bluuebunny/crossref_metadata_2025 huggingface dataset:
Cyclothymia or Unstable Mood Disorder? A Systematic Treatment Evaluation with Valproic Acid
Authors: Verhoeven Willem M. A. , Tuinier Siegfried
Published: March 2003

Cyclic changes in behaviour and mood which do not meet the criteria for bipolar affective disorder have been reported in people with intellectual disability (ID) since the beginning of the twentieth century. The present study postulates a functional disturbance of unstable mood disorder in such cases of an episodic pattern of disturbed behaviour, mood and anxiety. Since symptoms of hypomania or major depression are not observed in these individuals, the unstable mood disorder cannot be regarded as being part of the bipolar spectrum, although it resembles cyclothymia in some aspects. In this pilot study, 28 subjects with ID were treated with valproic acid in dosages leading to a mean plasma concentration of 63 mg L−1. A marked and sustained improvement was achieved in 68% of subjects in terms of both behaviour stability, and a reduction of symptoms in the mood, anxiety and motor domains.
Quality of Life Outcomes for People with Intellectual Disabilities Living in Staffed Community Housing Services: a Stratified Random Sample of Statutory, Voluntary and Private Agency Provision
Authors: Perry Jonathan , Felce David
Published: March 2003

Background  Small scale, community‐based, staffed housing is a significant form of residential provision for people with intellectual disabilities. Such services are provided by health and local authorities, and voluntary and private agencies, yet little is known about how provision varies between provider sectors.

Methods  This study compared sectors in terms of the processes operating within residential services, and objectively and subjectively assessed quality of life (QOL) resident outcomes. Measures of setting structure and processes and resident outcomes were undertaken on a stratified random sample of 47 small scale, community‐based residential settings which accommodated a total of 154 people with intellectual disabilities.

Results  In general, provider agencies did not differ in terms of the characteristics of the residents they served, the structure of settings, the processes underlying service operation or resident outcomes. However, across agencies there was considerable variation in residents' life conditions when they were measured objectively. Better outcome tended to be significantly correlated with the ability of residents. This was not the case with results on subjective measures (which were also higher than those on objective measures).

Conclusions  The results reinforce the need to design services which effectively support people across the ability spectrum. Also, an argument is made for the continued utility of objective measurement in the assessment of service quality.
Patterns of Ageing in 30–35‐Year‐Olds with Down's Syndrome
Authors: Carr Janet
Published: March 2003

Background  A population sample with Down's syndrome has been studied repeatedly since infancy, and has now been followed up again at age 35 years.

Methods  Intelligence, language, reading and arithmetic were tested and daily living skills were assessed. Two memory tests, the Rivermead Behaviour Memory Test and Oliver and Crayton's Dementia Battery were given at age 30 years and again at age 35 years.

Results  Results from all the tests used showed little change from those found at 21 and/or 30 years. Small, statistically insignificant, increases in mean scores were found in reading and on the British Picture Vocabulary Scale. Means of all other measures had declined, also by small and statistically insignificant amounts. Apart from one individual, who showed dramatic declines in all areas, the rest of the cohort has continued to be stable.

Conclusions  These results may be characteristic of healthy adults with Down's syndrome in the fourth decade of life.
Endovaginal ultrasound scanning to identify bladder tumors as the source of vaginal bleeding in postmenopausal women
Authors: Granberg S. , Wikland M. , Norstrdm A.
Published: March 2003

The increasing frequency of bladder tumors with increasing age is well documented, but the incidence of bladder tumors in a subgroup at potential risk, i.e. women with postmenopausal bleeding, is, however, not known.

In a prospective study of 400 women with postmenopausal bleeding, endovaginal scanning (EVS) was performed the day before planned dilatation and curettage (D & C). Five bladder tumors were identified. For comparison, the medical records of 4500 women admitted for D & C due to postmenopausal bleeding, during a 15‐year period, were reviewed. These women were not examined by ultrasound preoperatively. Eight bladder tumors were found in these women.

The number of bladder tumors found in women with postmenopausal bleeding was high, especially in the group of women that underwent endovaginal ultrasound, compared to the known incidence (25/100 000 women) in this age group. On the basis of the present data, it appears evident that EVS contributes to an early detection of bladder tumors. We emphasize the importance of scanning all women with postmenopausal bleeding with endovaginal ultrasound. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
First‐trimester diagnosis of cystic hygromata by transvaginal sonography
Authors: Podobnik M. , Singer Z. , Podobnik‐Sarkanji S. , Bulic M.
Published: March 2003

This paper reports two cases of fetal nuchal cystic hygromata diagnosed in the first trimester of pregnancy by transvaginal sonography. In the first case, at 10 weeks' gestation, in addition to the hygromata, the fetus had an exomphalos. In the second case, at 13 weeks' gestation, the fetus had hydrocephalus and pleural effusion. Transabdominal chorion villus sampling was carried out and the fetal karyotypes were trisomy 18 and trisomy 21, respectively. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Echo patterns of benign cystic teratomas by transvaginal ultrasound
Authors: Cohen L. , Sabbagha R.
Published: March 2003

The transvaginal ultrasound echo patterns of 39 surgically proven cystic teratomas were retrospectively reviewed. Six different ultrasound echo patterns could be differentiated, ranging from purely cystic to densely echogenic. Importantly, in 82% of the tumors, areas of dense echogenicity were noted. Although the transvaginal appearance of cystic teratomas may allow correct preoperative prediction, the variable nature of the echo patterns makes dtfferentiation from malignant tumors difficult. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Laser surgery under sonographic control: preliminary experimental investigations
Authors: Feichtinger W. , Strohmer H. , Feldner‐Busztin M.
Published: March 2003

The laser has gained increasing importance during recent years as a useful addition to the physician's therapeutic armoury. Reports on successful prostatectomy by ultrasound‐guided laser coagulation in an animal model encouraged us to evaluate the possibility of using this technique for gynecological indications (for example, ectopic pregnancy, endometriosis, ovarian cysts, and other areas of medicine). We used two different laser systems. The devices consisted of a real‐time abdominal scanner (4–5 MHz) or a transvaginal sector scanner (5–7.5 MHz) coupled to a neodymium : YAG laser with a 1064 nm wavelength or a holmium : YAG laser with 2120 nm wavelength. An experimental set‐up using a water bath revealed clear visibility of the fiber tip and the laser irradiation in real‐time ultrasound at 7.5 MHz. Subsequently, a needle (routinely used in transvaginal puncture of ectopic pregnancy) was placed in animal and human tissue specimens and the laser fiber was inserted. The tissue was exposed to both laser systems at different energy densities, pulse rates and pulse widths. The sonographic appearance was recorded and correlated with the macroscopic findings. Results indicate that the holmium : YAG laser at a pulse rate of 5 Hz and a power of 2 watts is effective in removing substantial amounts of tissue. Moreover, it offers immediate visualization and control of the damaged area by producing a strongly echogenic focus. The neodymium : YAG laser showed comparatively poorer sonographic visibility and a precarious thermal mode of action, which are important considerations influencing its applicability. The holmium : YAG laser system with its non‐thermal mode of action seems promising for the further clinical application of ultrasound‐guided laser surgery. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Aggressive direct treatment of a fetus with supraventricular tachycardia and hydrops fetalis
Authors: Jouppila P. , Mäkäräinen L. , Räsänen J. , Valkama M. , Paavilainen T.
Published: March 2003

We report a case, in which direct fetal therapy by amiodarone injected into the umbilical vein during the last trimester of pregnancy was used for the treatment of fetal supraventricular tachyarrhythmia in the presence of severe hydrops fetalis. Eight injections were needed due to the recurrence of supraventricular tachycardia 1–9 days after the initial normalization of fetal tachycardia after each puncture. A severe fetal hydrops was maintained despite the achievement of sinus rhythm, and thus two ascites draining procedures were performed during the last 3 days before delivery to expand the fetal lungs. A normorhythmic hydropic baby was born by Cesarean section at 34 weeks + 6 days. Only mild respiratory difficulties occurred after birth. Her electrocardiogram suggests a Wolff–Parkinson–White syndrome but the overall recovery has been uneventful. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Fetal eye movements
Authors: Horimoto N. , Hepper P. G. , Shahidullah S. , Koyanagi T.
Published: March 2003

Since 1981, when eye movements of the human fetus were first reported, the study of fetal eye movements has increased, mainly focusing on the ontogenesis of eye movements and as one parameter of behavioral states. Using real‐time ultrasound, fetal eye movements can be clearly observed from 14 weeks of gestational age. Fetal eye movements may be described in terms of their pattern, frequency and incidence of periods containing eye movements and no eye movements. Furthermore, the relationship of eye movements to other behaviors may be used to give information on the integration of central nervous system function. A picture of normal fetal eye movements can be constructed and used to detect abnormalities in eye movements which can indicate underlying abnormalities of the central nervous system. This paper concludes that, although in its early stages, the study of fetal eye movements holds promise for a greater understanding of brain development and the assessment of the condition of the fetus. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Intraventricular fused fornices: a specific sign of fetal lobar holoprosencephaly
Authors: Pilu G. , Ambrosetto P. , Sandri F. , Tani G. , Perolo A. , Grisolia G. , Ancora G.
Published: March 2003

Lobar holoprosencephaly can be recognized in utero with sonography. However, a specific diagnosis is difficult and thus far has relied upon a qualitative evaluation of the morphology of the cerebral ventricles. In infants with this condition, magnetic resonance imaging demonstrates at times an abnormal appearance of the fornices, which are rudimentary and fused in to a single fascicle running within the third ventricle. In a 30‐weeks' fetus affected by lobar holoprosencephaly, this finding could be well demonstrated by sonography and was confirmed after birth by both transfontanellar ultrasound and magnetic resonance imaging. It is proposed that the antenatal demonstration of an echogenic linear structure running within the third ventricle is a specific sign of lobar holoprosencephaly, and can assist this difficult diagnosis. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Fetal arachnoid cyst: report of two cases
Authors: Langer B. , Haddad J. , Favre R. , Frigue V. , Schlaeder G.
Published: March 2003

Two new cases of antenatal diagnosis of arachnoid cyst are described. Diagnosis was made at 2.5 and 32 weeks' gestational age. In the first case, a slight increase in the diameter of the anechoic mass was observed in the second trimester. In the second case, ventricular dilatation was present prenatally. Appropriate surgical therapy was initiated at 2 months in the first case and at 8 days in the second and the neurological development of the two children is considered as normal at 18 months of age. Major features of in utero diagnosis, treatment and follow‐up are discussed. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Parents' needs after ultrasound diagnosis of a fetal malformation: an empirical deficit analysis
Authors: Schuth W. , Karck U. , Wilhelm C. , Reisch S.
Published: March 2003

We studied 56 pregnant women and 24 partners after ultrasound examination in the 18–24th gestational week revealed a fetal malformation. The subjects were followed through the process of examination, information sharing and counselling about the option of terminating the pregnancy. Regardless of sociodemographic variables or attitude towards the pregnancy, the diagnosis was always traumatic. A detailed critique of the physician's behavior and function emphasized his important role in the process of coming to terms with the malformation and gave clear indications of the positive expectations parents had. The affected patients expected the role of the professionally competent expert to be combined with that of the empathetic approachable counsellor, whose step‐by‐step explanation would allow them to decide for themselves whether to terminate the pregnancy. The partner's participation was an essential aid to adjustment. It remains to be seen to what extent the functions of the doctor and the patient's expectations of the doctor are realistic and justified. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
The value of color Doppler ultrasound in the prenatal diagnosis of hypoplastic umbilical artery
Authors: Sepulveda W. , Flack N. J. , Bower S. , Fisk N. M.
Published: March 2003

The prenatal diagnosis of hypoplastic umbilical artery has recently been reported, based on the visualization of discordant size between both umbilical arteries in association with discordant umbilical artery flow velocity waveforms. In this report we present two cases of hypoplastic umbilical artery and describe the use of color flow imaging and Doppler ultrasound in the prenatal evaluation of this condition. The principal advantages of these techniques include the confirmation of blood flow within the hypoplastic artery, thus ruling out the possibility of an atrophic non‐functional artery, and the demonstration of size discrepancy at the level of the intra‐abdominal portion of the umbilical arteries, validating the intra‐amniotic cord findings. Color Doppler ultrasound is an important tool for diagnosing and evaluating vascular anomalies affecting the umbilical cord. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Postmenopausal intrauterine fluid collection: correlation between ultrasound and hysteroscopy
Authors: Pardo J. , Kaplan B. , Nitke S. , Ovadia J. , Segal J. , Neri A.
Published: March 2003

Postmenopausal intrauterine fluid is an alarming sign related to malignancy. Twenty postmenopausal women with intrauterine fluid were prospectively studied by means of sonographic evaluation, and hysteroscopic and histological examinations, to determine the correlation between ultrasound and hysteroscopy. All patients underwent endovaginal sonography, followed by hysteroscopy. Biopsies were performed on all patients with abnormal endometrium, and randomly on selected patients with normal or atrophic endometrium. In patients with abnormal endometrial structure and thickness (< 4 mm), two cases of endometrial cancer were histologically detected and one was revealed by cytology (Pup smear). Seventeen patients with thin endometrium (≤ 4 mm) had no pathology. Sonographic, hysteroscopic and histological findings correlated well in all cases. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Hysterosalpingo contrast sonography (HyCoSy) and its future role within the investigation of infertility in Europe
Authors: Campbell S. , Bourne T. H. , Tan S. L. , Collins W. P.
Published: March 2003

An important part of any protocol for investigation of the infertile couple is the assessment of Fallopian tube patency in the woman, as this can influence the future course of treatment. X‐ray hysterosalpingography and laparoscopy and dye tubation are currently the main procedures for investigating tubal patency, but the recent development of hysterosalpingo contrast sonography (HyCoSy) may offer some benefits over these two methods. HyCoSy involves a transvaginal ultrasound investigation of the Fallopian tubes both before and after the injection of an echo‐enhancing agent into the tubes via the uterine cavity. Evidence of tubal flow with B‐mode scanning is indicative of tubal patency. Clinical data using the echo‐enhancing agent, Echovist®, in over 600 patients, in addition to technical aspects of the HyCoSy procedures are reviewed. The data presented indicate that the sensitivity and specificity of HyCoSy compare favorably with the current ‘gold standard’ techniques. HyCoSy is a safe, well‐tolerated and relatively inexpensive procedure, which can be carried out in a short time during an outpatient consultation. Combining these undoubted benefits with the clinical results obtained to date would indicate that HyCoSy has the potential to be employed as a reliable and well‐accepted procedure for assessing tubal patency as part of the investigation of infertility. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
The use of transvaginal ultrasonography compared to routine gynecological examination to check the location of an intrauterine contraceptive device
Authors: Granberg S. , Bundsen P. , Bourne T. H. , Almén M. , Grenthe M. , Leandersson R. , Tönnberg C.
Published: March 2003

The objective of this study was to evaluate the use of transvaginal ultrasonography compared with a routine gynecological examination to check the location of an intrauterine contraceptive device (IUCD). Fifty‐two women attending the antenatal cure unit at Lundby hospital for contraceptive guidance were included in the study. All women had an IUCD inserted at this visit and were examined bimanually and by speculum. The same examination was repeated and a transvaginal ultrasound scan was curried out at 1 week and then 3 months later.

In 51 women, the threads of the device could be identified at the time of the gynecological examination and the IUCD was considered to be correctly positioned. In one woman, the threads could not be seen, but transvaginal ultrasonography confirmed that the position of the device was at the fundus of the uterus. Forty‐eight women were judged by ultrasound examination to have the device optimally placed in the uterine cavity. In four women, although the IUCD was apparently correctly located according to the gynecological examination, the device was shown by ultrasonography to be misplaced.

We suggest that transvaginal ultrasonography should replace the conventional gynecological examination as the best method of checking the locution of an IUCD.
Correlations in umbilical blood flow Doppler velocities in the human fetus during breathing
Authors: Indik J. H. , Reed K. L.
Published: March 2003

We hypothesized that changes in intrathoracic pressure during fetal breathing episodes result in quantifiable variations in umbilical arterial and venous blood flow velocities, and that these variations are related to compliance properties of each system. We further hypothesized that these variations in velocities are different in fetuses with normal and abnormal umbilical arterial Doppler velocities. Umbilical arterial and venous Doppler velocities were measured simultaneously during breathing episodes in 15 normal fetuses and 14 fetuses with elevated systolic‐to‐diastolic (S/D) umbilical arterial Doppler velocity ratios. Umbilical arterial end‐diastolic velocity changes were less than umbilical venous velocity changes in normal fetuses, but were significantly greater in four fetuses with elevated S/D ratios (p < 0.004). Furthermore, umbilical arterial diastolic velocity minima preceded umbilical venous velocity minima by a time lag that was greater in fetuses with elevated S/D ratios (p < 0.002). These results suggest that differences in umbilical arterial and venous velocity variation during fetal breathing episodes may be related in part to vascular compliance, which may be altered in fetuses with abnormal umbilical arterial Doppler velocity. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Fetal yawning
Authors: Sepulveda W. , Mangiamarchi M.
Published: March 2003

Incidental fetal yawning movements can rarely be observed during real‐time ultrasonographic examination. In this report we document repetitive fetal yawning movements in a 27‐week fetus over a 7‐min period. Each episode lasted for 4–6 s, and the intervals between them varied from 21 to 195 s. This case demonstrated that fetal yawning, a complex involuntary behavioral reflex, is present in its full extent during the second half of pregnancy. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Doppler studies of the placental and fetal circulation in pregnancies with preterm prelabor amniorrhexis
Authors: Carroll S. G. , Papaioannou S. , Nicolaides K. H.
Published: March 2003

This study has investigated the effect of intrauterine infection on placental perfusion, fetal circulation and fetal oxygenation in patients with preterm prelabor amniorrhexis. In 69 pregnancies with preterm prelabor amniorrhexis, Doppler ultrasound studies of the uterine and umbilical arteries and the fetal middle cerebral artery and thoracic aorta were performed. Within 1 h after the Doppler studies, cordocentesis and amniocentesis were carried out for microbiological investigations and measurement of blood pO2 and pH. In the amniorrhexis group, there were no significant differences from the appropriate normal mean for gestation in any of the Doppler indices or blood gas results. Furthermore, there were no significant differences between the groups with positive fetal blood or amniotic fluid cultures and those with no evidence of infection. These data demonstrate that, in preterm prelabor amniorrhexis, microbial invasion of the amniotic cavity and fetal bacteremia are not associated with detectable changes in placental perfusion, fetal circulation or fetal oxygenation. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal ultrasonographic diagnosis of ductus arteriosus aneurysm with spontaneous neonatal closure
Authors: Puder K. S. , Sherer D. M. , Ross R. D. , Silva M. L. , King M. E. , Treadwell M. C. , Romero R.
Published: March 2003

Aneurysm of the ductus arteriosus may be either spontaneous or acquired as a complication of surgical closure of a patent duct. Patients may be asymptomatic or present with a wide spectrum of symptoms, including hoarseness, respiratory symptoms, aortic or pulmonary thrombosis or embolism, or rupture of the aneurysm. We present the first report of prenatal ultrasonographic diagnosis of isolated ductus arteriosus aneurysm. The aneurysm presented at 39 weeks as an enlarged, dilated, vascular structure 15 mm in diameter, which began at the bifurcation of the main pulmonary artery and ended in the descending aorta. Doppler imaging demonstrated turbulent flow in this lesion. Following spontaneous delivery, a bidirectional shunt in the ductus arteriosus was found on the 1st day, but the caliber of the vessel was normal. An almost completely functionally closed ductus was found on the 2nd day. Spontaneous resolution of the lesion was confirmed by magnetic resonance imaging at 4 weeks of age. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
In utero sonographic appearance of intestinal duplication cysts
Authors: Degani S. , Mogilner J. G. , Shapiro I.
Published: March 2003

The antenatal appearance of gastrointestinal duplication cysts is described. Two cases are presented: a duplication cyst of the pylorus and a cyst of the terminal ileum. The embryogenesis and the clinical utility of prenatal diagnosis of these malformations of the alimentary tract are discussed.

Antenatal detection of these cystic masses allowed close neonatal surveillance and timely surgical intervention prior to neonatal complications. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Recurrent uterine rupture diagnosed by ultrasound
Authors: van Alphen M. , van Vugt J. M. G. , Hummel P. , van Geijn H. P.
Published: March 2003

A case of recurrent rupture of the uterus is presented. The patient had a history of left cornual uterine rupture, which was repaired, and she was considered to be suitable for a subsequent pregnancy. During the subsequent pregnancy, attempts were made to evaluate the condition of the uterine scar by ultrasound in order to anticipate threatening rupture of the scar. No signs of dehiscence could be detected until the patient presented with clinical signs. Ultrasound examination revealed protrusion of the membranes at the fundus uteri.

Uterine rupture is a rare, but hazardous, obstetric complication that can affect both mother and child. The possible role of ultrasound in cases of elevated risk for uterine rupture is discussed. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Blood flow velocity waveforms of the abdominal arteries in appropriate‐ and small‐for‐gestational‐age fetuses
Authors: Mari G. , Abuhamad A. Z. , Uerpairojkit B. , Martinez E. , Copel J. A.
Published: March 2003

The aim of this study was to describe flow velocity waveforms of abdominal arteries in the appropriate‐ and small‐for‐gestational‐age fetus. Splenic artery, superior mesenteric artery, hepatic artery and renal artery velocity waveforms were obtained from 57 appropriate‐for‐gestational‐age and nine small‐for‐gestational‐age fetuses with color flow Doppler ultrasonography. The pulsatility index was used to quantify the arterial waveforms.

Repeated measure analysis of variance indicated significant differences in the pulsatility index values in both the appropriate‐for‐gestational‐age and small‐for‐gestational‐age fetuses. A multiple comparison test revealed a significantly lower value for the pulsatility index in the splenic artery when compared to that of the other vessels for both the appropriate‐ and small‐for‐gestational‐age fetuses. In the small‐for‐gestational‐age fetuses, a lower pulsatility index value was observed at the superior mesenteric artery level when compared to the renal artery. Because of its lower frequency of successful insonation, the hepatic artery was not considered for the analysis.

In the normal fetus, the splenic artery had the lowest pulsatility index when compared to the other arteries we investigated. This difference remained in small‐for‐gestational‐age fetuses, reflecting a lower vascular resistance at the fetal spleen in both normal and small‐for‐gestational‐age fetuses. It appears that in small‐for‐gestational‐age fetuses the renal artery has a higher pulsatility index than the superior mesenteric artery, suggesting a preferential distribution of blood flow to the bowel. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Changes observed in Doppler studies of the fetal circulation in pregnancies complicated by pre‐eclampsia or the delivery of a small‐for‐gestational‐age baby. I. Cross‐sectional analysis
Authors: Harrington K. , Carpenter R. G. , Nguyen M. , Campbell S.
Published: March 2003

The aim of this study was to compare changes in Doppler ultrasound studies of the fetal circulation in normal pregnancies with a group of pregnancies complicated by proteinuric pregnancy‐induced hypertension (PPIH), delivery of a small‐for‐gestational‐age (SGA) baby, or both. A total of 167 uncomplicated pregnancies with a term delivery of an appropriately grown baby (AGA) were used to define the normal range. Altogether, 123 high‐risk pregnancies with a known outcome constituted the study group. A color duplex ultrasound machine was used to perform biometry and fetal Doppler studies. Measurements obtained from the fetal circulation included the umbilical artery (UA) pulsatility index (PI), the middle cerebral artery (MCA) PI and time‐averaged velocity (TAV), the thoracic aorta (AO) PI and TAV In addition, the ratio between the MCA PI and UA PI, the MCA PI and the A0 PI, and the product of the MCA PI and A0 TAV were used in the analysis.

A total of 105 pregnancies had a complicated outcome. They were divided into three categories: PPIH only (pregnancies complicated by PPIH with the delivery of an AGA fetus, n = 17), SGA only (delivery of an SGA baby, with no evidence of PPIH, n = 55), and PPIH + SGA (pregnancies complicated by pre‐eclampsia and delivery of an SGA baby, n = 37). The PPIH + SGA group represented true clinical intrauterine growth retardation.

Cross‐sectional reference ranges were created using the observations from the normal group. z‐scores (standard deviation from the mean of the normal range) of the last observations made before delivery were calculated for each of the vessel velocimetry measurements and ratios. The statistical significance of z‐score values was calculated using analysis of variance.

The MCA and UA PI values showed the greatest deviation for any single‐vessel parameter. The ratios of fetal Doppler indices (MCA/UA PI ratio, MCA/AO PI ratio and the MCA PI/A0 TAV index) demonstrated greater deviation from normal than any individual vessel. The UA PI z‐score for PPIH + SGA delivering < 34 weeks gestation (2.92) was significantly greater than the z‐score for PPIH + SGA delivering ≥ 34 weeks (1.20, p < 0.05).

Fetal Doppler indices, in particular ratios that include measurements obtained from the cerebral circulation, help in the recognition of the small fetus that is growth‐retarded. At term, evidence of fetal hemodynamic redistribution may exist in the presence of a normal umbilical artery PI. Fetal Doppler indices provide information that is not readily obtained from more conventional tests of fetal well‐being. It therefore has an important role to play in the management of the growth‐retarded fetus. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Is ultrasound unsound? A review of epidemiological studies of human exposure to ultrasound
Authors: Salvesen K. Å. , Eik‐Nes S. H.
Published: March 2003

We have reviewed the epidemiological studies of human exposure to diagnostic ultrasound during pregnancy. Studies have concentrated on possible associations between ultrasound exposure in utero and childhood malignancies, neurological maldevelopment, dyslexia, left‐handedness, delayed speech development and low birth weight. It is concluded that no associations between ultrasound exposure in utero and childhood maldevelopment have been proven. There are, however, some issues, such as non‐right handedness and low birth weight after frequent Doppler ultrasound exposures, for which no firm conclusions can yet be drawn. These issues need to be tested in future studies. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Modified Neonatal Growth Assessment Score: a multivariate approach to the detection of intrauterine growth retardation in the neonate
Authors: Deter R. L. , Nazar R. , Milner L. L.
Published: March 2003

The objective of this investigation was the development of a modified Neonatal Growth Assessment Score (mNGAS) for use in the evaluation of neonatal growth status. The growth of 74 fetuses at risk for intrauterine growth retardation (IUGR) was followed longitudinally, beginning in the first or early second trimester. Rossavik growth models derived from data obtained in the second trimester were used to predict the weight (WT), crown‐heel length (CHL) and head(HC) abdominal (AC) and thigh circumferences (ThC) at birth, which were then actually measured within 24 h after delivery. These measurements were compared to age‐specific size curves and used to calculate sets of five growth potential index (GPRIi) values, which in turn were used to calculate five‐variable Neonatal Growth Assessment Scores (NGAS5). Neonates were initially classified as normal or IUGR on the basis of NGAS5, GPRIi, and anatomic measurements. A final classification based on principal component analysis and linear discriminant analysis was carried out. The score obtained using the first principal component function was defined to be mNGAS51. The effectiveness of mNGASij values, determined from 1–4 GPRIi values, in separating normal and IUGR neonates was also evaluated.

Neonates initially considered to be normal had very few abnormal GPRI values or anatomic measurements, whereas the frequency of these abnormalities in IUGR neonates was significantly increased. However, no single anatomic variable was 100% normal in the normal neonates and 100% abnormal in IUGR neonates. Only 40% of IUGR neonates were small for gestational age. Classification of these neonates using principal component analysis and linear discriminant analysis was essentially the same (98.6%) as that made initially after reclassification of two IUGR neonates as normal. The characteristics of the initial and final normal and IUGR groups were very similar and the mNGAS51 was strongly correlated with the NGAS5 in the IUGR group. The effectiveness of mNGASij in separating normal and IUGR neonates increased with the number of GPRIi values included and the types used. GPRIThC and GPRIWT were the most important, followed by GPRIAC. GPRICHL and GPRIHC were much less important and in some cases detrimental. These findings support the concepts of a decrease in soft tissue mass as the initial step in the development of IUGR and the protection of head growth (brain‐sparing).

The characteristics of mNGAS51, particularly its comprehensiveness, its independence of differences in growth potential, its weighting of GPRIi values according to their importance in the detection of IUGR and its ability to detect different manifestations of IUGR in different individuals, indicate that this should be a most effective parameter for separating normal and IUGR neonates. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonographic assessment of the fetal urinary tract in early pregnancy
Authors: Rosati P. , Guariglia L.
Published: March 2003

Fetal renal size in the first trimester and the early second trimester of pregnancy was evaluated by high‐frequency transvaginal sonography in 537 singleton fetuses at risk for cytogenetic abnormality but not at risk for congenital kidney disease. The percentage of visualization of both kidneys and bladder at different menstrual ages (1l–l6 weeks) is presented, and centile reference charts for evaluating kidney growth have been compiled. All kidney measurements were found to increase as pregnancy progressed. At 13 weeks, fetal kidneys and fetal urinary bladder were visualized in 92% of the cases screened. The incidence of pyelectasis was high in our population (4.5%), and this pathology was studied by other sonographic scans during pregnancy and postnatally. All fetuses had normal karyotypes. The results presented provide a reference for the assessment of normal renal morphology and growth in early pregnancy. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Uterine and spiral artery flow velocity waveforms in pregnancy‐induced hypertension and/or intrauterine growth retardation
Authors: Murakoshi T. , Sekizuka N. , Takakuwa K. , Yoshizawa H. , Tanaka K.
Published: March 2003

The objectives of this study were to characterize spiral artery flow velocity waveforms in normal pregnancies and pregnancies complicated by pregnancy‐induced hypertension and/or intrauterine growth retardation, and to examine the diagnostic potential for predicting adverse perinatal outcomes in complicated pregnancies compared with uterine and umbilical artery flow velocity waveforms.

In this cross‐sectional study, 160 normal and 43 complicated pregnancies were assessed by color and pulsed Doppler during 18–41 weeks of gestation. Flow velocity waveforms were obtained from the spiral, uterine and fetal umbilical arteries.

In normal pregnancies, the resistance index of spiral artery flow velocity waveforms decreased significantly with advancing gestation (r = −0.256, p < 0.001). In abnormal pregnancies complicated by pregnancy‐induced hypertension and/or intrauterine growth retardation, the incidence of adverse perinatal outcome was significantly higher in patients with abnormal spiral artery resistance indices than in patients with normal spiral artery resistance indices (p < 0.001). An abnormal spiral artery resistance index had a better diagnostic accuracy for adverse perinatal outcome (sensitivity 8.5.0%, specificity 91.3%, positive predictive value 89.5%, negative predictive value 87.5%, accuracy 88.4%) when compared with the resistance index of uterine and umbilical artery waveforms and presence of a diastolic notch of the uterine artery waveform.

Color flow imaging facilitates the precise analysis of spiral artery flow velocity waveforms and provides more accurate information about the uteroplacental circulation in the evaluation of placental function. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Pathognomonic echo patterns of benign cystic teratomas of the ovary: classification, incidence and accuracy rate of sonographic diagnosis
Authors: Caspi B. , Appelman Z. , Rabinerson D. , Elchalal U. , Zalel Y. , Katz Z.
Published: March 2003

The great variability in the sonographic appearance of ovarian cystic teratomas poses difficulties for their diagnosis and classification. To overcome such difficulties, we have proposed a simplified classification of the pathognomonic echo patterns of ovarian cystic teratomas based on three basic types of echo pattern. In a prospective study of 118 echogenic adnexal masses, with postoperative histological confirmation, this classification enabled the correct diagnosis to be made in 11.5 cases (accuracy rate, 97.45%). In the three cases misdiagnosed preoperatively as ovarian cystic teratoma, the tumors proved to be benign and included a serous cyst adenoma, a serous cyst adenofibroma and a Brenner tumor. We suggest that, with our proposed classification of the echo patterns of ovarian cystic teratomas, sonography can become a quick and accurate tool in the recognition of this condition. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Cardiac functional changes in the human fetus in the late first and early second trimesters
Authors: van Splunder I. P. , Wladimiroff J. W.
Published: March 2003

Fetal cardiac function was studied in 52 women at 10–20 weeks of normal gestation using Doppler ultrasonography. According to a cross‐sectional study design, transmitral and ascending aortic flow velocity waveforms were obtained simultaneously, in order to calculate filling and ejection time as well as isovolumic contraction and relaxation time. A statistically significant gestational age‐dependent increase was established for both transmitral and ascending aortic flow velocities. Cardiac cycle length and filling time displayed a statistically significant increase with advancing gestational age, whereas ejection time and isovolumic relaxation time showed a gestational age‐related decrease. No relationship existed between isovolumic contraction time and gestational age. A statistically significant decrease was demonstrated for atria1 contribution to ventricular filling at 10–l4 weeks of gestation, with a constant pattern during the remainder of the study period. No relationship existed between the different components of the cardiac cycle and mitral and aortic flow velocity parameters.

This study shows that the late first and early second trimesters of pre,gnancy are characterized by gestational age‐related changes in fetal cardiac function. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Sonographically guided aspiration: an alternative therapy for tubo‐ovarian abscess
Authors: Caspi B. , Zalel Y. , Or Y. , Bar Dayan Y. , Appehan Z. , Katz Z.
Published: March 2003

Our objective was to evaluate the role of single‐step ultra‐sound‐guided aspiration in conjunction with intracavitary antibiotic instillation for the treatment of tubo‐ovarian abscess. Ten women with the clinical and sonographic diagnosis of tubo‐ovarian abscess, who failed to respond to systemic antibiotic therapy, were treated by ultrasound‐guided aspiration of the abscess followed by intracavitary instillation of a combination of antibiotics.

All ten women improved clinically and none required surgery. The mean time from aspiration to hospital discharge was 3.1 days with mean duration of hospitalization 7.8 days. No major complications were observed. The average time interval between aspiration of the lesion and resolution on sonographic follow‐up was 9.5 weeks. In three cases, pelvic inflammatory disease recurred, but none needed surgical intervention. The average follow‐up period of the patients was 12 months.

One‐step sonographically guided aspiration of tubo‐ovarian abscess followed by intracavitary antibiotic instillation may serve as an easy and safe alternative therapy in patients in whom treatment with systemic antibiotics has failed. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Uterine arcuate artery Doppler and decidual microvascular pathology in pregnancies complicated by type I diabetes mellitus
Authors: Barth W. H. , Genest D. R. , Riley L. E. , Frigoletto F. D. , Benacerraf B. R. , Greene M. F.
Published: March 2003

The objective was to correlate Doppler indices from the uterine arcuate arteries with an analysis of the decidual vascular histology in patients with type I diabetes. Pulsed wave Doppler was used to sample the uterine arcuate artery system beneath the placenta within 8 days of delivery in 47 patients with type I diabetes mellitus. A placental pathologist, without knowledge of either clinical outcome or Doppler information, classified the histological appearance of the decidual arteries as normal, type A (hyalinization, mural thickening), or type B (fibrinoid necrosis, atherosis, thrombosis). Patients were then grouped according to the histology of the decidual arteries. An analysis of variance (ANOVA) of the systolic/diastolic (S/D) ratios (log. S/D) showed significant variation (p < 0.025). A multiple range comparison test showed that patients with normal or only mildly abnormal (type A) vessels had similar values, whereas those with severe vasculopathy (type B) had significantly higher S/D ratios (p < 0.05). The study confirmed a relationship between arcuate artery Doppler indices and downstream decidual vascular pathology. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Early second‐trimester determination of fetal gender by ultrasound
Authors: Meagher S. , Davison G.
Published: March 2003

Ultrasound identification assists in determining chorionicity in twins, in the interpretation of sex chromosome mosaicism and aneuploidy and in sex‐linked conditions presenting after 14 weeks. This study addresses the frequency and accuracy of gender identification in a series of consecutive patients presenting for amniocentesis for genetic indications. Amniocentesis was performed at 14–20 weeks in 843 fetuses over a 5‐year period. Ultrasound prediction of fetal gender was documented in 93.3% (770/843). The overall accuracy of diagnosis of fetal gender was 99.3% (765/770). Errors in diagnosis of gender were more likely to occur in the assessment of the female fetus. Such errors in diagnosis may be minimized by combining both tangential/transverse and sagittal views of the fetal perineum. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Hysteroscopy provides proof of trophoblastic tumors in three cases with negative color Doppler images
Authors: Lindholm H. , Rådestad A. , Flam F.
Published: March 2003

Color Doppler sonography has replaced pelvic arteriography as well as real‐time ultrasound in the assessment of patients with gestational trophoblastic disease. In about 25% of patients in whom human chorionic gonadotropin (hCG) levels are suggestive of trophoblastic disease, there will be no evidence of abnormal vessels in the uterus. In these cases it is assumed that hCG was produced by metastatic lesions. We present here three cases in which color Doppler examination was negative and where myometrial biopsies containing tumor were obtained by means of hysteroscopy. The fact that color Doppler, in its present form, does not detect small areas of trophoblastic tumor might also have implications for other kinds of tumors. Knowledge of the exact microscopic diagnosis in molar patients with persistent disease may have an impact on management. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
The prevalence and clinical significance of tricuspid valve regurgitation in normally grown fetuses and those with intrauterine growth retardation
Authors: Gembruch U. , Smrcek J. M.
Published: March 2003

The aim of this study was to assess the prevalence and clinical significance of fetal tricuspid valve regurgitation. In a cross‐sectional study, 289 normally grown singleton fetuses with normal heart anatomy, normal estimated weight for gestational age, normal amniotic fluid volume and normal flow velocity waveforms in the umbilical and middle cerebral arteries and umbilical vein were examined. A further 31 singleton fetuses with intrauterine growth retardation (estimated fetal weight below the 3rd centile) were analyzed. Semiquantification of the tricuspid valve regurgitation by spatial and temporal parameters was performed in the four‐chamber view by color Doppler flow imaging and by color Doppler M‐mode echocardiography (M‐Q mode).

The prevalence of fetal tricuspid valve regurgitation among normally grown fetuses was 6.23% (n = 18). In all cases, the tricuspid regurgitation was part‐systolic (non‐holosystolic, early and mid‐systolic tricuspid regurgitation) and showed little spatial expansion of the jet as examined by color Doppler flow imaging (no jet reached the opposite atrial wall, the area of tricuspid regurgitation being less than 25% of the atrial area). The maximum velocity of the regurgitant jets was below 2 m/s with one exception. There was no statistically significant correlation between gestational age and occurrence of tricuspid regurgitation (U test, p > 0.05). Re‐examination of 14 of the 18 fetuses with tricuspid regurgitation showed that tricuspid regurgitation was a transient phenomenon in these instances. The fetal outcome in the presence of tricuspid valve regurgitation was normal. Regurgitations of the mitral, pulmonary and aortic valves were excluded in all 289 fetuses.

Only two of the 31 fetuses (6.45%) with intrauterine growth retardation showed tricuspid valve regurgitation. In one fetus the tricuspid regurgitation was only part‐systolic. In the other severely compromised fetus with highly abnormal flow velocity waveforms in the arterial and venous side of the fetal circulation, cardiac dilatation with holosystolic tricuspid and holosystolic mitral regurgitation occurred immediately before intrauterine death.

Fetal tricuspid valve regurgitation was a frequent finding during Doppler echocardiography. Although it may be a sign of increased preload, afterload or cardiac dysfunction, in most cases tricuspid valve regurgitation is an isolated transient finding with little temporal and spatial expansion, and it may be physiological. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology