bluuebunny/crossref_metadata_2025 huggingface dataset:
Doppler velocimetry and the assessment of fetal well‐being in normal and diabetic pregnancies
Authors: Reece E. A. , Homko C. J. , Wiznitzer A.
Published: March 2003

Doppler ultrasound has been proposed as a useful addition to antepartum testing in high‐risk pregnancies. Increased placental resistance has been associated with underlying placental vascular disease, as well as abnormal fetoplacental blood flow. Since pregnancies complicated by diabetes are at risk for these complications, the application of Doppler ultrasonography for such pregnancies has been evaluated by several investigators.

Multiple investigations have examined the relationship between maternal blood glucose levels and abnormal Doppler waveforms in women with diabetes. Of the nine published studies, four found a correlation between Doppler indices and glucose control, as measured by mean blood glucose levels and glycosylated hemoglobin levels, while five did not. However, this apparent discrepancy may be explained by the fact that the majority of women studied were in good or excellent control, as this is currently the accepted standard of care. In fact, the one study performed in primarily non‐diabetic women demonstrated that increases in maternal plasma glucose concentrations of 30 mg/dl were followed by significant rises in the mean pulsatility index in both the umbilical and carotid arteries. More dramatic was the finding by most investigators that systolic/diastolic (S/D) ratios in third‐trimester umbilical arteries were elevated in women with evidence of diabetic microvascular disease. Elevated third‐trimester S/D ratios were associated with adverse maternal and perinatal outcomes in these women, specifically pre‐eclampsia and intrauterine growth retardation.

In conclusion, although elevated Doppler indices correlated with adverse outcomes in diabetic pregnancies, Doppler indices may be elevated in the otherwise uncomplicated diabetic patient with associated microvascular disease and with a normal outcome. Therefore, the Doppler ultrasound assessment of fetal well‐being in diabetic pregnancies must be interpreted with caution. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Audit of a screening service for fetal abnormalities using early ultrasound scanning and maternal serum α‐fetoprotein estimation combined with selective detailed scanning
Authors: Chambers S. E. , Geirsson R. T. , Stewart R. J. , Wannapirak C. , Muir B. B.
Published: March 2003

The objective of the study was the evaluation of a screening service for fetal abnormality using early ultrasound scanning to date and establish viability of the pregnancy combined with maternal serum α‐fetoprotein estimation at 16 weeks and thereafter selective detailed scanning at 18–20 weeks based on clinical indication. The study was designed to be retrospective, emphasizing the possibility of diagnosis. Early scans were performed by radiographers and radiologists, detailed ones by radiologists and obstetricians with subspecialty training in prenatal diagnosis. The study was carried out in the ultrasound department of a large University Hospital. The subjects studied were all cases of abnormality identified pre‐ or postnatally in women delivering in the hospital over 4 years and to whom the screening service applied. Information was obtained from ultrasound and maternity records, birth notifications, pathology and autopsy reports and a special needs register. Cases were classified as not detectable, potentially detectable and usually detectable. Major fetal anomalies numbered 255 (total deliveries 19 497), a prevalence of 1.3%; 130 (51%) were diagnosed by ultrasound with 64%; before 24 weeks and 36% later. Eleven chromosomal anomalies (4%) were diagnosed by genetic methods and 114 (45%) anomalies were not diagnosed antenatally. The sensitivity of the program was 37% before 24 weeks. Chromosomal anomalies, lesions of the central nervous system and cardiac defects were most common, followed by lesions of the gastrointestinal and urinary tracts. A large proportion of the detected and detectable anomalies were lethal. The implementation of a policy of routine scans at 18–20 weeks for fetal abnormality would be justified if it led to improved obstetric decision‐making, reduction in child handicap and less parental suffering. A routine stun applied to our population might not have achieved these except in a comparatively small number of cases. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Early fetal endocardial fibroelastosis and critical aortic stenosis: a case report
Authors: Rustico M. A. , Benettoni A. , Bussani R. , Maieron A. , Mandruzzato G.
Published: March 2003

Endocardial fibroelastosis is characterized by an abnormal thickening of the endocardium of one or both ventricles; the disorder may occur with or without other cardiac anomalies. A diagnosis of endocardial fibroelastosis in utero using fetal echocardiography may be made on the basis of increased echodensity of the endocardium and poor contractility of the ventricle. We describe a case of very early diagnosis of fibroelastosis and aortic valve stenosis observed in utero at 14 weeks' gestation by transvaginal echocardiography. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Predictive value of antepartum ultrasound examination for anomalies in twin gestations
Authors: Edwards M. S. , Ellings J. M. , Newman R. B. , Menard M. K.
Published: March 2003

The purpose of this study was to evaluate the accuracy of antenatal ultrasonography in the detection of fetal anomalies among twin gestations cared for in a specialized antepartum twin clinic.

A retrospective study was performed of 245 consecutive twin gestations followed in our twin clinic. The sensitivity, specificity and diagnostic indices of ultrasound to detect prenatal anomalies in the 490 infants delivered from July 1988 to October 1994 were determined.

Fourteen infants had isolated congenital anomalies, and ten had multiple anomalies. The overall prevalence of congenital anomalies was 4.9%. Antepartum ultrasound examination had a sensitivity of 88% and a specificity of 100% for the detection of an anomalous infant, with a positive predictive value of 100% and a negative predictive value of 99%. The sensitivity of ultrasound for each individual anomaly within the cohort was 82%, with 100% specificity, 100% positive predictive value, and 98% negative predictive value.

Our conclusions are that serial antepartum ultrasound examination of twins for congenital anomalies in our institution is very specific, with high positive and negative predictive values. The sensitivity, while also excellent, has limitations, which should be discussed with the patient. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Intrauterine growth of triplets as estimated from liveborn birth weight data
Authors: Yuval Y. , Seidman D. S. , Achiron R. , Goldenberg M. , Alcalay M. , Mashiach S. , Lipitz S.
Published: March 2003

This study was conducted to estimate intrauterine growth of triplet pregnancies from liveborn birth weights. During the years 1975–92, 109 sets of triplets were born at our hospital. Ten sets were excluded because of either major fetal anomalies or fetal death of one or more of the fetuses. The remaining 99 sets of triplets consisted of 297 newborns that were weighed immediately after birth. The mean birth weight was plotted against gestational week. The estimated intrauterine growth of triplets, in contrast to singletons, exhibited neither an acceleration phase during the third trimester, nor a flattening of the growth curve during the last few weeks of the third trimester. The mean birth weight of triplets was slightly below the 10th centile for singletons at 38 weeks' gestation or later. We conclude that the growth of triplet fetuses as estimated from live born birth weights is slower than that of singletons. The diagnosis of intrauterine growth retardation in triplet pregnancies should be based on growth curves to be devised for triplet pregnancies. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal ultrasonographic diagnosis of fetal hydrocephalus due to infection with parainfluenza virus type 3
Authors: Seidman D. S. , Nass D. , Mendelson E. , Shehtman I. , Mashiach S. , Achiron R.
Published: March 2003

Parainfluenza virus type 3 is one of the most common causes of respiratory infection in infants. No complications of pregnancy or fetal anomalies have been reported in association with parainfluenza virus infection. A pregnancy was terminated at 22 weeks' gestation due to ultra‐sonographic diagnosis of hydrocephalus. Pathological examination was consistent with viral encephalitis, ventriculitis and pneumonia. Serological investigation demonstrated a significant rise in maternal antibody titers for parainfluenza virus type 3. Parainfluenza virus type 3 may be associated with severe fetal infection in the first half of pregnancy. Serological studies for this virus should be considered in cases of fetal hydrocephalus. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic characteristics of adenofibroma of the endometrium following tamoxifen therapy for breast cancer: two case reports
Authors: Huang K.‐T. , Chen C.‐A. , Cheng W.‐F. , Wu C.‐C. , Jou H.‐J. , Hsieh C.‐Y. , Lin G.‐J. , Hsieh F.‐J.
Published: March 2003

Adenofibroma of the endometrium is thought to be a rare benign variant of the mixed mesodermal tumor, and its preoperative diagnosis is difficult. We describe the sonographic characteristics of two cases of adenofibroma of the endometrium. In both cases the patient was receiving prolonged tamoxifen therapy following surgery for breast cancer. Sonographically, this rare disease is observed as an intracavitary mass containing multiple small cysts with low‐resistance intratumor blood flow. The unique sonographic findings make the preoperative diagnosis possible. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Doppler indices from inferior vena cava and ductus venosus in predicting pH and oxygen tension in umbilical blood at cordocentesis in growth‐retarded fetuses
Authors: Rizzo G. , Capponi A. , Talone P. E. , Arduini D. , Romanini C.
Published: March 2003

The objective of this study was to assess the value of Doppler indices calculated from the inferior vena cava and ductus venosus in the identification of acidemia and hypoxemia as determined by pH and gas analysis of fetal blood obtained by cordocentesis in growth‐retarded fetuses. Doppler measurements were performed in the inferior vena cava and ductus venosus in 209 normally grown fetuses and in 89 growth‐retarded fetuses. All growth‐retarded fetuses were free from structural and chromosomal abnormalities, and uteroplacental insufficiency characterized by Doppler changes in the umbilical and middle cerebral arteries was the most likely etiology of the growth defect. In this group of fetuses, Doppler recordings were performed immediately before cordocentesis. Ten different indices were calculated from venous velocity waveforms, and reference limits for gestation were constructed by the cross‐sectional analysis of data from normally grown fetuses. Logistic regression and receiver operator characteristic curve analysis were performed to examine the relationship between Doppler indices and acid‐base status. The pre‐load index (peak velocity during atrial contraction/peak velocity during systole) in the inferior vena cava was the best explanatory variable for acidemia (χ2 = 48.33; p ≤ 0.001). Hypoxemia was predicted less well by venous indices and the best results were achieved by the S/A ratio in the ductus venosus (χ2 = 9.46; p ≤ 0.005). In conclusion, our data suggest that acidosis in growth‐retarded fetuses may be non‐invasively identified by Doppler measurements of the inferior vena cava and that a higher efficiency can be achieved by the use of the pre‐load index. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound‐guided hysteroscopic management of endometrial osseous metaplasia
Authors: Coccia M. E. , Becattini C. , Bracco G. L. , Scarselli G.
Published: March 2003

In the past, most cases of osseous metaplasia of the endometrium were diagnosed following removal of bone from the endometrium by dilatation and curettage and frequently subsequently treated by hysterectomy. Nowadays, management involves a suggested diagnosis by transvaginal ultrasound examination, confirmation by hysteroscopy and hysteroscopic removal of ectopic intrauterine bone. This is usually carried out under laparoscopic guidance. However, the degree of visual control provided by combined transabdominal and transrectal ultrasonography may prove sufficiently accurate for hysteroscopic guidance. In this report we describe a case of endometrial osseous metaplasia successfully managed by ultrasound‐guided hysteroscopy. The advantages of our approach include reduced invasiveness, reduced costs and simultaneous visualization of the abdominal and intrauterine cavities. One limitation, however, is represented by the greater operator dependence of ultrasound guidance as compared to laparoscopy, the former requiring extensive training and state‐of‐the‐art equipment.

We suggest that ultrasound guidance for hysteroscopic removal of extensive osseous metaplasia may represent a potentially safer and more effective alternative to laparoscopy and would therefore encourage further clinical evaluation of this technique. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Fetal megacystis at 10–14 weeks of gestation
Authors: Sebire N. J. , Von Kaisenberg C. , Rubio C. , Snijders R. J. M. , Nicolaides K. H.
Published: March 2003

During the study period, 24 492 pregnant women attended the Harris Birthright Research Centre at 10–14 weeks of gestation, at which time, in addition to the measurements of nuchal translucency thickness and crown‐rump length (CRL), data on fetal abnormalities were recorded onto a computer database. Cases of megacystis were identified and the records were reviewed. Additionally, the relationship of the longitudinal bladder diameter with the CRL and the bladder diameter/CRL ratio (expressed as a percentage) were examined with the use of data from 300 normal fetuses at 10–14 weeks.

Megacystis was present in 15 of the 24 492 pregnancies (1 in 1633) and in these cases the minimum longitudinal bladder diameter was 8 mm and the minimum bladder diameter/CRL ratio was 13 %. In the 300 control fetuses the bladder was visualized in 278 (92.7%) of the cases and the longitudinal bladder diameter increased with the CRL (bladder diameter = 0.065 × CRL − 0.69; r = 0.47, p < O.OOl), none of the measurements was more than 6 mm and the median bladder diameter/CRL ratio was 5.4% (range 0–l 0.4%) which did not change significantly with gestation (r = 0.1, p = 0.09). The bladder was visible in all cases with a minimum CRL of 67 mm. In three of the IS cases with megacystis, there were chromosomal abnormalities. In the chromosomally normal group, there were seven cases with spontaneous resolution, whereas in four cases there was progression to severe obstructive uropathy.

The bladder diameter was 8–12 mm and the bladder diameter/CRL ratio 13–22% in all cases with resolution and in one case with progressive megacystis; in the other three cases with progressive obstruction, the bladder length was more than 16 mm and the bladder diameter/CRL ratio was more than 28%. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal ultrasound and computed tomography combined with clinical parameters and CA‐125 determinations in the differential diagnosis of persistent ovarian cysts in premenopausal women
Authors: Guerriero S. , Mallarini G. , Ajossa S. , Risalvato A. , Satta R. , Mais V. , Angiolucci M. , Melis G. B.
Published: March 2003

The purpose of this prospective study was to compare the accuracy of computed tomography (CT) (and transvaginal ultrasonography in the differential diagnosis of persistent cystic ovarian lesions. The candidates for this study were 161 premenopausal non‐pregnant women with an adnexal mass. After a 3‐month follow‐up, 83 masses persisted and were examined by both techniques before surgery. We also evaluated the CA‐125 plasma levels. The CT and ultrasonographic diagnoses were then compared with the histopathological diagnosis. The overall agreement between the test results and the actual outcome was calculated by means of the kappa statistic. Transvaginal ultrasonography has a closer accuracy in the diagnosis of serous cysts and serous cystadenoma, ovarian carcinoma and endometrioma (value of kappa: 0.78, 0.73 and 0.80, respectively) than CT, even if the latter is associated with clinical and biochemical parameters such as patient's age and CA‐125 plasma levels. Only in the diagnosis of cystic teratoma, is transvaginal ultrasonography less accurate than CT. In conclusion, in premenopausal women, transvaginal ultrasonography remains a cost‐effective method in the diagnosis of most cystic ovarian lesions. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Intra‐amniotic debris identified at ultrasound scanning: a feature of congenital ichthyosis
Authors: Montague I. , Fox R. , Mann R.
Published: March 2003

A case is described in which intra‐amniotic debris was identified during an ultrasound scan in a woman with polyhydramnios at 33 weeks' gestation. At delivery neonate was found to have severe ichthyosis involving the whole of her head, trunk and limbs, with large plaques of hyperkeratotic skin on the palms of her hands and the soles of her feet. The finding of excessive debris in association with polyhydramnios should raise the possibility of an exfoliative skin disorder. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Uterine cavity assessment prior to in vitro fertilization: comparison of transvaginal scanning, saline contrast hysterosonography and hysteroscopy
Authors: Ayida G. , Chamberlain P. , Barlow D. , Kennedy S.
Published: March 2003

A total of 44 patients undergoing in vitro fertilization (IVF) and requiring uterine cavity assessment agreed to have both saline contrast hysterosonography (ISCHS) and hysteroscopy. SCHS was performed following a baseline transvaginal scan by injection of saline into the uterine cavity during continuous scanning. Hysteroscopy was performed with a flexible fiberscope with a 3.6‐mm outer diameter; 38 of 44 women (84%) underwent both procedures. Hysteroscopy diagnosed intrauterine abnormalities in 16 women. SCHS was in complete agreement in 13 of 16 cases. As a screening test for any cavity abnormality, SCHS had a 87.5% sensitivity, 100% specificity, 100% positive predictive value and 91.6% negative predictive value. In 14 women, an abnormal uterine cavity was apparent on transvaginal scanning (TVS). However, TVS, unlike SCHS, could not (1) confidently diagnose submucosal fibroids in the presence of a uterus with multiple fibroids; (2) distinguish between a hyperplastic endometrium and a large polyp; or (3) differentiate between an arcuate and a septate uterus. In addition, ovarian pathology was diagnosed on TVS in five women: endometrioma (n = l), complex cysts (n = 2) and polycystic ovaries (n = 2). SCHS is a simple, accurate, well‐tolerated procedure that can be performed within a fertility unit, avoiding invasive and expensive diagnostic hysteroscopy. Significant findings can be treated by operative hysteroscopy prior to commencing an IVF treatment cycle. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Hepatic mesenchymal hamartoma: a pediatric tumor that may be diagnosed prenatally
Authors: Tovbin J. , Segal M. , Tavori I. , Lotan G. , Maymon R.
Published: March 2003

Hepatic mesenchymal hamartoma is a benign tumor, defined as an excessive focal overgrowth of mature normal cells and stroma native to the liver. The increasing popularity of antenatal scanning has resulted in in utero diagnosis of congenital malformations and anomalies that previously became apparent only after delivery. Herein, we present a rare case of fetal mesenchymal hamartoma of the liver, which was initially sonographically detected at 29 weeks of gestation. A brief literature survey and obstetric recommendations for management and monitoring of such rare cases are included. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Post‐Cesarean section pain secondary to intussuscepting colonic adenocarcinoma
Authors: Steinberg L. , Nisenbaum H. L. , Horii S. C. , Salhany K. E.
Published: March 2003

The differential diagnosis for lower abdominal and pelvic pain following Cesarean section includes many causes, such as endomletritis, abscess, pelvic hematoma, wound complications, pelvic vein thrombophlebitis, gastrointestinal dysfunction and obstruction. Colonic obstruction secondary to intussusception is a rare cause. We present a case of post‐Cesarean section pain in a 26 year‐old patient due to obstructing colocolic intussusception secondary to colonic adenocarcinoma. Review of the literature failed to identify a previous case report of colonic adenocarcinoma with intussusception presenting early in the postpartum period. The diagnosis was initially made by ultrasound, and later corroborated by computed tomography, harium enema and laparotomy. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Persistent patent urachus with allantoic cyst: a case report
Authors: Tolaymat L. L. , Maher J. E. , Kleinman G. E. , Stalnaker R. , Kea K. , Walker A.
Published: March 2003

Patent urachus results when there is a persistence of an allantois remnant which normally undergoes atresia during embryological development. It can lead to an abdominal wall defect similar in appearance on ultrasound to an omphalocele.

A 34‐year‐old primigravida presented at 19 weeks' gestation for evaluation of a cystic mass arising at the umbilical cord insertion. The initial impression of the referring physician was an omphalocele. The mass arose from the abdominal wall and the umbilical cord inserted into the membranous covering of the mass, which appeared to be fluid‐filled and separate from but contiguous with the urinary bladder. Serial sonography followed the progression of the abdominal wall mass. At term, the patient underwent primary Cesarean section with delivery of a 4494‐g male infant. The infant underwent repair and closure of the patent urachus and plastic reconstruction of the abdominal wall.

When the urachus remains patent, it can lead to a urinary fistula which mimics the ultrasound appearance of an omphalocele. However, patent urachus is associated with a much lower rate of abnormalities than omphalocele, yielding a better fetal prognosis. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Results of chromosomal analysis in fetuses with cardiac anomalies as diagnosed by first‐ and early second‐trimester echocardiography
Authors: Gembruch U. , Baschat A. A. , Knöpfle G. , Hansmann M.
Published: March 2003

Chromosomal analyses were performed in 36 fetuses with cardiac anomalies diagnosed by echocardiography at 11 + 1 to 15 + 6 weeks of gestation. Karyotyping was successful in 35 cases and 17 (48.6%) had anomalies, including five with Turner's syndrome, seven with trisomy 18, four with trisomy 21 and one with triploidy. The commonest cardiac anomaly observed in trisomy 21 was a complete atrioventricular canal; in trisomy 18 was ventricular septal defect; in Turner's syndrome was a hypoplastic aortic arch in combination with hypoplasia of the left ventricle and left ventricular outflow tract; and in the case of triploidy was a ventricular septal defect. These findings confirm the opinion that, in fetuses with chromosomal anomalies, there is a high incidence of cardiac defects. Furthermore, there is a distinct pattern of cardiac defects associated with each chromosomal anomaly. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Second‐trimester measurements of placental volume by three‐dimensional ultrasound to predict small‐for‐gestational‐age infants
Authors: Hafner E. , Philipp T. , Schuchter K. , Dillinger‐Paller B. , Philipp K. , Bauer P.
Published: March 2003

Objective

The objective of this study was to investigate the value of second‐trimester three‐dimensional sonographic placental volume measurements to predict infants who are below the 10th Gentile for birth weight.

Subjects and methods Placental volume measurements were performed using three‐dimensional ultrasound in 382 women with normal singleton pregnancies at 16–23 weeks' gestation. Logistic multivariate regression consisting of variables considered to influence birth weight was used to predict infants with a birth weight below the 10th centile from the placental volume measurements.

Results

Prognostic influence could be shown for placental volume (p ≤ 0.0001), gestational week at the time of measurement (p = 0.0002) and maternal weight at the time of registration (p = 0.0025). Values for specificity and sensitivity achieved by choosing an ‘optimal’ cut‐off point of 0.16 for the estimation probability for a small‐for‐gestational‐age (SGA) infant were low at 82.5% and 52.5%, respectively.

Conclusions

Three‐dimensional sonograpbic measurement of the placental volume alone is not a satisfactory technique for predicting SGA infants. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Blood flow changes in the ovarian and uterine arteries in women with polycystic ovary syndrome who respond to clomiphene citrate: correlation with serum hormone concentrations
Authors: Zaidi J. , Jacobs H. , Campbell S. , Tan S. L.
Published: March 2003

Objective

Our purpose was to study the hemodynamic changes in the uterine and intraovarian vessels in women with polycystic ovary syndrome (PCOS) and to relate the vascular changes to hormonal indices.

Methods

Six women with a history of previous anovulatory cycles and/or oligomenorrhea and/or elevated serum luteinizing hormone concentrations in addition to polycystic ovaries underwent induction of ovulation with clomiphene citrate. Serial transvaginal ultrasonography was performed on menstrual cycle day 2, daily from the estimated day of ovulation minus 6, 6‐hourly from the estimated day of ovulation minus 2 or when the mean follicular diameter was greater than 16 mm (whichever was earlier) until 6 h after follicular rupture, and once 7 days after follicular rupture. At each scan, uterine and intraovarian blood flow was assessed by transvaginal color Doppler ultrasound, and serum concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol and progesterone were assessed by fluoroimmunoassay.

Results

All six women demonstrated ultrasonographic features of ovulation. Follicular peak systolic blood flow velocity (Vmax) and ovarian stromal Vmax in the dominant ovary increased during the follicular phase of the menstrual cycle and reached a peak at 36 and 42 h after the onset of the LH surge of 30.7 ± 4.6 cm/s and 37.0 ± 3.9 cm/s, respectively. There was no significant change in the ovarian stromal Vmax of the non‐dominant ovary. There was no significant change in the pulsatility index (PI) in either the follicular or the ovarian stromal vessels during the menstrual cycle. The changes in follicular Vmax correlated significantly with changes in serum concentrations of FSH, LH and progesterone. Uterine artery time‐averaged maximum velocity (TAMX) declined to its lowest levels at LH surge minus 6 days, and thereafter increased. In contrast, the PI increased during the follicular phase of the cycle, reaching a peak at LH surge minus 4 days, and thereafter declined. The changes in uterine artery PI correlated inversely with serum estradiol and serum progesterone concentrations.

Conclusions

Women with PCOS have significant differences in intraovarian and uterine artery hemodynamics, both at the baseline ultrasound scan and during the clomiphene‐induced menstrual cycle, compared with women with normal ovaries. The intraovarian and uterine artery vascular differences are likely to be due to a primary disorder within the polycystic ovary and their different hormonal status. Clomiphene citrate may have an effect on uterine artery blood flow. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The umbilical artery pulsatility index in the first trimester: is there an association with increased nuchal translucency or chromosomal abnormality?
Authors: Brown R. , Di Luzio L. , Gomes C. , Nicolaides K. H.
Published: March 2003

Objective

The aim of this study was to examine the possible association between umbilical artery pulsatility index (PI) at 10–14 weeks of gestation and either increased fetal nuchal translucency (NT) or fetal chromosomal abnormality.

Design

This was a prospective study of women undergoing chorionic villus sampling (CVS). Subjects A total of 458 women undergoing CVS were studied; in 418 cases the karyotype was normal and in 19 cases fetal trisomy 21 was identified.

Subjects

A total of 458 women undergoing CVS were studied; in 418 cases the karyotype was normal and in 19 cases fetal trisomy 21 was identified.

Methods

Data from the women with a normal fetal karyotype and in whom the NT was also normal were used to calculate reference ranges for the umbilical artery PI. Associations were sought between umbilical artery PI and increased NT and between the PI and fetal trisomy 21. Results We found no association between umbilical artery PI and NT, nor was there a difference in the PI between chromosomally normal pregnancies and those with fetal trisomy 21.

Conclusion

The results suggest that fetoplacental vascular resistance per se does not contribute to increased NT and that measurement of the umbilical artery PI does not contribute to the first‐trimester detection of fetal trisomy 21. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Objective and subjective assessment of abnormal uterine artery Doppler flow velocity waveforms
Authors: Bower S. , Kingdom J. , Campbell S.
Published: March 2003

Objective

Abnormal uterine artery Doppler waveforms in the second trimester of pregnancy can predict adverse outcome. The presence of a diastolic notch is a better predictor than measurement of impedance indices. A notch has generally been assessed subjectively, which has raised questions as to the reproducibility of the method. The aim of this study was to compare subjective and objective assessments of 50 abnormal waveforms.

Design

This was a retrospective study of 50 abnormal uterine artery waveforms collected during a previous screening study. Subjective and objective assessments were compared and related to adverse outcomes. Five impedance indices incorporating a measurement of the diastolic notch were compared. Three indices predictive of adverse outcome were compared to subjective assessment.

Results

There was good agreement between experienced operators in their subjective assessment of uterine artery waveforms. Adverse outcome was predicted by only moderately or severely abnormal waveforms. Three impedance indices predictive of adverse outcome were the pulsatility index (PI), A/C and (D – C)/B (where A is the peak systolic, D is the maximum diastolic and B is the end‐diastolic frequency, and C is the nadir of the notch). The cut‐off values combining the highest sensitivity for the lowest false‐positive rate were 1.5 for PI, 3.0 for A/C and 0.15 for (D – C)/B. A PI of 1.5 had the highest sensitivity (100%) and positive predictive value (55%) for adverse outcome in this preselected group. These three indices were compared to subjective assessment using the kappa index and the (D – C)/B ratio had the closest agreement, although all three indices showed at least moderate agreement. The cut‐off values of 1.5, 3.0 and 0.15 for PI, A/C and (D – C)/B, respectively appear to differentiate between mildly abnormal waveforms and moderately/severely abnormal waveforms.

Conclusion

Objective assessment of uterine artery waveforms using cut‐off values of PI, A/C and (D – C)/B provides an estimation similar to that provided by subjective assessment by an experienced operator. These ratios will now need to be used prospectively in an unselected population to compare their screening properties. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of atypical cystic lesions of the fetal scalp
Authors: Okaro E. , Broussin B. , Ville Y.
Published: March 2003

Two cases of cystic lesions of the fetal scalp are described. They were initially thought to be meningoceles, but the brain was normal on ultrasound examination and there were no associated abnormalities. In the first case, by 26 weeks' gestation, the original cystic lesion had regressed to a dense tissue mass; in the second case, the cyst remained as a small anechoic mass.

Postnatal assessment in the first case revealed a plexiform skin lesion measuring 40 x 15 mm on the left parietal bone. This was mobile and not attached to the underlying structures. The skull showed no obvious defect and a cranial scan was normal. In the second case, an epidermal cyst was diagnosed. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Intravaginal saline as a contrast agent for cervical sonography in the obstetric patient
Authors: O'Brien J. M. , Allen A. A. , Barton J. R.
Published: March 2003

Objective

To determine whether intravaginal saline alters visualization of the cervix during endovaginal sonographic examinations.

Design

A prospective trial with comparison of sonographic measurements of cervical length prior to and after administration of an intravaginal contrast agent.

Subjects

Patients with an indication for endovaginal ultrasonographic assessment of the cervix were considered as candidates for the study.

Methods

After assessment of cervical dimensions and contour of the internal cervical os, 10 ml of normal saline was placed intravaginally via a needleless syringe. Pre‐ and post‐contrast sonographic examinations of the cervix were compared.

Results

Twenty‐six patients were enrolled. No differences were observed in the identification of funnelling (37% in each group, p = 1.0) or the quantification of cervical length for the entire cohort (p = 0.95). However, in a subset of patients in whom the external os was not satisfactorily visualized (23%), intravaginal contrast resulted in a mean difference in cervical length pre‐ and post‐saline infusion of 6.4 mm compared to 1.4 mm in patients in whom the external os could be easily identified (p < 0.001). No patient expressed undue discomfort related to the administration of contrast.

Conclusion

Intravaginal saline assists in visualization of the cervix during endovaginal sonography for selected patients in whom precise identification of the external os is difficult. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Fetal heart rate and umbilical artery velocity variability in pregnancies complicated by insulin‐dependent diabetes mellitus
Authors: Ursem N. T. C. , Clark E. B. , Keller B. B. , Wladimiroff J. W.
Published: March 2003

Objectives

To examine the variability in fetal heart rate and absolute flow velocity, which are possible hemodynamic markers of cardiovascular homeostasis in pregnancies complicated by diabetes mellitus.

Methods

Doppler studies of umbilical artery velocity waveforms were performed at 12–21 weeks of gestation in 16 women with well‐controlled type I (insulin‐dependent) diabetes mellitus. From umbilical artery velocity wave‐forms of at least 13 s in duration, we determined absolute values and beat‐to‐beat variability for fetal heart rate and umbilical artery flow velocities and compared these findings with normal controls matched for gestational age.

Results

Fetuses of diabetic women displayed increased fetal heart rate variability and umbilical artery peak systolic velocity. Fetal heart rate, umbilical artery time‐averaged velocity and variability in umbilical artery flow velocity were not essentially different between the two groups.

Conclusion

Fetal heart rate variability and umbilical artery peak systolic velocity may be markers for fetal cardiovascular homeostasis in pregnancies complicated by insulin‐dependent diabetes mellitus. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Yolk sac and umbilicoplacental hemodynamics during early human embryonic development
Authors: Mäkikallio K. , Tekay A. , Jouppila P.
Published: March 2003

Objectives

To determine the relationship between the yolk sac and umbilicoplacental circulations during the first trimester of pregnancy.

Design

Sixteen normal singleton pregnancies were included in this longitudinal study. Transvaginal ultrasonography with color and pulsed Doppler was performed at 5+, 7+, 8+ and 10+ gestational weeks. Fetal heart rate and blood velocity waveforms of yolk sac, umbilical and chorionic arteries were obtained.

Results

The detection rate of arterial blood flow in the yolk sac increased significantly from 5+ (2/16) to 7+ gestational weeks (12/16). Thereafter, it declined significantly and no arterial blood flow was detected at 10+ weeks. When the arterial blood flow was observable in the yolk sac, all waveforms consisted of continuous diastolic blood flow. There were no significant changes in peak systolic velocity (PSV), time‐averaged maximum velocity (TAMXV), pulsatility index (PI) or resistance index (RI) values of the yolk sac arteries during the study period. In umbilical arteries, blood flow was detected in two of 16 patients at 5+ weeks and in all cases thereafter. The mean umbilical artery PSV (SD) increased from 7.2 cm/s (3.7) at 8+ weeks to 13.0 cm/s (2.9) at 10+ weeks (p = 0.001). No changes in PI values were found and the absence of diastolic flow was typical of the umbilical artery during the study period. In chorionic arteries, blood flow was detected in six out of 16 subjects at the 5+ week, in 14 out of 16 patients at the 7+ week and in every case thereafter. No changes in PSV or TAMXV values were found.

Conclusions

Our results showed that the arterial signals in the yolk sac circulation disappeared and the umbilicoplacental circulation increased between 8+ and 10+ weeks of gestation. This indicates that the placenta replaces the yolk sac as an essential source of blood supply to the embryo at that time. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Do heart rate and velocity variability derived from umbilical artery velocity waveforms change prior to clinical pregnancy‐induced hypertension?
Authors: Ursem N. T. C. , Clark E. B. , Keller B. B. , Hop W.C.J. , Wladimiroff J. W
Published: March 2003

Objective

To investigate the hypothesis that alterations in heart rate variability, peak systolic velocity variability and time‐averaged velocity variability in the human umbilical artery may predict early signs of dysfunctional fetal‐ placental coupling in pregnancies that later develop pregnancy‐ induced hypertension.

Methods

Doppler flow velocity recordings from the umbilical artery were performed at 10–20 weeks of gestation in 12 nulliparous women who subsequently developed pregnancy‐induced hypertension. From umbilical artery velocity waveforms of at least 12 s in duration we determined absolute values and beat‐to‐beat variability in fetal heart rate, peak systolic and time‐averaged velocity and compared these findings with those in normal nulliparous pregnant women matched for gestational age.

Results

Absolute values for fetal heart rate, peak systolic and time‐averaged velocity as well as beat‐to‐beat variability in fetal heart rate did not differ significantly between women later developing pregnancy‐induced hypertension and normal controls. However, variability in peak systolic velocity and time‐averaged velocity were decreased in women who subsequently developed pregnancy‐induced hypertension.

Conclusions

Whereas fetal heart rate variability was similar, umbilical artery flow velocity variability was reduced in women developing pregnancy‐induced hypertension compared with controls. It is proposed from this study that variability of the umbilical artery flow velocity is associated with mechanical changes in the vascular bed of women who later develop pregnancy‐induced hypertension. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis and follow‐up of 14 cases of unilateral ventriculomegaly
Authors: Senat M. V. , Bernard J. P. , Schwärzler P. , Britten J. , Ville Y.
Published: March 2003

Objective

To report prospectively the prenatal diagnosis, management and outcome of 14 cases of unilateral ventriculomegaly.

Methods

Fourteen fetuses were diagnosed as having one ventricle of ≥ 10 mm, as measured at the level of the atrium.

Results

In ten cases, the scan showed mild unilateral ventriculomegaly with an atrium width between 11 and 13 mm and this remained stable up to term. Eight of these fetuses had a magnetic resonance imaging scan in utero between 32 and 34 weeks of gestation which confirmed the diagnosis of mild ventriculomegaly without other brain abnormalities and showed a normal cortical mantle. No obvious cause was found and the outcome was normal in all cases. In four cases, the unilateral ventriculomegaly evolved rapidly with an atrium width up to 20–25 mm. Causes included atresia of the foramen of Monro, toxoplasmosis, brain atrophy and Weaver syndrome. Three underwent termination of pregnancy and the postmortem examination confirmed the diagnosis. The baby with brain atrophy and schizencephaly had a ventriculoperitoneal shunt placed at 1 month of age and has severe developmental delay at 9 months.

Conclusion

The prognosis of unilateral ventriculomegaly is uncertain. Examination of both ventricles during the anomaly scan should be performed, as should ultrasound follow‐up of these cases up to the end of the third trimester. Fetuses with an isolated, mild, stable unilateral ventriculomegaly seem to have a favourable neurological outcome. However, fetuses with rapidly evolving unilateral ventriculomegaly or cases associated with other brain abnormalities may have a poor neurological outcome. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
The association between congenital heart disease and Down syndrome in prenatal life
Authors: Paladini D. , Tartaglione A. , Agangi A. , Teodoro A. , Forleo F. , Borghese A. , Martinelli P.
Published: March 2003

Objective To assess the relationship between congenital heart disease (CHD) and Down syndrome (DS) in utero.

Design Retrospective case series.

Subjects Fifty‐two fetuses with a cytogenetic diagnosis of DS managed at our Fetal Cardiology Unit in the study period. In particular, two populations of fetuses with DS were studied: a group of 41 DS fetuses referred to our unit for fetal echocardiography due to the chromosomal anomaly and a second group of 274 fetuses referred because of suspected CHD, 11 of which were found to have DS.

Methods All fetuses were submitted to detailed ultrasound evaluation of fetal anatomy. Associated extra‐cardiac anomalies, and presence and type of CHD, were recorded for all fetuses. Karyotyping was obtained by means of cordocentesis or amniocentesis. Necropsy or neonatal echocardiograms were sought for confirmation of the prenatal diagnosis.

Results In the group of 41 fetuses with known DS, the incidence of CHD was 56% ([atrioventricular septal defect (AVSD) 44%, ventricular septal defect (VSD) 48%], the remainder having other heart defects). Conversely, considering the incidence of DS in fetuses with CHD, 43% of all AVSDs (53% of AVSD with normal visceral situs) were associated with DS, whereas none of the 39 cases of VSD was associated with trisomy 21. Ventricular septal defects were diagnosed only in fetuses referred to our center with a known diagnosis of aneuploidy.

Conclusions We have confined that more than half of the fetuses with DS bear a CHD, which is an AVSD in 44% of cases. Conversely, 43% of fetuses with an AVSD have trisomy 21. For VSDS, the situation is controversial, due to the relatively low detection level of this heart defect at the routine mid‐trimester obstetric scan.
Comparison of Lerner score, Doppler ultrasound examination, and their combination for discrimination between benign and malignant adnexal masses
Authors: Valentin L.
Published: March 2003

Objective To determine whether the combined use of Lerner’s morphologic score and color Doppler ultrasound examination results in better discrimination of benign and malignant adnexal masses than the use of Lerner’s score alone or Doppler variables alone.

Design One hundred and seventy‐three consecutive women with a pelvic mass judged clinically to be of adnexal origin underwent preoperative ultrasound examination including color and spectral Doppler techniques. One hundred and forty‐nine tumors were benign and 24 malignant. The sensitivity and false‐positive rate with regard to malignancy were calculated for Lerner’s score, six Doppler variables and combinations of Lerner’s score and Doppler variables. Previously defined gray scale and Doppler criteria of malignancy were used and tested prospectively. The best method was defined as that detecting most malignancies with the lowest false‐positive rate.

Results Lerner’s score had a sensitivity of 92% and a false‐positive rate of 36%. The best Doppler variable—time‐averaged maximum velocity—had similar diagnostic properties with a sensitivity of 100% and a false‐positive rate of 41%. Combining Lerner’s score with Doppler measurement of time‐averaged maximum velocity—i.e. requiring both Lerner’s score and time‐averaged maximum velocity to indicate malignancy for a malignant diagnosis to be made—had a sensitivity of 92% and a false‐positive rate of 19%.

Conclusions The combined use of Lerner’s score and measurement of time‐averaged maximum velocity is a better method for discrimination of benign and malignant adnexal masses than the use of Lerner’s score alone or Doppler ultrasound examination alone. The clinical value of the combined method needs to be cross‐validated prospectively in a new series of tumors.
Acute bowel perforation in a fetus with gastroschisis
Authors: Haberman S. , Burgess T. , Klass L. , Cohn B. D. , Minkoff H. L.
Published: March 2003

Gastroschisis is a congenital anomaly with a reported incidence of 1 in 10 000 live births. Although prenatal diagnosis is more common with the widespread use of biochemical markers and obstetric ultrasound, the role of ultrasound in the identification of the fetus that might need early intervention has not been established.

Acute bowel perforation was diagnosed by ultrasound at 34 weeks gestation in a fetus with gastroschisis. An immediate Cesarean section was performed, followed by repair with primary closure. The neonatal outcome was favorable. The post‐partum findings, including bowel pathology, confirmed the antenatal diagnosis.

Acute bowel perforation can be diagnosed antenatally. Immediate intervention, before further bowel injury occurs, might enhance the ability of the surgeon to perform primary closure and obtain a favorable outcome. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology