bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiographic: evaluation of breech presentation: is it necessary?
Authors: Fontenot T. , Campbell B. , Mitchell‐Tutt E. , Read J. , Milligan D. , Miller F. , Lewis D.
Published: March 2003

The purpose of this study was to evaluate the use of ultrasound in identifying fetal position and cervical spine flexion in breech presentations. Radiographic and ultra‐sonographic determinations of the type of presentation (frank, complete or incomplete) and degree of cervical spine flexion in 52 breech presentations were compared. The angle of flexion was defined as the angle between the fetal mandible and main axis of the cervical spine and categorized as full flexion, military, partial extension and full extension. Ultrasound was concordant with radio‐graphic assessment of the type of presentation in 77% and the angle of flexion in 64% of the subjects and was even more accurate in those in labor. All cases predicted as having full flexion (< 90°) of the cervical spine by ultrasound had an angle of flexion ≤ 90° on radiographic assessment. Of subjects in labor, ultrasound accurately identified the type of breech presentation in all cases. In addition, sonographic identification of full flexion of the cervical spine excludes cases of fetal neck extension and precludes the need for radiographic assessment prior to a trial of labor. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal gray‐scale imaging of ureteral jets in the evaluation of ureteral patency
Authors: Haratz‐Rubinstein N. , Murphy K. E. , Monteagudo A. , Timor‐Tritsch I. E.
Published: March 2003

We have previously reported on the value of transvaginal color Doppler evaluation of the ureteral jets to confirm ureteral patency. In this study, we attempt to validate the simple and widely available gray‐scale ultrasound technique to perform the same task. Fifty consecutive patients without a history of urinary complaints were recruited. The presence or absence of the right and left ureteral jets was registered using gray‐scale imaging, comparing the technique to color Doppler as the ‘gold standard’.

The time to the detection of the first jet as well as the total scanning time were documented for each side. The jets were seen with equal frequency on both the right and the left sides (34 observations each). In 24 patients, both jets were visualized. The median time to detection of the first jet was 47 s (range 34–79 s) for the right jet and 53 s (36–84 s) for the left jet (p = 0.42). The median total scanning time was 176 s (139–259 s). Gray‐scale imaging was associated with a sensitivity of 68% and a positive predictive value of 100%. Although color Doppler results may be more attractive because of their impressive color‐coded appearance, the major disadvantage of this technique is that it requires sophisticated and costly equipment.

Transvaginal gray‐scale imaging is a reliable and useful test for the detection of ureteral jets in the bladder. It can be used as a first‐line diagnostic tool, particularly in settings where color Doppler is not available. Its benefits include safety, low cost, convenience and simplicity. With a positive predictive value of 100%, this test may be used in the postoperative patient, especially when ureteral patency is in question. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Early detection of reversed diastolic umbilical flow: should we offer karyotyping?
Authors: Comas C. , Carrera M. , Devesa R. , Muñoz A. , Torrents M. , Cusi V. , Ribas I. , de la Iglesia C. , Carrera J. M.
Published: March 2003

In normal pregnancy, end‐diastolic flow appears in the umbilical artery around the 13th week of gestation, with a velocity which increases progressively with advancing gestation. The detection of reversed flow in the umbilical artery, the highest expression of an increase in placental vascular resistance, is extremely uncommon in the first half of gestation and, in three of the four cases reported in the literature, there were chromosomal abnormalities. We report a new case of reversed end‐diastolic flow in the umbilical artery in a 13‐week fetus with increased nuchal translucency thickness, megacystis and tachycardia. Cytogenetic analysis of chorionic villi (and amniocytes revealed trisomy 13. The findings provide further evidence for a possible association between reversed end‐diastolic flow in the umbilical artery and chromosomal abnormalities. However, the effectiveness of this potential marker in an unselected population requires further evaluation. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasonography of normal fetal lung volume: a preliminary study
Authors: Laudy J.A.M. , Janssen M.M.M. , Struyk P.C. , Stijnen T. , Wladimiroff J.W.
Published: March 2003

The objective of this preliminary study was to evaluate three‐dimensional ultrasonographic lung volume measurement in the normally developing fetus in the second half of pregnancy.

Total fetal lung volume was determined by subtraction of fetal heart volume from thoracic volume, using the perpendicular transverse, sagittal and frontal planes of the fetus. Technically acceptable lung volume measurements were obtained in 29 out of 34 women with an uncomplicated pregnancy. A statistically significant increase in normal fetal lung volume was established with advancing gestational age and with increasing fetal estimated weight, demonstrating an approximately seven‐fold rise in fetal lung volume during the second half of pregnancy.

Three‐dimensional ultrasonography can be applied for estimation of fetal lung volume. Whether this technique is useful in the prenatal prediction of pulmonary hypoplasia remains to be determined. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Examination of a low‐cost pocket Doppler device for fetal assessment
Authors: Lockett M. , Bisits A. , Giles W.B.
Published: March 2003

The objective of this study was to evaluate a pocket Doppler device (Multi Dopplex II) for the waveform analysis of umbilical artery systolic/diastolic (S/D) ratios and resistance index (RI).

A prospective, paired study was undertaken in a perinatal ultrasound unit in a tertiary referral hospital. Forty‐three high‐risk pregnant women beyond 16 weeks' gestation had fetal umbilical artery flow velocity waveforms recorded with both Multi Dopplex II and duplex Doppler devices and the waveform analyses were calculated.

The Multi Dopplex II falsely indicated absent diastolic flow in two cases and failed to produce a flow velocity waveform in the presence of maternal obesity, poly‐hydramnios and some cases of anterior placenta (n = 8). As well as this, the limits of agreement overall for both S/D ratio and RI were wide (for S/D ratio, −1.6 to 2.2 and for RI, −0.20 to 0.20). Even though the levels of agreement were better for the third trimester (for S/D ratio, −0.8 to 1.1 and for RI, −0.10 to 0.20), we concluded that the limits of agreement were too wide for clinical use. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Intra‐abdominal sacrococcygeal mature teratoma or fetus in fetu in a third‐trimester fetus
Authors: Montgomery M. L. , Lillehei C. , Acker D. , Benacerraf B. R.
Published: March 2003

This case report describes a fetus with a large intra‐abdominal, complex, vascular mass, displacing the normal intra‐abdominal organs due to its large size. Extension to the presacral area was also identified, facilitating the diagnosis of a sacrococcygeal teratoma. Because of its highly mature nature, this was considered a fetus in fetu which was totally intra‐abdominal. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Early transvaginal ultrasonographic diagnosis of Beemer‐Langer dysplasia: a report of two cases
Authors: den Hollander N. S. , van der Harten H. J. , Laudy J. A. M. , van de Weg P. , Wladimiroff J. W.
Published: March 2003

The early second‐trimester sonographic diagnosis of two infants with short rib (polydactyly) dysplasia type IV (Beemer‐Langer dysplasia) is presented. In addition to short ribs, this syndrome is characterized by short limbs with or without polydactyly. There are often associated defects, particularly neural tube anomalies. The occurrence of consanguinity and of four affected siblings in this family support autosomal recessive inheritance. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The instantaneous measurement of multiple Doppler spectra in the investigation of ovarian masses
Authors: Shapiro I. , Friedman Z. , Lysyansky P. , Leibovitz Z. , Degani S. , Ohel G.
Published: March 2003

The use of Doppler indices of tumor vascularity as markers for malignancy has been a subject of debate, with inconsistencies in specificity and sensitivity as well as in the diagnostic cut‐off values. Part of the discrepancy might be explained by the limited number of vessels selected within the tumor for Doppler evaluation. A typical sample of three or four vessels may not be sufficiently large for correct representation of the vasculature of the tumor, which may contain many vessels. The existing conventional Doppler (color and spectral) techniques clearly have limitations.

We present here a novel Doppler modality, namely two‐dimensional spectral Doppler imaging (SDI), which allows the acquisition of many Doppler spectra within a few seconds. The operator selects a region of interest within a color Doppler image. The Doppler sequence is initiated and the entire selected region is automatically scanned for about 20 s until all spectral Doppler data have been acquired and processed. The system computer generates a color‐coded map of the desired Doppler indices overlaid on the gray‐scale image. The system also displays a cumulative histogram or a table of the requested Doppler index from all the sections in the tissue. The whole process is automatically performed by the system computer, without any need for operator intervention. The system provides the examiner with a ‘fishing net’ for Doppler indices, instead of the ‘fishing hook’ used in current techniques. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Doppler assessment of tracheal fluid flow during fetal breathing movements in cases of congenital diaphragmatic hernia
Authors: Kalache K. D. , Chaoui R. , Hartung J. , Wernecke K. D. , Bollmann R.
Published: March 2003

Objective

The purpose of this investigation was to examine the characteristics of breathing‐related fluid flow in the trachea of human fetuses with congenital diaphragmatic hernia in the hopes of developing a standard for the prenatal diagnosis of the degree of severity of the resulting pulmonary hypoplasia. Our ultimate goal is the prediction of postnatal mortality in fetuses with congenital diaphragmatic hernia.

Subjects and methods

The study comprised six cases of isolated congenital diaphragmatic hernia (one on the right side; five on the left) varying in gestational age from 26 to 36 weeks. Four of the patients survived after surgical repair and two died during the neonatal period owing to lung hypoplasia. Color Doppler was used to visualize the fluid displacement in the trachea generated by fetal breathing movements. Spectral Doppler was then used to analyze the fluid flow velocity waveforms. More than 40 continuous breathing cycles (inspiration + expiration) were recorded for each case. We distinguished between regular and irregular patterns.

Results

Only the regular breathing phases, defined as five or more consecutive cycles of symmetric appearance, were considered for analysis. The inspiration and expiration times, the peak velocity of inspired and expired fluid and the volume obtained by integration of the tracheal fluid flow displaced during fetal breathing were compared with those of five healthy fetuses for each gestational age. Only the tracheal volume flow was helpful in predicting outcome. In normal pregnancies this parameter increased from 0.21 ± 0.10 ml/breath (mean ± SD) at 26 weeks to 1.37 ± 0.48 ml/breath at 36 weeks of gestation. A significantly low (p < 0.05) volume flow was found only in the fetuses with congenital diaphragmatic hernia with a lethal postnatal outcome, whereas this parameter was normal in all survivors.

Conclusions

Our preliminary observations suggest that the tracheal volume flow during fetal breathing activity is related to lung growth. In fetuses with severe lung hypoplasia one would expect a significant reduction in this parameter as an expression of deficient fetal lung growth. The displaced fluid volume per breath in the trachea of human fetuses as assessed by Doppler ultrasound may be a useful predictor of outcome in cases of isolated congenital diaphragmatic hernia. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Fetal ascites associated with an imperforate hymen: sonographic observation
Authors: Jacquemyn Y. , De Catte L. , Vaerenberg M.
Published: March 2003

We report a case of fetal ascites in which no abnormalities other than an imperforate hymen were noted. The ascites resolved after abdominal tap and incision of the hymen. A possible mechanism for an association between imperforate hymen and fetal ascites is proposed. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonographic assessment of the uterine cervix and interleukin‐8 concentrations in cervical secretions predict intrauterine infection in patients with preterm labor and intact membranes
Authors: Rizzo G. , Capponi A. , Vlachopoulou A. , Angelini E. , Grassi C. , Romanini C.
Published: March 2003

Objective

Interleukin‐8 concentrations in cervical secretions have been related to microbial invasion of the amniotic cavity and histological chorioamnionitis. Since a short uterine cervix may be a risk factor for intrauterine infection, we set out to determine the interrelationship between cervical‐secretion interleukin‐8 concentration, cervical length measured by transvaginal sonography and intrauterine infection in women with preterm labor and intact membranes.

Design

The study group comprised 144 pregnant women admitted to hospital for preterm labor and intact membranes. At admission, interleukin‐8 in cervical secretions was assayed. The uterine cervix was evaluated by transvaginal sonography and the cervical index ((funnel length +1)/cervical length) was measured. In all cases, amniotic fluid was obtained by amniocentesis immediately after cervical examination and was cultured for aerobic and anaerobic bacteria including Ureaplasma ureolyticum and Mycoplasma hominis. Placentas were analyzed at delivery for the presence of histological chorioamnionitis.

Results

Forty‐three per cent (62/144) of pregnancies delivered preterm and 12.5% (18/144) of the amniotic fluid cultures were positive. Placentas were available from 54 pregnancies which delivered preterm and histological chorioamnionitis was found in 59.2% (32/54) of the cases. Interleukin‐8 concentrations in cervical secretions were significantly higher in the presence of microbial invasion of the amniotic cavity (median 1191.5 ng/ml, range 812–5234 ng/ml vs. median 109 ng/ml, range 12–2231 ng/ml; p ≤ 0.0001) and histological chorioamnionitis (median 982.5 ng/ml, range 430–5234 ng/ml vs. median 435 ng/ml, range 40–1750 ng/ml; p ≤ 0.0001). Similarly, higher values for cervical index were obtained in the presence of a positive amniotic fluid culture (median 1.23, range 0.35–5.88 vs. median 0.29, range 0.024–4.85; p ≤ 0.0001) or histological chorioamnionitis (median 1.18, range 0.043–5.88 vs. median 0.562, range 0.040–2.48; p = 0.011). Multiple logistic regression analysis indicates significant independent associations with a positive amniotic fluid culture and histological chorioamnionitis for the cervical interleukin‐8 concentrations (amniotic fluid culture positive ≥850, histological chorioamnionitis ≥450) and for the cervical index (amniotic fluid culture positive ≤0.58, histological chorioamnionitis ≤0.56).

Conclusions

Intrauterine infection is associated with increased interleukin‐8 concentrations in cervical secretions and a short cervix. Their combined analysis may reduce the indications for invasive procedures and improve the selection of women in preterm labor who may benefit from antimicrobial treatment. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Humerospinous distance measurements: accuracy and usefulness for predicting shoulder dystocia in delivery at term
Authors: Klaij F. A. V. , Geirsson R. T. , Nielsen H. , Hreinsdóttir M. , Haraldsdóttir K. R.
Published: March 2003

Objective

To investigate if the humerospinous distance, as an indicator of shoulder width, could predict shoulder dystocia at term.

Design

Prospective cross‐sectional study of a stratified reference group of healthy women and a test group of women with risk factors for shoulder dystocia. Measurements were not revealed. Outcome measures were difficulties with delivery of the shoulders and correlation with maternal body mass and birth weight.

Subjects

Seventy‐two women with singleton pregnancies at a University Clinic: 32 women at 39–42 weeks for reference and 40 women in an at‐risk test group (weight > 90 kg, weight gain > 20 kg, previous macrosomic baby, history of shoulder dystocia/difficult delivery, clinical suspicion of a large baby). Women with a breech fetus, twins and those not able to deliver vsaginally were excluded.

Methods

Fetal shoulders were measured from the convergence of the cervical spinous processes at the approximate cervicothoracic vertebral junction to the medial border of the humeral head. Correlations were made with maternal body mass, birth weight, birth weight estimation, ultrasound and postnatal humerospinous measurements.

Results

One case of shoulder dystocia in a fetus with an average humerospinous measurement occurred in the reference group and there were no cases in the test group. There was no predictive value of a large humerospinous measurement and no correlation with maternal or fetal size. Movement of the fetal arm could change the humerospinous distance considerably, which could account for the difference between a normal and large measurement.

Conclusion

The humerospinous distance cannot be used to predict shoulder dystocia. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Arrhythmia in early pregnancy: a predictor of first‐trimester pregnancy loss
Authors: Vaccaro H. , Amor F. , Leyton M. , Sepulveda W.
Published: March 2003

Objective

To determine the prognostic significance of cardiac arrhythmia detected in the first trimester.

Design

Cases in which embryonic arrhythmia was detected by transvaginal ultrasound between 6 and 9 weeks of gestation were retrospectively identified and reviewed.

Results

Embryonic arrhythmia was noted in four of 950 ultrasound examinations. There was associated ventricular bradycardia in three cases, one of which also had an atrial rate below the normal range for gestational age. No cardiac activity was detected at the follow‐up examination 1 week later in three cases. In the other, the embryo was alive but there was severe growth delay and the scan the following week confirmed embryonic death.

Conclusion

This report suggests that arrhythmia in early pregnancy is associated with subsequent pregnancy loss. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Fetal mustache in early pregnancy
Authors: Bronshtein M. , Zimmer E. Z. , Offir H. , Blazer S.
Published: March 2003

Objective

The aim of this study was to determine the incidence in an unselected population of a rod‐like structure on the fetal upper lip (called a ‘mustache’) which we had previously observed as an incidental finding. A secondary aim was to determine whether this was associated with any abnormalities or abnormal outcomes.

Design

Prospective non‐randomized study.

Subjects

Three thousand consecutive fetuses from an unselected population were scanned by one sonologist.

Method

Transvaginal ultrasound examinations were performed at 14–16 weeks' gestation. Repeat sonographic examinations were performed at 20–22 weeks' gestation in cases where a mustache was detected, and these neonates were examined by a pediatrician after delivery.

Results

Seven of 3000 fetuses had a mustache‐like structure on the upper lip. The ‘mustache’ disappeared later in gestation. No anomaly of the upper lip was detected after birth in these fetuses.

Conclusion

A mustache‐like structure on the fetal upper lip in early pregnancy probably represents a normal variant of lip development. It is likely to represent a delay in the normal process of lip fusion during embryonic life. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The growth of the human embryo. A longitudinal biometric assessment from 7 to 12 weeks of gestation
Authors: Blaas H.‐G. , Eik‐Nes S. H. , Bremnes J. B.
Published: March 2003

Objectives

Longitudinal studies of multiple parameters in the first trimester for assessment of embryonic growth are lacking. This study's aim was to register changes in growth over time, by taking several measurements of embryos on successive occasions and evaluating these changes by longitudinal analysis.

Design

This prospective longitudinal study describes the normal embryonic growth in vivo. Inclusion criteria were non‐smoking women with single uneventful pregnancies, regular menstrual periods (28–30 days) and no hormone therapy in the 3 months prior to the pregnancy. Exclusion criteria were pregnancy complications such as diabetes, pre‐eclampsia, delivery of preterm or growth‐restricted infants. Of 36 recruited pregnant women, 29 met these criteria. Each pregnancy was examined five times between 7 and 12 weeks of gestation. This resulted in a two‐level data set, where level 1 consisted of the observations and level 2 consisted of the individuals. The longitudinal data were analyzed with a software package specially created for multilevel analysis.

Results

The growth of the biparietal diameter (BPD), occipitofrontal diameter (OFD), mean abdominal diameter (MAD), chorionic cavity diameter and amniotic cavity diameter was constant; the growth of the crown‐rump length (CRL) and the yolk sac diameter was not constant. Variation in the data sets was mainly caused by variation between the embryos/fetuses.

Conclusions

The measured parameters except for the yolk sac showed a high degree of uniformity with virtually the same growth velocities. The yolk sac demonstrated uniform growth until week 10 only. Differences between the gestational age based on the last menstrual period and the true gestational age, and/or differences in the early growth of the embryos before the start of the study at 7 weeks, may have contributed to the variation between the individuals. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Single and serial estimates of amniotic fluid volume and umbilical artery resistance in the prediction of intrauterine growth restriction
Authors: Owen P. , Khan K. S. , Howie P.
Published: March 2003

Objectives

To determine whether single or serial estimates of both the amniotic fluid index (AFI) or pulsatility index (PI) of the umbilical artery Doppler waveform can usefully identify infants with anthropometric features of intrauterine growth restriction (IUGR).

Methods

A total of 274 women underwent serial antenatal ultrasound examinations at predetermined intervals. Four biophysical parameters were considered: AFI and PI prior to delivery and change in AFI and PI over a 28‐day period in the third trimester. All values were expressed as standard deviation scores. IUGR was diagnosed if the neonate demonstrated skinfold thickness < 10th centile, ponderal index < 25th centile or mid‐arm circumference to occipitofrontal circumference (MAC : OFC) < −1 SD. Receiver operator characteristic curves were used to determine an optimal cut‐off point, and test performance of the biophysical parameters were expressed as likelihood ratios (LR).

Results

The test performances of all four ultrasound parameters for any of the three diagnostic criteria for IUGR was poor. The highest positive LR was only 2.5 (95% CI 1.5–4.1) for PI prior to delivery in the prediction of ponderal index < 25th centile.

Conclusion

Despite positive associations between single and serial estimates of AFI and PI with abnormal neonatal morphometry, the likelihood ratios remained low. The results of this study do not support the use of single or serial estimates of AFI or umbilical artery PI in the prediction of IUGR. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Resistance to blood flow in ovarian tumors: correlation between resistance index and histological pattern of vascularization
Authors: Kidron D. , Bernheim J. , Aviram R. , Cohen I. , Fishman A. , Beyth Y. , Tepper R.
Published: March 2003

Objective

To investigate the correlation between the histological patterns of vascularization and the resistance index (RI) in ovarian tumors.

Design

In a retrospective study, the histological sections of the ovarian tumors with known preoperative RI values were reviewed and the pattern of vascularization was studied.

Subjects

Twenty‐two women underwent B‐mode sonography and color Doppler ultrasound within 3 days prior to explorative laparotomy for ovarian masses in the years 1992–93.

Methods

The RI of the ovarian tumors was calculated as the mean of three consecutive waveforms with the lowest RI. The representative histological sections were evaluated for quantity of arterioles and venules, after staining by Masson trichrome and Elastic Van Gieson. The arteriolar fraction (defined as the number of arterioles divided by the sum of the arterioles plus venules) and the density of vessels (defined as the number of arterioles and venules per microscopic field) were calculated in each histological section and correlated with the preoperative RI values.

Results

The mean RI was 0.36 ± 0.07 for malignant tumors and 0.57 ± 0.03 for benign tumors. Ovaries with malignancies showed significantly lower arteriolar fraction values (0.30 ± 0.12) than those with benign tumors (0.56 ± 0.05) and those with metastatic tumors (0.43 ± 0.2) (p < 0.002 and p < 0.001, respectively). The density of vessels was higher in malignant tumors (8.0 ± 3.8) than in benign lesions (2.7 ± 1.5) (p < 0.01). RI values showed a strong positive correlation (r = +0.85, p < 0.0005) with the arteriolar fraction and a negative and weaker correlation (r = −0.69, p < 0.001) with the density of vessels.

Conclusions

RI values are predominantly determined by the proportion of arterioles. The correlation between the histological pattern of vascularization and RI values reflects tumor angiogenesis and increases understanding of the advantages and limitations of measuring vascular resistance by color Doppler ultrasound. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Polycystic ovary syndrome: it is always bilateral?
Authors: Battaglia C. , Regnani G. , Petraglia F. , Primavera M. R. , Salvatori M. , Volpe A.
Published: March 2003

Objective

To evaluate whether patients with unilateral polycystic ovary showed different ovarian and uterine blood flow from those with bilateral polycystic ovaries, and to investigate whether there was a correlation between the ultrasonographic aspect and different hormonal parameters.

Design

An observational study.

Subjects

Sixteen patients with unilateral polycystic ovary and twenty patients with bilateral polycystic ovaries underwent clinical, biochemical, gray‐scale and color Doppler ultrasonographic evaluation.

Methods

The following parameters were evaluated: hormonal (luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH concentration ratio, estradiol, prolactin, androstenedione, testosterone), clinical (body mass index, Ferriman‐Gallwey score), ultrasonographic (ovarian volume, number and distribution of subcapsular follicles, stromal score) and Doppler (uterine artery and intraparenchymal vessel pulsatility index, ovarian stromal vascularization), in oligomenorrheic patients in the early follicular phase (cycle days 3–5) or in amenorrheic patients at random.

Results

Significantly higher androstenedione plasma levels and LH/FSH concentration ratios were observed in bilat‐eral polycystic ovaries. In unilateral polycystic ovaries, gray‐scale and color Doppler ultrasonography showed different features in the affected and the unaffected ovary, similar to the appearance of a polycystic and normal ovary, respectively.

Conclusion

Polycystic ovary syndrome does not predetermined single ultrasonographic and Doppler pattern. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Cervical pregnancy: assessment with three‐dimensional power Doppler imaging and successful management with selective uterine artery embolization
Authors: Su Y.‐N. , Shih J.‐C. , Chiu W.‐H. , Lee C.‐N. , Cheng W.‐F. , Hsieh F.‐J
Published: March 2003

Cervical pregnancy is frequently associated with extensive hemorrhage which, in severe cases, may be stopped only by hysterectomy. We report a case of an anembryonic cervical pregnancy diagnosed at 10 weeks, and associated with a large arteriovenous malformation. The patient was conservatively managed with simple selective uterine artery embolization. After embolization, her vaginal bleeding ceased and the level of serum β‐human chorionic gonadotropin decreased rapidly. No additional treatment was given. The patient's postoperative course was uneventful and the cervical mass had disappeared at the follow‐up 4 months later. To the best of our knowledge, this is the first report of conservative management of cervical pregnancy simply by uterine artery embolization. The role of three‐dimensional power Doppler ultrasonography in the assessment of cervical pregnancy and in monitoring the therapeutic response is discussed. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Nomogram of the fetal alveolar ridge: a possible screening tool for the detection of primary cleft palate
Authors: Goldstein I. , Jakobi P. , Tamir A. , Goldstick O.
Published: March 2003

Objective

The objective of this study was to obtain a nomogram of the fetal alveolar ridge development, as a basis for the diagnosis of primary cleft palate.

Design

A cross‐sectional study of 323 normal pregnant women of 14–32 weeks' gestation. Several biometric measurements were obtained throughout pregnancy, including the width of the fetal alveolar ridge.

Results

A nomogram of the width of the fetal alveolar ridge during 14–32 weeks' gestation is presented. A linear growth function was observed between alveolar ridge width and gestational age, biparietal diameter, head circumference, femoral length and humeral length. The alveolar ridge width in all eight cases of cleft palate was above two standard deviations and the 90th centile of our nomogram.

Conclusion

We provide a nomogram of the growth of the fetal alveolar ridge between 14 and 32 weeks' gestation. This will aid the detection of primary cleft palate during routine prenatal sonography. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Resolution of presumed arachnoid cyst in utero
Authors: Elbers S. E. L. , Furness M. E.
Published: March 2003

We present a case of presumed arachnoid cyst that was diagnosed at 18.5 weeks' gestation, developed a hematoma at 28 weeks and had virtually resolved by 32 weeks. Expectant management of antenatally diagnosed cases is suggested. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Implementation of nuchal translucency image‐scoring method during ongoing audit
Authors: Herman A. , Dreazen E. , Maymon R. , Tovbin Y. , Bukovsky I. , Weinraub Z.
Published: March 2003

Objective

The aim of this study was to evaluate the contribution of an ongoing audit, using the image‐scoring method, to the quality of nuchal translucency images and to set the basic standards required from the examiners.

Design

Evaluation of nuchal translucency images, before, during and after the implementation of an ongoing audit, without knowledge of the time period or the examiner.

Subjects

A total of 315 nuchal translucency scans were performed by three examiners. Methods Each of the retrospective, intermediate and prospective time periods included blind scoring of 105 images. The effect of the ongoing audit was examined by comparing the distribution of the quality groups and the mean final score between the time periods, for all cases and for each examiner separately. Improvement of the criteria was assessed by comparing the rate of scans meeting the demands between the time periods.

Results

The quality of the images improved significantly as the mean final score changed from 4.62 ± 0.21 to 6.19 ± 0.19 and to 6.91 ± 0.16 (p < 0.0001) and the rate of obtaining acceptable scans rose from 72% to 88% and to 92% (p < 0.001), respective to the three time periods. Whereas the three major criteria improved significantly before and after implementation of the audit (mid‐sagittal section from 48% to 94%, caliper placement from 60% to 75% and skin line from 19% to 77%), the minor criteria remained unchanged (image size 90%, amnion demonstration 25% and head position 77%). The average scores of two examiners, for whom improvement was more pronounced, were used to determine the basic standards required from examiners subjected to the audit as follows: unacceptable, none; intermediate, 5%; reasonable, 65%; excellent, 30%; with a mean final score of 7.25.

Conclusions

Implementation of an ongoing audit, using the image‐scoring method, proved to be an efficient method for surveillance and improving the quality of nuchal translucency images. We recommend centers or individuals practicing first‐trimester ultrasound screening to consider its routine utilization, in an unbiased and strict manner. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Functional urinary tract obstruction developing in fetuses with isolated gastroschisis
Authors: Reiss R.E. , Landon M.B. , Jayanthi V.R. , Caniano D.A. , Mutabagani K. , O'Shaughnessy R.W.
Published: March 2003

Objective To evaluate the frequency and natural history of urinary tract abnormalities developing in fetuses presenting with initially isolated gastroschisis.

Methods Serial ultrasounds were performed prospectively on fetuses identified by our prenatal diagnosis program as having a gastroschisis. When abnormalities in the urinary tract were identified prenatally, newborns were evaluated by a pediatric urologist.

Results Over a 1‐year period four out of 12 fetuses with gastroschisis developed deformations of the urinary tract. In three fetuses the bladder herniated through the abdominal wall defect. Two also had upper tract dilatation. A fourth fetus developed bilateral hydronephrosis with a normally situated bladder. Once the gastroschisis was repaired none of the newboms had evidence of structural obstruction of the urinary tract, however, hydronephrosis with or without reflux persisted for several months.

Conclusions Deformations of the fetal urinary tract can develop secondary to gastroschisis. They do not appear to represent separate malformations and evaluation with fetal karyotyping may not be indicated. When hydronephrosis is present ongoing urologic evaluation of the neonate is indicated.
P114Fetal echocardiography in chromosomally normal fetuses with increased nuchal translucency. A preliminary report
Authors: Puerto B. , Martinez J. M. , Borrell A. , Cararach V. , Fortuny A.
Published: March 2003

Objective

To determine the value of first trimester screening for congenital heart disease by measurement of nuchal translucency at 10–14 weeks of gestation.

Methodology

A transabdominal echocardiography at 20–22 weeks of gestation was performed in 104 singleton pregnancies with chromosomally normal fetuses and an increased nuchal translucency (> 95th centile) at 10–14 weeks. In the last 55 cases an early examination combining either the transvaginal or the transabdominal route at 13–16 weeks was also carried out. The heart evaluation was considered as complete when the four chamber view, with both atria, ventricles and atrioventricular valves, as well as the origin and double crossing of the great arteries were correctly identified. Colour and pulsed Doppler examination were used to assess blood flow through the aortic, pulmonic and atrioventricular valves, in order to detect regurgitation or very high velocities suggesting valve stenosis. The systemic and pulmonary venous return was also identified, and assessed by Doppler when possible.

Results

Only one structural cardiac defect was detected in this population. It was a tricuspid atresia with ventricular septal defect detected at 14 weeks of gestation.

Conclusion

Although the number of cases is too small to draw strong conclusions, the utility of nuchal translucency as a screening method for congenital heart disease in chromosomally normal fetuses is worth to be confirmed by further investigation.
P116The role of fetal echocardiography and detailed sonography in the prenatal diagnosis of the Edward's syndrome (analysis of the 30 cases)
Authors: Kaczmarek P. , Janiak K. , Krasoń A. , Nowicki G. , Czichos E. , Respondek‐Liberska M.
Published: March 2003

Background

The aim of this study a retrospective analysis from the video tapes fetuses with trisomy 18 (Edward's syndrome) who had detailed sonography and echocardiography.

Method

Between 1994 and 2000 at our Department 30 cases of trisomy 18 were diagnosed.

Results

Every fetus presented with congenital anomalies. The most common were: intrauterine growth retardation (96%) and fetal congenital heart defects (92%).

Conclusion

The ‘genetic sonography’ including fetal echocardiography allows a strong ‘suspicion’ of trisomy 18, which later can be confirmed by cytogenetic analysis.
P12High sensitivity of routine ultrasound scan at 20–24 weeks for detection of fetal anomalies
Authors: Cha S. C. , Toma O. T. , Braia G. , Carvalho M.B. , Pedreira D. L.
Published: March 2003

Aim

To emphasize importance of experienced sonographer for detection of fetal anomalies.

Materials and method

2726 routine scans were performed at 20–24 weeks for the detection of fetal anomalies between February 1997 and May 2000. All scans were performed by five sonographers with more than 10 years' experience and the duration of scan examination was 30–60 min. The scan protocol included not only visualization of fetal structures but also besides classical fetal biometry, we performed additional measurement of fetal structures such as cerebellar distance, ocular, cysterna magna, nuchal fold, length of nose bone, atrium of lateral ventricule, cardiac and toracic area, renal pelvis, iliac angle, relation feet/femur length, length of femur, tibia, fibula, humerus, radius and ulna.

Results

Ultrasound scans were able to detect 67 anomalies in a total of 74 malformations observed at delivery. The sensitivity of the method when performed by a highly skilled sonographer is 90%. A total of 7 anomalies were not diagnosed by ultrasound at 20–24 weeks, including 2 esophageal atresia with distal fistula and 5 perimembranous interventricular communication.

Conclusions

Ultrasound scanning for fetal anomalies is highly sensitive when performed by highly skilled sonographers. However, minor cardiac malformations for a low risk population is still the challenge for sonographers.
P123Congenital complete heart block. Prenatal diagnosis and successful fetal therapy
Authors: García C. , Lagos N. , Pazols R. , Carrasco M. , Hoffmann I. , Toledo P.
Published: March 2003

Objective

Congenital complete heart block (CCHB) affects 1:20.000 live births. This condition reappears in 18–24% of future pregnancys. 50% of the fetuses have a structural cardiac anomalies. It may present isolated or in mothers with autoinmune disease, or positive anti‐Ro (SSA) and anti‐La (SSB) antibodies. Our purpose is to show the improvement in perinatal outcome using 2D echocardiografy and foetal Doppler to diagnose CCHB in the prenatal period.

Case report

We present a 36‐year‐old female patient with 2 previous stillborns due to CCHB. She was positive for anti SSA and anti SSB antibodies and was evaluated for the first time at 22 weeks of her third pregnancy. An Echography showed foetal hydrops, and echocardiography showed an anatomically normal heart, with a complete heart block. The atrial rate was 120/min. and the ventricular rate was 60/min. Treatment was started with dexametasone 4 mg/day, salbutamol 12 mg/day and Sandoglubulin (Novartis) 400 mg/kg.

Following sonographys showed resolution of fetal hydrops, improvement in cardiac function and cardiac rates. Cesarian section at 34 weeks, newborn 2420 g. At day 7 a permanent pacemaker was implanted.

Conclusions

Fetal echocardiography is the best method to diagnose and treat CCHB in the prenatal period. The use of glucocorticoids, betamimetics and immunoglobulins has shown to be of benefit.
Ultrasound in gynecology P133The endometrium after 50: sonographic‐histologic correlation
Authors: Joutindo A. , Lescrainier J. P. , Van Pachterbeke C.
Published: March 2003

We wanted to test the accuracy of sonography in detecting endometrial pathology, in women over 50. Retrospectively, we enrolled 100 consecutive women over 50‐year‐old, who have had a monographic endometrial thickness measurement followed by a histological endometrial analysis, though endometrial biopsy, dilatation and curetage, or hysterectomy. The mean age was 64.3 years; 54% of the women presented metrorragies and 40% of them did not use hormonal replacement therapy (HRT). We found 6 endometrial cancers and 2 atypical hyperplasia (all of them were symptomatic); we found 7 simple hyperplasia (2 were asymptomatic) and 18 polyps (6 were asymptomatic). No serious endometrial anomaly (simple or atypical hyperplasia or adenocarcinoma) were found under 5 mm of double endometrial layer. The first endometrial cancer was encountered in an endometrial thickness of 10 mm, the first atypical hyperplasia at 9 mm, the first simple hyperplasia at 7 mm, and the first polyp in a 2‐mm endometrial thickness. If we used the endometrial thickness cut‐off level of < 5 mm for symptomatic women and for asymptomatic women without hormonal replacement therapy and the endometrial thickness cut‐off level of < 8 mm for asymptomatic women with HRT, we obtain a sensitivity in detecting any endometrial pathology of 85%, and a specificity of 41%; the false negative rate is low (5%) and represent in our study only small polyps.
P135Endometrial thickness ultrasound evaluation and its variations
Authors: Santos F. F. A. , Machado M. R. M. , Dertkigil M. S. J. , Marussi E. F.
Published: March 2003

Background

The aim of this study was to evaluate the variations in endometrial thickness considering years since the last menstrual bleeding, abnormal vaginal bleeding and hormonal replacement therapy (HRT). It was also studied the histological diagnosis.

Method

Endometrial thickness (ET) was measured in 100 postmenopausal women by pelvic and/or transvaginal US, that had gone to routine examinations.

Results

The mean age was 61.5 years (± 9.3) and the mean menopausal age was 48 years (± 5). Forty percent was under HTR and abnormal vaginal bleeding was present in 13% of the patients. Endometrial thickness in patient with 5 or less years since menopause was 5.5 mm (± 0.9) and 4.3 mm (± 0.5 mm) in those with 6 or more years. Patients under HTR the mean thickness was 5.07 mm (± 5.6) and without HTR was 4.35 mm (± 3.9). Women with abnormal bleeding had mean endometrium of 6.9 mm (± 6.2), against 4.2 (± 4.3) from assyntomatic patients. The histological diagnosis from patients with ET ≥ 6 mm were: endometrial polyps (9); endometrial cancer (1); proliferative endometrium (1); submucous mioma (1) and endometrial atrophy (1). All histological studies from patients with bleeding and ET < 6 mm showed atrophic endometrium.

Conclusions

The ET had no significant statistical variation when analised time since menopause and use of HRT. All patients with bleeding and ET < 6 mm had endometrial atrophy. 85% (11/13) patients with ET ≥ 6 mm had pathological finds in histological study, including one endometrial cancer.
P136Color flow mapping and Dopplerometry of myometrial and endometrial arteries in patients with hyperplasia and polyps
Authors: Fedorova E. V. , Lipman A. D. , Khokhlova I. D. , Pobedinski N. M.
Published: March 2003

Background

The aim is to investigate the influence of the benign hyperplastic process of endometrium over the uterine blood flow resistance.

Method

The transvaginal ultrasound with Color Flow Mapping and Dopplerometry was used for examination of 90 patients (28 with hyperplasia, 30 with glandular and 32 with fibroid polyps) and of 30 healthy women (in 1st phase of menstrual cycle). Arteries visualization rate and values of Doppler indices for myometrial (the main uterine, arcuate, radial) and endometrial (basal, spiral) vessels were assessed.

Results

The main uterine and arcuate arteries were visualized in all cases. As crossing from feeding uterine vessels deeper to the endometrium, the tendency of reduction possibility of its visualization was marked. That probably corresponds with reduction of arteries size. The resistance indices were:

Healthy
Hyperplasia
Glandular  polyps
Fibroid  polyps

Uterine arteries
0.88
0.81
0.83
0.83

Arcuate arteries
0.78
0.75
0.73
0.73

Radial arteries
0.71
0.68
0.67
0.63

Basal arteries
0.57
0.52
0.51
0.52

Spiral arteries
–
0.53
0.50
–

Polyp arteries

0.58
0.49

Conclusion

Benign hyperplastic process of endometrium was accompanied by lowering Doppler indices values in all arteries in comparison with normal condition, that show intensification of the blood supply.
P151Transvaginal ultrasonography in detection of cervical incompetency
Authors: Podobnik M. , Podgajski M. , Ciglar S. , Gebauer B.
Published: March 2003

Objectives

To examine the relationship between transvaginal ultrasound cervical changes and pregnancy outcome in women at risk of cervical incompetency and preterm delivery.

Method

In 100 pregnancies with clinical and ultrasonic signs of cervical incompetency, the length of the cervix, the thickness of the anterior wall of a lower uterine segment and the width of the endocervical canal have been evaluated ultrasonically. These parameters were followed longitudinally from the 10th to 36th gestational week in the healthy pregnancies and pregnancies at risk of cervical incompetency and preterm delivery.

Results

In patients from 10 weeks to 14 weeks the cervix is significantly longer than in the 25–36 week group and the anterior wall of the lower uterine segment in the 10–14 week group is significantly thicker than in the 20–36 week group. In pregnancies at risk of cervical incompetency, cervical lengths and wall thickness were significantly different from those in comparable controls. Forty‐five percent of the patients in the at‐risk group, with cervical cerclage, delivered at 37.5 weeks and 8.5% of pregnancies ended in abortion when the amnictic membrane herniated into the cervical canal. The frequencies of preterm delivery were 60%, 38% and 15% for cervical lengths of < 10 mm, 10–20 mm and 20–30 mm.

Conclusion

A shortened cervix with decreased thickness of the anterior wall of lower uterine segment and dilatated endocervical canal shows a strong association with cervical incompetency and preterm birth.