bluuebunny/crossref_metadata_2025 huggingface dataset:
F63Ultrasound guided fetal cystoscopic therapy for posterior urethral valves (PUV)
Authors: Welsh A. W. , Agarwal S. , Fisk N. M.
Published: March 2003

Background

The commonest cause of obstructive uropathy in males is PUV, with well‐recognised ultrasonographic features and a mortality of up to 95% if associated with oligohydramnios. Palliative treatment (vesicoamniotic shunting) has increased survival, but with a high complication rate and significant incidence of long‐term renal impairment. We evaluated the diagnostic and therapeutic role of thin gauge embryofetoscopy in suspected PUV.

Method

A joint fetal medicine and paediatric urological team performed the procedures under local anaesthetic. Nine fetuses were assessed, mean gestation 22 weeks (7 subsequently confirmed PUV, 1 unconfirmed, 1 suspected urethral atresia). After confirmation of urinary electrolyte normality, a 1.3‐mm semirigid fetoscope (Karl Storz Ltd) was inserted under ultrasound guidance into the dilated fetal bladder. Fetoscopic features were documented and an attempt made to enter the dilated upper posterior urethra. Two therapeutic procedures were assessed: valvular flushing under pressure and guidewire passage.

Results

The hypertrophied bladder neck was seen in 7 cases, the posterior urethra entered in 4 and the obstruction visualised in 2. Five therapeutic procedures were attempted (2 flushing, 3 guidewire). One case flushed therapeutically was confirmed after delivery to have a patent urethra.

Conclusions

Some cases of PUV may be treated in utero. Further studies are indicated to explore fetoscopy as a therapeutic tool.

Acknowledgements

Alec Welsh is supported by a Research Training Fellowship from RCOG/WellBeing.
F713D CDS of fibroid pre‐ and post‐embolization
Authors: Fleischer A.C. ,   E. Donnelly, Campbell M. , Mazer M. , Lipsitz N.
Published: March 2003

Objective

Evaluate and quantitate changes in fibroid vascularity and volume preand postembolization with 3D Color Doppler sonography (CDS).

Method

Quantitative 3D CDS was performed immediately prior to, 1 day, 3 months, and 6 months postembolization in 20 patients.

Results

All patients had symptomatic relief. Changes in vascularity were greatest 1 day postembolization whereas the most significant changes in volume occurred on the 3 month follow‐up scan.

Conclusion

Quantitative 3D CDS provides accurate information regarding fibroid vascularity and volume postembolization. This data may be helpful in monitoring response to treatment as well as detection of complications.
F73New modes of capture by freehand three‐dimensional ultrasound in the prenatal diagnosis of fetal anomalies
Authors: Guerra F. , Gutiérrez R. , Herrera L. , Anwandter C. , Caro J. , Aguilar R. , Isla A.
Published: March 2003

Background

The aim of this study was to see the contribution of three different modes of capture of data by the freehand three‐dimensional ultrasound (3D US) in the prenatal diagnosis of fetal anomalies.

Method

We studied a total of 34 pregnant women. In all of them a fetal anomaly was previously assessed by 2D US. Planar US probes and a 3D software (3D‐ViewTM) were used on a digital Gaia 8800 scanner. Three modes of data capture were employed: volume capture (to capture a volume), static capture (to capture motion; a combination of B‐mode and M‐mode), and free style capture (to capture a big region of interest; ROI), then the most suitable screen presentation was used according to the mode of capture.

Results

We found a total of 41 anomalies on 34 fetuses which are: Heart (17), abdomen (8), central nervous system (6) and miscellaneous (10). We were able to see all anomalies previously detected by 2D US. By using volume capture and rendering image we were able to detect also anomalies of fingers and face, no previously detected by 2D. However volume capture was the most difficult mode to perform. Static capture was the most suitable to study fetal heart malformations (as A‐V canal) and arrhythmias. Free style capture give us a B‐mode digital video of the ROI (hydrocephalus, spina bifida, gastroschisis, omphalocele, adominal cysts, kidney malformations). Good pictures by using the last two modes of capture were easy to obtain. We also benefit of all the advantages of using digital technology, like to have the information as a virtual patient.

Conclusion

The appropriate use of different modes of capture of data by free hand 3D US in combination with 2D US gives a new perspective of using this new technology in the diagnosis of fetal anomalies.
F09Detection of pelvic recurrent disease with transvaginal color‐Doppler analysis in women treated for gynecologic malignancy
Authors: Testa A. C. , Ciampelli M. , Mastromarino C. , Lopez R. , Mancuso S. , Scambia G.
Published: March 2003

Background

To evaluate Color Doppler characteristics of small tumor recurrences detected within the pelvis in follow‐up patients treated for gynecologic malignancy.

Method

Out of 310 patients monitored for gynecologic malignancy, a selected group of 14 patients, with small size pelvic masses located in the central region of the pelvis detected by transvaginal ultrasound, underwent a color Doppler evaluation.

A subjective assessment of the vascularization (vascular score), the lowest Resistance Index (RI), the highest Peak Velocity (PV) and the highest Time Averaged Maximum Velocity (TAMXV) of the vessels detected within the lesion were considered for the analysis.

Results

Color score of tumor recurrences (No 7) was significantly higher in comparison to benign lesions (No 7) (2.6 ± 0.5 vs. 2 ± 0, P < 0.05). The malignant lesions showed significantly higher mean values of PV and TAMXV when compared to benign ones (17.9 ± 4.3 cm/s vs. 7.5 ± 3 cm/sec, P < 0.0001; 9.7 ± 2.2 cm/s vs. 3.5 ± 3 cm/s, P < 0.01).

Conclusions

Color Doppler analysis added to transvaginal ultrasonography seems to be an helpful tool in the evaluation pelvis at an early stage of recurring tumor in the pelvis.
F100Dopplerometry at the prenatal diagnosis of congenital defects
Authors: Santavy J. , Lubusky M. , Polak P. , Hyjanek J.
Published: March 2003

Background

Pulse and colour Dopplerometry is going to be more and more routine investigation in the frame of specialised prenatal investigation. Despite the huge number of the works in this field in the past years we have found only very limited information about utilisation of these both methods at the cases of congenital defects found in utero, especially in the first trimester of pregnancy.

Method

During the past two years we have investigated both by pulse and colour Doppler mostly cord vessels, art. cerebri media, art. renalis and truncus arteriosus. By the colour Doppler we evaluated heart, moving of the chest and we assessed placental blood circulation in lacunas.

Results

Our collection consists from 28 pregnant women, where we have found congenital defects. There were chromosomal aberrations, morphological defects, serious intrauterine hypoplasias and Rh incompatibility there. Evaluation was not possible by the absolute values and so we divided the curves into four groups: higher, normal and lower levels, and zero flow. The results are not specific for individual defects, as we expected, but it is an option to utilise them at a suspicion for abnormal intrauterine findings.

Conclusion

Dopplerometry at the congenital defects has its limited value but it is helpful at the complex evaluation of the foetus health condition.
Does texture analysis improve breast ultrasound precision?
Authors: Bader W. , Böhmer S. , Van Leeuwen P. , Hackmann J. , Westhof G. , Hatzmann W.
Published: March 2003

Objective

To evaluate the possibility of distinguishing between benign and malignant breast tumors using a computer‐aided evaluation of echogenicity and echostructure of ultrasound findings at certain focal points.

Study design

The ultrasound images from 89 cases of breast tumor were documented under standardized conditions using a linear array machine and 7.5 MHz transducer. In each sonographic image, the maximum area of the ‘region of interest’ of the tumor was marked and then subjected to consecutive statistical analysis and correlation with the histological findings. For evaluation of tumor status eight parameters of first and second order texture statistics (gray level histogram, Fourier analysis, co‐occurrence matrix) were applied.

Results

Benign tumors were clearly distinguished from carcinomas in the evaluation of the co‐occurrence matrix and the Fourier analysis on the basis of Wilcoxon and Student t‐test (P < 0.05) but not in the gray level histogram. Using logistic regression a sensitivity of 73.8% and a specificity of 54.2% were obtained. A statistically significant difference between benign tumors and moderately differentiated together with poorly differentiated carcinomas could be demonstrated.

Conclusion

This study concludes that texture analysis appears to distinguish between benign and most malignant tumors. A computer texture analyzing system is able to improve the subjective assessment of ultrasound images of the breast but can not replace it. Where the limits of subjective assessment of a given tumor are reached, computerized texture analysis will provide additional information in the differentiation of benign from malignant findings. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Constriction band of the arm following insertion of a pleuro‐amniotic shunt
Authors: Brown R. , Nicolaides K.
Published: March 2003

In a 23‐week fetus with a large left‐sided pleural effusion a double pigtail pleuro‐amniotic shunt was inserted uneventfully. A healthy infant was delivered at 38 weeks' gestation. One end of the shunt was in the thoracic cavity but the other end was found wrapped around the upper arm resulting in a constriction band. There was no impairment of the vascular supply to the limb or in its motor or sensory function and by 6 months of age there was only a faint ring still apparent around the upper arm. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound markers of fetal chromosomal abnormality: a survey of policies and practices in UK maternity ultrasound departments
Authors: Maclachlan N. , Iskaros J. , Chitty Lyn
Published: March 2003

Objective

To evaluate the management of pregnancies where the fetus was found to have one or more sonographic markers of possible fetal chromosomal abnormality.

Design

Prospective anonymous postal survey of UK obstetric ultrasound units.

Main outcome measures

The management of pregnancies where the fetus is found to have a sonographic marker of aneuploidy.

Population

All 252 maternity ultrasound units in the United Kingdom.

Methods

Postal questionnaire to the superintendent sonographer in routine maternal ultrasound departments.

Results

Questionnaires were returned from 179 maternity units (71%). Of the respondents 94% offered a fetal anomaly scan at 16–20 weeks' gestation and 59% performed a dating scan at 10–14 weeks. Screening for Down syndrome was available in 99% of all maternity units.

The recognition of sonographic ‘soft signs’ for possible fetal chromosomal abnormality varied considerably between the units. When sonographers were asked about their unit's policy regarding offering amniocentesis to women with sonographic markers, 8–78% discussed amniocentesis when the marker was isolated and 53–88% when another abnormality was found.

Eighty nine percent of units documented the abnormal ultrasound findings in the hospital notes and 88% of the women were informed of the findings regardless of the intention to offer amniocentesis.

Conclusion

The practice of routine ultrasound examination is well established in UK, though precise policies vary. The existing wide variations in management policies possibly reflect a lack of data derived from low risk populations. There is a need to collect such data from low risk populations with known screening practices so that national guidelines to standardize practice can be formulated. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The influence of maternal exercise on placental blood flow measured by Simultaneous Multigate Spectral Doppler Imaging (SM‐SDI)
Authors: Feiner B. , Weksler R. , Ohel G. , Degani S.
Published: March 2003

Objective

To evaluate the effect of maternal isometric exercise on the placental blood flow as reflected by the velocimetric indices PI and RI derived from placental arteries.

Subjects

Thirty‐four healthy women with normal singleton pregnancies between 22 and 35 weeks of gestation.

Methods

All subjects underwent an isometric handgrip exercise test. Maternal blood pressure and heart rate together with placental PI and RI were measured at rest, during the exercise and in the post‐exercise recovery phase. All Doppler measurements were obtained using the Simultaneous Multigate Spectral Doppler Imaging (SM‐SDI) technique, a new ultrasound modality that enables a Doppler study of multiple locations to take place within a very short time.

Results

There was a significant increase in the mean values of the maternal blood pressure and heart rate during the exercise and a significant decline in the recovery phase. There was no significant change in the mean values of the Doppler indices throughout the examination.

Conclusion

Isometric handgrip exercise test during pregnancy does not affect the impedance of the placental circulation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of the Cerebro‐Oculo‐Facio‐Skeletal (COFS) syndrome
Authors: Paladini D. , D'Armiento M. , Ardovino I. , Martinelli P.
Published: March 2003

Background

The Cerebro‐Ocular‐Facio‐Skeletal (COFS) syndrome is an autosomal recessive condition characterized by neurogenic arthrogryposis, severe facial anomalies and brain maldevelopment. We describe here the first case of prenatal diagnosis of this syndrome in a 21‐week fetus.

Case

The woman was referred to our unit on suspicion of fetal microphthalmia. On trans‐abdominal ultrasound, severe bilateral microphthalmia was confirmed. Micrognathia, multiple joint contractures and rockerbottom feet were also detected. On the basis of these findings, the diagnosis of COFS syndrome was hypothesized. After termination of pregnancy, necropsy confirmed all prenatal findings. Histology showed severe architectural derangement of the eye and brain together with cerebellar anomalies compatible with the diagnosis of COFS syndrome.

Conclusions

To the best of our knowledge, this represents the first case of prenatal diagnosis of COFS syndrome. This case demonstrates the feasibility of such a diagnosis by ultrasound and identifies the malformations already present and detectable at mid‐gestation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Doppler evaluation of the uterine and spiral arteries from different sampling sites and phases of the menstrual cycle during controlled ovarian hyperstimulation
Authors: Hsieh Y.‐Y. , Chang F. C.‐C. , Tsai H.‐D.
Published: March 2003

Objective

To compare the pulsatility index (PI) and resistance index (RI) at different sampling sites of the uterine and spiral arteries in the early and mid‐menstrual phases.

Materials and methods

The uterine and spiral arteries of 110 women undergoing similar ovarian hyperstimulation and intra‐uterine insemination regimes were examined using transvaginal color Doppler ultrasound. The uterine artery was sampled at five sites: (1) ascending branch; (2) descending branch; (3) proximal, near branch division; (4) mid, 0.5 cm distal to the division; (5) lateral location, 1 cm distal to the division. The spiral artery was sampled at three sites: (a) anterior; (b) fundal; (c) posterior. The uterine and spiral arteries were examined twice, on days 2–3 and 14–16, respectively, of the menstrual cycle. The women were also grouped according to age at examination, ≤ 30 years and > 30 years. The PI and RI values for different sites, menstrual phase, and age were compared.

Results

The mean PI and RI values of the uterine artery were: (1) 2.86 ± 1.20 and 0.92 ± 0.13; (2) 2.66 ± 1.15 and 0.89 ± 0.12; (3) 2.88 ± 1.26 and 0.90 ± 0.15; (4) 3.03 ± 1.02 and 0.91 ± 0.07; (5) 3.23 ± 1.38 and 0.89 ± 0.12; and of the spiral artery were (a) 1.61 ± 1.01 and 0.69 ± 0.17; (b) 1.69 ± 0.74 and 0.74 ± 0.17; (c) 1.73 ± 0.86 and 0.68 ± 0.17. The PI values for uterine and spiral arteries at two phases of the menstrual cycle were 2.92 ± 1.18 and 1.55 ± 0.72 (days 2–3); 3.11 ± 1.15 and 1.80 ± 1.02 (days 14–16), respectively; for younger women (age ≤ 30 years) these values were 2.83 ± 1.22 and 1.6 ± 0.85 and for older women (age > 30 years) 3.0 ± 1.34 and 1.72 ± 0.96, respectively.

Conclusions

There were no significant differences in PI and RI values of the uterine and spiral arteries at different sampling sites, phase of the menstrual cycle or age. The higher PI values tended to occur in the lateral uterine artery and posterior spiral artery, during the mid‐menstrual phase and in the older age group. The PI and RI values of the mid‐uterine and fundal spiral artery sampling sites are representative of the whole uterine artery and spiral artery, respectively. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
A case of body stalk anomaly at 10 weeks of gestation
Authors: Paul C. , Zosmer N. , Jurkovic D. , Nicolaides K.
Published: March 2003

We describe a case of body stalk anomaly which was diagnosed at 10 weeks of gestation on a dating scan. The fetus was visualized within the exocelomic cavity outside an apparently intact amniotic membrane. The fetus displayed multiple anomalies characteristic of body stalk syndrome including a skull and brain defect, abdominal wall defect, kyphoscoliosis and gross deformities of the lower limbs. These findings do not support early amniotic membrane rupture as the primary event in the pathogenesis of body stalk anomaly and indicate that the exocelomic location of the fetus may actually be one of the features of this complex developmental anomaly. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Umbilical vein blood flow in fetuses with normal and lean umbilical cord
Authors: Di Naro E. , Ghezzi F. , Raio L. , Franchi M. , D'Addario V. , Lanzillotti G. , Schneider H.
Published: March 2003

Objective

To evaluate whether umbilical vascular coiling is correlated with the umbilical vein blood flow profile and to investigate if this is different between fetuses with a lean and those with a normal umbilical cord.

Methods

Consecutive women with a singleton gestation who delivered at term and who underwent an ultrasound examination within 24 h from delivery were studied. Umbilical cord and vessel areas were calculated. Umbilical vein blood flow parameters were obtained by digital color Doppler velocity profile integration. After delivery, the umbilical coiling index was calculated.

Results

One hundred and sixteen women were studied. Twelve (10.3%) had a lean umbilical cord (area < 10th centile). A significant correlation was found between the umbilical coiling index and the umbilical vein blood flow (r = 0.67, P < 0.001). A significant difference between fetuses with and without a lean cord was found in terms of: umbilical coiling index (0.18 ± 0.08 vs. 0.29 ± 0.09, P < 0.005), cord area (87.6 ± 5.1 mm2 vs. 200.6 ± 34.6 mm2, P < 0.001), Wharton's jelly amount (25.7 ± 10.3 mm2 vs. 122.1 ± 33.4 mm2, P < 0.001), umbilical vein blood flow (93.7 ± 17.8 ml/kg per min vs. 126.0 ± 23.4 ml/kg per min, P < 0.001), and umbilical vein blood flow mean velocity (6.6 ± 2.7 cm/s vs. 9.0 ± 3.6 cm/s, P < 0.05). The proportion of fetuses with an umbilical vein blood flow < 80 ml/kg per min was higher when the cord was lean than when it was normal (25% vs. 1.9%, P < 0.01).

Conclusions

Lean umbilical cords differ from normal cords not only from a structural point of view but also in the umbilical vein blood flow characteristics. This could explain the increased incidence of intrapartum complications and fetal growth restriction among fetuses with a lean and/or hypocoiled cord. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic prenatal diagnosis of intracranial fetus in fetu
Authors: Ianniruberto A. , Rossi P. , Ianniruberto M. , Rella G. , Ciminelli V.
Published: March 2003

A case of sonographic prenatal diagnosis of a complex intracranial mass, with features of a fetus in fetu at 17 weeks' gestation, is reported. This diagnosis is reserved for a highly organized tumor containing a vertebral column and recognizable fetal parts and should be differentiated from a teratoma. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Quantitative digital analysis of regional placental perfusion using power Doppler in placental abruption
Authors: Welsh A. W. , Bennett P. R. , Fisk N. M.
Published: March 2003

Purpose

To apply digital imaging techniques to the quantification of placental vascularity using power Doppler.

Materials and methods

Regional placental blood flow was measured in a case of large placental abruption, shortly after presentation and 1 week later. Images were stored digitally and analysed using purpose‐designed software (CQ Analysis) to extract and measure vascular energy information. The integrated color energy (ICE) was determined in the main body of placental tissue and in a cotyledon isolated by the retroplacental clot.

Results

Initial assessment at 25 weeks showed only a small difference in integrated energy between normal placenta and the isolated cotyledon (ICE ratio 1.44, P < 0.04). One week later, perfusion in the isolated cotyledon had fallen both on qualitative and quantitative assessment (ICE ratio 3.98, P < 0.0001). This area subsequently became devascularized.

Conclusion

Placental perfusion may be quantified using digital power Doppler analysis. Further studies are indicated to evaluate its role in assessing regional and/or global placental perfusion as well as fetal organ perfusion. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
The accuracy and indications of fetal echocardiography in high risk patients: a 4‐year clinical experience in an obstetric unit
Authors: Gómez O. , Puerto B. , Borrell A. , Palacio M. , Cararach V.
Published: March 2003

Objective:  To evaluate the accuracy and assess the indications of fetal echocardiography to diagnose structural heart disease in our high risk population, by an obstetric team.

Methodology:  Over a 4‐year period, a transabdominal echocardiography was performed in 912 high risk pregnancies for congenital heart disease at 18–38 weeks of gestation. In the last 140 cases, an early examination combining either the transvaginal or the transabdominal route at 13–16 weeks was also carried out. Follow up was obtained from neonatal examinations and autopsies. The main indications for referral were: pregestational diabetes mellitus, family risk, increased nuchal translucency, suspected cardiac anomaly at screening ultrasound, women at high risk of chromosomal abnormality reluctant to invasive test, suspected arrhythmia, single umbilical artery, exposure to teratogens, and pregnancies affected by a chromosomal abnormality.

Results:  There were 79 (8.6%) major congenital heart defects, and most of them were yielded in the group of screening by ultrasound. Seventy of them (88.6%) were diagnosed correctly as abnormal prenatally. Atrioventricular septal defects (21 cases) and hypoplastic left ventricle syndrome (12 cases) were the most prevalent heart anomalies in the fetus. Isolated septal defects and coarctation of the aorta were the most difficult lesions to detect, being the ones with false positive and negative diagnosis. Another four cases of non‐significant (<3 mm, no surgery nor medical treatment required) ventricular septal defects were overlooked during gestation, but closed by the sixth month of life. Fifteen apparently normal cases were lost to follow up.

Conclusion:  Our obstetric team results, in accordance with others previously published, show a good effectiveness to diagnose congenital heart anomalies. Most major detectable cardiac anomalies occur in the group without previously‐known risk.
Transvaginal 2D/3D US and MRI of the fetal CNS
Authors: Pooh R. K. , Pooh K.
Published: March 2003

Introduction:  Transvaginal sonography of the fetal brain produce a series of oblique sections from the same ultrasound window. Transvaginal 3D automatic volume acquisition requires only 1.84–6.07 s for scanning without a shift and angle‐change of the transducer. Multiplanar image analysis and volumetric system are useful for objective evaluation of the fetal brain. Recent advances in fast MRI technology has remarkably improved the T2‐weighted image resolution without motion artifacts, despite a short acquisition time. We used both technologies for the fetal brain assessment.

Patients and methods:  Between May 2000 and April 2001, 11 cases with fetal brain abnormalities at 20–37 weeks of gestation were examined by transvaginal 2D/3D sonography and MRI. Logiq 700/500 (GE MS) and Voluson 530D (Medison), and 1.5 T MR unit VISART (Toshiba) with 2D half‐Fourier fast SE sequence were used in this study. Obtained US images and MRI were compared for brain evaluation.

Results:  From our study, TVS is better in depicting the corpus callosum in the sagittal section, while MRI with 2D half‐Fourier fast SE is superior in brainstem detection. In evaluation of the ventricular system, cerebrum and cerebellum, the same information was obtained from both methods. The same prenatal diagnoses were obtained from US and MR data in 10 cases. In one case with partial agenesis of corpus callosum at 20 weeks of gestation, US image was more demonstrative than MRI.

Conclusions:  Prenatal neuroimaging has been approaching postnatal imaging. Both transvaginal sonography and MRI are useful for evaluation of the fetal CNS. Transvaginal 2D/3D sonography should be used for routine assessment of fetal CNS, and MRI device should be used for more detailed evaluation including brainstem assessment. Practically, MRI is useful regardless of fetal head position, while US is not influenced by fetal movement.
Fetal hydronephrosis – natural history and predictors of postnatal outcome
Authors: Sohn Y. K. , Han S. Y. , Chun D. W. , Park J. S. , Jun J. K. , Yoon B. H. , Syn H. C. , Lee H. P.
Published: March 2003

Objectives:  The aim of this study was to evaluate the natural history of antenatally detected hydronephrosis and to assess the relationship between the severity of fetal hydronephrosis and postnatal outcome.

Materials and methods:  During the study period (1992 through 2001), we identified 70 cases of fetal hydronephrosis and reviewed their antenatal and postnatal follow up record retrospectively. The inclusion criteria was renal pelvic antero‐posterior (AP) diameter 4 mm or greater before 33 weeks of gestation and 7 mm or greater at or after 33 weeks of gestation. Sonographically diagnosed fetal simple renal cyst, multicystic dysplastic kidney, or polycystic kidney were excluded.

Results:  Thirty cases (43.4%) showed hydronephrosis without definite renal pathology after postnatal evaluation. Thirty‐one cases (44.9%) had anatomical abnormalities and the most common renal pathology was ureteropelvic junction obstruction (18 of 31, 58%). Eight cases (11.5%) had regression of hydronephrosis before or at birth. One case was lost in follow up. Twenty cases (28.9%) required surgical intervention, 32 cases (46.3%) needed medical intervention, and 17 cases (24.6%) required neither intervention nor long‐term follow up. All with renal pelvic AP diameter of 15 mm or greater prior to delivery needed either medical or surgical intervention postnatally. With cut off value of 15 mm or greater, the sensitivity and specificity in predicting surgical intervention were 90, and 75%, respectively. The fetus with renal pelvic AP diameter of 15 mm or less prior to delivery had less risk for surgical intervention than 15 mm or greater (Odds ratio 0.046, 95% CI 0.009–0.224). Gestational age at detection of fetal hydronephrosis had no statistical significance in predicting outcome.

Conclusion:  We concluded that severity of fetal hydronephrosis could affect a postnatal management strategy, either medical or surgical intervention, which is useful in prospective counseling.
Lower abdomen cystic masses diagnosed in female infants in fetoneonatal period: diagnosis and management
Authors: Hrehorcak M. , Smetanova D. , Pycha K. , Zuntova A. , Horejsi J. , Holemarova M.
Published: March 2003

Cystic masses in female fetuses and neonates are in waste majority of cases identified in screening ultrasound during pregnancy. Often they are detected as early as in second trimester screening sonography (18–22 weeks). When they are identified, problems with differential diagnosis and management modalities arise. In majority of cases, the cystic formation is simple ovarian cyst. It might be misinterpreted with other conditions such as: hydronephrosis, bowel obstruction, mesenterial cysts, etc. We attempt to identify US criteria for reliable prenatal diagnosis of simple not complicated ovarian cysts. Define treatment possibilities and recommendations. Forty‐three cases of such formation in lower abdomen were reported in our hospital either in pediatric gynecology or pediatric surgery departments. Thirty‐three were diagnosed prenataly, nine diagnosed postnataly. Cysts were unilateral in all cases. Twenty‐two cases were treated surgically by ovarectomy. Nine of the treated cases were cysts larger than 60 mm, in four cases the diameter was less than 40 mm, Nine cases were cyst between 40 and 60 mm. Histological examination proved 18 cases with hemorrhagic necrosis of the ovarian cyst, four cases were diagnosed as follicular cysts and one case of malignant retroperitoneal sarcoma. Twenty cases of cystic formation were observed and expectation management was applied. All of them were smaller than 40 mm in largest diameter and they resolved spontaneously within 1 year of age. We conclude that basic criteria for accurate diagnosis include mandatory visualization of the kidneys and stomach in the time of diagnosis. Simple ovarian cyst has following features on ultrasound: one chamber cystic formation in lower abdomen, smooth walls, anechogenic. Expectation management with serial follow up is recommended for cysts smaller than 40 mm in diameter, Surgical treatment should be instituted only in case of ovarian torsion (cyst diameter seems to be of good predictive value) or rupture with bleeding. Simple cysts with diameter larger than 40 mm remains controversial. Should we treat them to prevent torsion? We conclude that conservative approach is adequate in certain cases, when risk of acute abdomen is low and spontaneous disappearance is presumable in respect to preservation of future reproductive function of female infant.
Changes in fetal blood flow in hypoxemia during labor
Authors: Ropacka M. , Dubiel M. , Marsal K. , Gudmundsson S. , Breborowicz G. H.
Published: March 2003

Objective:  The aim of this study was evaluation of intrapartum Doppler velocimetry changes in fetuses with signs of fetal hypoxemia in fetal pulse oximetry (arterial hemoglobin saturation <30%).

Study design:  Examinations were performed on 44 women in labor with singleton pregnancies. The subject of analysis was Doppler blood flow velocimetry in umbilical cord, fetal brain and lung. In all cases the following examinations were performed: blood flow velocimetry in middle cerebral artery (MCA), umbilical artery (UA), and pulmonary vein (PV). Among fetuses with normal Doppler velocimetry at the time of admission, we selected those with cephalic presentation and non‐reassuring fetal heart rate pattern during labor. The fetuses were included to the group of fetal pulse oximetry monitoring. All cases with signs of fetal distress in ctg and intrapartum fetal arterial oxygen saturation <30% for at least 5 min were included to the study group. Fetuses with abnormal ctg and fetal oxygen saturation >30% constituted the control group.

Results:  Doppler indices (PI, RI) in MCA were significantly lower in the presence of reduced oxygen saturation. Pulsatility and resistance index in UA in the study group were higher, comparing to the control group. But, there was no statistically significant difference between both groups in analyzing parameters. There were no statistically significant changes in parameters describing blood flow in pulmonary veins in both studied groups.

Comments:  The combined intrapartum fetal monitoring, including pulse oximetry and Doppler blood flow velocimetry, proved that the reduction of fetal arterial oxygen saturation (<30%) is associated with changes in hemodynamics of fetal cerebral circulation. It has been not observed any changes in blood flow in umbilical artery and pulmonary vein in the presence of decreased fetal saturation.
Prediction of pregnancy outcome in women with an empty gestational sac on ultrasound scan
Authors: Elson J. , Salim R. , Tailor A. , Zosmer N. , Jurkovic D.
Published: March 2003

Background:  The ultrasound finding of an empty gestational sac may represent either an early normal pregnancy or a missed miscarriage, and follow up visits are usually required to reach a correct diagnosis. The aim of this study was to examine whether a combination of ultrasound and other clinical data may help to predict the final outcome at the initial visit.

Methods:  In all women with a diagnosis of an empty sac on transvaginal ultrasound scan, a detailed clinical history was obtained and a blood sample was taken to measure serum human gonadotrophin and progesterone levels. They were managed expectantly and invited to attend for a follow up scan 1 week later. The presence of a live embryo at follow up scan was used to diagnose normal pregnancy, whilst the diagnosis of miscarriage was made if the embryo remained undetectable, and/or the gestational sac showed regressive changes.

Results:  A number of 197 women were included into the final analysis, 115 (58%) of whom had a normal pregnancy and 82 (42%) had a missed miscarriage. Women with normal pregnancies were significantly younger (P < 0.01), less likely to present with vaginal bleeding (P < 0.001), had smaller gestational sacs (P < 0.001) and higher serum progesterone (P < 0.001) than those women who had missed miscarriages. On inspecting the ROC curves, serum progesterone was the best test to discriminate between viable and nonviable pregnancies. Using a cut‐off of 25 nmol/L a viable pregnancy could be diagnosed with 100% sensitivity and 45% specificity.

Conclusion:  Serum progesterone can be used to differentiate between normal and abnormal pregnancies in women with the diagnosis of an empty sac on ultrasound scan. This may help to improve patient's counseling and significantly reduce the need for follow up visits in women with nonviable pregnancies.
The prediction of spontaneous preterm birth in women with threatened preterm labor using transvaginal ultrasound of the cervix
Authors: Cook C.‐M. , Ellwood D. A.
Published: March 2003

Purpose:  This study was to determine if cervical parameters, as assessed by transvaginal ultrasound, were predictive of spontaneous preterm birth in women following an episode of threatened preterm labor (TPL).

Methods:  Women with a singleton pregnancy (20–34 weeks gestation) and intact membranes were enrolled following admission for TPL. The transvaginal ultrasound assessment of the cervix was performed when uterine activity had ceased. Only the ultrasound relating to the episode of suspected preterm labor is reported.

Results:  Sixty women had a transvaginal scan performed at a gestation of 27.7 ± 3.7 weeks (mean ± SD) (range 20.1–33.7 weeks). Cervical parameters were significantly different in women who delivered preterm (shorter closed endocervical canal length –P < 0.0001; increased internal os dilatation –P < 0.0001) to the women who delivered at term. Twenty‐five women had an abnormal cervix (closed endocervical canal length <30 mm + internal os dilatation >5 mm). Of these, 16 (64%) delivered preterm (<37 weeks). In contrast, only one woman with a normal cervix delivered preterm (P < 0.0001; RR 22.4, 95% CI 3.17–158.1). Five women (20%) delivered within 1 day of their abnormal cervical ultrasound, seven (28%) in <7 days, and 10 (40%) in <14 days whereas no woman with a normal cervical ultrasound delivered within 14 days (sensitivity 100%; negative predictive value 100%). In a linear regression model with gestational age at delivery as the dependent variable, endocervical canal length had an R2 of 59.3% (P < 0.0001) which was not improved by the addition of any of the other parameter variables.

Conclusions:  Transvaginal ultrasound of the cervix can identify those women with an abnormal cervix following an episode of TPL who are at increased risk of preterm birth. It also identifies the women with normal cervices and therefore at low‐risk of preterm birth which potentially could reduce unnecessary interventions.
Measuring cervical length with ultrasound: evaluation of the procedures and duration of a learning method
Authors: Vayssière C. , Morinière C. , Camus E. , Le Strat Y. , Poty L. , Fermanian J. , Ville Y.
Published: March 2003

Purpose:  To evaluate the procedures and learning time required for a novice ultrasound operator to master the technique for measuring cervical length with transvaginal ultrasound.

Methods:  Two operators new to cervical ultrasound (one with experience in transvaginal ultrasound in gynecology) were assessed during their training. The subjects are asymptomatic patients with a singleton pregnancy between 21 and 38 weeks, consulting for a routine ultrasound. After an initial lecture session on the technique of cervical measurement, both trainees had one or two supervised practice sessions, separated by interobserver agreement studies with 30 patients at a time; these compared the level of agreement consent between trainer and trainee throughout the course. Five ultrasounds were performed at the first practice session; a second practice session was planned only if the trainee did not perform all five ultrasounds alone and correctly, in accordance with the four quality criteria defined in advance for good cervical measurements. The second practice session, if there was one, lasted until five consecutive ultrasounds meeting the quality criteria were performed without the trainer's aid. Agreement between the two operators was assessed by the intra‐class correlation coefficient (ICC). The ICCs were compared with Fisher's Z‐transformation.

Results:  The mean age of the 150 women included in the study was 29.2 ± 4.8. The nullipara rate was 45.8%. The preterm delivery rate was 2.7% for the entire set of interobserver studies. The trainee with no experience with transvaginal ultrasound required two practice sessions (of the five ultrasounds performed in the first session, none was correct). In the second session, 18 consecutive ultrasounds were necessary to obtain five consecutive correct examinations. During this trainee's interobserver studies with the trainer, each involving 30 patients, the ICC progressed from 0.43 in the first to 0.64 in the second and 0.77 in the third study. The ICC in the first study differs significantly from that at the third (P = 0.049). The trainee with experience in transvaginal ultrasound required only one practice session (the first five ultrasounds were correct, without help from the trainer). The ICC moved from 0.74 to 0.86 in the two inter‐observer studies with the trainer, not a significant change.

Conclusions:  Theoretical training including supervised practice of 23 ultrasounds seems necessary for a trainee with no knowledge or experience in transvaginal ultrasound to acquire the technique for ultrasound measurement of the cervix.
3D ultrasound study of uterine anomalies in women with history of recurrent miscarriage
Authors: Salim R. , Woelfer B. , Regan L. , Bakos M. , Jurkovic D.
Published: March 2003

Purpose:  Congenital uterine anomalies are associated with adverse reproductive outcomes. In this study, we have examined the significant differences in the severity of uterine malformation in women with history of recurrent miscarriage and those in whom uterine anomaly was diagnosed incidentally.

Methods:  A total of 503 consecutive women with a history of recurrent miscarriage and 3228 low risk women attending for an ultrasound scan for indications other than infertility or recurrent pregnancy loss were screened for the presence of congenital uterine anomaly using 3D ultrasound. The anomalies were classified according to the American Fertility Society classification. The length of uterine septa, depth of fundal indentation (arcuate uterus) and length of uterine cavity were all measured. The degree of distortion was expressed as a ratio of septum length (or fundal indentation) and the length of the uterine cavity (distortion ratio = septum length/septum length + residual cavity length).

Results:  Eighty‐one arcuate and 26 subseptate uteri were detected in the group of women with history of recurrent miscarriage, whilst 72 arcuate and 29 subseptate uteri were diagnosed incidentally. There was no significant difference in the septum length (P > 0.01) or fundal indentation (P > 0.01) between the two groups. The uterine distortion ratio in women with a history of recurrent miscarriage was significantly greater compared to women with a normal reproductive history in both arcuate (t = − 3.258, P < 0.01) and subseptate (t = − 1.126, P < 0.01) uteri.

Conclusions:  The uterine cavity was more distorted in women with history of recurrent miscarriage compared to low risk women. This finding may partly explain the differences in the past reproductive performance between these two groups of women.
First trimester termination of pregnancy: a comparative trial of intraoperative ultrasound guidance
Authors: Wolman I. , Shefer G. , Pausner D. , Har‐Toov J. , Amster R. , Fait G. , Lessing J. B. , Jaffa A. J.
Published: March 2003

Purpose:  To evaluate whether the frequency of major complications of surgical abortions could be reduced by the routine use of intraoperative ultrasound guidance.

Design:  Prospective, single‐blinded study of 1200 consecutive, 15–44‐year‐old‐healthy women, recruited at a gestational age below 12 weeks, and randomized to two groups of 600 women each. In group I, dilatation and vacuum evacuation were conducted under ultrasonographic guidance prior to sharp curettage. In group II (control group), the same procedure was performed, but without ultrasound guidance.

Results:  There was a significant lower rate of repeated evaluation after the procedure in the study group (P > 0.01). Furthermore, although the rate of complications was rare in both groups, when nine major complications were pooled together, they were significantly more frequent in the control group (P < 0.01).

Conclusion:  The routine use of intraoperative ultrasound guidance is a useful adjunct to surgical abortion. It allows for a shorter procedure, and a lower rate of complications.
Factors influencing the prenatal detection of structural congenital heart diseases
Authors: Wong S.‐F. , Chan F.‐Y. , Cincotta R. , Lee‐Tannock A. , Ward C.
Published: March 2003

Background:  Congenital heart disease is the commonest congenital anomaly, but the reported antenatal detection rate varies widely from 4.5 to 36%.

Purpose:  To assess the factors influencing the antenatal detection rate of structural congenital heart diseases.

Methods:  A retrospective study was conducted at a major obstetric hospital in Australia between 1st January 1996 and 30th June 1999. The medical records of all fetuses and infants born with congenital heart diseases, except isolated patent ductus arteriosus, were reviewed. Only pregnancies that had antenatal ultrasound scan assessments for morphological surveys were included. The antenatal detection rate for structural congenital heart diseases was determined. The following factors that might influence the detection rate, were assessed: complexity of the lesions; experience of the sonologists (performance in tertiary vs. non‐tertiary institutions); identification of other structural or chromosomal anomalies; and maternal body mass index.

Results:  The incidence of structural congenital heart disease in this series, excluding cases referred from other hospitals, was 7‰ (179/25529). One‐hundred and fifty‐three fetuses and babies with structural congenital cardiac diseases were included. The overall detection rate for congenital heart diseases in this series was 39.9%. Detection rates for isolated septal defects were poor (13.2%). The detection rates were significantly higher for complex lesions (54%), for lesions with concomitant septal defects (47.6%), and for lesions with abnormal four chamber views (62.9%). The detection rate was also higher if the scan was performed in the tertiary institution (59%), and if there were other chromosomal or structural anomalies. Maternal body mass index did not affect the detection rate in the current series. Stepwise logistic regression analysis showed that three independent variables affecting the detection rate were complexity of the cardiac lesion, experience of the operator (tertiary scan), and the detection of other chromosomal anomalies.

Conclusion:  The public needs to be educated on the limitations of antenatal screening for congenital heart anomalies, especially on isolated septal defects. To improve future detection rates, further emphasis on the training and supervision of the sonologists needs to be stressed.
Early diagnosis of fetal cardiac anomalies by transvaginal echocardiography in a high risk population
Authors: Comas C. , Mortera C. , Torrents M. , Carrera J. M.
Published: March 2003

Objective:  To examine the accuracy of early transvaginal fetal echocardiography (TV‐echo) performed in a high risk population.

Methods:  A series of 70 high risk pregnancies were screened by TV‐echo at 12–17 weeks gestation between March 2000 and May 2001. A total of 74 fetal heart examinations were performed, including four twin pregnancies. For each fetus, visualization of the four chamber view, the origin of the great arteries, aortic and arterial ductal arches was attempted in a segmental approach. B‐mode and color/pulsed Doppler flow imaging were used in all cases, while M‐mode was occasionally performed. The average duration of complete heart examination was approximately 30 min. All the examinations were performed by the same experienced operator. Reliability was assessed by conventional transabdominal echocardiography at 20–22 weeks, by postnatal follow up in the first three months of life, and/or by autopsy in cases of termination of pregnancy.

Results:  The rate of successful visualization of the fetal heart was 90.5% (67/74). In 12 out of 74 fetuses the final diagnosis was abnormal (16.2%), including 10 structural heart abnormalities and two cases of heart dysfunction. In 8 out of 10 cases with structural heart defects, the diagnosis was suspected at early TV‐echo. In three cases, although the main diagnosis was correct, details of cardiac defects were missed at early TV‐echo. Among the heart defect group, five cases had an abnormal karyotype (41.7%) and nine cases showed extra‐cardiac anomalies (75%). There were two false negative cases at early TV echo (two cases of hypoplastic left ventricle). There were no false positive diagnoses. In our series, the sensitivity to detect congenital heart defects was 83% by early TV‐echo and 80% by conventional transabdominal echocardiography.

Conclusions:  Early high‐frequency TV‐echo can provide a comprehensive assessment of the fetal heart. The high rate of successful visualization of the fetal heart provides a reliable diagnosis of major cardiac defects at this early stage of pregnancy. However, at present this examination should be restricted to high risk pregnancies.