bluuebunny/crossref_metadata_2025 huggingface dataset:
WS11: Media WS11‐01The Croatian ultrasound safety law
Authors: Breyer B.
Published: March 2003

Legal regulation of the safety of medical applications of ultrasound is important for protection of the patients and physicians.

The matter of ultrasound safety has recently been regulated in Croatia within the framework of the law on nonionising radiation protection. The law as approved by the parliament regulates the general principles and material cornerstones while the details are defined by rules and regulations issued by the Ministry of Health.

Apart from medical applications ultrasound is used in plastic and metal welding, food processing, cleaning, electroplating, drilling and metal flaw detection, to mention but some. The law had to be general and sufficiently cover the whole spectrum allowing for the special medical exception. Namely, the medical professional may breach the integrity of human body and even harm the patient if the expected net final result of the whole proceeding is expected to help the person who seeks help.

The law in Croatia states that ultrasound may not increase the temperature of the human body to more than 38.5 °C and may not induce cavitation there. However medical applications of ultrasound are specifically excluded from this limitation. The requirement is the application of the ALARA principle.

The specifics of the regulation of the total field of medical applications of ultrasound are now being prepared under consideration of the existing and the presently processed IEC from IEC committees TC 62 and TC 87 documents and taking into account the present regulation in the USA.
WS11‐03How to create multimedia ultrasound teaching programs
Authors: DeVore G. R.
Published: March 2003

For a number of years the teaching of ultrasound principles has relied on slides of static, nonreal‐time images. Although ultrasound originally employed only still images, the development of real‐time ultrasound ushered in a new imaging modality. Unfortunately, the presentation of real‐time images has not been incorporated into most presentations because of the difficulty of preparing and editing video tape recordings of the examination. With the advent of multimedia programs available for the laptop and desktop computer, it is now possible to display real‐time motion sequences that duplicate the actual scanning environment. To accomplish this, however, requires the physician to become versed in the various techniques required to capture video and audio sequences from the ultrasound machine. In addition, the proper computer software must be used to optimize these images. The purpose of this presentation is to review the methodology required to (1) acquire the highest quality video images from the ultrasound machine, (2) convert the ultrasound images from a analog‐to‐digital format, (3) review programs required to optimize the converted digital images, and (4) examine the software programs to optimally display these images for the Windows and Macintosh platforms. At the conclusion of the presentation, the physician should be able to accomplish these tasks.
WS12: Second and third trimester Doppler I WS12‐01Uterine artery velocimetry in the third trimester
Authors: Marsal K. , Hernandez‐Andrade E. , Lingman G. , Gudmundsson S.
Published: March 2003

Spectral Doppler velocimetry supported by directional color Doppler imaging became the method of choice for recording blood velocity signals from the maternal uterine arteries during the third trimester of gestation. Normally, the uterine artery waveforms show a high proportion of diastolic flow without any early diastolic notch and with a low resistance (RI) or pulsatility (PI) index. With increasing gestation, there is a slight decrease in the resistance to flow in the placental circulation. The placental side of the uterus shows lower values of the waveform indices than the nonplacental. In high‐risk pregnancies, the abnormally high PI or the presence of notch is predictive of the adverse outcome of pregnancy. Recently, a Uterine Artery Score (UAS) has been presented based on a combined evaluation of RI and notch (Sekizuka et al., J Mat Fet Invest 1997; 7: 197). We have modified this approach, using PI and a uniform cut‐off value for definition of the abnormal PI, disregarding the placenta location. The modified UAS in combination with the umbilical artery Blood Flow Classes possess a high predictive value with regard to the perinatal outcome in high‐risk pregnancies, especially in those with placental hemodynamic dysfunction. In cases of intrauterine growth restriction, the combined examination of the uterine and umbilical circulation improves the clinical value of the third trimester Doppler velocimetry.
WS12‐03Uteroplacental resistances and maternal cardiac function in normal and hypertensive pregnancy: a Doppler and echocardiographic study
Authors: Valensise H. , Vasapollo B. , Novelli G. P. , Larciprete G. , Arduini D. , Galante A. , Romanini C.
Published: March 2003

Objective

To verify the existence of a relationship between maternal cardiac function and peripheral hemodynamic parameters in normal and gestational hypertensive women.

Methods

43 normotensive primigravidae were evaluated at 12 ± 1, 21 ± 1, and 33 ± 1 weeks of gestation with uterine artery color Doppler and maternal echocardiographic examination comparing data of the third trimester with those of 21 gestational hypertensive women.

Results

The 43 healthy women showed a decrease in Uterine Resistance Index (RI) from I° to II° trimester (0.72 ± 0.10 vs. 0.54 ± 0.09, P < 0.001) and modifications in Diastolic function parameters: E wave velocity and E/A ratio decreased; A wave velocity and deceleration time of the E wave increased; the left ventricular isovolumetric relaxation time (IVRT) decreased significantly (88.7 ± 6.7, 75.6 ± 7.7, 71.1 ± 5.0 msec, P < 0.001) showing a correlation with left atrial dimensions and RI (r = −0.38, r = 0.47, P < 0.001). In the third trimester the comparison between normal and hypertensive women showed a significant reduction in (TVR) total vascular resistances (1006 ± 212 vs. 1620 ± 469, P = 0.000) and IVRT (71 ± 5.0 vs. 92.0 ± 7.6 msec, P = 0.000). Regression analysis showed a linear correlation between IVRT and TVR (r = 0.68; P < 0.01), Uterine RI and TVR were directly related (r = 0.59, P < 0.001).

Conclusions

Maternal diastolic function analysis may be useful to identify women who fully adapt to pregnancy and at risk for development of gestational hypertension.
WS13‐08Multifetal pregnancy reduction: clinical and pathophisiological aspects
Authors: Mikhailov A. , Koroteev A.
Published: March 2003

Background

To decrease perinatal mortality and morbidity rate in case of multifetal pregnancy fetal reduction (MFPR) in the first trimester was introduced.

Methods

Combine ultrasound and Doppler evaluation of fetal chromosomal abnormality markers, fetal structure and biometry, chorionicity and amnionicity, arterial and venous circulation in fetal‐placental‐maternal functional system were introduced as an algorithm before MFPR.

Results

355 fetuses in 112 women were examined before 141 MFPR. NT thickness was above 2.5 mm in 1,7% of fetuses and one fetus had reverse DV flow. But no fetal chromosomal defects were detected after CVS. No specific severe complications for multifetal pregnancy were registered in completed pregnancies. Average gestational age at birth was 35,5 w that was less then in essential twins but perinatal mortality rate was 5.8‰ and 12.8‰ correspondingly.

Conclusion

MFPR with combine fetal examination seems to be the way to improve multifetal pregnancy outcome.
WS14‐08Three dimensions in neonatal period
Authors: Stanojevic M.
Published: March 2003

Background

The aim of this study was to compare the application of 2D neurosonography (USG) and 3D USG in newborns with respect to the time required to obtain the data for analysis.

Method

All newborns in whom neurosonography was indicated underwent 2D USG and 3D USG by the same investigator. The Voluson 530 D Color System was used with vaginal 5–8 MHz 3D probe for 3D imaging. 2D real‐time imaging was performed with Aloka SSD 121 device using 5 MHz sector probe. The time needed to perform the examination was determined. Non‐parametric Kruskal–Wallis rank sum test was used in statistical analysis.

Results

A total of 30 newborn infants of different gestational ages (ranging from 25 to 40 weeks) underwent USG after delivery at different postnatal ages (ranging from 2 to 60 days). The median time required to perform the 2D USG was 14 min (10–21). The median time required to perform the investigation by 3D USG was 5 min (ranging from 3 to 10). The difference was statistically significant (H = 24.88; P = 0.0031). The median time of data interpretation for 2D USG was 25 min (15–35), and for 3D USG it was 45 min (30–63). The difference was not statistically significant (H = 13.22; P = 0.1531).

Conclusion

The time necessary to obtain 3D USG compared to 2D USG images was shorter, which made it less stressful for the newborns. 3D USG provides more reliable information than 2D USG performed in the same patient at the same age. The time needed to interpret the data is longer for 3D USG but it can be performed after the imaging was terminated.
F10The sonographic diagnosis of uterine venous plexus thrombosis made by transvaginal B‐mode and color Doppler scanning: two case reports
Authors: Leibovitz Z. , Degani S. , Shapiro I. , Tal J. , Paz B. , Levitan Z. , Schliamser L. M. , Toubi A. , Ohel G.
Published: March 2003

Background

Transvaginal sonography (TVS) enables a close imaging of the pelvic organs providing a clear imaging of the pelvic vessels. To the best of our knowledge – this is the first report of the diagnosis of uterine venous plexus thrombosis using this technique.

Case reports

1st case: 38‐year‐old patient diagnosed as having a left tubal ectopic pregnancy in the 7th week of gestation. On TVS examination the ipsilateral uterine plexus thrombosis was found. The blood clots were demonstrated as elongated echogenic structures within the dilated veins. The thrombi showed swinging movements caused by the surrounding blood flow. This effect could also be provoked by gentle transducer pressure. On the transverse view of the affected veins the thrombi appeared as free round structures in the lumen. The blood flow around the thrombi was seen on color Doppler.

2nd case: 36‐year‐old patient with fetal death in the 19th week of gestation. Two days after the induced labor the patient experienced excessive vaginal bleeding. A placental residue was confirmed by TVS. Upon examination the engorged uterine venous plexuses were seen with a thrombus on the right side. The sonographic description of the clot was as in the first case.

There were no signs of thromboembolic disease in both cases. The deep leg veins and iliac veins were studied and found to be normal. The uterine plexus thrombi could not be detected by transabdominal sonography and were only seen by TVS. Over 3 months of anticoagulation therapy the clots gradually disappeared in both cases.

Conclusions

In both patients the transvaginal sonographic diagnosis of uterine venous plexus thrombosis was accidental. There is not enough data in the medical literature to determine the evidence based approach to such cases. Nevertheless, focusing on the pelvic veins may reveal important findings with significant clinical implications.
F101Evaluation of a new and noninvasive method for determination of fetal lung maturity and risk to RDS
Authors: Cosmi E. V. , Torre R. L. A. , Piazze J. J.
Published: March 2003

Based on our observations in humans (AJOG 1999; 180:s86) that fetal breathing movements (FBMS) are associated progressively with nasal fluid flow velocity waveforms (NFFVW) as the fetus matures, we now assess this phenomenon relative to the development of neonatal RDS. In effect, we present the possibility that evaluation of FBMS by M‐mode US with simultaneous determination of NFFVW by Doppler flow analysis, may permit diagnosis of fetal lung maturity (FLM) and, thus, risk to NRDS by rapid and reliable noninvasive methods. To the purpose of the study, the FBMS and the NFFVW data were compared with conventional data from amniotic fluid (AF). 39 high‐risk pregnancies were enrolled; all babies were delivered by CS within a week. Each fetus was surveyed for 30 min for thoracic movements (TM), indicative of regular FBMS, by M‐mode and at the same time for NFFVW. Amniocentesis was then performed. The AF sample was analyzed for L/S, lamellar bodies and presence of PG. Of the 39 pregnancies studied, 25 of the neonates had no RDS. Of the latter, only 3 registered no FBMS and NFFVW in utero; they also failed each of the AF tests, while 2 registered only FBMS and equivocal AF tests. 14 neonates developed RDS and none registered NFFVW in utero and each failed the AF tests for FLM. Only 2 of the RDS group had no FBMS. The study indicates that the presence of both FBMS and NFFVW indicates no risk to RDS. Absence of NFFVW, with or without FBMS, has the opposite connotation. The diagnostic accuracy of the noninvasive tests was: sensitivity, 100%; NPV (‘no‐RDS’), 100%; specificity, 80% and PPV (‘RDS’), 73%. The results strongly encourage further evaluation of the noninvasive methods as reliable approaches for evaluating FLM, particularly in cases where af sampling is undesirable or impossible (Supported by EURAIL, Europe Against Immature Lung).
F110Human fetal gallbladder contractility exists in utero
Authors: Tanaka Y. , Senoh D. , Hata T.
Published: March 2003

Objective

The purpose of this study was to evaluate whether human fetal gallbladder contractility exists in the second half of pregnancy.

Method

Ultrasound examinations were performed on 54 normal pregnant women from 20 to 40 weeks of gestation. Fetal gallbladder volume was monitored every 30 min from 8 to 18 o'clock in each patient.

Results

Maximum gallbladder volume (Max) had a linear relationship with gestational age between 20 and 32 and 35 weeks of gestation, after which a plateau was observed. Minimum gallbladder volume (Min) was not changed throughout gestation. Functional capacity (Max – Min) of the fetal gallbladder increased linearly with advancing gestation until 32–35 weeks' gestation, thenafter became constant. Contractility rate [(Max – Min/Max) × 100] increased curvilinearly with advancing gestation. The change of fetal gallbladder volume in a day showed a typical sinusoidal pattern, and the contractility cycle of gallbladder volume was not changed during pregnancy.

Conclusion

We suggest that there is an gallbladder contractility in human fetuses in utero, and that maternal meals seem not to affect the volume of fetal gallbladder.
F113The diagnosis and therapy in pregnancies complicated by acute hydramnios
Authors: Szaflik K. , Borowski D. , Oszukowski P. , Wyrwas D. , Kunert A. , Hincz P. , Ciesielski A.
Published: March 2003

Background

The aim of the study was an analysis of frequency of hydramnios and its etiology, and assessment of therapeutic modalities.

Method

The study group consisted of 77 pregnant women with detected hydramnios. The entry criteria were amniotic fluid index (by Phellan) > 28 cm.

Results

The mean gestational age was 29 ± 4.5 weeks. The mean AFI was 35 ± 7.9 cm. In 30 cases of hydramnios the congenital malformation was diagnosed. The most frequent were anomalies of gastrointestinal tract, lesions of central nervous system and teratomas. In 23 cases viral infections were diagnosed. Another group of pregnancies with the acute hydramnios constitute 13 twin gestations with TTS. In 16 cases, no etiologic factor was found. In all cases, the therapy of acute hydramnios was based on serial amnioreductions. In two cases maternal treatment with indomethacin was introduced beside amniocentesis. In 13 cases there were performed additional intrauterine drainage procedures. The mean gestational age during delivery was 33.6 ± 4.6 weeks. The mean interval between the diagnosis and delivery was 4.6 weeks. The mean birth weight was 2055 ± 1060g. 5th min Apgar score was 4pt. In 13 cases intrauterine demise of fetus occurred.

Conclusion

The most frequent causes of acute hydramnios include fetal anomalies, the TTS in twin pregnancies and congenital infections. Amnioreductions are the therapeutic approach with a significant effect on the prolongation of pregnancy.
F116Wharton's jelly quantification during gestation and its correlation with fetal biometry
Authors: Ghezzi F. , Raio L. , Di Naro E. , Franchi M. , Ferronato R. , Brühwiler H. , Triacca P. , Bolla D. , Schneider H.
Published: March 2003

Background

Abnormalities of the umbilical cord size have been associated with the growth of the fetus (Raio et al. Ultrasound Obstet Gynecol 1999; 13: 176). Therefore, this study was undertaken to generate a nomogram for the amount of Wharton's jelly (WJA) during gestation and to investigate whether it is related to fetal biometric parameters.

Method

The sonographic cross‐sectional area of the umbilical cord and of its vessels was measured in 627 healthy fetuses between 15 and 42 weeks of gestation. The WJA was calculated subtracting the vascular area from the umbilical cord area. The conventional biometric parameters were measured.

Results

The WJA increases as a function of gestational age (r = 0.63, P < 0.001). A stron correlation was present between the WJA and the umbilical cord area (r = 0.97, P < 0.001). A significant correlation was found between the WJA and fetal biometric parameters (with BPD, r = 0.66, P < 0.001; with AC, r = 0.65, P < 0.001; with FL r = 0.64, P < 0.001) and between WJA and estimated fetal weight (r = 0.63, P < 0.001).

Conclusion

A nomogram for the WJ amount has been generated. The WJA increases as a function of gestational age and it is related either with fetal size and with umbilical cord diameter.
F121The routine use of the three vessels and trachea (‘3VT’) view in fetal echocardiography
Authors: Yagel S.
Published: March 2003

Detailed fetal echocardiography potentially detects most congenital heart defects. In the last decade, screening programs have been established in numerous institutions in an attempt to rule out fetal heart anomalies in all pregnancies. However, fetal heart examination is time‐consuming and requires special skills. The ‘four chamber view’ and identification of ventricular outflow tracks became standard tests in screening programs. Examination of the aortic arch and superior vena cava, the location of the trachea in the mediastinum, the size of the aortic arch, main pulmonary artery, and the ductus arteriousus, and the direction of flow in these vessels, demands special attention and increases significantly the time required for routine fetal heart examinations.

We introduced the identification of the main pulmonary artery, ductus arteriosus, aortic arch, transverse section of the superior vena cava, and transverse section of the trachea into our routine fetal heart study. This ‘three vessel view’ is obtained by sliding the transducer upward from the four‐chamber plane toward the fetal upper mediastimun. In more than 2500 cases this maneuver significantly reduced the time required to examine these structures. Moreover, this approach facilitated detection of pathologies such as abnormal vessel size, abnormal vessel alignment or arrangement, and was shown to be superior in detecting anomalies such as persistent left superior vena cava, right aortic arch, vascular ring, and others.

We believe that this view should be introduced into the routine examination of the fetal heart.
F128The sonographic detection of fetal cardiac rhabdomyomas
Authors: Pinto V. , Selvaggio S. , Volpe P. , D’Addario V.
Published: March 2003

Objective

To compare the sonographic appearance of suspected cardiac tumors with the postnatal results and to assess the influence of antenatal ultrasound on the management of these lesions.

Study design

The study group consisted of 6 patients at 28–37 weeks of gestation referred to our Ultrasonic Unit, between March 1992 and December 1998, for suspected fetal cardiac masses.

Results

All the 6 cases of suspected rhabdomyomas have been confirmed in the neonatal period. The tumors were single in three cases and multiple in the other cases. The size ranged from 11 to 47 mm. In two cases the tumors arose from the right ventricle, in one case from the interventricular septum and in three cases from the left ventricle. Five infants are alive and in a satisfactory hemodynamic compensation. In two patients a regression in the maximum diameter of the tumor masses has been observed. One case underwent a surgical treatment at the age of six months and the baby died after surgery. In 3 out of 6 cases an association with tuberous sclerosis has been detected.

Conclusions

Two‐dimensional and Doppler echocardiography are accurate non invasive methods to evaluate fetal cardiac masses. They allow an immediate diagnosis and a reliable follow‐up of fetal and neonatal cardiac tumors. In our cases prenatal diagnosis did not appear to influence the outcome.
F24Assessment of endometrial volume by virtual organ computer aided analysis (VOCALTM) with three‐dimensionnal ultrasound prior to embryo transfer
Authors: Rudigoz R. C. , Bory A. M. , Affif A. , Salle B.
Published: March 2003

Background

The aim of this study was to obtain quantitative data on endometrial volume at the time of the oocyte retrieval in IVF patients

Materials and methods

110 consecutive patients undergoing IVF were included. The day of oocyte retrieval, patients were scanned by 3D ultrasound with Voluson 530 D (Kretztechnik AG, Zipf, Austria). Once the uterus was centred in longitudinal section, the volume box was superimposed. The volume was captured and stored on a 540 Mbyte with an integrated magneto optical drive. Endometrial volume was calculated with Virtual Organ Computer Aided Analysis (VOCALTM).

Results

Pregnancy rate was 25.45% (28/110). There was no statistical difference in age, ampoule of rec FSH, E2 level at the time of the oocyte retrieval, number of oocyte, number of mature oocyte, embryos and embryos transferred between pregnant and non pregnant women. Mean endometrial thickness was 10.29 mm in the pregnant group and 9.54 mm in the non pregnant group. Mean endometrial volume was 5.10 cm3in the pregnant group and 4.31 cm3 in the non pregnant group. A paired t‐test showed no statistical difference in endometrial thickness (P = 0.4) and volume (P = 0.08) between the two groups of patients.

Conclusion

3D‐ultrasound enables easy calculation of the endometrial volume. Although there is a statistical tendency endometrial volume cannot be use to appreciate uterine receptivity during IVF.
F29Vascular network in LUF syndrome
Authors: Marton U. , Kupešić S. , Kurjak A.
Published: March 2003

Background

The principal aim was to reveal additional information and comprehension's on physiology of the normal and pathophsysiology of disturbed cycles, that may lead towards the new diagnostic approaches and treatments in infertile patients.

Method

The group of 22 patients included women with LUF syndrome. The emphasis was put on the intraovarian vascularity and especially on vascularity from inner vessels of ring of the follicle. Scans were performed on 5th, 10th, 12th, 21st and 24th day of menstrual cycle. A control group of 38 patients with regular menstrual cycles was selected on the basis of the normal gynecological, sonographical and hormonal findings. These patients had normal ovulatory cycles but were investigated for infertility due to the male factor.

Results

Doppler studies of the uterine artery and its evaluated branches have suggested significant decrease of the velocities at 12th and 15 h day of MC compared to control group. The RI of ovarian artery were around 0.84 ± 0.016 during the MC and excepted lowering of the RI has not occurred during the preovulatory period as in the control group. Velocity of ovarian artery of the dominant side showed significantly lower values, with the mean values of 34 cm/s ± 1.1 in the patients with LUF sy. compared to controls. The development of the RI of the intraovarian stromal vessels in LUF sy. were similar to that of anovulatory cycles, showing the loss in the cycling rhythm and post peak LH values similar to those of the follicular growth phase.

Conclusion

The results of this study showed again that there is clear relationship between hormone mediators, primarily the steroids and velocimetric indices taken during the observed cycles. It also would seem that the hormones, with its mediators and hemodynamic factors play an important role through systemic and local action, in regulating uterine and ovarian blood flow.
F37Serial measurements of ductus venosus flow velocity waveforms and nuchal translucency thickness: relationship with fetal outcome
Authors: Bilardo C. M. , Müller M. A. , Pajkrt E. , Bleker O.P.
Published: March 2003

Background

In a previous study we have demonstrated that a statistically significant relationship exist between nuchal translucency (NT) thickness and ductus venosus flow measurements. Moreover we have shown that a decrease in NT thickness at a subsequent examinationl reduces the chance of an abnormal outcome. The aim of this study was to investigate the interrelationship between NT thickness and ductus venosus Doppler measurement (a‐wave, pulsatility index PI) at repeated examinations and their relationship with fetal outcome.

Method

Ductus venosus flow velocity waveforms and NT thickness were measured twice (median 4 days range 2–7) in 36 fetuses with increased nuchal thickness.

Results

According to the behaviour in the two parameters the fetuses were divided into three categories: unchanged both abnormal (1), unchanged only NT persistently abnormal (2) and changed NT decreased. The fetuses in group 1 had a 20 fold increase chance of an abnormal outcome (chromosomal anomalies, unexplained intrauterine death, congenital anomalies, cardiac defects n.). Conversely fetuses in group 3 had a lower chance of an abnormal outcome than group 1 and 2.

Conclusion

In fetuses with normal karyotype the finding of persistently increased NT and ductus venosus flow represents a poor prognostic factor, more than when nuchal translucency alone is persistently abnormal.
F56Blood velocity in fetal Galen vein and outcome of pregnancy
Authors: Gudmundsson S. , Dubiel M. , Breborowicz G. H. , Laurini R.
Published: March 2003

Background

Pulsating blood velocity in the umbilical vein is an indicator of fetal compromise with poor outcome. Blood velocity in the fetal vein of Galen is normally even and without fluctuation. The propose of this study was to establish whether blood flow velocity pulsations in the Galen vein seen in high‐risk pregnancies were also related to adverse outcome of pregnancy.

Methods

The vein of Galen was located by color Doppler ultrasound in 102 pregnancies complicated by pregnancy‐induced hypertension and blood velocity recorded by pulsed Doppler within 2 days of delivery. The presence of blood velocity pulsation's was noted and correlated to perinatal outcome, including emergency operative intervention and/or neonatal distress. Umbilical artery and venous, uterine and middle cerebral artery blood velocity was also recorded at the same time.

Results

Pulsating blood velocity in the vein of galen was found in 68 cases and in the umbilical vein in 21. Venous pulsations were highly significantly related to adverse outcome of pregnancy. Pulsations in the Galen vein were three times more frequent than in the umbilical vein, suggesting that it appears earlier than in the umbilical vein. In all the 7 perinatal deaths there were pulsations in the Galen vein. Signs of brain sparing in the middle cerebral artery were seen in only 32 fetuses.

Conclusion

Venous pulsations in the umbilical and Galen vein were both significantly correlated to adverse outcome of high‐risk pregnancy. Pulsations in the vein of Galen seem to occur earlier than in the umbilical vein, which might be helpful when deciding the timing of delivery of a high‐risk case with minimal neonatal morbidity.
F06Transvaginal sonography, hydrosonography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium ≥ 5 mm
Authors: Epstein E.E. , Ramirez A. , Skoog L. , Valentin L.
Published: March 2003

Objective

To determine the ability of transvaginal ultralsound, with or without saline infusion (hydrosonography), to detect focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium ≥ 5 mm, and to determine the accuracy of conventional ultrasound, hydrosonography and hysteroscopy with regard to diagnosing endometrial polyps, submucous myomas and uterine malignancy.

Methods

In a proscpective study 105 women with postmenopausal bleeding and endometrium ≥ 5 mm, underwent conventional ultrasound examination and hydrosonography. Diagnostic hysteroscopy, D & C, and hysteroscopic resection were the performed. The presence of focally growing lesions, and the type of lesion (e.g. endometrial polyp, submucous myoma or malignancy) were noted at ultrasound examination and at hysteroscopy. The endpoints were focally growing lesions detected at hysteroscopy and final pathological diagnosis.

Results

There was almost perfect agreement (96%) between hydrosonography and hysteroscopy with regard to detecting focally growing lesions. Hydrosonography and hysteroscopy both had a sensitivity of around 80% with regard to endometrial polyps (false positive rate 24% and 6%, respectively), whereas conventional ultrasound missed half of the polyps (sensitivity 49%, false positive rate 19%). Hysteroscopy was superior to both hydrosonography and conventional ultrasound for discrimination between benign and malignant lesions in the uterine cavity (sensitivity 84%, 44%, and 60%; false positive rate 15%, 6%, and 10%). We found a seven fold increased risk of malignancy in women with distension problems at hydrosonography (odds ratio 7.3, 95% CI 1.9–27.8).

Conclusion

Hydrosonography is as good as hysteroscopy at detecting focally growing lesions in the uterine cavity in women with postmenopausal bleeding. However, neither hysteroscopy nor hydrosonography can reliably discriminate between benign and malignant focal lesions. Distension problems at hydrosonography should raise a suspicion of malignacy.
F75Determining fetal lung volume using three‐dimensional‐ultrasonography
Authors: Miric‐Tesanic D. , Merz E.
Published: March 2003

Background

The aim of the study was to establish fetal lung, thoracic and heart volume nomograms using 3D‐ultrasonography.

Method

For this purpose 115 fetuses were examined (between 18 and 33 weeks of gestation) using Voluson 530D (Kretztechnik, Austria) ultrasound device and 5 MHZ three‐dimensional annular volume transducer. Lung volumes of 15 fetuses suffering from skeletal dysplasia, renal agenesis or hydrothorax and secondary pulmonary hypoplasia were compared with previously established nomograms.

Results

Lung volumes in the pathologic group of fetuses compared to the nomograms were below the 5% for gestational age.

Conclusion

The encouraging first results suggest that this method could be a method of choice for the early detection of pulmonary hypoplasia, even before 24 weeks of gestation.
F78Three‐dimensional sonographic features of fetal central nervous system anomaly
Authors: Kuno A. , Ueta M. , Hanaoka U. , Tanaka Y. , Matsumoto M. , Kanenishi K. , Yamashiro C. , Tanaka H. , Hayashi K. , Yanagihara T. , Hara K. , Hata T.
Published: March 2003

Background

Our aim was to visualize an intracranial structure of the fetal central nervous system (CNS) anomaly using transabdominal three‐dimensional (3D) sonography.

Methods

A total of 18 cases with fetal cns anomalies (one unilateral ventriculomegaly; 6 hydrocephalus; 3 anencephaly; 4 holoprosencephaly; one Dandy‐Walker cyst; and 3 enlarged cisterna magna) from 17 to 37 weeks of gestation were studied with transabdominal 3D sonography (3.5 MHZ).

Results

In unilateral ventriculomegaly, insight view of dilated lateral ventricle, especially dilated atrium was depicted. In hydrocephalus, severely dilated bilateral ventricles and thin brain mantle were beautifully shown. In anencephalus, an absence of the brain and defect of the vault of the skull was clearly noted. In holoprosencephaly, absent interhemispheric fissure, common ventricle, and the extent of thalamic fusion were evident. In Dandy‐Walker cyst, cerebellar hemisphere was clearly depicted due to the agenesis of cerebellar vermis. In enlarged cisterna magna, posterior intracranial view of the fetus showed a large space of cisterna magna. Although the diagnosis of each CNS anomaly was made using conventional two‐dimensional sonography, 3D sonography proved most helpful delineating the exact nature and anatomic level of the anomaly.

Conclusion

Our results suggest that 3D sonography provides a novel means of visualizing fetal CNS anomalies in utero.
Breast F84The estrogen environment and Doppler parameters of breast lesions
Authors: Germer U. , Tetzlaff A. , Geipel A. , Gembruch U. , Diedrich K.
Published: March 2003

Background

A high physiological variation of blood flow during menstrual cycle was found by examining breast vascularity with CW‐Doppler and is influenced by endocine therapy. In this study the correlation between the vascularity of breast lesions to menopausal status, phase of menstrual cycle and endocrine therapy is analysed.

Method

249 breast lesions in 91 premenopausal patients and 152 postmenopausal patients (142 malignant and 105 benign tumors) were demonstrated in B‐mode ultrasound and intratumoral vessels were visualized by color Doppler imaging. Bloodflow velocity waveforms were detected by pulsed Doppler. Correlations between the Doppler parameters Vmax, RI, PI, S/D and the number of intratumoral vessels (n) to the endocrine factors mentioned above were analysed.

Results

The means of Doppler parameters in the group of premenopausal patients were: n = 1.38 (±1.53), RI = 0.69 (±0.09), PI = 1.25 (±0.36), S/D = 3.64 (±1.78), Vmax = 11.11 (±9.6) cm/s and in the postmenopausal group: n = 1.36 (±1.72), RI = 0.77 (±0.08), PI = 1.61 (±0.47), S/D = 5.08 (±3.21), Vmax = 11.04 (±6.4) cm/s. RI, PI and S/D‐values were significantly (P < 0.05) different between these two groups. The Doppler parameters of tumors examined in the follicular phase were similar to those in the luteal phase. During treatment with oral contraceptives the number of intratumoral vessels was higher n = 1.80 (±1.23) than during spontanous menstrual cycle n = 0.86 (±0.86).

Conclusion

Menopausal status and endocrine therapy have a robust influence on Doppler parameters of breast lesions.
F97Preterm fetal behaviour and the risk of sudden infant death syndrome
Authors: Smoleniec J. S. , James D.
Published: March 2003

Objective

To look for differences in fetal behavioural state coincidence between two groups categorised into a high and a low SIDS risk by the Oxford SIDS risk scoring system.

Patients and methods

The study population comprised low risk women with singleton pregnancies booked at St Michael's Maternity Hospital, Bristol, Avon. The ‘Oxford SIDS risk scoring system (Peters & Golding 1986) was used to recruit pregnancies into a high and a low SIDS risk group. The study involved performing two fetal behavioural studies (Nijhuis et al. 1982) at 30 and 36 weeks gestational age on the same fetuses. The unpaired t‐test was used to compare values for the low and the high SIDS risk groups.

Results

Fetal behavioural state coincidence results were analysed for a group of 58 fetuses. There were 39 in the low SIDS risk group and 19 in the high SIDS risk group. A cross‐sectional analysis of the fetal behavioural state coincidence results for the high and the low SIDS risk groups showed no significant difference (P < 0.05). A longitudinal comparison of the intrafetal change in coincidence with increasing gestational age also showed no significant difference.

Conclusion

The cross‐sectional and longitudinal comparison of FBS coincidence results failed to show a significant difference between the high and low SIDS risk groups. The results suggest that fetal behavioural state study based on the Nijhuis (1982, p. 182–4) criteria did not show any association with the Oxford SIDS risk score.
F98Sonographic assessment of fetal disproportion and perinatal outcome in small for gestational age fetuses
Authors: Mimica M. , Karelović D. , Tadin I. , Benzon Z.
Published: March 2003

Background

To assess the possibility of sonographic prediction of perinatal outcome in small for gestational age (SGA) fetuses according to the presence of fetal disproportion.

Method

SGA children (n = 138, birth weight for gestational age < 10th percentile) were classified by their neonatal ponderal index (PI) as proportional or disproportional (PI < 3rd centile for gestational age). Adverse perinatal outcome was considered in the presence of abnormal fetal heart rate (FHR), Apgar score < 7, respiratory and neurological complications in neonatal period.

Results

18 children (13%) were disproportionally small for age, having significantly higher incidence of abnormal FHR (50%), oligohydramnios (44%), neurological complications (22%) and perinatal mortality (17%) compared with proportionally SGA children. Multiple logistic regression analysis with perinatal complications as dependent variable revealed a significant effect of ponderal index (beta =− 0.17). Among sonographic parameters only umbilical artery resistance index was significantly associated (beta = 0.50). Oligohydramnios and FL/AC ratio did not reach statistically significant level of influence on perinatal complications.

Conclusion

Body disproportion is a significant factor of perinatal morbidity and mortality in growth retarded children. Abnormal umbilical artery blood flow is the best sonographic predictor of perinatal complications in this group. FL/AC ratio as antenatal equivalent of neonatal ponderal index is not enough sensitive to be used in prediction of perinatal complications.
Prenatal diagnosis of total arhinia
Authors: Cusick W. , Sullivan C. A. , Rojas B. , Poole A. E. , Poole D. A.
Published: March 2003

Complete or total arhinia, in which there is absence of the soft tissue of the nose, is extremely rare. The embryological origin of the defect is thought to be maldevelopment of the paired nasal placodes. Available neonatal case descriptions have reported the frequent coexistence of other facial anomalies. This report is the first to describe the antenatal diagnosis of total arhinia confirmed after delivery. Sonographic views of the fetal profile, showing an absence of the nose led to consideration of the diagnosis.
Ultrasonographic detection of fetal cranio‐facial hemangioma: case report and review of the literature
Authors: Viora E. , Grassi Pirrone P. , Comoglio F. , Bastonero S. , Campogrande M.
Published: March 2003

A case of an isolated cranio‐facial vascular anomaly, extending from the left parietal bone to the lateral margin of the omolateral orbit is presented. Detection and differential diagnosis of fetal hemangioma is important for a variety of reasons. First, it allows the prenatal growth of the mass to be evaluated. Second, it enables appropriate arrangements for delivery to be made including its timing and selection of the appropriate clinical team necessary to support the neonate. After birth these cranio‐facial anomalies can regress spontaneously, but plastic surgery is often necessary. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The influence of fetal position on nuchal translucency thickness
Authors: De Graaf I. M. , Müller M. A. , Van Zuylen‐Vié A. A. , Bleker O. P. , Bilardo C. M.
Published: March 2003

Objective

To determine whether nuchal translucency thickness is influenced by the fetal position at ultrasound examination.

Subjects

Transabdominal ultrasound examination for pregnancy dating and measurement of nuchal translucency thickness was performed at 10–14 weeks' gestation in all women attending the antenatal clinic of our hospital. During the examination special attention was paid to a change in fetal position from prone to supine or vice versa.

Methods

For each fetus the nuchal translucency measurement was repeated when a positional change from prone to supine or vice versa was recorded. All measurements were recorded on hard copy. An image‐scoring method was used and evaluated by three independent reviewers.

Results

Eighty‐five fetuses were included in this study. The mean nuchal translucency for supine fetuses was 1.91 mm compared with 1.93 mm for prone fetuses. The mean quality‐score was 6.54 for supine fetuses and 6.55 for prone fetuses. This difference was not statistically significant.

Conclusion

Fetal position has no influence on the measurement of nuchal translucency. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Nuchal translucency and congenital heart defects: heart failure or not?
Authors: Simpson J. M. , Sharland G. K.
Published: March 2003

Objective

To determine whether heart failure is the mechanism underlying the association between increased fetal nuchal translucency and congenital heart defects.

Methods

Retrospective analysis of the types of congenital heart defect observed in fetuses with increased nuchal translucency and those with normal nuchal scans. Retrospective quantitative analysis of cardiac size and left ventricular ejection fraction in fetuses with ventricular septal defects or the hypoplastic left heart syndrome.

Results

Eighty‐three fetuses with congenital heart defects had undergone nuchal screening of which 51 had increased nuchal translucency and 32 had normal nuchal translucency. A wide variety of different congenital cardiac lesions with different hemodynamic effects were observed in fetuses with increased nuchal translucency and those with normal nuchal scans. Defects primarily characterized by left heart obstruction, right heart obstruction and septal defects occurred in both groups. All measurements of cardiothoracic ratio and left ventricular ejection fraction fell within the normal range and there was no significant difference between fetuses with increased nuchal translucency and those with normal nuchal scans.

Conclusions

No specific type of congenital heart lesion is associated with increased nuchal translucency. The contention that heart failure explains the association between congenital heart defects and increased nuchal translucency is not supported by this study. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Longitudinal survey of fetal ventricular ejection and shortening fraction throughout pregnancy
Authors: Hsieh Y.‐Y. , Chang F. C.‐C. , Tsai H.‐D. , Tsai C.‐H.
Published: March 2003

Objectives

To assess and compare the ejection fraction (EF) and shortening fraction (SF) of both ventricles through pregnancy.

Materials

Uncomplicated singleton pregnancies, of between 10 and 40 weeks' gestation, were recruited. Transabdominal two‐dimensional M‐mode imaging of the right ventricular EF (REF), right ventricular SF (RSF), left ventricular EF (LEF), and left ventricular SF (LSF) were performed. Doppler surveys were performed at (1) 10–14 weeks; (2) 15–19 weeks; (3) 20–24 weeks; (4) 25–29 weeks; (5) 30–34 weeks; and (6) 35–40 weeks. The following values were measured: REF, RSF, LEF, LSF, REF/LEF and RSF/LSF.

Results

A total of 42 cases were included. The values of REF, RSF, LEF, and LSF for the six gestational time periods were (1) 0.86, 0.49, 0.85, 0.48; (2) 0.84, 0.48, 0.88, 0.51; (3) 0.76, 0.37, 0.84, 0.48; (4) 0.75, 0.37, 0.84, 0.48; (5) 0.76, 0.38, 0.83, 0.47; and (6) 0.77, 0.38, 0.84, 0.48, respectively. The ratios of REF/LEF and RSF/LSF in each gestational time period were: (1) 1.04, 1.11; (2) 0.95, 0.92; (3) 0.95, 0.90; (4) 0.94, 0.90; (5) 0.94, 0.92; and (6) 0.92, 0.89, respectively.

Conclusions

After 20 weeks' gestation both the EF and SF of the right ventricle decreased. A non‐significant change in the LEF and LSF was observed throughout pregnancy. A decreasing trend in the REF/LEF and RSF/LSF ratios during pregnancy was noted. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Vasa previa: prenatal detection by three‐dimensional ultrasonography
Authors: Lee W. , Kirk J. S. , Comstock C. H. , Romero R.
Published: March 2003

Objective

To describe three‐dimensional (3D) ultrasonography (US) for the antepartum diagnosis of vasa previa.

Design

This was a descriptive study of two pregnant women who were suspected to have vasa previa by conventional gray‐scale ultrasonography. Three‐dimensional studies were also performed during the early third trimester to further investigate the possibility of this condition.

Results

In the first case, 3D US provided gray‐scale multiplanar and surface‐rendered views of an aberrant vessel over the internal cervical os. For the second case, a ‘flight‐path’ technique allowed the examiner to follow axial views of the endocervical canal toward the internal os until an aberrant vessel was verified. The ‘niche‐mode’ analysis, with and without color power Doppler ultrasonography, was also used to confirm the diagnosis.

Conclusion

Three‐dimensional ultrasonography offers several additional imaging tools that are not currently provided by more conventional ultrasonography for the detection of vasa previa. It represents an important adjunct to two‐dimensional (2D) studies, especially when this diagnosis is questionable. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Predicting the risk of pre‐eclampsia and a small‐for‐gestational‐age infant by quantitative assessment of the diastolic notch in uterine artery flow velocity waveforms in unselected women
Authors: Ohkuchi A. , Minakami H. , Sato I. , Mori H. , Nakano T. , Tateno M.
Published: March 2003

Objectives

To develop a new quantitative index, the notch depth index (NDI), to evaluate its association with the risk of pre‐eclampsia and a small‐for‐gestational‐age (SGA) infant and to compare its clinical usefulness with that of the uterine artery resistance index (RI) and the peak systolic to early diastolic velocity (A/C) ratio.

Methods

Uterine artery color Doppler ultrasound was performed in 288 consecutive healthy pregnant women at 20.2 ± 2.0 (range 16.0–23.9) weeks of gestation. The NDI represents the depth of the early diastolic notch divided by the maximal diastolic velocity.

Results

Nine (3.1%) of the 288 women developed pre‐eclampsia and 18 women (6.3%) delivered an SGA infant. The NDI was associated with subsequent onset of pre‐eclampsia. The optimal cutoff value for the NDI in predicting pre‐eclampsia was 0.14, giving a sensitivity, specificity and a positive predictive value (PPV) of 67, 92, and 22%, respectively. The PPV of the NDI was the largest of the three indices evaluated (12% for the RI and 16% for the A/C ratio). The relative risk for pre‐eclampsia in women with values equal to or greater than the optimal cutoff values of the RI, A/C ratio and the NDI was 9.7 (95% confidence interval, 2.5–3.7), 19.2 (4.2–91), and 19.2 (5.1–71), respectively. The NDI of 0.14 improved the PPV of 18% determined by the presence of notches in bilateral uterine arteries. The optimal cutoff value of 0.14 for the NDI in predicting an SGA infant yielded a higher PPV (22%) than those for the RI (9%) and A/C ratio (12%).

Conclusions

The NDI value in the second trimester is associated with the later onset of pre‐eclampsia, and is clinically more useful in predicting pre‐eclampsia than the two conventional indices. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology