bluuebunny/crossref_metadata_2025 huggingface dataset:
Vaginal ultrasound and cervical cerclage: a prospective study
Authors: Quinn M. J.
Published: March 2003

Vaginal ultrasound is a new technique for the objective assessment of the pregnant cervix. Twenty patients (21 pregnancies) were scanned at regular intervals throughout pregnancy after cervical cerclage by the vaginal route. Patients were recruited in 2 consecutive years in each of two centers with a low incidence of cervical cerclage (less than 0.5% of all pregnancies). Cervical cerclage, using Mersilene tape inserted by anterior and posterior incisions, positioned the cervical suture in the middle third of the cervical canal in all procedures (21/21). Ultrasound features including dilatation of the internal cervical os and herniation of the gestational sac to the level of the cervical suture were detected in 4/21 pregnancies at 5–7 weeks prior to delivery (21–33 weeks). Six patients (6/21) delivered preterm (< 37 weeks) without ultrasound features associated with cervical incompetence. Eleven patients (11/21) had a closed internal cervical os throughout pregnancy that remained closed after removal of the cervical suture at 38 weeks. In this study ultrasound features associated with cervical incompetence had a sensitivity of 40% and a specificity of 100% in the prediction of preterm pregnancy loss in this group of patients undergoing cerclage. Vaginal ultrasound is a simple, non‐invasive technique that permits the detection of ultrasound features associated with cervical incompetence during pregnancy in patients who have had prophylactic cervical cerclage at 14–16 weeks' gestation. Ultrasound features associated with cervical incompetence were rare in this group of patients (4/21 from an overall obstetric population of 8000 deliveries) indicating a prevalence of cervical incompetence in the range of 1 : 1000–1 : 2000 deliveries. In the majority of patients undergoing cerclage (11/21) the clinical diagnosis of ‘cervical incompetence’ was incorrect as shown by the detection of a normal cervical canal following removal of the suture at 38 weeks. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Perforation of the uterus by an invasive mole using color Doppler ultrasound: case report
Authors: Chau M. T. , Ghan F. Y. , Pun T. C. , Leong L.
Published: March 2003

A case of invasive mole is presented. The diagnosis made using transabdominal color Doppler ultrasound was confirmed by the subsequent surgical removal of a large tumor. The authors suggest that the use of transabdominal color Doppler ultrasound shows encouraging promise in such cases and should be considered in addition to pelvic arteriograms. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound screening during pregnancy: psychological strain experienced by the investigating staff
Authors: Ursing I. , Jorgensen C.
Published: March 2003

Ultrasound screening during pregnancy in Sweden is mostly performed by midwives. Detection of abnormalities may lead to psychological stress in the pregnant woman as well as the sonographer. In order to evaluate the emotional reactions of the staff, 95 midwives participated in an inquiry. From the results, it is obvious that the midwives experienced strong and overwhelming emotions. There was no organization for feedback for 50% of the midwives and 33% did not feel that they had enough support. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Excess concepti compared with number of embryos transferred in in vitro fertilization
Authors: Tan S. L. , Curson R. , El Hussein E. , Rainsbury P. , Parsons J.
Published: March 2003

To reduce the risk of multiple pregnancy, most in vitro fertilization programs limit the number of embryos transferred; because monozygotic twinning may occur, it is possible that more concepti are produced than the number of embryos transferred. To quantify the prevalence of this phenomenon, 1820 clinical pregnancies generated from 11 601 in vitro fertilization treatment cycles were reviewed. Two patients conceived four fetuses each after having had three embryos transferred, while one conceived three fetuses after having had two embryos transferred. The overall prevalence rate was, therefore, one in 607 cases. The obstetric details of these three pregnancies are reported. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Stage I ovarian cancer by transvaginal color Doppler sonography: a report of 18 cases
Authors: Kurjak A. , Shalan H. , Matijevic R. , Predanic M. , Kupesic‐Urek S.
Published: March 2003

A total of 18 cases with ovarian carcinoma stage I (15 stage Ia and three stage Ib) were studied retrospectively to evaluate the efficiency of transvaginal color Doppler sonography in detecting the disease in its early stages. Four asymptomatic women (two cases with morphologically normal ovaries, and two with simple unilocular cysts) were found during the screening program. These cases would have been missed without the use of transvaginal color Doppler sonography. One ovary with stage Ia, and another ovary in a case with stage Ib ovarian cancer were missed. These data show the ability of transvaginal color Doppler sonography to detect ovarian cancer as early as stage I even in asymptomatic women as well as in the morphologically normal ovary. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal ultrasound diagnosis of twin reversed arterial perfusion syndrome at 9 weeks' gestation
Authors: Zucchini S. , Borghesani F. , Soffriti G. , Chirico C. , Vultaggio E. , Di Donato P.
Published: March 2003

Diagnosis of twin reversed arterial perfusion syndrome was made using transvaginal sonography at 9 weeks' gestation. The morphological evaluation of the abnormal twin revealed a dysmorphic cephalic pole and absence of the upper extremities. There was diffuse subcutaneous edema and no detectable cardiac activity. The other twin had a normal appearance and a size compatible with the gestational age. The fetuses were divided by a thin amniotic membrane with normal amniotic fluid in both sacs. Diagnosis was confirmed by demonstrating fetal growth and lower limb activity in the abnormal twin 10 days later. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Doppler flow velocity waveforms in late first‐ and early second‐trimester fetuses: reproducibility of waveform recordings
Authors: Huisman T. W. A. , Stewart P. A. , Stijnen T. , Wladimiroff J. W.
Published: March 2003

The objective of the study was to assess the reproducibility of Doppler flow measurements of the fetal umbilical vein and artery, descending and ascending aorta, mitral and tricuspid valve, pulmonary artery, inferior vena cava and ductus venosus in early pregnancy.

In a cross‐sectional study, Doppler measurements were obtained in a total of 54 women at 11–16 weeks of gestation, at 2–5 different vascular sites, on 3–5 different occasions, at 5‐min time intervals. The total variance in the various flow velocity parameters was partitioned in a between‐subject and within‐subject component by analysis of variance, and, from these calculations, coefficients of variation in waveform recording were calculated.

Flow velocity waveform recording was characterized by coefficients of variation in the range 2.2–5.7% except for the acceleration time (18.6–24.5%) and percentage reverse flow (8.8%).

In conclusion, our data suggest that fetal flow velocity waveforms in early pregnancy demonstrate good reproducibility in the individual subject, while all parameters depict larger variabilities for between‐subject values. Acceleration time turned out to be poorly reproducible. If a single flow velocity waveform measurement is used for the future evaluation of clinical conditions in early pregnancy, one has to consider that normal values will display a rather wide range. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Development of the Eagle—Barrett (prune belly) syndrome and a thickened, poorly functional bladder wall after early second‐trimester decompression of feta1 megacystis
Authors: Finley B. E. , Bennett T. L. , Burlbaw J. , Levitch L.
Published: March 2003

The management of bladder outlet obstruction in the fetus remains a debated issue. Recent data suggest the use of cystocentesis for the possible relief of the bladder neck obstruction or for the opening of posterior urethral valves. This case report adds further support for the use of cystocentesis and observation prior to the placement of an indwelling bladder shunt. The case further demonstrates that relief of the megacystis may not prevent prune belly syndrome, bladder dysfunction or renal damage. Finally, the case demonstrates that severe oligohydramnios in the second trimester need not invariably result in pulmonary hypoplasia. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Life without amniocentesis: elevated maternal serum α‐fetoprotein in the Manitoba program 1986–91
Authors: Kyle P. M. , Harman C. R. , Evans J. A. , MacDonald K. , Menticoglou S. M. , Manning F. A. , Chodirker B. N.
Published: March 2003

Pregnant women demonstrating an elevated maternal serum α‐fetoprotein level are at increased risk for fetal neural tube defect or other anomaly. Diagnostic procedures to evaluate these pregnancies include high‐resolution ultrasound and amniocentesis to measure amniotic fluid levels of α‐fetoprotein and N‐acetylcholinesterase. We wished to examine the efficacy of detailed ultrasound examination alone, in evaluation of women with ‘unexplained’ elevation of maternal serum α‐fetoprotein. The results showed that no neural tube defects were missed in the assessment of 1325 pregnancies with a raised level of maternal serum α‐fetoprotein over 6 years, despite complete reliance on ultrasound in 98%. Detailed fetal ultrasound evaluation by experienced personnel is adequate to identify all cases of neural tube defects in a selected high‐risk population. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
A novel technique for measuring bladder wall thickness in women using transvaginal ultrasound
Authors: Khullar V. , Salvatore S. , Cardozo L. , Bourne T. H. , Abbott D. , Kelleher C.
Published: March 2003

A new technique of measuring bladder wall thickness using transvaginal ultrasound is described. Measurement of the bladder wall using ultrasound was found to have a good intra‐ and interobserver reproducibility. Measurements of the bladder wall thickness were altered if more than 50 ml of fluid was within the bladder. Forty‐five women with urinary symptoms were recruited from the urodynamic clinic; those with urodynamically diagnosed detrusor instability were found to have significantly thicker bladder walls than women with urodynamically diagnosed genuine stress incontinence. Application of this technique may be useful in the diagnosis of detrusor instability. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonography of the internal genital organs in postmenopausal women on low‐dose estrogen treatment
Authors: Bakos O. , Smith P. , Heimer G. , Ulmsten U.
Published: March 2003

Thirty healthy postmenopausal women with symptoms and signs of atrophic vaginitis due to estrogen deficiency were examined with transvaginal ultrasound. The endometrial thickness, the uterus and the ovaries were measured before and after 6 months of treatment with a low dose of estradiol released from a vaginal ring. The mean endometrial thickness, before and after the treatment, was 2.9 mm and 2.5 mm, respectively. There were no changes in endometrial volume or uterine thickness and volume during the treatment period. The mean volume of the postmenopausal ovary before treatment was 4.2 ml, and there was no difference after treatment or between the right and the left side. With a low dose of estradiol, administered locally, all the women were relieved from their deficiency symptoms, without any effect on the endometrium, the uterus or the ovaries when measured by transvaginal ultrasound.
The role of Doppler velocimetry in the structurally normal second‐trimester fetus with elevated levels of maternal serum α‐fetoprotein
Authors: Bromley B. , Frigoletto F. D. , Harlow B. L. , Pauker S. , Benacerraf B. R.
Published: March 2003

Umbilical and uterine artery velocimetry was performed in 199 second‐trimester pregnancies undergoing sonographic examination for unexplained elevated levels of maternal serum α‐fetoprotein in order to evaluate the efficacy of Doppler waveforms for the prediction of adverse perinatal outcome.

A total of 169 pregnancies resulted in term deliveries of infants with appropriate growth for age, and 30 pregnancies (15%) had adverse outcomes, including preterm delivery, growth retardation and death. The umbilical artery systolic/diastolic ratio was not statistically different in the two groups (3.9 vs. 4.2, p = 0.16). The uterine artery systolic/diastolic ratio was slightly greater in the group with abnormal outcome (5.7) than in the group with normal outcome (3.3), but the difference was not significant (p = 0.11).

Forty‐six patients had uterine artery waveforms that exhibited an early diastolic notch. Of these, 31 had a grade 1 notch in which the lowest part of the notch was not greater than one half of the diastolic frequency shift. Fifteen patients had a severe or grade II notch in which the deepest part of the diastolic notch was less than half of the diastolic flow.

In patients with either no diastolic or grade I uterine artery notch, the incidence of adverse outcomes was 23/184 (12.5%). In patients with a grade II notch, 7/15 (47%) had a poor outcome. The rate of adverse outcome in patients with a grade II notch was more than three times that observed in women without severe uterine notch, yielding a relative risk of 3.4 (95% CI 1.9–6.0). Thus, the presence of a grade II uterine artery notch on second‐trimester sonographic evaluation is associated with an increased risk for adverse perinatal outcome over unexplained elevated levels of maternal serum α‐fetoprotein. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Perineal bladder neck ultrasound: appearances before and after continence surgery
Authors: Creighton S. M. , Clark A. , Pearce J. M. , Stanton S. L.
Published: March 2003

An objective method of quantifying suture tension during bladder neck elevation for genuine stress incontinence has long been sought. Perineal ultrasonography has been used to measure bladder neck position and excursion in continent and incontinent women. This study used perineal ultrasound findings to determine surgical positioning of the bladder neck and predict outcome. Eighteen asymptomatic controls and 72 women with genuine stress incontinence were studied before and after continence surgery. Perineal ultrasonography was used to plot bladder neck position at rest and on maximum Valsalva maneuver on an x, y co‐ordinate system to allow comparison between groups. Logistic regression analysis was then performed to derive an equation for the likelihood of continence. In both pre‐and postoperative analysis, the best correlation with continence was achieved with the use of the patient's age and the distance of the bladder neck resting position measured along the x‐axis. An equation was derived to give the probability of continence. The equation is easily calculated using a pocket calculator. The distance of the bladder neck along the x‐axis is under the direct control of the surgeon, so the patient's age can be put into the equation and the distance along the x‐axis most likely to make the patient continent can be calculated. This can be done during surgery to provide an objective method for evaluating suture tension. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Fifth digit measurement in normal pregnancies: a potential sonographic sign of Down's syndrome
Authors: Goldstein I. , Gomez K. , Copel J. A.
Published: March 2003

The objective of the study was to obtain measurements of the fetal fifth finger, as a basis for further studies and for future comparison with fetuses with Down's syndrome. The study group included 173 karyotypically normal fetuses at 15–23 weeks' gestation. Routine biometric measurements were obtained on all, including biparietal diameter (BPD), femoral length (FL) and humeral length (HL), and the length of the fetal fifth finger. Linear growth of the fifth finger was observed across the range of gestational ages (GA), and a linear correlation was shown to exist between the length of the fifth finger and gestational age (y = −7.804 + 0.9079 × GA; r = 0.923; p < 0.0001), biparietal diameter (y = −3.7010 + 0.3043 × BPD; r = 0.913; p < 0.0001), femoral length (y = −0.0983 + 0.3406 × FL; r = 0.926; p < 0.0001), and humeral length (y = −1.3453 + 0.3982 × HL; r = 0.929; p < 0.0001). These results provide normative data of the length of the fetal fifth finger across a range of gestational ages. These data may provide an additional screening parameter for the prenatal detection of Down's syndrome. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Continuous wave Doppler velocimetry of the main‐stem uterine arteries: the transvaginal approach
Authors: Weissman A. , Jaffa A. J. , Lurie S. , Har‐Toov J. , Peyser M. R.
Published: March 2003

The purpose of the study was (1) to establish the efficacy of the transvaginal approach for continuous wave Doppler velocimetry of the main‐stem uterine arteries in normal pregnancy and (2) to provide reference values for the flow velocity waveform indices of the main‐stem uterine arteries in normal pregnancy. In a cross‐sectional study from 16 to 40 weeks of pregnancy, 201 healthy normal women were examined by transvaginal continuous wave Doppler, and flow velocity waveforms were obtained from the main branch of the uterine artery on both sides. Nomograms were compiled for the systolic : diastolic ratio, pulsatility index and resistance index. Values for all variables declined during the course of pregnancy until 22 weeks' gestation, and then remained stable to term. Intra‐ and interobserver variations were 5% and 8%, respectively, and the examination time was < 5 min. Flow velocity waveform indices declined during pregnancy, indicating a decrease of resistance in the uteroplacental circulation. Our results are comparable to those obtained transvaginally by pulsed wave Doppler, previously reported in the literature, The transvaginal approach for continuous wave Doppler velocimetry of the main‐stem uterine arteries is a simple, quick, accurate, safe, cheap and highly reproducible method, and is therefore suitable for evaluating the uteroplacental circulation. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Differentiation between adenomyoma and leiomyoma with transvaginal ultrasonography
Authors: Huang R.‐T. , Chou C.‐Y. , Chang C.‐H. , Yu C.‐H. , Huang S.‐C. , Yao B.‐L.
Published: March 2003

The clinical utility of transvaginal ultrasonography in the differentiation of adenomyoma from leiomyoma was evaluated in 147 patients who had been scheduled for surgery due to symptomatic uterine masses. In all subjects, ultrasonographic images obtained preoperatively were correlated postoperatively with surgicopathological findings. Pathological findings showed that 110 patients proved to have fibroids, while 30 had adenomyomata. For the diagnosis of adenomyoma, transvaginal ultrasonography attained a sensitivity of 80%, a specificity of 94.3%, a positive predictive value of 85.7% and a negative predictive value of 90.9%, compared with a sensitivity of 94.3%, a specificity of 80%, a positive predictive value of 90.9% and a negative predictive value of 85.7(H) for leiomyoma diagnosis.

Further to assess which characteristic used in ultrasonography was useful in the differential diagnosis, five characteristics were analyzed and compared by χ² test. These were position, number, margin and echogenicity of the uterine masses and the presence or absence of hypoechoic spaces (lacunae). Margin, echogenicity, mass number and lacunae were significantly different between both conditions. A stepwise logistic regression procedure revealed that margin, lacunae and echogenicity were good parameters for differentiating adenomyoma from leiomyoma. If we selected the features of distinct margin and absence of hypoechoic lacunae within the masses for analysis, leiomyoma could be correctly predicted in 97% of patients. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Trisomy 18: first‐trimester nuchal translucency with pathological correlation
Authors: Jackson S. , Porter H. , Vyas S.
Published: March 2003

Diagnosis of trisomy 18 was made following prenatal screening at 11 weeks' gestation for ultrasonographically detected nuchal translucency and subsequent chorionic villus sampling. An intact fetus was therapeutically aborted and pathological examination was undertaken. We conclude that, although the etiology of nuchal translucency remains unclear, it does not appear to be lymphatic or cardiac in origin. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of a congenital astrocytoma: a case report and literature review
Authors: Heckel S. , Favre R. , Gasser B. , Christmann D.
Published: March 2003

Congenital intracranial tumors are very rare. We report an endovaginal ultrasonographic diagnosis of an anaplastic astrocytoma at 31 weeks' gestation. Other means, such as antenatal magnetic resonance imaging and fetal blood sampling were not shown to have any diagnostic advantage. A detailed literature review of the topic is provided. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound evaluation of the length of the fetal nasal bones throughout gestation
Authors: Guis F. , Ville Y. , Vincent Y. , Doumerc S. , Pons J. C. , Frydman R.
Published: March 2003

Subtle facial abnormalities, including smallness of the nose, are common findings in trisomy 21 and numerous other genetic conditions. The aim of this study was to construct a normal range for the length of the fetal nasal bones with gestation in a Caucasian population. Ultrasound measurements were performed on a strictly mid‐sagittal profile in 376 normal singleton fetuses at 14–34 (mean 24) weeks' gestation. It was found that the length of the nasal bones increased from 4 mm at 14 weeks to 12 mm at 35 weeks' gestation, and that there was a linear relationship between the length of these bones and biparietal diameter and femur length. We conclude that the length of nasal bones can easily be measured in fetuses at 14–34 weeks' gestation and that such measurements might prove useful in the evaluation of pregnancies at high risk for associated fetal abnormalities. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Centile‐based ultrasound morphometric tables
Authors: Lauria M. R. , Zador I. E. , Bottoms S. F.
Published: March 2003

Current ultrasound morphometric tables estimate centiles assuming normal distribution and similar variation throughout gestation. Our goal was to develop normative tables for biparietal diameter, femur length and average abdominal diameter using actual centiles. We studied the last complete ultrasound examination from 9510 singleton, live pregnancies without major malformations delivered at our hospital. Actual 5th, 10th, 50th, 90th and 95th centiles were calculated for each week and compared to estimates based on means and standard deviations.

With advancing gestational age, variation in average abdominal diameter increased and variation in biparietal diameter and femur length remained stable. The largest difference between an actual and an estimated centile limit was 2 mm for biparietal diameter or femur length and 3 mm for average abdominal diameter. Differences between true and estimated centile limits were less than the intraobserver variation of the ultrasound measurements and therefore clinically unimportant. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Effects of thyrotropin releasing hormone on cardiac and extracardiac flows of appropriately grown and growth‐retarded fetuses
Authors: Rizzo G. , Capponi A. , Rinaldo D. , Arduini D. , Romanini C.
Published: March 2003

The objective of this study was to establish the effect of thyrotropin releasing hormone on the fetal circulation of appropriately grown and growth‐retarded fetuses. Doppler recordings were performed immediately before and 15 min after maternal administration of 400 µg of thyrotropin releasing hormone in 14 women with appropriately grown and 19 with growth‐retarded fetuses. Furthermore, in six women with growth‐retarded fetuses, serial recordings were performed at 2‐hourly intervals for 8 h until a second thyro tropin releasing hormone dose was administered. Velocity waveforms were recorded from the outflow tracts, inferior vena cava, umbilical artery, middle cerebral artery and descending aorta, and different Doppler indices calculated. In appropriately grown fetuses, thyrotropin releasing hormone induced a significant increase of peak systolic velocity values in the aorta and pulmonary artery and an increase of Doppler‐estimated cardiac output. In growth‐retarded fetuses, these changes were more evident and associated with a significant decrease in reverse flow in the inferior vena cava during atria1 contraction. No changes were observed in fetal heart rate or in the other fetal vessels investigated. In the growth‐retarded fetuses followed longitudinally, these changes were evident for the following 8 h and were potentiated by the second thyrotropin releasing hormone administration. In conclusion, thyrotropin releasing hormone induces significant hemodynamic effects on the fetal heart that may temporarily improve the impaired cardiac function of growth‐retarded fetuses. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
B‐mode color sonographic images in obstetrics and gynecology: preliminary report
Authors: Dambrosio F. , Amy D. , Colombo A.
Published: March 2003

The standard B‐mode image shows 256 levels of gray, but the human eye can only differentiate 8–16 shades of gray. Color vision theoretically has several advantages in comparison with gray scale, because the human eye can distinguish 128 fully saturated hues and about 350 000 shades. In 1992, B‐mode color maps were introduced in our clinical practice, to establish whether this technology was able to detect the smallest contrast differences better than the gray‐scale map and therefore to increase diagnostic accuracy. This paper describes our experience with the technique and reports B‐mode color images of clinical complications in obstetrics and gynecology. We use the color figures to illustrate this new technology and to demonstrate the advantages of the increased sensitivity of the human eye to color in different clinical situations. We conclude that the use of B‐mode color maps does not change the ultrasonic diagnosis, but does enhance our ability to study and evaluate the morphological structure of different tissues, compared to the gray‐scale map alone. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Fetal exomphalos and chromosomal defects: relationship to maternal age and gestation
Authors: Snijders R. J. M. , Sebire N. J. , Souka A. , Santiago C. , Nicolaides K. H.
Published: March 2003

In an ultrasound screening study involving 15 726 viable, singleton pregnancies at 11–14 weeks of gestation, exomphalos was diagnosed in 0.11% of the cases and, in those with exomphalos, the frequency of trisomy 18, trisomy 13 or triploidy was 61%. The corresponding frequencies of exomphalos of fetuses with these chromosomal defects were 22.5%, 9.1% and 12.5%, respectively. The median maternal age of the screened population was 33 (range 15–48) years, which is higher than in all pregnancies in England and Wales. Expected prevalences of trisomy 18, trisomy 13 and triploidy in the total population were derived on the basis of the age distribution of all deliveries in England and Wales and maternal and gestational age‐specific risks for these chromosomal defects. From these numbers and the observed frequencies of exomphalos in association with the various chromosomal defects, it was estimated that the prevalence of exomphalos in a population with the maternal age distribution of all deliveries in England and Wales was 7.4 per 10 000 at 12 weeks of gestation, and this decreased to 3.5 at 20 weeks and 2.9 in live births. The estimated frequency of chromosomal defects in fetuses with exomphalos decreased from 39.4% at 12 weeks of gestation to 27.5% at 20 weeks and 14.4% in live births. The prevalence of chromosomal defects in 153 fetuses with exomphalos referred to our center at 16–26 (median 20) weeks of gestation was not significantly different from that predicted in an unselected population. However, the reported frequency of chromosomal defects in a total of 299 neonates with exomphalos (9.3%) was significantly lower than expected in an unselected population. This study demonstrates that the prevalence of a fetal abnormality and the frequency of associated chromosomal defects depends on the maternal age and gestational age distributions of the populations examined. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Uterine flow velocity waveform shape as an indicator of maternal and placental development failure mechanisms: a model‐based synthesizing approach
Authors: Talbert D. G.
Published: March 2003

High pulsatility indices ( PIs) and/or notches on the Doppler flow velocity waveforms of the uterine artery have been interpreted as indications of high placental flow impedance, and are known to be associated with poor fetal outcome. A software model of the uteroplacental blood path and its use to investigate possible interactions within the uteroplacental unit in more detail are described.

Increasing transcotyledonary resistance to represent intervillous obstruction raised the cotyledonary core pressure and spiral artery PI. Increased spiral artery flow resistance, representing failed spiral artery invasion, reduced the cotyledonary core pressure and reduced the spiral artery PI. In vivo, such changes in cotyledonary core pressure would modify the transplacental water balance, promoting oligohydramnios for spiral artery invasion failure and polyhydramnios for villous obstruction. Both mechanisms increased the uterine and arcuate PI, but failed to produce a notch.

It was found that notch formation depended on terms representing increased compliance (distensibility) of the uterine and/or arcuate artery walls, which have no direct effect on uteroplacental mean flow. The same mechanism steepened and increased uterine artery peak systolic flow, contributing to increased PI.

The notch phenomenon seems to be an indicator of abnormal maternal artery wall status, independent of placental obstructive mechanisms, which can mask obstructive PI changes. Computer analysis of the frequency index profile should allow separation. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
In utero sonographic diagnosis of vesicoureteral reflux by percutaneous vesicoinfusion
Authors: Quintero R. A. , Johnson M. P. , Arias F. , Cortez K. , Carreño C. , Romero R. , Evans M. I.
Published: March 2003

Vesicoureteral reflux affects approximately 1% of newborns. Although most affected children show only sonographic evidence of renal pelvic dilatation, others may show overt hydronephrosis, indistinguishable from that seen in fetuses with obstructive uropathy. Hydronephrosis secondary to fetal vesicoureteral reflux cannot be differentiated on ultrasound examination from that resulting from lower obstructive uropathy with or without reflux. As renal damage from vesicoureteral reflux may occur in up to 70% of cases, early identification and possible in utero treatment of these fetuses may be warranted. We report a sonographic technique, vesicoinfusion, for diagnosis of vesicoureteric reflux in utero. The accurate identification of vesicoureteral reflux in utero may have important diagnostic, prognostic and therapeutic implications. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Transcervical chorionic villus sampling beyond 12 weeks of gestation
Authors: Borrell A. , Costa D. , Delgado R. D. , Fuster J. J. , Soler A. , Cararach J. , Fortuny A.
Published: March 2003

The aim of this study was to evaluate the feasibility of transcervical chorionic villus sampling (CVS) after 12 completed weeks of pregnancy. The transcervical route for CVS, using thin biopsy forceps, was accomplished in 335 procedures in the study group, between 22 + 1 and 15 + 0 weeks. Cases were subdivided into two subgroups, the late (13 + 0 to 15 + 0 weeks) and intermediate (12 + 1 and 12 + 6 weeks) subgroups, and the results were compared with a previous series of 1202 early (8 + O−12 + 0 weeks) transcervical CVS.

A successful diagnosis was made in 97.3% of the cases. No differences were found in diagnostic success between the study subgroups, in comparison to the early transcervical CVS series. However, success rates in the study group increased from 90% in the first 60 procedures to 98.9% in the remaining cases (p < 0.001). Amniocentesis was eventually performed in nine cases (2.7%). All cases were rescanned 2 weeks after the procedure, and fetal demise was detected in five cases (1.5%). The spontaneous fetal loss rate up to 28 weeks was 3.1% (2.7% for intermediate and 4.0% for late subgroups). No cases of transverse limb reduction defects were observed.

The results of our study suggest that the transcervical route for CVS beyond the 12th week of pregnancy has a satisfactory diagnostic success rate, and an acceptable pregnancy loss rate. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonography vs. hysteroscopy in the preoperative staging of endometrial carcinoma
Authors: Gabrielli S. , Marabini A. , Bevini M. , Linsalata I. , Falco P. , Milano V. , Zantedeschi B. , Bovicelli A. , Stagnozzi R. , Cacciatore B. , Gubbini G. , Bovicelli L.
Published: March 2003

The aim of this study was to evaluate the diagnostic accuracy of transvaginal sonography vs. hysteroscopy in the preoperative staging of endometrial carcinoma, in order to establish the most appropriate surgical therapy. Transvaginal sonography and hysteroscopy were used preoperatively in 67 women with histologically proven endometrial carcinoma.

Deep myometrial invasion (> 50%) was present at post‐operative pathology in 26/67 (39%) women and spread to the cervix occurred in 1 l/67 (14%) women. Transvaginal sonographic examination was initially directed at assessing myometrial invasion, which was correctly predicted in 52/67 (78%) women. Transvaginal sonography demonstrated a sensitivity of 88% (23/26) and a specificity of 71% (29/41) for deep invasion, with a positive predictive d p value (PPV) of 66% (23/35) and a negative predictive value (NPV) of 91% (29/32).

The accuracy of transvaginal sonography in detecting cervical involvement was 82% (55/67), and that of hysteroscopy was 72% (48/67): transvaginal sonography was slightly less sensitive (54% vs. 64%), but more specific (87% vs. 73%) than hysteroscopy. When cervical invasion was present, the PPVs of transvaginal sonography and hysteroscopy were 46% (6/13) and 32% (7/22), respectively, while the NPV was 91% for both techniques (49/54; 41/45). Our data show that the accuracy of transvaginal sonography was comparable with that of hysteroscopy in detecting cervical involvement. Therefore, in the majority of cases, when both techniques showed that disease was limited, the appropriately limited type of surgery would be performed. Conversely, detection of a myometrial invasion of B 50% or an extension to the cervix would lead to an unnecessarily extensive operation if this was the sole criterion used for making the decision. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of left ventricular aneurysm in the late second trimester: a case report
Authors: Sherman S. J. , Leenhouts K. H. , Utter G. O. , Litaker M. , Lawson P.
Published: March 2003

Fetal echocardiography in a 24‐year‐old woman at 24 weeks' gestation: demonstrated a left ventricular aneurysm and pericardial effusion. The patient was treated with oral digoxin followed by intensive antepartum monitoring. Intrauterine fetal demise occurred at 31 weeks. The autopsy confirmed the presence of an apical left ventricular aneurysm. This is a rare congenital cardiac anomaly, which has been reported in only three prior cases. This represents the earliest prenatal diagnosis of this condition. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal uterine and umbilical artery Doppler examination of 12–16 weeks and the subsequent development of pre‐eclampsia and intrauterine growth retardation
Authors: Harrington K. , Goldfrad C. , Carpenter R. G. , Campbell S.
Published: March 2003

We aimed to determine whether Doppler measurements obtained from the uterine and umbilical arteries in early pregnancy correlate with the subsequent development of pre‐eclampsia, or the delivery of a small‐for‐gestational‐age (SGA) baby. A follow‐up study was carried out in 652 women with singleton pregnancies who had transvaginal uterine and umbilical artery Doppler examinations performed at 12–l6 weeks' gestation. Measurements included: the presence or absence of an early diastolic notch, vessel diameter, resistance index (RI), pulsatility index (PI), time‐averaged mean velocity (TAV), maximum systolic velocity and volume flow in the right and left uterine arteries and RI and PI in the umbilical arteries. The main outcome measures were: intrauterine death, birth weight, pre‐eclampsia (proteinuric pregnancy‐induced hypertension, PPIH) and antepartum hemorrhage.

Twelve pregnancies terminated in the second trimester, and in 14 the outcome is unknown. In the remaining 626 women, 44 (7.0%) pregnancies ended in a premature delivery, 30 (4.7%) women developed PPIH, 60 (9.6%) infants were SGA (< 10th centile), of which 19 were < 5th centile and five were < 3rd centile, and 23 (3.7%) women suffered an antepartum hemorrhage. At 12–16 weeks, 205 (32.7%) women had bilateral (right and left) notching of the uterine artery waveforms. When compared to values from women with a normal pregnancy outcome, women who subsequently developed PPIH demonstrated a significant difference in mean uterine artery TAV (24.6 cm/s for PPIH vs. 33.25 cm/s for normal outcome, p < 0.003),volume flow (120.5 ml/min vs. 184.5 ml/min, p < 0.001) and elevated resistance (mean RI = 0.80 vs. 0.695, p < 0.001). In women with bilateral notching, there were significant differences between values for pregnancies with PPIH (odds ratio (OR) 42.02, 9.5% confidence interval(CI) 5.66, 311.99), being SGA at birth (OR: 8.61, 95% CI 4.0, 20.0) or delivering prematurely (OR 2.38, 95% CI 1.19,4.75), compared with pregnancies with a normal outcome.

We conclude that abnormal Doppler values, indicative of a failure to modify the uterine circulation in early pregnancy, are associated with premature delivery, the development of PPIH and the delivery of an SGA baby. This information may be of value in increasing our understanding of the pathophysiological events that lead to the subsequent development of uteroplacental complications such as pre‐eclampsia. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Cutaneous hemangioma of the thigh: prenatal diagnosis
Authors: Gonçalves L. F. , Pereira E. T. , Parente L. M. M. , Vitorello D. A. , Barbosa U. C. , Neto J. Abi Saab
Published: March 2003

We report a case of cutaneous hemangioma of the thigh detected by prenatal ultrasound. A hypoechoic homogeneous mass, filled with low‐density echoes, was visualized on the posterior aspect of the right thigh, close to the genital region, at 36 weeks. Low‐velocity arterial flow was detected within the mass by color and pulsed Doppler and the diagnosis of cutaneous hemangioma was suspected. No other anomalies were detected and the pregnancy evolved uneventfully to term. The prognosis and management of this condition are discussed. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Lethal congenital arthrogryposis presents with increased nuchal translucency at 10–14 weeks of gestation
Authors: Hyett J. , Noble P. , Sebire N. J. , Snijders R. , Nicolaides K. H.
Published: March 2003

This study examines the ultrasonographic features of congenital lethal arthrogryposis. In 27 cases of arthrogryposis diagnosed in the second and third trimesters there was severe bilateral talipes, fixed flexion deformities of the wrists and elbows and either fixed flexion or extension of the knees. In seven (26%) of the cases there was nuchal edema. In two fetuses with arthrogryposis that were examined at 13 weeks of gestation the nuchal translucency thickness was above the 99th centile of the normal range for crown‐rump length. In three other women with previously affected pregnancies, ultrasound examination at 10–14 weeks demonstrated normal fetal nuchal translucency thickness and none of these fetuses were subsequently found to have arthrogryposis. These findings suggest that lethal arthrogryposis, which is usually diagnosed by the demonstration of multiple joint contractures during the second or third trimester of pregnancy, may present as increased nuchal translucency thickness at 10–14 weeks of gestation. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Pulmonary venous blood flow in the human fetus
Authors: Paladini D. , Palmieri S. , Celentano E. , Guida F. , Salviati M. , Morra T. , Martinelli P.
Published: March 2003

The objective of this study was to assess the feasibility of recording pulmonary venous blood flow in the human fetus, and to evaluate its relationship with gestational age.

We studied 152 singleton pregnancies between the 19th and 40th weeks of gestation. One hundred and one cases were studied cross‐sectionally to gather data on color flow visualization, and 51 were studied longitudinally. The upper right pulmonary vein was interrogated by pulsed wave Doppler to assess pulmonary venous blood flow.

On color Doppler, the upper right pulmonary vein could be imaged in 89.6% of cases in the peri‐atria1 tract and in 75% of cases within the lung. The upper left pulmonary vein could only be imaged in 8% of cases close to the atrium and in 41% of cases within the lung. Reliable velocity waveforms were obtained in 91% of cases. The mean systolic peak velocity was 22.19 ± 6.39 cm/s and the mean diastolic peak velocity was 22.1 ± 6.35 cm/s. Both increased significantly with gestational age. Reversed end‐diastolic blood flow was present in 18% of cases, regardless of gestational age and fetal heart rate. Expressed as a percentage of the forward flow velocity time integral, its value was 7.65 ± 5.2 %.

Our data seem to confirm the presence of pulsatile pulmonary venous blood flow in the second‐ and third‐trimester fetus. Normative data have been established for the second and third trimesters of pregnancy. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Fetal anomalies: what is the diagnosis when the chromosomes are normal?
Authors: Gagnon A. L. , Wilson R. D.
Published: March 2003

A retrospective study of cases of fetal anomalies associated with a normal karyotype was conducted (1) to evaluate the accuracy of prenatal diagnosis; and (2) to assess two different tools to assist in determining the correct diagnosis.

A total of 201 charts were reviewed. The accuracy of the prenatal diagnosis was assessed subjectively by one physician. The London Dysmorphology Database and a locally developed non‐computerized tool (Appendix) were assessed retrospectively using 36 test cases.

The population studied presented a spectrum of 97 different groups of single (67%) or multiple (33 %) anomalies. The prenatal diagnosis was accurate in 57% of the cases. The two proposed tools generated an average of 146 and 15 different diagnoses, respectively and the correct one in 26 and 22 of the 36 test cases.

The two studied tools have the potential to generate a differential diagnosis in the presence of a fetal anomaly prior to and following normal karyotype analysis. The non‐computerized tool presents the advantages of listing antenatal features and creating a shorter differential diagnosis list with a minimal decrease in the identification rate of the correct diagnosis. Its use should be studied prospectively. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of otocephaly using two‐dimensional and three‐dimensional ultrasonography
Authors: Lin H.‐H. , Liang R.‐I. , Chang F.‐M. , Chang C.‐H. , Yu C.‐H. , Yang H.‐B.
Published: March 2003

We report a case of the prenatal diagnosis of a very rare anomaly, namely isolated otocephaly, using two‐dimensional and three‐dimensional ultrasound at 24 weeks of gestation. Two‐dimensional ultrasound revealed poly‐hydramnios, absence of a stomach shadow, hypotelorism and a proboscis‐like mass. Three‐dimensional ultrasound gave a precise demonstration of the striking craniofacial features of otocephaly including agnathia, synotia, microstomia and protuberance of the nose‐mouth fusion. The use of three‐dimensional ultrasound provided a whole view of the very rare lethal malformation in utero and contributed significantly to prenatal diagnosis. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Outcome of fetuses with isolated borderline unilateral ventriculomegaly diagnosed at mid‐gestation
Authors: Lipitz S. , Yagel S. , Malinger G. , Meizner I. , Zalel Y. , Achiron R.
Published: March 2003

Objective

To evaluate the outcome of fetuses with isolated borderline, unilateral ventriculomegaly.

Design

A retrospective survey was conducted at four perinatal centers in Israel.

Subjects and methods

Only fetuses with one ventricular width of ≥ 11 mm and the other < 10 mm were included in the study. In all cases, the difference of the ventricular width between the two ventricles was > 2.4 mm (two standard deviations). Fetuses with other malformations, chromosomal abnormalities, or those with evidence of in utero infection, were not included in the study.

Results

Unilateral ventriculomegaly was found in 27 subjects (after excluding one case with unilateral ventriculomegaly and Down's syndrome). The mean width of the enlarged ventricle was 11.7 ± 0.9 mm, while the other normal ventricle was 7.2 ± 0.9 mm. The mean gestational age at diagnosis of the unilateral ventriculomegaly was 23.6 ± 2.7 weeks. In one case, pregnancy was terminated, and pathological examination of the fetal brain failed to detect any structural abnormality. Twenty‐five patients delivered at term and only one at 34 weeks' gestation. The neurological development in all 25 fetuses was normal, and one fetus had petit mal seizures.

Conclusion

Fetuses with isolated, borderline unilateral ventriculomegaly, but without other abnormalities, have a good neurological outcome. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology