bluuebunny/crossref_metadata_2025 huggingface dataset:
The characterization of common ovarian cysts in premenopausal women
Authors: Jermy K. , Luise C. , Bourne T.
Published: March 2003

Objectives

The evaluation of the predictive value of transvaginal ultrasound in the assessment of benign adnexal pathology in premenopausal women, based on the recognition of characteristic morphologic patterns particular to endometriotic and dermoid ovarian cysts.

Methods

This was a prospective study. All premenopausal women undergoing surgery for a suspected ovarian cyst underwent a transvaginal ultrasound examination in the week prior to surgery. Between June 1997 and January 2000, 132 women underwent surgery for a suspected ovarian endometrioma or dermoid cyst. The endpoints were either the direct visualization of the cyst wall and contents at surgery, or the histologic evaluation of removed tissues.

Results

Of 83 suspected endometriomas (11 bilateral), 80 were confirmed at surgery and of 68 suspected benign cystic teratomas (eight bilateral), 66 were confirmed by histology. The positive predictive value of transvaginal ultrasonography for the diagnosis of endometrioma and dermoid cysts was 96.4% and 97.1%, respectively. The false positive rates were 3.8% and 3.0%, respectively. There were no malignancies in either group.

Conclusions

Based on the recognition of characteristic ultrasound patterns alone, the positive predictive value of transvaginal ultrasonography for the diagnosis of these common, benign cysts in premenopausal women is very high and can be used reliably to select women for appropriate surgery. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Reproducibility of ductus venosus Doppler flow measurements at 11–14 weeks of gestation
Authors: Prefumo F. , De Biasio P. , Venturini P. L.
Published: March 2003

Objectives

To assess the intra‐ and interobserver repeatabilities of fetal ductus venosus Doppler measurements at 11–14 weeks of gestation.

Design

Flow velocity waveforms were recorded transabdominally. Intraobserver repeatability was studied in 22 fetuses in whom four repeated measurements were performed by the same observer. Interobserver repeatability was assessed in 54 fetuses in each of whom two observers performed two repeated measurements. The pulsatility index for veins (PIV), peak velocity during ventricular systole (S wave), peak velocity during atrial contraction (A wave) and time‐averaged maximum velocity (TAMV) were recorded. Reproducibility of the Doppler measurements was analyzed by calculating repeatability coefficient, coefficient of variation (CV), intraclass correlation coefficient (ICC), mean differences and their limits of agreement. Cohen's k‐coefficient was used for categorical data.

Results

Intraobserver repeatability was good with a CV of 10%, 13%, 22% and 13% and an ICC of 0.85, 0.94, 0.94 and 0.95, respectively, for PIV, S wave, A wave and TAMV. Interobserver repeatability was also good, and no bias between the observers was detected. A CV of 8.8%, 14%, 27% and 15% and an ICC of 0.86, 0.84, 0.87 and 0.84, respectively, for PIV, S wave, A wave and TAMV were obtained. There was 100% agreement for the detection of normal/abnormal blood flow.

Conclusions

Intra‐ and interobserver repeatability of all parameters was acceptable, allowing for the detection of moderate to large changes in Doppler measurements. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of fetal ovarian hyperstimulation
Authors: Berezowski A. T. , Machado J. C. , Mendes M. C. , Moura M. D. , Duarte G. , Cunha S. P.
Published: March 2003

A case of prenatal diagnosis of fetal ovarian hyperstimulation in a pregnancy of 35 weeks is reported. Two large cystic septate ovaries with no internal vegetations were observed in the fetal abdomen. The fetus was macrosomic and the remaining morphology was normal. Polyhydramnios and placental thickening were present, with no other macro‐ or microscopic alterations. The only significant maternal change detected was elevation of blood β‐human chorionic gonadotropin (β‐hCG) levels. Evaluation of the newborn confirmed the prenatal diagnosis, with progressive and spontaneous regression of fetal ovarian volume and of maternal serum β‐hCG occurring after delivery. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasound: a novel technique for investigating the urethral sphincter in the third trimester of pregnancy
Authors: Toozs‐Hobson P. , Khullar V. , Cardozo L.
Published: March 2003

Objectives

To measure urethral sphincter volume by three‐dimensional (3D) ultrasound. To assess the reproducibility of this measurement technique and to compare volumes obtained using 3D ultrasound with volumes calculated from a formula based on 2D ultrasound measurements.

Methods

Women were recruited as part of an ongoing study of changes to the pelvis resulting from pregnancy and childbirth. One hundred and eleven women in the third trimester of pregnancy (between 32 and 41 completed weeks' gestation) underwent a 3D transvaginal ultrasound scan of the urethra. In 10 cases the scan was analyzed twice by different observers to assess the reproducibility of the measurements from the scans and the results were analyzed using limits of agreement.

Results

The interobserver error was consistent between all the linear, 2D and 3D measurements obtained from the area scanned. There was a significant difference between volumes calculated directly by 3D ultrasound and the approximated volumes from conventional 2D measurements.

Conclusions

Three‐dimensional ultrasound appears to be a useful tool in measuring urethral sphincter volume. The error is consistent with that of linear and 2D imaging. However, the increase in normal range generated by biological variation in all three planes makes 3D ultrasound a more sensitive method of evaluating change to the urethral sphincter. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Power spectrum analysis of heart rate and blood flow velocity variability measured in the umbilical and uterine arteries in early pregnancy: a comparative study
Authors: Struijk P. C. , Ursem N. T. C. , Mathews J. , Clark E. B. , Keller B. B. , Wladimiroff J. W.
Published: March 2003

Objective

To compare power spectral derived variability parameters from the fetal side of the placental circulation with those from the maternal side of the placental circulation, during early pregnancy.

Methods

Doppler velocity waveforms were obtained from both the umbilical and the uterine arteries in a study group of 40 pregnant women between 10 and 14 (n = 25) and 15 and 20 (n = 15) weeks of gestation. The coefficient of variation of both the beat‐to‐beat heart rate variability and the blood flow velocity variability was determined. The ratio of the integrated low‐frequency components (< 0.2 Hz) and the integrated high‐ frequency components (> 0.2 Hz) from normalized power spectrum analysis (LH‐ratio) was established, to reflect sympathovagal balance.

Results

The coefficient of variation and LH‐ratio of fetal heart rate variability constitute only a fraction of the same maternal heart rate variability parameters. Nevertheless a highly significant increase (P < 0.001) in LH‐ratio was demonstrated with advancing gestational age. The coefficient of variation and LH‐ratio of blood flow velocity variability were significantly lower in the fetal umbilical artery only in the 10–14‐weeks' gestation group. Due to a decrease of the maternal uterine blood flow velocity variability parameters with advancing gestational age, statistically equal fetal and maternal values for coefficient of variation and LH‐ratio were found in the 15–20 weeks' gestation group.

Conclusions

The increase in LH‐ratio of fetal heart rate variability indicates functional development of the fetal autonomic nervous system at 15–20 weeks' gestation. The umbilical blood flow velocity variability may be secondary to maternal uterine arterial flow variability rather than due to primary changes in fetal cardiovascular function. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
A critical appraisal of the use of umbilical artery Doppler ultrasound in high‐risk pregnancies: use of meta‐analyses in evidence‐based obstetrics
Authors: Westergaard H. B. , Langhoff‐Roos J. , Lingman G. , Marsál K. , Kreiner S.
Published: March 2003

Objectives

To reanalyze randomized controlled trials on the use of umbilical artery Doppler velocimetry in high‐risk pregnancies and determine which high‐risk pregnancies benefit from the use of Doppler velocimetry.

Methods

Searching Medline, the Cochrane Library and Embase we found 13 randomized controlled trials on the use of Doppler velocimetry in high‐risk pregnancies. Of these, six included pregnancies with strictly defined suspected intrauterine growth restriction and/or hypertensive disease of pregnancy (‘well‐defined studies’); the rest included a great variety of high‐risk pregnancies (‘general risk studies’). The studies were analyzed with particular regard to the heterogeneity and to outcome. Audits of the perinatal deaths reported in the randomized controlled trials were performed by a panel of 32 international experts.

Results

The ‘well‐defined studies’ had a more uniform study design as compared to the ‘general risk studies’ and they showed a significant reduction in antenatal admissions (odds ratio, 0.56; 95% confidence interval, 0.43–0.72), inductions of labor (0.78; 0.63–0.96), elective deliveries (inductions of labor and elective Cesarean sections) (0.73; 0.61–0.88) and Cesarean sections (0.78; 0.65–0.94). By perinatal audit it was found that more perinatal deaths in the ‘well‐defined studies’ were potentially avoidable by use of Doppler velocimetry (P < 0.0005) and the rate of avoidable perinatal deaths was higher among controls (50%) than cases (20%) in this group.

Conclusion

The randomized controlled trials on umbilical artery Doppler velocimetry show major differences regarding study design and technical and clinical issues and, therefore, they should not be pooled in a simple meta‐analysis. By stratification it was found that only in pregnancies with suspected intrauterine growth restriction and/or hypertensive disease of pregnancy will the use of umbilical artery Doppler velocimetry reduce the number of perinatal deaths and unnecessary obstetric interventions. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonography combined with saline contrast sonohysterography in evaluating the uterine cavity in premenopausal patients with abnormal uterine bleeding
Authors: Dueholm M. , Forman A. , Jensen M. L. , Laursen H. , Kracht P.
Published: March 2003

Objectives

To evaluate whether saline contrast sonohysterography (SCSH) adds additional information to that obtained by transvaginal sonography (TVS) for predicting endometrial abnormality in premenopausal patients with abnormal uterine bleeding.

Patients and methods

This was a two‐center prospective study at a university clinic and a central hospital in Denmark. The uterine cavity was evaluated with TVS and SCSH in 470 premenopausal patients with abnormal uterine bleeding. One hundred and eighty‐nine of the patients had operative hysteroscopy or hysterectomy within 4 months which provided a detailed description of the uterine cavity and was used as the true value for exclusion of polyps and submucous myomas.

Results

Based on normal endometrial morphology alone, the results for detection of an abnormal uterine cavity were as follows: sensitivities of TVS 0.92, SCSH 0.99; specificities of TVS 0.62, SCSH 0.72; positive predictive values of TVS 0.80, SCSH 0.85; negative predictive values of TVS 0.82, SCSH 0.98. Transvaginal sonography combined with SCSH was superior to TVS for detection of intracavitary abnormalities (McNemar test, P = 0.008). The post‐test probability of there being an abnormal cavity after normal findings on TVS alone was 0.18 (0.10–0.32) and after TVS and SCSH it was 0.02 (0.01–0.11). When normal endometrial morphology was combined with an endometrial thickness of < 12 mm for evaluation of all abnormalities including hyperplasia, the diagnostic potential of TVS or SCSH was almost unchanged except for specificities, which were markedly lower (TVS 0.54; SCSH 0.57). In all the patients referred, TVS had a negative predictive value of 0.94 for identification of polyps and myomas when findings at subsequent SCSH were accepted as the true value. Transvaginal sonography reduced the pretest probability of polyps or submucous myomas from 0.35 to a post‐test probability of 0.06, but missed 21% of the polyps.

Conclusions

Sonohysterography was a sensitive tool and was superior to TVS used alone for evaluation of the uterine cavity in patients who underwent operative surgery for abnormal uterine bleeding. All abnormalities except one were found at SCSH, while TVS alone missed polyps and had almost one in four equivocal findings. The use of TVS, without saline contrast, left one in five of the polyps undiagnosed in referred patients with abnormal bleeding. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Doppler ultrasound examination of uterine arteries on the day of oocyte retrieval in patients with uterine fibroids undergoing in vitro fertilization treatment
Authors: Ernest N. H. , Ho P.
Published: March 2003

Introduction:  There is no consensus whether uterine fibroids have any adverse effects on the outcomes of assisted reproduction treatment. This prospective study compared the implantation/pregnancy rates of women with and without fibroids undergoing in vitro fertilization/embryo transfer (IVF/ET) and measured uterine blood flow indices of the fibroid group.

Methods:  Patients who had fibroids not distorting the endometrial lining during transvaginal scanning were in the fibroid group, while patients with normal uteri served as controls. Those with previous myomectomy or pedunculated subserosal fibroids only were excluded. All received a standard protocol of ovarian stimulation. Doppler ultrasound examinations of uterine arteries were carried out in the fibroid group prior to oocyte retrieval.

Results:  Between February 2000 and April 2001, 389 consecutive patients were recruited, 77 (19.8%) in the fibroid group and 312 (80.2%) in the control group. The median diameter of the largest fibroid was 2.1 cm (mean 2.4 cm, 2.5th−97.5th centiles 1.0–6.1 cm). Similar implantation/pregnancy rates, multiple pregnancy rates and pregnancy outcomes were noted between both groups. In the fibroid group, significantly lower pulsatility (PI) and resistance (RI) indices of the right uterine artery and the average of right and left uterine arteries were found in non‐pregnant patients than pregnant patients.

Conclusion:  The presence of fibroids not distorting the endometrial lining would not adversely affect implantation and pregnancy rates during IVF/ET treatment. Significantly lower uterine PI and RI were found in non‐pregnant women with fibroids than their pregnant counterparts.
The value of routine ultrasound screening for adnexal masses at the 11–14 weeks early anomaly scan
Authors: Salim R. , Woelfer B. , Aslam N. , Elson J. , Jurkovic D.
Published: March 2003

Purpose:  To investigate the feasibility and possible advantages of routine screening for ovarian pathology in asymptomatic pregnant women at 11–14 weeks' gestation.

Methods:  Pregnant women attending for a routine early anomaly scan at 11–14 weeks' gestation were invited to participate in this prospective study. In all cases, an attempt was made to visualize the ovaries on transabdominal ultrasound scan. The presence of all visible cysts was recorded. Small simple cysts <5 cm in diameter were all managed expectantly with no follow up. All women with a simple cyst >5 cm in diameter or a complex ovarian cyst had a detailed gynecological scan including color Doppler blood flow studies and serum tumor markers. Surgical intervention was offered only to women with clinical symptoms suggestive of cyst complications or those with ultrasound findings suggestive of malignancy. All other women were management expectantly until six weeks after delivery, when they were either discharged from follow up or were offered a definitive surgical intervention.

Results:  A total of 2925 women were included into the study. Both ovaries were seen in 1755 (60%) of women, only one ovary was seen in 614 (21%) and neither ovary was seen in 556 (19%). The presence of an ovarian cyst was recorded in 728 (25%) women. A total of 400 (55%) of these were small simple cysts which did not warrant further follow up, whilst 328 (45%) had further scans. Two hundred and seventy‐eight of these cysts resolved spontaneously during pregnancy, two required surgical intervention in pregnancy, four were removed at cesarean section and 40 were still present on the postpartum scan. At postpartum scan, 11 women opted for further expectant management. The ultrasound diagnosis in these cases was dermoid cyst (8), endometrioma (2) and peritoneal pseudocyst (1). Histological diagnoses in 33 women who had surgery were: dermoid cyst (12) and endometrioma (8) benign ovarian cystadenoma (5), luteoma of pregnancy (1), corpus luteum cyst (1), hydrosalpinx (3) and fimbrial cyst (3). Six women were lost to follow up.

Conclusions:  Asymptomatic ovarian cysts detected at routine ultrasound screening in the first trimester are unlikely to be malignant or cause clinical symptoms later in pregnancy. The policy of routine examination of the ovaries in pregnancy should therefore be discouraged.
Integrated first and second trimester screening for Down syndrome
Authors: Lam Y. H. , Lee C. P. , Sin S. Y. , Tang R. , Wong H. S. , Wong S. F. , Tang M. H. Y. , Woo H. H. N.
Published: March 2003

Purposes:  It is uncertain whether first trimester nuchal translucency is more effective than the well established second trimester serum screening for fetal Down syndrome or whether their combination works best. We report our data on a large multicenter non‐interventional trial in which all subjects underwent both first and second trimester screening to assess their relative efficacy.

Methods:  All women who attended the obstetric clinic before 15 weeks were recruited. An ultrasound examination was performed at 10–14 weeks to measure the nuchal translucency. The nuchal measurements were not acted upon unless the fetus showed gross features of hydrops fetalis. All women had serum alpha‐fetoprotein and human chorionic gonadotrophin assay at 15–20 weeks. The Down syndrome risk assigned by serum screening was disclosed and amniocentesis was offered if this assigned risk was at or >1:250 or if the women were 35 years and older. Efficacy of different combinations of screening were compared.

Results:  Between January 1997 and August 2000, 17590 women were recruited (19% was 35 years and older). After excluding subjects who miscarried, defaulted the serum test and other reasons, 16237 pregnancies were included in the final analysis. Of these, 35 pregnancies were affected by Down syndrome (2.2 cases per 1000 pregnancies). At a false‐positive rate of 5%, the detection rate of Down syndrome by nuchal translucency alone; nuchal translucency + age; serum human chorionic gonadotrophin, alpha‐fetoprotein + age and nuchal translucency + human chorionic gonadotrophin + alpha‐fetoprotein + age were 61, 69, 73 and 86%, respectively. Comparison of areas under the receiver‐operating characteristic curves showed statistically significant differences between these methods of screening.

Conclusions:  Integration of nuchal translucency and second trimester serum alpha‐fetoprotein and human chorionic gonadotrophin assay yielded the best screening efficacy for Down syndrome.
Effects of US on maternal–fetal bonding: 2D vs. 3D
Authors: Pretorius D. H. , Uyan K. M. , Newton R. , Hull A. , James G. , Nelson T.
Published: March 2003

Objective:  To compare the effects of two‐dimensional ultrasound (2DUS) vs. three‐dimensional ultrasound (3DUS) imaging on the maternal–fetal bonding process.

Methods:  A total of 100 normal pregnant subjects were randomly selected retrospectively. Ultrasounds were performed between 1998 and 2000. Fifty mothers who had 2DUS and 50 who had 3DUS were randomly selected to screen. We designed a postpartum survey consisting of 10 questions regarding parental–fetal bonding for telephonic interview.

Results:  A randomized sampling of data was performed to equalize cells for some study questions. Mothers who received 3DUS shared their ultrasound photographs with significantly more number of people (mean, 31.72) than did mothers receiving 2DUS (mean, 16.02) (t = − 2.810, d.f. 1, 46, P = 0.007). Subjects screened with 3DUS had a greater tendency to form a mental image of the baby post‐screening (82%) than 2DUS subjects (39%). The 3DUS parents were more likely to receive comments on similarities/differences with the actual baby than parents having 2DUS studies (x = 4.109 d.f. 1, P = 0.043). Further, 70% of the mothers receiving 3DUS felt they ‘knew’ the baby right after birth because of the images they saw compared to only 56% of 2DUS moms.

Conclusion:  The 3DUS images appears to have a more positive influence on the perceptions of mothers compared to 2DUS images. Specifically, mothers who had 3DUS showed their images to twice as many people as those having 2DUS studies. 3DUS may have the potential benefit to strengthen the support system for families expecting their newborns.
Three‐dimensional obstetric ultrasound (3DUS) is perceived by lay non‐pregnant adults to be more valuable than two‐dimensional ultrasound (2DUS)
Authors: Hull A. D. , Pretorius D. H. , Newton R. , Asfoor S. A. , James G.
Published: March 2003

Purpose:  To determine the impact of 3DUS on non‐pregnant lay adults.

Methods:  A 15‐minute audiovisual presentation on 3DUS and 2DUS was shown to 120 students It included a brief explanation of the technology and both 2D and 3D images of a normal fetus at 30 weeks gestation. A number of 87 subjects (64 female, 23 male, age 21 ± 0.2 years) completed a self‐administered questionnaire after the presentation.

Results:  Ninety percent of the subjects had never heard of 3DUS prior to the presentation. All were able to appreciate the difference between 2DUS and 3DUS. Seventy‐eight percent said that they would request 3DUS in a future pregnancy. The commonest reasons given for this choice were better detection of fetal anomalies and visualization of greater anatomical detail compared to 2DUS. Ninety‐four percent of subjects believed that 3DUS was likely to be a significant tool for medical use. Seventy‐five percent of women and 61% of men felt that 3DUS would affect parental fetal attachment.

Conclusion:  Lay subjects readily appreciate the differences between 2D and 3DUS. Most believed that 3DUS was superior to 2DUS in assessing the fetus, afforded a diagnostic advantage to physicians and would have beneficial effects on parental attachment. These findings have important implications when considering consumer demand for new imaging modalities in obstetrics.
Prenatal detection of cardiac rhabdomyomas and cerebral lesions in a fetus with tuberous sclerosis: a case report
Authors: Dias I. , Bernardo M. J. S. , Kay T. T. , De Almeida S. , Marques M. , Bugalho J.
Published: March 2003

Tuberous sclerosis is characterized by the development of hamartomatous lesions throughout many tissues, particularly the brain, the skin, the heart and the kidneys. The authors report a case of tuberous sclerosis suspected by prenatal ultrasound detection of cardiac rhabdomyomas and brain masses. At 20 weeks the ultrasound evaluation did not reveal any cardiac or brain lesions. Later on, at 33 weeks, multiple echogenic masses in the heart, located in the ventricular walls and interventricular septum and two small cerebral echogenic masses were diagnosed. No other abnormalities were noted. There is no previous genetics history in the family. Sequential examination revealed a discrete increase in size of the tumors; no hemodynamic or arrhythmic consequences were detected. A male fetus was delivered at term, with normal weight and Apgar score. Postnatal magnetic resonance imaging confirmed the small brain tumors. The baby had some seizures that were controlled with anti‐epileptic therapy. Cardiac tumors spontaneously decreased and their regression was confirmed, a few months later, by echocardiogram. The skin of the baby showed some de‐pigmented spots. No other abnormalities were detected namely in the kidneys. At 13 months, the child had normal growth and developed appropriately. As in other cases confirmed by literature the findings of cerebral lesions on fetal ultrasound can help in the prenatal diagnosis of tuberous sclerosis, but does not necessarily indicate a poor prognosis.
Transvaginal sonography of the uterine cervix prior to labor induction
Authors: Gabriel R. , Darnaud T. , Chalot F. , Gonzalez N. , Leymarie F. , Quereux C.
Published: March 2003

Objectives

To compare the Bishop score and transvaginal sonographic measurement of cervical length for predicting the mode of delivery following medically indicated induction of labor in term patients.

Methods

The study was conducted prospectively in 179 women who required medically indicated induction of labor. Inclusion criteria were singleton pregnancy, gestational age >37 weeks of amenorrhea, cephalic presentation and intact fetal membranes. Cervical length was measured upon arrival in the labor room but was not considered when choosing the induction procedure. Two receiver‐operating characteristic curves were plotted to calculate the best threshold value for the Bishop score and for cervical length for predicting the risk of Cesarean section.

Results

Fifty‐three women (29.6%) had a Cesarean section. The Bishop score was not predictive of the delivery mode, although Cesarean section for failure to progress was more frequent when the Bishop score was ≤5. Among the women with a Bishop score >5, the cervical length was not predictive of the induction outcome. However, among the women with a Bishop score ≤5, a cervical length <26 mm was associated with a lower Cesarean section rate (20.6 vs. 42.9%; P = 0.006). Furthermore, the interval between the beginning of cervical ripening and delivery was shorter in the case of a short cervix (11.01 ± 6.7 vs. 18.55 ± 7.07 h; P < 10−5).

Conclusion

The length of the uterine cervix, measured by transvaginal sonography, is a better predictor of the risk of Cesarean section than the Bishop score after induction of labor for medical reasons. In women with an unfavorable Bishop score, a cervical length of <26 mm is associated with a lower risk of Cesarean section and a shorter duration of labor. Copyright © 2002 ISUOG
Short‐term safety of celocentesis for the mother and the fetus
Authors: Makrydimas G. , Kaponis A. , Skentou C. , Lolis D.
Published: March 2003

Objective

Celocentesis offers the potential for prenatal diagnosis from as early as 6 weeks of gestation. The aim of this study was to examine the short‐term safety of celocentesis.

Methods

Eligible for the study were pregnant women with single live fetuses at 6–10 weeks of gestation, requesting pregnancy termination for social indications. At presentation, the patients were asked if they were willing to undergo celocentesis and in those women who agreed the procedure was performed at the time of the initial scan. A second scan was carried out just before termination to measure fetal crown–rump length and heart rate.

Results

Four hundred and forty‐seven women requested termination of pregnancy and 108 of these agreed to have celocentesis. There were no significant differences between the groups in maternal age, prevalence of primigravidas, cigarette smokers, existence of uterine fibroids, the median fetal crown–rump length or the interval between the initial scan (or celocentesis) at presentation and the pregnancy termination. At the time of termination, ultrasound examination demonstrated fetal death in five (4.7%) of the celocentesis group and nine (2.7%) of the controls (odds ratio, 1.804; 95% confidence interval, 0.5912–5.504). In all other cases, there was normal fetal growth and there were no significant differences between the groups in fetal crown–rump length.

Conclusions

The procedure related fetal loss associated with celocentesis may be approximately 2%. Copyright © 2002 ISUOG
Uterine and fetal cerebral Doppler predict the outcome of third‐trimester small‐for‐gestational age fetuses with normal umbilical artery Doppler
Authors: Severi F. M. , Bocchi C. , Visentin A. , Falco P. , Cobellis L. , Florio P. , Zagonari S. , Pilu G.
Published: March 2003

Objective

To assess the value of different admission tests in predicting the outcome of small‐for‐gestational age (SGA) fetuses with normal Doppler waveforms in the umbilical artery.

Methods

Criteria for admission into this retrospective study included: singleton pregnancy with a birth weight <10th centile; absence of severe maternal complications; no evidence of fetal anomalies on the sonogram; normal umbilical artery Doppler; and availability of complete follow‐up. At the first antenatal sonogram classifying the fetus as SGA, Doppler analysis of the uterine and middle cerebral arteries was performed and amniotic fluid volume was assessed. Outcome variables included adverse perinatal outcome (perinatal death, severe morbidity) and emergency Cesarean section for fetal distress.

Results

Two hundred and thirty‐one pregnancies were included in the study. The mean ± standard deriation birth weight and gestational age at delivery were 2222 ± 502 g and 37.3 ± 2.9 weeks, respectively. In 37 cases (16%), an emergency Cesarean section was performed. There was one intrauterine death and three fetuses delivered by emergency Cesarean section developed severe morbidity. Logistic regression demonstrated that abnormal velocimetry of the uterine arteries and fetal middle cerebral artery were independently correlated with the occurrence of Cesarean section.

Conclusions

SGA fetuses with normal umbilical artery Doppler waveforms and abnormal uterine arteries and fetal middle cerebral artery waveforms have an increased risk of developing distress and being delivered by emergency Cesarean section. Particularly when both uterine and fetal cerebral waveforms are altered at the same time, the risk is exceedingly high (86%) and delivery as soon as fetal maturity is achieved seems advisable. On the other hand, when both vessels have normal waveforms, the chances of fetal distress are small (4%) and expectant management is the most reasonable choice. Copyright © 2002 ISUOG
Ultrasonographic evaluation of cervical length in pregnancies complicated by preterm premature rupture of membranes
Authors: Gire C. , Faggianelli P. , Nicaise C. , Shojai R. , Fiori A. , Chau C. , Boubli L. , D'Ercole C.
Published: March 2003

Objective

To evaluate the usefulness of transvaginal ultrasonography in the determination of the risk of preterm delivery and chorioamnionitis in pregnancies affected by preterm premature rupture of membranes preterm premature rupture of membranes.

Design

One hundred and one singleton pregnancies with preterm premature rupture of membranes were included in this prospective study over a 3‐year period. Patients underwent cervical length measurement by transvaginal ultrasonography at admission and thereafter, in the absence of chorioamnionitis, were managed expectantly.

Results

The median time interval between admission and delivery (latency period) was 48 h. A cervical length of less than 20 mm was associated with a significant risk of early delivery (mean latency period was 59.44 ± 159.93 h vs. 240.94 ± 364.67; P < 0.05). There was no relation between cervical length and occurrence of chorioamnionitis or neonatal sepsis.

Conclusions

These data suggest that the use of transvaginal ultrasonography for cervical length measurement during preterm premature rupture of membranes may predict an early delivery but cannot anticipate the risk of chorioamnionitis or neonatal sepsis. Copyright © 2002 ISUOG
Umbilical venous volume flow in the normally developing and growth‐restricted human fetus
Authors: Boito S. , Struijk P. C. , Ursem N. T. C. , Stijnen Th. , Wladimiroff J. W.
Published: March 2003

Objective

To determine the reproducibility of measurement of umbilical venous volume flow components and to calculate umbilical venous volume flow in normal and growth‐restricted (small‐for‐gestational age) fetuses in a cross‐sectional study.

Method

Using Labview and Imaq‐vision software, the cross‐sectional inner area of the umbilical vein was traced. Vessel area (mm2) and Doppler‐derived time‐averaged flow velocity (mm/s) were multiplied to calculate volume flow (mL/min) including flow per kg fetal weight. The coefficient of variation for vessel area and flow velocity scans and tracings were determined (n = 13; 26–35 weeks). Normal charts for components and volume flow were constructed (n = 100; 20–36 weeks) and related to data from growth restricted fetuses (birth weight <5th centile) (n = 33; 22–36 weeks). In growth‐restricted fetuses the umbilical artery pulsatility index was also obtained.

Results

Reproducibility: The coefficient of variation was 5.4% (vessel area) and 7.3% (time‐averaged velocity) for scans and 6.6% and 10.5% for measurements, resulting in a coefficient of variation of 8.1% (scans) and 11.9% (measurements) for volume flow. A gestational age‐related increase exists for vessel area, time‐averaged flow velocity and umbilical venous volume flow from 33.2 (SD, 15.2) mL/min at 20 weeks to 221.0 (SD, 32.8) mL/min at 36 weeks of gestation, but there is a reduction from 117.5 (SD, 33.6) mL/min to 78.3 (SD, 12.4) mL/min for volume flow per kg fetal weight. In small‐for‐gestational age fetuses, the values were below the normal range in 31 of 33 cases for volume flow and in 21 of 33 cases for volume flow per kg fetal weight. Umbilical artery pulsatility index was significantly different between the subsets with normal and those with reduced volume flow per kg fetal weight.

Conclusions

Measurements of umbilical venous vessel area and time‐averaged velocity resulted in acceptable reproducibility of volume flow calculations, which show a seven‐fold increase at 20–36 weeks of gestation. In growth‐restricted fetuses, volume flow is significantly reduced. When calculated per kg/fetus, the values were reduced in 21 (63.6%) out of 33 cases. Copyright © 2002 ISUOG
Uterine artery Doppler patterns in abdominal pregnancy
Authors: Acácio G. L.
Published: March 2003

Changes in the uterine artery blood flow waveform during pregnancy have been the subject of several studies and are frequently attributed to trophoblastic invasion of the myometrium. We report on a case of a third‐trimester abdominal pregnancy in which we performed Doppler velocimetry of the uterine arteries and observed low‐resistance flow and absence of notching bilaterally. During the 29th week of gestation, there was an increase in umbilical artery resistance and a decrease in the middle cerebral artery resistance, so we chose to deliver the baby at that stage. The patient was discharged from hospital 7 days following delivery and the child was discharged having gained the necessary weight. Our findings suggest that modification of the uterine artery waveform may occur independently of trophoblast invasion of the spiral arteries. Other theories that may explain the changes in the uterine artery waveform during pregnancy are discussed. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Outcome of antenatally diagnosed talipes equinovarus in an unselected obstetric population
Authors: Bakalis S. , Sairam S. , Homfray T. , Harrington K. , Nicolaides K. , Thilaganathan B.
Published: March 2003

Objective

To investigate the natural history and outcome of fetal talipes diagnosed by routine ultrasound scanning at 18–23 weeks' gestation.

Patients and methods

This was a retrospective study of 103 228 pregnancies undergoing routine ultrasound scanning at 18–23 weeks' gestation. A computer search was made to identify all cases of fetal talipes and the records of these patients were examined to determine the incidence of other defects and pregnancy outcome.

Results

The incidence of fetal talipes following routine ultrasound examination was 0.10% (107/103 228) and was bilateral in 64 (59.8%) and unilateral in 43 (40.2%) cases. In 52 (48.6%) cases, talipes was of complex etiology, as it was associated with other defects, while, in 55 (51.4%) cases, it was classified as idiopathic. In 19% of cases, an initial diagnosis of idiopathic talipes was changed to complex, because of the subsequent development of associated features. Perinatal death and long‐term neurodevelopmental or musculoskeletal problems were significantly more common when the talipes was complex rather than idiopathic (odds ratio, 150; 95% confidence interval, 34–665). Adverse outcomes were also seen more frequently with bilateral compared to unilateral talipes (odds ratio, 3.44; 95% confidence interval, 1.50–7.90).

Conclusion

The outcome of antenatally detected talipes is mainly dependent on the presence or absence of other defects. A significant proportion of cases, thought to be idiopathic at presentation, will develop associated complex features when reassessed on subsequent scans or postnatally. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
First‐trimester diagnosis of fetal arachnoid cyst: prenatal implication
Authors: Bretelle F. , Senat M.‐V. , Bernard J.‐P. , Hillion Y. , Ville Y.
Published: March 2003

We report a case of the early diagnosis of an arachnoid cyst. Transvaginal ultrasound examination of the fetal brain at 13 weeks' gestation revealed the presence of an anechoic mass above the posterior fossa. After extensive counseling and because of the uncertain prognosis of a first‐trimester diagnosis of an arachnoid cyst, the parents opted for termination of pregnancy. The diagnosis was confirmed by postmortem examination. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Evolution of neural crest and placodes: amphioxus as a model for the ancestral vertebrate?
Authors: HOLLAND LINDA Z. , HOLLAND NICHOLAS D.
Published: March 2003

abstract

Recent studies of protochordates (ascidian tunicates and amphioxus) have given insights into possible ancestors of 2 of the characteristic features of the vertebrate head: neural crest and placodes. The neural crest probably evolved from cells on either side of the neural plate–epidermis boundary in a protochordate ancestral to the vertebrates. In amphioxus, homologues of several vertebrate neural crest marker genes (BMP2/4, Pax3/7, Msx, Dll and Snail) are expressed at the edges of the neural plate and/or adjacent nonneural ectoderm. Some of these markers are also similarly expressed in tunicates. In protochordates, however, these cells, unlike vertebrate neural crest, neither migrate as individuals through embryonic tissues nor differentiate into a wide spectrum of cell types. Therefore, while the protochordate ancestor of the vertebrates probably had the beginnings of a genetic programme for neural crest formation, this programme was augmented in the earliest vertebrates to attain definitive neural crest. Clear homologues of vertebrate placodes are lacking in protochordates. However, both amphioxus and tunicates have ectodermal sensory cells. In tunicates these are all primary neurons, sending axons to the central nervous system, while in amphioxus, the ectodermal sensory cells include both primary neurons and secondary neurons lacking axons. Comparisons of developmental gene expression data suggest that the anterior ectoderm in amphioxus may be homologous to the vertebrate olfactory placode, the only vertebrate placode with primary, not secondary, neurons. Similarly, biochemical, morphological and gene expression suggest that amphioxus and tunicates also have homologues of the adenohypophysis, one of the few vertebrate structures derived from nonneurogenic placodes. In contrast, the origin of the other vertebrate placodes is very uncertain.
Fetal and postnatal development of the patella, patellar tendon and suprapatella in the rabbit; changes in the distribution of the fibrillar collagens
Authors: BLAND YVETTE S. , ASHHURST DOREEN E.
Published: March 2003

The development of the patella, its associated tendons, and suprapatella of the rabbit knee joint is described from the 17 d fetus to the mature adult. The patellar tendon (ligament) with the patella on its posterior surface is seen in the 17 d fetus and is fully developed by 1 postnatal wk. It is composed of bundles of types I and V collagens separated by endotenons of types III and V collagens. Anteriorly there is an epitenon of types III and V collagens while synovium and a fat pad cover its posterior surface. In the 25 d fetus, the patella is cartilaginous and is separated from the femoral condyles. The cartilage contains type II collagen, but types I, III and V collagens are found along the articular surface. Ossification starts 1 postnatal wk and at 6 wk only the articular cartilage remains. In addition to type II, types III and V collagens are located around the chondrocyte lacunae. The long anterior junction between the patella and its tendon is fibrocartilaginous at 1 wk, but as ossification proceeds this is replaced by bone. Types I and V collagens are found in this region. The suprapatella on the posterior surface of the quadriceps tendon is first seen 1 wk postnatally as an area of irregularly organised fibres and chondrocyte‐like cells. Types I, II, III and V collagens are present from 3 wk onwards. It is compared with the fibrocartilage of other tendons that are under compression. The arrangement of the collagens in the patellar tendon is discussed in relation to its use as a replacement for injured anterior cruciate ligaments. It is suggested that the structural differences between the patellar tendon and anterior cruciate ligament preclude the translocated tendon acquiring mechanical strength similar to that of a normal cruciate ligament. The designation ‘patellar ligament’ as opposed to ‘patellar tendon’ is questioned. It is argued that the term patellar tendon reflects its structure more accurately than patellar ligament.
Abnormal Schwann cell/axon interactions in the Trembler‐J mouse
Authors: ROBERTSON A. M. , KING R. H. M. , MUDDLE J. R. , THOMAS P. K.
Published: March 2003

The Trembler‐J (TrJ) mouse has a point mutation in the gene coding for peripheral myelin protein 22 (PMP22). Disturbances in PMP22 are associated with abnormal myelination in a range of inherited peripheral neuropathies both in mice and humans. PMP22 is produced mainly by Schwann cells in the peripheral nervous system where it is localised to compact myelin. The function of PMP22 is unclear but its low abundance (∼5% of total myelin protein) means that it is unlikely to play a structural role. Its inclusion in a recently discovered family of proteins suggests a function in cell proliferation/differentiation and possibly in adhesion. Nerves from TrJ and the allelic Trembler (Tr) mouse are characterised by abnormally thin myelin for the size of the axon and an increased number of Schwann cells. We report ultrastructural evidence of abnormal Schwann cell‐axon interactions. Schwann cell nuclei have been found adjacent to the nodes of Ranvier whereas in normal animals they are located near the centre of the internodes. In some fibres the terminal myelin loops faced outwards into the extracellular space instead of turning inwards and terminating on the axon. In severely affected nerves many axons were only partially surrounded by Schwann cell cytoplasm. All these features suggest a failure of Schwann cell–axon recognition or interaction. In addition to abnormalities related to abnormal myelination there was significant axonal loss in the dorsal roots.
Growth pattern of the maxillary sinus in the Japanese macaque (Macaca fuscata): reflections on the structural role of the paranasal sinuses
Authors: KOPPE THOMAS , NAGAI HIROSHI
Published: March 2003

To investigate the claim that the primate paranasal sinuses possess not a functional but a structural role associated with the skull architecture (Blaney, 1990), the relationship between the maxillary sinus and the skull architecture was studied ontogenetically in 30 skulls of male and female Japanese macaques (Macaca fuscata). Coronal CT scan series and computerised 3‐dimensional images served to evaluate the maxillary sinus. The definitive hemispherical shape of the sinus was already achieved after the completion of the primary dentition. Sinus volume increased with a trend indicating positive allometry. When compared with an ontogenetic data set of orang‐utan (Koppe et al. 1995), however, the growth rate of the maxillary sinus of M. fuscata was significantly less. The maxillary sinus both of male and female macaques enlarged according to a common growth pattern. However, no sexual dimorphism could be established for the maxillary sinus size. Although the volume of the right maxillary sinus was normally bigger than that of the left side, the results suggested that asymmetry in maxillary sinus volume is related neither to skull size nor sex. Whereas a correlation analysis showed close relationships between the maxillary sinus volume and external cranial dimensions, the partial correlation coefficients revealed that these relationships were highly influenced by skull size. Although it cannot be ruled out that the paranasal sinuses are to some extent linked to the skull architecture, this study does not support a solely structural role for these air cavities.
Review. Articular cartilage chondrons: form, function and failure
Authors: POOLE C. ANTHONY
Published: March 2003

The chondrocyte and its pericellular microenvironment together represent the chondron, historically considered the primary structural, functional and metabolic unit of articular and other hyaline cartilages. This review summarises research over the last 10 years to establish the molecular anatomy, functional properties and metabolic contribution of the chondron in articular cartilage homeostasis, and its failure during the initiation and progression of degenerative osteoarthritis.
Teaching of gross anatomy to medical undergraduates: general practice as a guideline? A synopsis
Authors: FASEL JEAN H. D.
Published: March 2003

The amount of time officially available for the teaching of gross anatomy to medical undergraduates was substantially curtailed during the 1960s, both in the USA and in Europe (Kahn, 1966; Todd, 1968). Since then, this trend has been further enhanced by the expanding introduction of problem‐based learning (Pallie & Miller, 1982; Albanese & Mitchell, 1993) deplored by many gross anatomists, radiologists and surgeons (Collins et al. 1994; Anderson & Brown, 1996). But a modification of the content of anatomical teaching has become unavoidable, and is a matter for concern — although very little rejoicing — to the professional morphologist involved in teaching. The few studies which have been aimed at defining a suitable core programme were designed to determine the anatomical knowledge required for various clinical specialties (Lippert & Bernsau, 1972; Quast‐Höttge, 1972). These studies showed that the identified knowledge exceeds by far any currently available time for teaching anatomy to medical undergraduates (Lippert, 1974). Against this background, the present study was designed from a different concept, our aim having been to investigate the requirement of anatomical knowledge in general medical practice. The actual paper is a synopsis of the results obtained for 12 topics of systematic gross anatomy evaluated under this criterion. It is an attempt to contribute to a pragmatic solution to a pressing problem.