bluuebunny/crossref_metadata_2025 huggingface dataset:
P60Effectiveness of treatment the fetal hemolytic disease by intravascular transfusions
Authors: Puacz P. , Brzezińska E. , Sobczak E. , Drews K. , Słomko Z.
Published: March 2003

Background

The aim of our study was to estimate the efficacy of treatment the fetal hemolytic disease by intravascular transfusions (IVT).

Method

In the group of 71 immunized patients, after 21 weeks' gestation we performed amniocentesis. Results of the optical density at 450 nm in 2nd or 3rd zone in Liley's scale were an indication for cordocentesis, fetal blood sampling and in cases with low values of blood parameters – intravascular transfusion with drugs administration. In some cases we chose elective preterm cesarean delivery. The management depended on the gestational age, fetal maturity, blood parameters, ultrasound examination and FHR patterns.

Results

The number of 24/71 patients required IVT. We transfused 20–90 ml of blood in 3–10 days intervals. The total amount of IVT was 78: 65/78 into a free loop of umbilical cord and 13/78 into its placental insertion. In 22/24 cases there were born healthy neonates, five of them required exchange transfusion because of hyperbilirubinemia. We observed one intrauterine death 10 h after IVT, probably due to cord hematoma and one death of hydropic neonate 48 h after delivery.

Conclusion

The treatment of fetal hemolytic disease by IVT is associated with high perinatal survival rate and low perinatal mortality rate.
P66Early screening for chromosomal abnormalities: biochemical, ultrasonographic and Doppler assessment
Authors: Comas C. , Antolín E. , Figueras F. , Echevarría K. , Muñoz A , Torrents M.
Published: March 2003

Objective

To evaluate the role of prenatal markers in screening for chromosomal abnormalities (CA) at 10–16 weeks' gestation.

Methods

Biochemical serum assessment, nuchal translucency measurement (NT), fetal heart rate (FHR), umbilical artery pulsatility index (UAPI) and ductus venosus pulsatility index for veins (DVPIV) were prospectively evaluated.

Results

A total of 7718 cases were evaluated, including 76 CA. The table summarises the effectiveness of each single parameter as a marker of CA. Detection rate (DR), specificity (S), positive predictive value (PPV) and negative predictive value (NPV) are shown.

Single markers
DR (%)
S (%)
PPV (%)
NPV (%)

Chromosomal abnormalities

 NT > 95th c
75.0
95.6
14.5
99.7

 FHR < 2.5th or > 97.5th c
15.3
96.2
4.1
99.1

 UAPI > 95th c
19.1
96.0
4.5
99.2

 DVPIV > 95th c
81.5
95.6
15.3
99.8

Autosomal trisomies1

 NT > 95th c
89.9
95.6
11.5
99.9

 FHR < 2.5th or > 97.5th c
15.2
96.2
2.6
99.4

 UAPI > 95th c
16.3
96.0
2.5
99.5

 DVPIV > 95th c
85.0
95.6
12.2
99.9

 Biochemical risk > 1/2702
64.3
92.2
2.4
99.9

Referred to main autosomal trisomies (21, 18 and 13).

2
Referred to trisomies 21.

Conclusions

1. Early screening programmes for CA are, at least, as effective as later strategies. 2. NT is the most sensitive and specific marker for autosomal trisomies. 3. DVPIV is the most sensitive and specific marker for overall CA. 4. UAPT and FHR are not effective single markers for CA. 5. Biochemical serum strategies should be reconsidered when we early scan unselected population.
P77The usefulness of uterine artery Doppler velocimetry in the prediction of high risk pregnancy. I. Normal ranges
Authors: Sieroszewski P. , Suzin J. , Surkont G. , Karowicz‐Bilińska A.
Published: March 2003

Objective

1. To establish the value of Doppler ultrasound of the uterine artery in identyfying high risk pregnancies. 2. To assess the efficacy of prophylactic aspirin treatment in high risk pregnancies (abnormal uterine artery Doppler velocimetry). 3. To show the efficacy of arginin treatment of IUGR fetuses in high risk pregnancies (abnormal uterine artery Doppler velocimetry).

I. Normal ranges of uterine artery Doppler velocimetry

Design and methods

We studied 428 single normal pregnancies between 19 and 39 weeks. There were assessed S/D, RI & PI in both uterine arteries. We included results of singleton pregnancies where healthy babies were born.

Results

We assessed decreasing of S/D, RI & PI values with the progression of pregnancy. We did not find statistically significant differences between right & left uterine arteries.

Conclusions

1. The uterine artery velocimetry depends on gestational age – the values of S/D, RI, PI values decrease with the progression of gestation. 2. There are not significant differences between right and left uterine artery Doppler velocimetry.

We continue our studies. (KBN nr 4 P05E 01616 i 4 P05E 01717).
P89A longitudinal study of computerized cardiotocography in pregnancies with absent or reversed end‐diastolic velocity (AREDV) in the umbilical artery Doppler studies: preliminary results
Authors: Steinman D. S. , Yamamoto R. M. , Francisco R. P. V. , Miyadahira S. , Zugaib M.
Published: March 2003

Background

A study of computerized cardiotocography (CTG) results in pregnancies with AREDV.

Methods

Forty‐eight computerized CTGs of 13 AREDV cases were studied. All the patients were hospitalized after the AREDV diagnosis and submitted to intensive fetal vitality evaluation.

Results

From the 48 exams performed, 25 (52%) met Dawes/Redman's criteria, and the mean time of analysis was 31.7 ± 15.3 min. fhr decelerations were found in 1 (4%) of the 25 cases where the criteria were met and in 9 (39.1%) of the 23 cases where the criteria were unmet. Fetal death occurred in 2 cases. The results of the last CTG are shown in the table:

pH < 7.20  or fetal death (n = 5)
pH > 7.20  (n = 6)

STV < 4.0
2 (40%)
1 (16.7%)

Criteria unmet
4 (80%)
3 (50%)

Conclusion

The preliminary results show that, in AREDV cases, Dawes/Redman's criteria were not met in 47.9% of the exams performed. A high incidence of abnormalities (80%) was found in the computerized CTG in cases that presented acidosis at birth or fetal death.
P96Abnormal trajectory of the anterior cerebral artery. A key finding to the diagnosis of the fetal lobar holoprosencephaly
Authors: Zaarour P. , Bernard J. P. , Senat M. V. , Keersmaecker B D. E. , Molho M. , Ville Y.
Published: March 2003

Background

The prenatal diagnosis of alobar and semi lobar holoprosencephaly is accesible in routine ultrasound. In contrast the diagnosis of lobar holoprosencephaly is still difficult. Prenataly differential diagnosis of lobar holoprosencephaly with septal defects is important for counseling.

Case report

We describe the shape and trajectory by color Doppler of the anterior cerebral artery in a case of lobar holoprosencephaly.

Results

The anterior cerebral artery runs under the frontal bones and is a key to the diagnosis of fusion of the two frontal gyri. This has already been described on angiography in children with holoprosencephaly

Conclusion

This aspect in color Doppler of the anterior cerebral artery is particularly useful in the difficult diagnosis of lobar holoprosencephaly
P99Effect of the vitamin E on the vasoconstrictor reflex
Authors: López Ramón y Cajal C.
Published: March 2003

Background

The vitamin E is an antioxidant agent used in the regulation of the vascular reactivity. We describe the use of the vitamin E on the regulation of the vasoconstrictor effect (VE) of the proximal segment of the middle cerebral artery (pMCA).

Method

In 11 fetuses we performed a pressure test. First the VE was demonstrated using pulsed Doppler and then we administrate orally vitamin E to the pregnant (15–50 mg per day). Later, we repeat the pt to observe the response on the VE.

Results

After the vitamin E the VE was decreased or abolished (see table at top of page).

Number  of case
W/VE/E  (mg)
W/VE/E  (mg)
W/VE/E  (mg)
W/VE/E  (mg)

1
305/++/start 15
306/+/15
34/0/15
36/0/15

2
305/+/start 15
334/+I/15
34/0/15
37/0/15

3
332/++I/start 15
342/0/15
352/0/15
36/0/15

4
306/++/start 15
316/0/15
35/0/15

5
292/++I/start 50
312/0/50

6
313/++I/start 50
33/0/50
355/0/50

7
256/++/start 50
263/0/50

8
293/++I/start 50
296/0/50

9
293/++/start 50
296/++I/100
302/+/0/50
311/0/50

10
265/++I/start 50
272/0/50

11
282/++I/start 50
29/0/50

W = weeks. E = vitamin E. + = ve; 0 = no ve. i = inverse flow in the pMCA.

Conclusion

With vitamin E we can regulate the VE of the pMCA. This response could avoid some perinatal motor injury of intrauterine origin and best the neonatal vascular adaptation.
WS16‐02Sonoembryology using intrauterine sonography
Authors: Hata T.
Published: March 2003

Our first purpose was to describe embryonic anatomic structures by use of IUS with a 20‐MHz flexible catheter‐based, high resolutions, real‐time miniature transducer. The number and the clarity of structures increased from 7 to 8 weeks of gestation; however, the image quality was degenerated because of the increasing fetal size at 9 weeks. At 8 weeks secondary brain vesicles, spine, midgut herniation, liver, upper and lower limb buds, and sacral tail were visualized in all fetuses. The four‐chamber view was first identified at 8 weeks, as were fingers or toes. The stomach was first noted at 9 weeks.

Second purpose was to compare the ultrasound visualization of the early first‐trimester embryo using TVS and IUS as 6–8 weeks of gestation. The ability to view most organs was better with IUS compared to TVS, and this was especially true for the brain, spine, heart, liver, midgut herniation, extremities, and sacral tail. Moreover, it was possible to obtain finer image quality of very small embryonic structures with IUS than with TVS.

Third purpose was to evaluate embryonic organ growth (liver, heart, and brain vesicles) using IUS in the early first trimester of pregnancy. The significant good correlation between each parameter and gestational age was obtained.

Fourth purpose was to visualize normal embryonal surface anatomic structures using 3D‐IUS at 7–9.9 weeks gestational age. At week 8, prominent forehead was evident, and upper and lower limbs and midgut herniation were clearly depicted. At week 9, fingers and toes were depicted as small digital rays, and the sacral tail protruded caudally. At week 10, embryonic face and fingers were clearly shown.
WS16‐05Doppler assessment of early pregnancy
Authors: Ruiz‐Flores M.
Published: March 2003

Doppler velocimetry give possibility of making noninvasive evaluation of the vascular modifications from the beginning of pregnancy.

We have studied following vessels:

Retrocorial arteries

The flow increases since sixth to twelfth weeks, progressively which is explained by the increment of the conductancy and the reduction of resistance. Trophoblastic invasion of spirals arteries in the coral bed, and hormones produced during the gestation affect both values.

Uterine arteries

The resistance of the uterine arteries diminish since sixth to twelfth weeks, in normal pregnancy. The low increment depends on the modifications in the coral bed and of hormonal vasodilator effect.

OVF Luteum gravidicus

When ovary flow is greater in first stage of pregnancy suggest a favorable early gestation, and vice versa, a regress in those measures had a negative character. We could evaluate the role of Doppler examinations in the following situations:

• Abortion in any stage and variations

• Blighted ovum

• Ectopic pregnancy

In all these conditions, Doppler showed to be a trusty, predictive, prognostical and diagnostical instrument of great utility. Clinical application of Doppler Uterus Corial could be used in a preventive way when the increment of the resistance in the uterine arteries appears before clinical abortion symptoms.

We also applied Doppler exploration in AVF patients confirming that the deficit in uterine perfusion is significantly related with the failures in embryonary implantation. Recently, we are performing endovaginal color Doppler in the diagnoses of early ectopic gestation and trophoblastic disease with very satisfactory results.
WS16‐07Stem cell therapy in the first trimester: the role of ultrasound vs. embryoscopy
Authors: Surbek D. V.
Published: March 2003

Intrauterine allogeneic hematopoietic stem cell transplantation has been successfully used for the prenatal treatment of severe combined immunodefiency syndrome. However, this treatment has not been successful in other conditions in which the fetus is immunologically competent. The main obstacles to success are lack of competitive advantage of donor vs. host stem cells preventing stable engraftment and graft rejection by the host immune system. Strategies to overcome these hurdles include, among others, early transplantation before 12 weeks of gestation, and increase of cells dose in the target organs (fetal liver and fetal bone marrow) which might be best achieved by the intravascular administration route. However, whilst ultrasound‐guided intraperitoneal administration of the graft in the first trimester is feasible, access to the fetal circulation in the first trimester is more difficult. Combined ultrasound‐guided/embryofetoscopic approach is a promising technique to achieve this goal. Thin‐gauge embryofetoscopes allow the exact visualization of the optimal funipuncture site and the intravenous insertion of a 25G needle through a side‐port. They thus provide an additional tool to deliver the stem cell graft to the preimmune fetus.
WS03‐09Unilateral early timed vaginal ultrasound guided follicular aspiration (ETFA) 10–12 h after hCG prevents the syndrome of serious ovarian hyperstimulation
Authors: Tomazevič T. , Meden‐Vrtovec H. , Geršak K. , Bokal E.
Published: March 2003

Aim

To prevent the syndrome of severe ovarian hyperstimulation in IVF/ET cycles at high risk for the syndome of ovarian hyperstimulation by early timed unilateral ultrasound guided aspiration of one ovary (12 h after hCG).

Method.

We evaluated the preventive effect of ETFA by analysing the data on 821 cycles at high risk for SOHSS performed during the years 1987–99. In all cycles the high risk for SOHSS was defined by the estradiol values > 3000 pg/ml and more than 8 follicles > 14 mm plus intermediate and small follicles in each ovary on ultrasound.

Results

In the group of :729 female infertility cycles at high risk for SOHSS with preventive ETFA there were no cases of SOHSS. In the control group of 92 IVF/ET female infertility without ETFA there were 12 cases of SOHSS (P < 0.0001). No difference in live birth rate (17% vs. 16%) was noted. The results prove the preventive effect of ETFA. It is based on early timed withdrawal of paracine substances which are present in the follicular fluid.

Conclusion

The vaginal ultrasound guided ETFA is another successful option to decrease the incidence of severe OHSS in assisted reproduction.
WS04: Menopausis WS04‐01Transvaginal sonography of the endometrium and sonohysterography in the menopause
Authors: Zoricic D.
Published: March 2003

Background

All endometrial sampling methods are invasive. Therefore in sympyomatic women and for women at risk of developing endometrial pathology in menopause a technique that could reduce the number of biopsy procedures would be of a great value. This technique would be relatively non‐invasive, easy to learn and perform, cost effective and well accepted by the patients. The objective of this study was the assessment of the diagnostic potency of ultrasound measurements by comparison with the usual histological investigation.

Method

Endovaginal ultrasonography (measurement of endometrial thickness and morphology of endometrium) prior to endometrial sampling was done in 160 postmenopausal patients. 143 D&C, 15 hysteroscopies and 2 laparotomies were performed to collect endometrial tissue. Indications for endometrial sampling were bleeding in 72%, ultrasound suspicion of endometrium in 18%, or other (cervical or adnexal pathology) in 10% of patients. Sonohysterography, as an improvement over conventional ultrasound methods, was done in 12 cases (7.5%). Pathologic findings were compared to preoperative ultrasonography.

Results

Ultrasound measurement of endometrial thickness combined with morphology and sonohysterography detected more than 90% endometrial pathology (sensitivity 96%, specificity 92%).

Conclusion

We found endovaginal ultrasound as useful tool at identifying endometrial diseases in menopause. For a postmenopausal woman with vaginal bleeding with a 10% pretest probability of endometrial cancer, her probability of cancer is less than 1% following a normal endovaginal sonography and sonohysterography. Ultrasound should be considered as investigational and cannot be used as the only methods to evaluate abnormal bleeding in menopausal patients.
WS05‐4Assessment of uterine vascularity in endometrial cancer
Authors: Szabó I.
Published: March 2003

Background

This study was conducted to assess uterine blood flow characteristics in endometrial cancer and to evaluate the influence of myometrial invasion and cancer grading for uterine circulation.

Method

Transvaginal color doppler was performed on 97 women with endometrial cancer (11 in stage IA, 33 in stage IB, 37 in stage IC, 7 in stage II, 8 in stage III, and 1 in stage IV) and 51 asymptomatic postmenopausal women (control group). Intratumoral and main uterine artery blood flow was recorded and the peak systolic velocity (PSV) and impedance indices (RI, PI) were calculated.

Results

In 90 of the 97 postmenopausal endometrial cancer patients (92%) abnormal blood flow with low impedance levels (RI: 0.39 ± 0.08; PI: 0.51 ± 0.15) was found within the endometrial echo or very close to it. Impedance indices in the main uterine arteries were significantly (P < 0005) lower in women with endometrial cancer than in normal postmenopausal woman. Uterine blood flow was not modified by the cancer grading. There was, no difference in impedance indices of the uterine arteries between myometrial invasion of < 50% and > 50%.

Conclusion

These results suggest that uterine blood flow analysis in endometrial cancer could not predict the tumor staging and grading, but this examination can provide additional discriminatory information on tumor vascularity which can then be used with morphology for more accurate diagnosis.
WS08: Fetal brain WS08‐01Three‐dimensional‐ultrasound of the embryonic/early fetal brain
Authors: Blaas H.‐G. K.
Published: March 2003

In the growing embryo, the brain is the first organ system to develop in such a way that it can be imaged in detail with transvaginal ultrasound. The extension of the transvaginal ultrasound technique to 3D imaging makes it possible to obtain new ultrasound images of the developing embryonic brain in planes not available in the original scan plane, to present form and shape, and to calculate volume. New information about the embryonic brain development can be obtained: volume measurements of the embryonic brain compartments reflect the phylogenetic development. The ‘old’ rhombencephalon is large during the early phase, while the ‘young’ hemispheres are very small. During a few weeks, this correlation becomes reversed. Using 3D animations this dynamic developmental process can be visualized.

Ultrasound technology has reached a level where the diagnosis of embryonic malformations can be made. At present, we are at the borderline of being able to diagnose holoprosencephaly when the embryo is seven to eight weeks. At nine weeks, 3D images of anomalies such as holoprosencephaly and spina bifida have been made. We may expect the rapidly developing 3D technology, with the option of anyplane slicing, to help us establish early diagnoses in the future. Such multiplane presentations of a diagnosis will contribute to increasing the diagnostic accuracy.
WS09‐07Ultrasound, Doppler and contrasts in metastases from gynecologic tumor
Authors: Schmillevitch J.
Published: March 2003

The breast cancer metastases can be analyzed by ultrasound in ganglial and visceral organs.

The detection of metastatic lymphonod in the axillar, cervical or supraclavicular regions and intrammamarian changes both the cancer staging and therapeutic planning. Benign lymphonode usually have an oval shape, hilum hyperechogenicity, narrow cortex and show hilar vascularization or radical central symmetric vascularization and absence of peripheral flow at Color Doppler. Malignant lymphonode are usually rounded hyporechoic, without hilar hyperechogenicity, and, in color Doppler, present multifocal aberrant vascularization, tortuous vessels or flow in the periphery.

The most frequent visceral metastases of breast cancer are hepatic, the suprarenal glands and ovaries.

About 86% of breast cancer hepatic metastases are hypoechoic. Ovarian cancer metastases can be detected mainly in pelvic tumors, peritonium tumors, glanglial, abdominal wall, hepatic and splenic metastases and ascites.

Our study of 10 cases of splenic metastases of ovarian cancer has demonstrated six hyperechoic tumors, two hypoechoic and two tumors with necrosis.

The use of color Doppler and Powerangio has demonstrated weak or moderate vascularization in glanglial and visceral metastases of gynecological tumors. The use of contrast (Levovist) has shown a more detailed vascular analysis by detecting vessels that were not identified in color Doppler and Powerangio without contrast.
WS01‐07Borderline urinary tract malformations
Authors: D'ottavio G. , Paduano L. , Rustico M. A. , Meir Y. J. , Lenardon P. , Rosadini A. , Mandruzzato G. P.
Published: March 2003

Background

Ultrasonography is an effective diagnostic tool for identifying fetal urinary tract anomalies (UTA). Serious obstructive or dysgenetic abnormalities are often clearly detected and their implications well known. Less clear is the meaning of borderline (asymptomatic at birth) UTA, including: mild pyelectasis (MP), unilateral renal agenesis (URA), unilateral multicystic kidney (UMK) and ectopic kidney (EK).

Method

We determined the outcome of pregnancies and long‐term renal function in 120 cases of prenatally detected borderline UTA. A prospective protocol was proposed to the parents which comprised ultrasound evaluation every 3 months until the age of 24 months, and renal function assessment in case of suspected worsening of prenatal findings.

Results

A total of 120 fetuses had a borderline UTA (MP n = 58, URA n = 14, UMK n = 32, EK n = 16). Eighteen of them showed some postnatal complication including: associated anomalies (3 cases), need for surgical intervention (6 cases), vesico‐ureteral reflux (VUR, 5 cases) and repeated infection (4 cases).

Conclusions

Fetal pyelectasis, rarely requires neonatal intervention if the diameter of pelvis is included between 5 and 10 mm in the second trimester. Nevertheless, the risk of associated chromosome abnormalities should be ruled out if other risk factors are present. Unilateral multicystic kidney carries a high risk of nephrectomy and contralateral VUR, whereas unilateral agenesis or ectopic kidneys seem to carry limited, if any, negative implications, with the exception of possible undetected, associated anomalies.
WS12‐05Umbilical and fetal cerebral circulation and fetal growth
Authors: Petrović O. , Rukavina B.
Published: March 2003

Background

Fetal growth is determined by its genetic potential and growth support. The aim of our prospective study was to find out does the growth support (placental factor and blood flow) or genetic potential play a primary role in fetal growth.

Method

From 27 to 41 gestational weeks an umbilical artery (RI1), a middle cerebral artery resistance index (RI2) and umbilical‐cerebral (U/C) ratio were measured. Several US measurements in 3–4 week intervals of the same pregnancy were done. After delivery, fetuses were divided into the three groups (AGA, LGA, SGA) according to their birth‐weights. Pregnancies with gestational diabetes were excluded from the study.

Results

There were not statistically significant differences between the average values of RI1 (age related) in the groups of AGA and LGA fetuses. However, the mean values of RI1 (according to gestational age) in the mentioned two groups of fetuses were significantly lower than in the group of SGA fetuses, as well as their mean values of U/C ratios.

Conclusion

Placental factor is equally and efficiently functioning in the both groups of AGA and LGA fetuses. The genetic regulating factor of fetal growth can be adequately expressed in conditions of appropriate uteroplacental and umbilical blood supply. In other words, in identical or at least similar conditions of umbilical blood supply, fetal growth is exclusively influenced by its genetic potential.
WS12‐02Anticipating twin‐to‐twin transfusion syndrome: the putative role of venous return evaluation in the first trimester
Authors: Matias A. , Montenegro N.
Published: March 2003

Background

Twin‐to‐twin transfusion syndrome (TTTS) complicates 10–15% of monochorionic (MC) and is associated with high perinatal mortality and morbidity.

Method

Sixteen MC twin pairs were evaluated between 10–14 weeks for delta nuchal translucency (ΔNT) and Doppler blood flow in ductus venosus (DV). Sequential scans were performed to identify TTTS.

Results

Neither the 12 cases with ΔNT<0.7 mm/normal flow, nor the two cases with ΔNT>0.7 mm/normal flow in DV, developed TTTS. The two cases that combined ΔNT>0.7 mm and abnormal flow in DV eventually developed TTTS.

Conclusion

The presence of abnormal blood flow in the DV in MC twins, at 10–14 weeks, may be a precocious anticipatory sign of TTTS.
WS13‐03Dynamics and clinical significance of placental shunt flow in monochorionic diamniotic twins
Authors: Maeda K. , Utsu M. , Hirai T. , Sakata M. , Yamamoto N. , Ohki S.
Published: March 2003

Background

The aim is to clarify placental shunt flow patterns in monochorionic diamniotic (MD) twins and their clinical outcome after the intervention under unique criteria.

Method

Thirteen (13) MD twin pregnancies were studied from early pregnancy with 2D and 3D B‐mode, color Doppler, power‐angio mode, Doppler flow velocimetry, cardio‐thoraxarea ratio (CTAR) and preload index (PLI) under tocolysis.

Results

Artery to artery shunt flow was detected by fetalbeat‐to‐beat Doppler color change and cyclic bidirectionalflow at placental surface in 8 MD twin cases but not in 5. Shunt was more clear with 3D color Doppler and power‐angio. Umbilical vein flow pulsation, variable FHR deceleration andcord complications were more in placental shunt flow casesthan its absence. Deep shunt flow was prenatally detected in 2 cases and small anastomses in all postnatal placenta. Pregnancy was terminated by emergency C‐section in cases of uncontrollable contractions, unidirectional shunt flow, large CTAR and PLI (> 0.4) which were frequent in large twins after 30 weeks. Neonatal cardiac failure was more in shunt flow cases than its absence but the outcome was normal. Neonatal PVL and perinatal deaths were less than the MD twins in the past.
WS01‐08Three‐dimensional power Doppler of fetal malformations
Authors: Chaoui R.
Published: March 2003

Background

The aim of the study was to examine the impact of three‐dimensional power Doppler ultrasound (3D‐PDU) in fetal abnormalities involving the vascular system.

Method

Eighty seven selected pregnancies were included in the study. ATL HDI‐3000 and 5000 ultrasound equipment with integrated 3D‐Color Power Angio ® software were used. Data acquisition was done by the free‐hand‐technique and images were reconstructed online.

Results

Reconstruction was only possible in 56 out of the 87 (64%) considered pregnancies. These were abnormalities of placenta and umbilical vessels (n = 26), intra‐abdominal and intrathoracal anomalies (n = 12), renal malformations (n = 9), central nervous system (n = 4) as well as cardiac defects (n = 5). The main reasons for failure were fetal position and movements, overlapping with signals from neighboring vessels as well as the reduced attempts in 3D in an on‐line system. Details and figures of the potential field of interest in prenatal diagnosis are presented.

Conclusions

The study shows that 3D‐power Doppler can be applied in prenatal diagnosis. The method enables the visualization of main parts of the fetal vascular system under abnormal conditions with the exception of the fetal heart where a trigger system is still needed.
WS14: Three‐dimensional power Doppler in obstetrics and gynecology WS14‐01 3‐D ultrasound in routine check‐up of infertility patients
Authors: Radonćić E. , Funduk‐Kurjak B. , Kupešić Sanja , Kurjak A.
Published: March 2003

Objective

The aim of this study was to determine whether three‐dimensional ultrasound (3‐D US) can improve the diagnostic ability in a routine check‐up of patients undergoing in vitro fertilisation (IVF) in an office practice.

Methods

Three‐dimensional and power Doppler ultrasound were performed on 267 patients undergoing IVF on the first visit, during ovulation induction and aspiration of the oocytes. Patients with suspected uterine anomalies and/or abnormalities of the endometrium (N = 108) were treated by operative hysteroscopy. On the day of oocyte collection, multiplanar imaging and 3‐D reconstruction demonstrated cumuli in follicles greater than 15 mm. Cumulus assessment inside the ovarian follicles was correlated to the number of mature oocytes. Power Doppler reconstruction was performed in the cases when superponing vessels did not allow correct placing of the puncture needle.

Results

Of 108 patients with suspected uterine abnormality, the diagnosis was correct in all cases of endometrial polyp, submucous myoma, arcuate uteri and septate uteri, as confirmed by an office hysteroscopy. Intrauterine synechiae was correctly diagnosed preoperatively in one out of the four cases. The mean (± SD) number of follicles > 18 mm was 8.2 ± 5.8, and total number of follicles demonstrating cumulus in all three planes was 6.4 ± 5.1. The ratio cumuli/retrieved oocytes, cumuli/fertilised oocytes and cumuli/mature oocytes was 6.2 ± 4.2, 5.4 ± 2.8 and 5.9 ± 2.6, respectively.

Conclusions

Three dimensional ultrasound can become a standard of routine check‐up of infertility patients allowing improved recognition of the uterine anatomy, characterisation of the surface features, and precise depiction of the ovaries during stimulation cycles. It can enhance and facilitate the morphologic and functional evaluation of the anatomic structures of the inner reproductive organs, thus avoiding the need of invasive diagnostic procedures. Various puncturing procedures can be more precisely performed. The built‐in application of live 3‐D mode may be very helpful in performing invasive procedures, such as oocyte collection.
WS14‐023D color histogram: principles and practice in transvaginal and abdominal sonography
Authors: Pairleitner H. , Steiner H.
Published: March 2003

Objective

The 3D Color Histogram gives quantitative informations about (changes) of perfusion and vascularisation packed in indices. Aim of the presentation is to illustrate the information gained by the vascularisation and perfusion indices. In addition, to show the reproducibility of the indices according to published studies, preliminary results (transvaginal) obtained in ovarian tumors and preliminary results in phantom measurements to correct the decrease in signal power with depth of insonation using a 3D abdominal probe.

Results

Color Histogram indices are reproducible. Differences of perfusion and vascularisation between benign and malignant ovarian tumors could be observed in a limited number of investigations. The physical component of the decrease in signal power with depth of insonation could be calculated by mathematical algorythms according to first phantom measurements.

Conclusion

The 3D Color Histogram gives new possibilities to analyse neoangiogenesis.
WS15: Second and third trimester Doppler II WS15‐01High pathological Doppler flow findings (absent or reverse enddiastolic flow) and fetal outcome
Authors: Schmidt W. , Ertan A. K.
Published: March 2003

Background

Reversed enddiastolic Doppler flow velocity waveforms on umbilical velocimetry is regarded to be associated with catastrophical perinatal outcome with a high perinatal mortality ranging from 35% to 100%. This study focused on the differences of fetal morbidity and mortality between the cases with reverse flow and other Doppler flow velocity waveforms.

Method

During a 10‐year period we found 30 cases with reverse flow in the umbilical artery or fetal aorta (gr. I), we selected 30 cases with absent end diastolic velocities (gr. II), 30 cases with high A/B‐ratio (gr. III) and 30 cases with normal A/B‐ratio (gr. IV). All cases in this study were patients with similar para, gravida, maternal age and gestational ages by delivery (≤ 36 weeks).

Results

The fetuses with reverse flow showed the highest perinatal mortality of 27% (7% in the gr. II, 10% in the gr. III and 0% in the gr. IV). In the gr. I the neonatal morbidity of 78% was also the highest (59% in the gr. II, 36% in the gr. III and 30% in the gr. IV). 80% of intrauterine fetal death (IUFD) were within this group, while no IUFD has been found in the gr. IV. Furthermore, the incidence of cerebral haemorrhage by the neonates in the gr. I (28%) was also much higher than those in the gr. III (4%) and IV (0%).

Conclusions

Our study suggests that reverse flow represents severe fetal condition with the highest perinatal mortalities. The fetal outcome in cases with reverse flow is further worse than those with absent end diastolic flow velocity waveforms. A highest morbidity was also observed by those fetuses, especially high incidences of cerebral haemorrhage. Colour Doppler‐sonography is a very useful tool to identify high risk pregnancy leading worse perinatal outcome and allows to select worst perinatal prognosis if reverse end diastolic flow is detected.
WS15‐02Fetal biophysical profile and kinetic measurement: Doppler contribution
Authors: Troyano J. M.
Published: March 2003

Background

Two methods are presented for the assessment of fetal behaviours under the application of Doppler effects: (a) Measurement of the velocity wave of fetal limb by vibroacustic stimulating. (b) Hydrodynamic evaluation of the transnasal amniotic velocity wave and its relation to gastric peristalsis.

Method

A Doppler device was employed to assess the velocimetry wave from the ‘FEMORAL BONE’ in motion, following vibro‐acoustic stimulation in 138 phisiological pregnancy and Doppler‐aided evaluation of transnasal amniotic hydrodynamics.

Results and conclusion

Assessment of normal fetal behaviour. Quantification of patterns of reactivity of any body structure. Reduction in the duration of explorations for biophysical profiles. (3–4 min). Fetal reflex responses slow down and become increasingly complex as maturation carries on. Both mean velocity and acceleration of fetal reactive responses experience a gradual decline throughout gestation. The time a fetus takes to respond to a stimulus increases directly with gestational age. Simultaneousness between fetal respiration episodes and phases of gastric distention and activity. (physiological conditions). Fetal active respiration can be unequivocally accounted for by Doppler assessment of the activity of intake/release of amniotic fluid along the high respiratory branches of the pulmonary tree. Amniotic respiratory dynamics are always transnasal in physiological conditions. Velocities of transnasal, decreasing steadily from the 32nd gestational age to the end of gestation.
WS15‐03Fetal centralization
Authors: Montenegro C. A. B. , Lima M. L. A. , Rezende‐Filho J.
Published: March 2003

We have been studying fetal centralization in the toxemic/IUGR model since 1992, by means of Doppler of the umbilical and middle cerebral arteries and ductus venosus, computerized CTG and cordocentesis.

The natural history of fetal centralization may be divided into 3 phases: normoxemic centralization, hypoxemic centralization and decompensation. The natural history of fetal hypoxemia in these models and the patterns of computerized CTG were also described.

Having analysed 105 cases of very high‐risk pregnancies in the toxemic/IUGR model with fetal centralization, we tried to define the best parameter to indicate the ideal timing for delivery, and the presence of centralization after 28 weeks gestation appears to seems to indicate it.
WS15‐06Doppler ultrasonography of the human fetal pulmonary circulation and its role in the prediction of pulmonary hypoplasia
Authors: Laudy J. A. M. , Tibboel D. , Robben S. G. F. , De Krijger R. R. , De Ridder M. A. J. , Wladimiroff J. W.
Published: March 2003

Objectives

To determine the value of Doppler flow velocity waveforms from the fetal arterial pulmonary branches relative to fetal biometric indices and clinical correlates in the prenatal prediction of lethal lung hypoplasia (LH) in prolonged oligohydramnios.

Study design

42 singleton pregnancies with oligohydramnios associated with premature rupture of membranes (PROM, n = 31) or bilateral renal pathology (n = 11) were examined using a combined color coded Doppler and 2d real‐time ultrasound system. Thoracic (TC), cardiac (CC) and abdominal circumference (AC) and the largest vertical amniotic fluid pocket were measured. Pulsed Doppler measurements of the arterial pulmonary branches were made at the level of the cardiac four‐chamber view after visualization with color Doppler. Diagnosis of LH was based on pathological, clinical and radiological criteria.

Results

The prevalence of lethal LH was 43%. In the PROM‐subset, combination of onset of PROM = 20 weeks; duration of oligohydramnios = 8 weeks and degree of oligohydramnios = 1 cm, presented the highest clinical prediction rate for lethal LH. For both the total group and the PROM‐subset, the highest prediction rate for lethal LH from biometric and Doppler parameters was presented by TC/AC ratio, peak systolic velocity in the proximal branch and time‐averaged and end‐diastolic velocity in the middle branch of the pulmonary artery. In the prom subset, combination of all three clinical, biometric and Doppler parameters revealed the most favorable combination to predict lethal LH (PPV 100%, accuracy 93%, and sensitivity 71%).

Conclusion

Doppler velocimetry may detect changes in blood velocity waveforms from the arterial branches of the fetal pulmonary circulation in the presence of LH, but fails to be the ultimate test for the prenatal prediction of lethal LH. The best prediction can be achieved by combining clinical, biometric and Doppler parameters.
Workshops
Authors: Cafici D.
Published: March 2003

The prenatal diagnosis of fetal malformations seems to be a very difficult challenge, mainly for those who are beginning with the practice of ultrasound.

As it would be impossible to refer to so many fetal malformations the presentation will cover a few interesting issues.

These cases are not frequently diagnosed and in many cases present controversial aspects referred to their prognosis and management.

Those topics are:

Unilateral ventricular dilatation

Fetal hyperechogenic lung lesions

Umbilical vein varix

Facial clefts

Unilateral ventricular dilatation may be a difficult diagnosis and its prognosis is variable

Fetal hyperechogenic lesions include a broad range of anomalies with a variable behaviour. Even large lesions can disappear in utero but often the lesion can persist with severe prognosis for the fetus. Varix of the umbilical vein is a relatively uncommon abnormality that carries an increased risk for fetal demise, chromosomal abnormality and hydrops.

Facial clefts are a relatively common malformation and the fetal face must be properly scanned in every fetal study.

3D ultrasound helps a lot in the diagnosis of these and other malformations and we'll discuss some examples concerning this new technology.
F103Response of the fetal pupil in the chromosomal anomalies
Authors: López Ramón y Cajal C.
Published: March 2003

Background

We studied sonographically the response of the fetal pupil to the stimulus of color Doppler (CD) in fetuses with chromosomal anomalies below 22nd weeks.

Method

The pupils of 28 fetuses were studied sonographically between 15 h‐21 weeks' gestation, diagnosed of a chromosomal alteration through of genetic amniocentesis. The areas of the pupil and iris were compared before and after CD imaging.

Results

The great majority of the fetuses have some data out of range in the relationship pupil/iris in basal conditions or after CD. Usually, we observed an atypical response (mydriasis before the 19 weeks or miosis after this) and/or an exaggerated response (hyperreflexia).

Conclusion

These results affirm that this type of test increases the possibilities in a fetal study of high resolution performed before the 22nd weeks of gestation and it can be a useful indicator like an aneuploidy marker.
F120Effectiveness of screening for major cardiac defects in a routine obstetric population
Authors: Mavrides E. , Cobian F. , Moscoso G. , Campbell S. , Thilaganathan B. , Carvalho J.S.
Published: March 2003

Background

The aim of this study is to evaluate the effectiveness of routine antenatal screening for CHD in a routine obstetric population.

Method

A three‐year prospective, observational study. All women were routinely offered first trimester nuchal translucency screening and an 18–23 week anomaly scan, where the four chamber view and outflow tracts were visualised. The main outcome measure was identification of major CHD in all pregnancies, either in the antenatal or postnatal period.

Results

Major defects of the heart and the great arteries were identified in 51 out of 9277 pregnancies. Major CHD were diagnosed antenatally in 42 fetuses and postnatally in nine (including 15 aneuploidies). The overall antenatal detection rate was 82.4% in all pregnancies and 80.6% in chromosomally normal pregnancies. In 10 cases, the first trimester NT measurement was increased.

Conclusion

The overall prevalence of major CHD (5.4/1000) suggests that ascertainment in the study population was thorough. The combination of first trimester NT screening and visualisation of the four‐chamber/outflow tracts is effective in the detection of the majority of major CHD.
F127Prenatal diagnosis of fetal cardiac tumors: 18 cases reported
Authors: Galindo A. , Gutiérrez‐Larraya F. , Grañeras A. , Alvarez C. , De La Fuente P.
Published: March 2003

Aim

To evaluate our experience with fetal cardiac tumors.

Methods

Retrospective study of 18 cases from Jan.1991–Apr.2000, analyzing US features, histology and perinatal outcome.

Results

The incidence was one in 3224 deliveries (18/58037). Mean gestational age at diagnosis was 32 weeks (22–38). In 17 cases (94%) were isolated while in one the fetus had another defects. In 7 cases (39%) there was one tumor, in 6 two (33%) and in 5 three or more (28%); total number of masses was 42. Size ranged from 2 to 46 mm. In 3 cases (17%) a significant growth of the mass was observed prenatally. Most masses (26) were sited at ventricles (18 left and 8 right). Pericardial effusion was observed in 8 cases (44.4%). In 4 cases there were a significant arrythmia. Histology was available in 7; 5 rhabdomyomas, one cavernous hemangioma and one pericardial teratoma. In the other cases the sonographic appearance was compatible with rhabdomyoma. A postnatal conservative management has been performed in most cases. Overall survival rate was 67% and if top are excluded (2 cases) survival rate rose to 75%. At one year follow‐up, extracardiac manifestations of tuberous sclerosis were diagnosed in 5 cases (28%). In all the 5 cases, there were 2 or more cardiac masses. In 5 of the 11 cases (45%) with more than one tumor, extracardiac manifestations of tuberous sclerosis were observed.

Conclusions

Fetal cardiac tumors are unfrequent and the diagnosis is usually made in the III trimester. They appear commonly isolated and its size is widely variable; in up to 61% of the cases more than one tumor is observed. Main localization is ventricular and the most common type is rhabdomyoma. A conservative approach is recommended as can behave in a benign fashion. Caution is advocated when counselling families about tuberous sclerosis, mainly if several cardiac masses are detected.
Infertility F22Computerized analysis of uterine peristalsis from transvaginal ultrasound images after ovulation induction by clomiphen citrate
Authors: Eytan O. , Halevi I. , Har‐Toov J. , Gull I. , Wolman I. , Lessing J. B. , Elad D. , Jaffa A. J.
Published: March 2003

Background

Uterine peristalsis plays a central role in assisting the transport of an embryo to a fundal implantation site.

Objective

Computerized characterization of the dynamics of intrauterine fluid–wall interface (IUFWI) from in vivo images of the sagittal cross‐sections of the uterus of patients treated with Clomiphen Citrate (CC) and healthy women with normal cycle.

Method

Transvaginal ultrasound (TVUS) images of sagittal cross‐sections of nonpregnant uterus were scanned. Images at consecutive times (1 second apart) were digitized and processed by techniques of image processing. The images were compared to evaluate time variation of the IUFWI with respect to amplitude, frequency and symmetry.

Results

TVUS images from 6 women treated by CC (Group A) and 25 healthy volunteers (Group B) during the proliferative phase were analyzed. The amplitudes of the IUFWI of Groups A and B yielded 0.106 ± 0.041 mm and 0.082 ± 0.045 mm, respectively. The frequency of Group A, 0.036 ± 0.017 Hz, was higher than the frequency of Group B, 0.029 ± 0.017 Hz, in contrast to reported observations. The motility of IUFWI among Group B revealed higher symmetry, −0.712 (−1 yields full symmetry), than the symmetry of −0.660 of Group A.

Conclusions

It may well be that the differences in the amplitude, frequency and symmetry change the pregnancy rate of women undergoing ovulation induction by CC.
F25Changes in the endometrium between the day of oocyte retrieval and embryo transfer. Does it matter?
Authors: Sladkevicius P. , Ojha K. , Campbell S. , Nargund G.
Published: March 2003

Background

Multiple studies have confirmed a lower implantation and pregnancy rates in women who exhibit a homogenous pattern of the endometrium compared to a triple‐line pattern on the day of hCG administration. However, there are no studies comparing the pattern of endometrium and its vascularization on the days of oocyte retrieval and embryo transfer.

Methods

We prospectively evaluated the endometrium in 97 women undergoing 116 IVF‐ET cycles. Endometrial thickness and pattern, endometrial vascularization and blood flow waveforms in subendometrial vessels and uterine arteries were registered on the days of oocyte retrieval and embryo transfer.

Results

There was no difference in age, basal FSH, number of oocytes, number of embryos transferred and endometrial thickness between pregnant and nonpregnant patients, or between patients with homogenous endometrium and those with triple‐line pattern of the endometrium. The ongoing implantation rate was 11% having homogenous endometrium and 23% having triple‐line pattern of the endometrium on the day of oocyte retrieval. By the day of embryo transfer 89% of endometrium seemed to be homogeneously echogenic. All pregnancies occurred in the patients who had a homogenous endometrium on the day of embryo transfer.

Conclusion

Endometrial pattern, rather than endometrial thickness on the day of oocyte retrieval and its changes towards the day of embryo transfer appear to be important prognostic factors of endometrial receptivity.