bluuebunny/crossref_metadata_2025 huggingface dataset:
Doppler velocimetry of uterine arteries between 12 and 16 weeks of gestation
Authors: Char Sang Choon , Yamasaki A. A. , Braia G. , Toma O.
Published: March 2003

Introduction:  The aim of prenatal care is to identify high risk pregnant in order to adopt preventive and/or therapeutic treatments. The presence of an end diastolic ‘notch’ at uterine Doppler velocimetry has been considered a predictor to pre‐eclampsia and intrauterine reduced growth. It reflects an answer expressed by a wave of high amplitude representing vascular bed with high resistance (utero‐placental circulation).

Objective:  To identify high risk patients by analysis of uterine Doppler velocimetry between 12 and 16 weeks of gestation when occurs the second wave of trophoblastic invasion.

Patients and methods:  Between June 1999 and June 2001, we did a longitudinal study with 127 pregnant from 12 to 16 weeks. This study analyzed uterine Doppler velocimetry using two types of equipment: Aloka Model 1700 and Medison Model Voluson 530. We determined the incidence of end diastolic ‘notch’ between 12 and 16 weeks and its evaluation during pregnancy.

Results:  The incidence of end diastolic ‘notch’ was 26% (33 patients). Among these patients only nine (7%) still had notch at 16–24 weeks. Among patients with normal uterine Doppler velocimetry at 12–16 weeks, none developed pre‐eclampsia or intrauterine reduced growth.

Conclusion:  It is possible to identify low risk patients (74%) to pre‐eclampsia and intrauterine reduced growth at the end of first trimester of pregnancy by uterine Doppler velocimetry. At the end of first trimester, 26% of patients can be identified as high risk for pre‐eclampsia or intrauterine reduced growth. The advantage of this early screening method is the possibility to give aspirin (100 mg/day) at time of second wave of trophoblastic invasion as prophylactic treatment.
Impact of sonohysterography on the management of women with uterine myomas
Authors: Pretorius D. H. , Becker E. , Lev‐Toaff A. S.
Published: March 2003

Purpose:  Assess the importance of sonohysterography findings in women with suspected/known myomas particularly with regard to location within/near the endometrial cavity and its impact on treatment.

Methods:  Review of 240 sonohysterograms identified 109 women (age 24–76, mean 42.4; 84.4% pre‐menopausal, 15.6% post‐menopausal) with suspected/known myomas. Images, reports, pathology/surgery results, and clinical/imaging follow up were reviewed. Myoma location with respect to the cavity was described and feasibility of hysteroscopic resection assessed.

Results:  Indications for sonohysterography abnormal bleeding (74.3%), infertility (8.3%), other (17.4%). Five groups were defined (1) normal cavity (19/109 patients, 17.4%); (2) normal but displaced cavity (7/109, 6.4%); (3) myoma with endoluminal component (50/109, 45.9%); (4) other endoluminal findings, mostly polyps (25/109, 22.9%); (5) myoma plus other (8/109, 7.3%). An intracavitary myoma(s) (ICM), a submucous myoma >50% within the cavity, was found in 45 patients; submucous – 20; mural – 71; and subserosal – 37 (57 patients had myomas in more than one location). SHG indicated that myomas were amenable to hysteroscopic resection (HR) in 45 women; in 39 others SHG revealed that myoma(s) were not amenable to HR. There was a significant difference in the use of hysteroscopic resection between these two groups; HR was performed in 21/45 (46.7%) of the former but only in 2/39 (5.1%) of the latter (P < 0.01). Other treatments were not significantly different between the two groups: hysterectomy in 7/45(15.6%) and 5/39(12.8%); abdominal myomectomy in 1/45 (2.2%) and 3/39 (7.7%); uterine artery embolization, curettage or endometrial ablation in 4/45 (8.9%) and 3/39 (7.7%), respectively. Sonohysterography findings were proved by pathology, hysteroscopy, laparoscopy or imaging in 64/109 (63.3%) patients; however, in the ICM group, 41/45 (91.1%) were proved.

Conclusions:  SHG is useful for assessing the relationship of myomas to the cavity and for identifying or excluding concomitant endometrial abnormalities. Although other factors also influence treatment choices, SHG provides information that assists in determining therapeutic approach, particularly the appropriate use of hysteroscopic resection.
A prospective study to evaluate the effectiveness of ultrasound‐guided transvaginal aspiration in the treatment of recurrent endometrioma
Authors: Chan L. Y. , So W. W. K. , Lao T. T.
Published: March 2003

Purpose:  Recurrent endometrioma is a difficult clinical problem. Repeated conservative surgical treatment carries increase risk of damage to adjacent organs. Medical treatment has not been found effective. Ultrasound‐guided aspiration is an attractive option because it can be performed under conscious sedation and is applicable even when surgical excision is technically difficult. We postulated that the endometriotic tissue in the epithelial lining had undergone pressure atrophy after a period of observation and resolution of the endometrioma can be achieved by aspiration of its content.

Methods:  A prospective study was carried out in which patients with recurrent endometrioma that remain stationary in size for a period of at least 6‐month duration were included. Ultrasound‐guided aspiration of endometrioma was performed transvaginally under conscious sedation. Ultrasound scan examination was performed at 1, 3, 6 and 12 months after aspiration to detect recurrence.

Results:  Eight endometriomas were aspirated in six patients. All aspiration procedures were successful. The mean diameter and volume of endometrioma at aspiration were 31.0 mm (18.0–46.3) and 21.9 mL (3.16–52), respectively. The mean duration of procedure was 34.5 min (15–50). There were no major complications. Cytological examination revealed hemosiderin‐laden macrophages; neither malignant cells nor endometrial cells were detected in all cases. Six ovarian cysts recurred in five women (83.3%), all recurrence were detected within 3 months after aspiration.

Conclusions:  We concluded that although transvaginal ultrasound‐guided aspiration is a safe procedure. However, the recurrence rate after aspiration is unacceptably high, and hence cannot be recommended as a treatment option for recurrent endometrioma.
Use of sonohysterography in the diagnosis and management of abnormal uterine bleeding
Authors: Patil A. D.
Published: March 2003

Objective:  To assess the effectiveness of saline contrast sonohysterography in the diagnosis and management of abnormal uterine bleeding.

Materials and methods:  Fifty‐two patients (aged 28–56 years) with abnormal uterine bleeding were included in a prospective study. They underwent a transvaginal ultrasonography as well as saline contrast sonohysterography. Patients with findings of uterine cavity abnormalities (endometrial polyps or submucous myomas) were advised surgery (operative hysteroscopy or hysterectomy). Patients with normal cavity or thickened endometrium underwent diagnostic hysteroscopy and biopsy, following which they were advised medical therapy or thermal ablation of the endometrium.

Results:  Saline contrast sonohystergraphy depicted endometrial polyps (n = 22), submucous fibroids (n = 18) and normal cavities (n = 12). Hysteroscopic surgery resolved the bleeding in 20 of the patients with polyps and in 12 of the patients with fibroids. The findings of the measurement and localization of the lesions on saline contrast sonohysterography displayed good reliability at the time of surgery. Of the 12 patients with normal uterine cavity, eight patients had a normal histopathological report on biopsy and were offered either medical therapy or endometrial thermal ablation. Three patients had endometrial hyperplasia without atypia and one patient had endometrial carcinoma and underwent definitive surgery. The procedure of saline contrast sonohysterography was well tolerated by all patients with very minimal side‐effects. Between transvaginal ultrasound and saline contrast sonohysterography, the latter was found to be more specific and sensitive and the likelihood ratio was improved significantly with the use of this modality.

Conclusions:  Saline contrast sonohysterography enhances endovaginal ultrasound examination of the uterine cavity in patients with abnormal uterine bleeding. It is easy and safe to perform, and its use can optimize the therapeutic interventions.
Artificial neural networks in sonographic characterization of adnexal tumors: a preliminary study
Authors: Czekierdowski A. , Bednarek W. , Rogowska W. , Kotarski J.
Published: March 2003

Objectives:  To apply computer generated artificial neural networks (ANNs) for the development of a statistical model, helpful in better preoperative discrimination between benign and malignant adnexal tumors.

Materials and methods:  The retrospective study included data of 162 patients who were examined with gray scale and color Doppler sonography (B‐K Medical, 2002 ADI, Denmark and Voluson 530, and 730 Kretz, Austria) because of adnexal tumors. Following variables were analyzed with the use of ANN: patient's age, menopausal status, years since menopause, tumor size and volume, presence of solid parts, papillary projections >3 mm, localization of blood vessels (central or peripheral), resistive and pulsatility indices, peak systolic velocity and color Doppler score according to Timmerman et al. (1999). The output variable was classified as either benign or malignant. The ANNs were generated with the use of a statistical package (Statistical Neural Networks, Statsoft, USA) and included linear, radial basis function and multiple layer perceptron networks. The networks were trained on randomly selected 81 cases, verified (n = 40), and tested on the remaining 41 cases. Sensitivity and specificity of generated statistical models were compared with those calculated for all individual sonographic parameters.

Results:  In 43 women, the cysts resolved spontaneously whereas 119 patients were subsequently operated. Removed tumors were classified histologically as either benign (n = 93) or malignant (n = 26), including four borderline; five stage I ovarian cancers. The best performance was found for the radial basis function network with six input neurons and one hidden neuron. The specificity and sensitivity at the best decision cut‐off point were 96.1% (25 of 26) and 94.8% (129 of 136), respectively. These percentages were significantly better than respective prognostic values derived from independent use of each tested variable (P < 0.05).

Conclusion:  Evaluation of clinical and ultrasound derived data with the use of artificial neural networks may improve the accuracy of preoperative prediction of ovarian malignancy. Prospective analysis of a larger group of patients, especially with early stages of the disease is warranted.

Acknowledgements:  Supported by the Polish Scientific Investigation's Committee grant no. KBN 4P05E120 17.
The anatomy and morphology of the ductus venosus in the human fetus: relevance to clinical practice
Authors: Mavrides E. , Moscoso G. , Carvalho J. , Campbell S. , Thilaganathan B.
Published: March 2003

Background:  Doppler of the fetal ductus venosus (DV) is becoming increasingly commonplace in clinical practice. However, the true anatomical relationships of the DV are yet to be clearly defined. Furthermore, there is conflicting evidence regarding the structure of the DV, especially with regard to the presence of a DV inlet sphincter. The aim of the present study is to examine the anatomy and morphology of the DV.

Design:  A prospective study on 24 fetuses obtained from medical terminations between 13 and 17 weeks' gestation. Following microdissection of the liver, specimens were prepared for study of the anatomical relations, scanning electron microscopy or histology.

Results:  A venous confluence at the terminal end of the umbilical vein, termed the portal sinus, was identified connected to the right and left intrahepatic portal veins. The DV, a branchless hourglass shaped vessel, originated from the portal sinus ascended steeply in the direction of the diaphragm. The endothelial surface of the DV showed longitudinal corrugations and at the level of the inlet, there was ‘shelf’ separating the DV from the portal sinus. Histological studies revealed elastin fibers, six to seven cell layers thick at the DV inlet and a single layer of smooth muscle extending from the shelf to the DV outlet. A large number of nerve fibers were present in the adventia of the DV inlet.

Conclusions:  This study clearly delineates the anatomical relations of the fetal ductus venosus. The morphological findings refute the presence of a DV sphincter, but provide an insight into the physiology of the human fetal DV. In clinical practice, the consistent use of the suggested appropriate terminology would allow collection of comparable data between units and enable operators to be confident of which vessels they are sampling by Doppler ultrasound.
Preliminary experiences using quantitative color velocity imaging (CVI): a simple means to measure fetal volume flow?
Authors: Tutschek B. , Zimmermann T. , Wagner K. , Reihs T. , Henrich W.
Published: March 2003

Purpose:  Color velocity imaging (CVI) quantifies blood flow using time domain ultrasonography and M‐mode vessel diameter measurements. It has been validated in vitro and correlates well with Doppler based velocity measurements. The purpose of this study was to apply an easy to use CVI software algorithm in fetal studies.

Methods:  A high resolution ultrasound system (ATL HDI 5000, 7–4 and 5–2 MHz curved probes) was used. Analysis of ultrasound data was performed using dedicated software (HDILab, version 1.91; CVI_Q plug‐in version 2.0). The content of the cineloop, usually with several cardiac cycles, is stored in digital format, concurrent with an ongoing exam. Volume flow, peak velocity and vessel diameter (derived from color M‐mode) were measured off‐line.

Results:  Data acquisition is quick and simple. The proximal portion of the intrahepatic umbilical vein with its straight course offers good sampling conditions. The ductus venosus can also readily be measured. Off‐line analysis does not require specific hardware and takes less than 3 min per vessels. There is significant intraobserver variablity, but generally CVI volumes flow measurements agreed with published data derived from invasive or Doppler based methods.

Conclusions:  CVI volume flow measurement using this system is rapid and easy. The software also delineates the functional lumen diameter (based on color flow information) and calculates blood flow velocities, enabling correlation with Doppler measurements. The calculations are based on the assumption of certain standard conditions (laminar flow and circular cross section, e.g. in adult carotid artery), but restrictions in fetal vessels (e.g. tortuous vessels of the free umbilical cord with regions of non‐laminar flow, fetal and maternal movements) apply.
Ultrasonographic evaluation of changes in placental location with the advance in gestation
Authors: Luria M. , Diamant Y. Z.
Published: March 2003

Purpose:  To evaluate the change in location of the placenta during pregnancy and the actual increase in the distance between the internal oss and lower placental margins in relation to the advance in gestation.

Methods:  A total of 37 pregnant women were scanned three times during pregnancy: the first time between 14 and 22 weeks' gestation, the second between 23 and 29 weeks' gestation and the last between 30 and 34 week's gestation. Examinations were performed by two qualified examiners. Placenta and cervix were allocated and distance between the lower placental margin and the interval oss was measured. Examinations were either transvaginal or transabdominal, depending on patients' cooperation.

Results:  Gradual increase in the distance between the placental margin and the internal oss was found. Mean value of 50.8 mm at 14–22 weeks increased to 111.6 mm at 30–34 weeks. Significant statistical difference was found between first, second and third measurements. Effect of maternal age on these changes was evaluated too and was found not to affect this phenomenon. Borderline results were found regarding the effect of parity.

Conclusions:  Low‐lying placenta in early pregnancy is a known phenomenon. Little is known about quantitative change in placental location with advance in gestation. In the present study, we tried to quantitate the change. We found gradual, consistent and significant increase in the distance between placental margin and internal oss along gestation. This change increased with increase in parity in spite of the fact that parity is a risk factor for placenta previa. The present quantitative evaluation of placental location can serve as a predictor of low‐lying placenta.
The diagnostic value of fetal heart biometry in early pregnancy
Authors: Smrcek Jan , Germer U. , Berg C. , Gembruch U.
Published: March 2003

Purpose:  To evaluate the value of early cardiac biometry for the detection of congenital heart defects (CHD) using our normative data.

Methods:  Cases were selected from all cases with CHD diagnosed between 10 and 17 weeks of gestation between 1999 and 2000. Detailed fetal two‐dimensional and color‐coded Doppler echocardiography was performed. The transversal heart diameter, both ventricular dimensions, heart area and circumference, thoracic diameter, thoracic circumference and area and the diameters of the pulmonary trunk and ascending aorta were measured.

Results:  A total of 31 cases of CHD between 10 and 17 weeks of gestation were diagnosed. Eight fetuses presented with insufficient biometric measurements. In the remaining 23 fetuses different complex abnormalities were present. In three fetuses with an atrioventricular septal defect and two with a ventricular septal defect fetal heart biometry showed normal values. In 18/23 fetuses with CHD fetal heart biometry was partly abnormal. Nuchal translucency (NT) thickness measurements were performed before 14 weeks of gestation and 10/12 fetuses presented with an increased NT. Both fetuses with normal NT showed an abnormal fetal heart biometry. Venous Doppler evaluation was performed in 22 cases, 12 fetuses demonstrated an increased pulsatility in the ductus venosus and 7 with a pulsatile flow in the umbilical vein in addition. In 7/10 fetuses with normal venous Doppler fetal heart biometry was partly abnormal.

Conclusion:  Early fetal heart biometry may be helpful in the prenatal diagnosis of some major CHD by demonstration of discordant diameters of the fetal heart and great arteries. At 10–14 weeks of gestation, nuchal translucency thickness measurements and biometric measurements of the fetal heart seem to be complementary methods for the detection of cardiac defects.
The three‐dimensional ultrasound diagnosis of acrania in early pregnancy
Authors: Hsu T.‐Y.
Published: March 2003

Objective:  To compare the application of two‐ and three‐dimensional (2D and 3D) ultrasound for the antenatal diagnosis of acrania in the early pregnancy.

Materials and methods:  Two‐ and three‐diminsional (2D and 3D) ultrasound in early pregnancy were studies prospectively between April 1999 and March 2001. A volume scan (Voluson 530D Kretz Technik, Austria) were performed after the conventional 2D (Acuson 128 XP, mt. view, CA) ultrasound examination were complete. The ability to visualize acrania and weeks gestation of diagnosis were compared between the two techniques. All relevant English‐language clinical research articles retrieved were reviewed and compared.

Results:  Five fetuses with acrania in early pregnancy was detected, our cases were diagnosed earlier than previous reports (13.4 ± 1.67 weeks vs. 17 ± 1.83 weeks). The serum level of a fetoprotein were elevated in four cases. Only two fetuses had chromosome study and all were normal.

Conclusion:  Our experience of the use of 3D transvaginal ultrasound, a more accurate version of the fetal brain and face can be obtained. We believe that with technical improvements 3D, sonography permits more detailed evaluation than is possible with current 2D sonography.
The role of magnetic resonance imaging (MRI) in the prenatal diagnosis and evaluation of fetal tumors
Authors: Yagel S. , Nadjari S. , Gomori M.
Published: March 2003

Objective:  Fetal tumors are rare abnormalities, problematic to diagnose accurately by ultrasonography alone. In many cases precise diagnosis depends on advanced tissue characterization, difficult to accomplish with ultrasound. The recent advent of rapid MRI has made this modality more amenable to prenatal diagnosis. Our aim was to investigate the role of this modality in the diagnosis fetal tumors.

Patients and methods:  Thirteen cases with suspected fetal tumors underwent thorough early and/or late ultrasound examination, followed by rapid MRI. Postnatal MRI examination or postmortem (PM) pathology was performed as indicated.

Results:  Ultrasound examination follow by MRI revealed the following cases: brain tumor, 2; tuberous sclerosis, 1; intracerebral hemorrhage, 1; brain cyst, 1; cystic adenomatoid malformation CCAM, 2; pericardial teratoma, 1; intra thoracic hygroma, 1; sub diaphragmatic lung sequestration, 2; hemorrhagic ovarian cyst, 1; liver hemangioma, 1. Postnatal or PM examination confirmed prenatal rapid MRI diagnosis in 12/13 cases, while ultrasound diagnosis was confirmed in 7/13 cases. In 10/13 cases MRI examination was more accurate than ultrasound examination and significantly improved our prenatal evaluation of the findings, patient counseling and treatment.

Conclusion:  Rapid MRI plays an important role in the precise diagnosis of fetal tumors especially when tissue characterization is essential for the diagnosis.
Antenatal diagnosis of the absent inferior cerebellar vermis – is there any clinical significance?
Authors: Wong J. S. M. , Woo B. H. , Yeo G. S. H.
Published: March 2003

Objective:  The clinical significance of antenatal ultrasound diagnosis of the absent inferior cerebellar vermis (AICV), whether isolated or associated with other ultrasound findings, has not been well‐understood with limited research previously. Because of its association with some syndromes, e.g. Dandy–Walker or Walker–Warburg syndromes, we aim to study the outcome for the purpose of counseling of parents when this is diagnosed antenatally.

Methods:  A single‐center, prospective observational study of screening scans of a low risk population was conducted from 1 October 1996 to 30 September 2000. Cases of AICV diagnosed were followed up postnatally for up to 4 years with cranial ultrasound and developmental assessments.

Results:  There were 56 746 screening scans on 64 225 babies delivered during this period. Twenty‐eight cases of AICV were diagnosed between 19 and 34 weeks. Six had isolated AICV and all occurred in women less than 35 years old. All had normal outcome and developmental assessment on follow up. The other 22 were associated with other ultrasound findings like echogenic bowel, structural heart defects or Dandy–Walker malformation. Four of them occurred in mothers 35 years and older with three (75%) having abnormal karyotype. Five occurred in mothers aged 30–34 years with two (40%) having abnormal karyotype. Of the remaining 13 in those less than 30 years, five (38%) had abnormal karyotype. These include trisomy 13 and 18, Turner and Goldenhar syndrome.

Conclusion:  The antenatal diagnosis of the isolated AICV is associated with low risk of chromosomal abnormalities and thus, does not require further karyotypic analysis. However, if other ultrasound findings are also seen, an abnormal karyotype can be expected in up to 38% of the patients (in our series), and even more (75%) if the maternal age is 35 years and above. Karyotyping should be offered in these cases.
Gender‐adjusted multiples of the median in amniotic fluid alpha‐fetoprotein‐screening for neural‐tube defects halve false‐positive rate without affecting detection rate
Authors: Kozlowski P. , Knippel A. J. , Stressig R.
Published: March 2003

Introduction:  Previous studies have shown that fetal gender had influence on various pregnancy complications and prenatal diagnostic biochemical markers. We have evaluated, whether elevation of amniotic fluid alpha‐fetoprotein (AF‐AFP) is associated with fetal sex and whether a sex‐related difference can help to identify pregnancies with AFP‐associated malformations or poor pregnancy outcome.

Material and methods:  From our database, we obtained 6461 singleton gestations with absolute values and corresponding multiples of the median (MoM) for AF‐AFP for the period database April 1997–March 1999. In all instances high‐resolution ultrasonography was performed before amniocentesis to measure biparietal diameter. Patients with AF‐AFP ≥2 MoM were identified, details of pregnancy outcome were obtained and compared to matched‐pair‐controls having AF‐AFP <2 MoM.

Results:  A total of 262 patients showed AF‐AFP levels ≥2 MoM. Outcome information was available in 232 cases (88.6%) including all cases with fetal anomalies recorded at ultrasonographic examination. Of these fetuses significantly more had male gender (147 male fetuses vs. 85 female, P < 0005). Having a positive screen result in the risk of AFP‐associated malformations was significantly higher for female fetuses (25 female fetuses (29.4%) vs. 22 male fetuses (15%) with AFP‐associated malformations, P < 0025). Pregnancies with false positive AF‐AFP had a significantly higher risk for poor pregnancy outcome compared with pregnancies having normal AF‐AFP (11 fetal losses (59%) from 185 vs. two fetal losses (0.9%) from 232, P < 0025) but fetal gender had no significant influence.

Conclusions:  Measuring AF‐AFP routinely in amniotic fluid obtained for cytogenetic evaluation is a cheap method to identify fetuses, on which high‐resolution ultrasonography in a level 3 center should be focused. Adjusting the cut‐off MoM to 2.5 for male and to 2.0 for female fetuses halves the false‐positive rate from 3.4 to 1.7 without affecting the detection rate of 95% in our population. Larger studies are required to determine suitable sex‐adjusted cut‐off values.
Increased risk for prenatal asphyxia and death in fetuses with duodenal obstruction
Authors: Brantberg A. , Blaas H.‐G. K. , Salvesen K. Å. , Eik‐Nes S. H.
Published: March 2003

Purpose:  The aim of this study was to describe the outcome of a cohort of fetuses with duodenal obstruction diagnosed prenatally. Most previous studies are based on results from newborns and have shown a good outcome with a survival rate up to 95–100%.

Methods:  Fetuses with prenatally diagnosed duodenal obstruction were registered and prospectively evaluated at the NCFM from January 1985–December 2000.

Results:  Duodenal obstruction was found in 29 fetuses at mean 29 weeks and 2 days. Polyhydramnios was found in 24 (83%). Six (21%) had trisomy 21. Associated anomalies, including trisomy 21, were found in 18 cases (62%). Four pregnancies with normal karyotype ended with intrauterine fetal death at 31–35 gestational weeks. One of these had associated anomalies. In all cases, death occurred unexpectedly. Mean gestational age at delivery was 35 weeks and 5 days. Eighteen (64%) delivered prematurely. The mean birth weight was 2562 g. Four infants (14%) were small for gestational age. Three infants died postnatally; all three had associated anomalies. Two infants suffered from severe neurological impairment with cerebral palsy and epilepsy, and two suffered from psycho‐motoric impairment suggesting that these four might have had intrauterine asphyxia. Another fetus had sustained intrauterine bradycardia with subsequent emergency CS.

Conclusions:  The present study of 29 prenatally diagnosed duodenal obstructions showed a relatively poor outcome with four intrauterine deaths, three postnatal deaths and four infants with neurological sequele. The neurological sequele indicate possible intrauterine asphyxia. We suggest that there may also be a common reason for the cases of intrauterine fetal death as well as the case with bradycardia. We consider the possibility that it could be caused by bradycardia/asystolia following a vagal overactivity due to distension of the upper gastrointestinal tract.
Color Doppler in the assessment of cervical cancer
Authors: Testa Antonia , Ciampelli M. , Mastromarino C. , Lopez R. , Basso D. , Distefano M. , Poerio A. , Scambia G.
Published: March 2003

The treatment and prognosis of cervical cancer depends on the clinical stage based on the FIGO classification and the presence of lymph node metastases. Clinical staging of cervical cancer does not attain a good diagnostic performance, since it is incorrect in approximately one‐third of patients who undergo surgical staging. Magnetic resonance (MR) imaging resulted to be superior to clinical evaluation and computed tomography (CT) in parametrial evaluation and in the staging of uterine cervical carcinoma. Endoluminal ultrasound was introduced to analyse the cervix but no improvement in the diagnostic accuracy with respect to clinical staging was obtained. Color Doppler velocimetry was proposed as a non‐invasive tool in the examination of cervical cancer. Cervical cancers with detectable intratumoral blood flow were associated with larger size, invasion of parametrium, pelvic lymph node metastases and greater microvessel density. A ‘vascularity index’ resulted to be correlated with staging and lymph node metastases. The aims of our study were to assess color Doppler characteristics of 48 cervical cancers at different stages and to analyse the correlation between Doppler parameters and clinical–pathological features of the tumors. Three‐dimensional color power Doppler technique was used to investigate the vascular architecture of the neoplastic tissue. Three‐dimensional vascular images were compared to magnetic resonance results. The actual clinical application of the three‐dimensional vascular analysis in the evaluation of cervical cancers remains still to be defined.
Vascularity index of the testis: a guiding technique for testicular sperm extraction (TESE)
Authors: Har‐Toov J. , Eitan O. , Hauser R. , Butchan A. , Gull I. , Wolman I. , Yavez H. , Jaffa A. J.
Published: March 2003

Aim:  To develop a non‐invasive computerized technique that predicts the presence of spermatogenic sites within the testes of non‐obstructive azoospermic (NOA) patients.

Material and methods:  Power Doppler ultrasound images of the testes of seven NOA patients and six fertile men were acquired. Three sagittal, three transverse and one coronal cross‐sections of the testis were scanned by a linear 7.5 MHz transducer. Three‐dimensional (3D) matrix of 32 elements was generated from all images of each testis. Each element carried information (a vascularity index, VI) about the blood vessels that crossed its volume. The matrix (4 × 4 × 2) was divided into regions of 16 elements which were classified as ‘positive’, ‘negative’ and ‘undetermined’ according to the VI values in the anterior and posterior layers of a region. The NOA patients underwent testicular biopsies at three locations along the midline of the testis. The results of the biopsies were correlated to the appropriate regions in the 3D matrix.

Results:  Of the seven NOA patients, 12 testes were scanned, however, only 27 biopsies were performed. Accordingly, only 27 regions were considered. Thirteen regions were ‘positive’, 12 regions were ‘negative’, and two were ‘undetermined’. Motile spermatozoa were found in nine out of 12 ‘positive’ regions (69.2%). No sperm was found in 10 of the 12 ‘negative’ region (83.3%). In the control group of six patients, there were 12 testes, which divided into 36 regions. Twenty‐four regions were ‘negative’ (66.7%), one was ‘positive’ (2.7%) and 11 were ‘undetermined’ (30.6%).

Conclusion:  The results yielded that positive/negative region predict the presence or absence of spermatozoa, and thus, this method appears to be a promising non‐invasive guiding tool for TESE in NOA patients. TESE will be more effective, less biopsies will be needed, and testicular damage will significantly be lowered. However, this method is not suitable to identify spermatozoa in fertile men.
Factors associated with endometrial thickness and uterine size in a random sample of postmenopausal women
Authors: Gull B. E. , Karlsson B. , Milsom I. , Granberg S.
Published: March 2003

Objective:  To investigate factors possibly associated with endometrial thickness and uterine size in a random sample of postmenopausal women.

Study design:  A random sample (n = 1000) of the total population of women aged 45–80 years resident in the city of Göteborg was invited to attend for a transvaginal sonography examination. Eight hundred and twenty‐seven women accepted the invitation and underwent a gynecological and a transvaginal sonographic examination with measurement of endometrial thickness and uterine size. The women's height and weight were measured and a blood sample for analysis of serum estradiol and follicle stimulating hormone was taken. The women also provided information regarding previous medical and gynecological history, possible medication and smoking habits.

Results:  Five‐hundred and fifty‐nine women were postmenopausal and 183 of them were taking some form of hormonal substitution (33%). Factors associated with endometrial thickness and uterine size were analyzed using univariate and stepwise multiple regression analyses. The current use of hormone replacement treatment was the most important factor associated with both endometrial thickness and all the uterine size parameters studied. The presence of fibroids was also associated with endometrial thickness. Other factors shown to be associated with uterine size were age, parity, smoking, hypertension and diabetes mellitus.

Conclusions:  Several of the known risk factors for endometrial cancer were shown to be associated with endometrial thickness and uterine size parameters.
Uterine artery Doppler ultrasonography and pregnancy outcome in women with a history of early onset pre‐eclampsia and thrombophilia
Authors: Van Eyck J. , Arabin B. , Wibbens B.
Published: March 2003

Purpose:  To assess the relationship between persistence after 22 weeks' gestation of the notch in the uterine artery and pregnancy outcome in pregnant women with a history of early onset (<32 weeks) pre‐eclampsia, were tested for thrombophilia and subsequently received medication according to the disorder.

Methods:  Between 1995 and 2000, Doppler ultrasonography of both uterine arteries was performed between 18 and 24 weeks, in 80 pregnant women with a history of early onset pre‐eclampsia, were tested for thrombophilia. A total of 34 women had no thrombophilia and had received only low‐dose aspirin as from 12 weeks' gestation. Forty‐six women had thrombophilic disorders like: protein S deficiency (N = 10), APC‐resistance (N = 11), anticardiolipin antibodies (N = 15) and had received low‐dose aspirin as from 12 weeks gestation in combination with low‐molecular heparin as from 7 weeks' gestation. Seventeen women from this group of 46 women also suffered from hyperhomocysteinemia. Next to their treatment with folic acid and pyridoxin, they had received low‐dose aspirin as from 12 week gestation. Five women had a combination of two disorders and one woman had three disorders.

Results:  In 29 women with single hit thrombophilia (protein S deficiency, APC‐resistance or anticardiolipin antibodies), notches persisted in only one woman, who subsequently developed pre‐eclampsia (PE) at 31 weeks. Of the remaining 28 women, four developed PE at 31, 31, 35 and 39 weeks despite disappearance of notches. In 12 women with single hit hyperhomocysteinemia, notches persisted in three women, one of them developing PE at 33 weeks. From the remaining nine women, two developed PE at 31 and 35 weeks. In 34 women without thrombophilia, notches persisted in four, one of them developing PE at 36 weeks. From the remaining 30 women, 3 developed PE at 29, 29 and 38 weeks.

Conclusions:  The percentage of persistence of uterine notch in women with ‘treated’ thrombophilia is comparable to women without thrombophilia (11 vs. 12%), whereas recurrence rate of PE is, respectively, 19 and 12%. In both groups averaged gestational age at which PE developed was 3 weeks later than in the index pregnancy. Whether these observations can be contributed to the described medication is currently evaluated in a large prospective, randomized, multicenter study in The Netherlands (FRUIT study).
Accuracy of ultrasonographic determination of fetal weight at term among Filipinos
Authors: Vitug M. R. S. , Rivera R. P. , Clemente L. R.
Published: March 2003

Background:  The birth weight of an infant is one of the most important factors affecting its survival. Four computer‐generated formulas, Hadlock, Merz, Osaka and Shepard for weight estimation are in common use in our institution, but none of them has been devised specifically for Filipinos. It is the objective of the study to determine which among these formulas is accurate in diagnosing the fetus weighing 4000 g or more among Filipinos.

Methods:  The accuracy of in utero fetal weight estimations were evaluated prospectively in 74 Filipino patients during the study period. Sonographic estimate was performed by a single sonologist within 24–48 h of delivery. Estimates of fetal weight were calculated using the Hadlock, Merz, Osaka and Shepard. The newborn birth weight were measured within 30 min of delivery. The results were then compared with the actual birth weight.

Results:  Of the 74 patients seen, 62 patients were included. Eighteen (29%) had a birth weight less than 3000 g, 40 (65%) weighed between 3000 and 3999 g and six (10%) had a birth weight of 4000 g or more. When birth weight is less than 3000 g, Osaka and Merz conferred the same diagnostic accuracy but the former had a significantly higher negative predictive (88%). For birth weight ranging from 3000 to 3999 g, Hadlock had the highest diagnostic accuracy (100%). This report confirms that the best in utero weight estimations among fetuses weighing 4000 g or more result from the use of Shepard formula which has sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of 100%.

Conclusion:  Since the accuracy of Shepard formula in estimating fetal weight 4000 g or more is significantly better than those based on Hadlock, Merz and Osaka, we recommend the use of such formula in intrapartum fetal weight estimations among Filipinos. This estimated weights can offer guidance in predicting fetal macrosomia, and therefore, aid in obstetric management.
Does amniocentesis (AC) influence fetal growth?
Authors: Nguyen T. huu , Larsen T.
Published: March 2003

Purpose:  To examine the relationship between AC and birth weight.

Methods:  A cohort of singleton pregnancies with AC carried out in Denmark (n = 96893) was compared to the total population of singleton pregnancies without AC or CVS (chorionic villus sampling) (n = 873254) for infants born in years between 1980 and 1996. Exclusion criteria were multiple pregnancies, infants with malformations, chromosomal abnormalities, stillbirths, and death within the first living year. The pregnancies with AC were grouped according to gestational age (14–19th week of gestation) at the time of AC, and mean birth weight was calculated for each group. Maternal age, parity and previous abortions were taken into account when comparing mean birth weights. To exclude social status as a confounder, the overall mean birth weight (pregnancies without CVS or AC) was also compared to the mean birth weight of a subgroup of infants (also without CVS or AC) born to women who undergo AC in some other pregnancy.

Results:  The mean birth weight of the AC cohort was found to be significantly higher than that of the total population and inversely related to the gestational age at AC.

Conclusion:  The invasive procedure seems to stimulate growth. No known potential cofounders can explain the higher birth weight after pregnancies with AC.
Thromboelastography in the second trimester of pregnancy in the prediction of adverse pregnancy outcome
Authors: Karidas C. , Anastassopoulos P. , Perry D. , Economides D. L.
Published: March 2003

Thromboelastography (TEG) is a method of monitoring global homeostatic function as a dynamic process, involving the interaction between the protein coagulation cascade and platelets, as opposed to the isolated end points measured by conventional coagulation screens. The purpose of this study is to determine whether TEG variables can be used in the second trimester to predict the development of adverse pregnancy outcomes such as pre‐eclampsia and intrauterine growth restriction (IUGR defined as birth weight below the 5th centile for gestational age).

Methods:  A prospective study of a cohort of 273 pregnant women who underwent TEG assessment at 18–24 weeks gestation. Standard parameters were measured from each TEG tracing (R is the reaction time, K the clot formation time, A the angle, and MA the maximum amplitude). Pregnancy outcomes were obtained from the case notes of 251 participants. Twenty‐two patients were lost at follow up. The Mann–Whitney test was employed for analysis, as the above parameters did not follow normal distribution.

Results:  Twenty‐three pregnancies (9.2%) were complicated by IUGR and 10 (4%) by pre‐eclampsia. In the IUGR group, no significant difference was observed in any of the TEG parameters in comparison to the normal pregnancies (for R time: Mann–Whitney U = 2296, for K time: U = 2556, for MA: U = 2514.5, for A‐angle: U = 2433, 95% CI (1972, 3273)). Similarly, TEG parameters did not differ significantly in the pregnancies complicated by pre‐eclampsia (for R time: Mann–Whitney U = 971.5, for K time: U = 1063.5, for MA: U = 1199.5 and for A‐angle: U = 1183, 95% CI (765, 1646)). Comparisons after logarithmic transformation, did not reveal any significant differences between the two groups.

Conclusion:  Thromboelastography parameters in the second trimester of pregnancy did not differ in normally developed and complicated pregnancies. Therefore, they cannot be used as a single predictor of adverse pregnancy outcome. This is a pilot study, therefore, further studies are required to evaluate their use in conjunction with established predictive tests.
Transvaginal ultrasonography in detection of cervical incompetence
Authors: Podobnik M. , Podgajski M. , Gebauer B. , Ciglar S.
Published: March 2003

Background:  To examine the relationship between transvaginal ultrasound cervical changes and pregnancy outcome in women at risk of cervical incompetence and preterm delivery.

Methods:  In 100 pregnancies with clinical and ultrasonic signs of cervical incompetence, the length of the cervix, the thickness of the anterior wall of a lower uterine segment and the width of the endo‐cervical canal have been evaluated ultrasonically. These parameters were followed longitudinally from the 10 to 36 week gestation in the healthy pregnancies and pregnancies at risk for cervical incompetence and preterm delivery.

Results:  In patients from 10 to 14 weeks, the cervix is significantly longer than in the 25–36 week group and the anterior wall of the lower uterine segment in the 10–14 week group is significantly thicker than in the 20–36 week group. In pregnancies at risk for cervical incompetence, cervical lengths and wall thickness, were significantly different from those in comparable controls. Forty‐five percent of the patients in the at‐risk group, with cervical cerclage, delivered at 37.5 weeks and 8.5% of pregnancies ended in abortion when the amniotic membrane herniated into the cervical canal. The frequency of preterm delivery was 60, 38 and 15% for cervical length of <10, 10–20, and 20–30 mm.

Conclusions:  A shortened cervix with decreased thickness of the anterior wall of lower uterine segment and dilated endo‐cervical canal shows a strong association with cervical incompetence and preterm birth.
Ultrasound assessment of the cervix in recognizing preterm delivery
Authors: Brazert J. , Wender‐Ozegowska E. , Persona‐Sliwinska A. , Biczysko R.
Published: March 2003

Background:  Cervix is very important structure that separates the fetus from external environment, which we can visualize very precisely transvaginal ultrasonography. Sonographic examination allows visualization of the internal cervical os and the portion of the cervix that lies above the vaginal fornices, providing information that is inaccessible to digital examination. Cervical length in the pregnancy is one of the predictors of preterm delivery and diagnosis of cervical incompetence.

Materials and methods:  We have investigated 57 pregnant women: 20 diabetic pregnant women, 8 with hypertension, 14 with cervical incompetence, and 15 in uncomplicated pregnancy. Transvaginal sonography was used to measure cervical length between 20 and 30 weeks gestation. Ultrasound examination was performed using 2000 with 5.0 MHz transvaginal transducer. Maternal age ranged from 19 to 39 years (mean 27.2 ± 8.3). The following measurements were obtained: endo‐cervical canal length between the internal and external os, funneling of the cervix, funnel width, funnel length.

Results:  The mean endo‐cervical length measured in ultrasonography was 17.3 ± 5.2 mm in pregnancies delivered preterm (n = 7) and 33.4 ± 9.6 mm in pregnancies delivered at term (nP). The 11 pregnant women with cervical incompetence were treated with cervical cerclage, eight of them delivered at term and three preterm. The mean endo‐cervical length was 10.4 mm ± 3.0 and in all cases we observed funneling of the cervix in this group. Endo‐cervical length was 25 mm in 75% pregnant women, who delivered after 37 weeks of pregnancy. No significant relationships were shown between length of the cervix in pregnancy complicated by diabetes mellitus, hypertension and uncomplicated pregnancy. The mean endocervical length in diabetic pregnancy was 34.7 ± 4.7 mm; pregnancy with hypertension 32.9 ± 5.8 mm and uncomplicated pregnancy 35.6 ± 3.8 mm.

Conclusion:  Cervical length measured by ultrasonography between 20 and 30 week of pregnancy is very important predictor of preterm delivery. No significant relationships were shown between the length of the cervix and investigated pregnancy complications.
Prenatal diagnosis of ovarian cyst
Authors: Cha S. C. , Pares D.
Published: March 2003

Introduction:  The prenatal diagnosis of a fetal abdominal cyst raises the following possibilities: mesenteric cysts, obstructive uropathy with dilated ureter, intestinal duplication and ovarian cysts when the fetus is female. Ovarian cysts have been described in association with diabetes mellitus, alloimmunization and fetal hypothyroidism, but the etiology is often unknown. In normal pregnancies, the development of ovarian cysts has been attributed to hormonal stimuli due to immaturity of the neuro–endocrine axis. A possible mechanism involves gonadotropin elevation that stimulates fetal foliculogenesis and the development of cysts. Management is usually expectant since most cysts resolve spontaneously after birth. However, complications such as rupture or torsion of the cyst can lead to destruction of this organ. Drainage is indicated when the diameter is greater than 5 cm or there signs suggestive of internal hemorrhage, such as internal septa or echogenic debris. N.M.F., a 31‐year‐old, first pregnancy, had an ultrasound scan at 22‐weeks which showed no fetal abnormalities. At 30 weeks, repeat scan showed an abdominal cyst between the bladder and the right kidney measuring 4.3 cm × 4.2 cm × 3.8 cm in a female fetus. Two weeks later, it became larger (6.3 cm × 5.5 cm × 5.4 cm) and drainage was performed with aspiration of 50 mL of sero‐sanguineous fluid. Progesterone levels in the aspirated fluid were 17 000 ng/dL and estrogen levels, 1350 ng/dL; these findings confirmed the hypothesis that it was an ovarian cyst. This case highlights the need to perform follow up scans when a fetal abdominal cyst is diagnosed and the importance of intrauterine drainage as a diagnostic and therapeutic tool to preserve ovarian function.