bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of fetal male gender: prenatal sonographic measurement of the scrotum and evaluation of testicular descent
Authors: Achiron R. , Pinhas‐Hamiel O. , Zalel Y. , Rotstein Z. , Lipitz S.
Published: March 2003

The study was conducted to construct a centile chart of fetal scrotal size and to determine gestational age at testicular descent. A prospective, cross‐sectional study was performed on 210 fetuses of normal, singleton pregnancies between 14 and 37 weeks' gestation. Scrotal circumference was measured by transvaginal ultrasonography and abdominal ultrasound between 14 and 17 weeks' and 18 and 35 weeks' gestation, respectively. The regression equation for scrotal circumference (SC) modelled as a function of gestational age (GA) was:

The correlation r = 0.96 was found to be highly statistically significant (p < 0.0001). The prediction of scrotal circumference per week and the 95% confidence interval (CI) were defined. Testicular descent was not observed prior to 25 weeks' gestation, with 30% of the fetuses having one or both testes descended at 25 weeks (p < 0.001) and 97% after 32 weeks. The presented normative data may be helpful in the prenatal diagnosis of suspected congenital syndromes that include, among their manifestations, scrotal abnormalities and early detection of cryptorchidism. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Suggested ultrasound parameters for the assessment of fetal well‐being during chronic hemodialysis
Authors: Malone F. D. , Craigo S. D. , Giatras I. , Carlson J. , Athanassiou A. , D'Alton M. E.
Published: March 2003

There are no published guidelines on how to assess fetal well‐being during hemodialysis. We have developed a specific protocol of renal and obstetric interventions to ensure that hemodialysis is associated with minimal changes in fetal status. We tested this protocol serially over a 9‐week period in a pregnant patient who was undergoing chronic hemodialysis for end‐stage renal disease. Testing involved serial assessments of uterine and umbilical artery blood flow with Doppler velocimetry and continuous fetal heart rate tracings, before, during and after each hemodialysis session. We found that, by strict adherence to these guidelines, there were no significant alterations in maternal mean arterial blood pressure, continuous fetal heart rate tracings, uterine artery systolic/diastolic ratios, or umbilical artery systolic/diastolic ratios. We conclude that stable uteroplacental and fetal perfusion can be maintained during chronic hemodialysis in pregnancy by adhering to a specific set of precautions. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Arterial and venous Doppler velocimetry in the severely growth‐restricted fetus and associations with adverse perinatal outcome
Authors: Ozcan T. , Sbracia M. , d'Ancona R. L. , Copel J. A. , Mari G.
Published: March 2003

Objective

To evaluate the association between arterial and venous Doppler waveforms and adverse perinatal outcome in severe intrauterine growth restriction.

Design

Fetuses between 26 and 32 weeks' gestation with ultrasonographically estimated fetal weight below the 5th centile were included in this prospective study. The last Doppler measurements of the umbilical artery, ductus venosus, umbilical vein and middle cerebral artery before delivery and adverse outcome parameters without gestational age independence were used for statistical analysis. Adverse outcome parameters were defined as the following: fetal demise or neonatal death in the first 30 days of life; 5‐min Apgar score of < 7; intubation at birth; retinopathy of prematurity; respiratory distress syndrome; necrotizing enterocolitis; stay in neonatal intensive care unit of more than 60 days; intraventricular hemorrhage; periventricular leukomalacia.

Results

Nineteen fetuses fulfilled the inclusion criteria. Perinatal death, low 5‐min Apgar values and necrotizing enterocolitis were gestational age‐independent adverse outcome parameters. Abnormal Doppler velocimetry of the ductus venosus was the only significant parameter associated with perinatal death and low 5‐min Apgar scores. None of the Doppler parameters predicted necrotizing enterocolitis.

Conclusion

Our data suggest that management of severely growth‐restricted fetuses may be aided by the study of ductus venosus Doppler velocimetry. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Jarcho‐Levin syndrome: two consecutive pregnancies in a Puerto Rican couple
Authors: Wong G. , Levine D.
Published: March 2003

This report describes two consecutive pregnancies in a Puerto Rican woman that were complicated by the autosomal recessive form of Jarcho‐Levin syndrome (spondylothoracic dysplasia). This syndrome, with multiple vertebral and rib malformations, leads to respiratory insufficiency and early neonatal death. The prenatal sonographic appearance is characterized by the presence of fanned‐out ribs from fused thoracic vertebral bodies. The features that distinguish spondylothoracic dysplasia and another subtype of Jarcho‐Levin syndrome, spondylocostal dysplasia, are discussed. Prenatal diagnosis allows for parental counselling and the possibility of termination of pregnancy if the lethal type of spondylothoracic dysplasia is diagnosed prior to fetal viability. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonographic and color Doppler analysis in the treatment of polycystic ovary syndrome
Authors: Battaglia C. , Genazzani A. D. , Artini P. G. , Salvatori M. , Giulini S. , Volpe A.
Published: March 2003

Objective

To compare the effect of a gonadotropin releasing hormone (GnRH) analog plus ‘add‐back’ oral contraceptive (OC) therapy with OC therapy alone on the clinical and hormonal parameters that are characteristic of polycystic ovary syndrome (PCOS).

Design

Prospective, randomized study.

Subjects

Thirty PCOS patients were randomly assigned to treatment with leuprolide acetate for depot suspension plus a combined monophasic OC (Group I) or to OC alone (Group II).

Methods

Hormonal (luteinizing hormone (LH), follicle stimulating hormone (FSH), LH : FSH concentration ratio, estradiol, androstenedione, testosterone), clinical (Ferriman‐Gallwey score), ultrasonographic (ovarian volume, number of subcapsular follicles, stromal score) and Doppler (uterine artery and ovarian intraparenchymal vessels' pulsatility index, ovarian stromal vascularization) parameters were evaluated during 6 months' therapy and 6 months' follow‐up.

Results

Significant changes in all the parameters analyzed occurred as a result of therapy and the changes were more marked in the group undergoing treatment with GnRH analog plus OC.

Conclusions

GnRH analog plus OC use has a more rapid and marked effect on the hormonal milieu as well as the ovarian architecture and vascularization in patients with PCOS than OC used alone. The former treatment may be a more efficient therapy for PCOS. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Stuck twin syndrome without signs of twin‐to‐twin transfusion
Authors: Lees C. C. , Schwärzler P. , Ville Y. , Campbell S.
Published: March 2003

Twin‐to‐twin transfusion syndrome represents a dilemma for both diagnosis and management. It has recently been suggested that a difference in contrast on B‐mode ultrasound between the placentas is pathognomonic for the syndrome. We describe a case of monochorionic diamniotic twins with normal growth in one twin, the other showing features of stuck twin syndrome. In this case, although the contrast difference between the placentas was marked, twin‐to‐twin transfusion syndrome was ruled out, rendering this sign unreliable for diagnosis. Furthermore, evaluation of the stuck twin showed excessive adrenal artery flow, a feature that has been described in connection with poor antenatal and neonatal outcome. In this case, serial Doppler ultrasound evaluation of both fetuses enabled optimal timing of delivery. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Artificial neural network models for the preoperative discrimination between malignant and benign adnexal masses
Authors: Timmerman D. , Verrelst H. , Bourne T. H. , De Moor B. , Collins W. P. , Vergote I. , Vandewalle J.
Published: March 2003

Objective

The aim of this study was to generate and evaluate artificial neural network (ANN) models from simple clinical and ultrasound‐derived criteria to predict whether or not an adnexal mass will have histological evidence of malignancy.

Design

The data were collected prospectively from 173 consecutive patients who were scheduled to undergo surgical investigations at the University Hospitals, Leuven, between August 1994 and August 1996. The outcome measure was the histological classification of excised tissues as malignant (including borderline) or benign.

Methods

Age, menopausal status and serum CA 125 levels and sonographic features of the adnexal mass were encoded as variables. The ANNs were trained on a randomly selected set of 116 patient records and tested on the remainder (n = 57). The performance of each model was evaluated using receiver operating characteristic (ROC) curves and compared with corresponding data from an established risk of malignancy index (RMI) and a logistic regression model.

Results

There were 124 benign masses, five of borderline malignancy and 44 invasive cancers (of which 29% were metastatic); 37% of patients with a malignant or border‐line tumor had stage I disease. The best ANN gave an area under the ROC curve of 0.979 for the whole dataset, a sensitivity of 95.9% and specificity of 93.5%. The corresponding values for the RMI were 0.882, 67.3% and 91.1%, and for the logistic regression model 0.956, 95.9% and 85.5%, respectively.

Conclusion

An ANN can be trained to provide clinically accurate information, on whether or not an adnexal mass is malignant, from the patient's menopausal status, serum CA 125 levels, and some simple ultrasonographic criteria. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Focal aneurysmal dilatation of subchorionic vessels simulating chorioangioma
Authors: Reinhart R. D. , Wells W. A. , Harris R. D.
Published: March 2003

Subchorionic vascular aneurysms of the placenta are rare lesions and may present confusion with chorioangioma or focal mesenchymal dysplasia on sonography. To our knowledge, the findings of placental aneurysms have not been reported in the ultrasound literature. We present a case with detailed sonographic evaluation, including spectral and color Doppler and pathological analysis, that was mistaken for chorioangioma prenatally. Knowledge of this benign entity may allow the sonologist to recommend conservative management in similar cases. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Characteristics of blood flow in intrauterine growth‐restricted fetuses with hypercoiled cord
Authors: Nishio J. , Nakai Y. , Mine M. , Imanaka M. , Ogita S.
Published: March 2003

Objective

To clarify the characteristics of fetoplacental blood flow of growth‐restricted fetuses with hypercoiled umbilical cord.

Subjects

Eight growth‐restricted fetuses with hypercoiled cord.

Methods

Flow velocity waveforms of the umbilical cord artery and vein, fetal abdominal aorta and fetal inferior vena cava were analyzed.

Results

The resistance index in the umbilical artery in the hypercoiled cases was lower than that in normal fetuses. Early‐diastolic reversed flow was observed in the abdominal aorta in some cases. In all cases, umbilical venous pulsation was observed in the entire cord until delivery. In one case, fetal heart failure occurred, resulting in pre‐mature delivery. An atrophic type of single umbilical artery was observed in four cases.

Conclusion

Fetal blood flow disturbance caused by a hypercoiled umbilical cord may be a cause of growth restriction. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Johanson–Blizzard syndrome: a prenatal ultrasonographic diagnosis
Authors: Auslander R. , Nevo O. , Diukman R. , Morrad E. , Bardicef M. , Abramovici H.
Published: March 2003

Johanson–Blizzard syndrome is a rare autosomal recessive disorder characterized by aplasia of alae nasi, pancreatic insufficiency, aplasia cutis, anorectal anomalies and postnatal growth restriction.

In this case report, we describe the prenatal sonographic findings of Johanson–Blizzard syndrome in a 21‐week pregnancy of a consanguineous couple. Sonographic findings of aplastic alae nasi (beak‐like nose) and dilated sigmoid colon led to the prenatal diagnosis. This is the first report of the prenatal sonographic diagnosis of Johanson–Blizzard syndrome. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Tetralogy of Fallot in the fetus: findings at targeted sonography
Authors: Yoo S.‐J. , Lee Y.‐H. , Kim E. S. , Ryu H. M. , Kim M. Y. , Yang J. H. , Chun Y. K. , Hong S. R.
Published: March 2003

Objectives

To evaluate the findings of tetralogy of Fallot in various fetal sonographic views.

Methods

We reviewed the fetal sonograms and medical records of 20 fetuses with prenatal diagnosis of tetralogy of Fallot. We analyzed the indications for targeted sonography, the abnormalities seen in various sonographic views, the postnatal echocardiographic and angiographic findings and autopsy findings.

Results

The most common indication for targeted sonography was an abnormal (n = 12) or inadequate (n = 3) finding on sonographic screening in which the abnormality was most frequently found on the three‐vessel view (n = 9). The key pathological features of tetralogy of Fallot were uniformly demonstrated in the ventricular outflow tract, three‐vessel and short‐axis views. The ductus arteriosus was small in 70% of cases and not identifiable in the remaining fetuses. In three of six fetuses with no identifiable ductus, the ductus was shown to be absent at autopsy. The direction of ductal flow was variable.

Conclusion

The key features of tetralogy of Fallot were always demonstrable in the ventricular outflow tract, three‐vessel and short‐axis views. The most common reason for referral was the abnormal three‐vessel view. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Comparison of the non‐stress test with the evaluation of centralization of blood flow for the prediction of neonatal compromise
Authors: Ott W. J.
Published: March 2003

Objective

To determine whether the middle cerebral to umbilical artery systolic/diastolic velocity waveform ratio (MC/UA) was a more sensitive indicator of fetal compromise than the non‐stress test (NST).

Study design An outcome study of high‐risk patients undergoing NST testing and MC/UA studies within 10 days of delivery. Patients were divided into four groups based on their test results, and neonatal outcome parameters were compared.

Results

There were significant differences between all four test result groups with respect to length of stay in the neonatal intensive care unit (NICU). Patients in whom both the NST and MC/UA ratio were normal had significantly lower utilization of Cesarean section for delivery, admission and length of stay in the NICU and occurrence of significant neonatal complications. Logistic regression analysis indicated that the combination of the NST and MC/UA ratio was an excellent predictor of perinatal outcome.

Conclusions

The MC/UA ratio improves the sensitivity for the prediction of poor perinatal outcome when it is combined with the NST. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Perinatal management of fetal hemolytic disease due to Rh incompatibility combined with fetal alloimmune thrombocytopenia due to HPA‐5b incompatibility
Authors: Schild R. L. , Hoch J. , Plath H. , Geißen C. , Fahnenstich H. , Dame C. , Hansmann M.
Published: March 2003

We report our experience in the perinatal management of a complex case of fetal hemolytic disease primarily due to Rhesus incompatibility combined with fetal alloimmune thrombocytopenia. The lowest fetal hemoglobin and platelet levels were 2.6 g/dl and 13 000/µl, respectively. Intrauterine treatment consisted of six transfusions of packed red cells into the umbilical vein and one transfusion of platelets. The neonate required four transfusions of packed red cells to correct her hyporegenerative erythropoiesis. Postnatal management also included one platelet transfusion, intravenous immunoglobulins and erythropoietin. Although some degree of fetal thrombocytopenia may invariably be found in fetal red cell incompatibility, other rare causes need to be excluded. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Comparative study of transvaginal ultrasonography and CA 125 in the preoperative evaluation of myometrial invasion in endometrial carcinoma
Authors: Alcázar J. L. , Jurado M. , López‐García G.
Published: March 2003

Objective

To compare the ability of transvaginal sonography and serum CA 125 levels to predict myometrial invasion in patients with endometrial carcinoma.

Design and methods Prospective study in 50 consecutive patients (mean age 60 years, SD 10.5, range 29–77 years) diagnosed as having endometrial cancer and scheduled for surgical staging. All patients were evaluated by transvaginal ultrasonography. Endometrial thickness was measured in all cases and myometrial invasion was estimated as < 50% or ≥50%. Serum CA 125 level was determined in each patient. A cut‐off level of ≥35 IU/ml was considered to predict myometrial invasion of ≥50%. All patients underwent surgical staging, and definitive histopathological findings regarding myometrial invasion were used as the ‘gold standard’. Sensitivity, specificity and positive predictive value (PPV) and negative predictive value (NPV) were calculated for transvaginal ultrasonography and CA 125 and compared.

Results

On histopathological analysis, myometrial invasion was found to be < 50% in 35 (70%) cases and ≥?50% in 15 cases (30%). Mean endometrial thickness in patients with superficial invasion was significantly lower than in those with deep invasion (13.4 mm (95% CI 11.2–15.7) vs. 18.7 mm (95% CI 15.0–22.3), respectively; p = 0.014). Median CA 125 was significantly higher in patients with deep invasion than in those with superficial invasion (30 IU/ml, interquartile range (IQR) 46.0 vs. 16.9 IU/ml, IQR 13.9, respectively; p = 0.002). The sensitivity, specificity, PPV and NPV for transvaginal ultrasonography were 86.7% (95% CI 59.5–98.3), 94.3% (95% CI 80.8–99.3), 86.7% (95% CI 59.5–98.3) and 94.3% (95% CI 80.8–99.3), respectively. The sensitivity, specificity, PPV and NPV for CA 125 were 40% (95% CI 16.3–67.7), 91.4% (95% CI 76.9–98.2), 66.7% (95% CI 29.9–92.5) and 78% (95% CI 63.4–89.5), respectively. The sensitivity of transvaginal ultrasonography was significantly higher than that of CA 125 (p = 0.008). No differences were found in terms of specificity, PPV or NPV.

Conclusion

Our results indicate that transvaginal ultrasonography is more sensitive than CA 125 in predicting myometrial invasion in endometrial cancer. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
The expectant management of women with early pregnancy of unknown location
Authors: Banerjee S. , Aslam N. , Zosmer N. , Woelfer B. , Jurkovic D.
Published: March 2003

Objective

To assess the results of expectant management in women with pregnancy of unknown location and to identify diagnostic parameters that are predictive of spontaneous pregnancy resolution.

Design

Prospective, observational study.

Subjects

Women with a positive pregnancy test and suspected early pregnancy complications who were referred for ultrasound assessment.

Methods

Women were first examined by transvaginal ultrasound to establish the location and viability of pregnancy. All women with pregnancies that could not be located on the scan had a blood sample taken to quantify the serum human chorionic gonadotropin (hCG) and progesterone levels. Management was expectant until the pregnancy was identified, the condition resolved spontaneously or an intervention was required because clinical symptoms deteriorated or hCG levels did not decline. For each woman, age, clinical symptoms (pain and bleeding), menstrual dates, past gynecological history, endometrial thickness and levels of serum hCG and progesterone were recorded. All parameters were tested by univariate analysis and then analyzed in a stepwise procedure to form a logistic regression model for predicting spontaneous resolution of pregnancy.

Results

A total of 1625 women were included in the study. In 135 cases (8%) the location of pregnancy was unknown. Complete data sets were obtained in 127 cases. These included 34 (27%) normal intrauterine pregnancies, 11 (9%) miscarriages and 18 (14%) ectopic pregnancies. A total of 64 (50%) pregnancies resolved spontaneously. Stepwise analysis showed that four diagnostic parameters – vaginal bleeding, endometrial thickness, serum hCG level and progesterone level – contributed significantly to the predictive power of the logistic model. With the use of this model, spontaneous pregnancy resolution could be predicted at the initial visit with a sensitivity and specificity of 92%.

Conclusions

The majority of pregnancies of unknown location are abnormal; many resolve spontaneously when managed expectantly. A logistic model may be used at the initial visit to identify those cases in which the pregnancy is likely to resolve without the need for intervention. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
P101Doppler flow velocimetry in fetal and maternal circulation in relation to blood serum and amniotic fluid erythropoietin levels
Authors: We¸grzynowski J. , Ronin‐Walknowska E.
Published: March 2003

Objective

To correlate arterial Doppler flow velocimetry with amniotic fluid and umbilical cord erythropoietin levels and umbilical cord gasometry.

Material and methods

The study compromised 80 pregnant woman who delivered in cesarean section without prior uterine contractions. The AB, PI and RI indexes of fetal umbilical, cerebral arteries as well as uterine arcuate arteries was assessed max. 24 h before delivery. Amniotic fluid was collected during the cesarean section before the uterine incision and umbilical cord blood was retrieved after the delivery, 1 min after the cord was clamped.

Results

The correlation was found between umbilical arteries AB ratio and amniotic erythropoietin levels, fetal serum erythropoietin levels as well as umbilical artery pO2 and apgar score 5 min after delivery. The correlation was also found between fetal blood and amniotic fluid erythropoietin levels.

Conclusions

Doppler flow velocimetry of umbilical artery reflects the fetal and newborn well being. Umbilical cord and amniotic fluid erythropoietin levels reflect fetal oxygenation. Erthropoietin levels may be checked in amniotic fluid beceause amniocentesis is related to lower incidence of complications in comparisone with cordocentesis.
P102Preterm newborns with normal flow velocimetry and elevated S100B blood cord levels
Authors: Grondona C. , Bruschettini  , Gazzolo D. , Lituania M. , Vinesi P. , Marinoni E. , Di Iorio R. , Marras M. , Bruschettini P. L. , Michetti F.
Published: March 2003

S100B blood cord levels were significantly higher in the pretem group (1.31 ± 0.64 vs. 0.47 ± 0.35 g/L; P < 0.001), peaking in earliest weeks of gestation, and progressively decreased near term, being undetactable or at the limit of sensitivity in the term group. A significant correlation between S100B blood cord levels and gestational age was observed in all considered fetuses (r = −0.69; P < 0.01). We investigated 58 pregnancies (30 at term and 28 preterm), with normal flow velocimetry waveforms, whose delivery was between 27 and 42 weeks' gestation. Exclusion criteria were: multiple pregnancies, IUGR, gestational hypertension, diabetes and infections, fetal malformations, chromosomal abnormalities, perinatal asphyxia, and distocia. At birth, all newborn infants showed normal clinical conditions and no neurological injury was observed at the discharge from the Hospital. As expected, gestational age at birth (32.2 ± 3.1 vs. 39.4 ± 1.4 weeks) and birthweight (1859 ± 723 vs. 3250 ± 210 g) were higher in the term group (P < 0.01 for both), while no significant differences were observed regarding delivery mode, Apgar score at 1st (8 ± 2 vs. 9 ± 1) and 5th min (9 ± 1 vs. 8 ± 1) and gender (preterm female/male: 13/15; term female/male: 16/14). S100B levels significantly higher in female preterm and term fetuses (preterm 1.65 ± 0.48 vs. 0.99 ± 0.61; term 1.14 ± 0.69 vs. 0.75 ± 0.51, respectively; P < 0.05 for both).
P117Echocardiographic findings in fetuses with trisomy 18
Authors: Holan M. , Ferianec V. , Pohlodek K. , Kaldararova M. , Benedekova M.
Published: March 2003

The aim of this study was to present our 4 cases of trisomy 18, with a congenital heart defect detected during the last 6 months.

Results

Two complex congenital heart defects (CHD) with a very similar anatomy were found during a prenatal ultrasonographic examination – Double outlet right ventricle (DORV) with complete atrioventricular septal defect (AVSDC) – in the 20th and 38th week of gestation and in other two cases – in the 19th and 21st week of gestation – an isolated muscular ventricular septal defect (VSD) was proved. In All fetuses also noncardiac (central nervous, gastro‐intestinal and uropoetical) congenital malformations were present.

Conclusion

Trisomy 18 (Edwards sy) occurs approximately in 1:7000 live births. 95–100% of these newborns have some form of CHD. Because of a very poor prognosis a surgical correction is usually not considered. Left to their natural course, death occurs at the age of one hour to 18 months, the median life expectance is 5–48 days, according to the presence of severe CHD and associated anomalies.
P127Assessment of fetal anatomy in the first trimester using two and three dimensional ultrasound
Authors: Michailidis G. D. , Papageorgiou P. , Economides D. L.
Published: March 2003

Objectives

To study if a complete anatomical survey of the fetus at 12–13 weeks gestation can be achieved using stored volumes acquired by a 3D scanner.

Subjects/methods

One hundred and twenty‐two consecutive women at 12–13 weeks gestation who had a scan in our unit. A complete survey of the fetal anatomy was attempted by transabdominal and if needed transvaginal 2D scanning. Then using the 3D transvaginal probe (Kretz 530D) two volumes containing the fetus were acquired. A complete anatomical survey was attempted using the data from these volumes (excluding the anatomy of the heart).

Results

A complete anatomical survey was achieved in 93% (113/122) of cases with the 2D scanning comparing to 71% (86/122) with the 3D volumes (statistically significant difference, P < 0.01). The nuchal translucency was measured in 97.5% of cases with 2D scanning and in 82% with the 3D volumes. The mean time to perform the 2D scan was 15 min (SD: 4 min) while the time to examine the stored volumes was 6.6 min (SD: 2.66). Using the stored volumes we obtained the required views in 8 of the 9 cases in which the survey was incomplete by the 2D scan.

Discussion

Real time 2D scanning is still the best way to examine the fetal anatomy in the first trimester. However, 3D scanning can be a useful addition to clinical practice providing views not easily obtained by conventional 2D scanning. It can potentially minimise the actual scanning time and provides an excellent way to store scanned data.
P128Impact of patient initiated three‐dimensional ultrasound examination
Authors: Pretorius D. H. , Hull A. D. , Newton R. , Nelson T. R. , James G.
Published: March 2003

Background

News media and the internet have a significant impact on raising patient awareness of new care. Visualization of the fetal face made possible by 3‐dimensional ultrasound (3DUS) is one such area that has encouraged many pregnant patients to initiate requests for these studies. The purpose of this project was to identify indications, reactions and benefits for these studies.

Method

3DUS examinations were performed on 35 consecutive patients requesting studies from our service. We require a physician to order the 3DUS exam in conjunction with conventional 2DUS. Patients had a targeted 3DUS to the area of interest as well as the fetal face. Comments by the parents were recorded at the time of the study and after delivery.

Results

Medical indications for 3DUS studies were: patient reassurance (19), patients with prior anomalies (8), hospice patients carrying fetuses with fatal anomalies (2), patient with family history of anomaly (1), infertility (1), patient carrying a fetus with abnormal karyotype (1). Although most parents found the 3DUS to be a positive, reassuring experience (28), (7) found it to be extremely beneficial (previous children with anomalies or demise, fetuses with fatal anomalies, and infertile couples).

Conclusion

Patient initiated 3DUS studies had a positive impact and reassured all families and were extremely beneficial to 6/35 families.
P129The sonographic appearance of fetal micrognathia using a novel three‐dimensional ultrasound system
Authors: Malinger G. , Lerman‐Sagie T. , Gomel A. , Glezerman M.
Published: March 2003

Background

Fetal micrognathia is difficult to diagnose using conventional ultrasound and three‐dimensional surface rendering may provide additional information when available. We present two fetuses with micrognathia in whom this technique helped in the diagnosis.

Method

Three‐dimensional ultrasound examination was performed with an add‐on unit that fits any existing conventional ultrasound machine. The system contains a unique positional sensor and extremely powerful segmentation feature that allows to remove obscuring objects from the region of interest (BabyFace, Biomedicom, Jerusalem, Israel).

In both fetuses the diagnosis was suspected during conventional ultrasound examination.

Results

Good three‐dimensional images of both fetuses were obtained at the first acquisition intent and provided additional information about the severity of the anomaly.

Conclusion

We present a novel 3D ultrasound system, which is user friendly and cost‐efficient. Its compatibility as an add‐on to existing us equipment allows for immediate upgrades and increases diagnostic options in fetal imaging.
P13The impact of transvaginal obstetric ultrasound scan in high risk pregnancy
Authors: Benute G. R. G. , Wojciechowski V. , Dias T. V. , Cianciarullo P. , Quayle J. , Burlachini  , Bunduki V. , Yamamoto R. , Miyadahira S. , De Lucia M. C. s , Zugaib
Published: March 2003

Background

The acceptance of transvaginal ultrasound among Brazilian pregnant women is not yet established.

Objective

To evaluate the level of acceptance of transvaginal ultrasound (US) among high risk pregnant women.

Method

Psychological semi structured interview with 50 pregnant patients scheduled to undergo ultrasound exam.

Results

94% of the patients arrive without knowing they are going to undergo a transvaginal US and 80% believe they are going to undergo a regular abdominal US. Asked about the utility of transvaginal US, 46% didn't know; 70% didn't have any preferences about the sex of the ultrasonographist. After the exam, 76% of the patients referred no particular discomfort, but 46% would prefer to have an abdominal US scan if they could choose, but all emphasized they would undergo the exam again if the doctor said it was necessary. As far as sexuality, 12% mentioned some difficulty with the partner and 40% referred that it is hard for women to discuss subjects related to sex.

Conclusion

The discomfort eventually associated to transvaginal US is not related to the sex of the examiner but to his attitude. Patients' fantasies play an important role in the emotional discomfort elicited by the situation where cultural aspects are deeply imbricated.
P132Three‐dimensional ultrasound: A new diagnostic option monitoring cervical incompetence in higher order multiple gestation
Authors: Strauss A. , Heer I. , Fuchshuber S.
Published: March 2003

Background

Preterm birth is the greatest threat to the infants of a multiple pregnancy. Incompetent cervix is still a diagnostic and therapeutic dilemma. Is three dimensional volumetry of the cervix uteri the key to predict preterm birth in higher order multiples?

Method

From May 1999 to May 2000 we prospectively compared conventional measurements of cervical length to 3D‐volumetry in 10 triplet pregnancies.

Results

29 volume scans as well as conventional length measurements of the cervix in 10 triplet pregnancies were analyzed. 2.9 examinations per patient (1–5) were done on a weekly basis. The mean cervical length was 27 mm (4–50). The mean cervical volume decreased with gestational age parallel to the two dimensional data. In three women length‐assessment could not be obtained as the presenting part of the leading triplet obstructed a longitudinal scan of the cervix. In contrast, these anatomic difficulties did not present an obstacle in (transverse) 3D‐scans which were possible in all patients.

Conclusion

Transabdominal 3D‐volumetry as compared to 2D cervical length measurements represents an exact and potentially superior method to monitor cervical incompetence. We believe it a valuable parameter to predict preterm birth.
P139Transvaginal color Doppler study of uterine blood flow in primary dysmenorrhea
Authors: Dmitrović R.
Published: March 2003

Background

The pain in primary dysmenorrhea is caused by excessive prostaglandin production that leads to vasoconstriction and uterine ischemia. Changes in uterine blood flow are important factor in patophysiology of primary dysmenorrhea. The aim of the study was to determine if vasoconstriction of the uterine vessels in patients with primary dysmenorrhea is detectable by transvaginal color Doppler ultrasound.

Methods

Forty‐two women with primary dysmenorrhea and 50 healthy controls were included in this prospective study. Women were examined with transvaginal color Doppler ultrasound on first day of the cycle, once in the follicular and once in the luteal phase. Measurements of pulsatility index in uterine, arcuate, radial and spiral arteries were performed. Student's t‐test was used to establish statistical significance between groups.

Results

Women in dysmenorrhea group had significantly higher uterine blood flow indices than healthy controls in all three measurements periods. This includes all vessels studied on the first day of the cycle, the radial and spiral arteries during the follicular phase and the arcuate, radial and spiral arteries during the luteal phase.

Conclusions

We found that women with primary dysmenorrhea have elevated Doppler indices in uterine arteries not only on first day of the cycle but throughout the whole cycle. Therefore we postulated that primary dysmenorrhea is not only the disorder of menstruation but also a disease of a menstrual cycle in whole.
P144Color Doppler imaging of the testis in azoospermic subjects as a predictor of spermatozoa retrieval on testicular sperm extarction
Authors: Har‐Toov J. , Fait G. , Houser R. , Wolman I. , Gull I. , Amster R. , Yavetz H. , Jaffa A. J.
Published: March 2003

Background

There are no clinical parameters for identification of spermatogenic tissue within the testis of azoospermic subjects. Consequently, multiple biopsies are performed until spermatozoa are found. The aim of this study was to evaluate whether testicular blood flow can be a predictor of spermatozoa retrieval on TESE.

Method

Color Doppler ultrasound was performed in 13 azoospermic subjects affected by primary testicular pathology and in 7 fertile subjects. The PI, RI, and S/D ratio reflecting resistance to flow were measured in the mid‐portion of the testis in the longitudinal view. All azoospermic subjects underwent TESE in which a biopsy was taken from the head, mid, and tale portion of the testis. The specimens were evaluated for structure and for the presence of spermatozoa.

Results

Blood flow indices were similar in azoospermic subjects as compared to fertile subjects. (mean ± SD; PI = 0.99 ± 0.64, RI = 0.52 ± 0.16, S/D = 2.16 ± 0.74; PI = 0.99 ± 0.19, RI = 0.59 ± 0.07, S/D = 2.51 ± 0.48, respectively). In seven patients, spermatozoa was found in one or more of the testicular specimens. Blood flow indices in this group were similar to the indices in azoospermic patients in whom spermatozoa was not found.

Conclusion

At present testicular blood flow as evaluated by color Doppler can not serve as a predictor of spermatozoa retrieval on TESE.
P154Psychological stress and ultrasound screening in pregnancy: a risk‐group comparison
Authors: Fuchshuber S. , Strauss A.
Published: March 2003

Background

We intended to assess the psychological stress experienced by mothers during ultrasound screenings in pregnancy.

Methods

Between 1997 and 1999, 136 women (age 17–41, pregnancy week 9–41) were asked to record their stress level before, during and after the ultrasound exam on a scale from 1 to 10. 81 patients were generally concerned about their pregnancy, 22 were over age 35, 21 had specific pregnancy risks (family history, preeclampsia, first‐trimenon medication‐intake/infection, pathological ultrasound findings).

Results

Women generally concerned or with known pregnancy risk report significantly more stress before the exam (mean 3.8 vs. 1.9 and 4.6 vs. 2.8; P < 0.01). However, during or after the exam, stress levels are equal in all groups (5.1 vs. 4.3, 2.9 vs. 2.3; P > 0.01). We also find no significant differences between women above or below age 35 (3.0 vs. 3.1 before, 4.3 vs. 4.4 during, 2.5 vs. 2.2 after ultrasound exam; P > 0.01). Overall, all women experienced the most stress during, and the least stress after the exam (P < 0.01).

Conclusion

Or results show that we need to anticipate an equal level of anxiety in all women we examine. We cannot assume that a young mother without risk will experience the exam any more or less distressful than a woman with predisposed risk. The results cautions us to give adequate consideration to every individual patient, regardless of pregnancy risk.
P02The first results of the ultrasound transvaginal screening in early pregnancies in Kazan city, Tatarstan, Russia
Authors: Teregoulova L. , Bajazitova L. , Latypov A. , Shajhutdinova L.
Published: March 2003

In 1 January 2000 in order of Tatarstan Health Care Ministry transvaginal first trimester screening was introduced in Kazan city. All pregnant women have to be examined in one of 5 the medical centers.

We present the results of six month screening for all pregnant women between 10 and 14 weeks gestation.

Method

Routine transvaginal ultrasound examination included the measurement of fetal crown‐rump length, nuchal translucency and estimation of fetal anatomy.

Results

A total 1620 pregnant women of 10–14 weeks of gestation were examined from January till June 2000. All abnormalities were detected at the 12–13 weeks gestational ages. The increasing of nuchal translucency thickness were found in 23 cases, 7 of them chromosomal defects had, in this group in 5 cases cystic hygroma with hydrops were identified.

In 12 cases structural anomalies were found: 1‐body stalk anomaly, 1 case‐omphalocele with liver in it, 1‐holoprosencephaly with proboshisis and microphtalmia, 1‐encephalocele, 3‐acrania, 5‐anencephaly. In the cases of holoprosencephaly and encephalocele nuchal translucency measured at 10–11 week was normal.

Conclusion

Even the first results of early pregnancy transvaginal screening show its great significance in our city. The most adequate period for transvaginal screening is 12–13 weeks.
P40Fetal treatment for hydrops fetalis assisted by interventional ultrasound
Authors: Tanemura M. , Suzumori K.
Published: March 2003

Background

Fetal hydrops has many causes including hydrothorax and cardiac abnormality. Our fetal treatment experience with such disorders associated with hydrops fetalis is reviewed and the efficacy of new interventional ultrasound is presented.

Methods

Case 1. A case of fetal lung tumor. Color Doppler analysis and MRI were introduced for differential diagnosis. Case 2. A case of severe pleural effusion. Detailed examination of intrathoracic fluid led to a diagnosis of congenital fetal chylothorax. Fetal treatment by intrapleural injection of OK‐432 was introduced. Case 3. A case of fetal tachyarrhythmia. We introduced transmaternal‐abdominal fetal ECG and administered transplacental medication.

Results

Case 1. Color Doppler analysis revealed an anomalous arterial supply from the aorta to tumor, leading to a diagnosis of pulmonary sequestration. Only reduction amniocentesis was repeated, with the circulatory failure spontaneously improving. Case 2. The pleural effusion was reduced by adhesion of the intrathoracic space, with pulmonary hypoplasia successfully prevented by OK‐432. Case 3. Transmaternal‐abdominal fetal ECG led to a diagnosis of fetal PSVT. Transplacental propranolol stopped fetal PSVT quickly, while digoxin slightly improved fetal cardiac function.

Conclusions

OK‐432 may be considered as an alternate intrauterine therapeutic option to shunt insertion for severe fetal hydrothorax. Fetal ECG was also useful for the diagnosis of fetal tachyarrhythmia. Since some untreated cases show spontaneous improvement, the indications for fetal treatment should be reconsidered.
P48Parameters of renal function by the obtention of fetal urine by intrauterine aspiration
Authors: Troyano Luque J. M. , Clavijo M. T. , Feo C. M. , Laynez E. , Gómez M.
Published: March 2003

Background

We have studied the fetal renal function by urinary biochimical analysis obtained by aspirative nephrostomy.

Method

Since 1993 we have practiced in our ultrsound unite 51 aspirative nephrostomies in cases of over 15 mm hydronephrosis since the 20th week of pregnancy. We have determined the tubular dynamic of Na+, Cl−, K+, P+, the excretory response after overcharge of the NaCl, the tubular response to the aqueous diuresis, Calcium tubular dynamic, uric acid, glucose. Acid‐base equilibrium.

Results

Limited excretory capacity of Na+and Cl−. Excretory diminishing with Na+Cl− overcharge. The diuresis aqueous decreases the reabsortion of Na+, Cl−, Ca+, P+, glucose and uric acid. In premature fetuses there is hypocalciuria with hyperphosphaturia. The excretion of uric acid is higher in premature fetuses (7.7 ± 2.7 mg/dl) than in mature fetuses (5.2 ± 1.6 mg/dl). The excretion of glucose is higher in premature fetuses. In all the cases a perinatal renal function was verifyed. In a 78.4% of the cases, reparatory surgery was needed. Dyalisis wasn't needed in any new‐born. In two of the cases unilateral nephrectomy was needed.

Conclusion

The theoretical renal obstructive prenatal problems are not always associated to renal disfunction. The neprhourological matureness presents important changes in tubular dynamic of Ca+, P+, glucose and uric acid, nevertheless it keeps the same tubular dynamic with Na+, Cl− and potassium.
P51Prenatal detection of Fraser syndrome without cryptophthalmos
Authors: Berg C. , Geipel A. , Germer U. , Gembruch U.
Published: March 2003

Background

Fraser syndrome (cryptophthalmos–syndactyly syndrome) is an autosomal recessive multiple malformation syndrome whose major manifestations are cryptophthalmos, syndactyly, laryngeal atresia and urogenital defects. Enlarged hyperechogenic lungs contrasted by oligohydramnios, nonvisualization of the kidneys and microphthalmia were sonographic markers leading to the prenatal detection of this rare autosomal recessive disorder in earlier reports.

Case report

Fraser syndrome was diagnosed at 16.0 weeks gestational age in a women whose previous pregnancy was terminated because of multiple malformations. Abnormal sonographic findings included agenesis of kidneys and bladder, dilated trachea and main bronchi suggestive for high airway obstruction, hyperechogenic lungs, syndactyly of the fingers, hepatomegaly, oligohydramnios and hydrops placentae. Strikingly, face and cerebral structures appeared normal. However these findings together with the previously affected child led to the diagnosis of Fraser syndrome. The parents elected to terminate the pregnancy. Autopsy results were confirmatory. No defects of the face could be demonstrated.

Conclusion

Prenatal diagnosis of Fraser syndrome is possible in the hands of an expert, but due to the great variety of possible malformations the diagnosis will remain at doubt in most cases in which no previous child is affected.
P53Repetition of osteochondro‐dysplasia – a rare hereditary disorder of bones
Authors: Sipos S. , Marton T. , Ujházy A. , Rigó Jr J.
Published: March 2003

Background

Osteochondrodysplasia with defective bone mineralization is a rare hereditary disorder. It is characterized by bone structure defects and a deficiency of bone/liver/kidney alkaline phosphatase activity in serum and tissues.

Case report

Type 2a osteochondrodysplasia was detected in the first and second pregnancies of a 28‐year‐old woman. Fetal age was 20 and 17 gestational weeks, respectively. Ultrasonographical findings showed a soft, dilatated spine, narrow chest and short ribs as well as deformed bones and skull. An additional fetopathological finding ws hypomineralization of the skelet (diagnosed by hystopathology and X‐Ray examination). The disorder proved to be Infantile Hypophosphatasia (congenital lethal type).

Outcome

Both pregnancies were terminated after the diagnosis of the disorder.

Conclusion

In order to detect this disorder, careful, repeated ultrasound exam should be performed in the first and second trimester. A Serum alkaline phosphatase level and elevated urinare phosphoethanolamine level of the family members may help to predict the disorder.
P56Antenatal diagnosis and separation of conjoined twins: case report
Authors: Çelik E. , Sen C. , Kepkep K. , Vural A. , Yeker D.
Published: March 2003

The incidence of conjoined twins is extremely small and ranges between 1:30 000 and 1:100 000 live births. Recent years, the prenatal diagnosis is possible in very early pregnancy and also detailed USG gives us an opportunity for making differential diagnosis in the case of well or poor prognosis. We present two cases with thoracophagus which were diagnosed at 19th and 25th week of gestation. First case was terminated because of severely conjoined (Shared hearth with single ventricule, two atrium, single aorta under the diaphragm. Second one was diagnosed at 25th week of gestation whom had just conjoined liver, attached pericardium on the ventricular walls and no other anomaly. After given counseling, the family opted to continue the pregnancy and the follow up of the pregnancy was uneventful and delivered at 38th week by cesarean section. They well tolerated in the neonatal period. The babies have gone operation at 10th months of age. They recovered after separation procedure and the outcome was uneventful. In recent years, defining the anatomical relationship of conjoined twins is greatly simplified by new technologies like 2D and/or 3D ultrasonography. Differential diagnosis of the cases with good or bad outcome in terms of shared organ and anomalies is important in clinical making decision for the termination or continuation of pregnancy.