bluuebunny/crossref_metadata_2025 huggingface dataset:
Perinatal outcome in pregnancies with a positive serum screening for Down's syndrome due to elevated levels of free β‐human chorionic gonadotropin
Authors: Palacio M. , Jauniaux E. , Kingdom J. , Dell E. , Sheldrake A. , Rodeck C. H.
Published: March 2003

Objective

To evaluate the potential clinical use of maternal serum free β‐human chorionic gonadotropin (β‐hCG) and uterine artery Doppler investigation to screen for placenta‐related adverse outcome in pregnancies at positive risk for Down's syndrome at 15–18 weeks.

Design

A cohort of 329 consecutive pregnant women with a singleton viable pregnancy and a positive risk for Down's syndrome was retrospectively investigated. This group was obtained from an unselected population of 3952 women attending the same hospital over a 2‐year period. Using the results of this first analysis, we selected a group of 26 women with unexplained high levels of free β‐hCG and followed them prospectively with monthly ultrasound and uterine artery Doppler examinations.

Results

In the retrospective cohort, risk ratios stratified for maternal serum β‐hCG multiple of the median (MoM) values indicated that the highest incidence of adverse pregnancy outcome was in those women with values of ≥5.0. In the prospective study, pregnancy outcome was complicated by uteroplacental disorders in eight cases. Analysis of the Doppler investigation indicated that, in women with a very high level of hCG, an abnormally high uterine artery pulsatility index (PI) had lower sensitivity and negative predictive value than early diastolic notch, whereas the specificity and positive predictive value were higher for a high uterine artery PI.

Conclusions

These findings suggest an association between a high level of maternal serum β‐hCG at 15–18 weeks, the presence of an early diastolic notch in the uterine artery flow velocity waveform and adverse pregnancy outcome due to abnormal development of the uteroplacental circulation. Young women with an unexplained high β‐hCG level would benefit, apart from detailed sonography of the fetus and/or karyotyping, from uterine Doppler investigation and counselling about the follow‐up and management of placenta‐related pregnancy disorders. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
The sonographic identification of fetal gender from 11 to 14 weeks of gestation
Authors: Whitlow B. J. , Lazanakis M. S. , Economides D. L.
Published: March 2003

Objective

To determine the feasibility of correctly identifying fetal gender from 11 to 14 weeks' gestation.

Methods

A prospective cross‐sectional study in a university Department of Obstetrics and Gynaecology, London. A total of 524 women from an unselected population underwent a detailed assessment of fetal anatomy at 11–14 weeks of gestation (confirmed by crown‐rump length) by means of transabdominal sonography, and transvaginal sonography (26%) when necessary. Fetal gender was identified in the transverse and sagittal planes, and was confirmed at birth.

Results

The overall success of correctly assigning fetal gender increased with gestational age from 46% to 75%, 79% and 90% at 11, 12, 13 and 14 weeks, respectively. The ability of the operator to assign fetal gender significantly improved with increasing gestational age (p < 0.0001), being 59%, 87%, 92% and 98% at 11, 12, 13 and 14 weeks, respectively. The accuracy of correctly identifying fetal gender when attempted did not change with gestational age. Fetal gender or the performance of the scan by different operators did not affect the results.

Conclusion

Whilst the accuracy of sonographic determination of fetal gender at 11–14 weeks is good, it still falls significantly short of invasive karyotyping tests. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Biometrical threshold of biparietal diameter for certain fetal sex assignment by ultrasound
Authors: Mazza V. , Contu G. , Falcinelli C. , Battafarano S. , Cagnacci A. , Vito G. , Forabosco A. , Volpe A.
Published: March 2003

Objectives

The aim of this study was to establish the biometric threshold of biparietal diameter (BPD), assumed to be an independent variable of gestational age, at which 100% accuracy in the assessment of fetal sex by ultrasonography is achievable.

Methods

Transvaginal and/or transabdominal sonography was used for detecting the ‘sagittal sign’ as a marker of fetal sex in 385 fetuses with BPD between 18 and 29 mm. The results of ultrasound examination were compared with sex at birth or with karyotype obtained from amniotic fluid cells or chorionic villus sampling.

Results

Fetal sex assignment was feasible in 337 of 385 cases (87.5%). Of the 312 fetuses with known fetal sex outcome, 164 were males and 148 were females. An accuracy rate of 100% was achieved when a BPD of ≥ 23 mm was obtained.

Conclusion

This study provides important information about the earliest stage of fetal development, expressed in terms of BPD, at which a diagnosis of fetal sex can be made with 100% accuracy. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Translabial color Doppler for imaging in urogynecology: a preliminary report
Authors: Dietz H. P. , McKnoulty L. , Clarke B.
Published: March 2003

Objective

A prospective study was conducted to evaluate the use of color Doppler ultrasound in the investigation of female urinary incontinence.

Methods

Thirty‐seven patients underwent a full urodynamic assessment and translabial ultrasound examination using color Doppler‐capable equipment with 5–7‐MHz curved array transducers, both in the supine and in the erect positions.

Results

More than minimal leakage was seen in 13 patients by Doppler and in 16 by fluoroscopic imaging. Results were in agreement in 28/37 cases (kappa 0.49). The observed discrepancies may have been due to initial technical difficulties, differences in bladder filling and the presence of a catheter on fluoroscopic imaging. In five incontinent patients, urethral flow velocities ranged from 0.064 to 0.34 m/s, which is equivalent to physiological venous and slow arterial blood flow and one to two orders of magnitude above the detection threshold of standard Doppler ultrasound equipment.

Conclusions

Translabial color Doppler imaging of the lower urinary tract allows the documentation of fluid leakage from the bladder. It has the potential to become the new imaging standard for urogynecology. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Second‐trimester molecular prenatal diagnosis of sporadic Apert syndrome following suspicious ultrasound findings
Authors: Ferreira J. C. , Carter S. M. , Bernstein P. S. , Jabs E. W. , Glickstein J. S. , Marion R. W. , Baergen R. N. , Gross S. J.
Published: March 2003

Apert syndrome, an autosomal dominant disorder characterized by craniosynostosis, mid‐facial malformations, symmetric bony syndactyly of hands and feet, and varying degrees of mental retardation, is most frequently caused by a de novo mutation. Two missense mutations in the fibro‐blast growth factor receptor 2 (FGFR2) gene have been found to account for the disorder in approximately 98% of affected patients. Seven cases of prenatal ultrasound diagnosis have been reported. Although one earlier diagnosis has been made in a familial case, sporadic cases have not been definitively diagnosed until the third trimester when craniosynostosis is usually detected. We report a second‐trimester molecular diagnosis of a sporadic case, based on the ultrasound observation of fetal ‘mitten hands’ and craniosynostosis. We discuss the approach to such ultrasound features, given the current availability of molecular diagnosis for Apert syndrome. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
P107The study of the ductus venosus for predicting umbilical artery pH at birth below 7.10 in pregnancies with absent or reversed end‐diastolic velocity flow (ARED) in the umbilical arteries Doppler studies
Authors: Francisco R. P. V. , Yamamoto R. M. , Leite C. C. , Miyadahira S. , Zugaib M.
Published: March 2003

Background

A study of the relation between methods for assessment of fetal well‐being and umbilical artery pH at birth below 7.10.

Methods

A prospective study was conducted to assess the fetal well‐being in 61 singleton pregnancies with ARED. The results of these methods were compared with the occurrence of umbilical artery pH at birth < 7.10. All data were analyzed and compared using logistic regression.

Conclusion

The probability of umbilical artery pH below 7.10 in ARED fetuses could be predicted by means of the ductus venosus Doppler studies and the BPS. Knowledge of this probability can help to choose the best moment for delivery in these cases.
P118The role of fetal echocardiography and detailed sonography in the prenatal diagnosis of trisomy 13 – analysis of 11 cases
Authors: Janiak K. , Kaczmarek P. , Krasoń A. , Respondek‐Liberska M.
Published: March 2003

The aim of the study was to show the importance of sonography and echocardiography at 2nd trimester of pregnancy on the ground of the retrospective analysis of cases with Patau syndrome.

Materials and methods

From the database of 6430 fetuses examined throughout 1992 until 1999, aneuploidy in the form of patau syndrome was suspected in 11 fetuses (0,64%). Maternal, fetal and neonatal data were retrospectively evaluated.

Results

The majority of cases come from low risk pregnancies. The full genetic antenatal diagnostic was performed in 7 cases. The mean apgar score was 1 and the mortality in analyzed group was 100%. During fetal echocardiography the congenital heart defect were diagnosed in 5 cases: 3xVSD, 1xVSD + aorta dextraposition, 1xVSD + bright spot + cardiomegaly + pericardial effusion. Trisomy 13 in analyzed group manifested by malformations of various organs and systems: congenital heart defects was the most common anomaly diagnosed prenatally (7/11), the second one were central nervous system and genitourinary system anomalies (6/11) and others. In the analyzed group the mean number of anomaly per fetus was 3. Prenatal diagnoses were confirmed at autopsy, additionally cleft palate was identified at 2 cases.

Conclusion

Fetal detailed sonography and echocardiography in each case of trisomy 13 allows the visualisations of malformations at fetuses (min 1, max 5) and therefore this examination may be consider as ‘genetic sonogram’.
P121Pulmonary valve atresia. Fetal echocardiography findings in one case with intact ventricular septum
Authors: García C. , Lagos N. , Diaz C. , Meneses N. , Castillo G. , Pazols R. , Benavides C. , Hoffmann I. , Astorga  , Ortega P. , Ferres I.
Published: March 2003

Background

Right ventricular outflow obstruction with an intact ventricular septum leads to severe hemodynamic problems in the newborn, with hypoxemia and congestive heart failure due to tricusp regurgitation. Atresia of the pulmonary valve occurs in less than 3% of all congenital heart lesions, with a frequency of 1:25 000 of live births. Use of fetal echocardiography permits prenatal diagnosis of this and other congenital defects, for a better knowledge and therapy.

Case report

35‐year‐old pacient, with a previous newborn with an interventricular comunication. On her 30 week of pregnancy, a fetal echocardiography showed atresia of the pulmonary valve with an intact interventricular septum, severe tricuspid regurgitation, a right atrial dilatation, restriction of flow in the oval foramen of 8 m/seg and ductus arterioso with retrograde or bidirectional flow, from the aorta to the pulmonary circulation. Vaginal delivery occurred at 38 weeks, obtaining a female newborn, 2630 g, in good conditions. However she developed severe cardiac failure and died at day 4, in spite of pharmacologic with prostaglandins and surgical therapy.

Conclusions

Echocardiography is the basis of prenatal diagnosis of congenital heart disease, like pulmonary valve atresia, and is of great help to understand and decide the best perinatal therapy.
P124S‐shaped kinking and constriction of the fetal ductus arteriosus with pericardial effusion
Authors: Park M. Y. , Kim Y. J. , Woo B. H. , Kim H. S.
Published: March 2003

Usually fetal ductus arteriosus (DA) closure or constriction is caused by maternal medication of prostaglandin synthase inhibitor or corticosteroid. Although it is a rare condition, idiopathic DA constriction in the human fetus has been also reported. In our case, the patient was reffered at 26 weeks gestation due to pericardial effusion. The mother had not been received any medication of nonsteroidal anti‐inflammatory agents. The fetus had abnormally S‐shaped kinking and constriction of the DA, right arterial enlargement, right ventricular hypertrophy, tricuspid valve regurgitation and constrictive foramen ovale. An amniocentesis had been performed due to abnormal triple test and the fetal karyotype was 46XY. There was no evidence of fetal infection and other congenital malformation. Cesarean section was performed at 313 weeks gestation due to fetal hypoxia diagnosed by Doppler sonography and biophysical profile, and the baby was born in poor condition. On follow‐up, although the baby has right ventricular dysfunction for 2 month after birth, expected a good prognosis.
P125Prenatal diagnosis of cardiac rhabdomyoma
Authors: Hernádi L. , Tőrocsik M. , Player D. Á. , Vasas Z.
Published: March 2003

Background

Our aim was to present a case of cardiac rhabdomyoma diagnosed at 24 weeks of pregnancy.

A 20‐year‐old woman, G2P0, was referred for sonographic examination because of the history of cystic hygroma in her first pregnancy. Karyotyping revealed trisomy 21 and termination was performed. There were no cardiac and neurologic diseases in her family history. For the present pregnancy routine ultrasound scans at 12 and 18 weeks showed normal fetal anatomy. Fetal echocardiography at 24 weeks revealed a large cardiac tumour protruding from the intraventricular septum into the right ventricle (12 mm). Colour Doppler showed blood flow around the tumour and the flow pattern was not suggestive for obstruction of the right ventricular outflow tract. No other fetal anomalies were noted. The patient was informed about the diagnosis of rhabdomyoma and the possibility of associated tuberous sclerosis. Termination of pregnancy was performed upon patient's request. Pathologic examination confirmed the diagnosis but found no sign for tuberous sclerosis. Karyotyping was normal. Her next pregnancy was uneventful resulting a healthy newborn.

Conclusion

The natural history of intracardiac rhabdomyoma is not known and usually detected in the second half of gestation. The prognosis depends on its influence on cardiac functions and the associated anomalies.
Three‐dimensional power Doppler in obstetrics and gynecology P126The three‐dimensional ultrasound analysis of embryonal and early fetal development – an improvement of prenatal diagnosis
Authors: Malý Z. , Koudelka M.
Published: March 2003

Backround

There are two important trends in prenatal diagnosis – to avoid invasive diagnostic procedures as much as possible and to find anomaly as soon as possible. Ultrasound evaluation is playing an essential role. The first trimester of pregnancy seems to be the suitable period for diagnosis for above mentioned purposes.

Method

More than 450 first trimester pregnancies was evaluated with 3D sonography using its all computed features. The images which were obtained can be used also for educative goal.

Results

We provided 3D ultrasound diagnosis of fetal anomalies from the moment of their development, up the 9th week of gestation (from LMP). The image quality allowed so precise analysis, that pictures are comparable with embryological reality and will be present.

Conclusion

With 3D ultrasound the first trimester seems to be the most important period of prenatal diagnostics. 3D can display the same pictures in vivo, as invasive fetoscopy or embryological speciments in vitro. The technical limits disapear and the knowledge of embryology and of possible pathological fetal development remains the last limiting factor.
P130Three‐dimensional sonographic features of hydrops fetalis
Authors: Kuno A. , Ueta M. , Hanaoka U. , Tanaka Y. , Akiyama M. , Yamashiro C. , Tanaka H. , Hayashi K. , Yanagihara T. , Hara K. , Hata T.
Published: March 2003

Background

The aim of this study was to describe three‐dimensional (3‐D) sonographic features of hydrops fetalis.

Methods

A total of 8 cases with hydrops fetalis from 15 to 32 weeks of gestation were studied with transabdominal 3‐D sonography (3.5 MHz).

Results

The image clarity of 3‐D sonography was subjectively superior than those by 2‐D sonography in all cases studied, and it was possible to obtain finer image quality of internal organs with 3‐D sonography. Before around 20 weeks of gestation, the skin becomes a transparent‐like structure, so internal organs can be clearly identified. After 25 weeks, skin edema, pleural effusion, hypoplastic lungs were clearly recognized.

Conclusion

Our results suggest that 3‐D sonography provides a novel means of visualizing hydrops fetalis in utero.
P131Differential diagnosis between chorioangioma and chorionic villous haemorrhage by three‐dimentional ultrasonography
Authors: Kondo S. , Ninomiya  , Takahashi T. , Soma H. , Hata T.
Published: March 2003

We had 2 cases of ‘placental tumor’ with hydramnion and fetal anemia. Case 1: A 26‐y/o G‐1, P‐1 was introduced to our hospital at 25w due to drastic enlargemnet of her lower abdomen. 3‐D US exam revealed a tumor on her placental. Its volume was 137.8 ml and abundant bloodflow was observed in the tumor. The tumor and amnionic fluid volume were increased. At 26w, we performed C/S due to her dyspnea by hydramnion. A 1028 g male infant was delivered and was transferred to NICU immediately as an imature infant with his low Hb, 10.6 g/dl. The tumor was histologically diagnosed as chorioangioma. Case 2: A 26‐y/o G‐0, P‐0 was admitted at 29w due to placental tumor. By 3‐D US exam, we found a placental tumor. Its volume was 164.1 ml. C/S was performed because nst showed loss of variability. A 1982 g female infant was delivered. Her Hb was 9.1 g/dl. The tumor was diagnosed as chorionic villous hemorrhage. We could not differentiate those of ‘placental tumor’ by 2‐D US with color flow mapping. But using 3‐D US, chorioangioma showed as a hyper‐echoic mass although chorionic villous hemorrhage did as hypo‐echoic. ‘Placental tumor’ can be differentiated effectively by 3‐D US.
P137Ultrasound in the detection of endometrial pathologies in breast cancer patients with Tamoxifen treatment
Authors: Machado M. R. M. , Santos F. F. A. , Marussi E. F. , Neder V. M. , S
Published: March 2003

Background

The tamoxifen (TAM) is an antiestrogen that is widely used as adjuvant therapy for postmenopausal breast cancer patients with positive estrogen receptor proteins. It has been reported that the patients who have been treated for more than 12 months with TAM are at increased risk for endometrial carcinoma. The aim of this study was to investigate the relationship between histological endometrial findings in breast cancer patients and transvaginal ultrasound.

Method

Medical records and sonograms of 238 women treated for breast cancer with TAM were reviewed retrospectively. We included all patients using adjuvant therapy for breast cancer patients with TAM 20 mg of Tamoxifen. The exam was performed using a transvaginal probe 7.5 MHz transducer on a TOSHIBA 140 SSA and ACUSON XP‐4A ultrasonography set. Sonographic endometrial thickness was correlated to histologic findings and symptoms.

Results

A hundred‐55 (65.12%) had endometrial thickness of 8 mm or lower, measured by transvaginal ultrasound. We did not found any case of endometrial cancer, even with bleeding. From 51 patients with diagnostic hysteroscopy, the more frequent findings were: atrophic endometrium, endometrial polyps and insufficient material for histology exam.

Conclusions

Transvaginal sonography is an useful tool for the follow‐up of tamoxifen treated patients used as trial for invasive diagnostic procedures.
P145Ultrasound evaluation of ectopic pregnancy and laparoscopic approach
Authors: Sijanović S. , Popovic Z. , Lovric A. , Hrgovic Z.
Published: March 2003

In our department we prefer laparoscopic treatment ectopic pregnancy. In 1999 and 2000 years we were laparoscopically treated 70% ectopic pregnancy. For promtly and safely diagnosis we use clinical, ultrasound and beta choriongonadotropine hormon examination. In this period we treated 26 women with diagnosis of ectopic pregnancy. In 96% patients ultrasound examination was made. Ultrasound examination showed in 88% women adnexal masses or free fluid in Douglas space. In most cases ectopic pregnancy was in right tube (69%). Ultrasound evaluation in correlation with beta choriongonadotropin hormone creates early and safely diagnosis ectopic pregnancy and provides laparoscopic approach. Laparoscopic approach in treatment ectopic pregnancy is method of choice.
P149Ultrasound in the diagnosis and treatment of female stress urinary incontinence
Authors: Lukanovic A. , Kralj B.
Published: March 2003

Abstract not available.
P18Fetal cerebral ventriculomegaly. An observational study
Authors: Pinzano R. , Meir J. , Natale R. , Conoscenti G. C. , Fischer‐Tamaro L. , Maso G. P. , Bogatti P. , Rustico M. A. , D'ottavio G.
Published: March 2003

Background

The aim of this study is to review all the cases of FCV diagnosed in the Obstetric and Gynecology Unit of our Institution from 1990 to 1999 and to evaluate the neonatal outcome.

Method

This is a retrospective study. The diagnosis of ventriculomegaly is according to Cardoza criteria and to atrial width ≥ 10 mm between 15 and 40 weeks gestational. For all cases we consider: progression and/or resolution; association with other fetal ultrasound signs of malformations and with chromosomal abnormalities; fetal infections (TORCH); pregnancy termination and follow‐up by pediatric report. In cases of interruption of pregnancy we evaluate postmortem examination.

Results

Among 165 cases of FCV, n 84 (50.9%) are associated with malformation of SNC, n 59 (35.76%) are isolated, n 22 (13.33%) are associated with other fetal malformations. In the group of isolated: 32 case are borderline (≤ 15 mm), chromosomal abnormalities are 4 among 40 evaluated (10%), favourable neonatal outcome is present in 22 cases of 29 born (75.86%).

Conclusions

In this study the percentage of chromosomal abnormalities in the FCV isolated is higher than other series in the literature. The reproducibility of measurement of atria rather permits comparisons than other qualitative and quantitative signs.
P20Early membrane funnelling may occur from 16 weeks onwards and carries a worse prognosis
Authors: Bellver J. , Lberico G. , Lara C. , Ferro J. , Remohí J. , Pellicer A. , Serra‐Serra V.
Published: March 2003

Background

Sonographic screening for cervical incompetence during pregnancy is currently a routine procedure. However, no consensus exists on the optimal gestational age to perform such screening.

Method

Serial transvaginal ultrasound examinations of the uterine cervix were routinely performed from 12 weeks onwards. The screening was considered positive when membrane funnelling was present or the cervical length was < 2 cm. Therapeutic measures included bed rest, antibiotics, tocolytic treatment and a modified McDonald's cervical suture (up to 25 weeks).

Results

Membrane funnelling was detected between 16 and 22 weeks (group A) in 9 women (31%); between 23 and 28 weeks (group B) in 11 women (38%) and between 29 and 36 weeks (group C) in 9 women (31%). Two women presented with hourglass membranes at 20 and 23 weeks, respectively. Comparison between groups A and B showed similar women characteristics and risk factors (P = NS). Delivery rate at ≤ 28 weeks was higher in group A (62.5%) than in group B (9.1%) (P < 0.03). Only one woman in group A and three in group B delivered at term.

Conclusion

This small series provides evidence to recommend serial monographic examinations of the uterine cervix, starting at 16 weeks. A greater risk of very premature delivery was evident when membrane funnelling was diagnosed before 23 weeks.
P21Fetal liver volume in normal and reduced fetal growth
Authors: Boito S. , Struijk P. C. , Laudy J. , Stijnen H. R. , Wladimiroff J. W.
Published: March 2003

Background

To establish reproducibility and normal values for fetal liver volume and its significance in identifying fetal growth restriction relative to head (HC) and abdominal circumference (AC) according to a cross‐sectional study design.

Method

The measurements were obtained using a Voluson 530‐D for volume scanning. The coefficient of variation (CV) for liver volume scans (t0, t20 min) and liver area tracings (t0: 2x; t20: 2x) was determined (n: 20; 23–36 weeks). Normal charts for liver volume, HC, AC were constructed (n: 60; 22–37 weeks) and related to data from growth‐restricted fetuses (birthweight < P5) (n: 13; 23–36 weeks).

Results

CV is 2.9% for volume scans and 1.6% for area tracings. Mean liver volume (P50) ranges between 16.5 mL (± 5.9 (SD)) at 22 weeks and 101.8 mL (± 8.2 (SD)) at 37 weeks. In fetal growth restriction, liver volume, HC and AC expressed as percentage of the normal P50 is 45%, 91% and 83%, respectively. Mean difference in liver size between fetal growth restriction (FGR) and normal fetal development (Z score = Liver volumeFGR– P50normal/SDnormal) is −4.5 ± 1.6 (SD), which is significantly different (P < 0.05) from HC: − 3.2 ± 1.5 (SD), but not from AC: − 4.3 ± 1.3 (SD).

Conclusion

Acceptable reproducibility exists for liver volume determinations. Normal liver volume increases 6‐fold at 22–37 weeks. Fetal growth restriction: reduction is more pronounced for liver volume than HC and AC; liver volume is a better discriminator than HC, but not AC.
P24Fetal porencephaly as a rare complication of epignathus occluding blood flow in the internal carotid artery
Authors: Lex B. , Berg C. , Reusche E. , Masson D. , Gembruch U.
Published: March 2003

Background

Epignathus is a rare benign congenital teratoma of the hard palate. Some of these tumors protrude bidirectionally involving pharyngeal as well as intracranial structures. The poor prognosis of the affected fetuses is due to consecutive airway obstruction and destruction of brain tissue. We report an unusual case of epignathus leading to compression of the internal carotid artery with subsequent porencephaly.

In a 27‐year‐old gravida 1 at 25 weeks gestational age with polyhydramnios, ultrasound examination demonstrated extensive epignathus with displacement of adjacent structures, hydrocephaly and porencephaly. Neither brainstem nor cerebellum could be clearly identified. A steal effect was excluded as low tumor vascularisation and high resistance indices of the supplying vessels was demonstrated, therefore porencephaly was suspected to be caused by vascular compromise. Amniocentesis revealed a normal karyotype. The parents elected to terminate the pregnancy. Autopsy results were confirmatory. An immature teratoma of the hard palate measuring 95 × 42 × 32 mm compressing the left internal carotid artery was demonstrated, leading to colliquation necrosis of the left hemisphere. Additionally displacement of brainstem and infiltration of cerebellum led to cerebrospinal fluid block and consecutive hydrocephalus.

Conclusion

Only few reports exist on the prenatal diagnosis of epignathus. We report the first case of epignathus causing extensive brain damage by vascular compromise.
P25An alobar holoprosencephaly; a case report
Authors: Gül A.
Published: March 2003

Alobar holoprosencephaly characterised by median malformations of the face and brain due to incomplete cleavage and morphogenesis of the fore brain. The alobar holoprosencephaly occur in about 0.6–1.9 of 10.000 deliveries. Median facial abnormalities consist of orbital hypotelorizm, cyclopia in combination with a flat nose or proboscis and oral deformities can be diagnosed with ultrasonographicaly at the early antenatal period. In this case report we introduced a fetus with an alobar holoprosencephaly diagnosed at 24 weeks of gestation according to BPD and FL measures. In obstetric ultrasonography, spinal cord, vertebras and spinal canal were normal in structure, but interhemispheric fissure, falx cerebri and corpus callosum were not visualised. There was single‐chamber ventricle in semihiron shape that continued with a dorsal cyst filing the calvarium. Decision for pregnancy termination was made after the consultation with the pediatricians. In neonatal examination, there was no gross deformity of the trunk and extremities. As a facial deformity, cyclopia and 3 × 2 cm sized proboscis attacked above the insignificant nasal structure was detected and only one eye was present at the middle of the face.
P28Prenatal diagnosis of schizencephaly: case report
Authors: Lagos N. , García C. , Walton R. , Hoffmann I. , Muñoz H.
Published: March 2003

Background

Schizencephaly is a rare congenital malformation of the central nervous system. It consists in the finding of unilateral or bilateral clefts in the cerebral hemispheres.

Case report

36‐year‐old patient, at week 22, an ultrasound showed hydrocephaly with a 19‐mm atrium. At week 27, a 6‐mm diameter defect was shown in the cerebral parenchyma of the right hemisphere, that was comunicated with the lateral ventricle, with normal atrium. The conclusion was Schizencephaly. Magnetic resonance imaging (MRI) also showed the parenchymal defect, with comunication to the lateral ventricle, and no hydrocephalus. Cesarian section was performed at week 38, with a 2780 g.

Newborn

Postnatal echography and computed tomography showed no changes.

Discussion

Two types of schizencephaly have been described: Type I, in which the defect is closed‐lip, because the lips of the clefts are fused within a pia‐ependymal seam that is continous with the ependyma of the lateral ventricle, and type II, in which the lips remain open, and the clefts are more extensive. Pathogenesis is unclear but anomalies of neuronal migration during the third to fifth gestational months are invoked. Clinically, patients have seizures, developmental delay and hemiparesias. In this case, diagnosis was suspected by ultrasound and confirmed by MRI, which is the best method. Ultrasound permited us to follow the defect and best decide when to interrupt pregnancy.
P03The value of ultrasound screening for fetal abnormalities in the first trimester
Authors: Tankó A. , Steinmetz G. Y. , Varga Á. , Kovács A. G. , Godó G. Y. , Marton T. , Papp Z. Z.
Published: March 2003

Objective

Evaluation of routine screening in the early pregnancy by transvaginal sonography (TVS) in an unselected population. Design and methods: A routine ultrasound examination was offered to every woman in the 12th week of her pregnancy. Besides a detailed survey of fetal anatomy, a measurement of nuchal translucency and karyotyping was performed as appropriate.

Results

In a five‐year period (from 1. Jan. 1995 – to 31. Dec. 1999) 9556 women were examined. Fetal anomalies were diagnosed in 54 cases at the 12th week of pregnancy: 63 morphological abnormalities and 16 chromosomal aberrations. The detection rate for structural and chromosomal abnormalities in early pregnancy was 50.5% (54/107) of all anomalies, which were diagnosed antenatally.

Conclusions

It is possible to detect fetal abnormalities very early in pregnancy. The ultrasound screening may increase the detection rate of chromosomal disorders. The interpretation of fetal anatomy in the first trimester requires comprehensive understanding of embryological development. The detection rate of fetal malformations is increased significantly by introducing an early pregnancy scan in addition to the mid‐trimester scan. The fetopathological examination can add more information to the clinicians and to genetic counselling.
P30Early prenatal diagnosis of fetal seizures
Authors: Haddad S. , Younis J. , Peleg D. , Ben‐Ami
Published: March 2003

Background

Prenatal diagnosis of fetal seizures is rarely reported. We present the earliest prenatal case of fetal seizures diagnosed by ultrasound during the 15th week of gestation.

Method

A 34‐year‐old woman gravida 10, para 3, with 6 miscarriages and 2 healthy living children, was referred for targeted sonographic examination at 15 weeks' gestation because of her bad obstetric history. Normal fetal structures and biometry were revealed. Repetitive episodes of jerking movements of fetal body and limbs were detected. Limited flexion of the limbs was also observed.

Results

Triple marker screening performed at 17 weeks' gestation was abnormal with a 1:13 risk for Trisomy 21, but the woman refused amniocentesis. The couple received extensive counselling, but refused further investigation and were lost to follow‐up until delivery. At 36 weeks' gestation, the woman was admitted with prom and breech presentation. A female newborn weighing 2000 g with apgars of 8 and 9 and cord ph 7.32 was delivered by cesarean section. Several hours after delivery, the newborn developed apnea and seizures requiring anticonvulsive treatment. The neonatal investigation revealed mitochondrial disease.

Conclusion

Fetal seizures can be diagnosed in early gestation. In this presentation, we will present the case and review the literature and differential diagnosis of fetal and neonatal seizures.
P38Prenatal diagnosis of severe hypotonia and polihydramnius in a fetus with mitochondrial disorder
Authors: De León J. A. , Pérez Fernández R. , Granados M. , González M. , López J. , Clavero J.
Published: March 2003

Introduction

The diagnosis of polihydramnius is ultrasound and can be measure with a various test but finally the result is the increment of the amnioticus liquid. It is secundary from a differents pathological situations but severe hypotonia is a rare cause. The hypotonia is the result of a heterogeneous group of conditions including severe hypoxia, neuromuscular disorder, deposit disease, chromosomal, and mitochondrial pathology.

Case report

A 30‐year‐old woman in the 40th week of gestation came to us referring a decrease in foetal movements during the last 24 h. The pregnancy curse had been normal. The foetal heart rate variability was pathological and the ultrasound study showed a decrease in respiratory movements, foetal movements and foetal tone with a abnormal amniotic liquid volume. The foetus was delivered by urgency caesarean section. A 3160‐g male was born, Apgar 6/8, pH 7.32. The newborn was taken to nciu and the neonatal outcome was unfavourable. The newborn had a severe hypotonia, hyporeflexia, the eec was pathological. Finally the newborn died.
P44Fetal kidney biometry from 10 to 14 weeks of gestation
Authors: Spathopoulos Y. , Chatzipapas I. , Whitlow B. , Economides D.
Published: March 2003

Background

To determine fetal biometrical reference ranges for the fetal kidney from 10+° to 14+6 weeks' gestation.

Methods

A prospective cross‐sectional study in a University Department of Obstetrics and Gynaecology, London. Four hundred and thirty‐eight women from an unselected population underwent a detailed assessment of fetal anatomy at 10–14 weeks' of gestation (confirmed by crown‐rump length) using transabdominal sonography, and transvaginal sonography (37.4%: 164/438) when necessary. Anterior‐posterior (AP), transverse (T) and longitudinal (L) parameters for the kidney and renal pelvis were measured and charts for centiles derived using regression analysis and a model of best fit constructed.

Results

Centiles were derived for each biometrical parameter. New charts for each biometrical parameter are presented and compared with previously published data. The 95th centile for the renal pelvis anterior‐posterior diameter varied from 1.4 to 3.1 mm from 10+° to 14+6 weeks, respectively.

Conclusion

We have constructed new reference ranges for kidney dimensions including new data on the renal pelvis dimensions.
P63The effect of fetal neck position on nuchal translucency measurement
Authors: Chatzipapas I. , Spathopoulos Y. , Whitlow B. , Economides D.
Published: March 2003

Background

The aim of this study was to determine whether the position of the fetal neck has a significant effect on nuchal translucency measurement (NT).

Method

A prospective cross‐sectional study was carried out. One hundred and ninety‐six women from an unselected population underwent transabdominal sonography. The nuchal translucency was measured in the mid‐sagittal plane, with the fetal neck in the flexed, neutral and extended positions. Measurement was taken to the nearest 0.1 mm. Statistical analysis using a paired t‐test for the differences in the extended and neutral position nuchal translucency [delta extended NT] and in the flexed and neutral position nuchal translucency [delta flexed NT] was performed.

Results

On average the extended NT was 0.62 mm greater than the neutral NT value [95% confidence interval 0.53–0.70, T = 14.33, P = < 0.00001]. The flexed NT was on average 0.40 mm less than the neutral NT value [95% confidence interval 0.34–0.47, T = 11.99, P = < 0.00001]. The repeatability coefficient was lower in the case of neutral NT measurement [0.48] and was higher in the other groups [extended = 1.04, flexed = 0.70].

Conclusion

The effect of fetal neck position can make a significant difference on nuchal translucency measurement. Repeatability of measurements are more accurate with the fetal neck in the neutral position. These findings have important implications for clinicians using nuchal translucency to screen the general obstetric population.
P65Feasibility and accuracy of NT measurement in twin pregnancies
Authors: Dreazen E. , Maymon R. , Weinraub Z. , Herman A.
Published: March 2003

Background

The aim of our study was to evaluate the feasibility and accuracy of nuchal translucency measurement (NT) in twin pregnancies.

Method

We reviewed nt images of 66 pairs of twins (10.3–14 weeks gestation), matched with nt images of 66 pairs of consequent singleton pregnancies with similar gestational ages. Each of the inspected images was assigned a score, which classified it into one of four quality zones.

Results

In the twins, as well as in the singleton control group, the vast majority of the nt images were in the excellent‐reasonable zones (−88%), and 10% in each of the groups had their nt images in the intermediate zone (11% vs. 12%). Less than 1.5% of the images were of unsatisfactory quality (1.5% vs. 0.8%), according to the strict criteria, required for reliable, comparable and reproducible results. (Hennan et al. Ultrasound Obstet Gynecol 1998; 12: 398–403).

Conclusion

NT measurement in twin pregnancies is as feasible, accurate and reproducible as in singleton pregnancies. However, it provides a better DS risk assessment when compared with the second trimester triple test in twin pregnancies, as it evaluates DS risk individually for each of the fetuses.
P67Analysis of fetal karyotypes after abnormal ultrasound findings
Authors: Auren J. , Ekholm E. , Palo P.
Published: March 2003

Background

The aim of this study was to evaluate fetal karyotypes in pregnancies with abnormal ultrasound findings. The cases were obtained from the catchment area of the Turku University central Hospital between March 1993 and September 1999. In 48% of cases maternal age was below 30 years.

Methods

287 pregnancies with abnormal ultrasound findings were evaluated. Ultrasound examination was performed on average at 21 weeks of gestation (range 10–40 weeks). In 247 cases fetal structural abnormality was detected. In the remaining 40 cases ultrasound abnormality was fetal intrauterine death, small fetal size, and or oligohydramnion or polyhydramnion and partial hydatiform mola (two cases). Amniocentesis was done in 90% and villus biopsy in 10% of cases.

Results

Fetal karyotype was found abnormal in 15% of pregnancies. Trisomy 21 was found in 10 cases. Six of these pregnancies were sent for evaluation because of increased nuchal translucency, the remaining because of fetal hydrops, ascites or pleural effusion. Nine fetuses had monosomy XO and ultrasonography revealed a cystic hygroma. Four fetuses with trisomy 18 and four with trisomy 13 were found due to structural abnormalities. Fifty pregnancies were terminated, 19 of these because of fetal chromosomal abnormality. Six pregnancies ended in spontaneus abortion. Three of these carried a chromosomally abnormal fetus. Moreover, eight fetuses died in utero later in pregnancy. Karyotyping was not possible in one case.

Conclusion

Fetal karyotyping should be done also in young mothers in the first and second trimester when fetal ultrasound examination is abnormal.
P76Early diastolic notch of uterine artery Doppler velocimetry in relation to placental location
Authors: Lee C. H. , Park Y. W. , Cho J. S. , Han S. S.
Published: March 2003

Background

The aim of this study was to investigate the relation between types of early diastolic notch and placental location and to evaluate the difference in perinatal outcome.

Method

We evaluated the Doppler waveform of the uterine artery in 149 pregnant women having an early diastolic notch after 26 weeks gestation, however, we were unable to follow the obstetric outcomes in 20 women. Placental location was determined by transverse view of ultrasonography and classified as central and lateral placenta. The unilateral diastolic notches were divided into 3 groups depending on the placental location (ipsilateral: same side of the placenta, contralateral: opposite side of the placenta, and median: central placenta).

Results

In the bilateral notch group, the S/D ratio of the contralateral uterine artery was higher than the ipsilateral one (n = 60, mean = 3.22 VS 2.80, P = 0.0067). Of the 89 unilateral notches observed, the S/D ratio of the uterine artery in patients having early diastolic notch was higher compared to those without early diastolic notch. (t‐test, mean = 2.74, 1.92, P = 0.0001) Patients with bilateral notches were associated with poor perinatal outcomes significantly more than the patients with unilateral notches (P = 0.003). Among the unilateral groups (ipsilateral: n = 10, median: n = 21, contralateral: n = 58), there was no significant difference in perinatal outcomes.

Conclusion

The early diastolic notch can be observed on both or either sides of the uterine artery independent on placental location. More bilateral notches were associated with poor pregnancy outcomes than unilateral notches. The pregnancy outcomes tended to be similar in unilateral notch irrespective of placental side is necessary because of the frequent appearance of early diastolic notch and higher vascular resistance.
P08Case report: transvaginal ultrasonographic aspiration in the management of an ovarian cyst detected at the seventh gestational week
Authors: Tekin B. , Hassa H. , Şener T. , Saraç I.
Published: March 2003

Objective

To discuss a different approach, other than cystectomy, to an ovarian cyst detected at early gestation due to the risk of torsion.

Case report

During ultrasonographic control of a pregnant at seven weeks of gestation, 30‐year‐old with two gravidity, one parity and one living child, a cyst with regular contour, measuring 150 × 130 mm with a wall thickness smaller than two mm was detected. By Doppler evaluation, vascular pattern could not be detected on the cyst wall. Ca 125, AFP, CEA levels were measured as 41.4 U/ml, 2.4 IU/ml, 1.2 ng/ml, respectively. The cyst was aspirated by a 17 g needle through posterior fornix with the assistance of tranvaginal ultrasonography. In cytological evaluation of the cyst fluid, no malignant cells were found. The case was called for control at 12th week of gestation which was known as the week of the completion of luteoplacental shift.

Conclusion

Since ca125 levels could be increased by pregnancy and there was no malignant feature except the dimensions of the cyst, the cyst was supposed to be benign and a conservative approach was planned. Corpus luteum is necessary for the continuation of pregnancy at these weeks of gestation so the anxiety about cystectomy was the termination of pregnancy due to corpus luteum deficiency. On the other hand, however, expectant management could not also be chosen, because the risk of torsion was high due to the texture, dimensions and mobile characteristic of the cyst. For this case who was at a younger age for ovarian malignancy the shrinkage of the cyst by aspirating it with the assistance of transvaginal ultrasonography without dysfunctioning corpus luteum, was decided. The management could be changed according to the cytological evaluation.

In conclusion, at the early weeks of gestation, transvaginal cyst aspiration could be a way of management by decreasing the torsion risk without being a handicap for the continuation of pregnancy.
P83Fetal hemodynamic profile in pregnancies with absent or reversed end‐diastolic velocity waveforms in the umbilical artery that presented fetal death
Authors: Yamamoto R. M. , Francisco R. P. V. , Steinman D. S. , Miyadahira S. , Zugaib M.
Published: March 2003

Background

A description of the fetal hemodynamic profile in pregnancies with absent or reversed end‐diastolic velocity (AREDV) that presented fetal death.

Material and methods

Between 1997 and 2000, 107 high risk pregnant women with AREDV were followed by the Fetal Surveillance Unit. Seventeen cases that presented fetal death (FD) were submitted to Dopplervelocimetry of the umbilical artery (UA), descending thoracic aorta (DTA), middle cerebral artery (MCA) and ductus venosus (DV).

Results

The results are shown in the table:

AREDV diagnosis
19–24 week  (n = 10)
25–28 week  (n = 7)
Total  (n = 17)

GA at fetal death
24.7 + 1.6
26.3 + 1.0
25.4 + 1.6

Reversed flow
6 (60%)
7 (100%)
13 (76%)

UA Doppler PI
5.0 ± 3.1
6.3 ± 1.8
5.5 ± 2.7

Abnormal DV
10 (100%)
6 (86%)
16/17 (94%)

DV Doppler – PIV
2.3 ± 1.5
2.3 ± 1.3
2.3 ± 1.4

Abnormal DTA
9/10 (90%)
3/6 (50%)
12/16 (75%)

MCA PI < 5th p
6 (60%)
6 (86%)
12 (71%)

loss of redistribution
4 (40%)
1 (14%)
5 (29%)

Conclusions

The results show severe fetal hemodynamic profile abnormalities, revealed by Doppler studies conducted in AREDV cases that presented fetal death.
P90Growth hormone and insulin‐ like growth factor 1, in small‐for‐gestational‐age pregnancies with increased pulsatility index in the umbilical artery
Authors: Larsen T. , Main K. , Andersson A. M. , Juul A. , Greisen G. , Skakkebaek N. E.
Published: March 2003

Background

The aim of the study was to examine some endokrinological aspects of intrauterine growth retardation and, in particular, test whether low levels of GH and IGF‐1 in maternal serum are associated with direct evidence of placental dysfunction.

Method

Prospectively 48 singleton pregnancies with a SGA fetus and 28 with an AGA fetus were examined with maternal serum GH, IGF‐1, IGFBP‐1 and 3, and fetal weight and umbilical artery pulsatility index at 33 weeks of gestation.

Results

Serum IGF‐1 was lower in the SGA group, which was accounted for in the subgroup of SGA with increased pulsatility index.

Conclusion

A decreased maternal level of IGF‐1 seems to be specifically related to placental dysfunction as diagnosed by increased Doppler flow pulsatility