bluuebunny/crossref_metadata_2025 huggingface dataset:
The significance of choroid plexus cysts, echogenic heart foci and renal pyelectasis in the first trimester
Authors: Whitlow B. J. , Lazanakis M. L. , Kadir R. A. , Chatzipapas I. , Economides D. L.
Published: March 2003

Objective

To determine the significance of certain soft ultrasonographic markers for chromosomal abnormalities in the first trimester.

Design

This was a prospective cross‐sectional study.

Setting

University Department of Obstetrics and Gynaecology, London, UK.

Methods

A total of 5385 women from an unselected population underwent a detailed assessment of fetal anatomy at 11–14 weeks of gestation (confirmed by crown‐rump length) by transabdominal sonography (5.0 MHz) and transvaginal sonography (6.0 MHz) when necessary.

Results

In normal fetuses, the prevalences of choroid plexus cysts, pyelectasis and echogenic heart foci were 2.2, 0.9 and 0.6%, respectively in the first trimester and 2.0, 0.8 and 0.8%, respectively in the second trimester. Pyelectasis (likelihood ratio = 8.0, p = 0.03) and echogenic heart foci (likelihood ratio = 10.3, p = 0.02) were found to be associated significantly with fetal aneuploidy, while choroid plexus cysts were not.

Conclusions

Although the majority of aneuploidies were detected by increased nuchal translucency and/or the presence of structural abnormalities (78%; 25/32), the use of soft ultrasonographic markers in the first trimester would have increased the overall detection by a further 3%. These data are preliminary and many thousands of pregnancies will need to be examined to determine the significance of the individual markers in different chromosomal abnormalities. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Comparison of prenatal ultrasound and postmortem findings in fetuses and infants with congenital heart defects
Authors: Isaksen C. V. , Eik‐Nes S. H. , Blaas H.‐G. , Tegnander E. , Torp S. H.
Published: March 2003

Objective

Detection of congenital heart defects by prenatal ultrasound examination has been one of the great challenges since the investigation for fetal anomalies became part of the routine fetal examination. This prospective study was designed to evaluate the concordance of prenatal ultrasound findings with autopsy examination in a population consisting of both referred women and non‐selected pregnant women.

Design

Criteria for inclusion were an ultrasound examination at the National Center for Fetal Medicine and an autopsy performed during the years 1985–94. Results from the ultrasound and autopsy examinations were systematized into categories depending on the degree of concordance.

Results

Of 408 infants and fetuses with developmental anomalies, 106 (26%) had congenital heart defects. In 63 (59%) of these 106 cases, the heart defect was the principal reason for the termination of pregnancy or the cause of death. Excluding five cases with a secundum atrial septal defect, there was complete agreement between the ultrasound examination and the autopsy findings in 74 (73%) of 101 cases. In 18 cases, there were minor discrepancies between ultrasound and autopsy findings. The main diagnosis was thus correct in 92 cases (91%). From the first time period (1985–89) to the second (1990–94), the detection rate of all heart defects increased from 48% to 82%.

Conclusion

This study confirms a good correlation between ultrasound and autopsy diagnoses in fetuses and infants with congenital heart defects. A significant improvement in the detection of heart defects occurred from the first time period to the second and was probably due to increased experience and technical advances. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Magnetic resonance imaging supplements ultrasonographic imaging of the posterior fossa, pharynx and neck in malformed fetuses
Authors: Poutamo J. , Vanninen R. , Partanen K. , Ryynänen M. , Kirkinen P.
Published: March 2003

Objective

The objective of this study was to compare antepartum ultrasonography and magnetic resonance imaging (MRI) in the diagnosis and exclusion of malformations of the fetal neck, pharynx, skull base and posterior fossa in late pregnancy.

Materials and methods

The study involved 26 women and 27 fetuses with ultrasonographically or clinically suspected abnormalities of the fetal neck, pharynx or central nervous system (CNS). Findings obtained by ultrasound were compared with those obtained by MRI (1.5 T) in the last trimester.

Results

In cases with CNS malformation (n = 19), MRI provided additional information on the anatomy of the foramen magnum and posterior fossa in nine cases (47%). When antepartum ultrasonography indicated malformation of the soft tissues of the neck or pharynx (n = 8), MRI provided additional information on diagnosis or exclusion of the abnormality in six cases (75%). The imaging capacity of the anatomy of the naso‐, oro‐ and hypopharynx, trachea, esophagus and cervical skin outlines was better with MRI.

Conclusions

MRI proved to be a valuable supplementary method to ultrasound in obtaining accurate information from the fetal neck, pharynx and posterior fossa, particularly when acoustic shadowing by bony structures or adjacent malformation impaired the quality of the ultrasonographic examination. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Screening efficacy of the subcutaneous tissue width/femur length ratio for fetal macrosomia in the non‐diabetic pregnancy
Authors: Rotmensch S. , Celentano C. , Liberati M. , Malinger G. , Sadan O. , Bellati U. , Glezerman M.
Published: March 2003

Background

Antenatal weight estimations have limited sensitivity and specificity for the detection of macrosomia. The objective of our study was to examine the screening efficacy of the subcutaneous tissue width/femur length ratio for the intrapartum detection of fetal macrosomia in a non‐diabetic population at term.

Study design

Intrapartum sonographic measurements were performed in 178 well‐dated gravidas at 37–41 weeks' gestation with negative glucose tolerance screens. The biparietal diameter, femur length (FL), abdominal circumference and subcutaneous tissue width of the thigh (SCT) were determined. Subsequently, predictions for macrosomia (actual birth weights above the 90th centile) were made using varying cut‐off points of the examined parameters or estimated fetal weights.

Results

Macrosomia occurred in 27 newborns (15.1%). The SCTFL ratio was independent of gestational age (r = −0.017). Maternal age, gravidity, parity, gestational age and the ratio of male‐to‐female infants were similar in pregnancies resulting in appropriate‐for‐gestational‐age and macrosomic infants (NS). There was no difference in the SCT/FL ratio between these groups (p = 0.067; 99% power to detect 2 standard deviation differences). Comparison of screening efficacy by the univariate z score for the area under receiver operating characteristic (ROC) curves (θ) revealed that the abdominal circumference had the best sensitivity‐specificity trade‐off (θ = 0.8843; p < 0.0001 for comparison with SCT/FL ROC curve), followed by weight estimations based on the Hadlock formula (θ = 0.8773; p < 0.0005), the Shepard formula (θ = 0.8606; p < 0.0001), subcutaneous tissue thickness alone (θ = 0.6872; p < 0.01) and the SCT/FL ratio (θ = 0.6303).

Conclusions

We conclude that the SCT/FL ratio is a poor sonographic predictor of fetal macrosomia in the non‐diabetic pregnancy and does not improve fetal weight estimations by conventional sonographic parameters. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Spontaneous superfetation diagnosed in the first trimester with successful outcome
Authors: Tuppen G. D. , Fairs C. , de Chazal R. C. , Konje J. C.
Published: March 2003

We report a twin pregnancy in which a 4‐week discordance in size between the fetuses was identified in the first trimester. The discordance was maintained throughout the pregnancy, which was otherwise uneventful and resulted in the delivery of a live girl and boy. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Placental blood flow measured by simultaneous multigate spectral Doppler imaging in pregnancies complicated by placental vascular abnormalities
Authors: Yagel S , Anteby E. Y. , Shen O. , Cohen S. M. , Friedman Z. , Achiron R.
Published: March 2003

Objective

To evaluate the role of placental blood flow measurements by simultaneous multigate spectral Doppler imaging in pregnancies complicated by intrauterine growth restriction (IUGR), and for early detection of placental vascular abnormalities in highhyphen; and low‐risk pregnancies.

Methods

To assess the sensitivity and specificity of abnormal placental blood flow in detecting IUGR, we followed 22 women whose pregnancies were complicated by IUGR at 28–34 weeks' gestation, and compared the findings with those obtained in 22 matched controls. We defined placental blood flow impedance as abnormal when 10% of placental pulsatility index (PI) measurements were greater than, or equal to, the mean umbilical artery PI (placental PI / umbilical PI ≥1).

To determine the predictive value of abnormal placental blood flow measurement for identifying developing utero‐placental insufficiency, we examined an unselected group of 100 low‐ and high‐risk patients at 20–22 weeks' gestation. We correlated the Doppler findings with the development of pre‐eclampsia, IUGR, placental abruption, oligohydramnios and the presence of persistent late decelerations during labor.

Results

Placental blood flow determination was more sensitive than umbilical artery blood flow in detecting abnormal umbilical‐placental flow impedances as manifested by the presence of IUGR. Of the 100 mixed high‐ and low‐risk patients examined at 20–22 weeks, 32 had abnormal placental blood flow. Of these, 19 (59.4%) subsequently developed pathologies associated with placental vascular disease. Of the 68 patients with normal placental blood flow, only six (8.8%) developed such pathologies. The sensitivity was 76% (19/25), with positive predictive value 59.4% (19/32); the specificity was 82.7% (62/75), with negative predictive value 91.2% (62/68).

Conclusions

Abnormal intraplacental blood flow at 28–34 weeks' gestation is strongly associated with IUGR. In addition, it has moderate positive and negative predictive values for identifying subsequent development of uteroplacental vascular abnormalities. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Doppler waveform analysis of the intertwin blood flow in acardiac pregnancy: implications for pathogenesis
Authors: Shih J.‐C. , Shyu M.‐K. , Hunag S.‐F. , Jou H.‐J. , Su Y.‐N. , Hsieh F.‐J.
Published: March 2003

Objective

To investigate interfetal hemodynamics in acardiac twins andthe implications for pathogenesis.

Design

A retrospective study.

Subjects

All acardiac twins involved in this study were identified by B‐mode ultrasound at a teaching hospital in Taiwan.

Methods

Color Doppler imaging and, in one case, color power angiography were used to assess umbilical blood flow between acardiac twins and their normal co‐twins. Placental anastomoses were examined by pathologists after delivery.

Results

In total five sets of acardiac twins and their normal co‐twins were enrolled. Autonomous cardiac activity in the form of a contractile pocket was detected in two cases. Analysis of the pattern of the Doppler waveforms in each case enabled us to classify the type of hemodynamics into one of three categories: ‘collision‐summation’, typified by a pattern of cyclic alternations of bidirectional flow; ‘twin‐pulse’, which described the simultaneous recordings of two opposite constant flows with different pulsating rates; and the ‘pump in’ pattern, which indicated pulsatile flow in the reversed direction towards the acardiac mass. In two cases we detected, we believe for the first time, an artery‐to‐vein placental anastomosis between the acardiac twin and its co‐twin. The nature of the vascular connections were confirmed on pathological follow‐up.

Conclusions

Our observations suggest that acardiac twins may be not only the result of but also the cause of placental vascular anastomoses, which may involve either artery‐to‐artery or artery‐to‐vein anastomoses. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound
Authors: Chou M.M. , Ho E.S.C. , Lee Y.H.
Published: March 2003

Objective
 The aim of this study was to evaluate the efficacy of transabdominal color Doppler ultrasound in diagnosing placenta previa accreta.

Design 
Eighty patients with persistent placenta previa underwent transabdominal B‐mode and color Doppler ultrasound evaluation in the second and third trimesters because they had a high risk of placenta accreta. Color Doppler imaging criteria used included diffuse intraparenchymal placental lacunar flow; focal intraparenchymal placental lacunar flow; bladder–uterine serosa interphase hypervascularity; prominent subplacental venous complex; and loss of subplacental Doppler vascular signals. The color Doppler images were interpreted prospectively for signs of placenta previa accreta according to the exhibited color Doppler sonographic features.

Results 
Sixteen of the 80 patients exhibited characteristic color Doppler imaging patterns highly specific for placenta accreta according to the preceding criteria, and 14 of these had histopathological proof of placenta accreta. Two patients had false‐positive color Doppler imaging evidence mistaken for interphase hypervascularity caused by bladder varices. Thirteen patients underwent hysterectomy in the group suspicious for accreta. Of the 64 patients with negative color Doppler imaging results, three had placenta accreta, while two required cesarean hysterectomy; the remaining patient underwent uterine artery ligation for bleeding from the lower uterine segment. The sensitivity of color Doppler imaging in the diagnosis of placenta previa accreta was 82.4% (14/17) and the specificity was 96.8% (61/63). The positive and negative predictive values were 87.5% (14/16) and 95.3% (61/64), respectively.

Conclusions 
Variable vascular morphological patterns of placenta previa accreta were exhibited and categorized by transabdominal color Doppler sonography in the antenatal period. The identification of these specific vascular patterns had a positive impact on the peripartum clinical management of the affected patients.
Early prenatal ultrasound diagnosis of cleidocranial dysplasia
Authors: Stewart P. A. , Wallerstein R. , Moran E. , Lee M.‐J.
Published: March 2003

A woman was referred in the first trimester of her third pregnancy because of a family history of cleidocranial dysplasia. An ultrasound examination at 14 weeks 4 days revealed a fetus with appropriate biometric measurements. However, the clavicles were noted to be hypoplastic and the cranium appeared less well ossified than expected for gestational age, suggesting the diagnosis of cleidocranial dysplasia. On subsequent examination at 21 weeks, the findings were essentially unchanged.

Induced vaginal delivery owing to decreased amniotic fluid volume occurred at 37 weeks, and a female weighing 3200 g was delivered. The infant had clinical and X‐ray signs of cleidocranial dyplasia.
Fetal penile length
Authors: Johnson P. , Maxwell D.
Published: March 2003

Objective

To construct a reference range for fetal penile length.

Methods

The length of the penis was measured during ultrasound assessment of 95 structurally normal male fetuses of gestational ages 16–38 weeks. Two fetuses with bladder outflow obstruction were also examined.

Results

Fetal penile length increases significantly with gestational age, from a mean value of 6.0 mm at 16 weeks to 26.4 mm at 38 weeks. One fetus with urethral agenesis had a penile length on the 0.3rd centile.

Conclusions

Measurement of the fetal penis is easy and not time‐consuming. In cases of bladder outflow obstruction, assessment of penile length assists in the differentiation between urethral agenesis and posterior urethral valves. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Using three‐dimensional ultrasound to detect craniosynostosis in a fetus with Pfeiffer syndrome
Authors: Benacerraf B. R. , Spiro R. , Mitchell A. G.
Published: March 2003

A case of fetal Pfeiffer's syndrome is presented, showing the contribution of three dimensional (3D) sonography in the diagnosis of craniosynostosis – a major feature of this syndrome. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Maternal cerebral hemodynamics in pregnancy‐related hypertension. A prospective transcranial Doppler study
Authors: Zunker P. , Happe S. , Georgiadis A. L. , Louwen F. , Georgiadis D. , Ringelstein E. B. , Holzgreve W.
Published: March 2003

Aim

To compare maternal cerebral hemodynamics, as assessed by transcranial Doppler studies, with the clinical and radiological findings in different types of pregnancy‐related hypertension and to determine their pathophysiology.

Methods

A prospective study of 66 consecutive pregnant women with hypertensive disorders (eclampsia, n = 3; pre‐eclampsia, n = 41; isolated hemolysis, elevated liver enzymes, and low platelet count (HELLP)‐syndrome, n = 12; pre‐eclampsia superimposed on chronic hypertension, n = 5; chronic hypertension, n = 5) and 21 women with uncomplicated pregnancies. Mean blood flow velocities (Vmean) were assessed serially by means of transcranial Doppler in all basal arteries and correlated with changes in mean arterial blood pressure (MABP) and the clinical course.

Results

Patients with the pre‐eclampsia/eclampsia syndrome showed significantly elevated Vmean values as compared to controls. In the course of the illness Vmean over the whole length of all insonated basal arteries rose simultaneously. The three eclamptic patients showed the highest Vmean values (156, 182, 192 cm/s, respectively), of the middle cerebral artery (MCA) while MABP was 135, 135, and 150 mmHg, respectively. In pre‐eclamptic patients the maximal Vmean MCA ranged from 80 (67, 93) to 145 (114, 151) cm/s [median (25th, 75th percentile)] depending on the severity of clinical presentation. In patients with isolated HELLP‐syndrome changes in Vmean were either mild (5/12 cases) or absent (7/12 cases).

Conclusions

Considerable differences in cerebral hemodynamics were observed in the various types of pregnancy‐related hypertensive disorders examined in this study. Our findings in patients with pre‐eclampsia/eclampsia syndrome suggest a breakdown of autoregulation with hyperperfusion and vasogenic edema being the most probable pathophysiological mechanism. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Femur length and trisomy 21: impact of gestational age on screening efficiency
Authors: Snijders R. J. M. , Platt L. D. , Greene N. , Carlson D. , Krakow D. , Gregory K. , Bradley K.
Published: March 2003

Objective

This study assesses two methods used to define relatively short femur in screening for trisomy 21 and examines changes in performance of screening with gestational age.

Design

Retrospective analysis of data on menstrual age, femur length (FL) and biparietal diameter (BPD) in 49 trisomy 21 pregnancies and 6069 normal controls. Reference ranges were derived for BPD/FL versus menstrual age and for FL versus BPD. Two methods of defining short femur (BPD/FL and observed‐to‐expected FL ratio) were examined for false‐positive rates and detection rates for trisomy 21 at different gestational ages.

Results

In the control group the BPD/FL ratio and its standard deviation decreased with menstrual age. Trisomy 21 was associated with a significantly higher BPD/FL ratio (P < 0.001) and the deviation increased significantly with menstrual age (P < 0.05). Eleven percent of 28 fetuses examined at 15–17 weeks had a BPD/FL above the 95th centile compared with 24% of 21 fetuses examined at 18–20 weeks (P = 0.40). The median observed‐to‐expected FL ratio in the control group was 1.0 throughout the gestational age range but the standard deviation decreased significantly with menstrual age (P < 0.01). Trisomy 21 was associated with a significantly reduced observed‐to‐expected FL ratio (P < 0.001) and the deviation increased significantly with menstrual age (P < 0.05). A fixed cut‐off of 0.91 for observed‐to‐expected FL ratio provided a false‐positive rate of 12% at 15–17 weeks compared with 6% at 18–20 weeks of gestation (P < 0.001) with detection rates of 29 and 38%, respectively (P = 0.73).

Conclusion

Irrespective of the definition used to define the condition, relatively short femur is a poor marker for trisomy 21 particularly when the assessment takes place before 18 weeks of gestation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The fetal lung 2: pulmonary hypoplasia
Authors: Laudy J. A. M. , Wladimiroff J. W.
Published: March 2003

This review describes the pathogenesis of pulmonary hypoplasia and highlights its clinical, radiological and pathologic features, with emphasis on oligohydramnios‐related pulmonary hypoplasia. Since pulmonary hypoplasia may lead to severe respiratory distress immediately after birth and even to neonatal death, an accurate and patient‐friendly prenatal test for early detection and distinction between lethal and non‐lethal pulmonary hypoplasia is still highly desirable. An extended overview of the proposed methods for the prenatal prediction of pulmonary hypoplasia is presented. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The size of the fetal thoracolumbar spine: a three‐dimensional ultrasound study
Authors: Schild R. L. , Wallny T. , Fimmers R. , Hansmann M.
Published: March 2003

Objective

To evaluate three‐dimensional sonographic measurements of the thoracolumbar spine in the 16–37 week fetus.

Design

Prospective cross‐sectional study.

Subjects

Two hundred and eighty‐nine patients between 16 and 37 weeks of gestation were enrolled at the time of their anomaly scan or routine third trimester scan if fetal size was appropriate for gestational age and if no fetal anomalies were apparent.

Methods

Three‐dimensional (3D) volume calculation of the first and fifth lumbar vertebral body, the 12th thoracic vertebral body and the whole lumbar spine was performed in the transverse plane of the multiplanar mode while lumbar spine length was determined in the sagittal plane.

Results

All volumetric measurements were significantly correlated with gestational age and estimated fetal weight. For each examined parameter regression analysis was performed to describe the ‘best‐fit’ equation.

Conclusions

3D sonography allows volume calculation of the fetal spine. Our study provides further data relating to volume changes in the developing fetal spine between 16 and 37 weeks of gestation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Cumulus assessment by three‐dimensional ultrasound for in vitro fertilization
Authors: Poehl M. , Hohlagschwandtner M. , Doerner V. , Dillinger B. , Feichtinger W.
Published: March 2003

Objective

To correlate the appearances of intrafollicular cumulus‐like structures using three‐dimensional (3D) ultrasound technology with the recovery of mature oocytes.

Materials and methods

A prospective, observational study using 3D ultrasound examination was performed in 50 women undergoing in vitrofertilization (IVF) after ovarian stimulation. Examination was performed on the day of human chorionic gonadotropin (hCG)‐ovulation induction. Estradiol‐17‐β (E2) levels were measured on the same day. The ovaries were examined for the presence of cumuli in all follicles greater than 15 mm in diameter. Only cumuli demonstrable in all three planes, or in a computer‐animated 3D reconstruction, were recorded as ‘visible’. The number, maturity, and fertilization rate of retrieved oocytes were compared with the pre‐ovulatory assessment of cumuli by 3D ultrasound.

Statistics

Correlation coefficients (Pearson) between the variables were calculated and stepwise regression analyses performed.

Results

A total of 262 cumuli were visualized within 318 follicles from which 296 mature oocytes were retrieved and 218 fertilized. There was a significant correlation between the number of detected cumuli and the number of retrieved oocytes (r
2 = 0.83; P < 0.0001), mature oocytes (r
2 = 0.78; P < 0.0001), and the number of the fertilized oocytes (r
2 = 0.65; P < 0.0001). There was a marked correlation between E2 and the number of follicles and the number of fertilized oocytes.

Conclusions

Cumulus visualization by 3D ultrasound appears to be an indicator for mature oocytes and successful fertilization. Follicles in which the cumulus cannot be visualized in all three planes are unlikely to contain mature oocytes or oocytes in which fertilization is achieved. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Varix of the fetal intra‐abdominal umbilical vein: prenatal sonographic diagnosis and suggested in utero management
Authors: Zalel Y. , Lehavi O. , Heifetz S. , Aizenstein O. , Dolitzki M. , Lipitz S. , Achiron R.
Published: March 2003

Varix of the fetal intra‐abdominal umbilical vein (FIUV) is a rare entity. We describe an ultrasound diagnosis of this condition together with a review of the literature relating to its prognosis and management. Our conclusion is that close fetal monitoring should be performed, and delivery should be induced when lung maturity has been accomplished or any fetal distress is apparent. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Fetal heart rate in chromosomally abnormal fetuses
Authors: Liao A. W. , Snijders R. , Geerts L. , Spencer K. , Nicolaides K. H.
Published: March 2003

Objective

To determine the effects of chromosomal defects on fetal heart rate at 10–14 weeks of gestation.

Methods

Fetal heart rate at 10–14 weeks of gestation in 1061 chromosomally abnormal fetuses was compared to that from 25 000 normal pregnancies. The chromosomally abnormal group included 554 cases of trisomy 21, 219 cases of trisomy 18, 95 of trisomy 13, 50 of triploidy, 115 of Turner syndrome and 28 of sex chromosome abnormalities other than Turner syndrome.

Results

In the normal group, fetal heart rate decreased from a mean value of 170 beats per minute (bpm) at 35 mm of crown–rump length to 155 bpm at 84 mm crown–rump length. In trisomy 21, trisomy 13 and Turner syndrome fetal heart rate was significantly higher, in trisomy 18 and triploidy the heart rate was lower and in other sex chromosome defects it was not significantly different from normal. Fetal heart rate was above the 95th centile of the normal range in 10%, 67% and 52% of fetuses with trisomy 21, trisomy 13 and Turner syndrome, respectively. The fetal heart rate was below the 5th centile in 30% of fetuses with triploidy and 19% of those with trisomy 18.

Conclusions

Trisomy 21, trisomy 13 and Turner syndrome are associated with fetal tachycardia, whereas in trisomy 18 and triploidy there is fetal bradycardia. Inclusion of fetal heart rate in a first‐trimester screening program for trisomy 21 by a combination of maternal age and fetal nuchal translucency thickness is unlikely to provide useful improvement in sensitivity. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of umbilical cord aneurysm in a fetus with trisomy 18
Authors: Berg C. , Geipel A. , Germer U. , Gloeckner‐Hofmann K. , Gembruch U.
Published: March 2003

Aneurysm of the umbilical cord is an extremely rare vascular anomaly. We report a case of umbilical cord aneurysm with arteriovenous fistula in a fetus with trisomy 18. At 34 weeks' gestation a fetus with suspected intrauterine growth restriction and oligohydramnios was referred to our institution. Ultrasound examination was confirmatory and additionally revealed multiple markers for trisomy 18. In the umbilical cord an aneurysm was diagnosed characterized by a cystic lesion with hyperechogenic rim measuring 18 × 18 × 19 mm in diameter. Color flow and spectral Doppler examinations showed a jet originating from one of the umbilical arteries entering the cystic lesion which appeared to be the dilated umbilical vein. Fetal blood sampling and subsequent karyotyping revealed trisomy 18 (47, XY, +18). The patient elected to terminate the pregnancy. Pathologic examination of placenta and umbilical cord confirmed the prenatal diagnosis of umbilical cord aneurysm and arteriovenous fistula. Histology demonstrated a strongly dilated umbilical vein, one moderately dilated artery and a second, apparently normal artery. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Ductus venosus Doppler study in fetuses with homozygous α‐thalassemia‐1 at 12 to 13 weeks of gestation
Authors: Lam Y. H. , Tang M. H. Y. , Tse H. Y.
Published: March 2003

Objective

Fetuses affected by homozygous α‐thalassemia‐1 are anemic from the first trimester of pregnancy. We investigated ductus venosus Doppler velocimetry in these affected fetuses at 12–13 weeks of gestation.

Design

Prospective observational study.

Subjects

Women referred for the prenatal diagnosis of homozygous α‐thalassemia‐1 before 14 weeks of gestation.

Methods

All fetuses underwent pulsed Doppler investigations following color flow mapping at 12 or 13 weeks of gestation. Homozygous α‐thalassemia‐1 was diagnosed by DNA or hemoglobin study. The ductus venosus Doppler indices – V
max (peak velocity during ventricular systole), V
min (minimum forward velocity during atrial systole), TAMX (time‐averaged maximum velocity), PIV (pulsatility index for veins, V
max − V
min/TAMX), PLI (preload index, V
max − V
min/V
max) and V
max/V
min ratio – were compared between the affected fetuses and fetuses unaffected by homozygous α‐thalassemia‐1.

Results

Between June 1998 and October 1999, 102 eligible women were recruited. Fetal ductus venosus Doppler study was successful in 96 pregnancies (94%). Of these, 20 fetuses were affected by homozygous α‐thalassemia‐1. None of them showed hydropic changes at the time of Doppler study. The affected fetuses had significantly higher ductus venosus V
max (30% increase), V
min (50% increase) and TAMX (20% increase) and significantly lower V
max/V
min ratio, PIV and PLI values.

Conclusion

Fetuses affected by homozygous α‐thalassemia‐1 at 12–13 weeks had increased forward flow velocities in the ductus venosus throughout the cardiac cycle. The increase of venous return is consistent with our previous report of cardiac dilatation and an increase of cardiac output in the affected fetuses at this stage as a compensatory mechanism for anemia and hypoxia. However, extensive overlap of the ductus venosus Doppler indices between affected and unaffected fetuses precludes its use in predicting anemia at 12–13 weeks. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal ultrasonographic features of fetal giant hemangiolymphangioma
Authors: Senoh D. , Hanaoka U. , Tanaka Y. , Tanaka H. , Hayashi K. , Yanagihara T. , Hata T.
Published: March 2003

A giant multiseptate cystic mass covering the whole left hemitruncus of fetus was detected by ultrasonography at 23 weeks of gestation. Color and pulsed Doppler ultrasonography revealed marked blood flow in the mass. No other anomaly or chromosomal abnormality was recognized. Although the cystic lesion increased in size with advancing gestation a male infant weighing 4096 g was delivered in good condition at term. Histological examination of the lesion demonstrated hemangiolymphangioma with hyperplasia of both capillaries and lymphoducts. The infant was treated effectively with OK‐432 and interferon‐alfa‐2a. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal power Doppler findings in laparoscopically proven acute pelvic inflammatory disease
Authors: Molander P. , Sjöberg J. , Paavonen J. , Cacciatore B.
Published: March 2003

Objectives

To evaluate the usefulness of power Doppler transvaginal sonography (TVS) in the diagnosis of pelvic inflammatory disease (PID) and to assess the diagnostic reliability of specific sonographic findings.

Population

The study population consisted of 30 women admitted for suspected acute PID. The reference group consisted of 20 women with proven hydrosalpinx formation.

Methods

Both conventional TVS and power Doppler TVS were performed. All patients with suspected acute PID underwent laparoscopy in order to confirm the diagnosis. Sonographic criteria described earlier were used for the diagnosis of acute PID. Power Doppler was used to assess the vascularity of any adnexal mass.

Results

Laparoscopy confirmed the diagnosis of PID in 20 (67%) of the 30 women with clinically suspected acute PID. Specific TVS findings, including wall thickness > 5 mm, cog‐wheel sign, incomplete septa, and the presence of cul‐de‐sac fluid, discriminated women with acute PID from the control women with hydrosalpinx formation. Power Doppler TVS revealed hyperemia in all women with acute PID, but in only two women with hydrosalpinx (P = 0.01). Pulsatility indices were significantly lower in the acute PID group than in the control group (pulsatility index 0.84 ± 0.04 vs. 1.50 ± 0.10; P < 0.01).

Conclusion

Power Doppler TVS was 100% sensitive and 80% specific in the diagnosis of PID (overall accuracy 93%). Specific sonographic landmark findings and power Doppler findings augment the clinical diagnosis of PID and allow simple classification of the severity of the disease. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Hypoechoic hepatomegaly associated with transient abnormal myelopoiesis provides clues to trisomy 21 in the third‐trimester fetus
Authors: Hamada H. , Yamada N. , Watanabe H. , Okuno S. , Fujiki Y. , Kubo T.
Published: March 2003

We present two cases of transient abnormal myelopoiesis associated with trisomy 21 that had hypoechoic hepatomegaly during the late fetal period. Fetal chromosomal abnormality and fetal myeloproliferative disorder should be suspected in such cases. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of fetal abdominal lymphangioma by ultrasonography
Authors: Deshpande P. , Twining P. , O'Neill D.
Published: March 2003

We present a case of abdominal lymphangioma in a fetus together with a review of the literature. Diagnosis was made at 20 weeks' gestation by antenatal ultrasonography. In keeping with other reports, the lesion was located on the left and serial ultrasonography demonstrated rapid growth with extension into the lower extremity. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Abdominal circumference: a single measurement versus growth rate in the prediction of intrapartum Cesarean section for fetal distress
Authors: Williams K. P. , Nwebube N.
Published: March 2003

Objective

The fetal abdominal circumference is the most sensitive ultrasound biometric measurement for predicting intrauterine growth restriction, which is associated with an increased risk of intrapartum fetal distress. We sought to evaluate and compare whether a third‐trimester ultrasound measurement of abdominal circumference made within 1 week prior to delivery better predicts operative delivery for fetal distress when compared with the growth velocity of the abdominal circumference in the third trimester.

Methods

Retrospective analysis was carried out of prospectively collected ultrasound data on 117 patients with singleton gestations who had had at least two ultrasound assessments performed less than 6 weeks apart in the third trimester, with the last ultrasound performed within 1 week prior to delivery. The abdominal circumference value of the last ultrasound prior to delivery was placed into one of three categories: ≤ 5% centile, > 5 to ≤ 10% centile and > 10% centile for gestational age. The growth velocity of the abdominal circumference per week was placed into one of three categories: ≤ 5 mm/week, 6–10 mm/week and ≥ 11 mm/week. The chi‐squared test was used to compare differences between the incidence of fetal distress between the groups.

Results

The incidences of Cesarean section for fetal distress in relation to a single measurement of the abdominal circumference were: ≤ 5% centile, 8/23 (35%); > 5 to ≤ 10% centile, 3/12 (25%); > 10% centile, 8/81 (10%) (P < 0.05). The incidences of Cesarean section for fetal distress with the three abdominal circumference growth velocities were: ≤ 5 mm/week, 9/55 (16%); 6–10 mm/week, 4/11 (36%); ≥ 11 mm/week, 8/51 (16%) (P = 0.9401).

Conclusion

A single measure of the fetal abdominal circumference made within 1 week prior to delivery is superior to an assessment of growth rate of the fetal abdomen in the third trimester in discriminating patients who require Cesarean section for fetal distress. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic findings of the umbilical cord: implications for the risk of fetal chromosomal anomalies
Authors: Weissman A. , Drugan A.
Published: March 2003

In this review we summarize current knowledge on sonographic findings of the umbilical cord and the risk they impose for chromsomal abnormalities of the fetus. A Medline search of the literature was performed and the pertinent English‐language literature was reviewed. Anatomical and Doppler abnormalities of the umbilical cord may be associated with an increased risk of chromosomal aberrations in the fetus. Therefore, level II prenatal sonography should also include a careful examination of the umbilical cord. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of ventriculocoronary fistula
Authors: Baschat A. A. , Love J. C. , Stewart P. A. , Gembruch U. , Harman C. R.
Published: March 2003

Background

Cardiac anomalies may be associated with abnormal coronary vascular connections. We report the prenatal diagnosis of ventriculocoronary fistula in three fetuses with associated cardiac anomalies.

Materials and Methods

Fetal echocardiography was performed in three patients referred for suspected cardiac anomaly. Two‐dimensional fetal echocardiography was complemented by color Doppler flow imaging and spectral Doppler in all cases.

Results

A ventriculocoronary fistula was diagnosed in three patients referred at 22, 23 and 32 weeks. The first patient had hypoplastic left heart associated with transposition of the great arteries and pulmonary atresia with an intact interventricular septum. The coronary fistula arose from the transposed aorta to the left ventricle. In two patients ventriculocoronary fistula was found in association with pulmonary atresia and an intact interventricular septum. In all cases there was bidirectional flow within the fistula (diastolic blood flow towards the ventricle with reversal during ventricular systole). The pregnancy with hypoplastic left heart with transposition, and one of those with pulmonary atresia resulted in neonatal death and stillbirth, respectively. In the third instance the ventriculocoronary fistula was verified by postpartum cardiac angiography. The infant initially received a Blalock–Taussig shunt, subsequently replaced by a bidirectional Glenn shunt, and was doing well at the time of writing.

Conclusion

A ventriculocoronary fistula can be identified prenatally by color and spectral Doppler. This anomaly should be sought in fetuses with outflow tract obstructive cardiac lesions and an intact interventricular septum. Prenatal diagnosis allows early angiography postnatally. Delineation of coronary vascular regions may therefore facilitate preoperative planning. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Outcome of pregnancy in chromosomally normal fetuses with increased nuchal translucency in the first trimester
Authors: Souka A. P. , Krampl E. , Bakalis S. , Heath V. , Nicolaides K. H.
Published: March 2003

Objectives

To study the outcome of chromosomally normal pregnancies with increased nuchal translucency at the 10–14‐week scan.

Design

Retrospective study of 1320 chromosomally normal singleton pregnancies with nuchal translucency of ≥ 3.5 mm. In addition to fetal karyotyping these patients were managed with follow‐up scans at 14–16 and 20–22 weeks, specialist fetal echocardiography and in selected cases by infection screening and further genetic testing.

Results

In the 1320 pregnancies there were 68 (5.15%) spontaneous abortions or intrauterine deaths, 18 (1.36%) neonatal and infant deaths and 154 (11.67%) terminations of pregnancy. In the 1080 (81.82%) survivors, 60 (5.56%) had abnormalities requiring medical or surgical treatment or leading to mental handicap. The chance of a livebirth with no defects in the group with nuchal translucency of 3.5–4.4 mm was 86%, for those with translucency of 4.5–5.4 mm it was 77%, for those with translucency of 5.5–6.4 mm it was 67%, and for those with translucency of ≥ 6.5 mm it was 31%.

Conclusions

Increased fetal nuchal translucency is associated with chromosomal abnormalities, many fetal defects and genetic syndromes. In the majority of cases a series of antenatal investigations, including fetal karyotyping, detailed scans, fetal echocardiography, as well as genetic testing and infection screening, that can be completed by 20 weeks of gestation would distinguish between the pregnancies destined to result in adverse outcome and those leading to the delivery of infants without major defects. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Elective cerclage vs. ultrasound‐indicated cerclage in high‐risk pregnancies
Authors: To M. S. , Palaniappan V. , Skentou C. , Gibb D. , Nicolaides K. H.
Published: March 2003

Objective

To compare pregnancy outcome after elective vs. ultrasound‐indicated cervical cerclage in women at high risk of spontaneous mid‐trimester loss or early preterm birth.

Methods

This was a retrospective study comparing two management strategies in women with singleton pregnancies who had at least one previous spontaneous delivery at 16–33 weeks of gestation. One group was managed by the placement of an elective cerclage at 12–16 weeks and the other group had transvaginal ultrasound examinations of the cervix at 12–15 + 6, 16–19 + 6, and 20–23 + 6 weeks and cervical cerclage was carried out if the cervical length was 25 mm or less.

Results

A total of 90 patients were examined, including 47 that were managed expectantly and 43 treated by elective cerclage. In the expectantly managed group, 59.6% (28/47) required a cervical cerclage. We excluded from further analysis three patients who were lost to follow‐up and three because of fetal death or iatrogenic preterm delivery. Miscarriage or spontaneous delivery before 34 weeks' gestation occurred in 14.6% (6/41) of the elective cerclage group, compared with 20.9% (9/43) in the expectantly managed group (χ2 = 0.219, P = 0.640).

Conclusion

In women at increased risk of spontaneous mid‐trimester or early preterm delivery, a policy of sonographic surveillance followed by cervical cerclage in those with a short cervix reduces the need for surgical intervention without significantly increasing adverse pregnancy outcome. Copyright © 2002 ISUOG
Prenatal diagnosis of 22q11 microdeletion in an early second‐trimester fetus with conotruncal anomaly presenting with increased nuchal translucency and bilateral intracardiac echogenic foci
Authors: Machlitt A. , Tennstedt C. , Körner H. , Bommer C. , Chaoui R.
Published: March 2003

We report on a 16‐week fetus, in which detection of increased nuchal translucency thickness and bilateral intracardiac echogenic foci led to the prenatal diagnosis of truncus arteriosus communis, interruption of the aortic arch and aplastic thymus. Cytogenetic examination confirmed a 22q11.2 microdeletion consistent with the suspected CATCH 22 syndrome. Subsequently hydrops fetalis developed and the fetus died in utero at 18 weeks.

This case report supports the hypothesis that both cardiac failure and left ventricular outflow tract obstruction may cause increased nuchal translucency thickness. The association between increased nuchal translucency thickness and CATCH 22 syndrome should be considered in diagnostic procedures. The sonographic diagnosis of both increased nuchal translucency thickness and intracardiac echogenic foci requires specialist ultrasonography and echocardiography. In particular, identification of right‐sided or bilateral echogenic foci should prompt further detailed examination. Copyright © 2002 ISUOG
Three‐dimensional sonographic and power Doppler characterization of ovaries in late follicular phase
Authors: Järvelä I. Y. , Sladkevicius P. , Kelly S. , Ojha K. , Nargund G. , Campbell S.
Published: March 2003

Objective

To determine ovarian blood flow characteristics using three‐dimensional power Doppler ultrasound.

Methods

We examined 30 patients (30 cycles) prior to the start of their in vitro fertilization treatment in the late follicular phase using three‐dimensional power Doppler ultrasound. The volume, vascularization index, flow index, vascularization flow index, mean grayness and the presence of the dominant follicle were determined for each ovary separately.

Results

The dominant follicle could be detected in 24 out of 30 cycles (80.0%). The volume of the dominant ovary was 9.9 (standard deviation, 4.0) cm3 and the volume of the non‐dominant ovary 6.8 (standard deviation, 2.8) cm3 (P < 0.001). Mean grayness in the dominant ovary was 43.3 (standard deviation, 5.0) and in the non‐dominant 47.2 (standard deviation, 4.0) (P < 0.001), but no other differences could be observed between dominant and non‐dominant ovaries. The shell with a diameter of 2 mm surrounding the dominant follicle had a higher vascularization index (mean, 9.0; standard deviation, 5.9) and vascularization flow index (mean, 4.2; standard deviation, 2.8) than the whole dominant ovary (mean, 5.5; standard deviation, 2.5 and mean, 2.5; standard deviation, 1.3, respectively) (P = 0.003 and 0.002, respectively). In the cycles without a dominant follicle (n = 6), flow index (mean, 50.0; standard deviation, 5.9) and vascularization flow index (mean, 7.3; standard deviation, 6.2) on the left side were higher than on the right side (mean, 40.2; standard deviation, 3.1; mean, 1.5; standard deviation, 1.4; P‐values 0.013 and 0.046, respectively).

Conclusion

In the dominant ovary, the volume was higher and mean grayness lower than in the non‐dominant ovary. The vascularization index in the shell surrounding the dominant follicle was higher than the average vascularization index in the whole dominant ovary. In addition, there were differences in the vascularization and flow indices between right and left ovaries, which may be related to the anatomical difference in the venous drainage between right and left ovaries. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology