bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of fetal umbilical to middle cerebral Doppler velocimetry ratio in the presence of normal umbilical Doppler findings as a predictor for adverse perinatal outcome in term fetuses
Authors: To W. W. K. , Mok C. K. M.
Published: March 2003

Background:  Doppler velocimetry studies of the fetal umbilical artery (UA) in the antenatal period have been shown to be correlated with significant intrauterine growth restriction, subsequent intrapartum fetal distress requiring intervention, and other major adverse perinatal outcome. The addition of middle cerebral Doppler (MCA) studies and expression of the two parameters as a ratio has been shown to predict intrauterine growth restriction (IUGR) sensitively. However, an abnormal ratio was not shown to be associated with increased risk of major perinatal morbidity or mortality or subsequent neurological damage. This study aims at evaluating the correlation between the UA/MCA Doppler ratio and adverse perinatal outcome in a group of term fetuses with suspected IUGR when the umbilical Doppler findings were still largely within the normal range.

Methods:  A retrospective analysis of all pregnancies undergoing ultrasound and Doppler studies for evaluation of suspected IUGR after 34 weeks over a period of 6 months in a general obstetric unit that catered for an annual delivery of around 3500 deliveries per year. The data from the ultrasound and Doppler evaluation within 1 week from delivery were analyzed. Those with absent or reversed end diastolic flow, or a systolic/diastolic (S/D) ratio over 3.5 in UA Doppler studies were excluded from analysis. The S/D ratio of UA and MCA Doppler findings were then expressed as a ratio, and these were correlated with the perinatal events and immediate neonatal outcome parameters.

Results:  A total of 123 babies with complete data were included in the analysis, of which 10 were from five twin pregnancies. Seventy‐two (58.5%) were confirmed to be growth restricted with birth weight below the 10th percentile for gestation. Sixteen (13%) had an UA/MCA Doppler ratio under 0.75. The incidence of IUGR was significantly higher in this group with abnormal Doppler ratio (87.5%) as compared to the normal ratio group (55%) (P < 0.05). Similarly, the abnormal Doppler ratio group had higher incidence of significant oligohydramnios (75% vs. 17%, P < 0.001), induction of labor (50% vs. 20%, P < 0.01), total cesarean section (62.5% vs. 15.8%, P < 0.001), and cesarean section for fetal distress (43% vs. 11.2%, P < 0.001) than the normal ratio group. The incidence of admission to NICU, meconium stained liquor or intrapartum cardiotocogram abnormalities did not differ.

Conclusion:  In the presence of normal UA Doppler findings, early changes of cerebral vasodilation leading to a relatively low UA/MCA Doppler ratio are associated with a higher incidence of obstetric intervention and perinatal morbidity. The MCA Doppler studies should be valuable in the evaluation of suspected growth restriction even when UA Doppler findings are largely normal.
Ductus venosus Doppler velocimetry for the detection of Down syndrome: new criterion of risk
Authors: Moron A. F. , Ávila M. A. P.
Published: March 2003

Objective:  To test the hypothesis the application of ductus venosus Doppler velocimetry may serve as a screening tool between 10 and 14 weeks gestation for the detection of fetuses with Down syndrome and estimate new criterion of risk.

Patients and methods:  A total of 491 fetuses were studied consecutively. In 132 cases, a cytogenetic study was performed on material obtained from a biopsy of the chorionic villus, and in 359 cases the postnatal pheno‐type was used as a basis for the result. In addition to the routine ultrasonographic examination, all the fetuses were submitted to measurement of the nuchal translucency thickness. For statistical analysis the Student's t‐test and ANOVA were used. The sensibility, specificity, positive and negative predictive values, false‐positive probability and likelihood ratio was calculated.

Results:  There were 21 cases of Down syndrome. Of these 21 fetuses, ductus venosus blood flow during atrial contraction was either absent (n = 3) or reversed (n = 17) in 95.2%. In the chromosomally normal fetuses (n = 270), only eight had abnormal Doppler profiles in the ductus venosus (specificity = 98.2%, positive and negative predictive values = 71.4 and 99.8%, respectively, and positive and negative likelihood ratio was 56 and 0.1, respectively).

Conclusion:  Our preliminary results suggest that the presence of Down syndrome may be strongly suspected when there is reverse or absent flow in the ductus venosus Doppler velocimetry during atrial contraction. We speculate the possibility of new criterion to calculate the new risk of Down syndrome was calculated from the fetal medicine foundation risk, multiplied by a likelihood rate of Doppler of ductus venosus, using at least the values of 50 for positive likelihood rate and 0.1 for negative likelihood rate.
Quality assessment in prospective nuchal translucency screening for Down syndrome in the Copenhagen first trimester study
Authors: Wojdemann K. , Christiansen M. , Sundberg K. , Shalmi A.‐C. , Tabor A.
Published: March 2003

Purpose:  To develop and apply a quality control system in a Down syndrome (DS) screening study using nuchal translucency (NT) as interventional marker.

Methods:  In a prospective DS screening study, the NT was measured in 9236 pregnancies. For quality assessment two models were introduced: (I) image‐scoring evaluation of the NT measurements and (II) establishment of the distribution of NT multiple of the medians (MoMs) over time and influence of an intervention.

Results:  The observer variability in the image‐scoring evaluation was high with a kappa value of 0.48 in the overall validation. A revised model showed better interobserver agreement with a kappa value of 0.58; regarding the single criteria the differences were however, still unsatisfactory, i.e. we found highly significant differences for the criteria ‘position of the fetus’ (P = 0.0026) and ‘magnification of the image’ (P = 0.0001). Regarding the distribution of the NT MoMs, the median NT MoM (in groups of 50 fetuses each) stabilized after a short learning phase (representing the practical part of the sonographer's certification). The intergroup standard deviation decreased from initial 0.100–0.060 after the learning phase, and 0.046 after the intervention.

Conclusions:  When well‐trained certified examiners perform NT screening, continuous evaluation of the distribution of the NT MoM seems to be a good method to assess the quality for a center and may also be used to identify individual examiners deviating from the mean performance. Intervention towards the examiners seems to decrease variation, which should theoretically decrease the false positive rate. The image‐scoring methods we introduced cannot be recommended for quality control in an NT screening program.
Tissue characterization with gray level histogram width and assessment of fetal lung immaturity
Authors: Maeda K. , Utsu M. , Kihaile P. E. , Serizawa M. , Yamamoto N. , Ito T.
Published: March 2003

Purpose:  The aims are to clarify the reproducibility of gray level histogram width (GLHW) in ultrasound machines and to demonstrate tissue character of fetal organs and tissues in B‐mode image.

Methods:  The GLHW is calculated manually and automatically with the ROM provided by Aloka, and the values are compared among six Aloka, each one of Toshiba, Yokogawa and Kretz 503D wuth use of RMI phantoms. Clinically, the placenta, fetal brain periventricular echodensity (PVE), fetal lung and liver, those of preterm fetuses with the refernece to stable microbubbles of amniotic fluid, and meconium stained amniotic fluid are studied.

Results:  No influence of clinical gain control, image depth, STC, 1 cm2 or more ROI or 1000 or more pixels is confirmed. GLHW is large in high image contrast, but it is easily compensated. Some own values are corrected and standardized. GLHW is reproducible among machines. Clinically, GLHW is large in grade III placenta, the value is large in fetal brain PVE and it is large in meconium stained fluid. Normal fetal lung GLHW is low and lower than fetal liver before 30 weeks of pregnancy, fetal GLHW is 31% or less in the group of five or less stable microbubbles with 90% sensitivity and 80% specificity. In gynecology, GLHW is high and coefficient of variation is low in multiple ROIs of ovarian malignancy. GLHW is large in hyperplastic endometrium. Adult organs and tissues are of interest particularly in hepatic diseases.

Conclusion:  GLHW is reproducible in ultrasound machines, and it is useful in tissue characterization. It is possible to assess fetal lung immaturity with GLHW.
Fetal congenital heart block
Authors: Pennell C. , Reid K. P. , Dickson J. E.
Published: March 2003

Purpose:  To ascertain the incidence and outcome of all cases of prenatally diagnosed congenital heart block (CHB) referred to our institution during the decade 1990–2000.

Methods:  Cases were identified from the fetal medicine database permitting review of the clinical presentation, ultrasound findings, maternal immunological status, subsequent management and pregnancy outcome.

Results:  Eleven cases of CHB were identified during the period of review (100% ascertained for Western Australia) with a diagnosis at median gestation of 20 weeks (16.8–32). Fetal cardiac anatomy was normal in 64% of cases. Fetal hydrops was present at diagnosis in 27% with a further 33% subsequently developing hydrops. Only 18% of fetuses had major structural cardiac anomalies. The median gestation at delivery was 35 weeks (25–38) and there was a female gender bias (7 : 4). The mortality rate was 64% with three pregnancy terminations, one second trimester intrauterine fetal death, one neonatal death and two infant deaths. Maternal immunological abnormalities were common with 36% of the women having clinical autoimmune conditions. Seventy‐eight percent of women had SSA and/or SSB antibodies. Two of the six infants that survived the neonatal period had persistent abnormal autoantibodies during their first year of life. One infant with SSA and SSB died at one year of age from left ventricular failure believed to be of autoimmune origin. This infant was one of triplets, with only the female triplet being affected. Another fetus with SSA and SSB had thrombocytopenia at delivery. Postmortem assessment of five fetuses confirmed focal calcification at the atrioventricular junction associated with a lymphocytic infiltrate and subendocardial fibrosis. Eight subsequent pregnancies have occurred and none were complicated by CHB. Three women underwent prophylactic immunosuppression.

Conclusions:  Fetal congenital heart block is a rare condition with a strong association with autoimmune disease and poor outcome. The recurrence risk in this series is lower than previously reported.
Feasibility of a national Web‐based ultrasound learning portfolio for OB/Gyn residents: the KOALA program
Authors: Fung K. F. K. , Gagliari A. , Walker M. , Lacasse C. , Faught W. , Fung M. F. K.
Published: March 2003

Purpose:  To establish the feasibility of a national ultrasound learning portfolio in resident education in OB/Gyn in order to create a needs assessment for educational programming, ensure students are meeting educational objectives and promote self‐directed learning.

Methods:  The Internet‐based KOALA learning portfolio was introduced into 15 of 16 Canadian medical schools in 1997 to track resident learning encounters in OB/Gyn ultrasound. Data entered over 3‐year period analyzed using SPSS 10.0 to identify: (1) categories of ultrasound cases entered; (2) critical incidents of learning; (3) domain and stimulus of questions posed; and (4) educational resources used for learning.

Results:  Between 1 July 1997 and 30 June 2000, 3368 ultrasound encounters were voluntarily recorded by 50 residents at 11 university‐affiliated residency training programs. Twelve residents (25%) were categorized as high‐volume, having entered = 100 cases. Learning encounters were recorded according to the following themes: routine second trimester dating scans; diagnostic procedures; amniocentesis, CVS, cordocentesis; assessment of fetal well‐being; targeted anomaly screen; routine gynecological exam. Critical incidents of learning were identified in 25% of ultrasound cases (837/3368). Overall, the majority of questions asked by residents following their ultrasound learning encounter were of a cognitive nature (53.3%), and were significantly associated with identification of a critical incidence of learning (P < 0.001). Overall, medline was the educational resource most likely to be used case‐based learning when critical incidents were identified (P < 0.001). Questions of high volume users were most often stimulated by reflections and self‐assessment (81.5%) when compared to low‐volume users (61.3%). Textbooks were the educational resource most often used by high‐volume users (73.9%) to answer questions concerning their educational encounters. High‐volume users were more likely to report a change in their practice as a result of learning acquired through the use of KOALA systems (P < 0.001). Barriers identified during implementation included lack of computer Internet access in the clinical environment, suboptimal faculty development initiatives, and failure to integrate the learning portfolio as a component of the resident evaluation process.

Conclusions:  (1) Implementation of a Web‐based learning portfolio is feasible, allowing collection of data from geographically dispersed areas and programs; (2) voluntary use of the KOALA system was acceptable when the system was made available to OB/Gyn residents; and (3) use of Internet‐based learning portfolio such as KOALA presents a unique opportunity for ultrasound training programs and special society such as ISUOG to assess the educational needs of training physician learners.
Isolated oral clefts (OC) detected by routine ultrasonography – is it associated with chromosomal abnormalities?
Authors: Wee H. Y. , Woo B. H. , Yeo G. S. H.
Published: March 2003

Purpose:  To determine if chromosomal abnormalities are associated with isolated OC (cleft‐lip or palate) detected by sonographers trained to perform level two fetal structural surveys in a low risk obstetric population.

Methods:  A prospective observational study was conducted on women undergoing screening ultrasonography between 18 and 34 weeks from 1 October 1996 to 30 September 2000 in a single maternity unit. Obstetric and neonatal charts were reviewed in all cases where OC in isolation were detected by ultrasonography. Antenatally missed cases of isolated OC were also analyzed.

Results:  There were 64 225 deliveries in this period. Follow up was complete for 40/42 cases of isolated OC detected by ultrasonography. Unilateral, bilateral and central OC accounted for 30, 12, 0 cases, respectively. Karyotyping was performed in 11 cases; nine cases had normal chromosomes, one had 46XY, 16qh+ (same as mother's) and another had 46XX, t (2; 10) (q33; p12.2) (parental karyotype normal). In both cases with chromosomal aberrations, isolated unilateral cleft‐lip and palate were confirmed at delivery. Termination of pregnancy was performed for the latter; whether the balanced translocation would have contributed to an adverse outcome remains unknown. Six newborns had associated abnormalities at delivery: moderate VSD, mild pulmonary stenosis, bilateral clubfeet, Peter's anomaly and two cases of polydactyly. Except for one case of polydactyly which had no karyotyping, the other five had normal chromosomes. Karyotyping was deemed unnecessary by the neonatologist for 27 newborns with confirmed isolated OC. One newborn had no OC (PPV 39/40 = 97.5%). After excluding all cases where associated structural abnormalities were noted at birth, the sensitivity of detecting isolated OC confirmed at delivery was 33/40 (82%).

Conclusions:  Isolated OC detected by routine ultrasonography in a unit with high sensitivity is associated with a 1/40 (2.5%) risk of a significant chromosomal abnormality. However, this abnormality may have no adverse effect. This is useful for counseling couples considering prenatal karyotyping.
Prenatally diagnosed fetal thoracic malformations: a 5‐year experience
Authors: Portmann C. E. , Chan F. Y.
Published: March 2003

Background:  A 5‐year retrospective audit of cases referred to the Mater Mothers Hospital Fetal Medicine Unit with ultrasonographically identified thoracic anomalies was undertaken with specific reference to the distribution of pathologies, antenatal progress and outcomes of affected fetuses.

Results:  Twenty‐one fetuses with non‐cardiac, intrathoracic anomalies were identified and managed over a 5‐year period. Twelve demonstrated cystic mass lesions, seven echogenic lung masses were identified and one each of primary mediastinal shift (later found to be hypoplastic lung) and arterio–venous malformation of the lung. All lesions were unilateral. Antenatal diagnosis of congenital cystic adenomatoid malformations of the lung (CCAML) was made in the 12 cases of macrocystic lung lesions and proved correct in 10–1 was found at resection to be a bronchoplumonary sequestration (BPS) with associated AV malformation and chondromatous hamartoma, and one awaits follow up. Of the seven echogenic lung lesions, the antenatal diagnosis proved correct in only the two cases of BPS. Neonatal diagnoses included congenital diaphragmatic hernia (1), hybrid BPS/CCAM (1), resolving bronchial obstruction (2) and one loss to follow up with normal chest X‐ray. Complete resolution of the lesion occurred in five cases (mostly echogenic lesions). Polyhydramnios was found in only one case and resolved spontaneously – there were no cases of hydrops or fetal death. Neonatal outcomes included respiratory distress at birth (2), respiratory distress within 28 days (another two cases) and small for gestational age at birth (2/21). Thoracic CT scans were performed or awaited in all cases barring one loss to follow up with normal chest X‐ray. Some abnormalities were noted in all cases in which CT scan has been performed to date (15), including those cases with normal neonatal chest X‐ray and apparent antenatal resolution of ultrasound findings.

Conclusion:  While correct antenatal diagnosis can be made in many cases of cystic lung lesions, echogenic lung lesions may be difficult to diagnose correctly and adjunctive investigation such as MRI may prove beneficial. Postnatal CT scan should be considered as a routine for all antenatally diagnosed intrathoracic lesions regardless of apparent resolution of the lesion on antenatal ultrasound or apparently normal neonatal chest X‐ray.
Prediction of outcome of twin twin transfusion syndrome at presentation
Authors: Cincotta R. B. , Chan F. Y. , Lee‐Tannock A. , Amaraddio D.
Published: March 2003

Aim:  The aim of this study was to determine what factors are important in prediction of outcome in twin twin transfusion syndrome (TTTS) at presentation.

Methods:  A retrospective review was performed of all cases of TTTS managed at the Mater Mother's Hospital, Brisbane, Australia from 1994 until 2001. TTTS was diagnosed when there was coexisting oligohydramnios (MVP < 2 cm) and polyhydramnios (MVP > 8 cm) in a monochorionic pregnancy.

Results:  There were 50 cases of TTTS during this time (100 fetuses). Overall, there was a 61% survival rate, with 14% of the fetuses having an NND, 23% were stillborn and there was one termination of pregnancy. Both babies survived in 55% of pregnancies, one survived in 16% and both twins were lost in 29%. The average gestation at diagnosis was 21.5 weeks (range 16–29) and the average gestation at delivery was 28.5 weeks (range 16–36). Sixty percent of pregnancies had a mean of 2.1 amnioreduction performed, and 2002 ± 976 mL was removed. The poorest prognostic factor was the presence of hydrops in the recipient twin. Hydrops at presentation resulted in only a 36% survival for either twin in the affected pregnancy. Hydrops resolved spontaneously in two out of 11 cases and these were the only hydropic twins to survive. At the time of presentation, abnormal Dopplers in the recipient twin were associated with significantly poorer survival than for normal Dopplers (27% vs. 64% P = 0.02) but in contrast to other studies there was no significant difference seen in outcomes for the presence of abnormal Dopplers in the donor twin. Other individual factors did not prove to be good at predicting outcome.

Conclusions:  The poorest prognostic indicators for survival in TTTS were the presence of hydrops and abnormal umbilical artery and venous Dopplers in the recipient. Research into identifying good prognostic markers may identify subgroups of TTTS that may benefit from more aggressive therapies in order that we might further improve outcomes.
In utero release of constricting limb bands: successful timing of operation with Doppler flow assessments
Authors: Chan F.‐Y. , Cincotta R. , Borzi P.
Published: March 2003

Background:  Constricting limb bands in utero can lead to vascular compromise, resulting in limb amputations and/or significant neural compression sequele. In utero release has been described to improve outcome. When constriction bands were identified early in pregnancy, the question as to when operation should be performed remains controversial.

Purpose:  We report two cases, where the vascular status of the limbs was serially assessed and operation performed when Doppler flow assessment showed significant compromise.

Methods:  Case 1 had insertion of fetal vesico‐amniotic shunt performed at 17 weeks for bladder outlet obstruction. While the urinary bypass was successful, the free end of the shunt was found to have wrapped round the left fetal thigh. With advancing gestation, the shunt was shown to progressively indent on the thigh, and Doppler flow assessment showed 37% reduction in flow below the constriction by 29 weeks. Case 2 was found to have constricting amniotic bands to the left fetal thigh and right leg at 19 weeks. Serial assessments showed no evidence of worsening until 29 weeks, when Doppler flow showed reduction in flow by 50 and 34%, respectively, on the left and right legs. After extensive counseling, fetoscopic release of the constrictions were performed for the two cases at 30 and 32 weeks, respectively.

Results:  Both operations were performed with two port uterine accesses (3 mm) under general anaesthesia. The constrictions were identified and divided under direct vision. In case 1, the cut end of the shunt retracted into the fetal bladder. Recurrence of bladder outlet obstruction with hydronephrosis and anhydramnios necessitated delivery at 32 weeks. Anterior and posterior urethral valves were resected at 6 months. Follow up at 2 years of age showed no renal impairment. Case 2 delivered at 36 weeks. Significant limb indentations could be identified at the constriction sites for both fetuses after birth. Case 1 has no neurological deficit of the limbs while case 2 need further surgery for talipes and has minor functional impairments.

Conclusions:  In utero release of constricting limb bands may reduce long‐term sequele. Serial Doppler flow assessments can assist in the appropriate timing of such procedures.
Diagnosis and management of low segment Cesarean section scar pregnancies
Authors: Woelfer B. , Salim R. , Elson J. , Lawrence A. C. , Jurkovic D.
Published: March 2003

Background:  Rising Cesarean section rates have led to an increasing number of pregnancies implanted into postoperative uterine scars. We report a large series of Cesarean scar pregnancies treated in a single tertiary referral center.

Methods:  The diagnosis of Cesarean scar pregnancy was made on ultrasound scan when trophoblast was seen covering the lower segment uterine scar. Pregnancies <14 weeks size were treated either medically (local injection of methotrexate ± KCl) or with conservative surgery (dilatation and curettage ± insertion of Foley catheter). Surgical treatment was used for smaller, non‐viable pregnancies and in cases complicated by heavy bleeding or infection. Clinically stable patients with larger, viable pregnancies were treated medically. A single viable pregnancy >14 weeks required total abdominal hysterectomy.

Results:  In a 4‐year period, 14 Cesarean section scar pregnancies were diagnosed. Out of 13 women who were <14 weeks pregnant, seven were treated surgically (54%), five medically (38%) and one expectantly (8%). Surgery was successful in all cases. Three women (43%) required insertion of Foley catheter into the cervix to arrest the bleeding and one (14%) required blood transfusion. Three out of five (60%) women who received medical treatment were cured. Two women required surgery because of prolonged and heavy bleeding, one of them was transfused (20%). A case managed expectantly resolved spontaneously without any intervention. Five women tried to conceive again after treatment. All three women who succeeded (60%) had normal singleton intrauterine pregnancies.

Conclusion:  Early Cesarean scar pregnancies can be safely treated both medically and by conservative surgery. Although surgical treatment was more effective, this may be due to the selection criteria, which favored use of surgery in cases of smaller, non‐viable pregnancies.
How to discriminate between normal and abnormal early pregnancy
Authors: Jun S. A. , Ahn M. O.
Published: March 2003

Early fetal growth delay and early oligohydramnios have been suspected as signs of embryonal jeopardy. Sonographic examinations of 100 early pregnancies between the sixth and ninth gestational week were performed to investigate predictable sonographic findings of early abortion. Sonographic measurements of the gestational sac (G‐SAC), Crown‐rump length (CRL) and fetal heart rate (FHR) were performed using a transvaginal transducer with Doppler. All measurement of 11 early abortions were compared to those of 89 normal pregnancies to investigate the objective rules for the screening of early abortion. Most of the early aborted pregnancies were classified correctly by discriminant analysis with G‐SAC and CRL (G‐SAC = 0.5222 × CRL + 14.6673 = 0.5 × CRL + 15). In conclusion, early fetal growth retardation and oligohydramnios could discriminate the poor prognosis of early pregnancies.
A comparison of the uterine and intraovarian arterial flows in women having a history of recurrent spontaneous miscarriage associated with antiphospholipid syndrome
Authors: Jirous J. , Diejomaoh M. E. , Al‐Abdulhadi F. , Boland M. H.
Published: March 2003

Purpose:  To study the relationship between values of Doppler indices characterizing the uterine and intraovarian arterial flows in the presence of antiphospholipid syndrome in women with history of recurrent spontaneous miscarriage (RSM). We are not aware of any previous study undertaken on this specific topic.

Methods:  Sixty‐two women attending our recurrent spontaneous miscarriage clinic were recruited for this prospective study and subsequently divided to group A (n = 35) involving RSM women with normal anticardiolipin antibodies values (ACL IgM, ACL IgG) and group B (n = 27) for those with antiphospholipid syndrome (abnormal ACL IgM, ACL IgG values). ACL IgM and ACL IgG antibodies were measured in the blood using the standardized enzyme linked immunosorbent assay (ELISA). Color and power Doppler transvaginal ultrasonography was used to estimate the uterine artery pulsatility index (UTAPI), spiral artery resistance index (SARI) and intraovarian resistance index (IOARI) in the 21st day of a regular 28‐day unstimulated menstrual cycle. The data were analyzed using the statistical software SPSS 9.0 Windows. Statistical significance was defined as P < 0.05.

Results:  There was no statistically significant difference in the mean age in group A (33.67 ± 5.52 years) and group B (32.70 ± 5.85 years), the mean UTAPI values (3.14 ± 1.16 for group A and 3.44 ± 0.88 for group B), the mean SARI values (0.73 ± 0.13 for group A and 0.73 ± 0.07 for group B). The incidence of the first trimester miscarriages in women over 30 years was significantly higher in group B compared with group A (P < 0.01).

Conclusions:  Our preliminary study has revealed that there was no significant difference in UTAPI, SARI and IOARI values of RSM women with normal and abnormal ACL IgM and ACL IgG values. This fact could be explained by the predominantly mild form of antiphospholipid syndrome in Kuwait confirmed in our previous studies. We could hypothesise that such mild disease will have minimal/mild vascular effects in the non‐pregnant uterus and subsequently in the placental bed.
The evaluation of Doppler indices in renal vessels in normal fetuses and in fetuses with obstructive uropathy
Authors: Wyrwas D. , Szaflik K. , Borowski D. , Kozarzewski M.
Published: March 2003

Purpose:  The aim of the study was an evaluation of Doppler indices in renal vessels in normal fetuses and in fetuses with diagnosed obstructive uropathy.

Methods:  In the study, there were included 106 normal fetuses and 21 fetuses with signs of the obstructive uropathy. In pregnancies complicated by the uropathy, the measurements of Doppler flow in renal arteries were performed twice: in the ahydramnion settings and after the diagnostic amnioinfusion. The analyzed indices included the pulsatility index and the resistance index.

Results:  The diagnosis of uropathy was set‐up at the mean gestational age of 20.3 ± 2.0 weeks. The control group consisted of 106 healthy fetuses from normal pregnancies at the mean gestational age (28 weeks). The physiological absence of an end‐diastolic flow in renal arteries was found in normal pregnancies and that parameter was excluded from further analysis. The PI values in normal pregnancies decreased with the gestational age from the mean value of 3.16 at 15 weeks to 2.19 at 40 weeks of gestation. In pregnancies at gestational age below 26 weeks complicated by the uropathy, the PI was significantly lower with the mean value of 1.57. However, there were no statistical difference in PI values for pregnancies above 30 weeks of gestation, the mean values of PI were 2.39 and 2.33 for normal and pathological pregnancies, respectively. There were also no differences for PI values among pregnancies with the uropathy before and after amnioinfusion.

Conclusions:  There is a physiological linear decrease in the PI values in fetal renal arteries with the gestational age. The RI cannot be used for the evaluation of renal function due to the physiological absence of an end‐diastolic flow in renal arteries. The PI was significantly lower in pregnancies complicated by obstructive uropathy at the gestational age below 26 weeks.
The sensitivity of Doppler studies vs. biochemical indices in predicting fetal outcome in cases of pregnancy induced hypertension
Authors: Ghoneim M. R. , Nicolaides K. , Moneim M. A. Abd‐El , Megahid H. E. , Hafez M. S.
Published: March 2003

Location:  The Outpatient Clinic of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt and the High Risk Pregnancy Unit of King's College University Hospital, London, UK.

Aim of the work:  To compare the sensitivity and specificity of the Doppler studies vs. the biochemical indices in predicting fetal outcome in cases of pregnancy induced hypertension.

Material and methods:  A total of 252 cases were the subject of this study 192 cases from King's College Hospital and 60 from Suez Canal University Hospital. All cases were selected as having pregnancy‐induced hypertension, 226 cases with proteinuric hypertension and 26 cases with non‐proteinuric pregnancy induced hypertension. All cases were monitored weekly from 28th gestational week till delivery whereby all Doppler studies were carried out on a free loop of umbilical artery. Serum uric acid, liver enzyme aspartate‐aminotransferase, and platelet count were estimated weekly.

Results:  Out of 252 patients with PIH, 136 patients (54%) had abnormal Doppler flow velocimetry associated with abnormal higher mean AST proteinuria, serum urate >350 mm/L, lower platelet count and higher perinatal mortality. The sensitivity and specificity of abnormal Doppler velocimetry in the prediction of intrauterine growth retardation (IUGR) were 80 and 52.6%. These were raised to 94 and 88%, respectively, with higher mean serum urate and lower platelet counts. However, the specificity of the abnormal Doppler with abnormal all biochemical indices for the prediction of adverse neonatal outcome and IUGR was 100%, but this was a late event in cases of PIH as the sensitivity dropped down. It is not advisable to wait for both to happen before taking a decision for induction of labor.
Fetal responses to invasive procedures
Authors: Petrikovsky B. M. , Schneider E. , Holsten N.
Published: March 2003

Objective:  To study fetal responses to invasive procedures.

Study design:  Seven fetuses underwent invasive procedures between 23 and 38 weeks of pregnancy for accepted clinical indications. Two ultrasound machines were used simultaneously; one to provide guidance, and one to register FHR and respiratory rate (RR). A paired‐test was used for statistical analysis.

Results:  Three patients had bladder centesis, two placements of the bladder shunts and two placements of pleuro‐amniotic shunts. FHR changed from 128 ± 6 bpm prior to the procedure to 168 ± 8 after it (P < 0.05). RR also increased from 26 ± 12 to 32 ± 8 (P < 0.1).

Conclusion:  Invasive fetal procedures are accompanied by an increased FHR and RR which are likely to represent pain response.
Predicting neonatal outcome after prolonged preterm membrane rupture by ultrasound measurement of fetal lung length
Authors: Stone P. R. , Sadler L. , Battin M. , Grant S. , Mitchell J. , Roberts A.
Published: March 2003

Purpose of study:  To assess the ability of ultrasound measurements of fetal lung length to predict neonatal respiratory outcome after prolonged membrane rupture and oligohydramnios.

Methods:  From the database of all cases of spontaneous membrane rupture <28 weeks gestation, normal singleton pregnancies with membrane rupture for at least 7 days and delivery after 24 weeks gestation, where lung length measurements were available, were studied. At least one lung length measurement 7 days after membrane rupture needed to be available. The last lung length prior to delivery was used to predict the likelihood of pulmonary hypoplasia. Complete neonatal follow up was available on all babies. Neonatal outcome measures included, survival, bronchopulmonary dysplasia defined as an oxygen requirement at 36 weeks gestation and in non‐survivors a neonatal respiratory death. Two groups, good and poor outcomes were defined. A comparison between the last lung length before delivery corrected for gestation between the good and poor outcome groups was made to determine whether lung length could predict neonatal outcome. The trends in serial measures of lung length were also examined and compared with neonatal respiratory outcomes.

Results:  There were 43 live births eligible for study from the database of 57 babies. All had received antenatal corticosteroids as part of the management of prematurity. There were no differences in maternal age, ethnicity, parity and the incidence of antepartum hemorrhage between the good and poor outcome groups. Parameters significantly associated with a good outcome included gestation at membrane rupture, largest pool of amniotic fluid and gestation at delivery. The last fetal lung length did not predict adverse neonatal respiratory outcome in the 28 babies, in which membrane rupture was >21 days the findings were the same. Serial lung growth data also did not predict outcomes (figures are presented to illustrate the results).

Conclusions:  Fetal lung length determined by antenatal ultrasound does not predict adverse neonatal respiratory outcome and the prediction of pulmonary hypoplasia remains an elusive goal.
Differentiated evaluation of blood flow middle cerebral artery in relation to the fetal well‐being
Authors: Rozpravka P. , Ostro A.
Published: March 2003

Objective:  To state clinical signification of differentiated evaluation Doppler velocimetry middle cerebral artery (MCA) of ultrasonographically detected intrauterine growth retarded (IUGR) fetuses, during pregnancies complicated hypertension (PIH) and pre‐eclampsia.

Methods:  In prospective, comparative clinical studies evaluated Doppler velocimetric curve MCA separately in proximal (basal) segment (PS) and distal (cortical) anatomical segment (DS). Values of pulsatility index (PI) were compared in proximal and distal segment MCA. Corticocerebral index (CCI) was stated as ratio PIPS/PIDS. Results were compared in the group‐A with IUGR detected and in control group‐B with normal growth of the fetuses. Period of measurements complex biometry was l week, fetal flowmetry minimally 24 h, maximally l week.

Results:  Values of PI in PS and DS MCA were significantly different. Resistance of MCA in cortical direction decrease. Values of PIPS were higher comparing PIDS. We found statistically significant correlation CCI and >1 and chronical fetal hypoxy resulted in IUGR. Differentiated flow analysis of MCA did not show statistically significant differences of PIPS and PIDS. Calculated CCI = 1. MCA resistance does not show changes in cortical direction. We found significantly higher statistical occurrence of perinatal complications of the fetuses, elective cesarean sections for fetal intrauterine hypoxy, when values of CCI and >1. This is the fact concluded worse prognosis of the fetuses with cortical sparing effect in utero, but also worse postnatal adaptation. Main outcome – corticocerebral index is simple parameter for detection of different saturation of the brain of the fetus under hypoxemia. Fetal prosperity in utero has coming worse during cortical preservation. There is significantly higher occurrence of perinatal complications.
Three‐dimensional sonographic evaluation of fetal soft tissue deposition
Authors: Yanagihara T. , Matsumoto M. , Hanaoka U. , Kuno A. , Hata T.
Published: March 2003

Objectives:  To evaluate fetal nutritional status in utero and to detect intrauterine growth restriction and macrosomia by use of three‐dimensional ultrasonography.

Methods:  Fifty‐two fetuses from 28 to 41 weeks gestation were studied within 1 week before delivery using a transabdominal three‐dimensional transducer. The fetal nutrition score values were determined from a qualitative assessment of the amount of subcutaneous tissue present at three locations (face, ribs, and buttocks) on the antenatal three‐dimensional ultrasonograms. Fetal nutritional status, using fetal nutrition score, was compared with those by modified neonatal nutrition score and ponderal index, respectively.

Results:  There was a significant linear correlation between fetal nutrition score and modified neonatal nutrition score. Fetal or neonatal nutrition score correlated well with birth weight and neonatal crown‐heel length, respectively. However, no significant correlation between ponderal index and fetal nutrition score or modified neonatal nutrition score was evident. Ponderal index also did not correlate with birth weight and neonatal crown‐heel length, respectively.

Conclusion:  We do cast doubt on the usefulness of the ponderal index for measurement of neonatal soft tissue and muscle mass. Fetal nutrition score using three‐dimensional ultrasonography provides a novel means of evaluating the nutritional status of the fetus in utero, and should be useful for predicting the extreme in fetal growth earlier.
Cervical cerclage after hysteroscopic metroplasty
Authors: Leone F.P.G. , Ragusa G. , Lanzani C. , Digrandi M. , Ferrazzi E.
Published: March 2003

Purpose:  The objective of the study is to evaluate the role of cervical cerclage after hysteroscopic metroplasty.

Methods:  Forty‐six women, previously treated by hysteroscopic metroplasty for subseptate uteri, were prospectively recruited for this observational study. A total of 34 patients conceived 46 pregnancies. Miscarriages, ectopic pregnancies, and live births rate were 34, 7, 59%, respectively. Elective or ultrasound indicated cervical cerclage was proposed to these latter 27 patients. After discussing an informed consent form patients were asked to choose the elective cerclage or the ultrasound indicated cerclage. Cervical length was checked every 3 weeks, from 12 weeks of gestation. Indications for cervical cerclage were: cervical funneling or shortening <25 mm. In symptomatic patients, or when cerclage was indicated, a cervicovaginal swab was performed, and, if necessary, antibiotic therapy was started. The Shirodkar technique was adopted for cerclage.

Results:  Eleven of 27 patients underwent cervical cerclage: seven on ultrasound indication, four electively. Mean gestational age at the time of indicated cervical cerclage was 20 ± 2 weeks. Three patients, in the US‐indicated group, had a pathologic cervicovaginal swab. All no cervical cerclage delivered at term (39 ± 2 weeks). Mean gestational age at delivery in patients who underwent indicated cervical cerclage was significantly lower (P < 0.05) than in patients with no sonographic indication (37 ± 2 vs. 39 ± 1 weeks).

Conclusions:  Ultrasound cervical assessment is a useful tool to select patients for therapeutical cerclage. According to our data cervical cerclage should be performed only in cases of cervical changes diagnosed by transvaginal sonography.
Adenomyomatosis causing an echogenic fetal gallbladder – a new association
Authors: Bethune M. P. , Pahuja M.
Published: March 2003

Case report:  A primi gravida presented for a third trimester growth scan due to a history of SLE. Biometry was normal but a linear echogenicity was identified in the region of the fetal gallbladder, the gallbladder was not separately identified. The patient delivered an appropriately grown term baby with normal Apgar scores. Postnatal ultrasound identified a normal‐sized gallbladder with echogenic foci in the wall demonstrating the classical ‘comet tail artifact’ seen with adenomyomatosis.

Discussion:  The fetal gallbladder can be visualized from late in the first trimester. Previous case reports of echogenicities within the fetal gallbladder have found a high rate of resolution by the time of delivery [1,2]. The persistent echogenic foci in neonates were shown to be gallstones or sludge in almost all cases. All series failed to show any neonatal consequences of these findings [1]. Adenomyomatosis is a benign condition of the gallbladder where the lining epithelium extends as down‐growth between the muscle bundles to form gland like structures, known as Rokitansky–Aschoff sinuses. Within these foci secondary cholesterol crystal deposition occurs. Sonographically these appear as echogenic foci within the gallbladder wall with the classic description of ‘comet tail artefact’. A detailed medline search failed to reveal any reported cases of neonatal diagnosis of this condition. It has only rarely been reported in children. There have been no previous case reports of echogenic fetal gallbladder confirmed as adenomyomatosis in the neonatal period. Adenomyomatosis needs to be included in differential diagnosis of the antenatal echogenic gallbladder.
Radiofrequency ablation of fetal cervical teratoma
Authors: Chan F.‐Y. , Clouston J. , Cincotta R. , Borzi P.
Published: March 2003

Background:  Highly vascular fetal tumors can lead to death before viability as a result of vascular steal syndrome. Open fetal surgery is associated with significant risks for prematurity and maternal morbidity. Various local ablative techniques have been tried to reduce tumor vascularity, with variable success. Radiofrequency ablation has been performed for sacrococcygeal teratoma, but cervical teratoma poise further significant challenges with its proximity to vital neck structures.

Purpose:  This is the first report in which percutaneous radiofrequency ablation was used to reduce tumor vascularity in a human fetus with a large cervical teratoma.

Methods:  A partly solid, partly cystic neck tumor was first detected in a 19‐week fetus. The tumor grew rapidly and caused signs of cardiac decompensation by 26 weeks. After extensive counseling and ethics discussion, operation was performed at 28 weeks under general anesthesia. Radiofrequency ablation to the solid component of the tumor was performed with a nine‐prong retractable needle electrode with thermal couples (RITA), deployed to a maximum diameter of 5 cm. The operation was uneventful and fetal condition was monitored throughout the procedure.

Results:  Tumor growth was arrested temporarily with improvement of the cardiac status. Re‐growth of the tumor was noted after 32 weeks, necessitating delivery at 33 weeks. Postnatal investigation showed extensive tumor infiltration into the neck tissues and probable liver metastases. Biopsy showed immature teratoma, and chemotherapy was considered to be futile. Intensive care was withdrawn and the baby died 6 days after delivery.

Conclusions:  Radiofrequency ablation of fetal tumor in utero can reduce blood flow sufficiently to reverse high‐output fetal heart failure. Cervical tumors poise extra challenges with its proximity to vital neck structures. With careful and meticulous placement of the probe, ablation can be performed without injury to surrounding tissues. Experience in this area is preliminary and all such experiences should be reported.
The effect of intercellular Mg2+ in pre‐eclempsia
Authors: Mitrovic A. P. , Djukic M.
Published: March 2003

Approximately 2–10% of pregnancies are complicated by pre‐eclampsia. The pathophysiology of pre‐eclampsia is general arteriolar constriction and increased vascular sensitivity to precursor peptides and amines. The etiology of pre‐eclamsia is unknown. We examined (105 gravids) prospectively, the correlation between intra‐ and extracelullar magnesium deficit and uterine artery Doppler in women with pre‐eclampsia. We used bilateral early diastolic notch at 24 weeks as the definition of an abnormal waveform (circulatory parameters: Pi, Ri, of gravids art. uterina were excluded). For evaluation of RBC and plasma magnesium and calcium level we used atomic absorption spectrophotometry (AAS). According to our results, in majority of cases, we determined significantly low level of intracellular magnesium 0.86 + 0.22 mmol/L in group with bilateral notch, and positive correlation between bilateral notch, intercellular magnesium deficiency, increase level of intracellular calcium (0.69 + 0.18 mmol/L) and pre‐eclampsia. These results support hypothesis that misbalance of intracellular electrolytes, especially, intracellular magnesium and calcium are strong determinants of risk of pre‐eclampsia because these facts could cause grater excitability of vascular smooth muscle contraction.
Incidental ultrasound diagnosis of pseudomyxoma peritonei in an asymptomatic woman
Authors: Khan S. , Patel A. G. , Jurkovic D.
Published: March 2003

An incidental finding of pseudomyxoma peritonei is reported in a woman with a 6‐month history of postmenopausal bleeding. A transvaginal ultrasound scan revealed a poorly defined echogenic mass in the right iliac fossa above the right ovary and free fluid of mixed echogenicity in the pouch of Douglas. Laparoscopic appendicectomy and aspiration of mucinous fluid was performed without adjuvant chemotherapy. Regular postoperative follow‐up scans, which are needed as the disease may have an indolent course, showed no signs of recurrence. The differential diagnosis and management of pseudomyxoma peritonei are discussed. Copyright © 2002 ISUOG