bluuebunny/crossref_metadata_2025 huggingface dataset:
Chromosomopathies F30The clinical impact of increased nuchal translucency
Authors: Pajkrt E. , Muller M. A. , Bleker O. P. , Bilardo C. M.
Published: March 2003

Background

The aim of this study was to examine the relationship between nuchal translucency measurements and outcome of pregnancy.

Method

Fetal nuchal translucency measurements were performed on 6300 consecutive women attending the prenatal diagnosis centre of our Hospital.

Results

Of the 384 fetuses (6.1%) with an enlarged (≥ p95) nuchal translucency 104 (27%) had an abnormal karyotype. Ten (2.6%) pregnancies ended in a spontaneous abortion before karyotyping was performed. In the remaining 270 eukaryotic fetuses with enlarged nuchal translucency 22 (8.2%) had a structural anomaly or genetic syndrome detected by ultrasound later in pregnancy and 3 (1.3%) after birth. The total incidence of an unfavourable outcome in the group of fetuses with enlarged nuchal translucency was 40%. In contrast, in the group with a normal nuchal translucency (< p95), the incidence of an unfavourable outcome was 4.0%.

Conclusion

When counselling parents in case of an increased nuchal translucency fetal karyotyping is the first step. If the karyotype is normal detailed ultrasound examination around 20 weeks' gestation is the second step. When both the fetal karyotype and the anomaly scan are normal there is still a 1.3% risk that the fetus will be affected by a congenital abnormality or genetic syndrome.
F34Early prenatal diagnosis of chromosomal defects: value of sonographic markers
Authors: Galindo A. , Puente J. M. , Gómez M. J. , Moreno A. , Fernández J. , Alvarez C. , Grañeras A. , Barreiro E.
Published: March 2003

Aim

To evaluate the role of early sonographic markers (SM) of chromosomal defects combined with maternal age (MA).

Methods

Retrospective study of 1470 amniocentesis performed in high‐risk patients mainly because of advanced MA from Jan.97‐Dec.99. SM of chromosomal defects are routinely searched for at first scan at 11–14 weeks. We analyze the association between chromosomal defects and MA regarding the existence of SM.

Results

Overall chromosomal defects rate was 4.6% (66/1470). SM were detected in 147 cases (10%) and, regardless of MA, a chromosomal defect was diagnosed in 44 of these cases (30%). Of the 1323 cases without SM the rate of chromosomal abnormalities was 1.5% (20 cases) (P < 0001). When MA was = 35 years, the rate of chromosomal defects in cases with SM was 35.2% (19/54) and in those without SM 1.8% (20/1125) (P < 0001). No significant differences were found in cases with SM as a function of MA neither in cases without SM. The number and percentage of chromosomal defects according to MA and SM are expressed in the Table.

Age
< 35
35
36
37
38
39
= 40

SM+
25/91
1/7
2/13
1/5
–
5/6
10/23

27%
14%
15%
20%

83%
43%

SM–
2/198
3/102
5/207
1/262
6/204
2/158
3/192

1%
3%
2%
0,4%
3%
1%
2%

14 out of the 20 cases of chromosomal defects (70%) diagnosed in fetuses without SM were sexual aneuploidies or structural defects while the remaining 6 were trisomies 21 (30%). By contrast, in cases with SM were mainly trisomies 21, 18, 13 and 45X0.

Conclusions

SM are best correlated with chromosomal defects than other risk factors (RR = 15). However, when risk factors other than SM are present, fetal karyotype analysis is still also indicated.
F38Normogram of nuchal fold thickness during 14–16 weeks' gestation of 195 normal fetuses by transvaginal ultrasound
Authors: Perlitz Y. , Mukary M. , Ben‐Ami M.
Published: March 2003

Background

The aim of this study was to establish normal values of nuchal fold thickness during 14–16 weeks' gestation by transvaginal sonography (TVS).

Method

Singleton fetuses of 195 women with normal pregnancies were studied by TVS at 14–16 weeks' gestation. Gestational age was determined by last menstural period and confirmed by biometry. Nuchal fold thickness was measured by the modified axial view of the head, cerebellum and the nuchal fold. All women delivered normal infants with no evidence of anomalies. t‐testing was performed to determine any correlation between nuchal fold thickness and gestational age.

Results

Mean value of nuchal fold thickness during 14–16 weeks' gestation was 2.2 ± 0.5 mm (mean ± SD). The mean values for 14, 15 and 16 weeks' gestation were 2.1 ± 0.5 mm, 2.2 ± 0.4 mm and 2.4 ± 0.9 mm, respectively. There was only a marginally significant increase of the nuchal fold thickness between 15 and 16 weeks' gestation (P = 0.054, t‐test).

Conclusions

Normal values of nuchal fold thickness at 14–16 weeks' gestation for normal fetuses were constructed by TVS. The mean value of nuchal fold thickness only slightly increased during 14–16 weeks' gestation. Therefore, the same mean value (2.2 ± 0.5 mm) may be used throughout this period.
F39Chorionic villus sampling after the first trimester
Authors: Podobnik M. , Duić Ž. , Skalak D. , Podgajski M. , Ciglar S. , Gebauer B.
Published: March 2003

Objectives

The purpose of this article was to evaluate the association between late CVS (placental biopsy) and complications between sampling and delivery.

Method

Late chorionic villus sampling under ultrasound guidance was carried out in 2600 (86.7%) cases in the second trimester and 400 (13.3%) cases in the third trimester of pregnancy. Out of 3000 late CVS, 684 (22.8%) were performed because of suspicious ultrasonographic findings. In the 500 patients between 13 and 16 weeks of gestation color Doppler was used to investigate the uteroplacental and fetal vessels before and after late chorionic villus sampling.

Results

In 24 patients (0.8%), complications between sampling and delivery were found. There were only nine (0.35%) spontaneous abortions four to six weeks after late chorionic villus sampling. We found 156 (5.2%) chromosomal abnormalities. In the group with suspicious ultrasonic findings (684 cases) we found significant oligohydramnios in 300 (43.8%) and significant polyhydramnios in 150 (21.9%), and 105 (15.4%) had chromosomal abnormalities. Among the 156 patients with chromosomal abnormalities, ultrasonographic findings in 85 (54.4%) were detected after 20th week of pregnancy. There were no significant differences in mean pulsatility indices between uteroplacental and fetal vessels before and after late chorionic villus sampling. Preliminary data for 20 trisomic fetuses indicate an abnormally increased umbilical PI and abnormally decreased middle cerebral artery PI.

Conclusions

Late CVS is a safe method of prenatal diagnosis for high‐risk couples and does not significantly affect the outcome of pregnancy.
F45Acquired right heart outflow tract anomaly in twin–twin transfusion syndrome: not such a bad prognosis
Authors: Nizard J. , Vaillant M. C. , Grangé G. , Bonnet D. , Audibert F. , Fermont L. , Ville Y.
Published: March 2003

Background

Significant hemodynamic changes are commonly observed in both fetuses in twin–twin transfusion syndrome. Cardiac dysfunction is common and well known in the donor twin with hypertrophy of the left ventricle and overall enlargement of the heart, whereas there is dilatation of the right ventricle with tricuspid regurgitation in the recipient twin.

Cases

We report 3 cases of twin–twin transfusion syndrome with right ventricle outflow tract obstruction acquired in utero in the recipient twin which are likely to have developed as a cardiac dysfunction. Two of the tree recipient twins survived and are well being with more than one year of follow‐up due to correct surgical treatment.

Analysis

These acquired anomalies of the right heart are probably related to the very particular hemodynamic conditions and the volume shifted between the twins.

Conclusion

Right heart anomaly in the recipient twin should be known of all ultrasonographers since it calls a particular neonatal treatment.
F50Short‐term variation (STV) in centralized fetuses
Authors: Cha S.C. , Toma O.T. , Braia G.O. , Lopes M.A. , Carvalho M.B.
Published: March 2003

Aim

To evaluate the importance of STV in centralized fetuses.

Material and method

43 centralized fetuses were evaluated by computorized cardiotocography (CCT) (System 8002 – Oxford). As group control, 1235 computorized cardiotocography trace from fetuses with normal Doppler were analysed.

Result

At 10 min of CCT, 15/43 (35%) of centralized fetuses showed STV < 4 msec. At the end of CCT 4 (9.4%) centralizad fetuses maintainned STV < 4 msec against only 12 (1%) fetuses in the normal group. The duration of CCT in centralized fetuses was 30 ± 10 min and 20 ± 9 min in the normal group. The mean STV of centralized fetuses was significantly lower than normal fetuses at any time of the trace. At the end of the trace, STV in centralized fetuses was 5.5 ± 1.5 msec and in normal fetuses was 8.7 ± 2.5 msec (P < 0.05). However, 90% of centralized fetuses showed normal CCT (STV > 4 msec. or presence of two or more transitory acceleration).

Conclusion

This preliminary study shows that short‐term variation seems to be earliest abnormal finding at CTC in centralized fetuses. Since 90% of centralized fetuses had normal CCT (STV > 4 msec.), this parameter can be used to avoid premature interruption of the pregnancy due to abnormal Doppler.
Interventional procedures F62Interventional ultrasound based on national registrations of fetal interventions in Japan
Authors: Chiba Y. , Nakano H.
Published: March 2003

Methods

Japanese Society of Obstetrics and Gynecology conducted the Registration of Fetal Therapy. One hundred 62 Institutes in Japan join the registration. From 1966 to 1999, totally 584 fetuses treated inutero including interventional procedures were registered from 86 Institutes. Effects of fetal therapies were determined by self‐judgements of reporters.

Results

One hundred 81 cases of hydrops aspirated their pleural effusion or ascites. The mortality of this group was 38.7%. Totally 47 cases of hydrops were medicated through maternal vein or directly. Thirty‐four (72.3%) cases in 47 of this group judged ineffective or unknown effect. The mortality of the group was 68.1%. Sixteen fetal transfusions were reported, effectiveness of that was 62.5% and the mortality was 31.2%. Shunting operations for hydrothorax or ascites were performed on 28 fetuses. The effectiveness of feto‐amnio shunting for hydropic fetuses was high as 82.1% and the mortality was 46.4%. Medical therapies for tachycardia were performed for 31 fetuses. The effectiveness was 67.7% and the mortality was 12.9%. There were 21 cases of shunting operation for obstuctive uropathies. The effectiveness of urinary shunting operation was 71.4% and the mortality was 47.6%. One hundred 60 fetuses of the amnio‐aspiration for TTTS, 16 fetuses of the rupture of septal membrane, 2 fetuses of closure blood flow and 2 fetuses of selective delivery were reported. After the period of the registration, we performed successfully endoscopic closure of umbilical cord for acardiac twin by the good guidance of ultrasound.

Conclusions

There are some fetal interventions which we can accept as the general therapy for fetus. They are shunting operation for obstructive uropathy, medication for tachy‐arrythmia, and fetal transfusion. Shunting operation for hydrothorax will be accepted.
F07Hysterosonosalpingography – a new concept of diagnostic procedures in gynaecology
Authors: Bernardo M. J. , Leitão C. , Dias I. , Bugalho J. , Neto I.
Published: March 2003

Background

The aim of this study is to find the effectiveness of hysterosonosalpingography in the diagnosis of the endometrial pathology and in the study of tubal patency.

Method

We have studied 550 cases backwards. The women enrolled came from four departments of our Hospital: Menopause (n = 206), Reproductive Medicine (n = 195), General Gynaecology (n = 125) and Senology − Women on Tamoxifen (n = 24). We have analysed epidemiological data, Transvaginal Sonography and hysterosonosalpingography findings, as well as the conventional Hysterosalpingography, Laparoscopic, Hysteroscopic and histological data. We have looked for the concordance rate between the hysterosonosalpingography and the other diagnostic procedures.

Results

Main findings: Round hyporeflective broad‐based structures representing polyps or submucosal myomas, thin endometrium, floating thin or rigid strips, subseptate uterus, unobstructed tubes, uni or bilateral tubal occlusions. High concordance rate (from 85% to 95%) was verified between the hysterosonosalpingography and the classic diagnostic proceedings.

Conclusion

Hysterosonosalpingography is a good and valuable complement of Transvaginal Sonography in the endometrial study. It makes possible appropriate preoperative triage to hysteroscopy. It may be also a first class exam of screening infertility. The success of this technique led us to include it at the diagnostic protocols in our Hospital.
F74Live 3D – dynamic prenatal three‐dimensional‐sonography
Authors: Brauer M. , Dudenhausen J. W.
Published: March 2003

Background

3D‐Ultrasound (3D‐US) was lacking a mode of dynamic visualisation in the past. Recently a new method for dynamic 3D‐Sonography (Live‐3D) was developed. Live‐3D was evaluated concerning feasability and relevance in fetal sonography. The results will be demonstrated by short video sequences.

Method

The technical principle of Live‐3D is based on the Voluson‐technique, developed by Kretztechnik (Zipf/Austria). Special modifications enable the machine to perform a continuous serial volume‐scanning and image‐rendering. The result is a dynamic visualisation of tomographic images or surface renderings with a maximum speed of 3 images/second. Recent improvements even permit image‐frequencies up to 12 images/second.

Results

Live‐3D allows a 3‐dimensional visualisation of the moving fetus. Low image‐frequencies cause certain limitations but this problem has been improved tremendously and will be completely solved in near future. A still remaining problem is the lack of a selective elimination of artefacts.

Conclusions

Integrating motion into 3D‐US the development of Live‐3D is comparable to the step from Compound‐Scan to Realtime‐B‐Mode. Fetal behaviour (e.g. mimic) can be visualized 3‐dimensionally, which might be useful for fetal assessment. Furthermore realtime‐3‐dimensional‐guidance will allow a more precise performance of invasive procedures. Further modifications such as the acceleration of image‐frequencies and the improvement of the artefact‐elimination are necessary to optimize the method.
F76Patients undergoing three‐dimensional ultrasound: review of referrals for 111 patients
Authors: Pretorius D. H. , Hull A. D. , Nelson T. R. , Coffler M. , Daneshmand S.
Published: March 2003

Background

Three‐dimensional ultrasound (3DUS) is a rapidly emerging imaging technology offering improved visualization of patient anatomy. The purpose of this project was to identify the distribution of patients referred for 3DUS on a clinical service and assess the potential impact on care and management strategies.

Method

Charts from 111 patients having 3DUS studies in our clinical obstetrical and gynecological service were reviewed for indications. Patients were categorized as:

1) 3DUS specific referrals based on 2DUS findings, 2) value added DUS studies to

2) trouble shoot problems identified with 2DUS, 3) physician requested 3DUS studies to enhance patient reassurance and 4) patient initiated 3DUS studies for reassurance.

Results

Indication for 3DUS studies were: 3DUS specific referrals (30) (e.g. facial anomalies, sonohysterogams), trouble shoot problems identified with 2DUS (45) (e.g. club feet, vasa previa), physician requested studies to enhance patient reassurance (e.g. prior anomalies) and patient initiated 3DUS for reassurance (15) (e.g. prior anomalies, surrogate parents, hospice patients). Availability of 3DUS imaging resulted in new models of patient referral (internet, patient initiated, distant to the community).

Conclusion

As new technology (e.g. 3DUS) enters the clinical arena, new pathways for patients to access technology develop (outside referrals, patient referrals, internet).

Improved information alters and improves patient responses (comprehension, decision making, reassurance) to their medical situation.
F85Impact of ultrasound‐guided large‐core needle biopsy with frozen section on surgical management of breast cancer
Authors: Pohlodek K. , Janek Jr L. , Ferianec V. , Galbavý Š. , Holomáň; K.
Published: March 2003

The authors have undertaken to establish the ultrasound‐guided large‐core needle (14 G) biopsy with frozen section in preoperative histologic examination of palpable and nonpalpable breast tumors as well as to investigate the diagnostic reliability and significance of this procedure in breast cancer surgery. In 1998/99, 125 patients were surgically treated for breast lesions at the Department of OB/GYN II, Comenius University School of Medicine, Bratislava. 55 patients were operated for malign tumors. 38 of them (69%) were preoperative examined by ultrasound‐guided core‐cut biopsy. The core biopsy specimens were evaluated by frozen section and paraffin section. The results were then correlated with definitive paraffin sections from the surgical specimens. The correlation has not revealed any falsely positive or negative results. Therefore, the authors state that in correctly indicated cases, this procedure apparently represents a reliable method for preoperative histologic examination of breast tumors. Examination of core breast biopsy specimens with frozen section can minimize the interval between diagnosis and treatment, decrease the number of open diagnostic biopsies and reduce the time of surgery by period necessary for per‐operative frozen‐section.
F87Transvaginal sonography in prediction of preterm delivery in patients presenting with signs and symptoms of preterm labor
Authors: Hincz P. , Wilczyński J. , Borowski D. , Kozarzewski M. , Szaflik K.
Published: March 2003

Background

The purpose of the study was to assess the clinical value of transvaginal sonography in the group of women presenting with preterm contractions and cervical changes.

Methods

We prospectively evaluated 82 patients between 23 and 34 weeks of gestation presenting in our Department with signs and symptoms of preterm labor, intact membranes and cervical dilatation < 3 cm. In all cases transvaginal sonography was performed.

Results

The rate of preterm delivery (< 37 weeks) was 25.6% and 17.1% of the patients delivered ≤ 28 days from the examination. Among the analyzed parameters, the significant difference between patients delivered ≤ 28 and > 28 days from examination, was noticed only for the functional canal length (21.6 mm vs. 30.1 mm; P < 0.001). The analysis of ROC curves showed that functional canal length had the highest diagnostic capability. Two important thresholds were found – 20 mm and 31 mm. For predicting delivery ≤ 28 days the functional canal length ≤ 20 mm had sensitivity of 57.1%, specificity of 92.6%, PPV of 61.5% and NPV of 91.3%. The cutoff value of 31 mm had sensitivity of 100%, specificity of 47.1%, PPV of 28% and NPV of 100%. In multiple logistic regression analysis only FCL ≤ 20 mm (OR 8.18; P = 0.027) was independently associated with PTD.

Conclusions

The shortening of the functional canal length (≤ 20 mm) is predictive of impending preterm delivery and the functional canal length > 31 mm is the indicator of the absence of labor.
F88The value of cervical length measurement in the prediction of preterm delivery prior to 34 weeks gestation in women presenting with threatened preterm labour
Authors: Mavrides E. , Georgakopoulou A. , Tekay A. , Thilaganathan B.
Published: March 2003

Aim

The aim of this study is to evaluate whether cervical length and morphology assessed by transvaginal ultrasound in women admitted in threatened labour, can predict preterm delivery prior to 34 weeks gestation.

Method

Over a six‐month period, 25 women presenting with threatened preterm labour were prospectively recruited into the study. Women with ruptured membranes, chorioamnionitis or heavy vaginal bleeding requiring delivery were excluded. Transvaginal sonography for cervical length and morphology was performed shortly after admission. Demographic data, medical observations and interventions were recorded. Pregnancy outcomes were collected after delivery.

Results

The mean gestation at recruitment was 27+4 weeks (range 21+°−32+6 weeks). 16% (4/25) of patients delivered before 34 weeks gestation. In the latter cases, the cervical lengths were all ≤ 25 mm and the interval between presentation and delivery was < 2 weeks. All pregnancies with a cervical length > 25 mm delivered after 34 weeks gestation.

Conclusion

Transvaginal ultrasound assessment of cervical length in women presenting with threatened preterm labour is useful in predicting the likelihood of preterm delivery. This investigation may be useful in optimising the management of these women and reducing the risks of unnecessary tocolysis in women that are unlikely to deliver preterm.
F91The role of ultrasonography in the management of gestational trofoblastic disease: diagnostic, treatment and follow‐up modality
Authors: Hrehorcak M , Rob L. , Kulovaný E.
Published: March 2003

Since hysterectomy is no longer considered standard procedure in the treatment of malignant gestational trofoblastic disease (GTD), ultrasonography plays a major role in the detection of the myometrial involvement. The Ultrasonography is standardly used as one of the main diagnostic tools when GTD is suspected. It seems that the size of the mola is no longer considered predictive marker for malignant change. We demonstrate the role of ultrasonography as an excellent method in the treatment of presumed GTD particularly in the evacuation of possibly invasive mole or choriocarcinoma. The specimen for the diagnosis is obtained securely under the ultrasound supervision enabling us to control the diagnostic curettage and to prevent the possible uterine wall perforation. Together with serum hCG levels US and Doppler analysis are useful tools in the monitoring of the tumor regression in the course of chemotherapy. We demonstrate that possible ultrasonographic features of the tumor like intramyometrial signals and hypoechogenic areas (representing mainly arteriovenous malformations) may remain in the long term follow up of successfully treated GTD with negative hCG serum levels. Concluding that monitoring of serum hCG is of major clinical interest in the treatment of GTD suggesting the limited interpretation value of ultrasonographic finding.
F99The influence of maternal hematocrit on placental size and growth from the first to mid‐second trimesters of pregnancy
Authors: Michailidis G. D. , Mamopoulos A. , Papageorgiou P. , Economides D. L.
Published: March 2003

Objectives

To study the association of maternal hematocrit (Ht) levels with placental size and growth in the first and mid‐second trimesters of pregnancy.

Subjects/methods

One hundred and forty pregnant women with a singleton pregnancy were recruited at 11–14 weeks’ gestation. For each case we performed three scans of the placenta the first at recruitment and the following two in three weeks intervals. The volume of the placenta was measured at each visit using a three dimensional ultrasound scanner. The Hb and Ht were measured within two weeks from the first scan.

Results

The placental growth from early second (14–17 weeks) to mid‐second (17–20 weeks) trimesters was inversely related to the Ht levels (r = −0.263, P < 0.01). Similar results were observed for the overall placental growth (r = −0.27, P < 0.01). The placental volume at mid second trimester* (17–20 weeks) was also inversely related to Ht (r = −0.18, P < 0.05). However, the placental volume at the first trimester*, early second trimester* and the placental growth from 11 to 17 weeks were not found to be associated with ht levels.

Discussion

This study demonstrates the effects of maternal environment on placental growth. Our data suggests that the levels of Ht appear to affect the placental size mainly at the second trimester. Further studies about the factors that regulate placental growth are needed to elucidate the pathophysiology of these interactions and their effect to the pregnancy outcome.

*(Corrected for gestational age)
Free Communications Ultrasound in gynecology F01Transvaginal sonographic and Color/Power Doppler evaluation of cervical carcinoma
Authors: Romanini M. E. , Exacoustòs C. , Congiu M. , Arduini D. , Benedetti‐Panici P. , Romanini C.
Published: March 2003

Background

Aim of this study was to assess the accuracy of transvaginal sonography (TVS) associated to Color or Power Doppler (CFD/PD) for the evaluation of size and spread of disease in cervical cancer as diagnostic tool in the preoperative evaluation.

Method

All patients (pts) affected by cervical cancer were studied by TVS and CFD/PD. TVS probe was used also as a transrectal when deemed necessary. Tumor size was measured consecutively by gray scale sonography and using CFD/PD. Extension of the tumor to the parametria; to the corpus uteri, to the ovary, the bladder and the rectum was also evaluated. TVS findings were compared to gynecologic examination under anesthesia, MRI and laparoscopy and pathological specimen.

Results

20 cases were studied. 45% of pts had neoadjuvant chemotherapy. Tumor diameter measured by ultrasound correlated well with pathological specimen (r = 0.82). Accuracy of the measurement was increased when tumor diameter was > 4 cm. TVS correctly diagnose the extension of disease to the bladder and to the corpus uteri in 90% of cases. Involvement of the parametria was supected by sonography in 45% of cases.

Conclusions

TVS seems to be an accurate means of evaluation for tumor size and extension to adjacent organs, therefore TVS could be useful in the perioperative management of cervical cancer.
Prenatal diagnosis of an aneurysm of the vein of Galen with three‐dimensional color power angiography
Authors: Heling K. S. , Chaoui R. , Bollmann R.
Published: March 2003

The prenatal diagnosis of an aneurysm of the vein of Galen has been reported on only a few occasions. This rare arterio‐venous fistula is suspected when an intracerebral hypoechoic cyst is found in which blood flow can be demonstrated by Doppler ultrasound. This is one of the few conditions where Doppler ultrasound is critical for the diagnosis. Three‐dimensional color power Doppler (3D‐CPA) is a recent ultrasound modality which enables the three‐dimensional visualization of vessels and which is more readily available than magnetic resonance imaging (MRI) We report a fetus in which an aneurysm of the vein of Galen was detected at 33 weeks' gestation and where the application of 3D‐CPA enabled a better understanding of the spatial orientation and course of the dilated vessels. The neonate was successfully treated with coil angiography but subsequently died at 5 months of age from cardiac decompensation. Where fetal malformations involve the vascular system, 3D‐CPA appears to be a promising technique. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Reference values for differences between cardio‐circulatory variables of normal twin fetuses
Authors: Sonesson S.‐E. , Fouron J.‐C. , Leduc L. , Lessard M. , Grignon A.
Published: March 2003

Background

No reference values exist concerning the differences between cardio‐circulatory variables of normal twin fetuses. The normal data could be useful in the identification of conditions causing opposite hemodynamic effects on each twin.

Objective

To establish the normal differences among cardio‐circulatory parameters of twin fetuses during the second and third trimesters of gestation.

Materials and methods

Twenty‐seven normal twin pregnancies were used in this longitudinal and prospective study. Doppler‐echocardiographic investigations were performed every 2‐3 weeks starting at an average of 23.11 ± 3.13 (mean ± standard deviation) weeks' gestation. At each visit, the following cardio‐circulatory variables were evaluated: the cardio‐thoracic ratio, the ventricular wall and septal thicknesses, end‐diastolic and systolic diameters, ventricular fractional shortenings, velocity of circumferential fibre shortenings and left and right ventricular outputs. In addition the following measurements were made from Doppler recordings: through both aortic and pulmonary valve the acceleration and ejection times, the peak systolic velocities and the velocity time integrals; and through both mitral and tricuspid valves peak velocities of E and A waves and the E/A ratios. Finally the pulsatility index of the umbilical artery was also evaluated.

Results

There was no single variable where the intertwin difference changed with gestational age. No systematic difference between the smaller and larger twin could be demonstrated for any variables except for the cardio‐thoracic ratio.

Conclusion

Reference tables should permit a comparative approach between the two twins in the investigation of life threatening complications such as twin‐to‒twin transfusion syndrome. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Routine ultrasound fetal examination in pregnancy: the ‘Ålesund’ randomized controlled trial
Authors: Eik‐Nes S. H. , Salvesen K. Å. , Økland O. , Vatten L. J.
Published: March 2003

Objective

To evaluate the possible benefits of the routine use of ultrasound screening in pregnancy.

Design

A randomized controlled trial was designed to detect a 50% difference in the incidence of induction for apparent post‐term pregnancies between women who were screened with ultrasound and unscreened women. A total of 1628 pregnant women from the general population were included. Eight hundred and twenty‐five were allocated to an ultrasound examination at the 18th and 32nd week of pregnancy in addition to receiving routine antenatal care. The remaining 803 women received standard antenatal care, but could only be referred for ultrasound examination on clinical indication.

Results

The incidence of induced labor due to apparent post‐term pregnancies was approximately 70% lower in the ultrasound‐screened group. Inductions from all causes were also less frequent among ultrasound‐screened women. There were six perinatal deaths among the screened and seven among the controls after excluding three lethal malformations among the controls. There was no difference in Apgar score after 1 min, but the proportion with Apgar score less than 8 after 5 min was lower among the screened group (P = 0.04). The need for positive pressure ventilation for more than 1 min was lower among the screened group (P = 0.02). Birth weight was slightly higher in the screened group (39 g), but the difference was not statistically significant. Among the controls three pairs of twins remained undiagnosed until the mothers were admitted to the hospital in labor at between 36 and 38 weeks gestation.

Conclusion

These results suggest that for women who were screened with ultrasound, obstetricians were less likely to induce labor due to apparent post‐term pregnancy, than for women who were not screened. All 10 pairs of twins in the screened group were diagnosed at the routine examination. These data also suggest that perinatal morbidity might be slightly lower in the screened group. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Sources and impact of artifacts on clinical three‐dimensional ultrasound imaging
Authors: Nelson T. R. , Pretorius D. H. , Hull A. , Riccabona M. , Sklansky M. S. , James G.
Published: March 2003

The purpose of this paper is to investigate, identify and discuss artifacts and their sources arising in three‐dimensional ultrasound (3D US) in clinical practice in order to increase the awareness of clinicians and sonographers with respect to common 3D US artifacts and to use this increased awareness to avoid or reduce the occurrence of misdiagnosis in 3D US studies.

Patient 3D US data were acquired using several different scanners and reviewed interactively on the scanner and graphics workstations. Artifacts were catalogued according to artifact origin. Two‐dimensional ultrasound (2D US) artifacts were classified whether they were of a B‐mode or color/power Doppler origin and their presentation in the original scan planes and the resulting volume re‐sliced planes and rendered images was identified. Artifacts unique to 3D US were observed, noted and catalogued on the basis of whether they arose during acquisition, rendering or volume editing operations.

Acoustic artifacts identified included drop‐out, shadowing, etc. whose presentation depended on the relationship between slice and imaging plane orientation. Color/power Doppler artifacts were related to gain, aliasing, and flash which could add apparent structure or confusion to the volume images. Rendered images also demonstrated artifacts due to shadowing and motion of adjacent structures, cardiac motion or pulsatility of the cardiac septum or vessel walls. Editing artifacts potentially removed important structures.

Three‐dimensional ultrasound is prone to the same types of artifacts encountered in 2D US imaging plus others unique to volume acquisition and visualization. The consequences of these diagnostically significant artifacts include mimicking of abnormal development, masses, or missing structures thus requiring careful study before reaching a diagnosis. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal ultrasound diagnosis of congenital cystic adenomatoid malformation of the lung: a report of 26 cases and review of the literature
Authors: Monni G. , Paladini D. , Ibba R. M. , Teodoro A. , Zoppi M. A. , Lamberti A. , Floris M. , Putzolu M. , Martinelli P.
Published: March 2003

Objectives

To evaluate the sonographic appearances and prenatal natural history of congenital cystic adenomatoid malformation of the lung.

Methods

In each case a detailed examination of the thoracic lesion and a complete fetal survey was performed. The pregnancies that elected to continue were followed to term.

Results

A total of 26 cases were identified. The pregnancy was electively terminated in nine cases (35%). All the remaining 17 pregnancies ended in liveborn infants (100%). The lesion disappeared completely in three fetuses (18%). Of the 14 infants in whom the lesion was confirmed at birth nine required surgery in the neonatal or post‐natal period. Five children did not undergo surgery.

Conclusions

Conservative management appears to be an adequate medical practice in cases of isolated congenital unilateral cystic adenomatoid malformation of the lung, in the absence of hydrops and/or acute polyhydramnios. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prognostic value of ultrasound findings of fetal cystic hygroma detected in early pregnancy by transvaginal sonography
Authors: Rosati P. , Guariglia L.
Published: March 2003

Objective

To assess the prognostic value of first and early second trimester transvaginal ultrasound findings of fetal cystic hygroma such as volume, presence of septa and associated fetal anomalies or malformations.

Design

A prospective study of fetal cystic hygroma volume detected at 10–15 weeks of gestation by transvaginal scan.

Subjects

The study comprised a series of 33 cystic hygromas detected throughout the period March 1994 to March 1998 in 1918 pregnant women.

Methods

The volume of the hygroma and the presence of septa and other associated fetal anomalies or malformations were evaluated and correlated with fetal karyotype, persistence of the hygroma and pregnancy outcome.

Results

A volume equal to or greater than 75 mm3 revealed a sensitivity of 66.7% [eight of 12 cases; 95% confidence interval (CI), 34.9–90.1%] for the identification of abnormal fetal karyotype, 72.7% (eight of 11 cases; 95% CI, 39.0–90.4%) for the identification of persistence of the hygroma and 90% (nine of 10 cases; 95% CI, 55.5–99.7%) for identification of an unfavorable outcome of pregnancy. Furthermore, the prognostic value of ultrasound in determining pregnancy and fetal outcome were improved by combining data on the volume of the hygroma and the presence of associated anomalies or malformations.

Conclusions

Measuring the volume of a cystic hygroma proves to be a useful ultrasound prognostic indicator in determining the risk of an associated karyotypic abnormality and adverse fetal and pregnancy outcome. However, due to limited sample size, caution is required in interpretation of the data and further studies are needed. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Fetal anemia as a consequence of hemorrhage into an ovarian cyst
Authors: Abolmakarem H. , Tharmaratnum S. , Thilaganathan B.
Published: March 2003

Fetal ovarian cysts are usually benign in nature and resolve spontaneously. Complications such as torsion and rupture have been described previously. A case of presumptive spontaneous hemorrhage into a fetal ovarian cyst is presented. Serial ultrasound and Doppler assessments revealed the development of fetal anemia, which was managed by intrauterine blood transfusion. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Midterm follow up results of uterine artery embolization for the treatment of uterine adenomyosis and myomas
Authors: Lee E.‐H. , Ahn C. , Lee M.‐H. , Lee C.
Published: March 2003

Purpose:  The purpose of this study is to evaluate the natural course of uterine artery embolization for the treatment of uterine adenomyosis and myomas during the midterm follow up.

Materials and methods:  One hundred and sixty women (age range: 25–55 years; mean age: 40 years) having symptomatic (dysmenorrhea, menorrhagia, pressure symptoms) uterine adenomyosis or myoma were recruited in this prospective study. Technically or clinically failed cases and lost patients during the follow up period were excluded. We performed embolization with coaxial technique via right femoral route, PVA particles (250–710 mm), and gelfoam. Detailed clinical and sonographic follow up were obtained at a week for 143 patients, at 6 months for 80 patients, at 1 year for 24 patients, at 18 months for 25 patients, and at 2 years for 31 patients.

Results:  The volumes of uterus and myomas were progressively reduced in all patients until 1 year, and then stable during the next 1 year. Mean volume reduction of uterus and myomas were 43.2 and 70.2%, respectively. The peak systolic velocities of uterine arteries were markedly decreased at a week, recovered at 6 months, and then stable until 2 years after the procedure. Resistive indexes of uterine arteries were abruptly increased at a week, recovered at 6 months, and then stable thereafter. The flow of uterine arteries did not show the full recovery of initial levels.

Conclusion:  Uterine artery embolization for the treatment of uterine adenomyosis and myomas is minimally invasive procedure with stable natural course during the midterm follow up.
Wide iliac angle and short limbs. The best marker for Trisomy 21?
Authors: Pritchard G.
Published: March 2003

Aim: 

• To create a standard protocol for measuring the posterior angle of the iliac crests.

• To construct a score based upon the iliac angle and fetal proximal long bone lengths.

• To compare results between fetuses affected by Trisomy 21 and those unaffected.

Methods:  Fetal morphology and biometry including biparietal diameter, humeral length and femur length were assessed between 15 and 23 weeks gestation according to standard protocol. A symmetrical image of the transverse plane of the iliac wings demonstrating the widest angle and the longest length of the iliac bones was recorded. This view was best obtained with the ultrasound beam perpendicular to the long axis of the fetal spine and perpendicular to the skin line, imaged from posteriorly. It can also be obtained from an anterior aspect. The iliac angle was measured from the internal angle at the intersection of tangential lines drawn along the posterior iliac crests.

Results:  A total of 2998 fetuses, 30 with Trisomy 21 and 2968 unaffected fetuses (902 had amniocentesis) were assessed. There was a significant difference (16.78° (95% CI 16.694; 16.846)) between the mean iliac angle for Trisomy 21 fetuses (94.33 ± 7.2°) and unaffected fetuses (77.55 ± 8.86°). The total of 90° was selected as cut‐off. The 22 of 30 (83%) Trisomy 21 fetuses and 228 of 2968 (7.7%) unaffected had iliac angle greater than or equal to 90° (sensitivity 83%, specificity 92.3%). A previous study in our unit had shown that short proximal long bones occurred in 41 of 71 (58%) Trisomy 21 fetuses and 609 of 9022 (6.7%) of a low risk unaffected group (unpublished data). Iliac angle greater than or equal to 90° scored one. Short proximal long bones also scored one. A positive index was a score of 2. The 14 of 30 (46.7%) Trisomy 21 fetuses and 29 of 902 (3.2%) known unaffected fetuses had a score of 2. The likelihood ratio for positive limb–iliac index is 14 (46.7/3.2).

Conclusions:  In screening for Trisomy 21, the prevalence and likelihood ratio of fetal anomaly (29%, 96), nuchal skin fold (39%, 11), echogenic bowel (20%, 2), renal pelvic dilatation (20%, 4.2), echogenic intracardiac focus (35%, 2.6) and short long bones (58%, 1.9) are known for our population. A positive iliac angle/limb length score has a prevalence of 47% and likelihood ratio of 14. In our population, this combination surpasses the performance of other markers.
The role of thromboelastography in conjunction with second trimester uterine artery Doppler velocimetry in the prediction of adverse pregnancy outcome
Authors: Karidas C. , Anastassopoulos P. , Perry D. , Economides D. L.
Published: March 2003

Purpose:  A pilot, prospective study to evaluate the use of thromboelastography in conjunction with uterine artery Doppler in the second trimester as predictors of pre‐eclampsia and IUGR (intrauterine growth restriction defined as birth weight below the 5th centile for gestational age).

Methods:  Two‐hundred and forty‐nine (249) unselected pregnant women were recruited at their booking appointment in the Royal Free Hospital. They underwent thromboelastography assessment and color flow/pulsed Doppler imaging of both uterine arteries at 20–24 weeks gestation. Standard parameters were measured from each thromboelastography tracing (R, reaction time; K, clot formation time; A, angle; MA, maximum amplitude). The presence or absence of notches in the flow velocity waveform was noted and the resistance index measured. The main outcome measures were pre‐eclampsia and IUGR.

Results:  Twenty‐three pregnancies (9.2%) were complicated by IUGR and 10 (4%) by pre‐eclampsia. Assessment using abnormal Doppler velocimetry, defined as bilateral notches/mean RI ≥ 0.55 (27 cases) or unilateral notch/mean RI ≥ 0.65 (5 cases), demonstrated 52% (95% CI 33–71%) sensitivity for IUGR and 40% (CI 17–69%) for pre‐eclampsia with positive predictive values 37.5% (23–55%) and 12.5% (5–28%), respectively. Furthermore, in the pregnancies complicated by an adverse outcome, the groups with normal (14 cases) and abnormal (15 cases) Doppler velocimetry did not differ significantly in any of the thromboelastography parameters (Mann–Whitney test for comparisons).

Conclusion:  Pulsed Doppler velocimetry of the uterine arteries in the second trimester is an established predictor of adverse pregnancy outcome. The additional use of thromboelastography assessment does not appear to contribute significantly in providing further information. As this is a pilot study, larger trials are required to delineate its role.
Sonographic examination of puerperal uterus after repeat cesarean section with traditional and Misgav Ladach methods
Authors: Malvasi A. , Totaro P. , Liaci L. , D'Ambrosio M. , Traina V.
Published: March 2003

Purpose:  In our Department of Obstetrics, where 1600 deliveries are carried out on average every year, cesarean section (c.s.) with Misgav Ladach methods has been practiced since November 1995, for 2078 cases in all. In our study, we have examined sonographically 309 repeat c.s. with Misgav Ladach methods compared to 318 traditional repeat c.s. The aim of our investigation is the sonographic examination of patients with open peritoneum and those with closed peritoneum to discriminate the frequency of bladder flap hematomas and other complications in the two techniques.

Methods:  The patients were examined by transvaginal and transabdominal sonography, on the third and 10th postoperative day, to demonstrate the presence of a fluid or mixed mass on the lower‐uterine‐segment (LUS) of 3 cm or more, clean wall, with reinforcement of distal echoes.

Results:  It has been observed that, in the group open peritoneum c.s., there were masses of mixed echostructure referring to hematomas on the 12th day in nine cases, while in the group closed visceral peritoneum in 51 cases (P < 0.05). In 39 cases, they were collection on the LUS from 3 to 4.2 cm in six from 4.2 to 5 cm and only in one case it was a lateral collection of 6 cm which did not require surgical treatment anyway. Besides in 22 patients, the bladder‐flap hematoma was associated with puerperal fever (values >38.5 °C). In Misgav Ladach method, only seven women had adhesion of light‐medium importance so that uterine exteriorization was not necessary, and not significant (NS) in comparison with the reference of nine women.

Conclusion:  Peritoneum closure in repeat c.s. lengthens operative time and in some cases favors bladder‐flap hematomas which increase postoperative morbidity (P < 0.05), antibiotics use 2.6 and 4.8% (P < 0.01), length of hospital 3 ± 1 vs. 7 ± 2 days staying (P < 0.01) and costs (P < 0.05). In conclusion, follow up has shown no intraperitoneal compare to repeat c.s. with closed and open peritoneum.
Prenatal neuroimaging of progressive ventriculomegaly at 20–21 weeks of gestation – a case report
Authors: Pooh R. K. , Tanemura M. , Yamasaki M. , Pooh K.
Published: March 2003

Intrauterine course of genetic hydrocephalus has not been revealed. We had a case with progressive ventriculomegaly between 20 and 21 weeks of gestation. A pregnant woman was referred to the ultrasound unit at 20 weeks of gestation. Her 8‐year‐old son had congenital hydrocephalus, gait disturbance, mental retardation and adducted thumbs, but genetic examination was not done. The male fetus had grown normally with normal BPD. However, 2D/3D sonography and fetal magnetic resonance imaging (MRI) demonstrated partial agenesis of the corpus callosum, moderate ventriculomegaly and a small inter‐hemispheric cyst. Ventricular volume by 3D volumetry was estimated as 4.89 mL, which was more than twice as large as normal ventricle size. Subarachnoid space appeared normally. At 21 weeks of gestation, ventricular volume markedly increased to 8.29 mL within 7 days. Furthermore, 2D/3D ultrasound revealed the bilateral adducted thumbs. Genetic hydrocephalus, such as corpus callosum agenesis, retardation, adducted thumbs, spastic paraparesis, and hydrocephalus (CRASH) syndrome was strongly suspected from those sonographic findings. Pregnancy was terminated at the end of 21 weeks of gestation. Genetic examination by direct sequenced PCR resulted in a point mutation at Intron 6 of L1CAM located at Xp28. In our case, prodromic sign of progressive hydrocephalus was suspected by USG and MRI at the middle of gestation. Especially, 3D volumetry was useful for the assessment of the objective evaluation of the progressive ventriculomegaly.