bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Service User Cognitive Level on Carer Attributions for Aggressive Behaviour
Authors: Tynan Hannah , Allen David
Published: March 2003

Background  This study was designed to test the hypothesis that carer attributions for aggressive behaviour vary according to a service user's severity of intellectual disability.

Methods  Forty‐two residential care staff participated in an investigation examining the effects of the level of a service user's intellectual disability on causal attributions for their aggressive behaviour. Equal numbers of participants were assigned to either a ‘mild disability’ or a ‘severe disability’ condition and required to read a vignette depicting a service user with aggressive challenging behaviour. The service user's cognitive abilities were experimentally manipulated across conditions, whilst the behaviour described remained unchanged. Participants were required to make attributions along Weiner's (1980) dimensions of locus, stability and controllability, and in accordance with five prominent models of challenging behaviour (Hastings 1997b).

Results  The service user depicted in the mild disabilities condition was perceived to have significantly greater control over factors causing the aggressive behaviour than the service user in the severe disabilities condition. Participants in the severe disabilities condition considered the aggression to be significantly more challenging. Learned behaviour and emotional causal models of aggressive behaviour were favoured, whilst the physical environment account was seen as least appropriate. Additionally, the biomedical model was rated as significantly more applicable in the severe disability condition than in the mild disability condition.

Conclusions  Implications for staff and service users are discussed. In particular, the relationship between staff causal attributions for challenging behaviour, their emotional responses and willingness to engage in helping behaviour is explored.
Effects of maternal hyperoxygenation on ductus venosus flow velocity waveforms in normal third‐trimester fetuses
Authors: Soregaroli M. , Rizzo G. , Danti L. , Arduini D. , Romanini C.
Published: March 2003

On the basis of the data obtained in sheep fetuses showing a high interdependence between umbilical vein oxygenation and ductus venosus flow, we investigated the effect of maternal hyperoxygenation on ductus venosus velocity waveforms in normal third‐trimester human fetuses. Ductus venosus velocity waveforms were recorded by using color and pulsed Doppler ultrasonography before and after 15 min of maternal administration of humidified 60% oxygen. During maternal hyperoxygenation, there was a significant increase of both estimated peak velocities during systole, diastole and atrial contraction and the mean temporal velocity during the total cardiac cycle and systolic and diastolic portions. On the other hand, during maternal hyperoxygenation, no significant changes were found in fetal heart rate or in the ratios between peak velocities and mean temporal velocities during systole and diastole. These findings suggest a close relationship between fetal oxygenation and ductus venosus velocity waveforms that may be useful in monitoring fetal hypoxemia. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Fetal hydrometrocolpos
Authors: Saxena R. , Divan G. , Long A. M. , Arulambalam K. J. , Nicolaides K. H.
Published: March 2003

This report describes a case of hydrometrocolpos presenting antenatally as a cystic mass arising from the pelvis of a female fetus. The baby was born at 33 weeks and died within an hour due to pulmonary hypoplasia. Postmortem examination demonstrated hydrometrocolpos, dense adhesions in the abdomen and pulmonary hypoplasia. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Relapse of maternal thyrotoxicosis presenting as a second‐trimester fetal goiter
Authors: Vali A. , Wiles P. , Thomas N. B. , Ludlam A.
Published: March 2003

A large fetal goiter was detected at 22 weeks of gestation during an antenatal ultrasound scan of a woman with a previous history of Graves' disease treated by partial thyroidectomy. This unsuspected finding initiated maternal investigations and treatment. In untreated cases poor fetal outcome is common and unfortunately fetal thyrotoxicosis/thyroid enlargement frequently remains unrecognized in the first pregnancy. We report the case and its management and discuss the literature emphasizing the importance of screening for antibodies in the ‘at‐risk’ women and the increasing importance of ultrasound in the evaluation and follow‐up of these patients.

Reports of thyrotoxic fetal goiters are extremely rare and, to our knowledge, there have been no previous reports of this in the second trimester. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Incorporating the four‐chamber view of the fetal heart into the second‐trimester routine fetal examination
Authors: Tegnander E. , Eik‐Nes S. H. , Linker D. T.
Published: March 2003

The four‐chamber view of the fetal heart is reported to he the most useful view for detecting congenital heart defects. In 7322 non‐selected, consecutive pregnancies of women attending a second‐trimester (18 weeks) routine ultrasound scanning program, we examined our ability to obtain a four‐chamber view in the fetus within the 30 min generally allocated to do the scan and record data. Five trained nurse‐midwives performed the examinations between June 1988 and September 1990. In the first part of the study, a four‐chamber view could not be obtained in 7%, while in the second part, the failure rate was 4%, which showed a learning effect over time. The demonstration of a four‐chamber view was significantly better with a 5 MHz than with a 3.5 MHz transducer. The ability to obtain the four‐chamber view improved as the gestational age increased. The main reason for not being able to obtain the four‐chamber view with the 3.5 MHz transducer was poor imaging; for the 5 MHz transducer, it was an unfavorable position of the fetus. Education and experience, as well as good equipment, are important factors in obtaining good results. The time spent learning to obtain a four‐chamber view reliably was relatively long. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Transabdominal versus transvaginal ultrasound in the diagnosis of polycystic ovaries in a population of randomly selected women
Authors: Farquhar C. M. , Birdsall M. , Manning P. , Mitchell J. M.
Published: March 2003

A study was conducted which compared transvaginal and transabdominal ultrasound in determining the prevalence of polycystic ovaries in a population of women. Women, chosen randomly from electoral rolls, were sent a letter inviting them to take part in a study determining the presence of polycystic ovaries. A transvaginal and transabdominal ultrasound scan was performed on day 5–9 of their menstrual cycles. A total of 187 women (mean age 33 years) took part in the study. The prevalence of polycystic ovaries was 21% (40/187) by transabdominal ultrasound and 27% (36/134) by transvaginal ultrasound. No differences existed between women with polycystic and normal ovaries with respect to uterine size and endometrial thickness. Mean ovarian volume was larger in women with polycystic ovaries irrespective of the use of hormonal contraception or breast feeding. There was no difference in the prevalence of polycystic ovaries diagnosed by transabdominal or transvaginal ultrasound in the group of randomly selected women. However, almost 20% of the women declined a transvaginal ultrasound examination. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
The characterization of flow signals from tubal and ovarian arteries using intraoperative continuous wave Doppler
Authors: Aleem F. , Zeitoun K. , Calame R. , Trinca D. , Zalud I. , Schulman H.
Published: March 2003

Ovarian vascular Doppler is a promising screening test for early ovarian cancer detection. However, disagreements on flow indices used, flow signal shapes and ovarian vessel localization cause continuing controversy. We aimed at clarifying some of this confusion by directly measuring the adnexal arterial blood flow during laparotomy. A 10‐MHz continuous Doppler probe was used to examine adnexal vessels in 24 patients undergoing laparotomy for benign gynecological pathology. Resistance (RI) and pulsatility (PI) indices were calculated for each vessel and the shape of the flow signals was noted. The tubal arteries showed a low‐velocity flow pattern with relatively high end‐diastolic flow when compared to the ovarian artery signals obtained from the infundibulopelvic ligament.

The mean RIs for the tubal artery and ovarian artery in the infundibulopelvic ligament were 0.59 ± 0.02 and 0.73 ± 0.02, respectively. The mean PIs for the tubal and ovarian artery in the infundibulopelvic ligament were 1.11 ± 0.09 and 1.53 ± 0.1, respectively. The tubal artery showed a significantly lower RI and PI when compared to the ipsilateral ovarian artery at the infundibulopelvic ligament (p < 0.001 and p = 0.002, respectively) and its hilar branches (p = 0.03 for RI and p = 0.03 for PI). We conclude that tubal artery flow signals, which are measured directly for the first time in this study, are characteristic and are distinct from the ovarian artery signals. Tubal artery signals might be erroneously picked up during transvaginal color Doppler sonography of the ovaries, especially in the presence of conditions causing a decreased impedance to blood flow in the pelvis, such as ovarian tumors. Recognizing the flow signal from the tubal artery may help in differentiating ovarian and tubal vessels detected during color Doppler sonography.
Quantitative flow measurements for classification of ovarian tumors by transvaginal color Doppler sonography in postmenopausal patients
Authors: Prömpeler H. J. , Madjar H. , Sauerbrei W. , Lattermann U. , Pfleiderer A.
Published: March 2003

Color Doppler and Duplex measurements were obtained in 83 (42 benign, 41 malignant) ovarian tumors in postmenopausal patients. An ATL UM9/HDI was used. The following flow criteria were analyzed: lowest resistance index (RI) and pulsatility index (PI), total number of arteries and number of central arteries and the maximum, mean and sum of systolic, end‐diastolic and time‐averaged maximum velocities of all intratumoral vessels. In 98% of malignant and in 85% of benign lesions, vessels were detected. All flow criteria showed highly significant differences between benign and malignant tumors (p < 0.0001). However, there was a considerable overlap between benign and malignant tumors (e.g. the median of the lowest RI was 0.62 (range 0.26–1.0) for benign and 0.40 (0.22–0.66) for malignant tumors; the median of the maximum systolic velocity was 17.5 cm/s (range 5.2–61.5 cm/s) for benign and 47.05 cm/s (14.6–105.0 cm/s) for malignant tumors).

Differentiation of malignant tumors by the lowest RI and PI, number of arteries and maximum of systolic flow velocities gave a sensitivity of 77–85%, specificity of 77–83% and accuracy of 80–84%. Differentiation was superior by calculation of the maximum end‐diastolic velocities and by the summation of the systolic, end‐diastolic and time‐averaged maximum flow velocities: sensitivity 90–9.5% specificity 83–86% and accuracy 87–91%. This study confirms that a single measurement is not sufficient for an accurate differentiation of ovarian lesions and, besides the measurement of minimum RI and PI, the measurements of flow velocities as Doppler criteria play an important role. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonic demonstration of local myometrial thickening in early intrauterine pregnancy
Authors: Tadmor O. P. , Rabinowitz R. , Diamant Y. Z.
Published: March 2003

In a group of women in the first and early second trimesters of pregnancy, local thickening of a limited region of the myometrium was observed ultrasonically. This prospective study aimed to evaluate the incidence and nature of this phenomenon. Local myometrial thickening was observed in 72 women out of 5521 examined (1.3%). Twenty‐two were given ritodrine hydrochloride 10 mg by mouth, and 46 were monitored for up to 60 min without treatment. The local myometrial thickening in the ritodrine hydrochloride‐treated group disappeared in 21 out of 22 women (95.5%) compared with the observed group, where the phenomenon disappeared in only 37 women (80.4%). Local myometrial thickenings probably represent transient uterine contractions; they tend to appear early in pregnancy, are prolonged, and may respond to ritodrine hydrochloride. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
The role of color Doppler in diagnosis of endometriomas
Authors: Aleem F. , Pennisi J. , Zeitoun K. , Predanic M.
Published: March 2003

The aim of this study was to characterize the appearance of the .vascular pattern of endometriomas in terms of color Doppler and to verify the role of Doppler flow indices in differentiating endometriomas from other pelvic masses. Twenty patients with suspected endometriosis were referred for evaluation and surgical management of adnexal masses and/or infertility problems. Before surgery, transvaginal sonography was performed using an Ultramark 9 (ATL) Ultrasound system. The color Doppler was used for evaluation of the vascular color distribution. Flow parameters (resistance index (RI) and pulsatility index (PI)) were obtained using pulsed Doppler. A total of 24 masses were identified in the 20 patients studied. Sixteen masses proved to be endometriomas, with a mean size of 3.5 ± 0.4 cm. Of confirmed endometriomas, 81% had a regular internal surface and 63% showed the characteristic homogeneous low‐level echoes filling the cyst. Eleven of 16 (69%) endometriomas showed flow by color Doppler. The flow was characteristically limited, with few spots of vascular color seen in each mass. Cases that showed dense vascularity with color Doppler proved not to be endometriomas. The mean ± SE of the RI and PI for the endometriomas were 0.59 ± 0.02 and 0.95 ± 0.1, respectively. All endometriomas showed an RI of > 0.5 with a range of 0.5–0.74, while the PI was 0.59–1.95. No significant differences between flow indices for endometriomas and other benign cystic lesions were noted. Scattered vascularity, one feature of adnexal endometriomas, may help to differentiate them from other lesions of dense vascular distribution, such as corpora lutea or ovarian neoplasms. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal diagnosis and management of meconium peritonitis: a case report and review of the literature
Authors: Konje J. C. , de Chazal R. , MacFadyen U. , Taylor D. J.
Published: March 2003

We present a case of meconium peritonitis which was associated with a short bowel and complicated by progressive bowel distension and difficulty in making a definitive diagnosis of cystic fibrosis. Treatment was by bowel resection and an ileostomy (and later bowel anastomosis), followed by parenteral nutrition which was complicated by hepatitis. The literature is reviewed and management dilemmas and options are discussed. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of cerebral arteriovenous malformation using color Doppler ultrasonography: case report and review of the literature
Authors: Sepulveda W. , Platt C. C. , Fisk N. M.
Published: March 2003

Aneurysms of the vein of Galen are rare, representing less than 1% of all intracranial arteriovenous malformations. In the fetus, however, almost all cerebral arterial malformations involve the vein of Galen, usually presenting in the neonatal period with severe cardiac failure leading to neonatal death. In this report we present a case of arteriovenous malformation involving the vein of Galen detected prenatally at 3.5 weeks with the use of color Doppler ultrasonogvaphy. The literature is reviewed in an attempt to delineate the vole of prenatal ultrasonography in the diagnosis and its impact on perinatal outcome. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
A ‘potentially safer’ route for puncture and injection of cornual ectopic pregnancies
Authors: Timor‐Tritsch I. E. , Monteagudo A. , Lerner J. P.
Published: March 2003

Puncture and injection (usually by methotrexate) of ectopic pregnancies are relatively new modalities of treatment. Lately, these have been applied to cornual ectopic pregnancies. We describe here a proposed transvaginal ultrasound‐guided puncture route, leading the needle into the cornual ectopic pregnancy, first traversing the myometrium and approaching the gestational sac from the medial aspect. After extracting the needle, there is potentially less chance for rupture and bleeding. In six of the seven injected cornual pregnancies, this technique was used without complication. The only one punctured from the lateral aspect bled and required laparoscopic intervention. This technique may enable the wider use of this treatment modality by lowering the complication rate caused by bleeding at the puncture site. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Autosomal dominant cataracts of the fetus: early detection by transvaginal ultrasound
Authors: Monteagudo A. , Timor‐Tritsch I. E. , Friedman A. H. , Santos R.
Published: March 2003

Cataracts are lens opacities that account for approximately 10% of blindness in children. We report on four consecutive pregnancies in a woman at risk for recurrent autosomal dominant cataracts in which extensive ultrasound studies were helpful in establishing the correct diagnosis. The normal appearance of the fetal lens is that of a ring with a central sonolucency, but in cases of cataracts the lens appears hyperechogenic to various degrees. In the first pregnancy, normal lenses were seen at 15 postmenstrual weeks and, at birth, the baby girl had normal lenses. In the second pregnancy, the male fetus was affected by a left‐sided cataract and a right‐sided anophthalmia which were diagnosed at 16 postmenstrual weeks. The histological examination of the specimen from the aborted fetus correlated with the sonographic diagnosis. The third pregnancy, also a male fetus, had bilateral cataracts suspected at 14 weeks, but the final diagnosis was made at 19 weeks and confirmed at 21 weeks. The couple opted to terminate the pregnancy and the histology confirmed the presence of congenital cataracts. In the fourth pregnancy, we diagnosed asymmetry of the orbital sizes and bilateral cataracts at 15 weeks. In conclusion, the diagnosis of fetal cataract from the second trimester of pregnancy is possible and imaging of the fetal lenses should be part of the routine anatomical survey. Since the exact onset of fetal cataracts is uncertain at present, in cases at risk, serial sonograms may be indicated. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
The effect of maternal prostaglandin administration on fetal ductus venosus blood flow velocity
Authors: Degani S. , Lewinsky R. M. , Gonen R.
Published: March 2003

Our objective was to investigate whether maternal administration of prostaglandins PGE2 and PGF2α, is associated with changes in fetal ductus venosus flow velocity waveforms. Second‐trimester termination of pregnancy was induced in 11 women (group A) by intra‐amniotic instillation of 40 mg PGF2α. In group B, 19 patients received 0.5 mg PGE2 intracervically for preinduction cervical ripening. Doppler flow velocity waveforms were recorded from the fetal ductus venosus immediately before and 40–60 min after prostaglandin administration. The paired t‐test was used for statistical analysis of the ductus venosus index (DVI).

The mean DVI decreased after PGF2α, administration from 0.62 ± 0.12 to 0.52 ± 0.13 (p < 0.01); and from 0.62 ± 0.10 to 0.58 ± 0.12 (p < 0.05) after PGE2 administration. Atrial peak velocities were significantly increased after the procedures. No significant changes were found for systolic peak velocity values.

The data indicate that major changes in ductus venosus hemodynamics are induced by PGF2α and PGE2. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Development of a hypoplastic uterus in a patient with testicular feminization syndrome 21 years after gonadectomy
Authors: Chryssikopoulos A. , Antoniou A. , Loghis C.
Published: March 2003

We describe a case of a hypoplastic uterus, identified by transrectal ultrasonography and magnetic resonance imaging, which developed 21 years after gonadectomy for testicular feminization syndrome.

Its likely origin was Müllerian‐fusion remnant resulting from a deficiency in functional Müllerian inhibiting substance (MIS) and/or desensitization of the Müllerian tract to MIS., caused by diethylstilbestrol administration to the patient's mother during the sensitive period of the 6th and 9th gestational weeks of her pregnancy. This Müllerian‐fusion remnant remained latent, due to insufficient estrogen stimulation both endogenously (until gonadectomy)and exogenously during hormone replacement therapy. Initial growth was possibly induced in response to high doses of estrogen that the patient received over the last 3 years for the treatment of osteoporosis. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
The use of second‐trimester transvaginal sonography to predict placenta previa
Authors: Lauria M. R. , Smith R. S. , Treadwell M. C. , Comstock C. H. , Kirk J. S. , Lee W. , Bottoms S. F.
Published: March 2003

Our objective was to determine the incidence and rate of persistence of placenta previa diagnosed at 15–20 weeks' gestation by using transvaginal sonography (TVS), and to describe the characteristics of TVS that predict placenta previa at delivery.

Patients having placental tissue within 20 mm of the cervical os were prospectively identified by transabdominal ultrasound and underwent TVS. The distance of the placental edge from the cervical os was measured in millimeters. Characteristics of TVS predicting placenta previa at delivery were analyzed by logistic regression.

The incidence of placenta previa diagnosed by TVS at 15–20 weeks was 1.1 %; 14% persisted until delivery. Gestational age at the time of TVS and the distance of the placental edge to the cervical os helped predict placenta previa at delivery. Between 15 and 24 weeks' gestation, placenta overlapping the internal os by ≥ 10 mm identified patients at risk of placenta previa at delivery with 100% sensitivity and 85% specificity.

The use of TVS in the second trimester to diagnose placenta previa resulted in a lower incidence than was historically reported with the use of transabdominal ultrasound. The distance of the placental edge from the cervical os helps identify patients at risk of previa at delivery. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Indices of differential endometrial : myometrial growth may be used to improve the reliability of detecting endometrial neoplasia in women on tamoxifen
Authors: Pepper J. M. , Oyesanya O. A. , Dewart P. J. , Howell A. , Seif M. W.
Published: March 2003

The aim of this study was to test the hypothesis that the use of indices of differential endometrial : myometrial growth may be a non‐invasive method of improving the reliability of detecting endometrial neoplasia in women on tamoxifen.

Thirty postmenopausal women were involved in this prospective study. Nineteen had been treated with tamoxifen for 2 years or more, and eleven were age‐ and ponderal index‐matched controls who had never been exposed to tamoxifen and who were non‐smokers.

Transvaginal ultrasonography and color Doppler imaging were performed, to measure the length, anteroposterior diameter, uterine sagittal area, endometrial thickness and uterine blood flow (using the pulsatility index and the resistance index as measures of uterine blood flow impedance). The anteroposterior diameter : endometrial thickness ratio and product, and the saggital area : endometrial thickness ratio and product were used as indices of differential endometrial : myometrial growth. The predictive values (sensitivity, specificity, positive and negative predictive values) of each index were calculated using established criteria. For the purpose of analysis the women were allocated to three groups: controls (group I); women on tamoxifen without endometrial neoplasia (group 2) and women on tamoxifen who developed endometrial neoplasia (group 3). The mean age was similar in the three groups as was the duration of tamoxifen treatment in groups 2 and 3.

Analysis of the decision matrix based on increased endometrial thickness (> 5 mm) alone revealed good sensitivity (100%) and negative predictive value (100%) but poor specificity (46.l5%) and positive predictive value (26.32%). However, when the indices of differential endometrial : myometrial growth were taken into consideration, the sensitivities and negative predictive values were similar but the specificities and positive predictive values were significantly improved, indicating an improvement in the reliability of predicting the development of endometrial neoplasia. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Fetal liver length in twin–twin transfusion syndrome
Authors: Roberts A. B. , Mitchell J. M.
Published: March 2003

Fetal liver length was measured by ultrasound in 14 pregnancies with twin–twin transfusion syndrome. The liver size was increased above normal values in both the donor (small) and recipient (large) twin. The liver length was significantly greater than in a control group of dichorionic twin pregnancies with discordant growth. Measurement of liver length may be useful in diagnosing twin‐twin transfusion syndrome. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Acceptability by patients of transvaginal sonography in the elective assessment of the first‐trimester fetus
Authors: Braithwaite J. M. , Economides D. L.
Published: March 2003

The acceptability of transvaginal sonography (TVS) for visualization of first‐trimester fetal anatomy was investigated in 160 women sequentially attending a routine dating scan clinic at 12–13 weeks' gestation. All women under went transabdominal sonography (TAS) in the first instance to assess gestational age. Of these women, 88.1% agreed to undergo TVS. The main reasons for declining were fear of miscarriage (42.1%) and discomfort (36.8%). With TVS, 51.8% described no discomfort, 47.5% mild and 0.7% marked discomfort. Of the women who under went TVS, 9.5% said that they would have no concerns about a further TVS in another pregnancy. Of those women who had previously had TVS (1l.9%), all agreed to have TVS in this pregnancy and experienced significantly less concern about the procedure than did those who had never had TVS before. TAS was associated with discomfort and inconvenience only if women tried to fill their bladder prior to the scan.

In conclusion, TVS is acceptable and well tolerated by an unselected pregnant population. Acceptability rates for TVS should improve as its use becomes more widespread. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Doppler assessment of tracheal and nasal fluid flow during fetal breathing movements: preliminary observations
Authors: Kalache K. D. , Chaoui R. , Bollmann R.
Published: March 2003

Our aim was to determine if it was technically possible to assess fetal tracheal fluid flow during fetal breathing movements, and to compare the data obtained with those recorded in the fetal nasopharynx. Tracheal and nasal fluid flow was analyzed in ten uncomplicated pregnancies, the gestational age ranging between 28 and 38 weeks. Color Doppler was used to detect the fluid displacement in the trachea generated by fetal breathing movements. Spectral Doppler was then used to analyze the fluid flow velocity waveforms. During the same breathing episode, nasal fluid flow was assessed by the same technique. The inspiration and expiration times were variable and not statistically comparable for both nasal and tracheal flow. Peak velocities of inspired and expired fluid were higher in the trachea than in the nose (p < 0.05). We found that the peak velocity of tracheal flow waveforms was significantly higher for inspiration than expiration (p < 0.05). No significant differences were found in the time velocity integral between inspiration and expiration (p = 0.79). The calculated intratracheal flow volume displaced during one breathing cycle increased from 1.3 to 5.0 ml with advancing gestation. Assessment of nasal and tracheal flow, using color and spectral Doppler, is feasible in the human fetus. Intratracheal flow measurements may provide an insight into the effect of fetal breathing movements on lung fluid in the human fetus. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Reference resistance indices of the umbilical, fetal middle cerebral and uterine arteries at 24–42 weeks of gestation
Authors: Kurmanavicius J. , Florio I. , Wisser J. , Hebisch G. , Zimmermann R. , Müller R. , Huch R. , Huch A.
Published: March 2003

The objective of this cross‐sectional study was to construct new reference ranges for Doppler flow velocity waveform resistance indices for the fetal umbilical artery, middle cerebral artery, placental and non‐placental uterine arteries and the placentocerebral ratio in a large and minimally selected population attending a single clinic. Study design and data analysis adhered to a number of stringent and validated methodological recommendations derived both from the recent literature and from a review of earlier publications in this field. The final database comprised initial routine Doppler velocimetry at 24–42 weeks' gestation in 1675 pregnancies. Separate regression models were fitted to estimate the mean and standard deviation at each gestational age for each vessel. New charts, centile tables and regression equations are presented for the resistance indices of the fetal umbilical artery, middle cerebral artery, placental and non‐placental uterine arteries and the mean of both uterine arteries and for the placentocerebral ratio. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Transient increase in nuchal translucency thickness and reversed end‐diastolic ducks venosus flow in a fetus with trisomy 18
Authors: Huisman T. W. A. , Bilardo C. M.
Published: March 2003

In a twin pregnancy discordant for trisomy 18, the affected fetus at 13 weeks' gestation had an increased nuchal translucency thickness and reversed end‐diastolic ductus venosus flow. At 20 weeks' gestation there was no nuchal edema and Doppler study of the central venous vessels demonstrated normal waveforms. The findings support the hypothesis that one of the mechanisms in the development of increased nuchal translucency is temporary cardiac strain. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
The value of transvaginal ultrasonographic examination of the uterine cervix in predicting preterm delivery in patients with preterm premature rupture of membranes
Authors: Rizzo G. , Capponi A. , Angelini E. , Vlachopoulou A. , Grassi C. , Romanini C.
Published: March 2003

The objective of this study was to compare the value of ultrasonographic assessment of the uterine cervix and amniotic fluid tests in the prediction of the interval from admission to delivery in patients with preterm premature rupture of membranes.

Ninety‐two patients admitted to the hospital for preterm premature rupture of membranes between 24 and 32 weeks of gestation underwent both transabdominal amniocentesis and transvaginal ultrasonographic evaluation of the uterine cervix. Amniotic fluid analyses included cultures for aerobic and anaerobic bacteria, mycoplasmas and ureaplasmas, white blood cell count and glucose and interleukin‐6 determinations. The ultrasonographic variables evaluated were cervical length, presence of funneling and cervical index ((funnel length + 1)/cervical length). The outcome measure was the interval from admission to delivery.

The median interval from admission to delivery was 4.5 days (range 0–36). An abnormal uterine cervix was associated with a short time interval (cervical length ≤ 20 mm, median 2 days, range 0–14 vs. median 6 days, range 0–36; p ≤ 0.0001; presence of funneling, median 3 days, range 1–31 vs. median 8 days, range 0–36; p ≤ 0.001; cervical index > 0.50, median 2 days, range 0–7 vs. median 8 days, range 1–36; p ≤ 0.0001). However, interleukin‐6 concentration in the amniotic fluid was the best predictor of the interval from admission to delivery when compared to the ultrasonographic indices and to all the amniotic variables considered. Moreover, when a multiple model was applied, the cervical index significantly and independently improved the performance of interleukin‐6 in the prediction of the interval from admission to delivery.

These data suggest that the combined use of the amniotic fluid interleukin‐6 assay and the cervical index in patients with preterm premature rupture of membranes provides a good prediction of the interval from admission to delivery, thus identifying a subgroup of patients at high risk of imminent delivery. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The impact of fetal, maternal and external factors on prediction of the day of delivery by the use of ultrasound
Authors: Tunón K. , Eik‐Nes S. H. , Grøttum P.
Published: March 2003

In a non‐selected population comprising 15 241 women, an evaluation was performed of the impact of fetal, maternal and external factors on the ultrasonic measurement of the biparietal diameter (BPD) and the day of delivery. The 7824 women who constituted the study population had singleton pregnancies and reliable menstrual histories, and they delivered spontaneously after 37 weeks. Multiple linear regression analysis was used. There was a difference in the size of the BPD at the ultrasound scan related to the gender, parity, maternal age, gestational age according to the last menstrual period and the experience of the operators. There was a total difference of ± 1 day in the day of delivery as determined by ultrasound and the factors above. The effect on the day of delivery is explained by the differences in the BPD. An effect of gender on gestational length was present as well, which partly compensated for the difference in the BPD. In conclusion the accuracy of prediction of the day of delivery by ultrasound is influenced by the gender, parity, maternal age and the experience of the operator, but these differences are small and of no clinical importance. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
How repeat measurements affect the mean diameter of the umbilical vein and the ductus venosus
Authors: Kiserud T. , Rasmussen S.
Published: March 2003

Blood flow measurement in the fetus is susceptible to substantial error. Increased numbers of measurements can improve the precision. To quantify this, we assessed how the number of ultrasound measurements affected the calculation of individual mean diameters of fetal veins. A study of the umbilical vein (UV) and ductus venosus (DV) was carried out in 167 pregnancies in a clinical setting. The UV diameter was measured 2–13 times in 163 participants and the DV for the same number of times in 158. A one‐way analysis of variance gave mean within‐subject SD of 0.23 mm for the UV (diameter 2.0–8.0 mm) and 0.17 mm for the DV (diameter 0.3–2.3 mm). The 95% limit for the within‐subject mean diameter calculated from two, four, six and ten measurements of the UV were 0.31, 0.22, 0.18 and 0.14 mm, respectively. For the DV the corresponding results were 0.23, 0.16, 0.13 and 0.10 mm. The study shows how increasing the number of measurements to calculate a mean diameter substantially improves the precision of vascular cross‐section assessment. The limitation of the method is expressed in the exponential increase in numbers needed to achieve further improvement. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Influence of ethnic origin on nuchal translucency screening for Down's syndrome
Authors: Thilaganathan B. , Khare M. , Williams B. , Wathen N. C.
Published: March 2003

Objective

To determine the influence of ethnic origin on access to and equity of nuchal translucency screening for Down's syndrome in a multiethnic population.

Design

An observational study in a district general hospital with a large multiethnic population.

Subjects

1944 women attending at a hospital antenatal clinic.

Main outcome measures First‐trimester fetal nuchal translucency measurements at 10–14 weeks in women from different ethnic groups.

Results

The racial origin of the screened population was not significantly different from that of the population attending for initial antenatal examination. Multiple regression analysis showed a small but significant difference in nuchal translucency measurement between fetuses of different ethnic origin.

Conclusion

Nuchal translucency screening can be effectively and equitably delivered to a multiethnic population. Although there are significant differences in nuchal translucency measurement between ethnic groups, these differences are too small to require correction when nuchal translucency is used to screen for Down's syndrome. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Screening for Down's syndrome by fetal nuchal translucency measurement in a general obstetric population
Authors: Pajkrt E. , van Lith J. M. M. , Mol B. W. J. , Bleker O. P. , Bilardo C. M.
Published: March 2003

Objective

To examine the effectiveness of nuchal translucency measurement in the detection of trisomy 21 in a low‐risk population.

Design

Prospective cohort study.

Subjects

A total of 1473 women with viable singleton pregnancies between 10 and 14 weeks' gestation attending an antenatal clinic for routine obstetric care.

Methods

The fetal nuchal translucency was measured in all women. Fetal karyotyping was performed for the usual indications and in cases of a nuchal translucency measurement ≥3 mm.

Results

Down's syndrome was found in nine fetuses (0.6%). Screening by maternal age would have diagnosed six out of nine fetuses (67%) with trisomy 21 for an invasive testing rate of 24%. Because the actual uptake of prenatal diagnosis for maternal age was 79%, only 44% of the Down's syndrome fetuses would have been detected prenatally by this screening method. A nuchal translucency of 3 mm or more identified 67% of the fetuses with trisomy 21, for an invasive testing rate of 2.2%. The combination of nuchal translucency thickness, corrected for the influence of gestation by ‘delta‐value’, and maternal age performs differently according to the chosen cut‐off point for adjusted risk. A minimum risk of 1 : 100 would detect 78% of the Down's syndrome fetuses for a testing rate of 8.1%. By offering karyotyping to all women with a posttest risk of 1 : 300, the detection rate would increase to 100% with an invasive testing rate of 19.8%. This is lower than the invasive testing rate of maternal age screening.

Conclusions

These data suggest that nuchal translucency measurement is an effective screening method for trisomy 21 in an unselected obstetric population. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Early prenatal diagnosis of cord entanglement in monoamniotic multiple pregnancies
Authors: Arabin B. , Laurini R. N. , van Eyck J.
Published: March 2003

Objectives

Cord entanglement is a severe complication in monoamniotic multiple pregnancies. Three cases were reviewed to determine how early ultrasound diagnosis might improve counselling and management.

Methods

In two monoamniotic twin and one dichorionic diamniotic triplet pregnancies, cord entanglement was detected between 10 and 18 gestational weeks by color Doppler and pulsed Doppler velocimetry. Pregnancies were followed up on a weekly basis with special observation of fetal behavior and use of color Doppler velocimetry.

Results

In Case 1, a monoamniotic twin pregnancy with cord entanglement close to the umbilical insertions was diagnosed at 10 weeks. Longitudinal follow‐up showed intrauterine death of both twins at 15 weeks.

In Case 2, entanglement of the umbilical cords of two monoamniotic triplets within a dichorionic diamniotic triplet pregnancy was diagnosed at 10 weeks. The pregnancy continued uneventfully until 35 weeks when cord entanglement was confirmed at Cesarean section. All triplets have since developed normally.

In Case 3, monoamniotic twins were diagnosed at 18 weeks. Color Doppler detected side‐by‐side insertion of the umbilical cords and Doppler velocimetry suggested an entanglement at the chorionic plate. The pregnancy was complicated by polyhydramnios. Cesarean section at 36 weeks confirmed cord entanglement at the chorionic plate. Postnatal computer angiography and morphological examination of the placenta showed the presence of superficial artery‐to‐artery and vein‐to‐vein anastomoses and of deep arteriovenous shunts. The development of the twins was uneventful.

Conclusions

Diagnosis of cord entanglement is feasible early in gestation. Future protocols are proposed to document the gestational age at detection, the location, and the Doppler flow patterns and to facilitate the assessment of short‐ and long‐term development. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Congenital hernia of the abdominal wall: a differential diagnosis of fetal abdominal wall defects
Authors: Stepan H. , Horn L. C. , Bennek J. , Faber R.
Published: March 2003

A 28‐year‐old woman was referred at 33 weeks of gestation with suspected fetal intestinal atresia. Sonography showed a large extra‐abdominal mass on the right of the normal umbilical cord insertion. Following Cesarean section at 36 weeks and immediate surgical treatment, the malformation was not definable either as an omphalocele or as gastroschisis. This reported case involves a previously undocumented malformation of the fetal abdominal wall described as a ‘hernia’ of the fetal abdominal wall. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Doppler velocimetry of normal human fetal venous intrapulmonary branches
Authors: Laudy J. A. M. , Ursem N. T. C. , Mulder P. G. H. , Wladimiroff J. W.
Published: March 2003

Objectives

To describe the nature of flow velocity wave‐forms from fetal middle and distal venous pulmonary branches in the second half of normal pregnancy in relation to gestation, and to test repeatability and interrelationships of flow velocity waveform recordings from proximal, middle and distal venous pulmonary branches.

Design

Cross‐sectional study.

Subjects/methods

A total of 111 normal singleton pregnancies between 20 and 40 weeks' gestation were studied using a color‐coded Doppler ultrasound system. Pulmonary waveforms were obtained at the level of the fetal cardiac four‐chamber view. Repeatability was tested from two recordings at 15‐min time intervals in 25 separate normal pregnancies.

Results

The nature of middle and distal venous pulmonary flow velocity waveforms was comparable with that of proximal waveforms. Acceptable repeatability of pulmonary venous flow velocity waveforms with coefficients of variation below 15% was established for nearly all velocity parameters and their ratios. A gestational age‐dependent change was found for all flow velocity waveform parameters including pulsatility index for veins at both middle and distal venous levels. Significant interpulmonary changes were observed for nearly all pulmonary venous waveform parameters.

Conclusions

It is speculated that increase in volume flow and venous pulmonary pressure gradient plays a role in gestational age‐dependent changes, whereas changes in vessel diameter and distance between the heart and more distal venous pulmonary vessels are responsible for interppulmonary changes. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Morphology assessed by transvaginal ultrasonography differs in patients in preterm labor with vs. without bacterial vaginosis
Authors: Surbek D.V. , Hoesli I.M. , Holzgreve W.
Published: March 2003

Objective To determine whether cervical morphology in preterm labor patients differs in the presence or absence of bacterial vaginosis.

Design Observational study.

Subjects One hundred and twelve consecutive patients with objectively confirmed preterm labor admitted to a tertiary care centre were included in the study. Patients with placenta previa, active uterine bleeding or indication for an immediate delivery (e.g. severe pre‐eclampsia or suspected fetal asphyxia), or severe fetal anomalies were excluded.

Methods Transvaginal ultrasonography was used to measure cervical length and internal os width. Bacterial vaginosis was diagnosed by Gram stain of a vaginal smear.

Results A total of 36 patients (32%) had bacterial vaginosis. Cervical length in this group was shorter than in patients with normal flora (mean 20.4 ± 7.2 mm vs. 26.4 ± 6.7 mm, P = 0.0002), and more patients with bacterial vaginosis had a dilated internal cervical os ≥ 5 mm (67% vs. 30%, P = 0.001). There were no significant differences, however, in preterm delivery rate and birth weight between the two groups; the overall preterm delivery rate was 40%. A cervical length < 25 mm was predictive of preterm delivery (P = 0.001, RR 4.2, 95% CI 1.8–9.7).

Conclusions These data suggest that cervical change in preterm labor is more pronounced in patients with bacterial vaginosis but without a concomitant increase in the risk for preterm delivery. Despite this association, the cervical length measured by transvaginal ultrasonography alone is a useful predictor of preterm delivery, independent of the presence or absence of bacterial vaginosis.
Three‐dimensional (3‐D) ultrasonography for obtaining the four and five‐chamber view: comparison with cross‐sectional (2‐D) fetal sonographic screening
Authors: Meyer‐Wittkopf M. , Rappe N. , Sierra F. , Barth H. , Schmidt S.
Published: March 2003

Objectives

To assess the ability of Doppler‐gated 3‐D fetal echocardiography to reconstruct and display specific cardiac structures routinely visualized during antenatal ultrasound in a population at low risk for cardiac anomalies. To determine whether any advantage is offered by 3‐D sonographic cardiac examination over conventional sonographic fetal screening techniques.

Design

After routine two‐dimensional sonographic examination, 3‐D cardiac data were collected prospectively in 30 fetuses with gestational ages between 19 and 23 weeks from a low risk patient population. Basic echocardiographic key views were derived from 3‐D data and selected for reconstruction and analysis. Four‐ and five‐chamber views were rated and only those views judged to be well visualized were considered as positive results.

Results

The four‐ and five‐chamber views were well visualized in all but one fetus using conventional 2‐D imaging. Gated 3‐D volume data sets enabled visualization of these stuctures in only 19 of 30 fetuses but provided additional structural depth and allowed a dynamic 3‐D perspective of valvar morphology and ventricular wall motion. The right ventricular outflow tract was available from the 3‐D volumes in 16 subjects.

Conclusions

Considering the versatility of gated 3‐D fetal cardiac imaging we believe that it may soon become an important component of fetal screening thus helping to retrieve standard cardiac cross sections when 2‐D imaging is limited by lack of sonographer experience or sonographic windows. Diagnostically acceptable echocardiographic views were obtained more consistently with 2‐D ultrasound than with 3‐D volume data. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology