bluuebunny/crossref_metadata_2025 huggingface dataset:
Chorionic villus sampling after the first trimester
Authors: Podobnik M. , Podgajski M. , Duic Z. , Ciglar S.
Published: March 2003

Background:  The purpose of this article was to evaluate the association between late CVS (placental biopsy) and complications between sampling and delivery.

Methods:  Late chorionic villus sampling under ultrasound guidance was carried out in 3000 (85.7%) cases in the second trimester and 500 (14.3%) cases in the third trimester of pregnancy. Out of 3500 late CVS, 710 (20.3%) were performed because of suspicious ultrasonographic findings. In the 500 patients between 13 and 16 weeks of gestation color, Doppler was used to investigate the uteroplacental and fetal vessels before and after late chorionic villus sampling.

Results:  In 30 patients (0.85%), complications between sampling and delivery were found. There were only 11 (0.31%) spontaneous abortions four to six weeks after late chorionic villus sampling. We found 166 (4.74%) chromosomal abnormalities. In the group with suspicious ultrasonic findings (710 cases), we found significant oligohydramnios in 314 (44.2%) and significant polyhydramnios in 155 (21.8%), and 110 (15.5%) had chromosomal abnormalities. Among the 166 patients with chromosomal abnormalities, ultrasonographic findings in 90 (54.2%) were detected after 20th week of pregnancy. There were no significant differences in mean pulsatility indices between uteroplacental and fetal vessels before and after late chorionic villus sampling. Preliminary data for 25 trisomic fetuses indicate an abnormally increased umbilical PI and abnormally decreased middle cerebral artery PI.

Conclusions:  Late CVS is a safe method of prenatal diagnosis for high‐risk couples and does not significantly affect the outcome of pregnancy.
An audit of invasive prenatal diagnosis for Bart's hydrops
Authors: Tan T. Y. T. , Yeo G. S. H.
Published: March 2003

Objective:  To audit invasive prenatal diagnosis performed for pregnancies at risk of Bart's hydrops fetalis in KK hospital.

Methodology:  This is a retrospective study in a single tertiary center in Singapore. All cases of invasive prenatal diagnosis performed for parents whose pregnancies are at risk of Bart's hydrops fetalis between 16 September 1993–28 November 2000 were traced from the KK invasive procedures register.

Results:  A total of 63 invasive prenatal procedures were done (59 chorionic villus sampling and four cordocentesis) for a total of 44 couples. The majority of the carriers had SEA deletions (84 or 95.5%); Thai deletions (2), compound beta and SEA alpha thalassaemia‐1 traits (1), and HbH disease (1) accounted for the rest. The number of invasive prenatal procedures has increased steadily through the years from 3 in 1994 to 13 in 2000. The major indications for the invasive procedures were past history of Bart's hydrops (30) and both parents being known alpha thalassaemia carriers (27). Both parents were identified as carriers at ≤12 weeks in the 1st pregnancy in 12 couples (27.3%), beyond that time but before the development of hydrops in any pregnancies in 13 couples (29.5%), and after the development of hydrops in 19 couples (43.2%). Eighteen Bart's hydrops were diagnosed and most of them were terminated, either by vacuum aspiration within the first 14 weeks (8) or by prostaglandins beyond the first trimester (8). The iatrogenic fetal loss rate for the invasive procedures was 0% in this audit.

Conclusion:  Further measures are necessary to increase the proportion of at‐risk couples who are identified as carriers before the first trimester in the first pregnancy to allow early and safe prenatal diagnosis and early terminations of affected pregnancies.
The outcome of antenatally diagnosed talipes equinovarus
Authors: Bakalis S. P. , Sairam S. , Patton M. , Harrington K. , Nicolaides K. , Thilaganathan B.
Published: March 2003

Aim:  Congenital talipes equinovarus is a relatively poorly studied congenital anomaly with very little information available for parents. The aim of this study is to investigate the natural history and postnatal outcome of fetal talipes detected at 18–23 weeks in a large, unselected obstetric population.

Patients and methods:  This is a prospective study of routine antenatal ultrasound screening in an unselected obstetric population, carried out on patients booking at three major London hospitals. Congenital talipes was classified as postural, tetralogic (associated with other congenital abnormalities) and idiopathic. Outcomes measured included termination of pregnancy, stillbirth, aneuploidy, fetal structural abnormality and neonatal death.

Results:  The incidence of congenital talipes was 0.11% (111/103,228) in our study population. Of these, 64.9% were live born, 31.5% were terminated, and 3.6% were intrauterine deaths. Talipes was bilateral in 60% of the cases, with an overall male to female ratio of 1.5:1. There were significant differences in the prevalence of tetralogic, idiopathic and postural talipes in the unilateral vs. bilateral talipes groups. The outcome of pregnancy was good in 97% of fetuses with a diagnosis of idiopathic and in 36% of those with tetralogic talipes. Fetuses with a diagnosis of postural talipes were postnatally found to have other abnormalities in 7% of cases.

Conclusion:  The outcome of antenatally detected congenital talipes is significantly worse than previously reported. The outcome of pregnancy depends on the laterality of the talipes and the presence of associated features.
The postnatal significance of mild fetal pyelectasis
Authors: Chudleigh T. M. , Chitty L. S.
Published: March 2003

Purpose:  To determine the incidence of significant renal pathology in fetuses with mild pyelectasis in the second trimester, and to define prognostic criteria with which to identify those fetuses requiring detailed postnatal follow up.

Methods:  A prospective, observational, multicenter study of unselected fetuses identified during routine second trimester anomaly screening. Mild pyelectasis was defined as an antero‐posterior diameter of 5–10 mm. All fetuses with unilateral or bilateral pyelectasis identified between 16 and 25 completed weeks of gestation were recruited.

Results:  Four hundred and twenty‐five fetuses with mild pyelectasis were recruited from a population of 101600 pregnancies. Dilatation was bilateral in 270 and unilateral in 155 cases. Multicystic or horseshoe kidney was subsequently diagnosed in four cases. Prenatal pyelectasis improved in 90 cases, remained unchanged in 124 cases and deteriorated in 177 cases. One prenatal scan only was performed in 30 cases. Neonatal renal findings were abnormal in 185 cases. Pathological findings were present in 48 cases of which 16 resulted in surgery. The primary diagnosis was obstruction in 15 cases, duplex kidney in 11 and upper tract dilatation in 22 cases leading to surgery in eight, five and three cases, respectively. Significantly, more cases of pathology were present in fetuses where the dilatation increased to 10 mm or greater in the third trimester than in those where it remained unchanged.

Conclusions:  Postnatal upper urinary tract dilatation is demonstrated in 43.9% of fetuses with mild second trimester pyelectasis. Urinary tract pathology is present in 11.4% of such fetuses and 3.8% require surgery. All cases with persistent pyelectasis, particularly those with progressive dilatation, should be investigated postnatally.
Accuracy in estimating fetal urinary bladder volume using a modified ultrasound technique
Authors: Fägerquist M. A. , Fägerquist U. O. , Steyskal H. , Odén A. , Blomberg S. G.
Published: March 2003

Purpose:  The fetal urine production rate can be used as non‐invasive test of fetal well‐being. However, the accuracy of measuring urine production rate by ultrasound depends on the accuracy of volume estimation of the certain bladder image. The aim of this study was to assess the accuracy of measurement of volumes of the bladder using a modified ultrasound technique and digitising the bladder images. Also, it was possible to compare these results with the corresponding findings assessed by conventional ultrasound technique.

Methods:  A swaying movement of the ultrasound transducer causes characteristic changes on the screen, which can be utilized for identifying whether or not the ellipsoid configuration of fetal bladder is correctly sectioned along its midline. In this study, 34 unselected pregnant women participated and the gestational ages of the fetuses were between 24 and 40 weeks. The assumption was made of a circular appearance of the bladder in the transversal plane and then the calculation of volume was simplified. We distinguished between different kinds of errors, i.e. technical limitations due to the particular ultrasound machine, errors due to the operators measurement in the selected image of the bladder and errors due to the selection procedure of appropriate image.

Results:  The technical limitations and intraoperators errors measuring the volume of the selected bladder image (the ‘frozen’ error) occupied only a minor part of the total variability, whereas the major part consisted of errors was owing to the selection of scan, the ‘freezing’ procedure. Concerning this dominating part the standard deviation of the measurement errors of volume estimation using the modified technique was SD = 0.37892 + 0.04119 × volume, e.g. for 5–40 mL was 11.7–5.1%, respectively. Corresponding standard deviation without this modified technique was SD = 0.36516 + 0.09978 × volume, e.g. SD for 5–40 mL was 17.3–10.9%, respectively.

Conclusion:  When estimating the volume of fetal urinary bladder the major part of measurement errors due to the selection of appropriate bladder image. Using a modified technique this error can be reduced.
Experience with fetal nuchal translucency in a private clinic in São Paulo
Authors: Cha S. C. , Chinen P. A. , Pares D.
Published: March 2003

The fetal nuchal translucency (NT) has been used since 1995 as screening exam for abnormal karyo‐type and structural malformations. Fetal nuchal translucency measurements were performed in 1877 pregnancies, during the period from 1995 to 2000, between 11 weeks to 13 weeks and 6 days. From the 1877 exams, we obtained 29 (1.4%) with abnormal NT and these data are the object of our study. Nineteen pregnancies (65.5%) had no structural malformation and/or karyo‐type abnormalities. We had one (3.4%) case of congenital heart disease with hypoplasia of left ventricle (death in the third day of life), one (3.4%) case of fetal dead for true knots of the cord, without other morphological disturb. Others three (10.3%) cases had spontaneous abortion (one case of 46 XX; one case of 69 XXY and the other case does not have karyo‐type). In two (6.9%) cases induced abortion happened, without karyo‐type study.
Endometrial sampling during sonohysterography (SHGes)
Authors: Leone F.P.G. , Lanzani C. , Ciminera N. , Conserva V. , Ferrazzi E.
Published: March 2003

Purpose:  To assess the diagnostic accuracy of sonohysterography (SHG) and endometrial sampling during SHG (SHGes) compared to traditional hysteroscopy and biopsy.

Methods:  Seventy‐two consecutive patients with irregular bleeding and/or intracavitary abnormalities underwent transvaginal sonography (TVS) and SHG. SHG was performed with a 4.7‐mm intrauterine catheter. In all patients, an endometrial biopsy was performed by a syringe vacuum aspiration at the end of SHG. Procedure‐related pain was assessed. Sonographic findings at SHG were defined as normal, focal lesions or diffuse endometrial abnormality. In patients with diffuse endometrial abnormality, hysteroscopy and hysteroscopic guided biopsy were performed. In patients with focal lesions, an operative hysteroscopy was performed. Pathologic report was the gold standard.

Results:  Mean age was 48 years (interquartile range 38–54). At SHG, no pain, mild, and severe discomfort was reported by 75, 18 and 7% of patients, respectively. Fifty patients underwent hysteroscopic guided biopsy, 22 operative hysteroscopy. Hysteroscopic findings were compared to SHG–SHGes finding. (A) Benign lesions: in 56 cases SHG and SHG sampling was concordant with pathologic report, in five cases SHG and SHG sampling over diagnosed the endometrial lesion. In five cases, simple hyperplasia was missed by SHG endoemetrial sampling. (B) (pre)Malignant lesions (six cases): in five cases SHG–SHGes was correct. One case of adenocarcinoma was intepreted as atypical hyperplasia at SHG–SHGes. Sensitivity, specificity, positive and negative values of SHG and SHGes for intracavitary abnormalities were 100, 64, 94 and 100%, respectively.

Conclusions:  SHG and SHGes should be considered a reliable office triage in the management of patients with intracavitary uterine abnormalities, as adequate as hysteroscopic endometrial biopsies.
Asymptomatic endometrial polyps in postmenopausal women: are they an indication for surgical removal?
Authors: Leone F.P.G. , Lanzani C. , Ferrazzi E. , Conserva V. , Padoan A.
Published: March 2003

Purpose:  To compare demographic, sonographic, and outcome data of postmenopausal patients with asymptomatic endometrial polyp, surgically treated or not treated.

Methods:  Ninety postmenopausal women with sonographic/sonohysterographic diagnosis of asymptomatic endometrial polyp were prospectively enrolled in this study. All patients underwent transvaginal sonography with color Doppler evaluation (Voluson 5300, KRETZ), and sonohysterography in selected cases. Patients were counseled on the risk of malignancy (estimated risk < 1/200). Sonographic follow up at 3, 6 and 12 months was proposed as an option to standard hysteroscopic polipectomy. Surgery was considered in case of bleeding, polyp enlargement, or Doppler PI < 0.6. Demographic and sonographic data of both groups were recorded. Surgical complications in group B patients were considered as abnormal outcome.

Results:  Sonographic follow up was chosen by 42 women (group A) and surgical removal by 47 patients (group B). Forty‐three patients underwent operative hysteroscopy, and four patients hysterectomy (group B). One major (uterine perforation not requiring surgery) and three minor complications (two cervical lacerations requiring hemostatic suturing, one false entry) (9%). Demographic (age, years of menopause, blood hypertension/diabetes, BMI, nulligravidity, hormonal replacement therapy assumption, tamoxifen assumption) and sonographic data) Endometrial thickness mean (interquartile range) = 8 (5–10) vs. 11 mm (7–13); volume (cc): 3 (1–4) vs. 4 (1–5); PI: 0.48 (0.44–0.51) vs. 0.49 (0.45–0.53) were not significantly different between group A and B. Pathologic findings were glandulocystic and hyperplastic polyp in 45 and in two patients, respectively. All group A patients remained asymptomatic in the follow up period (mean 10 months, interquartile range 5–16).

Conclusions:  Demographic and sonographic data were not significantly different in the two groups. No untreated patient became symptomatic during follow up period. Benign lesions only were found in treated patients, at the cost of one uterine perforation. A large multicentre study is needed to understand the exact prevalence of endometrial cancer in asymptomatic endometrial polyp, and verify the safety of conservative management.
Transit‐time study of an ultrasound contrast agent in benign and malignant adnexal tumors
Authors: Ordén M.‐R. , Jurvelin J. S. , Kirkinen P. P.
Published: March 2003

Purpose:  To evaluate objectively the effects of a microbubble contrast agent on the power Doppler ultrasonographic examination of adnexal tumors specially focusing in timing of the transit of the microbubble bolus.

Methods:  Seventy patients with suspected ovarian tumors were examined pre‐operatively using contrast‐enhanced ultrasonography. A 5 min examination was stored digitally and the behavior of the contrast agent was evaluated objectively by measuring the time‐dependent image intensity at the region of interest with a computer program. A time–intensity curve of each case was derived and analyzed.

Results:  Both the baseline and maximum power Doppler intensities as well as the absolute and relative (%) rise in intensity were significantly higher (P < 0.001) in malignant as compared to benign tumors. The arrival time was shorter (17.5 s vs. 22.5 s; P = 0.005) and the wash‐out time longer (219 s vs. 128 s; P = 0.000) in malignant than in benign tumors. A wash‐out time >170 s showed a 91% sensitivity and 75% specificity for the diagnosis of ovarian malignancy, and the accuracy was 78%.

Conclusions:  After microbubble contrast agent injection, malignant and benign adnexal lesions behave differently in degree, onset, and duration of Doppler ultrasound enhancement.
Evaluation of placental Doppler velocimetry in pregnancies complicated with oligohydramnios
Authors: Wojcieszyn Michal , Blaszczyk K. , Lukasik A. , Swadzba K. , Stokowacka M. , Poreba R.
Published: March 2003

Objective:  The objective of the study was to evaluate intraplacental Doppler indices in pregnancies complicated with oligohydramnios.

Methods:  Thirty‐six singleton pregnancies between 32 and 39 weeks complicated with oligohydramnios (cases of premature rupture of the membranes and fetal malformations were excluded from the study) and 40 normal pregnancies were examined by real time ultrasonography, color and pulse Doppler. Placental Doppler velocity waveforms were estimated in the placental cord insertion (umbilical artery velocimetry) and in three different pulsatile intraplacental vessels (the mean value). Placental Doppler velocity waveforms analysis was performed on the base of Haberman and Friedman method. The ratios between intraplacental and umbilical artery pulsatility index values were calculated. Fetal well‐being was evaluated by means of non‐stress test analyzed according to Fischer method.

Results:  In normal pregnancies group all Doppler velocity waveforms values were between 10 and 90th percentile of the normal for gestational age values based on Doppler indices nomograms, as well as all patients had the normal (<1) intraplacental to umbilical artery pulsatility index ratio. In the group complicated with oligohydramnios in 15 patients abnormal (>1) intraplacental to umbilical pulsatility index ratio were observed (P < 0.05, sensitivity 42%, specificity 100%, positive predictive value 100%, negative predictive value 65%). In that group the results of non‐stress test analysis according to Fisher method were pathological (Fisher <5) significantly more often (P < 0.05).

Conclusion:  The results of the study demonstrate, that in pregnancies complicated with oligohydramnios the evaluation of intraplacental to umbilical pulsatility index ratio is a valuable method for estimation the fetoplacental circulation and is an important complement of fetal well‐being assessment.
Intrapartum umbilical artery, fetal aorta and middle cerebral artery Doppler velocimetry as a predictor of poor perinatal outcome in growth retarded fetuses
Authors: Klep N. , Concin H. , Kurjak A.
Published: March 2003

Background:  The aim of the study was to evaluate the diagnostic prediction of the Doppler waveform analysis during active labor for adverse perinatal outcome in a group at significant risk of intrapartum hypoxia.

Materials and methods:  The study population consisted of 33 pregnant women at high‐risk and ultrasonographic diagnosis of IUGR between 28 and 35 weeks of gestation. On the basis of the flow velocity changes in the fetal vessels during pregnancy, patients were divided into two study groups A, with physiological Doppler waveforms (12 women) and B, with pathological Doppler waveforms (21 women). The percentage of the changes of the index values during active labor were correlated with pH values of the blood from the umbilical artery.

Results:  In group A, no statistically significant correlation was found. In group B, following was established: high negative correlation between the changes of the index values and pH values of the blood from the umbilical artery: dPAU 24%, r = − 0.531, t = 2.179, P < 0.05. dPIAFD 26%, r = − 0.655, t = 3.0, P < 0.05; dPIACM 10%, r = − 0. 699, t = 3.1, P < 0.01.

Conclusions:  The study revealed a significant correlation between the changes of index values of the Doppler waveform analysis during active labor and pH values of the blood from the umbilical artery in the process of intrapartum aggravation of already antepartum from chronic hypoxemia suffering fetuses.
A nomogram for the umbilical cord cross‐sectional area in normal pregnancies
Authors: Vasques F. A. P. , Moron A. F. , Murta C. G. V. , Carvalho F. H. C. , Gonçalves T. R. , Cattini H. , Hisaba W. J. , Barbosa M. M.
Published: March 2003

A prospective cross‐sectional study was developed in order to determine reference ranges for the umbilical cord cross‐sectional area (UCCSA) during normal pregnancies (patients with known dates of LMP and an ultrasound examination before the 20th week, without any pathologic condition). The measurements of the UCCSA were obtained in a plane adjacent to the insertion of the cord abdomen, as proposed by Raio et al, 1999. The inclusion criteria were: (1) singleton pregnancy, (2) gestation age >20 weeks, (3) intact membranes, (4) normal umbilical Doppler flow velocimetry. The exclusion criteria, in the presence of any of those, were: (1) congenital and/or chromosomal abnormalities; (2) pregnancy complications (any type); (3) inadequate size for gestational age when the examination was performed, i.e. the weight below the 10th percentile or above the 90th; (4) abnormal AFI for the gestational age. The patients were examined and included only once. During the period of the study (February 2000–May 2001), 545 patients were examined, after meeting the inclusion criteria determined for the present study. The age of the patients ranged from 15 to 42 years (mean = 26.7 ± 4.8), 242 patients (44.4%) had two gestations, 135 patients (28.1%) were at their first gestation, 129 patients (23.7%) were at their third gestation and 39 patients had four or more gestations (3.8%). The ultrasound machine used was the Synergy Multi Sync M 500 and the statistical analysis was performed by the program called Statistical Package for Social Sciences (SPSS). Our data were considered normally by the Kolmogorov–Smirnov test and then we figured the nomogram by linear regression analysis. The analysis of variance obtained through the F‐test (value = 356.27) showed that our regression model was significant at the level of P < 0.001, showing that the curve represented well the studied population and that the confidence interval (95%) contained the real value of the UCCSA. The regression equation was: y = − 532.27 + 44.358x − 0.6555x2. We conclude that, there is a progressive increase in the UCCSA up to the 32nd week of gestation, followed by a stabilization until the 34th week and a fall of the values from the 35th week of gestation.
Fetal breathing: a clinically useful paradox
Authors: Hepper P. G. , Shannon A. , Dornan J. C.
Published: March 2003

Purpose:  To examine fetal breathing movements in fetuses with congenital diaphragmatic hernia and compare this to unaffected fetuses and with their outcome after birth.

Methods:  Twenty women with normal singleton pregnancies and four cases of congenital diaphragmatic hernia were studied. All fetuses were observed for 60 min at 36 weeks of gestation. Fetal breathing movements were observed by scan taking a cross‐sectional view across the abdomen. The scan was recorded and breathing movements analyzed off‐line. All sessions occurred at the same time of the day and two hours after a light meal. No patients were cigarette smokers. Bouts of fetal breathing activity were defined as the length in seconds of each series of successive individual breathing movements bracketed by periods of apnea. The absence of fetal breathing movements for more than 3 s was called the apnea period. Total duration of breathing was the sum of all bouts.

Results:  The normal fetuses exhibited a breath to breath interval of 1.3 s and displayed breathing movements for around 30–35% of the observation period. Of the four fetuses with congenital diaphragmatic hernia, three died during the neonatal period due to lung hypoplasia, one survived following surgical repair. All four fetuses exhibited a similar breath to breath interval as unaffected fetuses but the three fetuses who died spent 80% (range 70–90%) of the time breathing whereas the fetus that survived spent 32% of its time breathing. Increased yawning was also observed in the fetuses who died.

Conclusions:  It has been speculated that the inhibition of fetal breathing movements may result in pulmonary hypoplasia, yet fetuses with lung hypoplasia spend more time breathing than those without lung hypoplasia. The relationship between breathing movements and lung development requires further study. Breathing movements may provide important information on fetal health and outcome.
Pregnancy in women with Marfan syndrome
Authors: García C. G. , Lagos N. P. , Benavides C. E. , Hoffmann I. F. , Castillo G. A. , Astorga M. A. , Melgarejo X. , Ferres I.
Published: March 2003

Background:  The Marfan syndrome is inherited as an autosomal dominant trait, and the fetus has a 50% risk of inheriting the mutant gene. It is caused by an abnormal fibrin gene located on chromosome 15q. The prevalence of the syndrome is 7–17/100 000. The symptoms and complications usually affect ocular, skeletal and cardiovascular systems. Pregnancy in the Marfan syndrome is associated with major problems: the first are maternal catastrophic cardiovascular complications which include aortic dissection, aortic rupture, or cardiac failure, due to mitral and aortic valve regurgitation. These conditions are responsible for 90% of the maternal deaths. The second problem is the risk of having a child with the syndrome (50%).

Case report:  An 18‐year‐old patient with a Marfan syndrome and with mental retardation. She had long limbs, slenderness of hands and feet, marked hyperextensible joints, kyphoscoliosis, narrow chest with pectum excavatum, an high arched palate with malocclusion. On first evaluation by US, she was 18 weeks pregnant. A maternal echocardiography was done, showing that all four chambers, and the valvular structures were normal, and the aortic root measured 26 mm, which was normal. The echocardiography was repeated at weeks 29 and 36, and showed no change in the aortic root or in the rest of the parameters. Study of the fetus showed normal anatomy, without morphotype of Marfan in utero. Fetal echocardiography was normal. There was moderate IUGR. At 39th week, there was a vaginal delivery, without complications, of a male newborn, 2910 g, 49 cm, Apgar 9–9, on a normal physical examination.

Conclusions:  Maternal and fetal outcomes were monitored with systematic echocardiography, which is the best and safest method available for the follow up of the severe cardiovascular complications. Patients with Marfan syndrome with aortic root of <40 mm, usually tolerate pregnancy well and can undergo vaginal delivery with epidural anesthesia, with favorable maternal and fetal outcomes.
Diagnosis and prognostic value Doppler flow velocity waveform in high risk pregnancies
Authors: Ghoneim M. R. , Megahed H. , Habba M. , El‐Biely M. M. , Lotfy G. L.
Published: March 2003

Objective:  To determine whether Doppler umbilical artery flow velocity waveforms (FVW) would improve the clinical management and reduce the prenatal morbidity or not, in cases of high risk pregnancies.

Methods:  A total of 160 pregnant women of 28 weeks or more gestational age were included in this study. The age of the cases were from 20‐ to 30‐year‐old and their gravidity ranged from gravida 1 to 5. The cases were classified into two groups. Low risk group, not associated with medical or obstetric complications and includes 70 cases. High risk groups include, the other 90 cases, such as the following: mild pre‐eclampsia (20), severe pre‐eclampsia (15), diabetes mellitus (10), postdated pregnancy (15), previous one or more cesarean section (15), rheumatic heart (4), decreased perception of fetal movement (3), bronchial asthma (2), Rh incompatibility (2) and previous IUFD. All of them were subjected to thorough general and obstetric examination, investigations, ultrasonic examination, biophysical profile scoring and Doppler umbilical artery FVW study. The cases of low risk group were examined every 2 weeks, while high risk ones, were examined every week or twice weekly according to the results of the previous examination.

Results:  There is a highly significant difference between values of umbilical artery FVW indices in low and high risk group. Doppler has specificity 92.8% in cases of low risk group while has sensitivity 52.8% and specificity 55.6% in cases of high risk group and it is more sensitive than biophysical profile. Doppler of umbilical artery is very beneficial in cases of pre‐eclampsia, where its sensitivity 78.5% and its specificity 52%.

Conclusion:  There is a strong association between abnormal FVW and adverse fetal outcome. The Doppler will identify a group of fetuses truly at risk, where intensive fetal monitoring or delivery will be required.
Doppler assessment of the uterine circulation in the second trimester in twin pregnancies: prediction of hypertensive disorders, small‐for‐gestational age and weight discordance
Authors: Geipel A. , Berg C. , Germer U. , Gröger S. , Krapp M. , Katalinic A. , Gembruch U.
Published: March 2003

Objective:  To compare singleton nomograms of the uterine circulation with previously established twin nomograms in the prediction of hypertensive disorders, small‐for‐gestational age (SGA) and birth weight discordance >20%.

Methods:  This was an analysis of maternal and perinatal data obtained from 256 diamniotic–dichorionic twin pregnancies. The uterine artery resistance and pulsatility index were calculated as a mean from both sides and the presence and absence of notching was recorded. Cut‐off levels for abnormal flow parameters were the 95th centile of reference ranges using singleton and twin nomograms.

Results:  As mean uterine artery indices are lower in twin gestation, a higher number of patients (n = 73; 28.5%) was screen positive according to twin reference values when compared to those of singletons (n = 51; 19.9%). However, singleton reference ranges or recording of notches only proved to be more efficient than twin reference ranges to correctly predict SGA (17.6, 19, 13.7%), birth weight discordance >20% (30.6, 37.5, 23.9%), and hypertensive disorders (23.5, 21.4, 16.4%), respectively. Compared to singleton nomograms of uterine artery Doppler, twin nomograms had higher sensitivities, lower specific and positive predictive values, but equal negative predictive value to comprise adverse pregnancy outcomes.

Conclusion:  For routine clinical practice, it seems justified to use singleton nomograms to assess uterine circulation in twin gestation. However, as the negative predictive value of uterine Doppler studies is slightly lower when compared to singletons, maternal and fetal complications might occur despite normal uterine waveforms.
Three‐dimensional volumetry in fetal weight estimation, cerebral ventricle measurements, and cardiac function
Authors: Yagel S.
Published: March 2003

Objectives:  To examine the applicability and efficacy of 3‐D volumetry in three discrete areas: fetal weight estimation, cerebral ventricle measurements, and 3‐D echocardiographic studies of fetal cardiac function.

Materials and methods:  Group 1: fetal weight estimation: 250 gravidae with uncomplicated singleton gestations and first‐trimester confirmation of gestational age were examined up to 48 h before delivery using both standard 2‐D fetal weight estimation and 3‐D volumetry. Group 2: fetal cerebral ventricle measurements: 40 gravidae with first‐trimester confirmation of dates were examined at 15–25 weeks gestation. Fetal lateral ventricles were measured by 3‐D volumetry. Group 3: 3‐D echocardiography: 40 gravidae with 1st‐trimester confirmation of dates were examined at 15–25 weeks gestation. End‐systolic and ‐diastolic ventricular volumes were studied to evaluate fetal cardiac function.

Results:  In these preliminary groups 3‐D volumetry for fetal weight estimation was shown to have a considerable advantage over standard 2‐D methods. Three‐dimensional volumetry of the fetal cerebral lateral ventricles is a simple method of measuring the fetal brain, and may prove to be a more intelligent method of evaluating cerebral ventricular volume. Three‐dimensional echocardiographic volumetry of the end‐systolic and ‐diastolic ventricular volumes is a new method for evaluating fetal cardiac function, and has considerable potential in heart scanning in cases of suspected fetal heart failure.

Conclusions:  Three‐dimensional ultrasonography shows great potential in the evaluation and volumetric measurement of many fetal organ systems.
Evaluation of the effects of cervical properties
Authors: Kepkep K. , Gurpinar H. , Kar E.
Published: March 2003

Introduction:  Preterm delivery has been faced in all delivery with a 7–11% and it keeps its importance by causing perinatal mortality and morbidity. Therefore it is important to define preterm delivery risk during the earlier period of the delivery.

Objective:  The aim of our work is evaluating the influence of the cervical length and funneling which are measured by transvaginal ultrasonography (TVUSG) in the asymptotic singleton pregnant women, to predefine preterm delivery.

Material and methods:  The cervical length at 16th, 20th, 24th, 28th, 32nd and 36th week of the pregnancy has been measured by TVUSG within a sample of 60 pregnant women who do not have any risk about the preterm delivery or who have already had a preterm delivery or an abortus case before. Also, the funneling has been observed within the same sample. The relation of a cervical length less than or equal 30 mm and the existence of the funneling with a preterm delivery risk before the 37th week of the delivery has been evaluated statistically.

Results:  We have observed the preterm delivery in the seven of the 60 pregnant women which were controlled until the delivery (11.7%). In this group, the relation between the preterm delivery and a cervix which is less than or equal 30 mm has been found to be statistically reasonable with the cervical length value at the 28th and 32nd week (P = 0.0001; P = 0.00001). A cervical funneling has been found in one patient and it has been not defined as meaningful with regard to the preterm delivery risk (P > 0.05).

Conclusions:  In order to define the risk of the preterm delivery, it is more meaningful if the cervical length is less than 30 mm and measured at the 28th and 32nd week of the delivery. On the other hand, funneling could not been determined during the earlier period of the delivery; therefore it is not used as a criteria to predefine the preterm delivery.
Choroid plexus cyst revisited – the KK Hospital experience
Authors: Tan J. V. K. , Woo B. H. , Yeo G. S. H.
Published: March 2003

Objective:  To study the clinical outcome of cases of choroid plexus cysts (CPC), the prognostic factors that increase the risk of aneuploidy and to formulate a counseling strategy for CPC.

Study design:  Cases of CPC detected at screening ultrasonography (between 18 and 24 weeks gestation) from 1 October 1996 to 30 September 2000 in low risk antenatal patients at KK Women's & Children's Hospital, Singapore, were studied. The risk of aneuploidy and postnatal cranial ultrasonography of the cases were analyzed. Data was stratified according to maternal age, size of CPC, unilaterality or bilaterality and presence of concomitant structural abnormalities and/or ultrasound markers (non‐isolated).

Results:  There were 485 cases with CPC among 56 746 patients (incidence 0.08%). Overall risk of aneuploidy was 6.2%. There were 30 cases of chromosomal abnormalities including 23 cases of trisomy 18; five cases of trisomy 21; one case of monosomy X and one case of Klinefelter syndrome. Cases of non‐isolated CPC were at significantly higher risk for aneuploidy (56.8%) compared to isolated CPC (1.4%), P < 0.001. No significant difference in risk was detected between unilateral and bilateral isolated CPC (P = 0.4), and with increasing size of isolated CPC. A near significant increase in risk was found between the under‐30 age group (0.37%) and the above‐30 age group. (2.3%) (P = 0.07). In non‐isolated CPC, the risk of aneuploidy ranged from 14.3% at age 20–24 and 100% at age 41–45. Likelihood ratio for trisomy 18 was 7.2 for isolated CPC, 1276 for non‐isolated CPC and 0.54 for absent CPC in the whole scanned population.

Conclusion and recommendations:  Our results support the need for a thorough ultrasound anatomic survey for all cases of diagnosed CPC. Karyotyping should be offered to all cases of non‐isolated CPC. In isolated CPC, there may be benefit from offering karyotyping when maternal age exceeds 30.
Prenatal sonographic appearance of Beare–Stevenson cutis gyrata syndrome
Authors: Tsai C.‐C. , Hsu T.‐Y. , Chang S.‐Y. , Wang T.‐J. , Ou C.‐Y. , Chen Z.‐H. , Hsu P.‐U.
Published: March 2003

Background:  Beare first described a 2‐year‐old boy who had abnormal physical feature including hypertelorism, cutis gyratum, acanthosis nigrican, cleft palate, functional pyloric obstruction and abnormal genitalia. Ten cases of Beare–Stevenson cutis gyrata syndrome have been reported. Here, we present, the first case of antenatal ultrasound image of this rare syndrome. A 31‐year‐old Taiwanese, gravida 2, para 1, was referred for fetal evaluation at 32 weeks gestation because of polyhydramnios and fetal head anomaly. Conventional sonography revealed a single fetus with amniotic index of 27.3 cm, cover leaf skull, and a skin fold‐like umbilical cord. Three‐dimensional sonography of the face of the fetus showed, high wide forehead, ocular proptosis, and depressed nasal bridge. The patient delivered a male infant weighing 2980 g at 39 weeks gestation. Physical examination of the infant showed furrows of corrugated appearance of the skin, craniofacial anomalies, particularly craniosynosis, displaced ears, prominent umbilical stump and hypospadia. Computer tomography and magnetic resonance image were performed and revealed fronto‐ethmoid‐nasal, cephalocele, pansynostosis and frontal base defect.

Conclusion:  A total of 10 cases of Beare–Stevenson cutis gyrata syndrome have been previously reported. All of the previously reported cases of the syndrome were diagnosed postnatally. Our patient presented with ocular hypertelorism, low‐set and creased ears, ocular proptosis, choanal atresia, cloverleaf skull, craniosynosis, cutis gyrata, acanthosis nirican, prominent umbilical stump and bifida scrotum. Here we present the first case of antenatal ultrasound image of this rare syndrome.
The importance of fluid analysis in fetal intra‐abdominal cyst aspiration
Authors: Fait G. , Har‐Toov J. , Gull I. , Amster R. , Wolman I. , Lessing J. B. , Jaffa A. J.
Published: March 2003

The importance of fluid analysis in the evaluation of intraperitoneal cysts in female fetuses is demonstrated. Case 1: A 30‐year‐old woman had an unremarkable pregnancy until 29 gestational weeks, when a routine US examination revealed an anechoic cyst of 4.0 cm in diameter located in the lower abdomen of a female fetus. At 33 weeks of gestation the cyst enlarged to 6.5 cm. Intrauterine aspiration of the cyst was performed. A volume of 75 mL of yellow fluid was obtained and collapse of the cyst was noted. Fluid biochemistry revealed estradiol >200000 pg/mL, progesterone 1648 ng/mL, creatinine undetectable. A fetal ovarian cyst was diagnosed. At 34 weeks of gestation the cyst enlarged again to 6 cm and 78 mL of yellow fluid was obtained on intrauterine aspiration. Again, collapse of the cyst was noted on US. Repeated scans until birth showed an anechoic cyst of 4.0 cm. Postnatal abdominal US confirmed the diagnosis and a complete disappearance of the cyst after 2 weeks. Case 2: A 28‐year‐old woman had an unremarkable pregnancy until 34 gestational weeks, when a routine US examination revealed an anechoic cyst of 6.0 cm in diameter located in the lower abdomen of a female fetus. Intrauterine aspiration of the cyst was performed. A volume of 147 mL of yellow fluid were obtained and collapse of the cyst was noted. Fluid biochemistry revealed estradiol 781 pg/mL, progesterone 37 ng/mL, and creatinine 4 mg/dL. An unusual urinary tract malformation was diagnosed. Repeated scans until birth showed an anechoic cyst of 6 cm. After delivery a fistula between the urinary bladder and the upper vagina, and an imperforated hymen, were diagnosed. In cases of prenatal needle aspiration, fluid biochemistry may be helpful to establish the origin of intraperitoneal cysts in the female fetus, especially when recurrence occurs, and prevent unnecessary attempt of decompression of intraperitoneal cysts.
2D/3D sonographic imaging of thanatophoric dysplasia type I at 19 weeks of gestation
Authors: Pooh R. K. , Nishida S. , Ohno Y.
Published: March 2003

Thanatophoric dysplasia is a sporadic, lethal congenital skeletal dysplasia. There are two major subtypes: (1) a short, curved femur characterizes type I; and (2) a straighter femur with cloverleaf skull characterizes type II. We, here, present a case of type I disease. A 30‐year‐old pregnant woman was referred to the ultrasound unit due to fetal short extremities at 19 weeks and 4 days of gestation. Ultrasound revealed short limbs and a severely small thorax. Every limb bone was markedly short, and the femur, tibia, fibula and humerus were remarkably curved. 3D ultrasound demonstrated the abnormal appearance of extremities. Cranial and intracranial structures were normal. One week later, no growth of limb bones was seen. Thanatophoric dysplasia type I was strongly suspected and counseling of the couple was done. Pregnancy was terminated at 21 weeks of gestation and a female fetus was aborted. Short and curved limb bones were confirmed by postnatal X‐ray. Genomic DNA obtained by cord blood showed a point mutation in the fibroblast growth factor receptor 3 (FGFR3) gene; a C to T substitution at position 742 in the FGFR3 gene, resulting in a Arg248Cys substitution, known to be associated with type I disease. By ultrasound in the second trimester, prenatal diagnosis of skeletal dysplasia can be feasible. However, differentiating this lethal disease from non‐lethal skeletal disorders should be done prudently.
Fetal renal blood flow assessment by three‐dimensional power Doppler ultrasound: preliminary results of a three‐dimensional histogram study
Authors: Chang F.‐M. , Chang C.‐H. , Yu C.‐H. , Liao T.‐P. , Ko H.‐C. J.
Published: March 2003

Purpose:  To assess the fetal renal blood flow in normal gestation using three‐dimensional (3D) power Doppler ultrasound.

Methods:  The study was under a prospective, consecutive and cross‐sectional design. Normal pregnancies that attended the prenatal clinic were included. We used a three‐dimensional power ultrasound scanner, Voluson 530D MT (Kretz, Zipf, Austria) to assess the total blood flow of fetal kidney. First, we used the 3D transabdominal probe to scan the whole fetal kidney under the 3D power Doppler mode at a fixed condition. Second, we used the VOCAL software (Kretz, Zipf, Austria) to calculate the histogram indices of fetal renal blood flow obtained from the 3D power Doppler scanning. The histogram indices included vascularization index (VI), flow index (FI) and vascularization‐flow index (VFI).

Results:  In total, 81 fetuses ranging from 20 to 39 weeks of gestation were included for final analysis. Our results showed that VI had a high correlation with gestational age (r = 0.90, n= 81, P < 0.001). In addition, FI was positively correlated with gestational age (r = 0.35, n= 81, P < 0.05), and VFI also presented a high correlation with gestational age (r = 0.88, n= 81, P < 0.001). Furthermore, the VI, FI, and VFI of fetal kidney in the third trimester were all higher than those indices of fetal kidney in the second trimester (all P < 0.01).

Conclusion:  The 3D power Doppler ultrasound can assess the total blood flow of fetal kidney, which is superior to the previous methods of blood flow assessment. Our study indicates that fetal renal flow increases with the advancement of gestational age, and our data may be a useful reference for further studies of fetal renal flow in abnormal conditions.
Cervical ectopic pregnancy: a case report and literature review
Authors: Gun M. , Mavrogiorgis M.
Published: March 2003

We report a case of cervical ectopic pregnancy that was diagnosed using transabdominal ultrasound. Conservative management with methotrexate administration was undertaken and, following a period of heavy bleeding, bilateral uterine artery embolization was performed. Two weeks after presentation, the gestational sac was shown to have reduced in size. We describe the ultrasound findings in this case and discuss those reported in the literature along with the available management options. Copyright © 2002 ISUOG
Prenatal diagnosis of an infratentorial subdural hemorrhage: case report
Authors: Batukan C. , Holzgreve W. , Bubl R. , Visca E. , Radü E. W. , Tercanli S.
Published: March 2003

We report a case of a prenatally diagnosed infratentorial subdural hemorrhage. The hematoma located in the posterior cerebral fossa was detected by conventional ultrasound at 24 weeks of gestation. Intrauterine magnetic resonance imaging confirmed the diagnosis. Autopsy of the fetus revealed a well‐circumscribed subdural hematoma. The prenatal findings of intracranial bleeding located in the posterior fossa and the prognosis of such cases are discussed. Copyright © 2002 ISUOG
Fetal pulmonary venous flow pattern is determined by left atrial pressure: report of two cases of left heart hypoplasia, one with patent and the other with closed interatrial communication
Authors: Lenz F. , Machlitt A. , Hartung J. , Bollmann R. , Chaoui R.
Published: March 2003

We report two cases of fetal left heart hypoplasia with extremes of size of interatrial communication, i.e. a closed foramen ovale and an atrial septal defect. Doppler examinations of the pulmonary veins showed almost to and fro flow in the fetus with the closed foramen ovale and, in contrast, a normal flow velocity waveform in the fetus with the atrial septal defect, despite mitral atresia. Our observations support the importance of left atrial pressure in the creation of a pulmonary venous flow pattern in the fetus. Copyright © 2002 ISUOG
Harlequin fetus: three‐dimensional sonographic findings and new diagnostic approach
Authors: Bongain A. , Benoit B. , Ejnes L. , Lambert J. C. , Gillet J. Y.
Published: March 2003

Congenital ichthyosis, otherwise known as harlequin fetus, is a severe, generally lethal, anomaly. Prenatal diagnosis is usually possible in families at risk but requires invasive fetoscopy for skin biopsy. The application of three‐dimensional ultrasound enables a greatly improved analysis of the facial morphology and thus provides an important contribution to prenatal diagnosis. Although such three‐dimensional diagnostic procedures are performed in specialized centers, sonographers should be aware of the signs observed at routine two‐dimensional ultrasound examination in order to ensure appropriate referral for diagnosis. We describe two consecutive pregnancies of the same parents in which two‐ and three‐dimensional ultrasound were used in the prenatal diagnosis of harlequin fetus. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology