bluuebunny/crossref_metadata_2025 huggingface dataset:
Sonographic assessment of birth weight among breech presentations
Authors: Chauhan S. P. , Magann E. F. , Naef R. W. , Martin J. N. , Aforrison J. C.
Published: March 2003

The objective of this study was to determine whether there was a difference in the accuracy of sonographically determined birth weight estimate in fetuses presenting by the breech as compared to the vertex.

Prospectively, IO4 consecutive singleton fetuses presented by the breech presentation were identified who also had a sonographic estimate of birth weight within 72 h of delivery. The control group (n = 104) consisted of fetuses presenting by the vertex of women who had the following hospital number and who were of similar demographic characteristics; the birth weight estimate in the control group had to be within 100 g of that of the women with the breech fetus. The estimate of the birth weight was derived for both groups using seven published models. Prediction limits were calculated for an estimated vs. actual birth weight for parturients with breech presentation.

Among the study group, the mean standardized absolute error was similar for the seven models (range 120 ± 104 to 138 ± 118 g/kg; p = 0.08). For six of the models, the mean standardized absolute error was significantly higher for fetuses in the breech presentation than for fetuses in vertex presentation (range 80 ± 63 to 112 ± 95 g/kg; p = 0.02 to < 0.0001). Prediction limit calculations indicate that 99% of the time the actual birth weight was between 1500 and 3999 g if the estimate of birth weight was 2400–2900 g.

We conclude that, for fetuses in a breech presentation, the error with most models is significantly higher than for a singleton in the vertex position. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Early ultrasound‐guided transvaginal drainage of tuba‐ovarian abscesses: a randomized study
Authors: Perez‐Medina T. , Huertas M. A. , Bajo J. M.
Published: March 2003

A prospective study of 40 women diagnosed as suffering from tubo‐ovarian abscesses was carried out in order to compare the outcome after treating these abscesses with intensive antibiotic therapy alone or in association with early ultrasound‐guided vaginal drainage.

Patients were assigned to two groups, distributed on a random basis, with a clinical and ultrasound diagnosis of tubo‐ovarian abscess of less than 10 cm maximal diameter.

Both groups received an antimicrobial combination of clindamycin and gentamicin. In the study group, we performed, in addition, early transvaginal drainage of the abscess. Both short‐term (48–72 h) and medium‐term (4 weeks) responses to the treatment were evaluated.

In the study group we observed a favorable short‐term response in 90% of the cases, whereas this was 65% in the control group.

In the medium‐term follow up, one patient in the study group and three in the control group had an adnexal masson transvaginal sonography. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Three‐vessel view of the fetal upper mediastinum: an easy means of detecting abnormalities of the ventricular outflow tracts and great arteries during obstetric screening
Authors: Yoo S. ‐J. , Lee Y.‐H. , Kim E. S. , Ryu H. M. , Kim M. Y. , Choi H.‐K. , Cho K. S. , Kim A.
Published: March 2003

The three‐vessel view is a transverse view of the fetal upper mediastinum is as simple to obtain as the four‐chamber view. It demonstrates the main pulmonary artery, ascending aorta and superior vena cava in cross‐ or oblique sections. The purposes of this study were to describe the normal anatomy of the three‐vessel view and to analyze what anatomical changes would occur in this view when there are lesions of the ventricular outflow tracts and/or great arteries. Sonograms of 29 fetuses with lesions involving the ventricular outflow tracts and/or great arteries were reviewed. Three‐vessel views were evaluated in terms of vessel size, number, arrangement and alignment.

Twenty‐eight of 29 fetuses showed an abnormal three‐vessel view that included abnormal vessel size (n = 12), abnormal alignment (n = 8), abnormal arrangement (n = 7) and abnormal vessel number (n = 3). The vessel size was abnormal in obstructive lesions of the right (n = 4) or the left (n = 8) side of the heart. An abnormal alignment was seen in tetralogy of Fallot (n = 6) and double‐outlet right ventricle (n = 2) that showed anterior displacement of the aorta. An abnormal arrangement was seen in complete (n = 4) and corrected (n = 1) transpositions, double‐outlet right ventricle (n = 1) and pulmonary atresia with ventricular septal defect (n = 1). Only two vessels were seen in truncus arteriosus (n = 1). Four vessels were seen in persistent left superior vena cava (n = 2). A fetus with pulmonary atresia and intact ventricular septum showed a normal three‐vessel view.

In conclusion, most of the lesions involving the ventricular outflow tracts and/or great arteries showed an abnormal three‐vessel view. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal identification of a completely cystic internal sacrococcygeal teratoma (Type IV)
Authors: Winderl L. M. , Silverman R. K.
Published: March 2003

Sacrococcygeal teratomas can be diagnosed prenatally with a detailed ultrasound examination of the fetal anatomy. The majority of these teratomas are solid or mixed cystic and solid external caudal masses. A conclusion drawn from the literature is that only a small percentage are entirely cystic and few are completely internal or presacral without external component (Type IV). This report describes an unusual case of a large completely internal cystic sacrococcygeal teratoma identified prenatally by ultrasonography at 32 weeks' gestation. The differential diagnosis for this unique presentation of sacrococcygeal teratoma is different from that considered for predominantly external complex tumors. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Clinical and perinatal sonographic features of congenital adrenal cystic neuroblastoma: a case report with review of the literature
Authors: Chen C.‐P. , Chen S.‐H. , Chuang C.‐Y. , Lee H.‐C. , Hwu Y.‐M. , Chang P.‐Y. , Chen M.‐L. , Chen B.‐F.
Published: March 2003

Cystic formation in association with adrenal neuroblastoma may be related to hemorrhage and necrosis of the tumor. We present an unusual case of congenital cystic fetal neuroblastoma of the right adrenal gland detected at 37 weeks' gestation which evolved into a complex echogenic mass 6 weeks after birth. Surgical exploration revealed a 3.5 × 3 × 3 cm right complex adrenal tumor which was resected. The infant did well 10 weeks after tumor resection. Typically adrenal hemorrhage may appear sonographically to be entirely echogenic, of mixed echogenicity, or anechoic when first imaged. Gradually, the texture of the hematoma will evolve and become more cystic and echolucent on follow‐up ultrasound examinations. In contrast, our case of congenital adrenal cystic neuroblastoma became more complex after resolution of the hemorrhagic cyst. This case suggests that adrenal hemorrhage and adrenal cystic neuroblastoma with a hemorrhagic cyst have different sonographic appearances. We suggest that additional imaging and surgical intervention should be considered whenever a cystic suprarenal mass becomes more complex after resolution and demonstrates no significant decrease in size in postnatal examinations. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Unexpected effect of a nitric oxide donor on uterine artery Doppler velocimetry in oligomenorrheic women with polycystic ovaries
Authors: Lees C. , Jurkovic D. , Zaidi J. , Campbell S.
Published: March 2003

We compared uterine artery vascular responses following administration of the nitric oxide donor glyceryl trinitrate to ten women with oligomenorrhea and ultrasound evidence of polycystic ovaries with those of nine women with a normal menstrual cycle and ultrasonically normal ovaries.

Mean arterial blood pressure, pulse rate and uterine artery flow velocity waveforms were recorded before and 60–75 min after glyceryl trinitrate patch application. The pulsatility index and resistance index were calculated to describe changes in impedance to flow in the uterine artery. Peak systolic and time‐averaged velocities were also measured.

Pretreatment median arterial pressure was higher in women with polycystic ovaries (90 mmHg) compared to those with regular cycles (80 mmHg) (p < 0.05).

No differences were found in pulse rate and uterine artery blood flow indices between the two groups. After glyceryl trinitrate patch administration, there was no change in blood pressure or pulse rate in either group. In women with polycystic ovaries, there was an increase in uterine artery resistance index (0.93 to 1.00; p < 0.05) and pulsatility index (3.77 to 4.99; p < 0.05) and a decrease in peak systolic (36.8 to 32.3 cm/s; p < 0.05) and time‐averaged maximum (8.5 to 5.0 cm/s; p < 0.05) velocities. Uterine artery Doppler parameters remained unchanged in women with normal cycles.

Uterine artery vascular responses to the nitric oxide donor glyceryl trinitrate are different in women with normal cycles compared to oligomenorrheic women with polycystic ovaries. This may be relevant to an understanding of the pathophysiology underlying the higher risk of cardiovascular morbidity and mortality associated with polycystic ovarian syndrome. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The optimal gestational age to examine fetal anatomy and measure nuchal translucency in the first trimester
Authors: Whitlow B. J. , Economides D. L.
Published: March 2003

The objective of this study was to determine the optimal gestational age for examining fetal anatomy and nuchal translucency in the first trimester. In a prospective cross‐sectional study, 1288 women from an unselected population underwent a detailed assessment of fetal anatomy at 10–14 weeks of gestation (confirmed by crown‐rump length) with the use of transabdominal sonography and transvaginal sonography, when necessary.

Visualization of fetal anatomy improved with increasing gestational age: 6, 75, 96, and 98% of cases could be visualized at 10, 11, 12 and 13 weeks of gestation, respectively, and was similarly high (98%) at 14 weeks. The ability to measure nuchal translucency was similar from weeks 10 to 13 (100, 98, 98 and 98% success rate), but fell to 90% at 14 weeks. The need for transvaginal sonography steadily decreased with increasing gestational age, being 100, 42, 21, 15 and 11% at 10, 11, 12, 13 and 14 weeks, respectively. From these data it appears that the optimal gestational age to examine fetal anatomy and measure nuchal translucency in the first trimester is 13 weeks. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Examination of fetal coronary sinus blood flow by Doppler ultrasound
Authors: Baschat A. A. , Gembruch U.
Published: March 2003

The aim of this study was to demonstrate coronary sinus blood flow in the human fetus by color Doppler imaging and pulsed wave Doppler sonography and to determine the feasibility of using Doppler ultrasound for routine investigation.

Visualization of the coronary sinus blood flow by color Doppler imaging was attempted in 84 fetuses with appropriate growth and normal cardiac anatomy, and in which right or left lateral four‐chamber views could be obtained (median gestational age, 32 + 5 weeks). After successful identification, examination of the flow velocity waveform and measurement of peak blood flow velocities by pulsed wave Doppler were attempted.

Detection of coronary sinus blood flow by color Doppler imaging was possible in 48 fetuses (57.1%) at a median gestational age of 30 + 3 weeks. Pulsed wave measurements were successful in only 11 fetuses (13.1%) (median gestational age, 34 + 2 weeks). The flow velocity waveform is triphasic with antegrade flow towards the right atrium during systole and diastole and reverse flow during atrial contraction. Peak blood flow velocities during diastole were higher (median, 0.38 m/s) than during systole (median, 0.18 m/s); median peak velocity during atrial contraction was −0.05 m/s. Measurement difficulties were due to small fetal size and interference caused by intra‐atrial blood flow and/or atrioventricular valvular movement. Demonstration of coronary sinus blood flow by color Doppler imaging is possible in the human fetus. However, pulsed wave Doppler measurements are infrequently obtained, making this study for routine assessment of myocardial blood flow unfeasible. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Evaluation of different transvaginal sonographic diagnostic parameters in women with postmenopausal bleeding
Authors: Weber G. , Mere E. , Bahlmanw E. , Riisch B.
Published: March 2003

Objective

To determine whether the accuracy of transvaginal sonography to detect endometrial pathology is enhanced by assessing endometrial morphology and the regularity of the endometrial border in addition to measurement of endometrial thickness in women with postmenopausal bleeding.

Design and methods

A total of 159 women with post‐menopausal bleeding were included in a prospective study performed at the Clinic of Obstetrics and Gynecology, University of Mainz. The results obtained on transvaginal sonographic assessment of the endometrium were compared with the histological evaluation of the operative endometrial specimen.

Results

A cut‐off level for endometrial thickness of 5 mm had a sensitivity of 94%, specificity of 48% and positive and negative predictive values of 69% and 87%, respectively for the presence of endometrial pathology. Assessment of the regularity of the endometrial border showed a sensitivity of 75X, specificity of 66% and positive and negative predictive values of 73% and 69%, respectively. For the third sonographic parameter, endometrial morphology, the sensitivity was 82%, specificity 64%, the positive predictive value 73% and the negative predictive value 74%. The combined consideration of the three sonographic parameters showed a sensitivity of 97%, specificity of 69X0, and positive and negative predictive values of 80% and 94%, respectively.

Conclusion

The combined evaluation of endometrial thickness, endometrial morphology and the endometrial border enhances the accuracy of transvaginal sonography to detect endometrial pathology in women with postmenopausal bleeding, thus facilitating the decision regarding further diagnostic and therapeutic measures. It was therefore the aim of the present study to investigate whether, in addition to an evaluation of endometrial thickness, the assessment of endometrial morphology and the regularity of endometrial border may improve the accuracy of transvaginal sonography to detect endometrial pathology in women with postmenopausal bleeding. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Subjective assessment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience
Authors: Timmerman D. , Schwärzler P. , Collins W. P. , Claerhout F. , Coenen M. , Amant F. , Vergote I. , Bourne T. H.
Published: March 2003

Objective

The aim of the study was to evaluate the subjective assessment of ultrasonographic images for discriminating between malignant and benign adnexal masses.

Study design

The study was prospective. Initially, one ultrasonographer preoperatively assessed 300 consecutive patients with adnexal masses. Subsequently, the recorded transparent photographic prints were independently assessed by five investigators, with different qualifications and level of experience, who were also given a brief clinical history of the patients (i.e. the age, menstrual status, family history of ovarian cancer, previous pelvic surgery and the presenting symptoms). The diagnostic performance of the observers was compared with the histopathology classification of malignant or benign tumors. The end‐points were accuracy, interobserver agreement and the possible effect of experience.

Results

The first ultrasonographer and the most experienced investigator both obtained an accuracy of 92%. There was very good agreement between these two investigators in the classification of the adnexal masses (Cohen's kappa 0.85). The less experienced observers obtained a significantly lower accuracy, which varied between 82% and 87%. Their interobserver agreement was moderate to good (Cohen's kappa 0.52 to 0.76).

Conclusion

Experienced ultrasonographers using some clinical information and their subjective assessment of ultrasonographic images can differentiate malignant from benign masses in most cases. The accuracy and the level of interobserver agreement are both correlated with experience. About 10% of masses were extremely difficult to classify (only < 50% of assessors were correct). Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Maternal cardiolipin, β2‐glycoprotein‐I and prothrombin antibody expression in high‐risk pregnancies with bilateral abnormal uterine artery Doppler waveforms
Authors: Donohoe S. , Geary M. , Kingdom J. C. P. , Jauniaux E. , Purdy G. , Mackie I. J.
Published: March 2003

Objective

To compare the frequency of maternal serum antiphospholipid antibodies (to cardiolipin, β2‐glyco‐protein I and prothrombin) in pregnancies presenting with bilateral abnormal uterine artery Doppler waveforms.

Design

Retrospective analysis of stored serum.

Subjects

Cases comprised 47 singleton pregnancies with bilateral abnormal uterine artery Doppler waveforms at 24 weeks of gestation, followed from 20 weeks, and controls were 100 healthy pregnancies with normal uterine artery Doppler waveforms.

Methods

Ultrasound examination utilized a 5‐MHz curvilinear transabdominal transducer with pulsed and color Doppler facilities. Antiphospholipid antibodies were analyzed by ELISA methodology, and reference ranges were established using the geometric mean ± 2 SD of healthy non‐pregnant adults. Human chorionic gonadotropin (hCG) levels were obtained from patient notes.

Results

Anticardiolipin antibodies were detected in 11 (23%) of the cases (IgG, n = 7; IgM, n = 6) compared with ten (10%) of the controls (p < 0.05). Low titer anticardiolipin IgG (range, 5.5–35.3; median, 6.3 GPL units) and anticardiolipin IgM (range, 3.4–14.7; median, 5.3 MPL units) were detected in cases. Amongst the cases, adverse perinatal outcomes were more common in the presence of raised levels of anticardiolipin antibodies. Anti‐β2‐glycoprotein I IgG was not detected in any of the cases. Antiprothrombin IgG was not detected, but antiprothrombin IgM occurred in 10.6% of cases compared with 2% of controls.

Conclusions

Women with persistent bilateral abnormal uterine artery Doppler waveforms in mid‐gestation were more likely to express raised levels of anticardiolipin antibodies than healthy controls with normal uteroplacental perfusion. Anticardiolipin antibodies without anti‐β2‐glycoprotein I binding may be involved in the pathogenesis of uteroplacental ischemia in a proportion of high‐risk pregnancies. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
In utero diagnosis of cardiac hemangioma
Authors: Tseng J. J. , Chou M. M. , Lee Y. H. , Ho E. S. C.
Published: March 2003

Fetal cardiac hemangioma is rarely diagnosed prenatally. We present here a fetus with such a tumor diagnosed at 28 weeks' gestation. With the use of fetal echocardiography, a mixed echogenic mass protruding outward from the right atrial wall was observed. Moderate amounts of pericardial effusion were also found. Although no apparent blood flow signal was detected in the mass, fetal echocardiography showed signs suggestive of a hemangioma. Differential diagnosis, management and prognosis are discussed. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Evaluation of ultrasound‐estimated date of delivery in 17 450 spontaneous singleton births: do we need to modify Naegele's rule?
Authors: Nguyen T. H. , Larsen T. , Engholm G. , Møller H.
Published: March 2003

Objective

To compare the size of error in the predicted date of delivery by biparietal diameter (BPD) and last menstrual period (LMP) in different clinical models.

Materials and methods Predicted dates of delivery were calculated in 14 805 spontaneous deliveries with a reliable date of LMP using two assumptions: average length of pregnancy of 280 and of 282 days. Errors in these calculated dates were tested when used alone or combined, i.e. the LMP‐predicted date of delivery was used as first choice unless the discrepancy between gestational age calculated by BPD and LMP exceeded 7, 10 or 14 days.

Results

The average discrepancy (error) between predicted date of delivery from BPD and LMP and date of spontaneous delivery was 7.96 and 8.63 days, respectively (p < 0.0001). Adding 282 instead of 280 days to the first day of the LMP reduced the error of the LMP method from 8.63 to 8.41 days, reduced the percentage of classified post‐term deliveries from 7.9 to 5.2% and increased the preterm births from 3.96 to 4.48%. No models of combined use of LMP and BPD were superior to the use of BPD alone.

Conclusion

If both BPD and LMP are available, BPD should be used to predict term. If only LMP is available, term should be calculated as the first date of the LMP plus 282. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional power Doppler sonography: imaging and quantifying blood flow and vascularization
Authors: Pairleitner H. , Steiner H. , Hasenoehrl G. , Staudach A.
Published: March 2003

Objectives

To assess the feasibility of imaging low‐velocity blood flow in adnexal masses by transvaginal three‐dimensional power Doppler sonography, to analyze three‐dimensional power Doppler sonography data sets with a new computer‐assisted method and to test the reproducibility of the technique.

Methods

A commercially available 5‐MHz Combison 530 ultrasound system was used to perform three‐dimensional power Doppler sonography transvaginally. A cube (= volume of interest) was defined enclosing the vessels of the cyst and the Cartesian characteristics were stored on a hard disk. This cube was analyzed using specially designed software. Five indices representing vascularization (the vascularization index (VI)) or blood flow (the flow index (FI)) or both (the vascularization‐flow index (VFI)) were calculated. The intraobserver repeat‐ability of cube definition and scan repetition was assessed using Hartley's test for homogeneous variances. Inter‐observer agreement was assessed by the Pearson correlation coefficient.

Results

Imaging of vessels with low‐velocity blood flow by three‐dimensional power Doppler sonography and cube definition was possible in all adnexal masses studied. In some cases even induced non‐vascular flow related to endometriosis was detected. The calculated F value with intraobserver repeated Cartesian file‐saving ranged from 0 to 18.8, with intraobserver scan repetition from 4.74 to 24.8 for VI, FI 1, FI 2 and VFI 1; for VFI 2 the calculated F value was 64. The interobserver correlation coefficient ranged between 0.83 and 0.92 for VI, FI 1, FI 2 and VFI 1; for VFI 2 the correlation coefficient was less than 0.75.

Conclusion

Vessels with low‐velocity blood flow can be imaged using three‐dimensional power Doppler sonography. Induced non‐vascular flow was detected in endometriotic cyst fluid. Three‐dimensional power Doppler sonography combined with the cube method gave reproducible information for all indices except VFI 2. These indices might prove to be a new predictor in all fields of neoangiogenesis. The clinical relevance remains to be determined. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
WS06‐04Intracardiac echogenic focus and fetal heart defects
Authors: Chaoui R. , Bierlich A.
Published: March 2003

Background

Intracardiac echogenic foci are controversially discussed whether or not they are marker for chromosomal aberrations. The possible association with fetal congenital heart defects (CHD) and its impact were not yet analyzed extensively.

Method

During 30 months, prenatally detected structural CHD were prospectively analyzed for the presence of EF. Frequency, localization, number, association with chromosomal defects and pattern of CHD were assessed.

Results

279 fetal CHD could be examined and EF were found in 31 cases (11.1%). The localization was in 17 cases (54%) the left, in 7 (22%) the right, and in 7 (22.5%) both ventricles. Multiple EF were found in 10 cases. 14 cases (42%) were associated with a chromosomal aberration (T18 n = 2; T21 n = 5, T13 n = 3, Triploidy n = 2, Del22q n = 1, others n = 1). Among the remaining 17 fetuses with normal chromosomes following heart defects were found: 3 × VSD, 3 × Left‐persistent SVC, 2 × TGA, 2 × TOF, 2 × Coarctation, and 1 × PS, PA, Ebstein, TAC, AS each.

Conclusions

Compared to low‐risk groups EF are more frequent in the presence of CHD and show another distribution involving more right ventricular or bilateral EF. The combination of EF and CHD is highly associated with aneuploidies. Since associated CHD include also conotruncal anomalies EF can be considered as an indication for targeted fetal echocardiography especially when EF is localized in the RV or in both ventricles.
The use of chorionic villus biopsy catheters for saline infusion sonohysterography
Authors: Platt L.D. , Agarwal S.K. , Greene N.
Published: March 2003

Background 
Saline infusion sonohysterography is one of the recent refinements of ultrasonography that has the ability to enhance imaging of the uterine cavity in a safe, inexpensive and expedient manner. The technique can be difficult in women with a stenotic cervical os. This report describes a single‐pass technique using chorionic villus sampling (CVS) catheters for saline infusion sonohysterography.

Method 
Saline infusion sonohysterography requires the transcervical passage of a catheter, through which saline is infused. The subsequent distension of the uterine cavity enhances the ability to detect intrauterine pathology with ultrasonography. In women with cervical stenosis, a catheter can be used in place of the more conventional two‐pass technique, which requires the use of a uterine sound or probe followed by a conventional catheter.

Experience 
We have used CVS catheters in women with cervical stenosis on 12 occasions. All have been successful and without significant discomfort to the patient.

Conclusion 
The use of CVS catheters for saline infusion sonohysterography in women with cervical stenosis can alleviate the need to remove the cervical probe prior to introduction of the catheter.
Relationship between fetal femur diaphysis length and neonatal crown–heel length: the effect of race
Authors: Lim J.M.H. , Hong A.G. , Raman S. , Shyamala N.
Published: March 2003

Objective To determine whether racial differences affect the relationship between the fetal femur diaphysis length and the neonatal crown–heel length.

Design A prospective study in a teaching hospital with a multiracial population.

Subjects Four hundred and fifty pregnant women (150 Malays, 150 Chinese and 150 Indians) who delivered live infants.

Methods Ultrasound scan measurement of the fetal femur diaphysis length was carried out within 48 h of delivery in all cases. The relationship between the neonatal crown–heel length and the femur diaphysis length was obtained by regression using the method of least squares. Dummy or indicator variables were used to determine the effect of race on the relationship.

Results The relationship between the neonatal crown–heel length and the femur diaphysis length in all three races was well described by a linear model but a quadratic model described the relationship better. There was no significant difference in relationship of the neonatal crown–heel length and the femur diaphysis length between the Malay and Chinese populations, but the relationship in the Indian population was significantly different was from both the Chinese and Malay. For a given femur diaphysis length, the crown–heel length of the Indian population was found on average to be 1. 1 cm shorter than the crown–heel length of the Malay and Chinese populations.

Conclusion Differences in fetal body proportions exist between some races. The longer femur diaphysis length noted in certain races does not necessarily imply that the corresponding crown–heel length is longer. These inter‐racial differences may increase the error of fetal weight and length estimates if formulae, which have been derived from samples racially dissimilar to that of the target population are used.
Fetal aortic arch measurements between 14 and 38 weeks' gestation: in‐utero ultrasonographic study
Authors: Achiron R. , Zimand S. , Hegesh J. , Lipitz S. , Zalel Y. , Rotstein Z.
Published: March 2003

Objective To establish in‐utero reference ranges for fetal transverse aortic arch diameter (TAD) and distal aortic isthmus diameter (DAID) using high‐resolution ultrasound techniques.

Design A prospective, cross‐sectional study was performed on 125 normal singleton pregnancies between 14 and 38 weeks' gestation. Transverse and diameter and DAID were measured by transvaginal ultrasonography until 17 weeks' gestation, and by abdominal ultrasound between 18 and 38 weeks' gestation.

Results Transverse arch diameter as a function of gestational age was expressed by the regression equation TAD = − 1.17 + 0.169 X GA, and DAID = − 1.39 + 0.189 X GA; TAD and DAID are transverse aortic and distal aortic isthmus diameters expressed in millimeters and GA is gestational age in weeks. The correlation r = 0.924 and 0.938 was found to be highly statistically significant (P < 0.001) for TAD and DAID. The normal mean of TAD and DAID per week and the 95% prediction limits were also defined.

Conclusions The normative data established by us may be helpful in the prenatal diagnosis of congenital heart defects, including abnormal growth of the aortic arch.
Diagnosis of small‐for‐gestational‐age fetuses between 24 and 32 weeks, based on standard sonographic measurements
Authors: Thiebaugeorges O. , Fresson J. , Audibert F. , Guihard‐Costa A. M. , Frydman R. , Droulle P.
Published: March 2003

Objective

To create and validate a formula using sonographic biometry measurements for the optimal diagnosis of small‐for‐gestational‐age (SGA) fetuses between 24 and 32 weeks of gestation.

Methods

A logistic model using gestational age, femur diaphysis length, abdominal and head circumferences to diagnose SGA was set up in a first group of 64 fetuses born between 24 and 32 weeks (group I). A Receiver Operating Characteristic (ROC) curve was drawn. Our model was compared with standard single ultrasound measurements or combined into an estimated fetal weight (EFW) formula. An external validation was carried out on a second group of 183 fetuses (group II) from another maternity unit (ROC curve and comparisons).

Results

The area under the ROC curve was 0.91 in group I and 0.93 in group II. Using a 0.5 cut off point for our model yielded a sensitivity of 76% and specificity of 91% for group I. This model is more specific than most other measurement methods with a similar sensitivity.

Using the same cut off point (0.5) in Group II, our model was more specific (98%) but less sensitive (66%) when compared with single ultrasound measurements and EFW formulae. By varying the cut off point, we were able to demonstrate that, for a similar sensitivity, our model had a higher specificity than single ultrasound measurements and had similar specificity to EFW formulae.

Conclusion

The logistic model we set up was able to calculate an SGA risk score between 24 and 32 weeks of gestation in a population at high risk for elective delivery. The cut off point with a view to diagnosis can vary and makes it possible to give greater importance to the sensitivity or specificity depending on the clinical context. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Artifacts and the visualization of fetal distal extremities using three‐dimensional ultrasound
Authors: Hull A. D. , Pretorius D. H. , Lev‐Toaff A. , Budorick N. E. , Salerno C C. , Johnson M. M. , James G. , Nelson T. R.
Published: March 2003

Objectives

To demonstrate that acoustic shadowing in 3D US may give rise to artifacts simulating limb defects and provide a solution to eliminate its occurrence.

Methods

Twenty second trimester fetuses (gestational age 15–24 weeks) were scanned with three‐dimensional ultrasound (3D US) using a sagittal acquisition plane. Fetal tibia/fibula and radius/ulna pairs were assessed for completeness of imaging. A further 20 fetuses (gestational age 20–26 weeks) were scanned in both axial and sagittal planes and the results compared to verify clear visualization of both bones.

Results

Shadowing from adjacent structures produced an apparent limb defect in 55% of the first 20 fetuses imaged only sagittally (18% of limb pairs). Acquiring data from more than one orientation avoided this artifact.

Conclusions

The 3D US is subject to the same artifacts as two‐dimensional (2D US) in terms of acoustic shadowing, although their presentation may be different. Awareness of this fact is essential for correct interpretation of 3D US studies. Three‐dimensional scanning protocols should be modified to ensure that fetal structures are adequately visualized by acquiring volume data in more than one acquisition orientation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Nuchal thickness evolution in trisomy 18 fetuses
Authors: Borrell A. , Farré M. T. , Echevarría M. , Martinez J. M. , Costa D. , Fortuny A.
Published: March 2003

Objective

To assess the natural evolution of nuchal thickness in trisomy 18 fetuses.

Methods

Serial measurements of nuchal thickness were performed over a 1‐ to 5‐week period in 17 fetuses with trisomy 18, from the 10th to the 20th week of pregnancy. To avoid a confounding effect due to gestational age, nuchal thickness was also expressed in standard deviations (SD) for the corresponding gestational week. In addition, the changes were assessed in terms of the presence of clinically positive thickening, considered as such when its measurement was above 2.5 SD for the corresponding gestational week.

Results

On the initial nuchal thickness measurement, sensitivity for trisomy 18 decreased from 66% on assessment at 10–13 weeks of gestation to 38% at 14–16 weeks. In serial determinations, a mean increase of 1.3 mm [95% confidence interval (CI), 0.1–2.5] was observed for a mean period of 21 days. When corrected for gestational age, the mean increase of 0.2 SD (95% CI, −1.2 to −1.6) was found to be non‐significant. No clinically relevant changes were recorded on re‐examination, with nuchal thickening remaining stable in 76% of cases.

Conclusion

Nuchal thickening at re‐examination was observed in a similar proportion of trisomy 18 fetuses as when initially observed. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Umbilical vein blood flow in growth‐restricted fetuses
Authors: Ferrazzi E. , Rigano S. , Bozzo M. , Bellotti M. , Giovannini N. , Galan H. , Battaglia F. C.
Published: March 2003

Objective

To determine whether umbilical blood flow is reduced in a subset of growth‐restricted (IUGR) fetuses when expressed as flow per kilogram or flow per unit of specific sonographic fetal measurements.

Design

Prospective.

Subjects

Thirty‐seven IUGR fetuses were examined by Doppler ultrasound within 4 h of the last non‐stress test prior to delivery. This population was divided into three groups of varying clinical severity according to the characteristics of umbilical arterial pulsatility index (PI) and heart rate.

Methods

Absolute and weight‐specific umbilical vein (UV) flow were calculated from measurements of UV diameter and UV mean velocity. Umbilical vein diameter, velocity and UV flow were calculated also per unit head (HC) or abdominal circumference (AC) and correlated with gestational age.

Results

Umbilical vein flow (UVf) per kilogram fetal weight was significantly lower in the more severe IUGR fetuses (abnormal umbilical arterial PI) than in normally grown comparable fetuses (P < 0.001). Umbilical vein flow per unit HC was significantly lower in the three groups (P < 0.001) than in the control population. The UV diameter/HC ratio was normal whereas UV velocity/HC ratio was significantly lower in IUGR fetuses than in comparable controls.

Conclusions

The present study clearly establishes that umbilical venous blood flow is reduced in IUGR fetuses on a weight‐specific basis. The sonographic growth parameter which best distinguishes umbilical flow differences of IUGR fetuses from normal fetuses is the head circumference. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Abnormalities of the fetal central veins and umbilico‐portal system: prenatal ultrasonographic diagnosis and proposed classification
Authors: Achiron R. , Hegesh J. , Yagel S. , Lipitz S. , Cohen S.B. , Rotstein Z.
Published: March 2003

Objectives

Anomalies of the fetal venous system are poorly documented and their pathogenesis is not well understood. The present study was undertaken to review the spectrum of fetal central veins and umbilico‐portal system anomalies, and to propose a classification system.

Methods

A 7‐year restrospective survey was conducted.

Results

Nineteen fetuses showed abnormal connection between central veins and the fetal heart. Three fetuses showed abnormal connections of the cardinal veins, two of which had interruption of the inferior vena cava, and one had isolated persistent left superior vena cava. Anomalies of pulmonary veins were seen in four fetuses: in two with asplenia syndrome, a vertical confluent pulmonary artery was observed. In a further two cases total anomalous pulmonary venous connections were found. Abnormalities of the umbilical vein (UV) were seen in 10 cases; seven had persistent right UV, and three had a spectrum of anomalies: One had abnormal connections of the UV to the left iliac vein associated with agenesis of the ductus venosus (DV) and hydrops fetalis. One case showedin utero occlusion of the DV by echogenic foci that resulted in a persistent left proximal UV and porto‐systemic shunt. One case had obliteration of the DV secondary toin utero fetal hepatic fibrosis. Abnormalities of the vitelline veins or portal system were demonstrated in two cases. One had a left porto‐systemic shunt which resolved spontaneously at 3 months of age, and one had secondary partial occlusion of the left portal system with liver echogenicities and direct communication of the UV with the right atrium. None of the 19 cases had an abnormal karyotype or evidence ofin utero infection.

Conclusions

Detection of various fetal vein anomalies in utero is feasible. The anomalies vary according to embryologic precursors or etiology. Two major mechanisms seem to be involved in the genesis of fetal vein anomalies: in most cases primary maldevelopment of the venous system occurs, while in the minority secondary anomalies from possible thromboembolic events or systemic disease may play a role. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The pulmonary vein Doppler flow velocity waveform: feature analysis by comparison of in vivo pressures and flows with those in a computerized fetal physiological model
Authors: Talbert D. G. , Johnson P.
Published: March 2003

Objectives

Doppler flow velocity waveforms (FVW) in fetal veins that discharge into the atria show fluctuations related to atrial events. Pulmonary veins are of particular interest because both ends (atrial and collecting venule) are within the intrathoracic pressure environment reducing fetal breathing artifacts. Indices, such as pulsatility index for veins (PIV), have been suggested to classify FVWs and relate them to fetal well being.

We wished to examine the relationship between function and FVW in circumstances which cannot ethically be examined in vivo by studying the mechanisms which produced altered ‘flows’ in a detailed fetal computer model. We then related these findings to current flow indices.

Methods

A computer model of the feto‐placental unit, responding to changes in organ oxygenation and regional flow is briefly described. In vivo intracardiac pressures and FVWs obtained from other studies were used to extend detail in the model until matching ‘pressures’ and ‘flows’ resulted. The effects of flow redistribution in the hypoxic fetus on pulmonary vein ‘Doppler’ flow velocity waveforms were then studied.

Results and conclusions

Flow reversal in pulmonary veins during atrial contraction indicates hypoxia, but change of shape of the FVW envelope reflects the changes in the pressure waveform of the left atrium. Of the major veins the pulmonary vein Doppler FVW gave the truest representation of atrial pressure response to both intracardiac and systemic vascular status. Although current indices indicate general fetal condition, more specific indices are needed if pulmonary venous flow is to be used as an end‐point. A pulmonary vein pressure gradient index is suggested. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Using unconditional and conditional standard deviation scores of fetal abdominal area measurements in the prediction of intrauterine growth restriction
Authors: Owen P. , Burton K. , Ogston S. , Khan K. S. , Howie P. W.
Published: March 2003

Objective

To compare the performance of unconditional and conditional standard deviation scores (Z scores) of fetal abdominal area (FAA) measurements in the antenatal identification of infants born with anthropometric features of intrauterine growth restriction.

Methods

A prospective observational study, involving 274 low‐risk women participating in a longitudinal study of serial ultrasound in pregnancy. Conditional Z scores were established for the last FAA prior to delivery with reference to measurements made both 28 and 56 days previously. Unconditional Z scores (size) were calculated from the last FAA measurement prior to delivery. Receiver–operator characteristics curves were employed to determine an optimal cut‐off point for Z scores to predict intrauterine malnourishment. The main outcome measures were: likelihood ratios (LR) for conditional and unconditional Z scores of FAA in the prediction of infants with skinfold thickness < 10th percentile; ponderal index < 25th percentile or mid‐arm circumference to occipito‐frontal circumference ratio (MAC/OFC) of < −1 SD. An LR of > 10 generates significant changes in the pretest probability of growth restriction, whereas an LR of 5–10 generates only moderate changes.

Results

Conditional Z scores with 28‐ and 56‐day separations predicted growth restriction with LR 7.5 (95% confidence interval [CI], 3.7–14.7) and 4.8 (95% CI, 2.8–7.8) for ponderal index but did not usefully predict skinfold thickness or MAC/OFC. Unconditional Z scores did not usefully predict any of the parameters of growth restriction.

Conclusions

Quantifying third trimester fetal growth by means of FAA conditional Z scores is moderately useful in predicting infants with a low ponderal index and is superior to unconditional FAA Z scores in late pregnancy. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal evaluation of cephalopagus conjoined twins by means of three‐dimensional ultrasound at 13 weeks of pregnancy
Authors: Kuroda K. , Kamei Y. , Kozuma S. , Kikuchi A. , Fujii T. , Unno N. , Baba K. , Taketani Y.
Published: March 2003

Cephalopagus twinning, an extremely rare type of conjoined twins, is characterized by the anterior union of the upper half of the body, with two faces each situated on the opposite side of a conjoined head. The prognosis for cephalopagus twins is extremely poor because surgical separation is not an option. Thus early prenatal diagnosis of cephalopagus twins is important to provide an opportunity for pregnancy termination if desired. However, in many instances, cephalopagus twins are misdiagnosed as a singleton pregnancy because of the extreme degree of fusion which makes accurate demonstration of the abnormalities very difficult. This report presents a case of cephalopagus twins which was confirmed at 13 weeks of gestation using three‐dimensional ultrasound. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The progression of mediastinal lymphangioma in utero
Authors: Jung E. , Won H. S. , Lee P. R. , Lee I. S. , Kim A. , Nam J. H.
Published: March 2003

We describe a case of mediastinal lymphangioma that suddenly progressed in utero. The initial sonographic impression was one of pericardial effusion while the follow‐up examination revealed a mediastinal cystic mass. At 35 weeks of gestation preterm labor occurred. An ultrasound examination performed at this time demonstrated the mediastinal cyst with internal hemorrhage and fetal hydrops. The cystic mass was resected 5 days after birth. The diagnosis of lymphangioma was made from histological examination. The infant was followed up for 18 months and remained well. We recommend frequent prenatal sonographic follow‐up when a localized fluid collection is shown in the mediastinum. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Serial sonographic findings in a fetus with congenital hiatal hernia
Authors: Ogunyemi D.
Published: March 2003

A continuum of prenatal findings in a case of hiatal hernia is described. Second‐trimester scans showed absence of fetal stomach and polyhydramnios suggestive of esophageal atresia. Third‐trimester scans revealed a dilated tubular structure in the thoracic cavity with intermittent visualization of an intra‐abdominal small stomach. A diagnosis of hiatal hernia was entertained. After birth, the diagnosis of a dilated esophagus with the stomach herniated into the thoracic cavity through a very lax esophageal hiatus was confirmed and the baby underwent corrective surgery. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Isolated hyperechogenic foci in the fetal thalamus in early pregnancy
Authors: Bronshtein M. , Zimmer E. Z. , Auslander R. , Blazer S.
Published: March 2003

Objective

To describe the sonographic features and outcome of fetuses with isolated hyperechogenic foci in the thalamic region.

Methods

A detailed sonographic survey was performed in 46 244 consecutive pregnancies. Both low‐ and high‐risk pregnancies were included. Transvaginal examinations were performed at 14–16 weeks' gestation, while transabdominal examinations were performed after 18 weeks' gestation.

Results

Isolated hyperechogenic foci in the thalamic region were observed in seven fetuses. All cases were diagnosed at 14–16 weeks' gestation. Six fetuses had one hyperechogenic focus, and one fetus had two foci. The size of these foci ranged from 2–4 mm. A serologic work‐up was negative in all these fetuses and their karyotype was normal. The hyperechogenic foci disappeared in mid‐pregnancy in all cases, and fetuses were normal at delivery and on follow up to the age of 9 years.

Conclusions

Isolated hyperechogenic foci in the thalamic region in early pregnancy are probably benign in nature. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology