bluuebunny/crossref_metadata_2025 huggingface dataset:
Nuchal translucency screening and antenatal maternal serum screening for Down syndrome: results of a project
Authors: Benavides C. E. , Garcia C. C. , Lagos N. C. , Melgarejo X. C. , Ferres M. I. C.
Published: March 2003

Objectives:  To asses the implementation of antenatal screening for Down syndrome using individual risk estimates based on maternal age, nuchal translucency and three serum markers; alpha fetoprotein, unconjugated estriol and human chorionic gonadotrophin (hCG) in maternal blood. Women with an estimated risk of 1 in 250 or greater were classified as screen positive and offered diagnostic amniocentesis.

Subjects:  A total of 1956 women of all ages with singleton pregnancies seen between June 1999 and March 2001.

Results:  The screening result of combination of first trimester ultrasonographic and serum screening was 85% Down syndrome detection and the false positive rate was 3%. The median gestational age of nuchal translucency was 11 weeks and the time of serum screening was 16 weeks.

Conclusion:  The combination of nuchal translucency and serum screening increases the Down syndrome detection and decreases the false positive rate. Is very important because the amniocentesis is associated with a risk of pregnancy loss from 0.5 to 1%. Besides, it is cost‐effective and performs better than the selection for amniocentesis on the basis of maternal age only, nuchal translucency only or serum screening.
Associated anomalies and perinatal outcome in fetuses with prenatally diagnosed single umbilical artery
Authors: Park M. H. , Oh K. Y. , Park J. S.
Published: March 2003

Objective:  To evaluate pattern of associated structural anomalies, abnormal karyotypes and perinatal outcomes of fetuses with prenatally diagnosed single umbilical artery and to evaluate the relation of absent side of a single umbilical artery in association with anomalies and abnormal karyotypes.

Materials and methods:  Thirty fetuses with a single umbilical artery were detected by prenatal ultrasound examination between March 1998 and June 2001 at Eul‐Ji University Hospital. All medical records were reviewed for maternal demographics, associated anomalies, karyotypic analysis, pregnancy complications, and neonatal outcome.

Results:  Of the 30 fetuses, 11 (36.7%) were terminated because of severe anomalies and 1 (3.3%) experienced neonatal death. 17 fetuses (56.7%) had an associated structural anomaly. The structural anomalies found in association with single umbilical artery were multiple malformations (seven cases, 41.2%), cardiovascular anomalies (four cases, 23.5%), urinogenital anomalies (four cases, 23.5%), CNS anomalies (one case, 5.9%) and ectopia cordis (one case, 5.9%). Karyotype analysis was available in 25 cases and 5 of these were chromosomally abnormal. All of the karyotypically abnormal fetuses had a structural defect diagnosed on prenatal ultrasound examination in addition to the single umbilical artery. Of the 13 fetuses without any associated structural or chromosomal anomalies, 3 (23.1%) demonstrated growth restriction. Of the 26 cases identified, the absent side of a single umbilical artery, the right umbilical artery was absent in 13 (50%) and the left in 13 (50%) fetuses. The frequency with associated structural and chromosomal anomalies was equal on right (46.2, 15.4%) and left (69.2, 23.1%) sides.

Conclusion:  When single umbilical artery is detected, a detailed ultrasonographic examination and fetal karyotyping should be recommended for search of associated structural and chromosomal abnormalities. In cases, where single umbilical artery is an isolated finding on prenatal ultrasound, careful attention to fetal growth is necessary.
Dystrophic calcification within fetal myocardium: a case report
Authors: Rowlands S. L. , Sampson A. J. , Kahler S.
Published: March 2003

A woman presented at 19 weeks gestation for a second opinion of an echogenic cardiac focus. The pregnancy had been complicated by 2 episodes of first trimester vaginal bleeding. She had no significant personal or family medical history. The ultrasound reported a viable fetus with biometry equivalent to 19 weeks gestation. Morphological examination revealed an anatomically normal heart, but there were multiple echogenic foci present within the myocardium. These ranged in size from 2 to 6 mm, and were within both ventricular walls and the interventricular septum. There were no abnormalities of cardiac blood flow. The remaining morphology was normal, the amniotic fluid volume was appropriate and the fetus was active. Rhabdomyomata were thought to be the likely diagnosis. Their association with tuberous sclerosis was discussed and the couple elected to terminate the pregnancy. Postmortem examination showed these echogenic foci to be multiple areas of dystrophic calcification. These were isolated findings. There were no features of rhabdomyomata. Dystrophic calcification within the fetal myocardium has rarely been reported at autopsy. It is thought to represent sites of injury to the myocardium. There are few previous reports of its antenatal detection on ultrasound later confirmed at autopsy and, although reported in fetuses which are stillborn or miscarried, it is rarely otherwise seen (Veldtman et al. Heart 1999; 81: 92–93). Although generalized ischemia can lead to myocardial calcification in older individuals, the present case and those reported by Veldtman et al. do not show evidence of this. The extent of the myocardial calcification suggests that there would have been significant cardiac dysfunction if the pregnancy had progressed. However, we are unaware of cases in which the pregnancy has continued. This report will discuss the appearance, etiology and prognosis of dystrophic calcification of the fetal myocardium and the importance of differentiating it from rhabdomyoma on ultrasound.
Antenatal transabdominal amnio‐infusion for oligo‐hydramnios due to preterm premature rupture of membranes
Authors: Tan T.‐C. , Tan A.
Published: March 2003

A reduction in the amount of amniotic fluid occurs in 3–5% of all deliveries. This could be due to congenital anomalies, IUGR or premature rupture of membranes. Preterm rupture of membranes places the fetus at risk of cord compression and amnionitis. On the other hand, oligo‐hydramnios has been associated with severe pulmonary hypoplasia. In 1983, Miyazaki and Nevarez first reported the effectiveness of intrauterine installation of saline solutions in relieving variable decelerations during labor. Since then, amnio‐infusion has aroused interest. To our knowledge, there has been no conclusive study done to evaluate the use of antenatal amnio‐infusion for oligo‐hydramnios diagnosed antenatally. We would like to present three case‐studies of oligo‐hydramnios seen in our department in the period 1997–2001 which we performed antenatal transabdominal amnio‐infusion. Warm saline/Hartmann solution was injected through a 22G spinal needle under ultrasound guidance. Vaginal delivery occurred in two cases (one term and one preterm); the third pregnancy is still on‐going. There was no meconium aspiration and no signs of fetal distress. Both cases had good maternal and neonatal outcome except that the preterm baby was treated with intravenous ampicillin/gentamicin for pneumonia. There was no congenital malformation noted.
Transvaginal sonography of myometrial invasion in endometrial cancer: a reappraisal
Authors: Savelli L. , De Iaco P. , Pilu G. , Rosati F. , Ceccarini M. , Bovicelli A. , Zamparelli A. , Bovicelli L.
Published: March 2003

Purpose:  A number of studies have suggested that transvaginal sonography can be successfully used in estimating the depth of myometrial invasion of endometrial cancers, thus permitting to tailor the surgical treatment to the needs of the patient. We undertook this study with the aim of evaluating, in a large group of patients, the accuracy of a well‐established method for preoperative sonographic staging of endometrial cancer.

Patients and methods:  A total of 136 patients with endometrial carcinoma consecutively admitted to the Department of Gynecology and Obstetrics from 1991 to 2000 underwent a transvaginal sonography within 7 days before surgery. The maximum thickness of endometrial echoes (d1) and the antero–posterior diameter of the uterus (d2) were recorded. As regards depth of myometrial invasion, staging was performed by means of calculating the ratio between the thickness of endometrial echoes and the antero–posterior diameter of the uterus (d1/d2).

Results:  Mean age of the study population was 63 years (35–88). Invasion of >50% of the myometrium was histologically found in 60 (44%) women. Transvaginal sonography demonstrated a sensitivity of 57% (34/60) and a specificity of 67% (51/76) for deep invasion, with a PPV of 58% (34/59) and a NPV of 66% (51/77). Overall accuracy was 62% (85/136).

Conclusions:  Although the technique for sonographic staging of endometrial cancer might be of value in the preoperative assessment of myometrial invasion, its diagnostic performance, when applied to a large group of patients, is not as good as that reported in the original publication.
Clinical utility of saline solution sonohysterography in the diagnosis of uterine pathology
Authors: Vitug M. R. S. , Clemente‐Chua L. R.
Published: March 2003

Sonohysterography involves the instillation of sterile saline solution under continuous sonographic visualization to assess the endometrial cavity. It is the objective of this study to determine the diagnostic accuracy of saline solution infusion sonohysterography and compare the reliability of transvaginal ultrasonography with and without saline solution infusion sonohysterography in detecting intrauterine pathology. The reliability of saline solution infusion sonohysterography were evaluated in 31 patients seen in our institution. These were then compared with the pathological results on available specimens. The sensitivity of transvaginal ultrasonography improved after saline solution infusion sonohysterography from 56 to 94% and the specificity from 40 to 60%. The positive predictive value increased from 75 to 88% and the negative predictive value from 22 to 75%. The diagnostic accuracy also increased from 52 to 86%. When the transvaginal ultrasonography and saline solution infusion sonohysterography results were combined, they had sensitivity of 100%, specificity of 100%, positive predictive value of 89%, negative predictive value of 100% and a diagnostic accuracy of 90%. The use of saline solution infusion sonohysterography also improved the quality of information about the location and size of uterine mass. This development has implications for the management of uterine bleeding disorders. It can distinguish women who only require medical therapy from those who require surgery. The method is easy to learn and is well tolerated by the patients.
Correlation between fetal cardiac diagnosis by obstetric and pediatric cardiologist sonographers and comparison with postnatal findings
Authors: Meyer‐Wittkopf M. , Schönfeld B. , Cooper S. G. , Sholler G. F.
Published: March 2003

Fetal echocardiography is optimized by a team strategy of imaging by obstetricians/high risk obstetric scanners (O) and fetal pediatric cardiologists (FPC). We retrospectively examined 1037 studies (1995–1999), and identified 249 cases of major congenital heart disease. The O diagnosis was compared to the FPC diagnosis and postnatal diagnosis. The rate of complete accurate diagnosis for O and FPC diagnosis were 59% (17% false positive, 41% negative), respectively. Major differences in diagnosis or detail were found in 79 patients after FPC was completed and in 35/79 (44%) this was judged to have potential significant impact on management and prognosis counseling. The complementary roles of O and FPC remain important. FPC can contribute with additional detail in some cases which may significantly impact on counselling and planning.
Role of routine fetal echocardiography in clinical practice: its impact on prenatal diagnosis of congenital heart disease in low risk population
Authors: Chinnaiya A. , Mohammed N. B.
Published: March 2003

Purpose:  Congenital heart disease occurs in approximately 8 of 1000 live births. Its prenatal diagnosis is important for proper perinatal and neonatal management. Basing referral for fetal echocardiography on presence of risk factors, excludes about 85% of fetuses with severe detectable heart defects from screening. The present study aims to examine the non‐selected low risk population to determine the diagnostic accuracy of fetal echocardiography in detecting cardiac anomalies.

Methods:  We included 39 808 low risk pregnant women who received antenatal care at the National University Hospital, Singapore between January 1986 and December 1994 and underwent routine second trimester ultrasound imaging to exclude fetal anomalies at the Antenatal Diagnostic Center. Ultrasonographers trained to do congenital abnormality scan including echocardiography (level IV scanning), performed examinations that was checked by obstetricians specially trained in obstetric ultrasonography. The duration of each scan was approximately 30 min. Equipment used were Hitachi 40,400,565A, Alokha 650 and Acuson 128XP. All subjects were followed to delivery. Postnatally, the neonates were examined by a neonatalogist for the confirmation of presence or absence of congenital anomalies. Patients who elected to terminate their pregnancies had their fetuses sent for postmortem assessment.

Results:  A total of 294 cases of congenital heart defects were identified prenatally by fetal echocardiography. Atrial and ventricular septal defects were the commonest anomalies identified (154), followed by left hypoplastic heart (23). In 36 subjects, abnormal cardiac sonographic findings were not confirmed postnatally on examination. On the other hand, there were 44 cases of cardiovascular anomalies that were missed by ultrasound prenatally. We obtained sensitivity of 85.4% for detection of congenital heart disease and a specificity of 99.9% to rule out any such anomalies. Our positive predictive rate was 87.7% and a negative predictive rate was 99.9%.

Conclusion:  We recommend routine screening by fetal echocardiography of all pregnancies for prenatal detection of cardiac anomalies, to increase the sensitivity and cost‐effectiveness of antenatal obstetric ultrasound screening and hence, to improve the perinatal management of cardiac anomalies.
Analysis of the hemodynamics of the renal artery of normal fetuses by the color Doppler method
Authors: Iura T. , Higashiyama N. , Miyazaki S. , Ooshima K. , Makinoda S.
Published: March 2003

Objectives:  Urination interval or the pulsatility index (PI) and resistance index (RI) of the renal artery have often been measured to assess renal function of fetuses in cases such as oligoamnion. However, PI and RI do not reflect dynamic changes of the renal artery not only in fetuses with oligoamnion, etc. but also in normal fetuses. For this reason, we have analyzed the blood flow of the renal artery in normal fetuses using new indexes to clarify its hemodynamics.

Study methods:  The healthy fetuses of 33 pregnant women participated in this study with informed consent of mothers in their 20–40th week of pregnancy. The blood flow of the renal arteries was examined at the renal hilum using a color Doppler apparatus using the indexes of PI, RI, maximum velocity (Vmax), mean velocity time (VMT), sectional area of the renal artery (AREA) and renal blood flow (RBF). The gestational age of the fetuses were divided into five groups of 20–24, 25–28, 29–32, 33–36, and 37–40 weeks through longitudinal study. Statistical analysis was performed using Fisher's protected least significant difference.

Results:  RI did not show marked changes throughout all gestational age. In contrast, the Vmax and RBF of the renal artery for the 20–24 weeks group were 21.98 cm/s and 0.049 L/min, respectively (mean), and those for the 25–28 weeks group were significantly higher at 27.68 cm/s and 0.003 L/min, respectively (P < 0.05 and 0.05, respectively). The same applied for VMT and AREA. The 95% confidence interval of the Vmax of the right renal artery was 23.2–20.8, 28.7–26.6, 33.7–31.4, 34.6–32.8 and 40.7–37.8 for the 20–24, 25–28, 29–32, 33–36 and 37–40 weeks group, respectively. Thus, we have determined the 95% confidence interval for the Vmax, VMT, AREA and RBF of the renal artery of fetuses in different stages of development.

Conclusions:  The present study demonstrated that Vmax, VMT, AREA and RBF were more useful than either PI or RI in assessing the hemodynamics of the renal artery of fetuses in different stages of development. Moreover, we have clarified the normal range of the Vmax, VMT, AREA and RBF for the renal artery of fetuses after the 20th week of gestation. These results are very useful to assess the renal function of fetuses.
Ultrasound time domain and color M‐mode analysis of uterine blood flow in twin pregnancy: prediction of uteroplacental complications, placental insufficiency and intrauterine growth restriction
Authors: Thompson M. O. , Vines K. S. , Harrington K.
Published: March 2003

Objectives:  A preliminary assessment of the usefulness of a non‐Doppler technique of uterine artery blood flow measurement in twin pregnancy, for the prediction of preeclampsia, utero‐placental insufficiency and intrauterine growth restriction. To compare the results obtained with the contemporary Doppler method.

Methods:  A prospective study of 32 twin pregnancies presenting consecutively for a routine second trimester ultrasound scan. Maternal demographic and physical characteristics were recorded in all cases. Using previously described methods, blood flow studies were then conducted using the two different techniques; pulsed color Doppler was used to measure blood flow velocity waveform resistance indices, while a time domain correlation technique with color M‐mode imaging was used to measure blood volume flow in both uterine arteries. The placental site and morphology, uterine artery waveform characteristics, and presence or absence of diastolic notches were recorded. The ultrasound fetal growth measurements were plotted on reference charts to assess individual fetal growth patterns, and the obstetric outcomes were recorded for all the pregnancies. Statistical analysis was performed to assess the predictive value of each method of blood flow measurement for the relevant obstetric complications.

Exclusions:  One mother with sickle cell trait (Hb A + S).

Results:  An abnormal uterine artery waveform (high resistance with persistence of uterine artery notching) was of limited value in the prediction of pre‐eclampsia and IUGR in twin pregnancies. There was close correlation between a significant reduction in uterine artery blood volume flow and early onset intrauterine growth restriction requiring delivery before 34 weeks gestation. Uterine artery blood volume flow may be less influenced by the placental site compared with traditionally used resistance and pulsatility indices.

Conclusions:  Uterine artery notching appears to be of limited value in the direct prediction of growth complications in twins. The volume flow method correctly identified all the pregnancies complicated by early onset intrauterine growth restriction. Both methods may well prove to be complementary in the antenatal management of twin pregnancy although further studies will be required.
Evaluation of normal and abnormal fetal heart anatomy using 3D echocardiography
Authors: Meyer‐Wittkopf M. , Vaughan J. , Sholler G. F.
Published: March 2003

We applied 3D echocardiography to the diagnosis or exclusion of congenital heart disease (CHD) using rate gating with Doppler. Gated 3D volume data sets enabled diagnostically acceptable visualization of all cardiac structures in 16 of 29 fetuses without CHD and in 7 of 22 fetuses with CHD, and significant elements of anatomy in the remainder. In fetuses without CHD a dynamic 3D perspective of valve morphology and ventricular wall motion of the four‐ and five‐chamber view projection was available in 19/29 cases. A high quality 3D reconstruction of the site and spatial orientation of VSD could be obtained in 9/13 patients with CHD. The 2D imaging remained the principal diagnostic modality in all cases with additonal structural detail obtained by 3D imaging in only two fetuses with CHD. The 3D imaging of the fetal heart is feasible and may provide additional information of clinical value in a small number of cases with CHD when compared with 2D imaging.
Congenital diaphragmatic hernia: prenatal evaluation and outcome
Authors: Masini L. , De Santis M. , Noia G. , Milej B. , Cavaliere A. F. , Romagnoli C. , Perrelli L. , Caruso A.
Published: March 2003

Objectives: 

• To describe the incidence of congenital diaphragmatic hernia (CDH).

• To describe the hernia type (right, left, eventration), the gestational age at diagnosis, the associated anomalies and chromosomal disorders.

• To describe the perinatal outcome and the pre‐ and postoperative mortality rate.

Material and methods:  A total of 51 fetuses and babies with congenital diaphragmatic hernia or eventration (referred to collectively as CDH) were studied at Dept. Obstetrics and Gynecology, Università Cattolica di Roma, in the 20‐year period from 1981 to 2001.

Results:  Prenatal diagnosis was made in 48 cases (17 were diagnosed before 26 weeks, 31 between 27 and 40 weeks), two cases were diagnosed in the neonatal period and one case at the postmortem analysis. The most common hernia was left‐sided (38 cases); six cases were right‐sided; four cases had eventration; four cases had complex anomaly with exomphalos and ectopia cordis (suspicious Cantrell's pentalogy). Twenty‐three fetuses had associated anomalies, including four chromosomal disorders (trisomy 18 in two cases, trisomy 13 in one and unbalanced translocation in one). Polyhydramnios was present in 20 fetuses.

Perinatal outcome:  Two patients had termination of pregnancy in other institutions; 44 patients delivered (36 cesarean section and 8 vaginal delivery); 2 pregnancies are still ongoing and 3 patients (early diagnosis) have no follow up. Out of the 44 live births, 16 died before surgery and 28 underwent surgical repair. Fifteen early postoperative deaths occurred.

Conclusions:  The overall survival in babies with CDH is very poor, despite multidisciplinary management, mainly for associated anomalies. A careful ultrasound survey may suggest which fetuses have an isolated diaphragmatic defect and a better prognosis.
Neonatal renal ultrasound – a 5‐year review in an obstetric hospital
Authors: Acton C. M. , Pahuja M.
Published: March 2003

Aim:  To review a consecutive series of neonatal renal scans presenting to the imaging department in an obstetric hospital, record the abnormalities seen and assess the accuracy of the antenatal diagnosis with subsequent outcome.

Material and methods:  In the 5 years (1996–2000), there were 788 neonates referred for renal ultrasound scans. Many of the infants had a micturating cystourethrogram (MCU) at the time of presentation. The commonest indication in 92% of neonates was fetal pyelectasis reported on the antenatal scan. The hospital records of these infants were reviewed with further details obtained from clinicians and surgeons and subsequent investigations.

Results:  The results were classified according to the findings. There were a total of 788 neonates who had a renal scan. There were 592 (75%) in whom the scan was considered normal and of these 49 had an MCU and 17 had associated vesico‐ureteric reflux (VUR) grades 1–4. There were 125 (16%) infants with persisting mild‐moderate pyelectasis/hydronephrosis and of these 61 resolved or were lost to follow up and 64 persisted at follow up scans variably timed 3–15 months later. Most of these had an MCU and 26 had associated VUR grade 1–5, not always on the side of the pyelectasis. Miscellaneous abnormalities were seen in 71 (9%) neonates, multicysticdysplastic kidney 25, pelviureteric junction obstruction (PUJ) 7, solitary kidney 6, crossed renal ectopia 5, uncomplicated duplex kidney 5, ureterocoele 5, two with posterior urethral valves and one with vesico‐ureteric junction obstruction (VUJ). There were four infants with significant VUR, three with thinned renal parenchyma and one with a small kidney. There were three with autosomal recessive polycystic kidney disease (Potter's type II), one with small dysplastic kidneys.

Conclusion:  In this review, there were 113 neonates (14%) found to have significant renal anomaly or VUR. Many of the miscellaneous fetal renal abnormalities have a characteristic and identifying appearance on the antenatal ultrasound. The majority of neonatal renal scans are referred because of mild/moderate fetal pyelectasis and many of these resolve over a variable time. Persisting moderate pyelocaliectasis is not a sensitive sign of VUR, nor in differentiating early PUJ obstruction from the normal variant that subsequently resolves. Follow up ultrasound may confirm resolution or increasing hydronephrosis. Nuclear medicine studies will compare function and drainage of the systems in patients with PUJ obstruction.
Long‐term neurological outcome of survivors of twin twin transfusion syndrome (TTTS)
Authors: Cincotta R. B. , Gray P. H. , Rogers Y. M. , Chan F. Y.
Published: March 2003

Aim:  The aim of this study was to examine the long‐term neurological outcome of survivors of TTTS.

Methods:  Survivors of TTTS were followed up in the multidisciplinary Growth and Development Unit in the Mater Children's Hospital. A detailed neurological examination and a neurosensory motor developmental assessment was performed. Cerebral palsy (CP) was diagnosed on the basis of this examination according to standard criteria. A Griffith's developmental assessment was performed by a psychologist. A general quotient (GQ) more than two standard deviations below the mean (GQ < 76) represented global developmental delay (GDD).

Results:  There were 39 cases of TTTS delivered at the Mater Mother's Hospital, from January 1994 until June 2000. There were 48 surviving infants (62%), 17 stillbirths (22%), and 13 NND (17%). The mean gestation of delivery was 28.5 weeks (range 19–36). Fifty‐nine percent of cases were treated with amnioreduction whilst the others were delivered prior to treatment. Of the 48 survivors, detailed neurological assessment from 1 to 4 years was available for 35 (73%). An additional four twins were known to have normal long‐term outcomes but formal neuro‐developmental assessment had not been performed and the others had been lost to follow up. Of those with complete assessment, 29 (83%) were normal. There were three (8.6%) cases with CP and three (8.6%) with GDD. Of the three cases with CP, one had a co‐twin that had a FDIU, one had a co‐twin with GDD and the other had a normal co‐twin. The other two cases of GDD had normal co‐twins.

Conclusion:  Survivors of TTTS have a significant risk of major neuro‐developmental impairment such as cerebral palsy and global developmental delay. Further research is required to determine what factors contribute to this risk and to develop treatments to minimise the incidence and severity of these handicaps.
Ductus venosus blood flow assessment at 10–16 weeks' gestation and chromosomal abnormalities
Authors: Antolín E. , Comas C. , Echevarría M. , Torrents M. , Muñoz A. , Figueras F. , Cararach M. , Carrera J. M.
Published: March 2003

Background:  Enlarged fetal nuchal translucency (NT) is a well established ultrasonographic marker for aneuploidy screening, especially during the first trimester of gestation. Nuchal translucency screening combined with maternal age at early mid‐trimester can identify about 75–80% of chromosomal abnormalities with a false–positive rate of 5%. Recently, Doppler parameters have been included in fetal aneuploidy screening, in order to improve the test performance. Changes in the ductus venosus (DV) blood flow velocity waveforms have been reported in a significant proportion of chromosomally abnormal fetuses at first and early mid‐trimester of pregnancy.

Objective:  The aim of our study was to evaluate the role of the DV blood flow assessment at 10–16 weeks' gestation in the screening for chromosomal abnormalities.

Methods:  From December 1998 to June 2001, DV blood flow was prospectively evaluated in 5067 consecutive pregnancies between 10 and 16 weeks of gestation. Pulsatility index for the DV (DVPI) was calculated. All cases were screened for chromosomal defects combining maternal age and fetal NT thickness.

Results:  The average maternal age was 32 years (range 22–47). Seventy‐four percent of the women were younger than 35. The incidence of chromosomal abnormalities was 1.06% (n = 54), including trisomy 21 (n = 25), trisomy 18 (n = 6), trisomy 13 (n = 2) and others (n = 21). The incidence of chromosomal abnormalities was 13.8% in those cases where DVPI was greater than the 95th centile, compared with an incidence of 0.3% in the remaining cases with a DVPI below this cut‐off. This fact gives and odds ratio (OR) of 48 (95% IC: 26–87). The overall detection rate (DR), specificity (S), positive predictive value (PPV) and negative predictive value (NPV) for chromosomal abnormalities were 70.4, 95.3, 13.8, and 99.7%, respectively, when using the 95th centile DVPI as a cut‐off. According to gestational age, all the statistical parameters were increased in early gestational age (10–13 weeks) when comparing with late gestational age (14–16 weeks), the corresponding DR and OR being 76.3% and 64 (95% CI: 30–138) compared with 56.3% and 26 (95% CI: 9–72), respectively. Moreover, when only autosomal trisomies were considered, a DR of 87.9% was reached with an S, PPV, NPV and OR of 95.3, 10.9, and 99.9% and 146 (95% CI: 51–418).

Conclusions:  Our results suggest that the evaluation of DVPI at 10–16 weeks' gestation is a useful tool in the screening for chromosomal defects, especially in detecting autosomal trisomies and when it is assessed in early gestational age.
First trimester determination of fetal gender by ultrasound
Authors: Podobnik M. , Podgajski M.
Published: March 2003

Objective:  To determine the feasibility of correctly identifying fetal gender from 11 to 13 weeks of gestation.

Methods:  Fetal gender assessment by ultrasound was prospectively carried out in 425 singleton pregnancies at 11–13 weeks of gestation (confirmed by crown‐rump length or biparietal diameter) immediately before chorionic villus sampling for karyo‐typing. A total of 425 women underwent a detailed assessment of fetal anatomy at 11–13 weeks of gestation by means of transabdominal and transvaginal sonography. Fetal gender was identified in transverse and sagital planes, and was confirmed by chorionic villus sampling.

Results:  The accuracy of sex determination increased with gestation from 91.7% at 11 weeks, to 97.2% at 12 weeks and 100% at 13 weeks. Male fetus were wrongly assigned as female in 5.5% of cases in 11 weeks, 2.4% at 12 weeks and 0% at 13 weeks. The accuracy of correctly identifying fetal gender increased with gestational age.

Conclusion:  Whilst the accuracy of sonographic determination of fetal gender at 11–13 weeks is good, our decision on invasive testing for sex‐linked conditions should be undertaken only after 12 weeks of gestation.
Sonohysterographic staging of submucous myomas
Authors: Leone F.P.G. , Lanzani C. , Digrandi M. , Padoan A. , Ferrazzi E. , Mastromatteo C.
Published: March 2003

Purpose:  To assess the diagnostic accuracy of sonohysterography in preoperative assessment of submucous myomas.

Methods:  Twenty premenopausal patients with submucous myomas and irregular uterine bleeding and/or infertility were consecutively collected in 12 months. Before surgery, all patients underwent transvaginal sonography (TVS) (Voluson, KRETZ, 5300), with color Doppler evaluation, and sonohysterography (SHG). Number and site of myomas and the myoma–perimetrium distance were considered at TVS. SHG was performed with a 4.7‐mm (14F) intrauterine catheter. Patient compliance to SHG was evaluated by a subjective pain scale. Duration from TVS to completion of the procedure, and volume of saline solution instilled for SHG, were evaluated. Sonographic findings at TVS and SHG were classified as submucous myoma G0, G1 and G2 and compared to hysteroscopic finding. Depending on myoma grading and volume, selected patients underwent preoperative medical treatment with triptorelin (decapeptyl‐ipsen). Hysteroscopic myomectomy was the standard surgical approach. Diagnostic accuracy of TVS and SHG was evaluated.

Results:  Mean age was 41 years (interquartile range 34–47). Mean BMI was 24 kg/m2 (interquartile range 21–28). Twelve patients reported irregular bleeding, eight infertility. Eleven patients had additional intramural and or subserous myomas. Mean duration time of SHG was 12 min (interquartile range 9–16). Mean volume of sterile solution instilled for SHG was 16 mL (interquartile range 8–24). In all cases, a successful SHG was performed, with no and mild discomfort in 16 (80%) and 3 (11%) patients, respectively. Hysteroscopic findings were compared to TVS and SHG considering the submucous myoma grading. SHG correctly classified all miomas (five cases of G0, 11 cases of G1, five cases of G2). TVS correctly classified all G0 cases, over classified two G1 cases as G2, correctly classified five cases of G2.

Conclusions:  Sonohysterography was a simple and well tolerated imaging technique, with a diagnostic accuracy comparable to hysteroscopy. We speculate that endometrial sampling performed during SHG could help to exclude coexisting endometrial abnormalities which are likely to occur in larger series.
Uterine Doppler evaluation in 12 women with pregnancy‐induced hypertension: correlation with fetal Doppler study and perinatal outcome
Authors: Gómez O. , Del Río M. , Martínez J. M. , Palacio M. , Puerto B. , Cararach V.
Published: March 2003

Introduction:  Classification of hypertensive disorders of pregnancy is problematic due to variable clinical presentation and confusing terminology. Management is based on severity of clinical and laboratory criteria, which, unfortunately, do not select pregnancies that will be delivered because of maternal or fetal indication.

Objective:  To evaluate whether maternal uterine Doppler evaluation correlates with fetal Doppler study and maternal and perinatal results.

Design:  Twelve women with pregnancy‐induced hypertension (ISSHP criteria) between 26 and 38 weeks of gestation were divided into two groups based on uterine Doppler examination (presence – group A, or absence – group B, of a bilateral protodiastolic uterine notch) at diagnosis.

Results:  There were seven patients in group A (four severe and three mild pre‐eclampsia) and five patients in group B (one severe and one mild pre‐eclampsia, two severe gestational hypertension, one Hellp syndrome). The mean gestational age at delivery (weeks gestation), the mean birth weight (grams) and the mean umbilical artery pH in groups A and B were, respectively, 31.1 vs. 36.1, 1256 vs. 2428, and 7.20 vs. 7.25. Doppler evaluation showed statistically significant higher pulsatility index of the right and left uterine artery, as well as in the umbilical artery, in group A vs. group B. Fetal vascular redistribution or a ductus venosus PI >1 were detected only in group A (5/7 and 3/7, respectively), whereas in none of the group B. Indication for delivery was always for fetal risk (four cases) or maternal risk (three cases) among group A, whereas for maternal indication was only in one case of the group B.

Comments:  We suggest that uterine Doppler examination at the time of diagnosis in patients with hypertensive disorders of pregnancy may help to identify pregnancies at serious maternal and fetal risks better than classical clinical and laboratory criteria.
Computerized cardiotocography: correlation between STV > 4 ms and response of fetal cardiac frequency to vibroacoustic stimulation test
Authors: Char Sang Choon , Yamasaki A. A. , Braia G. , Toma O.
Published: March 2003

Introduction:  In classic cardiotocography, a fetus is considered active when there are two transitory accelerations (TA) or elevation of 20 bpm in cardiac frequency after vibroacoustic stimulation test. In computerized cardiotocography there must an instant variability, also named short‐term variation (STV), higher than 4 ms.

Objective:  Comparison between STV > 4 ms and fetal response to acoustic stimulus.

Patients and methods:  Twenty‐four normal pregnant were analyzed between 30 and 36 weeks by computerized cardiotocography (SYS 8002). If STV > 4 ms, but TA is absent after 10 min, a vibroacoustic stimulation test was done for 3 s. The fetus was considered reactive when heart rate increased by 20 bpm for 3 min. The fetus was considered hyper‐reactive when heart rate increased less than 20 bpm or duration of response less than 3 min.

Results:  Among 24 fetuses, 20 (87%) were considered reactive after vibroacoustic stimulation test (elevation of 20 bpm for 3 min or more). Only four fetuses (13%) were hyperactive.

Conclusion:  When STV > 4 ms fetuses are reactive in 87% cases and hyperactive in 13%. The STV can be used as isolated parameter for assessment of fetal well‐being.
Cardiac function in fetuses of poorly controlled pregestational (pre‐existing) diabetic pregnancies
Authors: Wong S.‐F. , Chan F.‐Y. , Cincotta R. , Ward C.
Published: March 2003

Background:  Cardiac impairment is frequently found in fetuses of diabetic mothers. Poor diabetic control has been implicated as one of the cause for cardiac dysfunction, but it is still controversial.

Aim:  To assess the cardiac function in fetuses of well‐controlled and poorly controlled pregestational (pre‐existing) diabetic pregnancy in the third trimester.

Methods:  Women with pregestational diabetes (Type 1 and 2) were enrolled at 30–36 weeks. Right‐, left‐ventricular septal wall and interventricular septal wall thickness were measured by M‐mode at end‐diastolic phase. At the mitral and tricuspid valves inflow, the ratio between early ventricular filling and active atrial filling (E/A) at both atrioventricular valves were measured by Doppler echocardiography. Peak velocities of ascending aorta and pulmonary artery were assessed. Angle of isolation was kept at less than 20°. Results from women with poorly controlled diabetes (HbA1c > 6.5%) were compared with those whose diabetes were satisfactorily controlled (HbA1c ≤ 6.5%).

Results:  A total of 15 women were included in this study. Six had well‐controlled diabetes and the other seven had poorly controlled diabetes. HbA1c in the poorly controlled group was 7.3% and in the well‐controlled group was 5.4% (P < 0.001). There was no difference between the groups in cardiac size, interventricular septal wall thickness, ejection fraction, aorta and pulmonary artery peak flow velocities. The right atrioventricular E/A ratio was significantly lower among the poorly controlled DM pregnancies (0.71 vs. 0.54; P < 0.05). This reflected an impaired right ventricular compliance in fetuses of poorly controlled diabetic mothers.

Conclusion:  Fetuses of poorly controlled diabetic mothers had lower atrioventricular E/A ratio. This may be due to impaired right ventricular compliance.
Echocardiography should be also performed during the third trimester in fetuses of pregestational diabetic mothers
Authors: Puerto B. , Martínez J. M. , Gomez O. , Moyano D. , Palacio M. , Martínez S. , Borrell A. , Cararach V.
Published: March 2003

Objective:  To assess the risk and types of congenital heart disease in our population of insulin‐dependent pregestational diabetic mothers.

Methodology:  Over a 3‐year period, a transabdominal echocardiography at 20–22 weeks of gestation and a second one at 32–34 weeks of gestation was performed in 142 insulin‐dependent diabetic pregnancies. In the last 30 cases, an early examination combining either the transvaginal or the transabdominal route at 13–16 weeks was also carried out. A complete heart evaluation and measurement of the interventricular septum thickness was performed, with color and pulsed Doppler assessment. An accurate postnatal cardiac examination was always performed.

Results:  Twelve significant cardiac defects (8.45%) were detected, but only two of them before 22 weeks of gestation (one tetralogy of Fallot, and another one critical aortic stenosis). Both followed early termination of pregnancy, and postmortem evaluation confirmed the diagnosis. The other 10 cases were diagnosed during the third trimester: two coarctation of the aorta (one neonatal death because hemodynamic disturbance), three pulmonic stenosis, five significant hypertrophic cardiomiopathy with subaortic stenosis, and a case of supraventricular tachycardia (>240 bpm needing postnatal cardioversion). All the babies, but one are alive and well, although most of them have needed catheterization or pharmacological treatment. One case of a ventricular septal defect (2.5 mm, muscular) was overlooked during gestation, but closed by the sixth month of life.

Conclusion:  Our results confirm that diabetic women are at increased risk of having a child with congenital heart disease, and therefore we recommend conventional fetal echocardiography in all pre‐gestational diabetic pregnancies at 20–22 weeks of gestation. In view of the pattern of defects we have found, we strongly suggest that a further scan during the late trimester should always be performed.
Fetal intracardiac echogenic foci: frequency of detection with respect to maternal race and other abnormalities
Authors: Fitchat E.
Published: March 2003

Objective:  To determine if there is a racial difference in the frequency of detecting an echogenic intracardiac focus in fetuses and the incidence of other related abnormalities.

Methods:  Over a 3‐month period (December 2000 to February 2001) all fetuses scanned between 12 and 30 weeks were evaluated for the presence of intracardiac echogenic foci. The sonographer indicated the maternal race (black, colored, white or other), gestational age, maternal age and the presence of other abnormalities. Amniocentesis or cordocentesis was performed when indicated. Follow up on fetuses and neonates were obtained from the patient records. The groups were compared with respect to maternal race, presence or absence of foci and other associated abnormalities.

Results:  There were 725 fetuses scanned during this period where the gestation was between 12 and 30 weeks. There were 606, 98, and 21 fetuses of colored, black and white mothers, respectively. Intracardiac foci were present in 33 (5.4%) colored, 8 (8.1%) black and one (4.7%) white mother, respectively. The association with other abnormalities was 7/42 (16.6%). This was higher in the colored group 5 (15%) compared with the black group 1 (12.5%). There was only one fetus in the white group with an intracardiac focus and this was a baby born with congenital rubella syndrome. There were two (5%) fetuses with chromosomal abnormalities. One was a black fetus with trisomy 21 and one colored fetus with trisomy 18. The remaining four fetuses had markers associated with normal karyotype on culture. These were polihydramnios, hyperechogenic bowel, pyelectasis, and intrauterine growth restriction.

Conclusions:  In this preliminary study the black fetus had a higher incidence of intracardiac echogenic foci. Detection of an intracardiac focus is associated with a 5% risk of chromosomal abnormalities and other associated features should be evaluated.
A critical evaluation of three‐dimensional and two‐dimensional sonographic studies, and color Doppler ultrasound in detecting nuchal cord in utero
Authors: Hanaoka U. , Yanagihara T. , Kuno A. , Tanaka H. , Hata T.
Published: March 2003

Objective:  To evaluate whether three‐dimensional sonography is more valid than two‐dimensional sonography, and color Doppler ultrasound in diagnosing nuchal cord in utero.

Methods:  Eighty‐five singleton pregnancies without nuchal cord and 35 with nuchal cord (30 single nuchal cord, four double nuchal cords, and one triple nuchal cords) were studied within 1 week before delivery using a transabdominal three‐dimensional sonography. Two‐dimensional sonography and color Doppler ultrasound were also conducted.

Results:  Three‐dimensional sonography identified in utero 22 (73.3%) single and 3 (60%) multiple nuchal cords found at birth. There were no significant differences in overall diagnostic indices of each diagnostic modality for detecting nuchal cord. However, the ability to view nuchal cord was better with three‐dimensional sonography than with two‐dimensional sonography or color Doppler ultrasound.

Conclusions:  Three‐dimensional surface imaging does not provide more useful diagnostic information than two‐dimensional sonography and color Doppler ultrasound for detecting nuchal cord in utero.
Transvaginal sonographic examination of the cervix in asymptomatic pregnant women: review of the literature
Authors: Rozenberg P. , Gillet A. , Ville Y.
Published: March 2003

Different strategies have been developed to refine the prediction of the risk of preterm delivery in asymptomatic patients. Transvaginal sonography has been used for this reason to measure and examine the length and shape of the cervix. In this review, we focus on clinical studies involving transvaginal sonographic assessment of the cervix in asymptomatic women at high risk of preterm delivery and in the general pregnant population.

Three ultrasound signs are suggestive of cervical incompetence, namely, dilatation of the internal os, sacculation or prolapse of the membranes into the cervix (with shortening of the functional cervical length) either spontaneously or induced by transfundal pressure, and short cervix in the absence of uterine contractions. Transvaginal sonography has clearly demonstrated that cerclage leads to a measurable increase in cervical length which may contribute to the success of this procedure in reducing the risk of preterm delivery. Several non‐randomized interventional studies among patients with cervical incompetence have been published. They have defined a new group of patients requiring cerclage when the women show progressive cervical modifications on transvaginal sonography, while in other studies, cerclage performed on the basis of cervical changes on transvaginal sonography did not prevent premature delivery. One prospective randomized trial in asymptomatic high‐risk women has shown two benefits of cerclage following indications for transvaginal sonography: (1) it would generate fewer prophylactic cerclages in high‐risk women; (2) therapeutic cerclage before 27 weeks may reduce the incidence of premature delivery before 34 weeks.

The risk of preterm delivery is inversely correlated with cervical length. Routine transvaginal sonography of the cervix performed between 18 and 22 weeks can help identify patients at risk of preterm delivery. However, given the low prevalence of preterm births, screening would generate either a high false‐positive rate or a low sensitivity. One non‐randomized interventional study among patients with a short cervix on routine ultrasound examination found a lower risk of delivery before 32 weeks in the cerclage group than in the expectant management group. However, to date, there have been no prospective randomized trials in a general population. Although evidence is still lacking, there does appear to be a benefit in performing a cerclage rather than continuing with expectant management in cases with sonographic appearance of cervical incompetence in asymptomatic women at high risk of preterm delivery. Ultrasound can be offered to reduce the indications of cerclage for cases in which the situation is uncertain. Within the general obstetric population, transvaginal sonography might help in the selection of asymptomatic but high‐risk women. However, the benefit associated with cerclage for sonographic indication has not been demonstrated. Copyright © 2002 ISUOG