normative data may facilitate the detection of coronary sinus dilation as an indirect marker for abnormalities in venous return to the heart.
Quantitative transvaginal two‐ and three‐dimensional sonography of the ovaries: reproducibility of antral follicle counts
Authors: Scheffer G. J. , Broekmans F. J. M. , Bancsi L. F. , Habbema J. D. F. , Looman C. W. N. , Te Velde E. R.
Published: March 2003

Objective

To assess the intra‐ and interobserver reproducibilities in addition to the between‐method reliability of antral follicle counts using two (2D)‐ and three (3D)‐dimensional transvaginal sonography (TVS).

Methods

Two groups of women with regular menstrual cycles were studied. One group consisted of healthy volunteers with proven fertility and the other group consisted of patients visiting the general infertility clinic. In each woman, 2D or 3D TVS was performed in the early follicular phase (day 2, 3 or 4) of the menstrual cycle to measure the number of antral follicles (2–10 mm).

Results

Intraobserver reproducibility was calculated from follicle counts using 3D TVS in 41 women. The intraclass correlation coefficient was 0.99 and the 95% coverage interval of the difference (CID) was −3.2 to +3.2. Interobserver reproducibility was assessed from both 2D (n = 37) and 3D (n = 49) TVS‐based follicle counts. An interclass correlation coefficient of 0.98 was found for both methods. The 95% CID was −5.0 to +4.1 for 2D and −5.6 to +5.7 for 3D measurements. The latter CID appeared to increase in the higher range of counts. Finally, the degree of agreement between 2D and 3D TVS counts (n = 76) was characterized by a 95% CID of −5.3 to +8.3. This coverage interval widened when higher numbers of follicles were counted. With the exception of the between‐method analysis, kappa values indicated overall that follicle counts will hardly change from one category to another when repeatedly carried out.

Conclusions

Determination of antral follicle numbers by both 2D and 3D TVS is adequate with regard to the intra‐ and interobserver reproducibility. The between‐method reproducibility of follicle counts measured both by 2D and 3D ultrasound is moderate. When higher follicle counts are observed both interobserver and between‐method reproducibilities tend to decline. If used in categorical classifications, ultrasound‐based follicle counts appear to have a high level of agreement between and within observers. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Splenic artery Doppler in the prediction of the small‐for‐gestational age infant
Authors: Oz U. , Kovanci E. , Jeffress A. , Mendilicioglu I. , Mari G. , Bahado‐Singh R. O.
Published: March 2003

Objectives

We hypothesized that, as with other areas of the peripheral circulation, fetal splenic artery blood flow undergoes changes in small‐for‐gestational age (SGA) fetuses due to a redistribution of cardiac output, and that the Doppler peak systolic velocity (PSV) reflects such changes and thus may be used to predict fetuses being SGA.

Methods

Splenic artery Doppler PSV, end‐diastolic velocity (EDV), resistance index (RI) and umbilical artery RI were measured prospectively in fetuses at risk for being SGA at birth. Normal reference data were generated from appropriately grown fetuses delivering at ≥ 37 weeks without complications, and SGA was defined as birth weight < 10th percentile. The Doppler indices were expressed as multiples of the normal median (MoM) for gestational age. Using receiver operating characteristic curves, optimal Doppler thresholds for the detection of SGA cases were determined and the areas under the curves calculated. The analysis was limited to singleton pregnancies delivered within 2 weeks of the last Doppler examination.

Results

There were 88 study patients of which 60 had SGA babies. The mean gestational age at Doppler examination was 31.4 weeks with a mean interval of 5.6 days from Doppler to delivery. The splenic artery PSV was lower in SGA, compared to normal cases: mean PSV (MoM), 0.93 vs. 1.09, respectively (P = 0.0001). The sensitivity, specificity and area under the curve were 70.0%, 72% and 0.734, respectively (P < 0.003), for the PSV in the prediction of delivery of a SGA fetus. For the splenic artery RI, values were 70%, 46% and 0.539, respectively (not significantly different), and for umbilical artery RI these were 70%, 61% and 0.689, respectively (P < 0.01). Splenic artery EDV was significantly reduced in SGA vs. normally grown fetuses (0.924 MoM vs. 1.145 MoM, P = 0.007).

Conclusions

Fetal splenic artery PSV decreases in SGA infants, and is a strong predictor of the delivery of a SGA infant. It appears to be superior to the standard Doppler index, the RI, in predicting this outcome. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Unilateral eye enucleation in adult rats causes neuronal loss in the contralateral superior colliculus
Authors: SMITH S. A. , BEDI K. S.
Published: March 2003

Several studies have reported the morphological changes induced by unilateral enucleation during early neonatal life on the developing visual system. This study has examined cellular changes in the superior colliculi by removal of a single eye in adult rats. Anaesthetised male hooded rats aged 90 d had their right eyes removed. Groups of nonenucleated control and enucleated rats were killed when aged either 150 or 390 d. The brains were removed and both the right and left superior colliculi dissected out. The volume of the stratum griseum superficiale (SGS) within these colliculi was estimated stereologically by light microscopy, as well as the numerical density and total number of neurons within this cell layer. The volume of the cell layer was reduced by about 40% on the side contralateral to the enucleated eye but not on the ipsilateral side at both survival periods examined. The numerical density of neurons within the SGS was unaffected by the enucleation so that the colliculi contralateral to the enucleated eye showed a substantial loss of neurons within this cell layer. This study demonstrates the importance of the retinal ganglion cell input, even in adult animals, for maintaining the viability of neurons in the SGS layer of the superior colliculus.
Number, distribution and neuropeptide content of rat knee joint afferents
Authors: SALO PAUL T. , THERIAULT ELIZABETH
Published: March 2003

Retrograde tracing with Fluoro‐Gold was used to identify the complete population of knee joint afferents in the lumbar dorsal root ganglia of adult female Wistar rats. There was an average of 581±31 (mean±
S.D.) afferents supplying each joint. These were found distributed from L1 to L5 with the great majority localised in the L3 and L4 ganglia. Electron microscopy of the posterior articular nerve of the knee revealed an average of 103±15 (mean±S.D.) myelinated and 513±39 unmyelinated axonal profiles. Since about 50–60% of the unmyelinated profiles would be expected to be sympathetic efferents, these numbers are consistent with the numbers of afferents found by Fluoro‐Gold retrograde tracing and suggest that the posterior articular nerve contains about 50% of the total number of knee joint afferents in the rat. Immunohistochemistry revealed that an average of 10% of identified joint afferents expressed substance P‐like immunoreactivity and that 33% expressed calcitonin gene‐related peptide‐like immunoreactivity.
Changes in muscle fibre type, muscle mass and IGF‐I gene expression in rabbit skeletal muscle subjected to stretch
Authors: YANG SHIYU , ALNAQEEB MAJED , SIMPSON HAMISH , GOLDSPINK GEOFFREY
Published: March 2003

The relationship between IGF‐I and changes in muscle fibre phenotype in response to 6 d of stretch or disuse of the lower limb muscles of the rabbit was studied by combining in situ hybridisation and immunohistochemistry procedures. Passive stretch by plaster cast immobilisation of the muscle in its lengthened position not only induced an increase in IGF‐I mRNA expression within the individual muscle fibres but also an increase in the percentage of fibres expressing neonatal and slow myosin. This change in phenotype was also found to be accompanied by a rapid and marked increase of muscle mass, total RNA content as well as IGF‐I gene expression. In contrast, IGF‐I appears not to be involved in muscle atrophy induced by immobilisation in the shortened position and the inactivity which results from this procedure. The level of increase in expression of IGF‐I mRNA varied from fibre to fibre. By using adjacent serial sections, the fibres which expressed IGF‐I mRNA at the highest levels were identified as expressing neonatal and the slow type 1 myosin. These data suggest that the expression of IGF‐I within individual muscle fibres is correlated not only with hypertrophy but also with the muscle phenotypic adaptation that results from stretch and overload.
Correspondence. Superficial brachial artery continuing as the common interosseous artery
Authors: NAKATANI TOSHIOI , TANAKA SHIGENORI , MIZUKAMI SHIGEKI
Published: March 2003

The superficial artery of the arm with a course anterior to the median nerve is found at an incidence of ≈13%, and it continues as the radial artery twice as frequently than as the ulnar artery; less frequently it continues as both arteries (Bergman et al. 1988). We report a rare case in which the superficial brachial artery continued as the common interosseous artery only and the deep brachial artery continued as the radial and superficial ulnar arteries in the cubital fossa.