bluuebunny/crossref_metadata_2025 huggingface dataset:
Comprehensive analysis of uterine artery flow velocity waveforms for the prediction of pre‐eclampsia
Authors: Aquilina J. , Barnett A. , Thompson O. , Harrington K.
Published: March 2003

Objectives

To evaluate the performance of velocimetric indices of uterine artery flow velocity waveforms (FVW's) at 20 weeks' gestation, alone or in combination with qualitative analysis, and establish the optimal screening method for the prediction of pre‐eclampsia.

Methods

A total of 614 primiparous women had color flow/pulsed Doppler (CFPD) imaging of both uterine arteries at 20 weeks gestation. Receiver operator characteristic (ROC) curves were created for the systolic/end‐diastolic (A/B) ratio, resistance index (RI) and systolic/early diastolic (A/C) ratio for placental and non‐placental uterine arteries, individually or in combination with the presence of unilateral or bilateral notches. Based on data from ROC curves, the sensitivity of each method was compared with the false‐positive rate set at 17 and 11%.

Results

The highest sensitivity (88%) and specificity of (83%) was obtained using bilateral notches/mean RI ≥ 0.55 (50th centile) and unilateral notches/mean RI ≥ 0.65 (80th centile). When the false‐positive rate was set at 17%, the inclusion of bilateral notches significantly improved the sensitivity of RI (P < 0.001), placental RI (P < 0.01), placental A/C ratio (P < 0.05), mean A/C ratio (P < 0.01) and mean A/B ratio (P < 0.05). Bilateral notches/mean RI or A/B cut‐offs were also superior to the persistence of a notch in either artery combined with RI (P < 0.01) or A/B ratio (P < 0.05). When the false‐positive rate was set at 11%, the inclusion of bilateral notches did not improve the sensitivity of the A/C (P = 1.00) or A/B ratio (P > 0.10). Placental velocimetric indices performed better than mean indices but the differences in sensitivity at the set false‐positive rates were not statistically significant.

Conclusion

At 20 weeks' gestation, bilateral notches with mean RI cut‐offs is the best screening method if further screening later in pregnancy is proposed. The A/C ratio is complementary to bilateral notches when the false‐ positive rate is set at 17% and an effective quantitative substitute when the false‐positive rate is set at 11%. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonographic evaluation of the postpartum uterus
Authors: Edwards A. , Ellwood D. A.
Published: March 2003

Objective

To define the ultrasonographic appearance of the uterus and the uterine cavity, including its contents, in normal women making an uncomplicated postpartum recovery.

Methods

Forty women were scanned on days 7, 14, and 21 postpartum. At each scan the uterine and cavity volumes were estimated, and the appearance of the uterine cavity contents was documented. The amount and duration of postpartum vaginal bleeding, and method of infant feeding were also recorded.

Results

The mean duration of postpartum bleeding was 24.5 (range 14–45) days. Fifty‐one percent (95% confidence interval 34–68) of the subjects scanned at 7 days postpartum, 21%(8–36) at 14 days, and 6%(0.8–20) at 21 days, had an echogenic mass within the uterine cavity. Statistical analysis revealed no difference, in terms of bleeding duration, between women with a uterine cavity echogenic mass noted at 7, 14, or 21 days postpartum, and those without (unpaired t‐test, P = 0.42, 0.39, and 0.06). The presence of an echogenic mass was not associated with heavier bleeding at the time of any of the scans (chi‐squared test, P = 0.58, 0.56, and 0.28). Statistical analysis revealed no correlation between the duration or amount of bleeding, and the uterine or cavity volume, at any of the three scans.

Conclusion

In this study, ultrasound evaluation of the uterine cavity revealed an echogenic mass in 51% of women with normal postpartum bleeding at 7 days, 217% at 14 days, and 6% at 21 days postpartum. This questions the significance of echogenic material within the uterine cavity in the postpartum period. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Fetal ovarian cysts: a report of three cases managed by intrauterine aspiration
Authors: Perrotin F. , Potin J. , Haddad G. , Sembely‐Taveau C. , Lansac J. , Body G.
Published: March 2003

Small follicular or functional theca‐lutein cysts are a common finding in fetal and neonatal ovaries. After delivery, decrease of hormonal stimulation may lead to spontaneous resolution of the cyst. A high rate of complication has been underlined by recent studies, the most common being ovarian torsion with subsequent loss of the ovary. Because torsion may happen with any size of cyst, however large or small, we suggest in utero decompression even in small fetal ovarian cysts (< 5 cm). We report here three cases of such cysts managed by intrauterine aspiration with good outcome and no further need for neonatal surgery. In all cases cytology of the cyst aspirate demonstrated numbers of granulosa cells and fluid biochemistry showed a high amount of estradiol, progesterone, and testosterone that confirmed the etiology as ovarian. Despite the small size of the cysts, no technical difficulties were encountered and no maternal or fetal morbidity occured. Prenatal management of fetal ovarian cysts remains controversial, however, and our limited experience needs to be assessed on a larger number of cases. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Cervical assessment at the routine 23‐week scan: standardizing techniques
Authors: To M. S. , Skentou C. , Chan C. , Zagaliki A. , Nicolaides K. H.
Published: March 2003

Objective

To examine the frequency of curvature of the cervix and to establish the degree of curvature with increasing cervical length. To assess the significance of this phenomenon in terms of the classification of patients as high risk for pre‐term delivery.

Method

Cervical length was measured prospectively by transvaginal sonography in 301 women at 23 weeks of gestation. The distance between the internal and external os was measured both as a straight line and also as a curved line along the endocervical canal. In addition, a search of our database was made to identify all women who had undergone cervical assessment as part of a policy of routine screening. In those with cervical length of less than 26 mm the thermal images of the cervix were used to obtain straight and curved measurements. The frequency of curved cervix was calculated and the relationship between the ratio of straight to curved measurement to the curved one was determined.

Results

In the prospective study curvature of the cervix was observed in 143 (48%) of the 301 women. Curvature was observed in 51% (135 of 267) with cervical length of 26–55 mm, 25% (8 of 32) with length of 16–25 mm, and none of the two with length of 1–15 mm. The ratio of the straight to the curved measurement decreased with increasing cervical length (r = −0.27, P = 0.001). In the retrospective study curvature of the cervix was found in 72 (15%) of 471 with length of 16–25 mm and in none of the 76 with length of 1–15 mm.

Conclusion

Cervical length is influenced by the degree of cervical curvature. The disparity of measurements between the internal and external os taken as a straight line or along the cervical canal increases with cervical length. However, this disparity may not have any clinical implications because at short cervical length (less than 16 mm) the cervix appears to be always straight. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis and outcome of a ruptured aneurysm arising from the left atrium
Authors: O'Brien J. M. , Barton J. R. , Spirek A. J. , Allen A. A. , McCaffrey F. M.
Published: March 2003

Prenatal diagnosis of a fetal cardiac aneurysm or diverticula is rare. We report what we believe to be the first case of an atrial wall aneurysm diagnosed as ruptured or leaking by fetal pericardiocentesis. Spontaneous resolution of the anomaly was observed in the third trimester with delivery of a vigorous newborn at term. The infant did not require surgical intervention after birth and has done well at follow‐up examinations. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm
Authors: Epstein E. , Ramirez A. , Skoog L. , Valentin L.
Published: March 2003

Objectives

To determine the ability of transvaginal ultrasound, with or without saline infusion, to detect focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium > 5 mm, and to determine the accuracy of conventional ultrasound, saline contrast sonohysterography and diagnostic hysteroscopy under general anesthesia to diagnose endometrial polyps, submucous myomas and uterine malignancy.

Design

In a prospective study, 105 women with postmenopausal bleeding and endometrium > 5 mm underwent conventional ultrasound examination and saline contrast sonohysterography. Diagnostic and operative hysteroscopy under general anesthesia was then performed. The presence of focally growing lesions and the type of lesion (endometrial polyp, submucous myoma, malignancy or unclear focal lesion) were noted at ultrasound examination and at hysteroscopy.

Results

There was almost perfect agreement (96%) between saline contrast sonohysterography and hysteroscopy in the diagnosis of focally growing lesions. Saline contrast sonohysterography and hysteroscopy both had a sensitivity of approximately 80% with regard to diagnosing endometrial polyps (false‐positive rates of 24% and 6%, respectively), whereas conventional ultrasound missed half of the polyps (sensitivity, 49%; false‐positive rate, 19%). Hysteroscopy was superior to both saline contrast sonohysterography and conventional ultrasound with regard to discriminating between benign and malignant lesions (sensitivity, 84%, 44%, and 60%; false‐positive rate, 15%, 6% and 10%, respectively). The risk of malignancy was increased seven‐fold (odds ratio, 7.3; 95% confidence interval, 1.9–27.8) in women with distension difficulties at saline contrast sonohysterography, and two thirds of the women with a poorly distensible uterine cavity had a malignant diagnosis.

Conclusion

Saline contrast sonohysterography is as good as hysteroscopy at detecting focally growing lesions in the uterine cavity in women with postmenopausal bleeding. However, neither hysteroscopy nor saline contrast sonohysterography can reliably discriminate between benign and malignant focal lesions. Distension difficulties at saline contrast sonohysterography should raise a suspicion of malignancy. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
The value of sonohysterograpy in the diagnosis of abnormal uterine bleeding
Authors: Kepkep K. , Koç A. , Gurpinar H.
Published: March 2003

Purpose:  The aim of study was to evaluate the value of transvaginal sonohysterography in the diagnosis of endometrial, submucosal and intracavitary lesions in patients with abnormal uterine bleeding.

Methods:  This was a prospective case controlled study. Sonohysterography was performed in 50 women (aged 33–64 years) with abnormal uterine bleeding in whom transvaginal sonography suggested an increased endometrial thickness or poorly defined endometrium. Sterile saline solution (10–30 mL) was injected into the endometrial cavity under direct ultrasonographic visualization. Once the endometrial cavity was expanded, the presence of polyps or submucous myomas and the anterior and posterior endometrial thickness was assessed. Following that the endometrial biopsy was performed. The 26 of 50 patients underwent hysterectomy.

Results:  In sonohysterographic examination, 11 patients had submucous myomas, six patients had endometrial polyps and the others had diffuse or focal increased endometrial thickness. The results of sonohysterography and transvaginal ultrasonography differed significantly (x2 = 11, P < 0.05). The results of sonohysterography and endometrial biopsy differed significantly (x2 = 11, P < 0.05). There was no significant difference between sonohysterography and pathologic findings of hysterectomy materials (x2 = 2, P > 0.05). Sensitivity and specificity for sonohysterography were 85 and 100% and positive and negative predictive values were 100 and 85%, respectively.

Conclusion:  Sonohysterography is highly accurate method which allows differentiation of intracavitary, endometrial and submucosal lesions in patients with abnormal uterine bleeding.
First trimester ductus venosus Doppler screening in pregnancies with increased nuchal translucency risk
Authors: Mavrides E. , Sairam S. , Hollis B. , Carvalho J. , Thilaganathan B.
Published: March 2003

Objective:  To evaluate the role of ductus venosus (DV) Doppler in pregnancies with an increased nuchal translucency (NT) adjusted risk for the prediction of fetal outcome.

Methods:  Doppler assessment of the DV was performed in 124 fetuses with a first trimester NT‐adjusted risk of >1:300 for Down syndrome. The pregnancy outcome, including karyo‐type and structural abnormalities, were ascertained for all pregnancies.

Results:  The DV Doppler was abnormal in 27 (21.8%) pregnancies with an increased first trimester NT‐adjusted risk. The outcome was normal in 69 pregnancies (55.6%). Thirty‐nine pregnancies (39.5%) were aneuploid and further six pregnancies had adverse outcomes (three unexplained intrauterine deaths, two structural abnormalities and one major cardiac defect). The sensitivity of abnormal DV in this selected population was 51.3% for aneuploidy and 33.3% for adverse outcome. An abnormal DV Doppler increases the risk for aneuploidy by 11.8 (95% CI: 3.3–42.2).

Conclusions:  The finding of an abnormal DV Doppler signal increases the risk for aneuploidy 12‐fold in a pregnancy with an increased NT‐adjusted risk. Although DV Doppler can be used in addition to NT screening for aneuploidy, the sensitivity of DV Doppler is less than previously reported.
Congenital heart disease and the spectrum of karyotypic abnormalities in a prenatal population
Authors: Quinton A. E. , Smoleniec J. S. , Clarke J. , Ogle R. F.
Published: March 2003

Aim:  To evaluate the frequency and type of chromosome anomalies in fetuses diagnosed by ultrasound with congenital heart disease (CHD).

Methods:  The study is a retrospective descriptive case series with the nonrandom sample taken from all the pregnant women who had an ultrasound at the Feto‐Maternal Unit. There were 69 cases of congenital heart defects (CHD) collected from a data base search.

Results:  Abnormal chromosomes were present in 47% of cases. Fifteen percent had trisomy 18, 13% trisomy 21 and 5% trisomy 13. Triploidy, monosomy X and 22q11 deletion occurred with a frequency of 3% each. Unusual chromosome anomalies were trisomy 16 mosaic and trisomy 7p, unbalanced translocation 7 and 11. Chromosome analysis was unavailable in 9% of cases. Maternal age was significantly different for those with CHD and an abnormal karyotype (P = 0.019, t‐test). CHD and the presence of other fetal anomalies was significantly associated with an abnormal karyotype (Fisher's exact test, P = 0.029). Hypoplastic left heart syndrome was the most common heart defect found with 44% of fetuses having an abnormal karyotype. Fifty percent of fetuses with an atrioventricular septal defect had an abnormal karyotype. Hypoplastic left heart was found in 33% of trisomy 18 fetuses and an atrioventricular septal defect in 50% of trisomy 21 cases. These results show a poor outcome for fetuses diagnosed in utero with CHD, with an overall mortality rate of 72%.

Conclusion:  The frequency and type of abnormal chromosomes found in fetuses diagnosed with CHD agrees with other reports in the literature. The risk of aneuploidy with CHD is influenced by maternal age. Detection of CHD is improved when other fetal anomalies are present.
Determination of fetal gender by first trimester ultrasonography
Authors: Cha Sang Choon , Yamasaki A. A. , Braia G.
Published: March 2003

Objective:  To assess the accuracy of first trimester ultrasonography in determining fetal sex by orientation of genital tubercle in relation to spine in a midsagittal plane.

Material and methods:  Between May 2000 and 2001, 110 patients were studied from 11 to 14 weeks of gestation (average 12.1 weeks) at first trimester ultrasonography. The genital region was examined in a midsagittal plane and the fetal gender was assigned as male if the angle of the genital tubercle to a horizontal line through the lumbosacral skin surface was greater than 30° and female when the genital tubercle was parallel or convergent (<30°). All final results were checked after birth.

Results:  Among 148 patients, only in 16 (10.8%) fetal sex was not determined. In 132 patients (89.2%), genital tubercle was identified and sex was determined. There were 106 (80.3%) hits and 26 mistakes (19.7%).

Conclusion:  The diagnosis of fetal sex at first trimester has an important role in case of X‐linked anomalies so invasive procedures can be avoided if fetuses are female. Our results are similar to others in literature. The accuracy of gender determination by ultrasonography was 80.3%. Most common mistake was to assign male fetuses as female. We believe that this error is due to the angle variation of the genital tubercle during the exam.
Separation of siamese twins at the head (craniopagus): the Brisbane experience
Authors: Campbell S. F. , Jamieson K. G. , Sinnott S. J.
Published: March 2003

Siamese twins have intrigued both the physician and layperson for many centuries. Craniopagus twins (joined at the head) are exceedingly rare with an incidence of 1/5 million births. Most clinicians never see a case of craniopagus, and those who do rarely see more than one. The author would like to present two cases of craniopagus twins born and separated recently in Brisbane, Australia. The problems associated with separation and outcomes will be discussed.
Correlation between ductus venosus, gestational age and nuchal translucency at 11–14 weeks scan: preliminary study
Authors: Munoz H. , Parra M. , Pedraza D. , Jimenez P. , Villa S. , Puga M.
Published: March 2003

Background/objective:  Fetal ductus venosus assessment at 11–14 weeks' gestation is one of the best tests to identify fetuses with cardiac malformation. Negative blood flow during atrial contraction has been used as qualitative sign in this cases. The aim of this study is to describe normal ranges for Doppler velocimetry of ductus venosus at 11–14 weeks' gestation and correlate it with nuchal translucency thickness.

Material and methods:  We performed a prospective study, 88 patients were examined at 11–14 weeks of pregnancy. Crown rump length, nuchal translucency, fetal anatomy and uterine artery Doppler velocimetry were evaluated transabdominally. Ductus venosus was identified using longitudinal plane and Doppler velocimetry index was measured using Doppler duplex ultrasound. An average of three waveforms were analyzed and pulsatility index venousus was measured. For statistical analysis mean values and 95% CI for pulsatility index of ductus venosus was established for each crown rump length, Spearman regression and normal centile distribution was performed.

Results:  The 77 out of 88 patients with nuchal translucency below 95th centile were used for calculating normal ranges for each gestational age. Mean maternal age was 29 ± 6.5 years old (range = 15–42), and 20% was over 35 years old. Mean pulsatility index was 1.02, 0.99, 0.95 and 0.92 at 11, 12, 13 and 14 weeks, respectively. Although ductus venosus pulsatility index was not modified according to gestational age, there was a significant positive correlation with nuchal translucency thickness (r = 0.59, P ≤ 0.001).

Conclusion:  Ductus venousus pulsatility index is correlated positively with nuchal translucency at 11–14 weeks' gestation.
Ultrasonographically measured umbilical cord cross‐sectional area – reproducibility of the method
Authors: Vasques F. A. P. , Moron A. F. , Murta C. G. V. , Carvalho F. H. C. , Cattini H. , Gonçalves T. R. , Barbosa M. M. , Hishaba W. J.
Published: March 2003

A prospective cross‐sectional study was developed in order to determine the reproducibility of the measurement of the umbilical cord cross‐sectional area (UCCSA) during normal pregnancies (patients with known dates of LMP and an ultrasound examination before the 20th week, without any pathologic condition), measured by different and trained examiners. The measurements of the umbilical cord cross‐sectional area were obtained in a plane adjacent to the insertion of the cord abdomen, as proposed by Raio et al. 1999, after the different examiners were trained by the author. The inclusion criteria were: (1) singleton pregnancy; (2) gestation age >20 weeks; (3) intact membranes (4) normal umbilical Doppler flow velocimetry. The exclusion criteria, in the presence of any of those were: (1) congenital and/or chromosomal abnormalities; (2) pregnancy complications (any type); (3) inadequate size for gestational age with when the examination was performed, i.e. the weight below the 10th percentile or above the 90th; (4) abnormal AFI for the gestational age. The patients were examined and included only once. During the period of the study (February 2000–May 2001), 545 patients were examined, after meeting the inclusion criteria determined for the present study. The age of the patients ranged from 15 to 42 years (mean = 26.7 ± 4.8), 242 patients (44.4%) had two gestations, 135 patients (28.1%) were at their first gestation, 129 patients (23.7%) were at their third gestation and 39 patients had four or more gestations (3.8%). The ultrasound machine used was the Synergy Multi Sync M 500. The statistical program used was the statistical package for social sciences (SPSS). The first examiner collected 22% of the data, the second examiner collected 45% of the data, the third examiner collected 24% of the data and the fourth one collected 9% of the data. According to the analysis of variance (anova), we performed, comparing the data obtained by the different examiners, no significance was found and this fact was also showed by the comparison of the data among them and verifying that the data had a dispersion inside tolerable limits. The anova showed the following data (example for 3 weeks): At 25 weeks, the F‐test showed a value of 0.930 and a P‐value of 0.454; at 32 weeks the values were 0.106 for the F‐test and 0.956 for the P‐value and for week 38 the values were 0.102 (F‐test) and 0.904 (P‐value). We conclude that the measurement of the UCCSA as proposed by Raio et al. 1999 is reproductible and can be adopted as a new obstetric ultrasound parameter.
Sonographic based triage – transvaginal sonography (TVS) and sonohysterography (SHG) – for benign uterine lesions and surgical management
Authors: Leone F. P. G. , Tonta A. , Lanzani C. , Di Grandi M. , Mastromatteo C.
Published: March 2003

Purpose:  To assess the reduction of clinical indications to hysterectomy as a consequence of sonographic based triage – transvaginal sonography (TVS) and sonohysterography (SHG) – in the surgical management of benign uterine lesions.

Methods:  All women undergoing surgery for symptomatic (methrorragia) benign uterine lesions were included. Women with prolapse, cervical lesions and malignant lesions were excluded. Data from 180 and 154 patients treated during 1998–99 (group A) and the year 2000 (group B), respectively, were analyzed.

Diagnostic triage:  All patients had complete history collected and pelvic examination performed. Group A. Patients were evaluated by TVS – not mandatory – VABRA curettage and/or D&C and/or diagnostic histeroscopy with biopsy. Group B. All patients were evaluated by TVS and in case of endometrial thickness >4 mm, a SHG was performed to distinguish focal lesions (polyps, myomas, focal hyperplasia) and diffuse lesions (hyperplasia). Theraputic protocol (in group A) was decided in each single case by the medical‐equipe; in group B: patients with focal endocavitary lesions underwent operative hysteroscopy. Patients with diffuse lesions underwent hysteroscopy and endometrial guided biopsy. Indications to abdominal miomectomy were: submucous myomas (G0–G1) > 5 cm, G2 or subserous myomas in women asking to preserve the uterus. Indications to hysterectomy (vaginal/abdominal) were large miometrial lesions non‐responding to medical therapy.

Results:  Median age of group A and B patients was not significantly different (46 years, interquartile range 40–56). The frequency of abdominal/vaginal hysterectomy was significantly lower in group B (28%) than in group A (54%) (P < 0.01). Laparotomic myomectomy were not significantly different in the two series (24% vs. 22%). The frequency of operative hysteroscopy was significantly higher group B 63%) than in group A (9%) (P < 0.01).

Conclusions:  The introduction of sonographic based triage and therapeutic protocols for benign uterine lesions determined a dramatic reduction of demolitive uterine surgery, even in the same medical equipe. This involves a significant reduction of economic cost and an improvement in health care for the same abnormal conditions.
Ultrasonic fetal and placental tissue characterization and the role of Doppler ultrasound in lung maturity
Authors: Podobnik M. , Podgajski M. , Gebauer B. , Breyer B.
Published: March 2003

Background:  The aim of this study is to confirm the relationship between the gestational age and quantitative assessment of ultrasonic signs of placental tissue, fetal lungs and liver tissue and to correlate Doppler parameters from main stems of the pulmonary arteries for determining fetal lung maturity in normal pregnancy and pregnancy with pre‐eclampsia and diabetes.

Methods:  The placenta, fetal lungs and fetal liver in 300 normal pregnancies, 100 pre‐eclamptic pregnancies and 100 diabetic pregnancy were examined by ultrasound at 30–41 weeks of gestation. The coefficients of variation (the standard deviation divided by the mean value) were used to characterize the tissue in different groups during pregnancy. Doppler velocimetry was performed in the main stems of pulmonary arteries in normal pregnancies and pregnancies with pre‐eclampsia and diabetes.

Results:  The coefficients of variation in mature fetuses were greater than 29% for placentas in vivo, greater than 34% for placentas in vitro, greater than 28% for liver tissue and greater than 30% for lung tissue. Placental, lung and liver tissue of diabetic pregnancy tended to have lower coefficients of variation throughout their pregnancies. We found in mature fetuses mean peak systolic velocity higher than 40 cm/s and PI lower than 3.00. In mature fetuses with pre‐eclampsia, we found higher mean peak systolic velocity in compared with normotensive patients.

Conclusions:  The coefficient of variation values for placentas in vivo and in vitro, and fetal lungs and liver increase during pregnancy in normal and pre‐eclamptic patients with increasing gestational age and decrease in diabetic patients.
Effect of income on fetal biometry by ultrasound
Authors: Taher M. A.
Published: March 2003

Objective:  To compare gestational age corrected fetal biometry among rich and poor women.

Methods:  An ultrasound database from August 2000 to January 2001 was used for the purpose of this study. One hundred and seventy‐five patients with certain menstrual history were included. Patient's income was assigned based on their report during the initial evaluation. There were 137 rich and 38 poor women. All data were enter into Statistix 7.0 statistical package, and analyzed using appropriate statistical tests. Probability values less than 5% were considered significant.

Results:  Multiple regression analysis using a second‐order model for gestational age a S function of fetal biometry, income, and fetal biometry–income interaction did not show income to alter the relationship between gestational age and fetal biometry except for femur lengths. Ninety‐five percent prediction intervals for gestational age did not show clinically significant difference between rich and poor.

Conclusion:  There does not appear to be a significant difference in ultrasound measured fetal biometry among different income groups.
Fetal magnetic resonance imaging
Authors: Sinnott S. J. , Traves D. , Ryan T. , Frawley K. , Wood T. , Cincotta R. B.
Published: March 2003

Fetal magnetic resonance imaging (MRI) is rapidly establishing a key role in the diagnostic evaluation of fetal central nervous system (CNS) anomalies. We present, a pictorial essay of the effectiveness of fetal MRI in the assessment of cerebral anomalies and ventriculomegaly. High resolution neurosonography remains the cornerstone in antenatal CNS screening. When cerebral anomalies are diagnosed or suspected by ultrasound examination, MRI clearly has a role and often adds useful information or can increase the level of diagnostic confidence and may alter patient counseling and management. MRI examinations also can be used to obtain further opinions from different subspecialists, such as neuroradiologists, neurosurgeons, neurologists and intervention radiologists. Subtleties that may not be distinguishable on ultrasound can be seen on MRI. The MRI should not be seen as a competitor to ultrasound, rather a complementary study from which the imaging specialists can improve their working knowledge in CNS anatomy and pathology.
Comparison of two methods of cervical stress testing
Authors: Okitsu O. , Niki H. , Mimura T.
Published: March 2003

Purpose:  Cervical ultrasonography provides useful information on the prediction of preterm delivery. However, the cervix in natural state evaluated by sonography does not always show the predicting signs of preterm delivery. Some insist on the usefulness of the cervical stress testing like transfundal pressure or Valsalva maneuver, which provoke cervical shortening or funneling by increasing intrauterine pressure. Our object was to compare the efficiency of the transfundal pressure with that of the Valsalva maneuver as cervical stress testing.

Methods:  Normal pregnant women visiting our outpatient department for routine check up underwent transvaginal ultrasonography. Cervical length was measured and the shape of the internal os were evaluated. When the shape of internal os was flat or mildly depressed, these women were regarded as candidates for the stress testing. First, Valsalva maneuver, second, transfundal pressure were applied. Cervical shortening ratio was calculated in comparison with the natural state, and appearance of funneling was evaluated.

Results:  Twenty‐five examinations were performed on 20 pregnant women. The shortening ratio in transfundal pressure was 9.8%, which was greater than that in Valsalva maneuver, 6.5%. However, the number in which cervical length became 25 mm or less was same in each test. On the other hand, funneling was induced in two cases only by transfundal pressure.

Conclusion:  Although transfundal pressure seemed better testing than Valsalva maneuver, further examinations is required to conclude which test is superior.
Outcome of 25 pregnancies complicated with CCAM
Authors: Higgins S. P. , NiChuileannain F.
Published: March 2003

Congenital cystic adenomatoid malformation (CCAM) is a pulmonary developmental anomaly arising from an overgrowth of the terminal respiratory bronchioles, while the development of the alveoli is completely suppressed except at the periphery. The condition, in the vast majority of cases is confined to a single lung (85%) or lobe. Congenital cystic adenomatoid malformation has been classified into three subgroups according to the size of the cysts. The inheritance pattern of the lesion appears to be sporadic, with no known teratogenic associations. The condition is usually isolated and there is no association with chromosomal defects. The ultrasound diagnosis is based on the finding of a solid or cystic, non‐pulsatile intrathoracic tumor. Common associated findings are polyhydramnios (65%), which is likely to be due to decreased fetal swallowing, the consequence of esophageal compression by the mass or decreased absorption of lung fluid by the hypoplastic, malformed lungs, hydrops (common in microcystic form) and placentomegaly (in cases of hydrops). Unilateral lesions are often associated with deviation of the mediastinum in the contralateral side. In bilateral disease, the heart may be severely compressed, and this is usually associated with ascites from venocaval obstruction or cardiac compression. We wish to present the outcome of 25 pregnancies where a diagnosis of congenital cystic adenomatoid malformation was made on the basis of ultrasound findings during second and third trimester scans. The patients were subsequently managed through the Fetal Management Unit at the Royal Women's Hospital over the 6‐year period from 1995 to 2001. We will present data on the progression of the lesions through pregnancy, pregnancy outcome with short‐ and long‐term follow up data on the babies.
Three‐dimensional ultrasound (3DUS) does not enhance maternal bonding during pregnancy
Authors: Hull A. D. , Pretorius D. H. , James G. , Parry B. , Newton R.
Published: March 2003

Purpose:  To assess the impact of 3DUS on maternal–fetal bonding during pregnancy.

Methods:  A total of 36 primi gravidae were randomized to either 3DUS or conventional two‐dimensional ultrasound (2DUS) at 12 or 24 weeks of gestation. Prior to imaging all subjects were given a structured clinical interview at 12 weeks of gestation. The following instruments were also applied: Parent Bonding Instrument, Beck Depression Inventory (BDI), Maternal Social Support Index, State‐Trait Anxiety Inventory (STAI), and the Maternal Fetal Attachment Scales (MFA). After their scan, all subjects received a ‘best picture’ image of their fetus and a short video tape of their study. The BDI STAI and MFA were re‐administered to all subjects during the second and third trimesters.

Results:  A total of 20 subjects underwent 3DUS (10 at 12 weeks, and 10 at 24 weeks) and 16 underwent 2DUS (7 at 12 weeks, and 9 at 24 weeks). No serious psychological disorders were identified at the initial interview. Maternal–fetal bonding, as assessed by the various instruments increased steadily throughout pregnancy in all subjects with a marked increase following quickening. No significant differences (P < 0.001) in objective measures of maternal–fetal bonding were identified between the 3D and 2D groups regardless of gestational age at imaging.

Conclusion:  The 3DUS does not appear to increase maternal–fetal bonding during the course of normal primi gravid pregnancy when compared to 2DUS.
Evaluation of color Doppler usefulness in diagnostics of pathological changes in endometrium supported by histological verification
Authors: Stachowiak G. , Jedrzejczyk S. , Pertynski T. , Polac I. , Romanowicz H.
Published: March 2003

Purpose:  To evaluate in Doppler examinations the frequency of vascularization and its character in individual types of pathological changes within endometrium in postmenopausal women without HRT on the basis of histological verification.

Methods:  A total of 327 postmenopausal women were under initial uniform diagnostic algorithm ended in dilatation and curretage or hysteroscopy with uterine sampling for histopathological examination. In all the patients, vaginal sonography, and then color Doppler study was performed. The frequency of vascularization, its character and distribution, resistance and pulsatility indices in uterine arteries and in detected vessels inside pathological changes were estimated.

Results:  In all cases, in which in histological results did not show any pathological changes, no intraendometrial flows were detected in Doppler examination. Internal vascularization was found in 69% of patients with submucosal fibroids, in 66% of patients with endometrial polyps, in 37% of patients with endometrial hyperplasia, whereas in 78% of patients with endometrial cancers. In 50% of patients with endometrial hyperplasia regular distributed internal vascularization was found, however, in 66.7% of patients with endometrial cancer ample irregular distribution of vascularization was detected. Doppler flows in arteries detected in pathological changes showed mean lowered PI and RI only in the group with endometrial hyperplasia and no statistically significant changes in the above indices in the groups with other pathological changes. In uterine arteries, statistically significant lowering of both RI and PI in the group with hyperplasia was found as well as in the group with endometrial cancers, whereas statistically significant increased PI were measured in the group with endometrial polyps.

Conclusions:  (1) Detection of endometrial flows during color Doppler examination in postmenopausal women without HRT may be a substantial sign of pathology requiring histological verification. (2) Lowering of RI and PI in uterine arteries together with irregular distribution of vascularization inside endometrial echo may be auxiliary elements in sonographic differentiation of endometrial cancers from other pathological changes. (3) Lowered RI and PI both in uterine arteries and arteries inside endometrial echo seem to be characteristic features of endometrial hyperplasia.
Should the three vessels view be the part of routine scanning for congenital heart defects?
Authors: Ioudina E. V. , Medvedev M. V.
Published: March 2003

Objective:  To estimate the effectiveness of the three vessels view in prenatal diagnosis of congenital heart defects (CHD).

Methods:  A total of 44 904 pregnant women of low‐ and high risk for CHD were examined from 16 to 39 weeks and followed throughout their gestation between January 1994 and December 2000.

Results:  CHD were diagnosed in 249 cases, 169 (67.9%) were classified as major cardiac anomalies. The overall prevalence of CHD was 5.5‰. Out of 169 cases 130 (76.9%) were detected prenatally including 46 isolated CHD. The detection rate of isolated CHD was 63.9% (46/72). From 1994 to 1996 four chamber view was the only one obligatory plan of heart examination. For the next three years, we used four chamber view in combination with identification of outflow tracts. In 1999 the three vessels view became the standard test in screening program for CHD. The detection rate of CHD increased from 54.2% over the first period of time to 80.4% in 1997–98 and to 87.9% at the end of the study. In 2000, this index run up to 89.4%. The part of missed main vessels malformations decreased from 39% in 1994 to 20% in 2000.

Conclusion:  The three vessels view is an easily obtained scan of the fetal heart. This plane can simplify prenatal cardiac examination and appreciably increase the detection rate of CHD. The three vessels view should be an obligatory part of routine scanning for CHD.
Early antenatal diagnosis of cardiac failure using Doppler ultrasound of umbilical artery
Authors: Murta C. G. V. , Moron A. F. , Ávila M. A. P. , Vasques F. A. P.
Published: March 2003

Background:  During the last 2 years, few prenatal ultrasonographic studies have documented a strong association between abnormal fetal venous return and chromosomal abnormalities. Articles in the English language medical literature were identified through MEDLINE. There is only one report of reverse flow pattern in the umbilical vein in severe intrauterine growth restriction at 29 weeks' gestation. The present case is the earliest documentation of this alteration in fetal venous return.

A 30‐year‐old primigravida was referred to our ultrasonography clinic at 12 weeks of gestation. The fetal crown‐rump length (57 mm) was not compatible with menstrual dates. The ultrasound examination showed an increased nuchal translucency (9.1 mm), bilateral pyelectasis, hiperechoic bowel, echogenic intracardic focus and ventricular septal cardiac defect. The fetal heart rate was 147 beats/min. The Doppler examination revealed high retrograde flow in the inferior vena cava, reverse flow in the ductus venosus during atrial contraction and reverse flow in the umbilical vein. Cytogenetic analysis by chorionic villus sampling diagnosed trisomy 9. Ten days later, fetal demise was observed. A non‐mosaic trisomy of chromosome 9 was confirmed on fetal cells' analysis. At autopsy, the characteristics findings were of complete trisomy 9 and the multiple abnormalities detected by ultrasonography were confirmed.

Conclusion:  Doppler blood evaluation of the venous return to the heart might provide relevant information on cardiac function. The reverse blood flow in umbilical vein may indicate an impending fetal death. We speculate that the association of abnormal nuchal translucency thickness with alterations of the fetus venous return might be a complementary tool to assess the risk for fetal aneuploidy in the first trimester of pregnancy. In addition, these Doppler velocimetry alterations can be an alarm sign for investigating cardiac abnormalities.
Prenatal diagnosis of cardiosplenic syndromes by fetal echocardiography: a 10‐year experience
Authors: Berg C. T. , Geipel A. A. , Baschat A. A. , Kohl T. , Krapp M. , Germer U. , Gembruch U.
Published: March 2003

Purpose:  To assess the accuracy of fetal echocardiography in the diagnosis of cardiosplenic syndromes.

Methods:  Retrospective survey of 27 fetuses with the pre‐ or postnatal diagnosis of cardiosplenic syndromes in our database over a period of 10 years.

Results:  In 24 out of 27 fetuses, the diagnosis of cardiosplenic syndrome was confirmed postpartum. In the remainder, two cases of situs inversus totalis with heart block and multiple cardiac malformations, but no evidence of heterotaxy were diagnosed at autopsy or after birth. In one fetus with situs ambiguus, dextrocardia, bradyarrhythmia and transposition of great arteries (TGA) no autopsy was performed after termination of pregnancy. In 18 fetuses, left atrial isomerism were prenatally diagnosed and confirmed at autopsy or postpartum. Main echocardiographic features were azygos continuation of interrupted inferior caval vein (15), complete atrioventricular septal defect (CAVSD) (11), persistent bradyarrhythmia (11), pulmonary stenosis (PS) (9), ventricular septal defect (VSD) (8), fetal hydrops (8) and dextrocardia (5). Other associated cardiac malformations were l‐TGA (2), double outlet right ventricle (DORV) (3), hypoplastic left ventricle (3), and partial/total anomalous venous connection (1/1). Ten pregnancies were terminated, two fetuses demised in utero, six children survived. In six fetuses, right atrial isomerism was prenatally diagnosed and confirmed postpartum. Echocardiographic features were CAVSD (4), dextrocardia (4), PS (2), l‐TGA (1), azygos continuation of interrupted inferior caval vein (1), fetal hydrops (1), DORV (1) and bradyarrhythmia with cardiomegaly (1). One pregnancy was terminated, two fetuses demised within 10 days postpartum, three children survived.

Conclusion:  A combination of CAVSD, first and early second trimester persistent bradyarrhythmia and/or azygos continuation of interrupted inferior caval vein, and/or visceral situs ambiguus should suggest specific diagnosis of cardiosplenic syndrome. The correct diagnosis made in utero allows for maternal counseling and transfer to an appropriate facility prior to delivery for corrective surgery.
Sonographers and sonologists hold favorable views of the role of three‐dimensional ultrasound (3DUS) in obstetrics following a formal lecture on the subject
Authors: Hull A. D. , Pretorius D. H. , Newton R. , James G.
Published: March 2003

Purpose:  To assess awareness and attitudes towards the use of 3DUS in obstetrics in a group of medical professionals attending a national imaging conference.

Methods:  Around 200 subjects attended a 45‐min lecture on 3DUS and obstetrics at a major national meeting. The lecture included slides and multimedia content. Eighty‐eight individuals (68 female and 20 male) completed a self‐administered questionnaire regarding their impressions of the subject following the talk.

Results:  No subject had personally undergone 3DUS, however, 78% of women said that they would like to have a 3DUS in a future pregnancy. Sixty‐five percent of men said they would encourage their partner to have a 3DUS in a future pregnancy. Of those who favored 3DUS in a future pregnancy, 54% cited better visualization of fetal anatomy as their main reason for this choice, 12% felt that 3DUS afforded advantages over 2DUS in anomaly detection. Only 5% felt that 3DUS would be more reassuring than 2DUS to them personally. Despite this, 80% of all subjects felt that 3DUS would have a major role in reassurance for lay women carrying a normal fetus in the future. Seventy‐two felt that 3DUS should be more widely available for prenatal diagnosis than at present. 3DUS was felt to offer advantages over 2DUS for anomaly detection by 38% of subjects. The multiplanar capability of 3DUS, production of ‘realistic images’ and ready recognition of fetal structures were cited as reasons for this view.

Conclusion:  3DUS used in an obstetric setting appears to have already gained significant levels of acceptance amongst this audience of imaging professionals. Most believe that 3DUS should be more widely available for the evaluation of both normal and abnormal fetuses. The value of 3DUS in the production of readily understandable images of a normal fetus in the reassurance of pregnant women was widely endorsed.
Three‐dimensional sonographic assessment of fetal behavior in the early second trimester of pregnancy
Authors: Kuno A. , Yanagihara T. , Hanaoka U. , Tanaka H. , Hata T.
Published: March 2003

Objective:  The purpose of our study was to evaluate the fetal behavioral pattern in the early second trimester of pregnancy by use of a specially developed abdominal real‐time three‐dimensional sonography.

Methods:  Real‐time three‐dimensional sonographic examinations were performed on 11 normal pregnant women from 14 to 18 weeks of gestation. This imaging system provides continuous three‐dimensional sonographic images every 1–2 s. The fetal movement was monitored for 60 min in each patient, and head, mouth, arm, trunk, and leg movements were evaluated. All fetal behavioral patterns were observed during the period studied.

Results:  Active phase (time with fetal movements) was 59.4%, and resting phase 40.6%. The most active fetal behavioral pattern was an arm movement, whereas the least was a mouth movement. Moreover, each fetal movement was synchronized and harmonized with other fetal movements.

Conclusions:  Real‐time three‐dimensional sonography provides a novel means on the evaluation of fetal behavior in the early second trimester of pregnancy. These results suggest that real‐time three‐dimensional sonography become an important modality in future early fetal behavior research and in evaluation of fetal well‐being in the second trimester of pregnancy.