bluuebunny/crossref_metadata_2025 huggingface dataset:
Uterine sarcoma: can it be differentiated from uterine leiomyoma with Doppler ultrasonography? A preliminary report
Authors: Hata K. , Hata T. , Maruyama R. , Hirai M.
Published: March 2003

Our objective was to evaluate whether intratumoral blood flow analysis could differentiate uterine sarcoma from uterine leiomyoma. Color and pulsed Doppler findings obtained from 41 patients with histologically proven uterine leiomyoma and five with uterine sarcoma (four leiomyosarcoma, one mixed mesodermal tumor) were retrospectively assessed. Intratumoral blood flow velocicy waveforms were recorded, and the resistance index (RI) and peak systolic velocity (PS V) were calculated.

There was no significant difference between the RI (median 0.647; range 0.422–0.896) in the uterine leiomyomas and the RI (median 0.663; range 0.330–0.774) in the uterine sarcomas. The PSV (median 61.6 cm/s; range 410.0–124.0 cm/s) in the uterine sarcoma was significantly higher (median 21.6 cm/s, range 6.3–48.6 cm/s) than that in the uterine leiomyomas (p < 0.05). When a cut‐off value for the PSV of 41.O cm/s (mean PSV of the uterine leiomyomas plus 2 standard deviations) was considered, the detection rate for uterine sarcoma was 80.0%, and the false‐positive rate was 2.4%. These results suggest that the PSV within the tumor detected by color and pulsed Doppler ultrasonography could be useful for the preoperative differential diagnosis of uterine sarcoma. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Uterine perfusion and endometrial thickness in postmenopausal. women on long‐term continuous combined estrogen and progestogen replacement
Authors: Dören M. , Süselbeck B. , Schneider H. P. G. , Holzgreve W.
Published: March 2003

We assessed the resistance index (RI) and pulsatility index (Pi), peak and average systolic velocities in uterine, arcuate and radial arteries, and endometrial thickness (ET) by transvaginal B mode and color Doppler sonography in patients on continuous combined hormonal replacement therapy (HRT) and controls. HRT consisted of 2 mg estradiol, 1 mg estriol and 1 mg norethisterone acetate daily (n = 33) compared to controls, who received none of these (n = 21). Age was 61 ± 6 and 59 ± 9 years (mean ± standard deviation) in the HRT and control groups, respectively. The duration of HRT was 5 ± 2 years, with a minimum of 1 year. We found that the uterine RI and, to a lesser extent, the uterine PI were significantly lower and the radial peak systolic velocities were significantly higher in the HRT group compared to controls. The highest uterine PI values were measured in controls with the shortest life‐time exposure to endogenous estrogens, i.e. late menarcheal age or early menopause. The endometrial thickness of 2.8 ± 1.8 mm in the HRT group was not significantly different from that in the controls (4.2 ± 5.6 mm). In conclusion, the alteration in blood flow parameters demonstrated in this study would suggest that the long‐term use of continuous oral estradio12 mg, estriol 1 mg and norethisterone acetate 1 mg daily is associated with a slight increase of flow in the uterine arteries compared to controls matched for (postmenopausal) age. Endometrial thickness does not increase with duration of use of continuous combined HRT. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of ventriculo‐coronary communications in a second‐trimester fetus using transvaginal and transabdominal color Doppler sonography
Authors: Chaoui R. , Tennstedt C. , Göldner B. , Bollmann R.
Published: March 2003

We report on the prenatal diagnosis of ventriculo‐coronary communication associated with pulmonary atresia and an intact interventricular septum. The diagnosis was made by transvaginal color Doppler sonography at 17 weeks' gestation and confirmed by transabdominal sonography at 19 weeks. Color Doppler demonstrated the communication between the distal hypoplastic right ventricle and the right coronary artery, with the course of this vessel situated along the outer heart wall. Spectral Doppler assessment showed bidirectional arterial flow in this vessel. Extra‐cardiac skeletal anomalies (cleft hands and feet) were also detected and classified as an ectrodactyly‐ectodermal dysplasia clefting (EEC) syndrome. This led the parents to opt for termination of pregnancy. All findings were confirmed on autopsy. Using stereomicroscopy the malformations of the coronary system and main connections to the lumen of the right ventricle were additionally demonstrated.

To our knowledge this is the first report on the identification of coronary artery malformations in a midtrimester fetus using transvaginal color Doppler. The early appearance enabled us to investigate the pathophysiological sequence of the combined defect. Further investigation might elucidate whether ventriculo‐coronary communications arise secondary to pulmonary atresia and intact inter‐ventricular septum, due to increased ventricular pressure, or are the primary defect leading to intrauterine pulmonary atresia or, indeed, whether both defects appear simultaneously. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Abnormal pulmonary venous return diagnosed prenatally by pulsed Doppler flow imaging
Authors: Feller Printz B. , Allan L. D.
Published: March 2003

Pulsed Doppler ultrasound has been used to characterize distinctive pulmonary venous flow patterns in the normal fetus and child. Changes in these characteristic flow patterns have been related to abnormal atria1 and ventricular hemodynamics. We report a case of total anomalous pulmonary venous return diagnosed prenatally because of an abnormal pulsed Doppler echocardiographic flow pattern, even though color flow mapping appeared to demonstrate normal pulmonary venous drainage. This case demonstrates the importance of obtaining pulsed Doppler pulmonary venous flow profiles during fetal echocardiography, especially in cases of complex congenital heart disease. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
A cross‐sectional study of changes in fetal renal size with gestation in appropriate‐ and small‐for‐gestational‐age fetuses
Authors: Konje J. C. , Okaro C. I. , Bell S. C. , de Chazal R. , Taylor D. J.
Published: March 2003

This cross‐sectional study aimed to determine whether there are differences in kidney size and shape in small‐ and appropriate‐for‐gestational‐age fetuses at different gestations. In the Fetal Growth Clinic: of a large university hospital in England, 219 singleton fetuses were studied cross‐sectionally at different gestational ages from 22 to 38 weeks. At each gestational age, the fetal kidney length, circumference and anterior‐posterior and transverse diameters were measured using an Aloka 650 SL machine. At birth, the fetuses were classified as small or appropriate for gestational age, depending on the birth weight centile; the various kidney measurements for the two groups were compared.

The kidney lengths at different gestational ages were similar in the two groups. The circumference and transverse and anterior‐posterior diameters were significantly greater in the appropriate‐for‐gestational‐age fetuses from about 28 weeks' gestation.

We conclude that differences in fetal kidney size with gestation manifest from as early as 26–28 weeks. The differentially smaller anterior‐posterior and transverse kidney diameters in small‐for‐gestational age fetuses resulted in altered renal morphology, producing sausage‐shaped kidneys. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Limb amputation in amniotic band syndrome: serial ultrasonographic and Doppler observations
Authors: Tadmor O. P. , Kreisbe G. A. , Achiront R. , Porat S. , Yagel S.
Published: March 2003

A 28‐year‐old woman, gravida 7, para 6, was referred at 21 weeks' gestation to our ultrasound unit because of bilateral fetal lower limb edema diagnosed previously. Ultrasonography showed a constriction ring around both legs, and, with the aid of color Doppler, arterial flow was demonstrated in both legs beneath the constriction ring. Subsequent examinations during the 24th and 28th weeks revealed absence of flow below the constriction ring of the right leg and decreased flow in the left leg. This was followed by the gradual bending, breaking and resorption of the tibia and fibula of the right leg. Between weeks 30 and 34, gradual shrinkage of the remains of the right leg beneath the knee was recorded by serial ultrasonic observations. At the 38th week of gestation, a male infant was born by normal vaginal delivery. Examination at birth revealed amputation of the right leg below the knee, with a denuded end of the stump. There was a partial amputation of the left leg below the knee, with tissue continuity being maintained by the posterior neurovascular bundle, and a posterior strip of skin. The left foot was extremely edematous, with an area of necrosis dorsally.

This case afforded us the opportunity of in utero following of natural limb amputation in the amniotic band syndrome. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
The incorporation of maternal age into the sonographic scoring index for the detection at 14–20 weeks of fetuses with Down's syndrome
Authors: Bromley B. , Lieberman E. , Benacerraf B. R.
Published: March 2003

Sonographic markers for Down's syndrome have been useful in the identification of affected fetuses. In this study, we evaluated the accuracy of an expanded scoring index that included recently described sonographic markers as well as maternal age to optimize identification of fetuses with Down's syndrome.

Over a 27 month period, we performed 4075 genetic amniocenteses for advanced maternal age or an abnormal triple panel. Prior to each amniocentesis, a complete sonographic assessment of the fetus was performed including a structural survey and fetal biometry. Each patient was assigned a score based on the sonographic markers in a previously reported scoring system, modified by the addition of an echogenic intracardiac focus. The sonographic scoring system was then combined with the assignment of additional points based on maternal age. Karyotypic results were obtained subsequent to the scans, and Down's syndrome fetuses and a control group of normal fetuses were compared.

Fifty‐three fetuses with Down's syndrome were identified by karyotype and compared to a control group of 177 normal fetuses. A score of ≥ 2 as a criterion for a positive test resulted in the identification of 75.4% of fetuses with Down's syndrome, with a 5.7% false‐positive rate. A score of ≥ 1 increased the sensitivity to 83.0%, with a false‐positive rate of 17.5%. The age‐adjusted modification resulted in the identification of 86.8% of fetuses with Down's syndrome, with a false‐positive rate of 27.1%. It is for the individual patient and her practitioner to weigh the risks and benefits in selecting her options for prenatal diagnosis. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Body stalk anomaly at 10–14 weeks of gestation
Authors: Daskalakis G. , Sebire N. J. , Jurkovic D. , Snijders R. J. M. , Nicolaides K. H.
Published: March 2003

In a multicenter project of screening for chromosomal defects by fetal nuchal translucency thickness and maternal age at 10–14 weeks, 14 of 106 727 fetuses examined had body stalk anomaly. The ultrasonographic features were a major abdominal wall defect, severe kyphoscoliosis and a short umbilical cord. In all cases, the upper part of the fetal body was in the amniotic cavity, whereas the lower part was in the celomic cavity. The nuchal translucency thickness was above the 95th centile in ten (71.4%) of the cases, but the fetal karyotype was normal in all 12 fetuses evaluated. The findings suggest that early amnion rupture before obliteration of the celomic cavity is a possible cause of the syndrome. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal ultrasonography combined with color velocity imaging and pulsed Doppler to detect residual trophoblastic tissue
Authors: Alcázar J.L.
Published: March 2003

The value of transvaginal B‐mode ultrasonography combined with color velocity imaging and pulsed Doppler to detect retained trophoblastic tissue was evaluated prospectively in a series of 40 patients with postpartum (n = 15) or postabortion (n = 25) bleeding. Color velocity imaging was used to identify color‐coded blood flow signals within myometrium and/or endometrium. Flow was subjectively quantified as absent, scanty or abundant. Pulsed Doppler was used to assess blood flow impedance by calculating the resistance index. The presence of abundant flow with a lowest resistance index of less than 0.45 was considered as suspicious of residual trophoblastic tissue. Twenty‐two (55%) out of the 40 patients underwent dilatation and curettage and chorionic villi were demonstrated in 1.5 of these. Eighteen (45%) patients were managed conservatively. None of these patients suffered complications or needed readmission for curettage, and all of them were considered as not having retained tissue. On color pulsed Doppler ultrasound examination, 15 patients had suspected retained tissue; all of these underwent curettage and residual trophoblast was found in 14 (93.3%). Out of 2.5 patients considered as having no residual tissue on color pulsed Doppler ultrasound examination, seven underwent curettage and chorionic villi were found in one patient (false‐negative rate 6.7%) All patients managed conservatively had an unsuspicious scan. We concluded that transvaginal ultrasonography combined with color velocity imaging and pulsed Doppler could be useful to detect retained trophoblastic tissue and to select patients suitable for conservative management. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Bilateral massive ovarian edema: a case report
Authors: Roberts C.L. , Weston M.J.
Published: March 2003

Massive ovarian edema is an unusual cause of ovarian enlargement in young patients. Most cases are thought to result from venous and lymphatic obstruction, producing edema. We report the case of a 15‐year‐old girl with bilateral massive ovarian edema, findings on ultrasound imaging, and a review of the literature. The sonographic appearance is non‐specific and can mimic neoplasia, and the definitive diagnosis requires histological examination. It is, however, an important condition to consider in a young patient with a complex ovarian mass in an appropriate clinical setting, as conservative treatment with ovarian preservation is often possible. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal sonographic characteristics and Doppler blood flow study in a case of a large fetal mediastinal teratoma
Authors: Liang R.‐I. , Wang P. , Chang F.‐M. , Chang C.‐H. , Yu C.‐H.
Published: March 2003

Although fetal mediastinal teratomas may result in respiratory distress in the neonatal period and lead to perinatal mortality, they are rarely diagnosed prenatally. Furthermore, their impact on fetal hemodynamics has never been described. We report a case of a large fetal mediastinal teratoma prenatally visualized at 38 weeks' gestation by both two‐ and three‐ dimensional ultrasound. We also describe the associated changes in the Doppler flow velocimetry, namely, a decrease in cardiac output, prolonged acceleration time in the pulmonary artery and an increase in the umbilical artery S/D ratio. The baby was well at the 5‐month follow‐up after an operation in the neonatal period. From our case, we believe that accurate prenatal diagnosis and assessment by two‐ and three‐dimensional ultrasound as well as Doppler flow velocimetry may contribute to a better perinatal outcome. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis and outcome of subamniotic hematomas
Authors: Deans A. , Jauniaux E.
Published: March 2003

Subamniotic hematomas are classical placental pathological lesions resulting from the rupture of chorionic vessels near the cord insertion. Most subamniotic hematomas are found after birth and result from excessive traction on the umbilical cord at delivery. The development of these lesions has been rarely reported in utero. We report here five cases of subamniotic hematomas diagnosed by ultrasound between 18 and 30 weeks of gestation. The sonographic features were those of a poorly reflective oval‐shaped cystic mass overlying the fetal plate of the placenta and covered in a thin membrane. In all the cases, a cystic structure containing a thrombotic mass arising from the amniotic membrane, which was attached to the fetal placental surface, was found after delivery. A high maternal serum α‐fetoprotein level was found retrospectively in the four cases for which this information was available. Two pregnancies were complicated by slow fetal growth, one by vaginal bleeding and one by polyhydramnios. These findings demonstrated that subamniotic hematoma can be accurately diagnosed in utero by ultrasound and differentiated from other lesions of the placental chorionic plate. The findings also show that, although the lesion is located between the chorion and the amnion, it can be associated with fetomaternal hemorrhage and with fetal growth restriction. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Outcome of fetuses with enlarged nuchal translucency and normal karyotype
Authors: Bilardo C. M. , Pajkrt E. , de Graaf I. , Mol B. W. , Bleker O. P.
Published: March 2003

The aim of this study was to examine the relationship between nuchal translucency measurements and outcome of pregnancy with special regard to fetuses with an enlarged nuchal translucency and a normal karyotype. Fetal nuchal translucency measurements were performed on consecutive mothers attending the prenatal diagnosis center of our hospital. A complete follow‐up was obtained in 88.4% of the cases. Of the 74 fetuses (4.4%) with an enlarged nuchal translucency (<3 mm), 25 (33.8%) had an abnormal karyotype. Two pregnancies ended in a spontaneous abortion before karyotyping was performed. In the remain‐ing 47 eukaryotic fetuses with enlarged nuchal translucency, five (10.6%) had a structural anomaly, two were affected by genetic syndromes (4.2%) and an additional four fetuses (8.5%) were affected by a single‐gene disorder. A spontaneous abortion or an intrauterine death occurred in 6.4% and in 2.1% of these fetuses, respectively. The total incidence of an unfavorable outcome in the group of chromosomally normal fetuses with enlarged nuchal translucency was 32%. In contrast, in the group with a normal nuchal translucency (+3 mm), the incidence of an unfavorable outcome was 7.5%. There is a strong association between enlarged nuchal translucency measurements and congenital (structural and genetic) abnormalities, as assessed by receiver operator characteristic analysis. This may represent, in fetuses with a normal karyotype, a non‐specific sign of a disturbance in the developmental process. In these cases, detailed ultrasound surveillance is recommended. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Cervical length at 23 weeks of gestation: prediction of spontaneous preterm delivery
Authors: Heath V. C. F. , Southall T. R. , Souka A. P. , Elisseou A. , Nicolaides K. H.
Published: March 2003

Objective

To examine the potential value of routine measurement of cervical length in singleton pregnancies at 23 weeks of gestation in the prediction of the risk for early spontaneous preterm delivery.

Methods

Cervical length was measured by sonography at 23 weeks in 2567 singleton pregnancies in women attending for routine antenatal care. In 43 women, the length was ≤15 mm and 21 of these were managed expectantly, whereas in 22 cases a cervical cerclage was placed. In the pregnancies that were managed expectantly, the relation between cervical length and preterm delivery was examined and the risk of spontaneous delivery at ≤ 32 weeks was estimated.

Results

Cervical length at 23 weeks was ≤ 15 mm in 1.7% of cases; this group contained 86%, 58% and 20% of pregnancies that delivered spontaneously at ≤ 28, ≤ 32 and ≤ 36 weeks, respectively. The risk for delivery at ≤ 32 weeks decreased from 78% at a cervical length of 5 mm to 4% at 15 mm and 0.5% at 50 mm.

Conclusions

Cervical length at 23 weeks is ≤ 15 mm in < 2% of the population; this group contains about 90% and 60% of the women delivering at ≤ 28 and ≤ 32 weeks, respectively. Measurement of cervical length provides accurate prediction of risk for early preterm delivery. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Detection rate of the cervical gland area during pregnancy by transvaginal sonography in the assessment of cervical maturation
Authors: Sekiya T. , Ishihara K. , Yoshimatsu K. , Fukami T. , Kikuchi S. , Araki T.
Published: March 2003

Objectives

To detect the cervical gland area during normal pregnancy, and to determine its detection rate and relationship with cervical maturation.

Design

This was a mixed longitudinal and cross‐sectional sonographic study involving a total of 514 transvaginal scans performed for detection of cervical gland area and measurement of cervical length in 260 normal singleton pregnancies at 16–41 weeks of gestation. The conventional cervical maturation index was measured simultaneously by digital examination.

Results

The detection rate of cervical gland area remained practically constant until the 31st week of pregnancy, but significantly decreased thereafter. Highly significant correlations were noted between the detection rate of cervical gland area and cervical length, cervical gland area and cervical maturation index, and cervical length and cervical maturation index.

Conclusions

This study showed for the first time that cervical gland area can be detected sonographically and that its absence might be a predictor of preterm labor. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of a large fetal arachnoid cyst
Authors: Rafferty P. G. , Britton J. , Penna L. , Ville Y.
Published: March 2003

A case of prenatal diagnosis and management of a giant fetal arachnoid cyst is presented. The importance of an accurate diagnosis is highlighted and the use of three‐dimensional ultrasound is discussed. The recent literature is reviewed. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Can transvaginal fetal biometry be considered a useful tool for early detection of skeletal dysplasias in high‐risk patients?
Authors: Gabrielli S. , Falco P. , Pilu G. , Perolo A. , Milano V. , Bovicelli L.
Published: March 2003

Objective

To evaluate the possibility of an early diagnosis of skeletal dysplasias in high‐risk patients.

Methods

A total of 149 consecutive, uncomplicated singleton pregnancies at 9–13 weeks' amenorrhea, with certain menstrual history and regular cycles, were investigated with transvaginal ultrasound to establish the relationship between femur length and menstrual age, biparietal diameter and crown‐rump length, using a polynomial regression model. A further eight patients with previous skeletal dysplasias in a total of 13 pregnancies were evaluated with serial examinations every 2 weeks from 10–11 weeks.

Results

A significant correlation between femur length and crown‐rump length and biparietal diameter was found, whereas none was observed between femur length and menstrual age. Of the five cases with skeletal dysplasias, only two (one with recurrent osteogenesis imperfecta and one with recurrent achondrogenesis) were diagnosed in the first trimester.

Conclusions

An early evaluation of fetal morphology in conjunction with the use of biometric charts of femur length against crown‐rump length and femur length against biparietal diameter may be crucial for early diagnosis of severe skeletal dysplasias. By contrast, in less severe cases, biometric evaluation appears to be of no value for diagnosis. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of alobar holoprosencephaly at 10 weeks of gestation
Authors: Turner C. D. , Silva S. , Jeanty P.
Published: March 2003

Alobar holoprosencephaly is an intracranial abnormality characterized by failure of proper cleavage of the prosencephalon, accompanied by incomplete midfacial development. The prenatal sonographic diagnosis of alobar holoprosencephaly was first described in 1984; however, there have been only two reports of alobar holoprosencephaly diagnosed in the first trimester. We report a case of alobar holoprosencephaly diagnosed at 10 weeks of gestation. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Does the measurement of four fetal arteries provide more information than the measurement of just two arteries in prenatal Doppler sonography?
Authors: Meyberg G. C. , Solomayer E.‐F. , Grischke E.‐M. , Bastert G.
Published: March 2003

Objective

The objective of this study was to evaluate whether the measurement of two or more fetal arteries provides more information and leads to a selection of fetuses at higher risk.

Design

In 244 pregnancies Doppler examinations in four fetal arteries (fetal aorta, common carotid artery, middle cerebral artery, umbilical artery) were performed. The evaluation of the results was made by means of a Doppler score for standardization and systematization. The results were divided into four groups (normal, pre‐pathological, pathological, highly pathological) and the individual correlations with fetal outcome parameters were investigated. The results from measuring only two fetal arteries (the fetal aorta and middle cerebral artery) were then compared with those from all four arteries.

Results

Increasing pathology of the Doppler score correlated with fetal outcome parameters. The results showed that if the Doppler result in the two‐vessel measurement was normal (n = 180), pre‐pathological (n = 29) or highly pathological (n = 12) then measuring four vessels generally brought no additional information. However, the four‐vessel measurement was of advantage in the pathological group (n = 23) because it selected the high‐risk fetuses (30.4%), as categorized by outcome.

Conclusions

Differentiating between several degrees of pathology is important for the estimation of fetal risk. In cases of pathological Doppler findings, the measurement of more than two vessels is important in order to select fetuses at increased risk. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of adrenal neuroblastoma by ultrasound: a report of two cases and review of the literature
Authors: Kesrouani A. , Duchatel F. , Seilanian M. , Muray J. M.
Published: March 2003

Prenatal diagnosis of neuroblastoma is a rare event. Two cases diagnosed at 32 and 34 weeks are reported together with a description of the various ultrasound appearances of this tumor. Both cases had a favorable outcome and surgery was necessary in only one case. The management options are discussed in the light of the current literature. The role of ultrasound in the detection and follow‐up of this tumor in the third trimester of pregnancy is discussed. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Pathophysiology and treatment of fetal anemia due to placental chorioangioma
Authors: Haak M. C. , Oosterhof H. , Mouw R. J. , Oepkes D. , Vandenbussche F. P. H. A.
Published: March 2003

Placental chorioangiomas occur in 1% of pregnancies. Large chorioangiomas may cause serious complications such as fetal anemia, hydrops and fetal death. In this case report, a pregnancy complicated by a large placental chorioangioma is described. Severe fetal anemia without the occurrence of hydrops fetalis was suspected using ultrasound and Doppler examinations. Successful intrauterine blood transfusion was performed, with an unusually large amount of blood needed to obtain an adequate rise in fetal hematocrit. Two weeks later, at 32 weeks, the infant was born in good condition.

In pregnancies with large chorioangiomas, we advise regular ultrasound and Doppler examinations, with the aim of detecting fetal anemia before hydrops develops. When anemia is suspected, fetal blood sampling is indicated and intrauterine transfusion therapy may be beneficial to preserve fetal health until maturity is reached. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of dacryocystocele: a possible marker for syndromes
Authors: Sharony R. , Raz J. , Aviram R. , Cohen I. , Beyth Y. , Tepper R.
Published: March 2003

We present our experience of the sonographic prenatal diagnosis of dacryocystocele and review the literature. This lesion can be distinguished from a facial hemangioma, dermoid or anterior encephalocele by the ultrasound findings and Doppler flow studies. These conditions are separate entities and their associated diagnosis and prognosis are very different in each case. As dacryocystocele may be part of numerous syndromes, its prenatal visualization raises the rare possibility of associated anomalies. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
The assessment of endometrial pathology and tubal patency: a comparison between the use of ultrasonography and X‐ray hysterosalpingography for the investigation of infertility patients
Authors: Strandell A. , Bourne T. , Bergh C. , Granberg S. , Asztely M. , Thorburn J.
Published: March 2003

Objectives

The aim of the present study was to examine the role of hysterosalpingocontrast sonography (HyCoSy) as a screening test for endometrial and tubal pathology at the start of the infertility investigation protocol.

Methods

HyCoSy was compared with X‐ray hystero‐salpingography (HSG) for the assessment of the endometrial cavity and Fallopian tube patency. A total of 103 women with a history of at least 1 year's infertility were included. Each woman underwent both HyCoSy and HSGon the same day. Laparoscopy was performed in 43 cases. For HyCoSy examinations, saline was used for evaluation of the endometrial cavity and Echovist ® contrast medium to assess Fallopian tube patency.

Results

The concordance between HyCoSy and HSG for the presence of endometrial cavity pathology was 90%, but for tubal patency the concordance was lower (72%). HyCoSy classed more examinations of tubal patency as uncertain. HSG more frequently classified tubes as occluded. In the subset of patients in whom all three techniques were used, HSG and HyCoSy demonstrated a high concordance with laparoscopy (83% and 80%, respectively). The prevalence of occluded tubes according to laparoscopy as the reference standard was 13%. The two methods had a high negative predictive value for tubal disease (HSG, 94%; HyCoSy, 88%), and the positive predictive values were 47% and 75%, respectively. The detection rate for occluded tubes was 73% and 27%, and specificity 87% and 90%, respectively.

Conclusions

Our data demonstrate that HyCoSy obtains similar information about the status of the endometrial cavity and Fallopian tube patency to that of HSG. It is possible that in some cases HyCoSy may replace HSG in order to select women with patent tubes who may be suitable for further infertility treatment without more invasive investigation. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
WS09‐05Sonographic appearance of borderline ovarian tumors
Authors: Exacoustòs C. , Rinaldo D. , Carusotti C. , Arduini D. , Romanini C.
Published: March 2003

Background

The aim of the present study is to individuate sonographic markers which make it possible to distinguish borderline ovarian tumors from benign and malignant cysts, thus allowing conservative treatment.

Method

We reviewed transvaginal sonograms in 23 women who presented borderline ovarian tumors histologically confirmed. Sixteen were premenopausal and 7 postmenopausal. The size and morphologic criteria of each mass and color flow Doppler characteristics were evaluated. We compared these findings with those of 337 patients with benign ovarian tumors and those of 40 patients with malignant ovarian tumors.

Results

Of the 16 borderline ovarian tumors in premenopause 6 were mucinous cystoadenomas and 10 serous cystoadenomas. Of the 7 borderline tumors in postmenopause 3 were mucinous cystoadenomas and 4 serous cystoadenomas. The analysis of grey scale morphologic findings revealed the presence of solid tissue in 92.5% of malignant masses, in 13.3% of benign tumors (P < 0.01) and in 31% of LMP tumors (P < 0.01 vs. malignant, P = n.s vs. benign tumors). The presence of papillae within the cysts was significantly higher in borderline tumors (21%) compared to benign and malignant tumors. Three unilocular cysts with a diameter > 5 cm were borderline tumors.

Conclusion

The most frequent diagnostic imaging was that of a papillae inside a cyst without other signs of complexity and also the presence of septa was frequent. Neither papillae nor septa constituted sensitive sonographic markers.
Patient acceptance of endovaginal ultrasound
Authors: Cowan Bennett C. , Richards D.S.
Published: March 2003

Objective
 To assess women’s experiences and attitudes regarding endovaginal ultrasound.

Methods
 Women attending the obstetrics and gynecology clinics at the University of Florida were asked to complete an anonymous questionnaire.

Results
 Of respondents who had had a prior endovaginal ultrasound examination, 26% reported that ‘it hurt a lot’ and 50% reported that ‘it hurt a little’. In contrast, only 23% of patients had experienced any pain with a prior abdominal ultrasound (P < 0.001). Multivariate analysis showed that discomfort with a prior vaginal ultrasound was related to patient age category, with less discomfort being experienced with increasing ages (P = 0.001). A history of unwanted sex, sexual or physical abuse, or dyspareunia was not associated with more painful examinations. Most patients were willing to undergo a future vaginal ultrasound investigation if it were recommended by their doctor. Multivariate analysis showed that more willingness was associated with older age category (P = 0.004), a history of dyspareunia (P = 0.03) and bleeding in a current pregnancy (P = 0.005). Of the patients (less than half) who had a preference, most preferred a female sonographer for endovaginal sonography (P < 0.001) and most preferred that a doctor, rather than a nurse or technician, perform the examination (P < 0.001).

Conclusions
 The majority of women who had experienced a vaginal ultrasound examination found it somewhat uncomfortable, but almost all women who returned the questionnaire expressed a willingness to undergo endovaginal ultrasound if it were recommended.
Demonstration of a recto‐vaginal fistula with the ultrasound contrast medium Echovist
Authors: Henrich W. , Meckies J. , Friedmann W.
Published: March 2003

The demonstration of a recto‐vaginal fistula in a patient with Crohn's disease is described. The patient was examined by vaginal ultrasound using the contrast medium Echovist‐200 (SHU 454, Schering AG, Berlin). This agent had not been used before under these circumstances and proved to be successful.
Congenital microcephaly detected by prenatal ultrasound: genetic aspects and clinical significance
Authors: Den Hollander N.S. , Wessels M.W. , Los F.J. , Ursem N.T.C. , Niermeijer M.F. , Wladimiroff J.W.
Published: March 2003

Objective

The aim of this study was to analyze fetuses with prenatally diagnosed microcephaly including the nature of associated anomalies and the genetic‐diagnostic implications.

Design

Retrospective study design.

Methods

A total of 30 fetuses with reliable dates and with prenatally diagnosed microcephaly as a common feature were analyzed.

Results

Microcephaly was diagnosed at a mean gestational age of 28 weeks. More than half of the fetuses were also small for gestational age. Five subsets of microcephaly emerged from this study: (1) isolated microcephaly (16.7%); (2) microcephaly due to holoprosencephaly (16.7%); (3) microcephaly associated with chromosomal disorders (23.3%); (4) microcephaly as part of a genetic syndrome (20.0%); and (5) microcephaly as part of multiple anomalies (23.3%).

Conclusions

In 25 out of 30 infants microcephaly proved to be part of a complex problem, emphasizing the need of a meticulous search for structural anomalies and fetal karyotyping when biometric data are not according to gestational age. The etiologic heterogeneity and variability of microcephaly in genetic syndromes are among the more difficult issues in prenatal ultrasound in pregnancies either with an incidental finding of this anomaly, or in cases with a recurrence risk. The complex situations described in this study demonstrate the importance of follow up, post‐mortem investigation and careful genetic counseling. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Automated cardiac output measurements by ultrasound are inaccurate at high cardiac outputs
Authors: Basdogan F. , Visser W. , Struijk P. C. , Jansen J. R. C. , Vletter W. B. , Wladimiroff J. W. , Lotgering F. K.
Published: March 2003

Objective

The sonographic technique of automated cardiac output measurement (ACM) is a promising new method to measure cardiac output and could be of use in a high‐risk obstetric unit in the treatment of pre‐eclamptic patients. The aim was to determine the accuracy of the ACM method.

Design

Comparative study of the sonographic technique of ACM versus cardiac output measured by thermodilution (TD).

Methods

The study included 39 intensive care patients, 21 men, 13 non‐pregnant women and five severely pre‐eclamptic pregnant patients, with a wide range of cardiac outputs, in whom TD catheters had been inserted for clinical reasons. Two separate experienced observers, blinded to the results obtained with the other method, performed four successive measurements in each patient with either the ACM or TD technique. The averaged cardiac output value per patient and method was used for comparison.

Results

Cardiac output was successfully measured with ACM and TD in 85 and 100% of patients, respectively. Mean cardiac output measured by ACM (6.77 ± 1.90 L/min) was significantly lower than that measured by TD (9.12 ± 3.06 L/min). Although cardiac output values obtained with ACM were significantly correlated with those measured by TD, the ACM values were consistently lower than TD values in the higher cardiac output range; the relationship was represented by ACM = 0.35 TD + 3.55 L/min (r = 0.57, P < 0.001). The (ACM − TD) difference increased significantly with cardiac output, through a difference in stroke volume, not in heart rate.

Conclusion

The ACM is not an accurate tool to measure cardiac output in patients with a high cardiac output, including treated pre‐eclamptic women. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Echocardiographic assessment of ventricular filling pressure during the second and third trimesters of gestation
Authors: Pacileo G. , Paladini D. , Russo M. G. , Pisacane C. , Santoro G. , Calabrò R.
Published: March 2003

Aims

To confirm changes in the atrioventricular diastolic flow velocities (peak E, peak A, E/A ratio) with gestational age and to define whether these changes genuinely reflect variations in filling pressure in the fetal heart.

Methods

Fifty normal pregnancies were studied between the 13th and the 37th weeks of gestation. The fetal flow velocity patterns were evaluated by pulsed‐wave (PW) Doppler and the annular velocities of the atrioventricular valves by PW‐Doppler tissue imaging (DTI).

Results

All indexes evaluated (atrioventricular peak flow and annular velocities) correlated significantly with gestational age. This correlation was stronger for the early diastolic indexes (tricuspid E and EA, 0.69 and 0.78; mitral E and EA, 0.61 and 0.77, respectively) and weaker for the end‐diastolic indexes (tricuspid A and AA, 0.46 and 0.37; mitral A and AA, 0.45 and 0.39, respectively). Neither mitral nor tricuspid E/Ea ratio changed significantly with gestational age.

Conclusions

The lack of correlation between the Doppler‐assessed ventricular filling pressures and gestational age suggests absence of significant changes of ventricular compliance during the second and third trimesters of pregnancy, and a progressive enhancement of active relaxation and/or changes in loading conditions. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of solid placental masses: the value of color flow imaging
Authors: Sepulveda W. , Aviles G. , Carstens E. , Corral E. , Perez N.
Published: March 2003

Objectives

To determine the value of color flow imaging in the prenatal differentiation of solid placental masses protruding from the fetal surface of the placenta.

Methods

Seven pregnancies in which a large solid mass was seen on the fetal surface of the placenta were prospectively studied. Color flow imaging was used to identify vessels within the mass and the prenatal ultrasound finding correlated with placental pathology.

Results

Postpartum examination of the placenta revealed four cases of chorioangioma, two cases of subchorionic thrombohematoma and one case of subamniotic hematoma. Prenatal ultrasound using color flow imaging correctly identified all cases of placental chorioangioma by the demonstration of blood flow within the mass. Conversely, absence of blood flow signals was invariably documented in both cases of subchorionic thrombohematoma and in the single case of subamniotic hematoma. Among the four cases of chorioangioma, two developed complications requiring delivery. No complications were noted in cases of avascular placental masses in this series.

Conclusions

Color Doppler ultrasound plays an important role in the prenatal evaluation of solid placental masses. This technique allows the identification of those cases at increased risk of pregnancy complications which need close monitoring throughout gestation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
New use for Argyle trocar catheter: treatment of pelvic abscess following transvaginal ultrasound‐directed follicle aspiration (UDFA)
Authors: Nargund G. , Parsons J.
Published: March 2003

This report describes the use of an Argyle trocar catheter for the drainage of pelvic abscesses following transvaginal ultrasound‐directed follicle aspiration (UDFA) for oocyte collection. Three patients treated with this technique recovered uneventfully. We conclude that the use of an Argyle trocar catheter for colpotomy in the management of pelvic abscesses appears to be simple and effective. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Selective versus non‐selective laser photocoagulation of placental vessels in twin‐to‐twin transfusion syndrome
Authors: Quintero R. A. , Comas C. , Bornick P. W. , Allen M. H. , Kruger M.
Published: March 2003

Objective

We have recently described a surgical technique for the treatment of twin‐to‐twin transfusion syndrome (TTTS) that allows precise identification of vascular anastomoses (selective laser photocoagulation of communicating vessels, or S‐LPCV). The purpose of this study was to compare S‐LPCV with the previous non‐selective technique (NS‐LPCV) that targeted all vessels crossing the dividing membrane.

Materials and Methods

Patients with TTTS were treated with NS‐LPCV from May 1994 to June 1997 and with S‐LPCV from July 1997 to December 1999. TTTS was defined as polyhydramnios of ≥8 cm maximum vertical pocket (MVP) in the recipient twin and oligohydramnios of ≤2 cm MVP in the donor twin. Outcome was measured as survival per number of pregnancies and per number of fetuses together with limited morbidity data.

Results

NS‐LPCV was used in 18 patients and 74 were treated with S‐LPCV. Three patients interrupted their pregnancies electively after surgery (S‐LPCV) and were removed from further analysis. Survival of at least one fetus was higher in S‐LPCV (83.1%) than in NS‐LPCV (61.1%) (P = 0.04), mostly due to a lower rate of dual intra‐uterine fetal demise in S‐LPCV (5.6%) than in NS‐LPCV (22%) (P = 0.05). There were more hydropic fetuses in the NS‐LPCV group (27%) than in the S‐LPCV group (5.4%), but this difference did not account for the results. There was no difference in the survival per number of fetuses between the two groups.

Conclusions

S‐LPCV represents an important evolution in the surgical treatment of TTTS. The use of this technique by all centers should allow better comparison of fetal survival and morbidity rates. S‐LPCV should be the standard technique in trials comparing amniocentesis versus laser for the treatment of severe TTTS. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic markers of exencephaly at 9 + 3 weeks of gestation
Authors: Becker R. , Mende B. , Stiemer B. , Entezami M.
Published: March 2003

Following the introduction of transvaginal sonography, several first trimester diagnoses of the exencephaly anencephaly sequence have been reported, with the earliest being described at 10 weeks of gestation. We report a case with a high index of suspicion for exencephaly at 9 weeks and 3 days because of three sonographic features: the cranial pole of the embryo was smaller than the chest, the cranial pole bulged dorsally and the surface of the cranium was irregular. The diagnosis was confirmed by a repeat ultrasound examination at 11 + 4 weeks and by autopsy after termination of pregnancy. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic assessment of amniotic fluid volume between 11 and 24 weeks of gestation: construction of reference intervals related to gestational age
Authors: Gramellini D. , Delle Chiaie L. , Piantelli G. , Sansebastiano L. , Fieni S. , Vadora E.
Published: March 2003

Objective

At present, most of the methods for sonographic assessment of amniotic fluid volume are unreliable in the second trimester of pregnancy, or else they do not present nomograms related to gestational age.

Design

The aim of this prospective cross‐sectional study was to construct normal reference ranges of four ultrasound parameters for the evaluation of amniotic fluid volume which could be applied in the second trimester. For these parameters we calculated normal curve limits suitable for use in clinical practice.

Subjects

From a population of normal pregnant women between the 12th and the 24th weeks of gestation undergoing a routine ultrasound examination during 1997 at our institute, 273 were found to be suitable for the study, after the exclusion of all cases which presented any feto‐maternal pathology or complications up to the 24th week.

Methods

The largest ‘amniotic pocket’ in a vertical direction, free of small fetal parts and umbilical cord, was measured: the maximum vertical and transverse diameters were measured on the same scan; the mean diameter and the product of the two diameters were calculated. The ‘mean amniotic fluid diameter’, the ‘two‐diameter pocket’, the ‘largest vertical pocket’ and the ‘largest transverse pocket’ were the four sonographic parameters considered.

Results

The four parameters correlated well with gestational week and with the biparietal diameter; the normal reference intervals and normal curve were then calculated. All these parameters were found to have good intra‐ and interoperative reproducibility.

Conclusions

We conclude that the use of an ultrasound semiquantitative method based on the measurement of a single amniotic fluid pocket and involving normal reference intervals according to gestational age could improve the early diagnosis of amniotic fluid variations during the second trimester, although this has yet to be confirmed by extensive clinical trials. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology