bluuebunny/crossref_metadata_2025 huggingface dataset:
Doppler velocimetry, placental morphology and outcome in insulin‐dependent diabetes
Authors: Bracero L. A. , Beneck D. , Schulman H.
Published: March 2003

The purpose of this study was to determine the underlying cause of abnormal umbilical artery Doppler velocimetry in pregnancies complicated by insulin‐dependent diabetes, by evaluating placental morphology and correlating Doppler results with pregnancy outcome. Our study population consisted of 14 pregnancies with normal Doppler results and 11 pregnancies with abnormal Doppler results. Quantitative placental examinations were performed. Maternal and perinatal characteristics were analyzed. Infants from the abnormal Doppler group had a statistically significantly higher incidence than those from the normal Doppler group of hyperbilirubinemia, Cesarean delivery for fetal distress, and neonatal intensive care stay of 2 or more days. Women with abnormal Doppler results delivered earlier (36 vs. 38 weeks) and had infants of lower birth weight (3079 vs. 3629 g). They were also three times more likely to have poor glycemic control (relative risk = 3.2; p = 0.0067). The placentae of both groups showed no statistically significant dtfferences in placental weight, number of tertiary stem villi, number of small muscular arteries, or mean arterial width. Our findings suggest a functional rather than structural placental process as the cause of the abnormal Doppler results in pregnancies complicated by diabetes. An association between glycemic control and Doppler velocimetry is suggested. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic findings and fetal chromosomal studies undertaken prenatally by fetal blood sampling using cordocentesis
Authors: Murotsuki J. , Tanigawara S. , Uehara S. , Okamura K. , Yajima A.
Published: March 2003

Prenatal karyotyping was carried out on 206 pregnancies with sonographic abnormalities, including fetal malformations, growth retardation and disorders of the amniotic fluid volume. Overall, chromosomal aberrations were detected in 37 cases (18.0%), but the frequency of chromosomal aberrations was 8.2% in fetuses with a single anomaly and 52.7% in fetuses with multiple anomalies. The chromosomal risk was very high in malformations associated with growth retardation (81.8%) or with both growth retardation and disorders of the amniotic fluid volume (82.4%). High rates of chromosomal aberrations were observed in cases of heart anomalies, diaphragmatic hernia, urinary tract obstruction, hydrocephalus, intestinal atresia, abdominal wall defect and fetal effusion/hydrops. In fetuses at high risk of chromosomal aberrations, cordocentesis for rapid karyotyping is justified in the second or third trimester. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Uteroplacental resistance index: analysis of intra‐ and interobserver variability
Authors: Bewley S. , Chang T. C. , Campbell S.
Published: March 2003

The aim of this study was to assess the intra‐ and interobserver variability of second‐trimester uteroplacental continuous‐wave flow velocity waveforms. The left and right uterine and arcuate resistance indices were measured in women having their routine booking scan at 16–24 weeks' gestation. Four experiments assessed the intra‐observer between‐frame variability, the intraobserver beat‐to‐beat variability, the intraobserver temporal variability, and the interobserver variability, using the limits‐of‐agreement method. The intraobserver between‐frame variability was greater than the beat‐to‐beat variability at three of the four sites. The temporal variability was not significantly different between sites. There were wide interobserver limits of agreement with respect to the reference ranges, although they were greater at arcuate sites than uterine sites. These observations suggest that the reproducibility of the resistance index in continuous wave Doppler uteroplacental flow velocity waveforms is poor, particularly from arcuate sites. The uterine site is preferable and descriptive analysis may be better. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Magnetic resonance imaging in pregnancy: study of fetal cerebral malformations
Authors: Resta M. , Greco P. , D'Addario V. , Florio C. , Dardes N. , Caruso G. , Spagnolo P. , Clemente R. , Vimercati A. , Selvaggi L.
Published: March 2003

This paper reports 15 examinations by magnetic resonance imaging (MRI) performed in pregnant women whose fetuses had cerebral malformations identified by sonography. In all the cases the fetuses were immobilized by ultrasound‐guided intravenous or intramuscular curarization.

The diagnoses by MRI and ultrasound differed only in one case where an occipital meningocele had first been suggested. No cerebral abnormalities were demonstrated in this case by the MRI study, and this was confirmed at birth. In the remaining 14 cases, MRI confirmed the ultrasound diagnosis of cerebral malformation. In four of these cases, MRI added some additional information to the ultrasound diagnosis of ventriculomegaly by detecting agenesis of the corpus callosum in two fetuses, one Chiari malformation and one triventricular hydrocephalus. Another two ultrasound diagnoses of microcephaly actually proved to be semilobar holoprosencephaly with MRI. In the following cases, the MRI diagnoses concurred with those of ultrasound, and was therefore used unnecessarily despite providing further anatomical details of the lesions: two cases of agenesis of the corpus callosum, one case of anencephaly, a cystic hygroma of the neck, an alobar holoprosencephaly, a Dandy–Walker malformation and a mild isolated hydrocephalus associated with diaphragmatic hernia. In one case of iniencephaly, sonography offered closer approximation to the correct diagnosis.

The results obtained unequivocally confirm the high sensitivity of ultrasound examinations in the prenatal screening of cerebral malformations and show that MRI proves to be complementary in uncertain cases or when more accurate anatomical detail is required. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Is oligohydramnios a risk factor for infection in term premature rupture of membranes?
Authors: Romero R. , Gomez R. , Galasso M. , Salafia C. , Yoon B. H. , Behnke E. , Cotton D.
Published: March 2003

Our objective was to determine if a reduced volume of amniotic fluid is a risk factor for microbial invasion of the amniotic cavity in women with rupture of membranes at term. Transabdominal amniocentesis under ultrasound guidance was used to evaluate the microbiological state of the amniotic cavity in 53 patients with term premature rupture of membranes before vaginal examination. Amniotic fluid index was measured prior to the procedure in all cases. The prevalence of microbial invasion of the amniotic cavity was 32.1% (17/53). Women with microbial invasion of the amniotic cavity had a significantly lower median amniotic fluid index than did women without evidence of infection (median 4.4 cm, range 1.0–8.1 vs. median 7.8 cm, range 1.3–14.4, respectively; p < 0.001). An amniotic fluid index of < 5 cm had a sensitivity of 71% (12/17) a specificity of 89% (32/36), a positive predictive value of 75% (12/16) and a negative predictive value of 87% (32/37) in the prediction of microbial invasion of the amniotic cavity. Among women who delivered vaginally, those with an amniotic fluid index of < 5 cm had a higher rate of endometritis than those with an amniotic fluid index of ≥ 5 cm (19% (3/16) vs. 0% (0/26), respectively; p < 0.05). We conclude that women with term premature rupture of membranes and an amniotic fluid index of < 5 cm are at an increased risk for microbial invasion of the amniotic cavity and puerperal infection after a vaginal delivery. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Doppler flow velocity waveforms in the fetal ductus arteriosus during the first half of pregnancy: a reproducibility study
Authors: Brezinka C. , Stijnen T. , Wladimiroff J. W.
Published: March 2003

Reproducibility of flow velocity waveform measurement in the fetal ductus arteriosus was studied in 52 normal pregnancies between 11 and 25 weeks of gestation. The flow velocity parameters studied were the peak systolic velocity, mean velocity, end‐diastolic velocity, flow velocity integral and acceleration time. In each woman two consecutive measurements were performed with a time delay of 15 min. An acceptable reproducibility was achieved for all flow velocity parameters, except for the acceleration time and end‐diastolic velocity. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonic antepartum assessment of a classical Cesarean uterine scar and diagnosis of dehiscence
Authors: Avrech O. M. , Weinraub Z. , Herman A. , Ariely S. , Tovbin Y. , Bukovsky I. , Caspi E.
Published: March 2003

Prior classic incision through the uterine corpus carries the most significant risk of catastrophic uterine rupture and subsequent maternal and fetal morbidity or mortality. A trial of labor is not carried out in this group of patients, but the risk of uterine rupture exists during the antepartum period. An accurate and prospective method for diagnosing the presence of uterine defects or documenting their absence would be clinically useful. Our unusual case emphasizes the obvious need for antepartum sonographic scans of the classic uterine scar, starting from the third trimester to term, using the high‐frequency (> 5 MHz) transducer. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Doppler studies of fetal cerebral blood flow
Authors: Degani S. , Lewinsky R. M. , Shapiro I.
Published: March 2003

Doppler flow velocity waveforms from fetal cerebral vessels can be reliably obtained by a transabdominal or transvaginal scanning route. Changes in pulsatility imply alterations in cerebral impedance and reflect the physiological regulatory mechanisms underlying pathological processes during pregnancy. In fetuses severely distressed due to failure of placental function, the ratios reflecting the redistribution of fetal circulation (e.g. the ‘brain‐sparing effect’) help to identify fetuses at risk for fetal hypoxia.

Apart from providing an increase in medical knowledge, this non‐invasive technique is proving to be clinically useful. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Does measurement of amniotic fluid index detect changes in amniotic fluid volume after second‐trimester amniocentesis?
Authors: Cacciatore C. , Rizzo G. , Pietropolli A. , Capponi A. , Bufalino L. , Arduini D. , Romanini C.
Published: March 2003

The objective of this study was to establish whether variations of amniotic fluid volume induced by second‐trimester amniocentesis could be detected by serial measurements of amniotic fluid index. A total of 130 singleton pregnancies undergoing second‐trimester amniocentesis for genetic indications were considered. Amniotic fluid index was measured at three different time intervals: 30–60 min before amniocentesis, immediately after the procedure, and 60 min after the procedure. Serial measurements were obtained either by a single operator (n = 55) or by the three independent operators (n = 75).

Significantly lower amniotic fluid index values were demonstrated immediately after amniocentesis when compared with the pre‐amniocentesis and subsequent measurements in the study design with both the single and multiple operators. No statistically significant changes were found between the first amniotic fluid index measurements and those obtained 1 h after amniocentesis.

These results suggest that second‐trimester amniocentesis induces a temporary decrease of amniotic fluid volume detectable by serial amniotic fluid index measurements, no longer evident 1 h after the procedure. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
An approach to multifetal pregnancy reduction in a pregnancy of grand order (12 fetuses)
Authors: Monteagudo A. , Timor‐Tritsch I. E.
Published: March 2003

Our objective was to determine the best method to approach a multifetal pregnancy reduction of a patient with a multiple pregnancy of grand order (12 fetuses). Transvaginal ultrasound‐guided reduction was performed in three stages. Successful outcome was achieved. The patient delivered twins at 37 weeks' gestation. The published and unpublished literature is reviewed and discussed in the light of this case. Our conclusion is that a multifetal pregnancy reduction of grand order can be performed in stages to achieve the desired number of fetuses.
Use of transvaginal ultrasonography with color Doppler imaging to determine an appropriate treatment regimen for uterine fibroids with a GnRH agonist before surgery: a preliminary study
Authors: Creighton S. , Bourne T. H. , Lawton F. G. , Crayford T. J. B. , Vyas S. , Campbell S. , Collins W. P.
Published: March 2003

The aim was to obtain data that could be used to determine the most appropriate treatment regimen for uterine fibroids with a gonadotropin releasing hormone analog (goserelin) before surgery. Fifteen premenopausal women (aged 27–53 years; mean 40 years) were referred from a gynecological outpatients' clinic. They all had uterine fibroids and were awaiting hysterectomy or myomectomy. All women were scheduled to receive an implant of goserelin (3.6 mg), undergo transvaginal ultrasonography and have a sample of peripheral blood taken at monthly intervals for 6 months. The main outcome measures were fibroid size and indices of blood flow (the pulsatility index and peak systolic velocity) in both uterine arteries and the principal artery supplying the largest fibroid. The concentrations of follicle stimulating hormone, estradiol, luteinizing hormone and progesterone were measured in peripheral plasma. Twelve women (80%) completed 2 months of treatment, but only three (20%) completed the study (due to side‐effects of the drug). After 2 months of treatment, the plasma hormone levels were all in the low‐normal range; the mean fibroid volume had decreased by 53% and the mean peak systolic blood velocity in the fibroid artery had decreased by 45%. Mean changes in all indices were < 10% over the next 4 months of treatment. Six women (40%) had fibroids with an initial volume of > 100 ml; these tumors showed the largest reduction in size. We conclude that women with a uterine fibroid of > 100 ml are the best candidates for treatment with goserelin (3.6 mg/month) before surgery. Two months' treatment effects a marked reduction in fibroid volume and blood flow and is associated with good compliance. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Subendometrial–myometrial contractility in conception and non‐conception embryo transfer cycles
Authors: Narayan R. , Goswamy R.
Published: March 2003

This study describes the characteristics of subendometrial–myometrial contractions seen on transvaginal sonography on the day of embryo transfer in assisted conception cycles and their significance for pregnancy outcome.

A total of 112 cycles were studied where three embryos with minimal or no fragmentation were transferred. Transvaginal sonography was performed just prior to embryo transfer. A sagittal view of the uterine cavity was obtained and the ultrasound probe was held steady for 2 min. The video recorded image was analyzed at normal, three and five times normal speed. The frequency (contractions/min), direction (fundally or cervically directed) and length (entire cavity or localized) of contractions were noted. Conception and non‐conception cycles were compared by determining the standard error of difference between means and proportions and the confidence intervals.

The mean frequencies of contractions in the conception and non‐conception cycles were 2.09 (SD = 0.8) and 1.92 (SD = 0.85), respectively. A total of 57.6% of cycles in the conception group and 46% in the non‐conception group had contractions directed towards the cervix. There was no statistically significant difference between the two groups in any of the parameters studied. However, when frozen embryo replacement cycles (n = 40) were studied separately, the incidences of fundally directed contractions were 28.6% and 66.7% in conception and non‐conception cycles, respectively. This was statistically significant. Comparison of cycles resulting in miscarriage with those leading to pregnancies beyond 16 weeks revealed no statistical difference in the characteristics of the contractions.

We concluded that subendometrial–myometrial contractions studied on the day of embryo transfer (luteal day 2) do not predict the outcome in in vitro fertilization cycles. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Doppler studies of the fetal circulation in twin–twin transfusion syndrome
Authors: Hecher K. , Ville Y. , Snijders R. , Nicolaides K.
Published: March 2003

This cross‐sectional study investigated the circulatory profile of the donor and recipient fetuses in 20 pregnancies with twin–twin transfusion syndrome presenting with acute polyhydramnios at 17–27 (mean, 22) weeks' gestation. Doppler investigations of the arterial vessels and ductus venosus, inferior vena cava, right hepatic vein, tricuspid and mitral ventricular inflow were performed in both fetuses. Mean values of most blood flow velocities on the venous side showed a significant decrease in both groups of fetuses, and a significant increase in mean values for indices describing waveform pulsatility was found in all three venous vessels in the group of recipients, whereas in the donor group this was only the case in the ductus venosus. Mean values of atrioventricular flow velocities showed a significant decrease in the donor group. The most significant findings on the arterial side were an increased mean umbilical artery pulsatility index and a decreased mean value for aortic blood flow velocity in both groups of fetuses. Five recipients and four donors had absence or reversal of blood flow during atrial contraction in the ductus venosus. All these fetuses showed pulsations in the umbilical vein. Tricuspid regurgitation was present in eight recipients. Absence or reversal of end‐diastolic velocities in the umbilical artery was found in four donors. The recipient's circulation showed the characteristics of congestive heart failure due to hypervolemia. The significant decrease of diastolic venous blood flow velocities is compatible with increased end‐diastolic ventricular pressure. Alterations in the donor's circulation are consistent with decreased venous return due to hypovolemia and increased cardiac afterload due to increased placental resistance. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Errata corrige
Authors: David Cristina , Gabrielli Sandra , Pilu Gianluigi , Bovicelli Luciano
Published: March 2003

The original article to which this Erratum refers was published in Ultrasound Obstet. Gynecol., 5, 256–9
First clinical experience with sonicated human serum albumin (Albunex®) as an intrafallopian ultrasound contrast medium
Authors: Holte J. , Rasmussen C. , Morris H.
Published: March 2003

The safety and preliminary efficacy of a new ultrasound contrast medium. Albunex® for evaluating Fallopian tube patency during transvaginal sonography were studied in seven women. All of the women had sought medical attention because of uterine fibroids and excessive menstrual bleeding and were scheduled for a subsequent hysterosalpingectomy 3 weeks after the ultrasound examination. Albunex was injected transcervically in doses ranging from 0.5 to 9 ml, alternating with saline, during concomitant transvaginal ultrasound scanning. There were no serious adverse reactions. Peroperative macroscopic and postoperative microscopic investigations of the endometrium, Fallopian tubes and peritoneal biopsies revealed no pathological changes. Agreement between hysterosalpingo contrast sonography (HyCoSy) and postoperative testing for the evaluation of tubalpatency was observed in 12 out of 14 Fallopian tubes. These findings suggest that Albunex may safely be used as an intrafallopian contrast medium in ultrasound investigations. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Differential diagnosis of mammary tumors with vocal fremitus in sonography: preliminary report
Authors: Sohn C. , Baudendistel A.
Published: March 2003

During sonographic examinations using the new color Doppler technique, maximum‐entropy method (MEM), it was discovered, by chance, that artefacts which are produced by vibrations of the thorax can be used to differentiate between malignant and benign breast lesions. These artefacts, in the form of small color pixels, can either be brought about by vocal fremitus known from internal medicine or by humming in a low tone.

In the case of malignant tumors, the color pixels are visible in the middle of the sonographically portrayed tumor as well as in the surrounding tissue, whereas in benign tumors the artefacts are only found in the surrounding tissue and are quite clearly not present in the center of the tumor.

On the preoperative day, 95 patients with 46 benign and 49 malignant lesions were examined using the method described above. In 91% the differential diagnosis was in accordance with the histological results. In seven cases a benign lesion was classified before the operation as malignant and in two cases malignancy was incorrectly diagnosed as benign.

Our explanation of the phenomenon is based on the fact that most benign tumors exhibit a restricted growth and form a clear‐cut boundary with the surrounding tissue, so the vibrations are not conducted into the tumor. In contrast, malignant lesions grow by infiltrating the surrounding tissue, allowing the vibrations to be conducted into the tumor, where they can be demonstrated as small color pixels. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Reproducibility of the amniotic fluid index: its effect on clinical practice
Authors: Chang T. C. , Yeo S. H. , Huang H. F. , Leng J. H.
Published: March 2003

Two methods of measuring the amniotic fluid index (AFI) were subjected to tests of intra‐ and interobserver reproducibility. In the first method, amniotic fluid in each quadrant was measured by using the deepest pool perpendicular to the floor; in the second method, amniotic fluid in each quadrant was measured by using the deepest pool perpendicular to the uterine contour. Intraobserver and interobserver variability were assessed by using one‐way analysis of variance and limits of agreement, respectively. Intraobserver standard deviations were all < 9 mm. When the AFI was measured using the first method, there was an inverse relationship between the interobserver difference and mean values of AFI. Plots of the differences between observers against their means showed that the lower the AFI, the greater the interobserver variability. No such correlation was noted when the AFI was measured by the second method. The limits of agreement (within which 95% of interobserver differences lie) were comparable for the two methods [(−42 mm to 29.4 mm) and (−46.4 mm to 41.6 mm), respectively]. The results suggest that the amniotic fluid index measured by the second method is more reproducible, especially in the presence of reduced amniotic fluid. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Detection of abnormal intrauterine vascularization by color Doppler imaging: a possible additional aid for the follow up of patients with gestational trophoblastic tumors
Authors: Zanetta G. , Lissoni A. , Colombo M. , Marzola M. , Cappellini A. , Mangioni C.
Published: March 2003

Uterine morphology assessed by transvaginal ultrasound and the hemodynamics of intratumoral vessels assessed by color Doppler ultrasound were prospectively correlated with the clinical outcome of 25 patients with trophoblastic tumors. Twenty patients were followed without treatment (observation group) and 16 achieved complete local resolution. The four subjects with local persistence were combined with five patients referred from other institutions and received chemotherapy (treatment group).

In the observation group both techniques had 100% accuracy in predicting local resolution or local persistence. Persistence was predicted 1–3 weeks before the increase of β‐human chorionic gonadotropin (β‐hCG) levels, whereas resolution was observed up to 8 weeks before the disappearance of β‐hCG. In one patient normal uterine morphology and vascularization in the presence of elevated hCG levels was associated with extrauterine spread. In the treatment group, normal uterine ultrasound morphology and negative color Doppler results had 100% negative predictive value. False‐positive results were observed in two cases.

We conclude that ultrasound evidence of abnormal uterine morphology or persistent vascularization on color Doppler examination with persistent hCG levels is indicative of local persistence. Normal uterine morphology with negative color Doppler results may be associated with extrauterine spread. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of vasa previa presenting as amniotic band. ‘A not so innocent amniotic band’
Authors: Clerici G. , Burnelli L. , Lauro V. , Pilu G. L. , Di Renzo G. C.
Published: March 2003

We describe a case in which the early antepartum diagnosis of vasa previa was made in an asymptomatic patient by means of color Doppler ultrasonography. A woman, gravida 3 para 1 at 22 weeks' gestation, was diagnosed as having an anterior low‐lying placenta, a velamentous cord insertion and an amniotic band with vessels traversing the internal cervical os towards a succenturiate lobe. At the 39th week, a Cesarean section was performed and a healthy female baby was born. Transvaginal color Doppler flow imaging facilitated the accurate diagnosis of this condition. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Outcome of singleton pregnancies with severe oligohydramnios in the second and third trimesters
Authors: Shipp T. D. , Bromley B. , Pauker S. , Frigoletto F. D. , Benacerraf B. R.
Published: March 2003

We evaluated the significance of severe oligohydramnios, or anhydramnios, in the second and third trimesters, by determining the range of etiologies as well as the differences in fetal and neonatal outcome. All prenatal ultrasound results on pregnancies found to have severe oligohydramnios over a 75‐year period at 13–42 weeks' gestation were retrospectively collected. Follow‐up results were obtained from review of medical records, autopsies and pathology reports. A total of 2.50 singleton pregnancies met the criteria of having severe oligohydramnios. A bimodal distribution in gestational age at diagnosis was seen, with more cases diagnosed at 13–21 weeks and at 34–42 weeks. Fetal abnormalities were present in 50.7% of those diagnosed with severe oligohydramnios in the second trimester and in 22.1% of those in the third trimester. There were 10.2% and 85.3% survivors when severe oligohydramnios was diagnosed in the second and third trimesters, respectively. The rate of aneuploidy was at least 4.4% for the entire singleton population. A bimodal distribution of pregnancies presenting with severe oligohydramnios represents two different naturally occurring populations in (terms of both etiology and prognosis. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Placental lakes, absent umbilical artery diastolic flow and poor fetal growth in early pregnancy
Authors: Jauniaux E. , Nicolaides K. H.
Published: March 2003

Uteroplacental insufficiency is a common cause of intrauterine growth retardation in the third trimester of pregnancy. We report a case in which placental vascular lesions, absent end‐diastolic frequencies in the umbilical artery and high maternal serum levels of α‐fetoprotein and human chorionic gonadotropin were observed from the beginning of the second trimester in a patient with a history of recurrent first‐ and second‐trimester miscarriages. Fetal growth started to slow down from 14 weeks of gestation and no end‐diastolic phase was found in the umbilical artery until 18 weeks of gestation, when the pregnancy was terminated. In apparently healthy women with or without a history of fetal death during the first half of pregnancy, the discovery of placental vascular lesions together with a high resistance to blood flow in the umbilical circulation should prompt early antepartum surveillance. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of amniotic band syndrome in a methadone user: review of the literature and a case report
Authors: Daly C. A. , Freeman J. , Weston W. , Kovar I. , Phelan M.
Published: March 2003

We present a case and review of the literature of an amniotic band causing malformation in the distal forearm in a baby born to a methadone‐dependent mother. This diagnosis was made prenatally at the routine 18–20‐week gestation anomaly ultrasound scan. Histology of the amniotic band postpartum revealed hair shafts within its structure. This has not previously been documented, nor has an association of this syndrome with systematic abuse of methadone. The fact that this anomaly could be detected by prenatal ultrasound scanning is of value in the counselling of high‐risk pregnancies such as this. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Nuchal translucency measurement: training of potential examiners
Authors: Braithwaite J. M. , Kadir R. A. , Pepera T. A. , Morris R. W. , Thompson P. J. , Economides D. L.
Published: March 2003

The aim of this study was to assess a training regimen for nuchal translucency measurement by transabdominal (TAS) and transvaginal sonography (TVS). After initial instruction regarding the criteria for correct nuchal translucency measurement, trainees (A and B) and an experienced examiner (C) performed nuchal translucency measurements on fetuses of 10–13 weeks' gestation, and the trainees' ability to obtain a measurement, repeatability and levels of agreement were assessed. In addition, a further experienced examiner (D) performed nuchal translucency measurements to validate the training regimen.

Examiner C obtained nuchal translucency measurements in 94% by TAS, 93% by TVS and 100% by a combination of both scan modes. The repeatability coefficient was 0.40 mm and 0.24 mm for TAS and TVS, respectively. Trainees A and B were considered trained after 80 and 100 scans with TAS and TVS, respectively. They were considered trained when they could consistently obtain measurements that were of comparable repeatability and comparable levels of agreement with those of examiner C. The trainees' difficulties with TAS were in achieving satisfactory repeatability and levels of agreement, but with TVS it was ability in obtaining a measurement. We propose the training methods, standards and criteria used in this study as the basis for training sonographers in nuchal translucency measurements. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Uterine and umbilical circulation during the oxytocin challenge test
Authors: Olofsson P. , Thuring‐Jönsson A. , Marsál K.
Published: March 2003

Our objective was to study uterine and umbilical artery flow resistance during the oxytocin challenge test (OCT). The study population was 21 women with suspected placental insufficiency; one woman was excluded because of a positive OCT with reactive fetal heart rate pattern. We carried out simultaneous electronic fetal heart rate monitoring and Doppler velocimetry of uterine and umbilical artery flow during the OCT.

The uterine artery flow resistance increased significantly during contractions in both OCT‐positive (n = 5) and OCT‐negative (n = 15) cases compared with basal values, but the increase was significantly higher in positive cases. The umbilical artery flow resistance increased significantly during contractions in OCT‐positive cases, but was almost unchanged in negative cases. During uterine inactivity, there were no differences between the groups for any vessel.

This study showed that fetal heart rate decelerations during the OCT are associated with rapid and exaggerated increases of vascular resistance in both uterine and umbilical arteries. The causal relationship is unknown, but the findings indicate pathophysiological, mechanisms revealed only during uterine contractions. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Doppler velocimetry of the uterine and fetal circulations during prostaglandin E2, cervical ripening
Authors: Rotmensch S. , Liberati M. , Celentano C. , Bellati U. , Tiboni G. M. , Ben‐Rafael Z.
Published: March 2003

The objective of the study was to investigate flow characteristics of the maternal uterine and fetal umbilical and middle cerebral arteries following intracervical administration of prostaglandin E2 (PGE2). Doppler velocimetry of uterine, umbilical and middle cerebral arteries was performed immediately before and 2 h after PGE2 administration in 28 women with uncomplicated post‐term pregnancy and an unfavorable cervix. Placental position was determined in all cases. When all patients were considered jointly, regardless of placental position, the mean uterine artery resistance index (RI) values were 0.41 ± 0.07 before and 0.48 ± 0.13 2 h after PGE2 administration (p < 0.05). When patients with lateral placentas (n = 20) were analyzed separately, only the non‐placental uterine artery showed a significant increase 2 h after PGE2 administration, whereas no significant differences were found in the placental uterine artery. No changes were observed in uterine RI values of patients with central placentas. No significant differences were observed for umbilical artery and middle cerebral artery before and after PGE2 administration. It is concluded that intracervical PGE2 administration increases uteroplacental resistance but probably does not substantially affect placental perfusion; that the umbilical circulation is not affected; and that there were no signs of redistribution of fetal blood flow. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Cardiotocogram compared to Doppler investigation of the fetal circulation in the premature growth‐retarded fetus: longitudinal observations
Authors: Hecher K. , Hackelöer B.‐J.
Published: March 2003

It was our objective to compare computerized fetal heart rate analysis with blood flow velocity waveform analysis of the arterial and venous fetal circulation in intrauterine growth retardation. We report five illustrative cases with longitudinal observations of fetal Doppler findings and fetal heart rate between 23 and 32 weeks of gestation. Blood flow waveforms were recorded from the umbilical artery, middle cerebral artery, descending aorta, ductus venosus and inferior vena cava. Fetal heart rate was analyzed by a computer system according to the Dawes‐Redman criteria.

The time sequence of deterioration is described individually for each fetus. An abrupt increase in pulsatility of ductus venosus waveforms with loss of forward flow velocity during atria1 contraction preceded abnormally low short‐term variation of fetal heart rate. With advanced gestational age and concomitant maternal disease, we observed severe alterations of flow velocity waveforms within 12 h of normal Doppler measurements, which is in contrast to findings in the second trimester, in which severely abnormal venous waveforms were observed over a period of several weeks before intrauterine death occurred. In a fetus with terminally low short‐term variation, normal venous waveforms indicated fetal well‐being despite an abnormal cardiotocogram (CTG).

We challenge the current concept that the CTG is the best available parameter to determhe the optimal time for elective delivery of premature growt b‐retarded fetuses. De‐terioration in ductus venosus blood flow seems to precede an abnormal CTG and thus heralds the need for delivery. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Sonodynamic changes after transcatheter arterial embolization in a vaginal hemangioma: case report
Authors: Emoto M. , Tamura R. , Izumi H. , Sukimoto S. , Kawarabayashi T. , Shirakawa K.
Published: March 2003

A 36‐year‐old pregnant woman with a rapidly growing hemangioma in the vagina was treated by transcatheter arterial embolization after delivery. Blood flow characteristics within the tumor were evaluated using transvaginal color Doppler ultrasound both before and after the embolization. The vascular resistance in the tumor vessels within the vaginal hemangioma was observed to be significantly decreased; the tumor reduced in volume following this non‐surgical treatment. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Amniotic fluid index in twin gestation
Authors: Gerson A. , Free S. M. , Russino J. , Maenner G. , Weitz G. , Young L.
Published: March 2003

This study was performed to describe a methodology for a two‐pocket amniotic fluid index (AFI) for each fetus of a twin gestation. Data included 216 pairs of measurements that were analyzed to yield regressions (curves) for all observations, as well as for the larger and smaller AFI of each observation on a particular set of twins. The twin AFI increased non‐linearly until week 27. From week 27 to week 36, decreasing linear trends were found. Measures of intrasonographer, intersonographer, within‐mother and between‐mothers variation are reported. The estimates of variation were used to plot confidence limits for all three curves. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal intestinal vascular accident with subsequent small bowel atresia: case report
Authors: Kimber C. P. , MacMahon R. A. , Shekleton P. , Yardley R.
Published: March 2003

A woman was referred at 2.5 weeks' gestation with decreased fetal movements. Ultrasound revealed a large solid fetal abdominal mass and gross fetal ascites. Amniocentesis and viral titers were normal. On subsequent ultrasound examinations, the mass and ascites slowly disappeared, but a small bowel obstruction developed.

Spontaneous labor occurred at 3.5 weeks and the child was born with a distended abdomen. At laparotomy there was type 3 jejunal atresia, indicating that the fetal mass and ascites were secondary to this antenatal small bowel iscbemia. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Quantitative assessment of gray‐level perception: observers' accuracy is dependent on density differences
Authors: Smith‐Levitin M. , Blickstein I. , Albrecht‐Shach A. A. , Goldman R. D. , Gurewitsch E. , Streltzoff J. , Chervenak F. A.
Published: March 2003

Sonographic image density represents tissue echogenicity, or the acoustic nature of scanned tissue. It has the potential to distinguish normal from abnormal tissue. Humans are poor assessors of tissue echogenicity, yet their abilities have not been quantitatively compared to more objective methods. We compared the accuracy of image density differentiation by the human eye and by densitometry in the fetal liver model.

A group of 60 observers was asked to compare the echogenicity of three pairs of images of a fetal liver. Twenty‐three repeated the comparison several weeks later. Image density was measured by electro optical densitometry. The two‐tailed signed rank test was used to compare the observer's perceptions with the density values and the repeated observations with the original responses.

The density of each fetal liver image in pair A was the same. Image B1 had a 12.3% lower density than image B2, and image C1 had a 6.3% greater density than image C2. Observers were accurate more often when comparing images with large density differences (pair B) than they were when comparing images with the same density (pair A) or with small density differences (pair C). Accuracy was not related to being medically qualified or from an obstetric or gynecological department. Intraobserver variation was not significant.

We conclude that the human eye is extremely inaccurate at discerning differences in echogenicity when images have small or no differences in optical density. Densitometry is, therefore, indispensable for accurate image density assessment. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of neural tube defect before 12 weeks' gestation: direct and indirect ultrasonographic semeiology
Authors: Bernard J. P. , Suarez B. , Rambaud C. , Muller F. , Ville Y.
Published: March 2003

We describe the direct and indirect ultrasonographic features of a case of lumbar open spina bifida. The spinal defect was the prominent feature at 10 weeks + 5 days' gestation; however, cranial signs including narrowing of the frontal bones and flattening of the occiput were helpful at 12 weeks. This ‘acorn’ sign is likely to precede the ‘lemon’ sign, describing scalloping of the frontal bones at a later gestation. The diagnosis of spina bifida was confirmed by electrophoresis of the amniotic fluid, which showed an abnormal migration of acetylcholinesterase. Postmortem ultrasound examination of the same fetus proved useful in refining the diagnosis and also revealed the presence of the Arnold‐Chiari malformation. Development of ultrasound screening in the first trimester of pregnancy should allow further evaluation of these findings. It seems reasonable to confirm such an early diagnosis by electrophoresis of the amniotic fluid as an alternative to ultrasonographic confirmation at 13–14 weeks. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Two‐dimensional echocardiographic evaluation of ventricular systolic function in human fetuses with ductal constriction
Authors: Harada K , Rice M J , Shiota T , McDonald R W , Reller M D , Sahn D J
Published: March 2003

This paper was originally published in Ultrasound Obstet Gynecol 1997; 10:247–53. Figure 1 on p.248 was mislabelled in respect to the right and left ventricles. The correct figure is given. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Ductus venosus agenesis prevents transmission of central venous pulsations to the umbilical vein in fetal sheep
Authors: Kiserud T. , Crowe C. , Hanson M.
Published: March 2003

Velocity pulsations in the umbilical vein are widely used as a marker for congestive heart failure in the fetus. It has been suggested that the atrial pressure waves are transmitted to the umbilical vein mainly through the ductus venosus. In a case of ductus venosus agenesis in a fetal sheep of 110 days' gestation, we recorded pressures in the inferior vena cava and umbilical vein simultaneously with Doppler velocimetry in the medial hepatic vein and umbilical vein, under general anesthesia. During fetal respiratory acidosis (pH 7.01) and varying degrees of umbilical clamping, we did not observe the typical pulsations in the umbilical vein (deflections of the maximum velocity during atrial contraction) in spite of varying degrees of reversed flow in the hepatic vein (5–16%). The systolic‐diastolic pressure amplitude in the inferior vena cava was 5.5–6.4 mmHg, sometimes reaching 9.19–11.03 mmHg. Varying degrees of reversed portocaval pressure gradient during atrial contraction (1.40–9.51 mmHg), periods of reversed portocaval pressure gradient throughout the entire cardiac cycle, tachycardia (240 beats/min) or bradycardia (99 beats/min) also did not produce the type of pulsation in the umbilical vein that reflects augmented atrial contractions. The results support the hypothesis that the ductus venosus is essential for the transmission of atrial pressure waves to the umbilical vein. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Image magnification does not contribute to the repeatability of caliper placement in measuring nuchal translucency thickness
Authors: Herman A. , Maymon R. , Dreazen E. , Caspi E. , Bukovsky I. , Weinraub Z.
Published: March 2003

The objective of this study was to assess whether nuchal translucency image magnification contributes to the repeat‐ability of caliper placement. Twenty‐seven women undergoing first‐trimester ultrasound screening at 11–14 weeks were examined by two qualified examiners. Fetal nuchal translucency thickness was measured twice by each examiner on a regular‐sized image and subsequently on the same still image magnified. Intraobserver repeatability coefficients of the regular‐sized images were 0.28 mm and 0.34 mm for examiners A and B, respectively. Identical intraobserver repeatability coefficients of 0.28 mm were attained for both examiners on the magnified images. Interobserver repeatability of regular‐sized image measurements showed a significant difference (p < 0.01) but the mean difference (± standard deviation) of 0.10 (0.18) mm was negligible. Similarly, interobserver repeatability of the magnified‐ image measurements yielded a significant difference (p < 0.02), but again with a small mean difference of 0.13 (0.26) mm. There were also significant differences when regular‐sized images and magnified images were compared for both examiners: 0.08 (0.16) mm for examiner A (p < 0.02) and 0.10 (0.17) mm for examiner B (p < 0.01). Our results demonstrate that nuchal translucency image magnification does not contribute to the reproducibility of the measurement. Despite significantly smaller mean values obtained from the magnified images, compared to the regular‐sized measurements, those differences do not justify modification of the criteria for caliper placement on magnified images. Blind repeated measurements on a regular‐sized and/or magnified image are recommended as a tool for self‐assessment, quality control and training. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonographic measurement of crown‐rump length in high‐order multifetal pregnancies
Authors: Saade G. R. , Gray G. , Belfort M. A. , Carpenter R. J. , Moise K. J.
Published: March 2003

The objective of the study was to evaluate the crown‐rump length (CRL) in high‐order multifetal pregnancies (three or more fetuses). The records of patients who underwent multifetal pregnancy reduction were reviewed. The following parameters were defined: the mean CRL (CRLMEAN) and the difference between the largest and smallest CRL (CRLRANGE) for each pregnancy. CRLMEAN was plotted versus gestational age (GA) and the line of best fit was derived. The residual for each CRL (CRLRES) was calculated by subtracting the value predicted by the regression line from the individual CRL (CRLIND). Regression lines for single‐tons with confirmed GA from four previously reported studies were used for comparison. A total of 82 patients were included (29 triplets, 38 quadruplets and 15 quintuplets; mean GA 10.7 ± 0.78 weeks). CRLMEAN correlated with GA (CRLMEAN = 38.88 ± 8.78(GA) + 0.82(GA)2; R = 0.83; R2 = 0.70). This second‐degree polynomial remained within the range for singletons. No significant differences in maternal age, GA and CRLMEAN were noted between the patients with different numbers of fetuses. The median CRLRANGE was largest in quintuplets, followed by quadruplets and triplets. The CRLRANGE correlated poorly with GA. The mean CRL in multifetal pregnancies increases with GA similarly to that in singletons. The variability of individual measurements increases with the number of fetuses and CRLs are lower in quintuplets. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology