bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal diagnosis of interrupted inferior vena cava as an isolated finding: a benign vascular malformation
Authors: Celentano C. , Malinger G. , Rotmensch S. , Gerboni S. , Wolman Y. , Glezerman M.
Published: March 2003

We report two cases of interrupted inferior vena cava with azygous continuation diagnosed as an isolated finding during routine prenatal scans. Visualization of the venous vasculature of the abdomen and thorax in the mid‐sagittal plane failed to visualize the segment of the inferior vena cava between the kidneys and the liver. A vessel with venous flow was observed parallel, adjacent and posterior to the aorta between the kidney and the right atrium. This blood vessel connected with the superior vena cava. Axial planes of the thorax confirmed the presence of two vessels running paravertebrally. A detailed ultrasound examination of the fetal anatomy failed to demonstrate other anomalies. The neonatal course of both fetuses was uneventful. Isolated interruption of the inferior vena cava can be a vascular malformation without known pathological consequences. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Prospective cross‐validation of Doppler ultrasound examination and gray‐scale ultrasound imaging for discrimination of benign and malignant pelvic masses
Authors: Valentin L
Published: March 2003

Objective

To cross‐validate, prospectively, the diagnostic performance of established ultrasound methods for discrimination of benign and malignant pelvic masses.

Methods

A total of 173 consecutive women with a pelvic mass judged clinically to be of adnexal origin underwent preoperative ultrasound examination including color and spectral Doppler techniques. A total of 149 tumors were benign, and 24 were malignant. The sensitivity and false‐positive rate with regard to malignancy were calculated for the following methods, using cut‐off values recommended in previous publications: Lerner score; ultrasound morphology, i.e. tumors without solid components being classified as benign and tumors with solid components as malignant; tumor color score; pulsatility index; resistance index; time‐averaged maximum velocity; peak systolic velocity; the combined use of ultrasound morphology and tumor color score and the combined use of ultrasound morphology and peak systolic velocity. Sensitivity and false‐positive rate were also calculated for subjective evaluation of the gray‐scale ultrasound image and for subjective evaluation of the gray‐scale ultrasound image supplemented with subjective evaluation of color Doppler ultrasound examination. The confidence with which the diagnosis was made, based on subjective evaluation, was rated on a visual analog scale.

Results

Subjective evaluation of the gray‐scale ultrasound image was by far the best method for distinguishing benign from malignant tumors (sensitivity 88%, false‐positive rate 4%), followed in descending order by subjective evaluation of the gray‐scale ultrasound image supplemented with color Doppler examination, the Lerner score and the time‐averaged maximum velocity. Adding Doppler examination to subjective evaluation of the gray‐scale image did not increase the number of correct diagnoses, but it increased the confidence with which a correct diagnosis was made in 14% of tumors. In 11 tumors (6% of the series as a whole), the addition of Doppler examination changed the diagnosis based on subjective evaluation of the gray‐scale ultrasound image from an incorrect (n = 1) or uncertain (n = 10) diagnosis to a correct and confident diagnosis.

Conclusion

In experienced hands, subjective evaluation of the gray‐scale ultrasound image is the best ultrasound method for discriminating between benign and malignant adnexal masses. The main advantage of adding Doppler examination to subjective evaluation of the gray‐scale image is an increase in the confidence with which a correct diagnosis is made. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Cardiac defects in chromosomally normal fetuses with abnormal ductus venosus blood flow at 10–14 weeks
Authors: Matias A. , Huggon I. , Areias J. C. , Montenegro N. , Nicolaides K. H.
Published: March 2003

Objective

To assess a possible relationship between ductus venosus blood flow abnormalities and cardiac defects in chromosomally normal fetuses with increased nuchal translucency thickness at 10–14 weeks of gestation.

Methods

Ductus venosus Doppler ultrasound blood flow velocity waveforms were obtained at 10–14 weeks' gestation immediately before fetal karyotyping in 200 consecutive singleton pregnancies with increased nuchal translucency. Fetal echocardiography was subsequently carried out in those with normal fetal karyotype.

Results

Reverse or absent flow during atrial contraction was observed in 11 of the 142 chromosomally normal fetuses with increased nuchal translucency. Major defects of the heart and/or great arteries were present in seven of the 11 with abnormal ductal flow and increased nuchal translucency, but in none of the 131 with normal flow.

Conclusion

These preliminary results suggest that abnormal ductus venosus blood flow in chromosomally normal fetuses with increased nuchal translucency identifies those with an underlying major cardiac defect. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Alobar holoprosencephaly at 9 weeks gestational age visualized by two‐ and three‐dimensional ultrasound
Authors: Blaas H.‐G. K. , Eik‐Nes S.H. , Vainio T. , Vogt Isaksen C.
Published: March 2003

We present the ultrasound detection of alobar holoprosencephaly (HPE) with cyclopia in an embryo of 9 weeks 2 days last menstrual period (LMP)‐based gestational age; the crown–rump length (CRL) was 22 mm. The use of three‐dimensional (3‐D) ultrasound made additional diagnostic ultrasound tomograms possible, and the volume reconstructions improved the imaging and the understanding of the condition.
Prenatal ultrasound evaluation of fetal diastematomyelia: two cases of type I split cord malformation
Authors: Allen L.M. , Silverman R.K.
Published: March 2003

Isolated diastematomyelia is a rare form of spinal dysraphism characterized by a sagittal cleft in the spinal cord, conus medullaris and/or filum terminale with splaying of the posterior vertebral elements. This condition is the result of the presence of an osseous or fibrocartilaginous septum producing a complete or incomplete sagittal division of the spinal cord into two hemicords. It may be isolated or associated with other segmental anomalies of the vertebral bodies. Prenatal diagnosis of this anomaly is possible in the early midtrimester by sonography, thus allowing for early surgical intervention and a favorable prognosis. Two cases of fetal diastematomyelia diagnosed by prenatal sonography are presented, each demonstrating the typical sonographic features diagnostic of this condition. The first case, detected at 28 weeks’ gestation, presented with disorganization of the bony processes of the vertebral column with a midline echogenic focus. The second fetus, diagnosed at 17 weeks’ gestation, had a similar appearance with widening of the posterior elements and the presence of a midline echogenic bony spur. Postnatally, both infants underwent magnetic resonance imaging for a definitive diagnosis. Surgical repair of the defect was performed in the neonatal period in both cases.
Prediction of discordant twins by real‐time ultrasonography combined with umbilical artery velocimetry
Authors: Chittacharoen A. , Leelapattana P. , Rangsiprakarn R.
Published: March 2003

Objective To evaluate the role of umbilical Doppler velocimetry combined with ultrasonographic intertwin differences derived from estimated fetal weight, biparietal diameter, abdominal circumference and femur length as a comprehensive test for the prediction of discordancy.

Methods The sets of twins were studied with real‐time ultrasonography for morphometric measurements and with duplex Doppler velocimetry for the S/D ratio of the umbilical artery in third trimester. The following cutoff values were used to indicate abnormal test results: Δ biparietal diameter > 6 mm, Δ abdominal circumference > 20 mm, Δ femur length > 5 mm, Δ estimated fetal weight > 15% and Δ systolic/diastolic ratio > 15%. Discordancy was identified when the birth weight difference exceeded 15%.

Results Among the 52 sets of twin pregnancies studied, 40 sets of twins fulfilled the study criteria. Thirteen sets of twins were discordant (32.5%) The mean gestational age at delivery was 37.15 ± 2.24 weeks (range 28–41 weeks). The diagnostic accuracy provided by ultrasonographic morphometries was not significantly different from that provided by umbilical Doppler velocimetry. Overall the best predictors appeared to be the presence of either Δ systolic/diastolic ratio > 15% or Δ estimated fetal weights > 15% with sensitivity and specificity values of 92% and 70%, respectively.

Conclusion Real‐time ultrasonography combined with umbilical artery velocimetry is useful in predicting discordant twins.
Prenatal diagnosis of single umbilical artery: determination of the absent side, associated anomalies, Doppler findings and perinatal outcome
Authors: Geipel A. , Germer U. , Welp T. , Schwinger E. , Gembruch U.
Published: March 2003

Objective To determine the absent side of a single umbilical artery and its association with malformations and abnormal karyotypes.

Methods We prospectively studied 102 fetuses from 13 to 39 weeks of gestational age with a prenatally identified single umbilical artery. The absent side, pregnancy data, Doppler findings and the perinatal outcome were reviewed.

Results (1) The left umbilical artery was absent in 71 (69.6%) and the right in 31 (30.4%) fetuses; (2) Single umbilical artery as an isolated finding occurred in 59 (57.8%) pregnancies and was not associated with aneuploidy. The mean gestational age at delivery in this group was 38.4 weeks and the mean birth weight was 3047 g. Six (10.2%) fetuses were small for gestational age, all of them with normal umbilical and uterine Doppler findings; and (3) Chromosomal abnormalities were diagnosed in 10 of 43 fetuses with single umbilical artery and congenital malformations. In nine of 10 fetuses with aneuploidy the left umbilical artery was not developed. Absence of the left artery occurred in 21 of 33 fetuses with sonographic anomalies and normal karyotype. Pathologic Doppler measurements of the umbilical artery were found in only one case of nonchromosomal abnormality.

Conclusion Our data suggest that in fetuses with single umbilical artery the absence of the left artery is more frequent than the absence of the right artery. The association with additional malformations seems to be equal on each side.
Reference ranges for two‐dimensional echocardiographic examination of the fetal ductus arteriosus
Authors: Mielke G. , Benda N.
Published: March 2003

Objectives To establish reference ranges for 2D‐echocardiographic examination of the fetal ductus arteriosus and its relationship to the main pulmonary artery and the aorta.

Methods A prospective cross‐sectional echocardiographic study was performed in 222 normal fetuses from 13 to 41 weeks of gestation using high resolution/color Doppler ultrasound equipment.

Results Gestational age‐specific reference ranges are given for the diameter of the pulmonary valve anulus, diameter of the ductus arteriosus at its beginning, middle, and end, ductal length, ductal diameter‐to‐pulmonary valve anulus diameter ratio, and the spatial relationship of the ductus arteriosus to the main pulmonary artery and to the aorta.

Conclusions The presented data derived from a study group of 222 normal fetuses provide in‐vivo insights into the morphology of the ductus arteriosus and its relationship to the adjacent vessels. The reference ranges may be helpful in prenatal diagnosis of cardiac malformations and abnormalities of the ductus arteriosus, such as obstruction or aneurysm from 13 to 41 weeks of gestation.
Doppler obstetric ultrasound: a graphical display of temporal changes in safety indices
Authors: Deane C. , Lees C.
Published: March 2003

Objective

To investigate ultrasound use and exposure in pregnant women undergoing Doppler ultrasound investigation of the maternal and fetal circulation using Doppler ultrasound techniques.

Methods

Sample graphical displays were generated showing duration of each mode, thermal and mechanical index levels and overall elapsed time of scan and modes.

Results

The displays revealed combinations of scanner settings which delivered higher output intensity levels and which we subsequently altered in our practice to reduce ultrasound exposure.

Conclusion

A display of this type would enable monitoring of output levels and exposures, especially for operators undergoing training in Doppler applications. It would also identify poor practice where there is prolonged exposure at high output levels. Such a display, in combination with accurate output measurement from manufacturers and independent laboratories, would help to ensure the safe use of ultrasound in fetal assessment. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Fetal arterial and venous Doppler parameters in the interpretation of oligohydramnios in postterm pregnancies
Authors: Selam B. , Koksal R. , Ozcan T.
Published: March 2003

Objective

The objective of the current study was to evaluate fetal arterial and venous Doppler parameters in postterm pregnancies with oligohydramnios and those with normal amniotic fluid.

Study Design

A cross‐sectional study was performed in 38 pregnancies beyond 41 weeks' gestation. Pulsed Doppler imaging was used to determine the pulsatility index (PI) for the fetal middle cerebral artery (MCA), renal artery, umbilical artery, inferior vena cava (IVC) and ductus venosus. The amniotic fluid index (AFI) was used for semiquantitive assessment of amniotic fluid volume. Oligohydramnios was defined as an AFI < 5 cm.

Results

Oligohydramnios was detected in 10 cases, and a normal AFI was present in 28 cases. In the presence of oligohydramnios the PI of the MCA was decreased, while the renal artery PI and the MCA PI/UA PI ratio were found to be elevated. In cases of oligohydramnios the PI in the IVC was increased but was unchanged in the ductus venosus.

Conclusion

Oligohydramnios in post‐term pregnancies is associated with arterial redistribution of fetal blood flow typifying the brain sparing effect and with decreased resistance in the MCA and increased resistance in the fetal IVC. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Virilizing tumors of the ovary: imaging features
Authors: Outwater E. K. , Marchetto B. , Wagner B. J.
Published: March 2003

Aim

Virilizing tumors of the ovary are an uncommon cause of a common clinical problem. The reported imaging features of these tumors are based on case reports. The purpose of this study was to determine the spectrum of imaging characteristics of these tumors based on a larger referral population.

Patients and Methods

Case records from the Armed Forces Institute of Pathology were searched for clinical evidence of virilization as a presentation of an excised sex cord‐stromal and steroid cell ovarian tumor. Records and imaging studies on 14 patients with virilizing tumors were found. All available imaging studies (ultrasound studies of the pelvis (11 patients), CT scans of the pelvis (five patients), MRI examinations of the pelvis (two patients), and plain films of the pelvis (four patients) were reviewed by three radiologists independently for ascites, calcification, percent solid portion, echogenicity and attenuation.

Results

On CT and/or ultrasound most (69%) of the tumors appeared to be solid or mostly solid. The amount of solid tissue varied with the tumor type, granulosa cell tumors were predominantly cystic. The masses were isoechoic (82%) or hypoechoic (18%). Ascites was an infrequent (23%) finding. Only a minority of these tumors (14%) were calcified on imaging studies. Six tumors were 5.0 cm or less in mean size, and two less than 3.0 cm in size. All cases were stage I tumors at presentation.

Conclusion

The majority of virilizing tumors of the ovary are typically solid, noncalcified, confined to the ovary at presentation, and not associated with ascites. Variability in appearance depends in part on tumor type. Many are small and may be difficult to recognize as a mass morphologically. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Non‐invasive assessment of endothelial function in normal pregnancy
Authors: Savvidou M. D. , Kametas N. A. , Donald A. E. , Nicolaides K. H.
Published: March 2003

Objective

To assess endothelial function in normal pregnancy by non‐invasive methods.

Methods

Flow‐mediated dilatation of the brachial artery was measured by ultrasonography in 157 women with normal singleton pregnancies between 10 and 40 weeks' gestation and 19 non‐pregnant controls.

Results

Flow‐mediated dilatation in the non‐pregnant controls was 6.42 ± 2.45%. In pregnant women, between 10 and 30 weeks, the mean flow‐mediated dilatation (8.84 ± 3.18%) was significantly higher than the non‐pregnant controls (P = 0.002), but after 30 weeks of gestation there was a decrease to prepregnancy levels. Resting vessel diameter and blood flow were significantly increased in pregnancy, mainly after 30 weeks' gestation (P < 0.001, P < 0.001, respectively). Flow‐mediated dilatation was significantly correlated to resting vessel diameter and reactive hyperemia.

Conclusion

Normal pregnancy is associated with enhanced endothelial function which is apparent from at least 10 weeks' gestation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasound evaluation of the fetal brain: the three horn view
Authors: Timor‐Tritsch I. E. , Monteagudo A. , Mayberry P.
Published: March 2003

Objective

To describe an easy technique for obtaining one of the most important views of the fetal brain and image. Tthe entire lateral ventricle including the anterior, posterior and inferior horns is demonstrated on one image. We propose to call this view, obtained in an oblique plane ‘the three horn view’.

Methods

Depending upon the scanning technique employed there are two ways to obtain the three horn view: (1) by two‐dimensional (2D) transvaginal transfontanelle sonography obtained by using the left and right Oblique‐1 sections, and (2) by three‐dimensional (3D) imaging of the fetal brain, is obtained by acquiring a volume scan of the brain orienting the fetal head in the three main orthogonal planes and by rotating or tilting the midcoronal section to the left and right.

Results

To illustrate the technique of obtaining the three horn view four normal fetal brains were scanned. Two scans utilized the 2D transvaginal transfontanelle approach and two scans utilized the 3D scanning technique. The same technique was then applied to six fetuses with various brain malformations with inflicted changes in the shape of the proposed three horn view.

Conclusion

The three horn view, depicting the anterior, posterior, and inferior horns on the same image, was easy to obtain using both the 2D and the 3D ultrasound techniques. It provided diagnostic and clinically useful information much like neonatal transfontanelle ultrasound imaging after which it was emulated. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasound in the evaluation of fetal anomalies
Authors: Dyson R. L. , Pretorius D. H. , Budorick N. E. , Johnson D. D. , Sklansky M. S. , Cantrell C. J. , Lai S. , Nelson T. R.
Published: March 2003

Objectives

To determine the additional information and clinical impact provided by three‐dimensional ultrasound (3D US) imaging of fetal anomalies compared to conventional 2‐dimensional ultrasound (2D US).

Materials and methods

Sixty‐three patients with 103 anomalies were scanned prospectively with both 2D and 3D US. Each anomaly was reviewed by one or more fetal imaging specialists to determine whether the 3D US data were advantageous, equivalent, or disadvantageous when compared with 2D US images. Clinical impact and pathologic or clinical outcome were determined in all cases.

Results

The 3D US images provided additional information in 53 anomalies (51%), were equivalent to 2D US images in 46 anomalies (45%), and were disadvantageous in four anomalies (4%). The 3D US was most helpful in evaluating fetuses with facial anomalies, hand and foot abnormalities and axial spine and neural tube defects. Planar images derived from 3D US volume data sets generally were more helpful for diagnostic purposes, whereas rendered 3D US images were more useful as a point of reference and were better appreciated by patients in understanding fetal abnormalities. Additional information provided by 3D US images impacted clinical management in 5% of patients. The 3D US images were disadvantageous in two fetuses with multiple anomalies and two with cardiac anomalies.

Conclusion

The 3D US offered diagnostic advantages in about one‐half of the selected cases studied and had effect on patient management in 5% of cases. This modality can be a powerful adjunctive tool to 2D US in providing a more comprehensible, 3D US impression of congenital anomalies. Thus, 3D US is currently most helpful as a targeted study complementing 2D US. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Fetal adrenal and middle cerebral artery Doppler velocimetry in high‐risk pregnancy
Authors: Dubiel M. , Breborowicz G. H. , Marsal K. , Gudmundsson S.
Published: March 2003

Objectives

Animal studies have shown that hypoxic fetuses redistribute their blood flow, giving preferential supply to the brain, heart and adrenal glands. The aim of this study was to establish whether blood velocity waveforms in the human fetal adrenal artery and middle cerebral artery showed signs of redistribution of fetal circulation in high‐risk pregnancy, and to analyze the relationship between signs of such redistribution and the outcome of pregnancy.

Methods

Fetal middle adrenal artery and middle cerebral artery waveforms were recorded between 27 and 41 weeks of gestation in 102 pregnancies complicated by pregnancy‐induced hypertension. Signs of fetal adrenal‐sparing were deemed present when the pulsatility index (PI) fell below the fifth percentile of the normal range. Signs of fetal brain‐sparing were deemed present when the cerebral artery PI was below the mean −2 SD of the normal range and the cerebroplacental PI ratio was < 1.08.

Results

Signs of adrenal sparing were found in 64 cases and brain sparing in 32 cases. Fetal adrenal sparing was strongly associated with adverse perinatal outcome; all perinatal mortality cases showed signs of adrenal sparing. There was a significant positive correlation between the fetal adrenal artery PI and umbilical arterial and venous pH.

Conclusions

Signs of adrenal sparing are frequent in high‐risk pregnancies. Adrenal artery velocimetry may be a useful procedure for fetuses at risk for hypoxemia. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction
Authors: Baschat A. A. , Gembruch U. , Reiss I. , Gortner L. , Weiner C. P. , Harman C. R.
Published: March 2003

Objective

The aim of this investigation was to assess the relationship between abnormal arterial and venous Doppler findings and perinatal outcome in fetuses with intrauterine growth restriction (IUGR).

Methods

Doppler velocimetry of the umbilical artery (UA), middle cerebral artery (MCA), inferior vena cava (IVC), ductus venosus (DV) and free umbilical vein was performed in 121 IUGR fetuses with a UA pulsatility index (PI) > 2SD above the gestational age mean and subsequent birth weight < 10th centile for gestational age. Groups based on the last Doppler exam were: 1 = abnormal UA‐PI only (n = 42, 34.7%), 2 = MCA‐PI > 2SD below the gestational age mean (= ‘brain sparing’) in addition to abnormal UA‐PI (n = 29, 24.0%), 3 = DV or IVC peak velocity index (PVIV) > 2SD above the gestational age mean and/or pulsatile UV flow (n = 50, 41.3%). Z‐scores (delta indices) were calculated for Doppler indices. Perinatal mortality, respiratory distress (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), circulatory failure and umbilical artery blood gases were recorded.

Results

Absence or reversal of umbilical artery end‐diastolic flow was observed in 4 (9.5%) of fetuses in group 1, 10 (34.5%) fetuses in group 2 and 41 (82%) fetuses in group 3. A low middle cerebral artery pulsatility index was found in 39 (78%) fetuses in group 3. Multiple regression analysis with gestational age at delivery, delta indices and cord artery blood gas as independent parameters and individual perinatal outcomes as dependent variables was performed. In this analysis the association was strongest with gestational age for each complication. There were no significant differences in Apgar scores between groups. At delivery, ‘brain sparing’ was associated with hypoxemia and abnormal venous flows with acidemia. Perinatal mortality was highest in group 3 and stillbirth was only observed when venous flow was abnormal. All postpartum complications were more frequent in fetuses with abnormal venous flows. The only statistically significant relation between Doppler indices and outcome was the association between abnormal ductus venosus flow and fetal death (r2 = 0.24, P < 0.05).

Conclusion

Growth restricted fetuses with abnormal venous flow have worse perinatal outcome compared to those where flow abnormality is confined to the umbilical or middle cerebral artery. In fetuses with low middle cerebral artery pulsatility, venous Doppler allows detection of further deterioration. While abnormal venous flows can be significantly associated with fetal demise, gestational age at delivery significantly impacts on all short‐term outcomes. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Natural history of fetal hydronephrosis diagnosed on mid‐trimester ultrasound
Authors: Sairam S. , Al‐Habib A. , Sasson S. , Thilaganathan B.
Published: March 2003

Objectives

Renal tract dilatation is a common finding in routine prenatal ultrasound. However, there is no consensus as to the criteria used for differentiating pathological from physiological dilatation. The aim of this study was to evaluate the natural history and postnatal outcome of fetal hydronephrosis in an unselected obstetric population.

Design

This was a prospective study of fetal hydronephrosis, detected at 18–23 weeks' gestation, in a routine obstetric population. Fetal hydronephrosis was diagnosed as ‘mild’ if the antero‐posterior renal pelvic diameter (APRPD) measured ≥ 4 mm and as ‘moderate/severe’ if the APRPD measured ≥ 7 mm or if there was associated calyceal dilatation. The postnatal outcome of fetuses with persistent hydronephrosis (≥ 10 mm in the third trimester) was determined from a postal questionnaire.

Results

During the study period, 11 465 women underwent an anomaly scan at 18–23 weeks of gestation. Fetal hydronephrosis was identified in 2.3% (268/11 465) of women. Mild hydronephrosis was present in 80.6% (216/268) and moderate/severe hydronephrosis in 19.4% (52/268). The hydronephrosis resolved in the antenatal or early neonatal period in 88% of fetuses. None of the fetuses with mild hydronephrosis and approximately one in three fetuses with persistent moderate/severe hydronephrosis required postnatal surgery. Overall, only one in every 1000 total births in the study population required postnatal urological surgery.

Conclusions

The current study highlights the natural history of antenatally detected hydronephrosis. Mild fetal hydronephrosis appears to be associated with an excellent prognosis and probably represents the group with physiological renal pelvic dilatation. Moderate/severe fetal hydronephrosis is associated with poorer outcome and is perhaps the group that will need more intense follow up both antenatally and postnatally. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Comparative analysis of pattern, management and outcome of pre‐ versus postnatally diagnosed major congenital heart disease: a population‐based study
Authors: Jaeggi E. T. , Sholler G. F. , Jones O. D. H. , Cooper S. G.
Published: March 2003

Objectives

Most pregnant women in New South Wales undergo obstetric ultrasound examination, including some assessment of fetal cardiac anatomy. We aimed to review the spectrum of cardiac defects, management and outcome data of all fetuses with diagnosis of major congenital heart disease between 1994 and 1996 and compare them to major congenital heart disease in infants born during the same 3‐year study period.

Methods

Descriptive comprehensive study of the New South Wales population. Study centers included the single fetal echocardiographic referral service and the two pediatric cardiac centers of New South Wales.

Results

Ninety‐seven fetuses and 562 infants with major congenital heart disease were identified (240 000 livebirths), resulting in a prenatal detection rate of 15%. Anomalies detectable by cardiac four‐chamber views were diagnosed at an average rate of 30% (68/229) in utero. By contrast, lesions associated with abnormal ventricular outflow and great artery views were detected in only 6.7% (29/430; P < 0.0001) of cases prior to birth. Of the 97 fetuses, 29 were aborted, 16 died in utero, and 9 died early postnatally without treatment. Within 2 weeks of age, 23% with fetal and 40% (P < 0.05) with infant major congenital heart disease diagnosis required an intervention, mainly for patent ductus arteriosus dependent lesions. Postnatal survival was similar for the fetal and infant series up to 2 years of age: 77% (95% confidence interval 64–90%) vs. 85% (95% confidence interval 82–88%).

Conclusions

Prenatal diagnosis has important implications for pregnancy outcome, in particular for univentricular lesions. However, the present mode of obstetric routine ultrasound scanning fails to identify most ductus arteriosus dependent cardiac lesions with a predictable need for early postnatal intervention. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Doppler studies on the fetal renal artery in the severely growth‐restricted fetus
Authors: Stigter R. H. , Mulder E. J. H. , Bruinse H. W. , Visser G. H. A.
Published: March 2003

Objectives

To examine changes with time in the fetal renal circulation by Doppler sonography in the severely growth‐restricted preterm fetus during the period of gradual deterioration prior to delivery, and to examine the relationship between Doppler measurements, amniotic fluid index, birth weight and fetal condition at birth.

Methods

This was a prospective observational study in 16 preterm growth‐restricted fetuses between 26 and 35 weeks of gestational age. Serial Doppler measurements were made of the renal artery, umbilical artery, middle cerebral artery and ductus venosus.

Results

The pulsatility index in the renal artery did not show any correlation with cord blood pH, birth weight or amniotic fluid index corrected for gestational age (Δ/SDAFI). However, peak systolic velocities in the renal artery showed a significant reduction with time (n = 7, P < 0.05) and a significant correlation with: venous cord pH at delivery (n = 12, r = 0.84, P < 0.001), Δ/SDAFI (n = 16, r = 0.67, P < 0.01), and birth weight (n = 16, r = 0.61, P < 0.02). Birth weight correlated significantly with: Δ/SDAFI (n = 15, r = 0.57, P < 0.05), pulsatility index values of the middle cerebral artery (n = 15, r = −0.61, P < 0.02), and pulsatility index values of the ductus venosus (n = 16, r = 0.55, P < 0.05), and Δ/SDAFI correlated significantly with: pulsatility index values of the ductus venosus (n = 15, r = 0.51, P < 0.05) and arterial cord pH values at delivery (n = 8, r = 0.78, P < 0.05).

Conclusions

Progressive redistribution of the circulation occurs with deterioration of the fetal condition in the growth‐restricted preterm fetus. On spectral Doppler this is reflected by changes in peak systolic velocities, but not by changes in pulsatility values of the fetal renal artery waveforms. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonographic pattern of peritoneal inclusion cysts
Authors: Savelli L. , Cacciatore B. , Pilu G. , De Iaco P. , Ceccarini M. , Rosati F. , Bovicelli A. , Bovicelli L.
Published: March 2003

Purpose:  To assess the transvaginal sonographic pattern of peritoneal inclusion cysts, a common consequence of adhesions formation often related to pelvic surgery, endometriosis and pelvic inflammatory disease.

Patients and methods:  Twenty‐two patients (mean age: 40 years; range: 22–56 years) with surgically proved peritoneal inclusion cysts, examined by transvaginal sonography with power Doppler within 7 days before surgery were retrospectively recruited. Indication to surgery was pelvic pain (55%), an adnexal mass (50%) or abdominal discomfort and increasing abdominal girt (27%). Ten patients (45%) had been previously submitted to some form of pelvic surgery, nine (41%) had ovarian endometriosis and two patients had a positive anamnesis for pelvic inflammatory disease.

Results:  In 20 cases (91%), peritoneal inclusion cysts appeared as a pelvic mass close but separated from the ovary. Mean cyst diameter was 6 cm (range 3–20 cm) and the walls were irregular in 18 (82%) cases, due to invaginations of surrounding pelvic organs (bowel loops, uterus, broad ligaments …). Cystic content was anechoic in 16 (77%) and hypoechoic in 5 (23%) cases. In one case of multilocular cyst, both hypo‐ and anechoic content was seen. A mean of five septa were found inside each cyst (range 1–15): these appeared as being of <3 mm in thickness in 17 (85%) cases and >3 mm in 3 (15%), while in two cysts both thick and thin septa were present. Septa were complete in 15 patients, incomplete in one while in six cases both complete and incomplete septa were detected. Septa had a random distribution in 12 cysts with more than one septum (67%) and a spider appearance in 6 (33%) cases, departing from the ovary and reaching the opposite wall of the cyst. Echoic projections of the cystic walls were detected in 41% of the cases, usually of few millimeters in diameter.

Conclusion:  Peritoneal inclusion cysts show a wide range of dimensions and morphology and can mimic malignant adnexal masses as septa and solid projections are common findings. In a woman with previous pelvic surgery or a history of ovarian endometriosis, the detection of an irregularly shaped hypo/anechoic cyst, close but separated from the ovary and attached to normal pelvic organs should suggest the peritoneal nature of the mass.
Congenital diaphragmatic hernia: evaluation of prenatal diagnosis in 20 European regions
Authors: Garne E. , Haeusler M. , Barisic I. , Gjergja R. , Stoll C. , Clementi M.
Published: March 2003

Objective

To evaluate prenatal diagnosis of congenital diaphragmatic hernia by ultrasound in well‐defined European populations.

Design

Data from 20 registries of congenital malformations in 12 European countries were included. The prenatal ultrasound screening programs in the countries ranged from no routine screening to three ultrasound investigations per patient being routinely performed.

Results

There were 187 cases with congenital diaphragmatic hernia, with an overall prenatal detection rate of 59% (110/187). There was considerable variation in prenatal detection rate between regions. There was a significant difference in the detection rate of isolated congenital diaphragmatic hernia (59/116, 51%) compared with congenital diaphragmatic hernia associated with multiple malformations, karyotype anomalies or syndromes (51/71, 72%) (P = 0.01). Termination of pregnancy was performed in 39 cases (21%) of which 14 cases were isolated congenital diaphragmatic hernia. Mean gestational age at discovery was 24.2 weeks (range, 11–38 weeks).

Conclusions

The overall prenatal detection rate of congenital diaphragmatic hernia is high (59%) but varies significantly between European regions. The gestational age at discovery was greater than 24 weeks in half of the prenatally diagnosed cases. Copyright © 2002 ISUOG
Sonographic diagnosis of spina bifida at 12 weeks: heading towards indirect signs
Authors: Buisson O. , De Keersmaecker B. , Senat M. V. , Bernard J. P. , Moscoso G. , Ville Y.
Published: March 2003

Retrospective examination of ultrasound images obtained at 12 weeks of gestation in two fetuses with spina bifida demonstrated retraction of the frontal bones, resulting in an acorn‐shaped head, the cerebral peduncles appearing parallel to each other. These craniocerebral signs may improve the accuracy of first‐trimester diagnosis of spina bifida by sonography. Copyright © 2002 ISUOG
Prenatal diagnosis and perinatal management of left coronary artery to right atrium fistula
Authors: Mielke G. , Sieverding L. , Borth‐Bruns T. , Eichhorn K. , Wallwiener D. , Gembruch U.
Published: March 2003

Serious complications due to coronary artery fistulae have been described. Most authors recommend early intervention at the time of diagnosis. We present a case of a fistula originating from a dilated left coronary artery and draining into the right atrium, which was diagnosed prenatally by color Doppler echocardiography. During pregnancy, the echocardiographic findings remained unchanged, and there were no signs of heart failure. After birth, the fistula was confirmed by angiography. Additionally, a persistent left superior vena cava draining into the coronary sinus and a very small ventricular septal defect were detected. The fistula was closed successfully by transcatheter coil embolization. At 17 months old the child was in good clinical condition. Prenatal diagnosis of coronary artery fistulae may be possible and may improve perinatal management and outcome. Copyright © 2002 ISUOG
British National Health Service's and women's costs of antenatal ultrasound screening and follow‐up tests
Authors: Henderson J. , Bricker L. , Roberts T. , Mugford M. , Garcia J. , Neilson J.
Published: March 2003

Objective

To estimate resource use and costs associated with routine obstetric ultrasound and follow‐up tests from both the British National Health Service and women's perspectives.

Methods

Women attending Liverpool Women's Hospital (UK) in 1998 and 1999 were involved in the study. Bottom‐up and top‐down costings of National Health Service resources using questionnaires and diaries to record staff time associated with procedures were performed. Questionnaires were used to assess women's costs of attending for antenatal ultrasound scans.

Results

Routine antenatal ultrasound scans at Liverpool Women's Hospital cost the National Health Service between £14 and £16 per scan. More detailed secondary scans and other follow‐up procedures cost substantially more. Costs to women, their families and their employers were estimated at between £9 and £15 per scan, depending on assumptions about the opportunity costs of time when not in paid employment and costs to employers of women who were in paid employment.

Conclusions

Accurate estimates of costs to the National Health Service associated with routine antenatal ultrasound scanning are substantially lower than that cited in much of the literature. Costs to women are very similar to National Health Service costs. Economic evaluations should attempt to include costs to users of the service, particularly when the burden of cost is likely to shift.
An algorithm including results of gray‐scale and power Doppler ultrasound examination to predict endometrial malignancy in women with postmenopausal bleeding
Authors: Epstein E. , Skoog L. , Isberg P.‐E. , De Smet F. , De Moor B. , Olofsson P.‐Å. , Gudmundsson S. , Valentin L.
Published: March 2003

Objective

To determine if power Doppler ultrasound examination of the endometrium can contribute to a correct diagnosis of endometrial malignancy in women with postmenopausal bleeding and endometrium ≥ 5 mm.

Methods

Eighty‐three women with postmenopausal bleeding and endometrium ≥ 5 mm underwent gray‐scale and power Doppler ultrasound examination using predetermined, standardized settings. Suspicion of endometrial malignancy at gray‐scale ultrasound examination (endometrial morphology) was noted, and the color content of the endometrium at power Doppler examination was estimated subjectively (endometrial color score). Computer analysis of the most vascularized area of the endometrium was done off‐line in a standardized manner. Stepwise multivariate logistic regression analysis was carried out to determine which subjective and objective ultrasound and power Doppler variables satisfied the criteria to be included in a model to calculate the probability of endometrial malignancy.

Results

Endometrial thickness, vascularity index (vascularized area/endometrial area), and use of hormone replacement therapy (HRT) satisfied the criteria to be included in the model used to calculate the ‘objective probability of endometrial malignancy’. Endometrial morphology, endometrial color score and HRT use satisfied the criteria to be included in the model to calculate the ‘subjective probability of malignancy’. Endometrial thickness ≥ 10.5 mm had a sensitivity with regard to endometrial cancer of 0.88 and a specificity of 0.61. At a fixed sensitivity of 0.88, the specificity of the ‘objective probability of malignancy’ (0.81) was superior to all other ultrasound and power Doppler variables (P = 0.001–0.02). The ‘objective probability of malignancy’ detected more malignancies at endometrium 5–15 mm than endometrial morphology (5/7 vs. 1/7, i.e. 0.71 vs. 0.14; P = 0.125) with a similar specificity (49/57 vs. 51/57, i.e. 0.86 vs. 0.89).

Conclusions

Power Doppler ultrasound can contribute to a correct diagnosis of endometrial malignancy, especially if the endometrium measures 5–15 mm. The use of regression models including power Doppler results to estimate the risk of endometrial cancer deserves further development. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
The three vessels and trachea view (3VT) in fetal cardiac scanning
Authors: Yagel S. , Arbel R. , Anteby E. Y. , Raveh D. , Achiron R.
Published: March 2003

Objective

Comprehensive evaluation of the fetal heart has become a major part of targeted organ scanning to rule out fetal malformations. Evaluation of the mediastinal major vessels seems to be the most difficult and time‐consuming part of fetal heart examination. Our aim was to define and evaluate the three vessels and trachea (3VT) view, a novel and simple method to examine the great vessels in the mediastinum, and its applicability in the clinical practice of fetal echocardiography, while establishing nomograms for cardiac vessel measurements obtained in this view.

Methods

The three vessels and trachea view was examined in 379 low‐risk gravidae between 14+0 and 23+6 weeks' gestation. Six parameters in this plane were measured to establish nomograms. In another group of 984 mixed high‐ and low‐risk patients we compared the time required to identify the aortic arch using the 3VT view as compared to the long‐axis view.

Results

The 3VT view was readily and satisfactorily demonstrated in all but two of the 1363 cases examined. In 17 cases (out of a total of 982) more than 10 min were required to identify the aortic arch using the 3VT view and in 71 patients when employing the long‐axis view (P < 0.001).

Conclusion

The clinical applicability of the 3VT view to evaluate the anatomy of the major vessels in the mediastinum is demonstrated. Although a wide variation in the six parameters of the 3VT view used here precludes their use in diagnosing great vessel anomalies, some of the ratios between them have promising potential in the evaluation of great vessel malformations. Further, the 3VT view seems to be more efficient in identifying the aortic arch than does the long‐axis view. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Confocal laser scanning microscopy of porcine skin: implications for human wound healing studies
Authors: VARDAXIS N. J. , BRANS T. A. , BOON M. E. , KREIS R. W. , MARRES L. M.
Published: March 2003

The structure of porcine skin as examined by light microscopy is reviewed and its similarities to and differences from human skin are highlighted. Special imaging techniques and staining procedures are described and their use in gathering morphological information in porcine skin is discussed. Confocal laser scanning microscopy (CLSM) was employed to examine the structure of porcine skin and the findings are presented as an adjunct to the information already available in the literature. It is concluded that CLSM provides valuable additional morphological information to material examined by conventional microscopy and is useful for wound healing studies in the porcine model.
Muscle fibre types and their distribution in the biceps and triceps brachii of the rat and rabbit
Authors: FUENTES I. , COBOS A. R. , SEGADE L. A. G.
Published: March 2003

Muscle fibre type composition and distribution in the biceps brachii (long head) and triceps brachii (long head) of the rat and rabbit were investigated using the following histochemical techniques: myosin ATPase, with preincubation at pH 10.4 and 4.35; succinate dehydrogenase (SDH) and glycogen phosphorylase. The muscle fibres were classified into slow‐twitch (SO), fast‐twitch glycolytic (FG), fast‐twitch oxidative glycolytic (FOG and FOg) and fast‐twitch oxidative fibres (FO). Significant differences in the regional distribution of muscle fibre types have been observed between the rat and the rabbit. In the rat, SO fibres were restricted to the deep regions of both biceps and triceps brachii, whereas FG fibres were located in the intermediate and superficial regions (the superficial regions contained the highest percentages of FG fibres). In the rabbit, SO and FG fibres were spread over the entire muscle, although SO and FG fibres were most abundant in the deep and superficial regions respectively. These findings indicate that the biceps and triceps brachii are more regionalised in the rat than in the rabbit.