bluuebunny/crossref_metadata_2025 huggingface dataset:
Pregnancy outcome among non‐participants in a trial on ultrasound screening
Authors: Kieler H. , Hellberg D. , Nilsson S. , Waldenström U. , Axelsson O.
Published: March 2003

Our objective was to characterize and evaluate pregnancy outcome in women who declined participation in a trial on ultrasound screening in the second trimester. Between 1985 and 1987, 8768 women were recruited for a trial on ultrasound screening. By randomization, 4997 women were assigned to either a screening or a non‐screening group. Of the 1414 excluded women, data were retrieved from 1211 (86%). Participation was declined by 526 of these 1211 women, either because of anxiety regarding harmful effects of ultrasound or because they could see no benefits of ultrasound scanning. Non‐participants and participants were compared.

The non‐participants were older, had a higher birth/pregnancy ratio, were less often smokers, and had fewer ultrasound examinations than the participants. There was a longer mean pregnancy length, an increased number of post‐term deliveries, more suspicions of small‐for‐gestational‐age fetuses and later detections of multiple pregnancies among non‐participants as compared with the screening group. No differences in neonatal morbidity were found except for a greater number of mild respiratory disorders in the non‐participant group.

The non‐participant women were more obstetrically experienced and showed indications of a healthier lifestyle in comparison with participants. The differences found in pregnancy outcome could be explained by the ultrasound screening procedure. There were no major differences in neonatal morbidity between the groups. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
3D Color Power Angio™ imaging: a new method to assess intracervical vascularization in benign and pathological conditions
Authors: Suren A. , Osmers R. , Kuhn W.
Published: March 2003

It is well known that angiogenesis is a fundamental event in the growth of tumors as well as in physiological conditions. In an ongoing prospective study involving eight women, we investigated the microvasculature within the cervix by the use of 3D Color Power Angio™ imaging. The ultrasound equipment was used in conjunction with specialized software providing high‐resolution ‘3D‐Angiomode’. The system provides the ability to visualize blood flow in small vessels that are undetectable by conventional color Doppler techniques and also to study the architecture and determine the number of blood vessels. Comparison of the vessels in the normal cervix with those in the cervix affected by carcinoma or bacterial or viral infection demonstrated that, in malignant tissue, there is a chaotic network of tortuous vessels traversing the tumor mass, whereas, in benign tissue or tissue that is inflamed as a result of infection, the course of the vessels has a regular structure. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal ultrasound observations in subsequent pregnancies with Perlman syndrome
Authors: van der Stege J. G. , van Eyck J. , Arabin B.
Published: March 2003

Perlman syndrome is a rare disease with a poor prognosis. Until now, the specific antenatal diagnostic criteria of this syndrome have not been documented.

We report on two pregnancies with Perlman syndrome, in the same woman, in which karyotyping and ultrasound examination were performed. In the first pregnancy, the final diagnosis was made only postnatally, whereas, in the second affected pregnancy, nuchal translucency was seen at 11 weeks. From 23 weeks onwards the classical signs of renal and abdominal enlargement were observed.

The impact of non‐specific early ultrasound markers on decision‐making in pregnancies with family risks, where specific tests are not yet available, must be evaluated. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Can fetal iliac bone measurement be used as a marker for Down's syndrome screening?
Authors: Zoppi M. A. , Ibba R. M. , Floris M. , Monni G.
Published: March 2003

Objective

The aim of this study was to assess the application of iliac bone length measurement in screening for Down's syndrome.

Design

Measurement of fetal iliac bone length was prospectively carried out in 609 pregnant women at the time of amniocentesis, and correlated with the results of karyotype analysis.

Subjects

Following exclusion of cases with chromosomal abnormalities other than trisomy 21, cases with intra‐uterine growth impairment or structural abnormalities and cases with incomplete follow‐up, 466 karyotypically normal fetuses and 14 fetuses with trisomy 21 were included in the analysis.

Methods

Centiles, standard deviations, expected values by means of linear regression analysis of the iliac bone, in relation to the biparietal diameter, were calculated in the normal fetuses. In order to identify pregnancies at risk for trisomy 21, where a ‘longer’ than normal iliac bone was expected, three cut‐offs previously proposed by other authors and three new criteria were employed. Sensitivity, false‐positive rate and likelihood ratio were calculated to assay the different cut‐off criteria.

Results

Eleven of the 14 (79%) fetuses affected by trisomy 21 had an iliac bone length greater than the 50th centile of normal values. The most useful threshold was an iliac bone length ≥ 2 SD of the normal (29% sensitivity and 2% false‐positive rate).

Conclusions

This study confirms that fetuses with Down's syndrome tend to have a longer iliac bone length measurement than those with normal karyotype. However, due to the different methods used in different centers, the application of this measurement does not offer sufficiently convincing results for it to be used when screening for Down's syndrome. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Cervical length at 23 weeks of gestation: the value of Shirodkar suture for the short cervix
Authors: Heath V. C. F. , Souka A. P. , Erasmus I. , Gibb D. M. F. , Nicolaides K. H.
Published: March 2003

Objective

To examine the possible benefit of cervical cerclage in women with a very short cervix identified during routine sonographic assessment of cervical length at 23 weeks of gestation.

Methods

Transvaginal sonography was used to measure cervical length at 23 weeks of gestation in 2702 women with singleton pregnancies attending for routine antenatal care. In 43 (1.6%) cases the cervical length was ≤ 15 mm. The 43 women in this group were referred to their obstetricians for the further management of pregnancy; in 21 cases, the pregnancy was managed expectantly and in 22 a Shirodkar suture was inserted under spinal anesthesia. The two groups were compared in terms of patient characteristics and pregnancy outcome.

Results

The 22 patients that were treated with cervical cerclage were not significantly different from the 21 given expectant management in ethnic origin, ponderal index, cigarette smoking or past obstetric history. The median cervical length was 10 mm in both groups. In the cervical cerclage group, 21 delivered after 32 weeks and one (5%) had spontaneous onset of labor and delivery before 32 completed weeks; all 22 infants survived. In the expectant management group, 11 (52%) had spontaneous onset of labor and delivery before 32 weeks; 20 infants survived but one baby died in the neonatal period.

Conclusions

In women with a cervical length of ≤ 15 mm at 23 weeks there is a more than 50% chance of spontaneous delivery at less than 32 weeks. Insertion of a Shirodkar suture in women with a very short cervix may be associated with a ten‐fold reduction in risk for such early delivery. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Screening for chromosomal abnormalities at 10–14 weeks: the role of ductus venosus blood flow
Authors: Matias A. , Gomes C. , Flack N. , Montenegro N. , Nicolaides K. H.
Published: March 2003

Objective

To assess the possible role of Doppler ultra‐sound assessment of ductus venosus blood flow in screening for chromosomal abnormalities at 10–14 weeks of gestation.

Methods

Ductus venosus flow velocity waveforms were obtained immediately before fetal karyotyping in 486 consecutive singleton pregnancies at 10–14 weeks of gestation. All cases were screened for chromosomal defects by a combination of maternal age and fetal nuchal translucency thickness. The peak systolic and diastolic velocities, the velocity during atrial contraction and the pulsatility index were measured.

Results

There were 63 chromosomal defects (38 cases of trisomy 21, 12 cases of trisomy 18, seven cases of trisomy 13, three cases of Turner's syndrome and three cases of triploidy). In 57 (90.5%) cases there was reverse or absent flow during atrial contraction. Abnormal ductus venosus flow was also observed in 13 (3.1%) of the 423 chromosomally normal fetuses. In the chromosomally abnormal group, compared to the normal group, the median heights of the S and D waves were significantly lower and the pulsatility index was significantly higher. However, multivariate regression analysis demonstrated that only the height of the A wave provided a significant independent contribution in distinguishing between the chromosomally normal and abnormal groups.

Conclusion

These preliminary results suggest that assessment of ductus venosus blood flow in pregnancies considered to be at high risk for chromosomal defects may result in a major reduction in the need for invasive testing, with only a small decrease in sensitivity. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Enlarged nuchal translucency and low serum protein concentrations as possible markers for Zellweger syndrome
Authors: de Graaf I. M. , Pajkrt E. , Keessen M. , Leschot N. J. , Bilardo C. M.
Published: March 2003

We present a case of a fetus in which an enlarged nuchal translucency was detected at 12 weeks' gestation. The karyotype was normal. Subsequent ultrasound examination showed no obvious fetal abnormalities apart from a mild pericardial effusion. Serum screening revealed very low concentrations of estriol and human chorionic gonadotropin. After birth the diagnosis of Zellweger syndrome was made. Nuchal translucency screening, estriol level identification and detailed ultrasound scanning may help to identify fetuses affected by this syndrome. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Fetal lumbar spine volumetry by three‐dimensional ultrasound
Authors: Schild R. L. , Wallny T. , Fimmers R. , Hansmann M.
Published: March 2003

Objectives

To evaluate three‐dimensional sonographic volume measurements of the thoracolumbar spine from 16 to 25 weeks of gestation in the normally developing fetus.

Design

Prospective cross‐sectional study.

Subjects

The study included 103 women between 16 and 25 weeks of gestation. They were enrolled at the time of their anomaly scan. None of the pregnancies was associated with structural anomalies and in each case fetal size was deemed appropriate for gestational age.

Methods

Three‐dimensional volume calculation of the 1st and 5th lumbar vertebral body, the 12th thoracic vertebral body and the whole lumbar spine was performed, using the perpendicular frontal, sagittal and transverse planes. The lumbar spine length was determined.

Results

A statistically significant increase in all measurements was found with advancing gestational age.

Conclusions

Three‐dimensional ultrasonography allows volume calculation of the fetal spine. Our study provides preliminary data about volume changes in the developing fetal spine between 16 and 25 weeks' gestation. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonographic ovarian findings in a random sample of women 25–40 years old
Authors: Borgfeldt C. , Andolf E.
Published: March 2003

Objective

To investigate the occurrence rate of adnexal lesions in premenopausal women.

Methods

A random sample of women 25–40 years old was invited to undergo a transvaginal ultrasound examination, and 335 women were examined. The criteria used to define an adnexal lesion were either a cystic lesion with its largest diameter of at least 25 mm within the pelvic region, or the appearance of solid parts in any lesion regardless of size.

Results

Adnexal lesions were found in 26/335 cases, (7.8%) (95% confidence interval (CI), ± 2.9%). The occurrence rate of ovarian cysts was 22/335 (6.6%) (95% CI, ± 2.7%). There were no differences between the women with or without ovarian cysts related to age, smoking habits, parity or body mass index. At follow‐up 3 months later, 18 of the 22 (82%) cysts had disappeared (95% CI, ± 16%). Women using progesterone contraception (either oral contraception or an intrauterine device with levonorgestrel) had a significantly higher relative risk of 2.7 (95% CI, 1.1–6.9) of functional cysts as compared to women with natural cycles. Polycystic ovaries were found in 10.2% (95% CI, ± 4.2%) of the women not using any hormonal contraception. The mean volumes of the polycystic ovaries were significantly larger compared to those in natural cycles.

Conclusion

Adnexal lesions are common in asymptomatic women in the age group 25–40 years, but four out of five ovarian cysts disappeared spontaneously after 3 months. The ultrasound appearance of the cyst, the woman's family history and her own feelings must be considered if a persisting cyst is to be surgically removed or followed by repeated transvaginal ultrasound. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Altered hemodynamics in chick embryos after extraembryonic venous obstruction
Authors: Broekhuizen M. L. A. , Hogers B. , DeRuiter M. C. , Poelmann, R. E. , Gittenberger‐De Groot A. C. , Wladimiroff J. W.
Published: March 2003

Objective

To obtain insight into hemodynamics duringabnormal cardiac development, a chick model was developed recently in which a spectrum of conotruncal anomalies, in combination with abnormal semilunar valves and/or pharyngeal arch artery malformations, was induced through extraembryonic venous obstruction (venous clip) at stage 17 (70‐h incubation).

Methods

In chick embryos of stage 24 and stage 34 control (n = 8; n = 21) and with venous clip (n = 11; n = 18), we simultaneously measured dorsal flow velocities with a 20‐MHz pulsed Doppler velocity meter and dorsal aortic (stage 24) and vitelline artery (stage 34) blood pressures with a servo‐null system. After the hemodynamic recordings were collected, all 58 embryos were subjected to morphological examination. The hemodynamic data were correlated with the morphology. Statistical comparison was performed between control and experimental values.

Results

At stage 24, venous clip embryos showed impaired looping. Physiologically, only a decrease in peak acceleration was found in these embryos (p < 0.05). At stage 34, a spectrum of conotruncal malformations was seen, that consisted of a ventricular septal defect in combination with abnormal semilunar valves and/or pharyngeal arch malformations. A dextroposed aorta in combination with a ventricular septal defect was diagnosed as double‐outlet right ventricle. Hemodynamically, peak systolic and mean velocities, peak systolic and mean blood flows and stroke volume were increased while the heart rate was reduced after placement of the venous clip (p < 0.05). In both stages, pressure readings showed no statistically significant differences between control and experimental embryos.

Conclusion

Our findings suggest that the hemodynamic changes seen in venous clip embryos reflect the presence of a compensatory mechanism. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Fetal outcome when the ultrasound estimate of the day of delivery is more than 14 days later than the last menstrual period estimate
Authors: Tunón K. , Eik‐Nes S. H. , Grøttum P.
Published: March 2003

Objective

To evaluate the effect on fetal outcome of changing the estimated day of delivery as calculated according to ultrasound measurements more than 14 days later than the day estimated according to the last menstrual period.

Design

A non‐selected population comprising 15 241 women was evaluated. A study group (the day of delivery based on the ultrasound estimate being changed to more than 14 days later than the estimate based on the last menstrual period) and a control group (the two estimates being within 7 days of each other) were compared regarding various parameters concerning fetal outcome.

Results

Changing the estimated day of delivery, based on the ultrasound evaluation, to a date 14 days later than the day of delivery as estimated according to the last menstrual period did not influence the risk of abortion, perinatal death or transferral to the neonatal intensive care unit. There was a difference of 3 days in the accuracy of the prediction of day of delivery between the two groups. There was a greater number of infants with a birth weight below 2500 g in the study group, but no difference was found between the groups in the number of infants with a birth weight < 2 SD from the mean according to the ultrasound estimate.

Conclusion

There was no indication of any adverse consequence of the routine scan and change of estimated day of delivery among 15 000 pregnancies in a non‐selected population. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
The possible impact of a myomatous uterus on the accuracy of fetal biometric measurements
Authors: Bronshtein M. , Zimmer E. Z. , Miselevich I. , Sabo E. , Ohel G. , Löwenstein L.
Published: March 2003

Objective

The propagation speed of ultrasound beams changes in different media. The aim of the study was to assess the possible measurement error of fetal biometry performed in cases of a myomatous uterus.

Design

Three iron phantoms of 30 mm, 50 mm and 70 mm were measured by ultrasound. Each phantom was measured by three different transducers of 3.5 MHz, 6.5 MHz and 7.5 MHz. Measurements were performed in a water bath and the intraobserver variability was assessed. Thereafter phantoms were measured with one of their edges covered by a specimen of a myomatous uterus while their other edge was covered with water.

Results

Artifactual lengthening of the phantoms' size was observed in measurements performed with the uterine myoma. The measurement errors were inversely related to the length of the phantoms and became statistically significant in the phantoms of 30 mm (13.15 ± 3.16% without the myoma vs. 17.38 ± 4.39% with the myoma; p < 0.0001). Measurement errors were independent of the transducer type (p = 0.001, p = 0.01 and p = 0.014 for the 3.5‐MHz, 6.5‐MHz and 7.5‐MHz transducers, respectively).

Conclusions

Ultrasound measurement errors are expected while examining small fetal organs which are partially overshadowed by a myoma. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Comparison of quantitative ultrasound in the human calcaneus with mechanical failure loads of the hip and spine
Authors: Lochmüller E.‐M. , Eckstein F. , Zeller J.‐B. , Steldinger R. , Putz R.
Published: March 2003

Objective

Quantitative ultrasound of the calcaneus is used clinically for evaluating bone fracture risk, but its association with the mechanical properties at other skeletal sites is not well characterized. The objective was therefore to determine its predictive ability of the mechanical failure loads of the proximal femur and lumbar spine.

Method

In 45 human cadavers (29 males and 16 females, aged 82.5 ± 9.6 years), we determined the speed of sound, broadband ultrasonic attenuation (BUA) and the empirical stiffness index, using a commercial quantitative ultrasound scanner. The proximal femora and the fourth vertebral body were excised and loaded to failure in a testing machine.

Results

Femoral failure loads ranged from 933 to 7000 N and those of the vertebrae from 1000 to 7867 N, their correlation being 0.51 in females and −0.08 in males. Forty percent of the variability of femoral, but only 24% of the variability of the vertebral fracture loads could be predicted with calcaneal speed of sound. In the femur, a combination of speed of sound and BUA improved the prediction (r2 = 50–60%), but not in the spine.

Conclusions

The study provides experimental evidence that calcaneal quantitative ultrasound is capable of predicting mechanical failure at other skeletal sites and has potential to identify patients at risk from osteoporotic fracture. The different association of quantitative ultrasound with femoral and vertebral failure may result from the influence of the cortical bone and a higher microstructure‐related similarity of the calcaneus and the femur. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Assessment of umbilical arterial and venous flow using color Doppler
Authors: Lees C , Albaiges G. , Deane C. , Parra M. , Nicolaides K. H.
Published: March 2003

Objective

To estimate the umbilical artery and vein blood volume flow using B‐mode and Doppler ultrasound in the second and third trimesters of pregnancy.

Design

This was a cross‐sectional study of 129 singleton, healthy pregnancies at 23–33 weeks' gestation. The umbilical artery and vein cross‐sectional area, time‐averaged velocity and pulsatility index were measured in a free loop of cord, and the fetal weight was estimated. Ranges for each parameter were obtained; from these the blood flow for the vein and artery was calculated, and the average flow corrected for fetal weight was derived.

Results

The median time for examination was 6 min. The mean crosssectional area and time‐averaged velocity for both the vein and artery increased linearly with gestation. The umbilical artery flow correlated closely with the average vein flow (r = 0.9, p < 0.001). There was a significant, though poor, inverse correlation between the umbilical artery pulsatility index and the average umbilical flow (r = −0.25, p < 0.05). The average umbilical flow (calculated from the mean of arterial and venous flow), corrected for estimated fetal weight, decreased from 189.2 ml/kg per min at 23 weeks to 176.2 ml/kg per min at 33 weeks' gestation.

Conclusion

The estimates of fetal umbilical flow obtained by this Doppler method are consistent with previously published data. Averaging the arterial and venous flow is theoretically advantageous in reducing the inherent errors in estimating either the arterial or the venous flow. This method of measuring umbilical flow may have clinical potential in assessing fetal health and disease processes. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of tracheal obstruction: possible association with maternal pertussis infection
Authors: Haugen G. , Jenum P.A. , Scheie D. , Sund S. , Stray‐Pedersen B.
Published: March 2003

A fetus with the sonographic appearance of echogenic and enlarged lungs and dilated trachea and bronchi, indicating laryngotracheal obstruction, is reported. Additionally, the fetus had ascites and subcutaneous edema and the amniotic fluid volume was reduced. Doppler flow investigation of the systemic venous circulation revealed signs of heart failure, and color Doppler visualized possible increased pulmonary flow. Following termination of pregnancy, autopsy confirmed the sonographic observations and revealed a hypoplastic thymus. During the present pregnancy the mother suffered from sustained cough, and serological tests revealed acute pertussis infection. Polymerase chain reaction investigation for Bordetella pertussis in the amniotic fluid was negative. The possibilities of pertussis toxins as noxious factors and of an atypical presentation of DiGeorge anomaly are discussed.
Prenatal diagnosis of thrombocytopenia‐absent‐radius (TAR) syndrome
Authors: Tongsong T. , Sirichotiyakul S. , Chanprapaph P.
Published: March 2003

The prenatal diagnosis of thrombocytopenia–absent‐radius (TAR) syndrome using ultrasound and cordocentesis in the 16th week of gestation is established. The sonographic findings detected in this case included bilateral absence of the radius and club hands with normal thumbs and metacarpals. Because of a high index of suspicion for the syndrome, cordocentesis for fetal blood analysis was performed. Thrombocytopenia, with a platelet count of 14 000/mm3, was identified. The pregnancy was electively terminated and subsequent findings confirmed the sonographic diagnosis. This report, to our knowledge, is one of a very limited number of cases published in the literature, in which the prenatal diagnosis of TAR syndrome was made.
Transabdominal first trimester embryofetoscopy as a potential approach to early in utero stem cell transplantation and gene therapy
Authors: Surbek D.V. , Tercanli S. , Holzgreve W.
Published: March 2003

Objective

To explore the potential of embryofetoscopy for early diagnosis and for access to the fetal circulation in the first trimester of gestation.

Design

Transabdominal embryofetoscopy was performed in 14 patients scheduled for termination of pregnancy using a 1‐mm semirigid fibreoptic telescope with a 18 gauge examination sheath and a single‐chip digital camera. A 25 gauge needle was inserted through an additional 21 gauge side port to access the fetal circulation.

Results

Fetal head, face, abdomen, complete upper and lower limbs could be visualized in over 80% of cases. On the contrary, the fetal back and external genitalia could be examined in detail only in some cases (35.7% and 64.3%, respectively). Injection of 10–20 ml saline improved visibility in 43% of cases. Funipuncture was successful in two of three attempts.

Conclusions

Our experience suggests that embryofetoscopy is a useful tool for early diagnosis in the first trimester of pregnancy. Funipuncture is possible thus providing the means for an early intravascular stem cell application. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Color ultrasonography: a useful technique in the identification of nuchal cord during labor
Authors: Qin Y. , Wang C. C. , Lau T. K. , Rogers M. S.
Published: March 2003

Objective

To compare the accuracy of intrapartum ultrasound with and without color Doppler for identification of nuchal cord displacement during labor.

Methods

180 normal pregnant women, admitted in labor, or for induction to labor, were examined independently by two researchers, using either conventional real‐time gray‐scale imaging or color Doppler imaging. A repeat examination was performed by the other researcher using the other ultrasound modality. Nuchal cord displacement was classified as either negative, definite or suspicious. Nuchal cord at birth was classified as either tight or loose.

Results

Sixty‐two (34%) cases examined using the two ultrasound imaging modalities presented with nuchal cord at delivery. The sensitivity of color Doppler was 96.8%. The accuracy of color Doppler in detecting nuchal cord during labor was significantly better (P < 0.05) than gray‐scale imaging alone. The results of a restricted sequential t‐test analysis of 53 un‐tied pairs showed an overall preference in favor of color Doppler assessment: statistical significance (P <0.01) was reached after 41 un‐tied pairs.

Conclusions

The tight and loose nuchal cord could not be distinguished by ultrasound. Color Doppler imaging can provide useful additional information to gray‐scale imaging in the detection of nuchal cord displacement during labor. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The role of enhanced Doppler Ultrasound in differentiation of benign vs. malignant scar lesion after breast surgery for malignancy
Authors: Bäz E. , Madjar H. , Reuss C. , Vetter M. , Hackelöer B. , Holz K.
Published: March 2003

Aim

To evaluate the benefit of echo‐contrast‐enhanced Doppler sonography in the differentiation of benign vs. malignant breast lesions after surgical removal of a malignant breast mass.

Methods

Thirty‐eight patients referred for biopsy of a palpable, suspicious scar lesion 1–15 years (mean 3.3 years) after surgery for breast cancer were examined. During baseline ultrasound examination a subjective scoring system of the vascularity, the number, the regularity of vessels' course and their Doppler parameters were assessed. After injection of an ultrasound contrast agent (Levovist®) the same scoring system was applied to the parameters together with enhancement kinetics, enhancement intensity and enhancement pattern.

Any increase in the scoring level of two or more characteristics (vascularity, number of vessels, intensity of enhancement in the tumor or regularity score of vessels in the lesion) was defined as suspicious for malignancy. A marked increase of enhancement in the immediate tumor periphery was also regarded as suspicious for malignancy. The sonographic results were assessed prospectively and correlated with the histology of the lesion.

Results

Of the 38 patients with a clinically‐suspicious scar lesion, there were 28 true scars and 10 malignant scar lesions. All scar lesions showed no or slight vascularity on baseline sonography. After Echocontrast‐enhancement a significant increase in tumor vascularity and the number of tumor vessels could be demonstrated in all 10 malignant lesions but in only one of the 28 benign scars.

Conclusion

Scars pose inherent technical problems for optimal mammography. Sonographic evaluation of the vascularity of the lesion with contrast enhancing agents showed improved diagnostic accuracy in the hands of an experienced examiner. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The Prognostic significance of hyperextension of the fetal head detected antenatally with ultrasound
Authors: Shipp T. D. , Bromley B. , Benacerraf B.
Published: March 2003

Objectives

The purpose of this study was to evaluate the clinical significance of hyperextension of the fetal head detected by ultrasound prior to the onset of labour.

Methods

Over a 10‐year period, we retrospectively identified all fetuses who had hyperextension of the fetal head reported on antenatal ultrasound. Hyperextension referred to persistence of the cervical spine in extreme extension, with an extension angle of at least 150 degrees persisting for the duration of the scan. Follow‐up information was obtained from Hospital medical records and obstetrical care providers.

Results

Follow‐up was obtained on 57 of the 65 fetuses (87.7%) identified over the study period. Ten of the 57 fetuses had normal structural fetal surveys and had sonographically identified resolution prior to delivery. All 10 patients delivered at term and had newborns with normal neonatal courses. Twenty‐six of 57 fetuses had no sonographic findings other than persistent hyperextension, and 19 of these 26 fetuses (73%) had normal neonatal courses. Twenty‐one of 57 fetuses (37%) had structural anomalies sonographically identified in addition to hyperextension of the fetal head. All 21 of these pregnancies ended in either termination or fetal or neonatal demize.

Conclusions

Although resolution of isolated hyperextension of the fetal head is associated with a normal neonatal outcome, persistent isolated hyperextension of the fetal head can be associated with either a normal or an abnormal neonatal outcome. Fetuses with hyperextended heads and antenatally diagnosed structural anomalies have dismal outcomes. The identification of a fetus with hyperextension of the fetal head should prompt a detailed search for structural abnormalities. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The effect of methyldopa on retinal artery circulation in pre‐eclamptic gravidae
Authors: Hung J. H. , Yen M. Y. , Pan Y. P. , Hsu L. P.
Published: March 2003

Objective

To evaluate the effect of methyldopa on retinal artery circulation in pre‐eclamptic gravidae using color Doppler imaging and spectral analysis.

Methods

Fifty‐three pre‐eclamptic singleton gravidae of gestational age greater than 22 weeks were examined. Patients with sustained hypertension after 1–2 days hospital rest were treated with oral antihypertensive medication, 250–500 mg methyldopa, three to four times a day for a minimum of 5–7 days. The right central retinal arteries were insonated and Doppler waveform values were analysed before and after medication.

Results

The change of the maternal heart rate after methyldopa treatment was −3.96 ± 7.88 beats per min (P = 0.0006). The change of fetal heart rate was not significantly altered. The change of the diastolic arterial blood pressure after treatment was −4.19 ± 12.36 mmHg (P = 0.0169). In 36 gravidae, in whom hypotensive effects were noted after treatment with methyldopa, the increase in peak velocity, end‐diastolic velocity and mean velocity of the retinal artery were 2.41 ± 2.20 (P < 0.0001); 1.48 ± 1.23 (P < 0.0001) and 1.70 ± 1.42 (P < 0.0001), respectively. The decrease in pulsatility index of the retinal artery after treatment with methyldopa was −0.17 ± 0.22 (P < 0.0001). In the remaining 17 gravidae, in whom no hypotensive effects were noted after treatment with methyldopa, the decrease in end‐diastolic velocity and mean velocity were −1.50 ± 1.70 (P = 0.0022) and −0.98 ± 1.90 (P = 0.0488), respectively. The increase in pulsatility index was 0.34 ± 0.30 (P = 0.0003).

Conclusions

In pre‐eclamptic gravidae in whom the hypotensive effects were noted after treatment with methyldopa, the mean velocity of the retinal arteries was significantly higher and the mean pulsatility index lower after treatment. We conclude that the hypotensive effect of methyldopa in pre‐eclamptic gravidae is associated with a significant decrease in retinal artery vascular resistance. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Longitudinal changes in the ductus venosus, cerebral transverse sinus and cardiotocogram in fetal growth restriction
Authors: Senat M. V. , Schwärzler P. , Alcais A. , Ville Y.
Published: March 2003

Objective

To evaluate the changes in flow velocity waveforms in the transverse cerebral sinus in growth‐restricted fetuses and to correlate these changes with (1) flow velocity waveforms in the ductus venosus and (2) changes in computerized analysis of the fetal cardiotocogram.

Design

Fetuses between 22 and 37 weeks' gestation with an estimated fetal weight below the fifth centile were included in this prospective longitudinal study. Doppler measurements of the umbilical artery, descending aorta, middle cerebral artery, transverse cerebral sinus and ductus venosus were recorded. Fetal heart rate was analyzed by a computer system according to the Dawes–Redman criteria.

Results

We measured a significant correlation between pulsatility index in the cerebral transverse sinus and in the ductus venosus over the study period and at delivery. There was a negative correlation between these indices and short‐ and long‐term variability of the fetal heart rate. There was a parallel increase in pulsatility in the ductus venosus and the transverse cerebral sinus. These changes were inversely correlated with fetal heart rate variability and preceded fetal distress.

Conclusion

Cerebral venous blood flow in IUGR fetuses may be a useful additional investigation to discriminate between fetal adaptation and fetal decompensation in chronic hypoxemia. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasound in embryo transfer
Authors: Baba K. , Ishihara O. , Hayashi N. , Saitoh M. , Taya J. , Kinoshita K.
Published: March 2003

Objective

To examine the feasibility of using three‐dimensional (3D) ultrasound (US) guidance in routine embryo transfer (ET) procedures.

Methods

Seventy‐five ETs were performed using a 3D US scanner to locate the catheter tip in the uterine cavity.

Results and conclusion

Three‐dimensional ultrasound could show the exact position of the tip of the catheter in the uterine cavity quickly enough in most cases. It should be used in ET for seeking an optimal transfer area in the uterine cavity to assist in achieving high success rates and less complications. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Transient hyperechogenicity of the fetal pericardium: a case report
Authors: Ibba R. M. , Zoppi M. A. , Floris M. , Putzolu M. , Monni G.
Published: March 2003

An unusually echogenic fetal pericardium was visualized using ultrasound at 21 weeks' gestation. Serial prenatal examinations revealed its progressive, spontaneous resolution. Follow‐up examinations of the newborn and infant failed to demonstrate any clinical or echocardiographic abnormality. The occurrence of this unusual pericardial abnormality and its transient nature should be considered during sonographic examination of the fetus. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Value of the electronic scalpel (cut mode) in the evaluation of the fetal face
Authors: Merz E. , Miric‐Tesanic D. , Welter C.
Published: March 2003

Objectives

To evaluate the improvement of image quality and diagnostic value of fetal face examinations using the electric scalpel.

Methods

A total of 232 cases were examined. The fetuses were separated into two groups: Group A, including normal fetuses (n = 152) and Group B, fetuses with facial pathology (n = 80). The fetuses were divided into eight subgroups according to gestational age (9–12 weeks, 13–16 weeks, 17–20 weeks, 21–24 weeks, 25–28 weeks, 29–32 weeks, 33–36 weeks and 37–40 weeks).

Results

The number of cutting steps for the improvement of image quality ranged from 1 to 9 (mean value 3) in the group of normal fetuses and from 1 to 10 (mean value 3) in the group of fetuses with facial pathology. In the group of normal fetuses, superior image quality improvement was achieved in 68.4% of cases, moderate improvement in 28.9% and poor improvement in 2.6%. In the group of fetuses with facial pathology, high image quality improvement was obtained in 72.5% of cases, moderate improvement in 25.0% and insufficient improvement in 2.5%. There were no differences among the eight subgroups in the number of steps required relating to gestational age.

Conclusions

The use of the electronic scalpel was associated with diagnostic improvement in 71.1% of cases in the group of normal fetuses, and in 75.0% in the group of fetuses with facial pathology. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The fetal lung 1: developmental aspects
Authors: Laudy J. A. M. , Wladimiroff J. W.
Published: March 2003

A literature survey is presented on normal fetal development during the embryonic, pseudoglandular, canalicular, saccular and alveolar stages in the human fetus. Normal anatomical and physiological aspects of fetal lung development including the fetal pulmonary circulation are described. Factors which may influence fetal lung growth and consequently may play a role in the development of pulmonary hypoplasia are discussed, such as intrauterine and intrathoracic space, lung fluid, fetal breathing movements, normal balance of volume and pressure in the lung and interference with the blood supply. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Doppler sonographic demonstration of arterio–venous anastomosis in monochorionic twin gestation
Authors: Machin G. A. , Feldstein V. A. , Van Gemert M. J. C. , Keith L. G. , Hecher K.
Published: March 2003

Arterio‐venous connections, which are known to occur in monochorionic twin placentae and are a mechanism for the development of twin‐to‐twin transfusion syndrome, can be demonstrated in utero by means of targeted sonography with the use of spectral and color flow Doppler techniques. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional power Doppler imaging in the assessment of Fallopian tube patency
Authors: Sladkevicius P. , Ojha K. , Campbell S. , Nargund G.
Published: March 2003

Objective

The aim of the study was to evaluate the feasibility of three‐dimensional power Doppler imaging (3D‐PDI) in the assessment of the patency of the Fallopian tubes during hysterosalpingo‐contrast sonography (HyCoSy).

Methods

Women attending the fertility clinic were offered a Fallopian tubal patency test as part of the initial investigation. Hysterosalpingo‐contrast sonography using contrast medium Echovist was performed on 67 women. Findings on the two‐dimensional (2D) gray‐scale scanning and three‐dimensional power Doppler imaging were compared. The first technique visualizes positive contrast in the Fallopian tube; the second demonstrates flow of medium through the tube.

Results

Contrast medium Echovist produced prominent signals on the 3D‐PDI image. Free spill from the fimbrial end of the Fallopian tubes was demonstrated in 114 (91%) tubes using the 3D‐PDI technique and in 58 (46%) of tubes using conventional HyCoSy. The mean duration of the imaging procedure was less with 3D‐PDI, but the operator time which included postprocedure analysis of the stored information was similar. A significantly lower volume of contrast medium (5.9 ± 0.6 mL) was used for 3D‐PDI in comparison with that (11.2 ± 1.9 mL) used for conventional 2D HyCoSy.

Conclusion

Color coded 3D‐PDI with surface rendering allowed visualization of the flow of contrast through the entire tubal length and free spill of contrast was clearly identified in the majority of cases. The 3D‐PDI method appeared to have advantages over the conventional HyCoSy technique, especially in terms of visualization of spill from the distal end of the tube, which was achieved twice as often with the 3D technique. Although the design of the investigation did not allow the side effects of the two techniques to be compared, the shorter duration of the imaging and lower volume of the contrast medium used suggested that the 3D‐PDI technique might have a better side‐effect profile. The 3D‐PDI technique allowed better storage of the information for re‐analysis and archiving than conventional HyCoSy. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of 13q– syndrome in a fetus with holoprosencephaly and thumb agenesis
Authors: Gutierrez J. , Sepulveda W. , Saez R. , Carstens E. , Sanchez J.
Published: March 2003

Partial deletion of the long arm of one of the chromosomes 13 is an exceedingly rare condition. We report such a case in a 32‐week fetus presenting with polyhydramnios, growth restriction and multiple structural defects including alobar holoprosencephaly, facial abnormalities, clubfoot, clinodactyly and thumb agenesis. Fetal blood sampling revealed a 46,XY, del(13)(q22 → qter) abnormal male karyotype. Postmortem examination confirmed the prenatal findings and showed other manifestations of the syndrome. To our knowledge, this case represents the first in which the prenatal ultrasound detection of holoprosencephaly in association with distal limb abnormalities led to the prenatal diagnosis of the 13q– syndrome. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
A large‐scale evaluation of amnio‐PCR for the rapid prenatal diagnosis of fetal trisomy
Authors: Levett L. J. , Liddle S. , Meredith R.
Published: March 2003

Objective

Traditional chromosome preparation from amniotic fluid samples often involves lengthy culture procedures in order to obtain cells for analysis. Multiplex quantitative fluorescent polymerase chain reaction (PCR) is a new molecular biological technique capable of quantifying in‐situ DNA without the need for cell culture. Our objective was to test the reliability of PCR using fetal DNA from amniotic fluid (amnio‐PCR) for the rapid prenatal diagnosis of the common trisomies.

Design

This was a large prospective study of 5000 amniocentesis specimens. Multiplex quantitative fluorescent PCR was performed specifically for short tandem repeat sequences within chromosomes 21, 18, 13, X and Y. All amniocentesis samples were subsequently analyzed by traditional karyotyping methods.

Results

Amnio‐PCR detected all 89 major autosomal trisomies in this cohort. Diagnosis of sex chromosome anomalies was accurate for cases involving first meiotic division nondisjunction. However, further markers were necessary to detect sex chromosome anomalies arising from second meiotic division nondisjunction, highlighting the importance of using specific markers that enable the quantification of both the X and the Y chromosomes simultaneously.

Conclusions

Rapid prenatal diagnosis of trisomies 21, 18, and 13 and the sex chromosome anomalies using amnio‐PCR is a reliable technique that aids the clinical management of pregnancy. The speed of the methodology will help to minimize the period of parental anxiety in the wait for a diagnostic test result. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of thrombosis of the dural sinuses with real‐time and color Doppler ultrasound
Authors: Visentin A. , Falco P. , Pilu G. , Perolo A. , Valeri B. , Santini D. , Bovicelli L.
Published: March 2003

Objective

To assess the sonographic findings and clinical implications of fetal thrombosis of dural sinuses.

Design

Retrospective study of cases with a prenatal diagnosis of thrombosis of the dural sinuses.

Results

The diagnosis of fetal thrombosis of the dural sinuses was established in three uncomplicated pregnancies at 21, 22 and 28 weeks' gestation by transabdominal and transvaginal sonography, demonstrating a blood clot within the dilated dural sinuses, always in the region of the torcular Herophilii. The diagnosis was further confirmed by the color Doppler demonstration of absence of blood flow within the dilated dural sinuses. Upon request of the couples two pregnancies were terminated. One infant was delivered at term by Cesarean section and died during neurosurgery.

Conclusions

Thrombosis of the cerebral venous circulation can occur antenatally. Accurate diagnosis can be made using fetal real‐time and color Doppler ultrasound. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Fetal cardiac effects of doxorubicin therapy for carcinoma of the breast during pregnancy: case report and review of the literature
Authors: Meyer‐Wittkopf M. , Barth H. , Emons G. , Schmidt S.
Published: March 2003

Cardiotoxicity is a recognized complication of anthracycline drugs given as part of chemotherapy; however, the pre‐ and postnatal cardiac effects of in utero exposure are not well documented. In this report we present a case of gestational breast cancer with initiation of four cycles of doxorubicin/cyclophosphamide chemotherapy after modified radical mastectomy and axilla dissection during the early second trimester. Serial echocardiographic measurements of the ventricular shortening fraction and biometry of the ventricular cavities were performed. Allowing for the individual variability of these values in the fetus no myocardial dysfunction was observed. The literature was reviewed in an attempt to delineate the possible role of prenatal echocardiography in the diagnosis of doxorubicin‐induced cardiotoxicity in the fetus. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Cerebral lateral ventricular atrial diameter of male and female fetuses at 20–24 weeks' gestation
Authors: Haddad S. , Peleg D. , Matilsky M. , Ben‐Ami M.
Published: March 2003

Objective

To determine if the lateral ventricular atrial diameter differs between male and female fetuses at 20–24 weeks' gestation.

Design

Prospective study.

Methods

The transverse diameter of the ventricular atrium was measured from inner wall to inner wall for a total of 202 pregnant women with 105 male fetuses and 97 female fetuses.

Results

The mean diameter of the ventricular atrium for the 202 fetuses was 4.96 ± 0.96 mm (range, 2.1–8.4 mm). The 105 males had a mean diameter of 4.95 ± 0.98 mm and the 97 females a mean diameter of 4.97 ± 0.94 mm. There was no statistical difference between the sexes.

Conclusions

In our population, there was no difference between ventricular atrial diameter in male and female fetuses at 20–24 weeks' gestation. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology