bluuebunny/crossref_metadata_2025 huggingface dataset:
F35Trade‐off of different combining methods of ultrasound and biochemical screening tests for Down syndrome
Authors: Herman A. , Dreazen E. , Bukovsky I. , Weinraub Z. , Maymon R.
Published: March 2003

Aim

To assess the efficacy of different combining methods of 1st trimester nuchal translucency and 2nd trimester triple test.

Methods

Results of both NT and TT were obtained in 706 euploid fetuses and in 16 DS cases. The net effect of each test was evaluated by using its likelihood ratio (LR). A combined risk for DS live birth > 1:400 was used to assess false‐positive rate (FPR) and detection rate (DR), adjusted to different age groups.

The tests were combined using the following methods:

a. Summation – all cases with a risk > 1:400 by either NT or TT;

b. Calculated risk – derived from combined LR (LRNTx LRTT).

Results

In normal pregnancies the overlap of cases with a LR > 1.5 – by both tests – was negligible (P < 0.001), whereas in DS cases the overlap was 33%. The table at the foot of the page shows better efficacy of the calculated risk vs. the summation method (e.g. for 30‐year‐old group yield of 1:26 and 1:78, respectively).

Conclusions

The FPRs derived from the summation method seems to be a reasonable trade‐off for the high DR obtained by this method. Also, the yield of the summation combining method is much more efficacious than that obtained by the worldwide policy of karyotyping patients at 35, 37 or even 40 y.

Summation (NT or TT risk > 1:400)
Calculated risk  (Combined risk > 1:400)

Age Years
Yield* by age only
Yield*
FPR
DR
Yield*
FPR
DR

20
1:1529
4.5%
81%
1:85
1.0%
56%
1:27

25
1:1351
4.5%
81%
1:75
1.0%
56%
1:24

30
1:910
6.9%
81%
1:78
2.0%
69%
1:26

35
1:384
15.7%
94%
1:65
4.3%
81%
1:20

40
1:112
44.7%
100%
1:50
10.6%
94%
1:13

Number of invasive procedures required to detect 1 case of DS.
F52Evidence of unidirectional pulsatile flow in the umbilical interarterial anastomosis
Authors: Raio L. , Ghezzi F. , Di Naro E. , Franchi M. , Bolla D. , Lischetti B. , Balestreri D. , Dürig P. , Schneider H.
Published: March 2003

Background

An anastomosis between umbilical arteries (UAS), located within 1–3 cm from the placental insertion, has been previously described at delivery and in utero. However, the prenatal investigation of this vessels is limited to case reports. We report a series of antenatal functional evaluation of this vessel.

Method

41 women underwent a target ultrasonography to evaluate the blood flow characteristics of UAS and UAS anastomosis. The resistance index (RI) of the anastomosis and the UAS RI before and after the anastomosis was obtained. The direction of the blood flow in the anastomosis was determined by color Doppler evaluation.

Results

An anastomosis between the two stems of the UAS was present in 36 cases while a fusion of the two UAS was found in the remaining 5 cases. The median (range) gestational age at diagnosis was 33.1 weeks (25.5–40.1). The median (range) diameter of the anastomosis was 2.3 mm (1.3–7.1). The blood flow in the anastomosis was pulsatile with a median (range) RI of 0.62 (0.45–0.85). The difference between UAS RI was higher after than before the anastomosis [0.07 (0–0.3) vs. 0.04 (0–0.17), P = 0.051]. The anastomosis blood flow was always unidirectional.

Conclusion

During fetal life, the UAS anastomosis acts as a pressure‐equalizing system between UAS and the placental lobes.
F53Umbilical venous volume flow: reproducibility and developmental data
Authors: Boito S. , Struijk P. C. , Stijnen H. R. , Wladimiroff J. W.
Published: March 2003

Background

To determine reproducibility of volume flow components; to calculate volume flow in normal and growth restricted fetuses in a cross‐sectional study design.

Method

Using Labview and Imaq‐vision software, the cross‐sectional inner vessel area was traced. Vessel area (mm2) and mean flow velocity (cm/s; Doppler) were multiplied to calculate volume flow (ml/min) including flow/kg fetus. The coefficient of variation (CV) for vessel area and flow velocity scans and tracings was determined (n:13; 26–35 weeks). Normal charts for components and volume flow were constructed (n:72; 20–36 weeks) and related to data from growth restricted fetuses (birthweight < P5) (n:20; 23–36 weeks).

Results reproducibility

CV was 5.4% (vessel area) and 7.3% (mean velocity) for scans and 6.6% and 10.5% for tracings resulting in a CV of 8.1% (scans) and 11.9% (tracings) for volume flow. Gestational age related increase exists for vessel area, mean flow velocity, and volume flow: 47.5 ± 19.3(SD) ml/min at 20 week and 229.6 ml/min ±29.6(SD) ml/min at 36 week, but not per kg/fetus. In fetal growth restriction, volume flow was reduced (P < 5) in 18/20 cases, but for volume flow/kg fetus only in 11/20 cases.

Conclusion

Measurements of vessel area results in acceptable reproducibility of volume flow calculations, which show a 5‐fold increase at 20–36 week. In fetal growth restriction, volume flow is significantly reduced but equally distributed between normal and reduced values when calculated per kg/fetus.
F57Intra‐observer and inter‐observer variability of Ductus Venosus blood flow indices in fetuses between 10 and 14 weeks of gestation
Authors: Mavrides E. , Holden D. , Hollis B. , Tekay A. , Thilaganathan B.
Published: March 2003

Background

The aim of this study is to assess the intra‐observer and inter‐observer variability of transabdominal Doppler velocity measurements of ductus venosus (DV) blood flow in fetuses at 10–14 weeks.

Method

Doppler indices in the DV of first trimester fetuses were repeated three times by the same trained observer in 67 pregnancies and by a second trained observer in 24 pregnancies. In addition, both observers documented the presence of normal/abnormal blood flow during atrial contraction.

Findings

Intra‐observer reproducibility of measurements of peak systolic velocity, end‐diastolic velocity and systolic to diastolic ratio were poor. Intra‐observer pulsatility index (PI) repeatability was adequate (CC 0.60, CV 8.9%). Inter‐observer agreement for all the Doppler measurements was unsatisfactory (CC 0.18–0.44; CV 11.5% to 47.2%).

Conclusion

There is significant variability in all Doppler indices, except for the intra‐observer repeatability of PI. Determination of normal/abnormal atrial flow is a repeatable measurement.
F59Fetal venous Doppler in the normal first and second stage of labor
Authors: Krapp M. , Denzel S. , Germer U. , Gembruch U.
Published: March 2003

Background

The aim of the study was to evaluate, whether differences in fetal venous flow velocity waveforms can be seen in fetuses during labor compared to fetuses before labor.

Method

The Pulsatility index for veins (PIV) of the ductus venosus was analysed in 127 fetuses (37th to 41th weeks) before labor by color Doppler sonography (control group). Identically 42 fetuses with normal cardiotocogram were analysed during and between contractions consecutively in the early first stage of labor, at 2–4 cm and 6–8 cm and at full dilatation of the cervix (study group).

Results

The control group showed a normal PIV of 0.59 (SD 0.24). In the study group between contractions the PIV was normal during all stages of labor with average values of 0.55 − 0.68 (SD 0.26 − 0.42). During contraction the average values of the PIV were 1.64 – 2.48 (SD 0.76 – 1.16). These values were significant elevated (P < 0.001) during contraction compared to the values of contraction free episodes as well as to the control group. The increase of the PIV during contractions was not related to any fetal heart rate deceleration.

Conclusion

During contractions the fetal venous pressure is significantly elevated in normal labor. Reference ranges for the ductus venosus should be established and compared to values in compromised fetuses.
F61The ductus venosus blood flow velocity waveforms during labour in 42 singleton fetuses at term
Authors: Denzel S. A. , Krapp M. , Germer U. , Gembruch U.
Published: March 2003

Background

The aim of this study was to learn about the physiological changes in the ductus venosus blood flow velocity waveforms during labour.

Method

Ductus venosus flow curves were obtained by Doppler ultrasonography during and in‐between uterine contraction during the first and second stage of labour in 42 singleton fetuses at term. In every patient we tried to measure at four different times of dilatation of the cervix (0–2 cm, 2–4 cm, 6–8 cm, fully dilated). In average we obtained 3.76 measurement periods. At every period the ductus was continuously recorded on video tape throughout 5–10 min.

Results

Changes in the ductus venosus blood flow were observed during labour. The flow profiles did not change with increasing cervix dilatation, but they changed during contraction compared to in absence of contractions. The peak velocity index (PVIV) and the pulsatility index for veins (PIV) within uterine contraction differed significantly (P < 0.001) compared to pviv and piv in absence of contractions in all four stages of cervix dilatation.

Conclusions

The ductus venosus blood flow velocity waveforms undergo great changes intrapartum in cases of uneventful pregnancy and delivery. It has to be further evaluated which subgroup of pregnancies will benefit from Doppler velocimetry of the ductus venosus for intrapartum surveillance.
F68Changes in ovarian vascularization during the menstrual cycle as assessed by three‐dimensional Power Doppler imaging (3D‐PDI)
Authors: Sladkevicius P. , Ojha K. , Campbell S. , Nargund G.
Published: March 2003

Background

The study was conducted to determine the pattern of the vascular changes during the normal menstrual cycle in the ovaries using the 3D Power Doppler imaging technique.

Methods

Observations were made during 19 normal menstrual cycles. Women were scanned transvaginally using VOLUSON 530D ultrasound machine during midfollicular, perifollicular and midluteal phases. The presence of a dominant follicle was recorded and ovaries were classified as dominant or nondominant based on these findings. The volume of the ovaries was acquired using 3D‐PDI. The vascularization index (VI), flow index (FI) and vascular flow index (VFI) were calculated using VOCAL software.

Results

The dominant ovary VI 4.6 ± 2.5, FI 51.6 ± 4.8, VFI 2.5 ± 1.5 in the midfollicular phase were significantly lower than those in the midluteal phase (VI 19.8 + 10.5; FI 61.1 + 1 + 3.8; VFI 12.2 + 6.3). These parameters in the perifollicular phase had intermediate values, although being significantly higher than in midfollicular phase and significantly lower than in the luteal phase. In the contralateral nondominant ovary, no cyclical changes were seen in the values of VI, FI, VFI. There were significant differences between dominant and nondominant ovaries in all phases investigated. The most prominent midluteal increase of VI, FI and VFI in the dominant ovary were 6.6, 1.3 and 9.2 folds, respectively.

Conclusion

These data indicates that there are significant vascularization and blood flow changes in the dominant ovary.

There were no changes observed on the nondominant ovary.
Media F81OBGYN.net and internet
Authors: Banović S.
Published: March 2003

The web site is the largest specialized women's health care suite in the world, diversified by more than 50% of its visitors being women and patients looking for medical information and over 40% being physician and other medical professionals.

Every month, the web site is recording over 7000 forum entries which are read more than 350 000 times monthly. Thus each posted comment or question is read on average of 50 times, confirming the popularity and relevance of the content being addressed. Some of OBGYN.net's most popular forums deal with topics like endometriosis, pregnancy and birth and ultrasound.

The average time visitors spend on the OBGYN.net web site is 11.5 min. OBGYN.net also welcomes over 12 000 visitors every day, a number that is growing every week. OBGYN.net creates original content with cooperation of staff employees and over 200 medical professionals who contribute on a world‐wide basis located at http://www.obgyn.net on the web. OBGYN.net is a physician‐reviewed service providing women physicians and industry professionals a place to publish articles, participate in discussion groups, access information and communicate online. OBGYN.net web site operates on a global level and offers three main sections, each focusing on different segments of the woman's health community; Medical Professionals, the Medical Industry and women and Patients.
The cervix as a predictor of preterm delivery in ‘at‐risk’ women
Authors: Cook C.‐M. , Ellwood D.A.
Published: March 2003

Objective To examine the relationship between ultrasound‐determined cervical status and pregnancy outcome in women ‘at‐risk’ of spontaneous preterm delivery.

Design A prospective cohort study of 120 pregnant women considered to be ‘at‐risk’ of spontaneous preterm delivery by their clinician. Transvaginal ultrasound of the cervix was used to assess overall cervical length, closed endocervical canal length, diameter and internal os dilatation in the second trimester. The main outcome measure was occurrence of spontaneous preterm birth (< 34 and < 37 weeks of gestation).

Results The overall preterm delivery rate (< 37 weeks gestation) in these women was 35% (n = 42) with 20% (n = 24) delivering < 34 weeks gestation. Of the 71 women with a normal cervix, 8 (11%) delivered < 34 weeks, whereas of the 49 women with an abnormal cervix, 16 (33%) delivered < 34 weeks (RR 2.90; 95% CI 1.35–6.24). Using linear regression, closed endocervical canal length of < 21 mm before 20 weeks is associated with delivery < 34 weeks in 95% of women, and with delivery < 37 weeks in 95% of women if the canal length is < 33 mm. Logistic regression showed closed endocervical canal length to be the only significant factor in those women who delivered < 34 weeks after controlling for possible confounders.

Conclusions A strong relationship is demonstrated between cervical status and pregnancy outcome, particularly the cervical findings before 20 and 24 weeks of gestation. The length of the closed portion of the endocervical canal is the best predictor. A beneficial effect of this approach to ‘at‐risk’ women is the reduction in unnecessary interventions in those with normal cervical findings.
Middle cerebral artery peak systolic velocity in the prediction of fetal anemia
Authors: Teixeira J.M.A. , Duncan K. , Letsky E. , Fisk N.M.
Published: March 2003

Objective The fetal middle cerebral artery peak systolic velocity (MCA PSV) has been suggested as a potential test to predict the fetal hematocrit level. We tested the hypothesis that a low fetal hematocrit is associated with an increase in MCA PSV in a prospective study of normal and alloimmunized pregnancies.

Methods Fetal hematocrit and MCA PSV were obtained in 26 alloimmunized fetuses, immediately before their first fetal blood transfusions between 15 and 35 weeks. Results were compared with the MCA PSVs from 170 control fetuses not at risk of alloimmune anemia between 13 and 37 weeks.

Results In control fetuses, PSV varied with gestation (PSV = 0.56 − 0.032 GA + 0.00086 GA2, where GA is gestational age; R2 = 0.41). The correlation between PSV and hematocrit Z scores (Pearson correlation coefficient r = − 0.69) was highly significant (P = 0.0001). Using a PSV > 1 SD, the sensitivity of the test in predicting a fetal hematocrit < 2 SD below the mean was only 64% but the specificity was 100%. However, the sensitivity of the test in predicting a fetal hematocrit < 3 SD and < 4 SD rose to 73% and 83%, while the specificity was still good (93% and 80% respectively).

Conclusions MCA PSV and fetal hematocrit are highly significantly correlated. The sensitivity of the test was good and the high positive predictive value indicates that the presence of a raised PSV (defined as > 1 SD) is a strong indicator of fetal anemia. In conclusion, MCA PSV is a useful test in clinical practice for the detection of fetal anemia.
Favorable pregnancy outcome in a woman with osseous metaplasia of the uterus
Authors: Van den Bosch T. , Dubin Marleen , Cornelis Ann
Published: March 2003

We present an asymptomatic case of osseous metaplasia of the uterus, diagnosed 20 days after a spontaneous delivery, in a 25‐year‐old woman (para 1, gravida 2). Her first pregnancy ended in a mid trimester termination. The short interval between delivery and diagnosis, and the histological features of the lesion suggested that the intrauterine bone was already present before the second pregnancy was conceived. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of campomelic dysplasia
Authors: Tongsong T. , Wanapirak C. , Pongsatha S.
Published: March 2003

A pregnant woman of 24 weeks' gestation underwent ultrasound examination for fetal anomaly screening. The ultrasound findings revealed a single fetus with biparietal diameter of 61 mm, which was consistent with menstrual dates. The thoracic cage was small compared to the abdomen with hypoplastic scapulae and normally ossified unfractured ribs. All bony structures demonstrated normal echogenicity. The upper long bones were normal length and shape. Both femurs and tibiae were obviously bowed anteriorly, and slightly shortened. Bilateral talipes equinovarus were clearly demonstrated. A prenatal diagnosis of campomelic dysplasia was made and was confirmed by postnatal radiography and autopsy. The sonographic diagnosis in this case was based on the findings of small thorax, hypoplastic scapulae and bowed tibiae and femurs. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Diagnosis of conjoined twins at 10 weeks using three‐dimensional ultrasound: a case report
Authors: Bega G. , Wapner R. , Lev‐Toaff A. , Kuhlman K.
Published: March 2003

A case report is presented of the prenatal diagnosis of conjoined twins at 10 weeks and 2 days' gestation using three‐dimensional ultrasound (3D US). The multiplanar display coupled with 3D US surface rendering clearly confirmed the presence of craniopagus. The twins were facing in opposite directions with the left occipital region of one embryo fused with the left parietal‐temporal region of the other. Additional multiplanar analysis above the level of the biparietal diameter demonstrated brain sharing. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Identification of arterio–venous anastomoses in vivo in monochorionic twin pregnancies: preliminary report
Authors: Taylor M. J. O. , Farquharson D. , Cox P. M. , Fisk N. M.
Published: March 2003

Objective

To determine whether it is possible to identify in vivo placental arterio–venous anastomoses (AVAs) by color Doppler flow mapping.

Methods

Three monochorionic twin pregnancies (one with and two without twin‐to‐twin transfusion syndrome) underwent placental mapping by color Doppler ultrasound. Placental vessels along the chorionic plate were recorded together with the direction of blood flow and their location in relation to the cord insertions and to superficial arterio–arterial anastomoses. Suggestive AVAs were mapped topographically and results were compared with the findings of formal postnatal placental injection studies.

Results

An AVA was identified in each of the three cases. Injection studies showed multiple AVAs. Each antenatally identified AVA was confirmed at placental injection study. Their placental location correlated to other landmarks as predicted by ultrasound.

Conclusions

This preliminary report demonstrates that AVAs can be identified using color Doppler ultrasound. This may facilitate planning for highly selective ablation of AVAs, and shorter procedure times. Formal studies are now indicated to determine the accuracy of this technique. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic characteristics of massive ovarian edema
Authors: Umesaki N. , Tanaka T. , Miyama M. , Kawamura N.
Published: March 2003

Massive ovarian edema (MOE) is a very rare disease characterized by a tumor‐like enlargement of the ovary. The ultrasound findings have been reported as a solid tumor‐like mass or as a solid mass containing a cystic component. Recent reports using magnetic resonance imaging of MOE have demonstrated that multiple ovarian follicles situated around the periphery of the cortex of the enlarged ovary is the most important diagnostic indicator of MOE. This finding was first demonstrated by ultrasound in the case we present here. Thus we suggest that the ultrasound detection of multiple peripheral ovarian follicles in a solid ovarian tumor‐like mass may make the preoperative diagnosis of MOE possible by ultrasound alone. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Pena–Shokeir phenotype with variable onset in three consecutive pregnancies
Authors: Paladini D. , Tartaglione A. , Agangi A. , Foglia S. , Martinelli P. , Nappi C.
Published: March 2003

The Pena–Shokeir phenotype represents an autosomal recessive syndrome characterized by neurogenic arthrogryposis, facial anomalies and pulmonary hypoplasia. Prenatal diagnosis of this disease has been reported prospectively and in cases with positive family history. We describe here a patient who has had three consecutive pregnancies affected by the Pena–Shokeir syndrome. In these pregnancies, the onset of the arthrogryposis varied between the 12th and the 18th week of gestation. Therefore, the possibility of a variable chronological development of the main diagnostic feature of the syndrome, arthrogryposis, has to be taken into proper consideration while counseling families with a positive history for the Pena–Shokeir phenotype. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
The variability in the interpretation of prenatal diagnostic ultrasound
Authors: Smith‐Bindman R. , Hosmer W. D. , Caponigro M. , Cunningham G.
Published: March 2003

Objectives

Although prenatal ultrasound is broadly used to detect abnormal fetuses, the variability in the interpretation of second‐trimester prenatal ultrasound examinations is unknown. We sought to evaluate the consistency of the interpretation of prenatal ultrasound examinations.

Design

Physicians who perform prenatal ultrasound and who participate in the California Maternal Serum Expanded AFP program were asked to interpret a series of test ultrasound examinations. The series of cases was selected to include a random sample of fetal structural abnormalities, ultrasound markers that have been associated with chromosomal abnormalities, and normal cases. Interobserver agreement was evaluated using a κ statistic for each organ system. The sensitivity and false‐positive rate were calculated for detecting specific anatomic abnormalities within each organ system.

Results

Of the 210 sonologists eligible for inclusion in the study, completed responses were received from 148 (70%). There was moderate to substantial agreement between physicians in reporting the presence of fetal abnormalities for all organ systems (κ range 0.40–0.88, P < 0.001). The consistency was highest for the central nervous system (CNS), neck, and face. Within each organ system, the consistency was similar for major structural abnormalities and ultrasound markers of chromosomal abnormalities. The sensitivity ranged from 62% (95% confidence interval (CI) 58–66%) for major renal abnormalities to 91% (95% CI 88–94%) for CNS abnormalities, with corresponding false‐positive rates of 7% (95% CI 6–9%) for renal abnormalities and 9% (95% CI 7–11%) for CNS abnormalities. For most organ systems, the sensitivity for detecting ultrasound markers of chromosomal abnormalities was similar to the sensitivity for detecting structural abnormalities.

Conclusion

There is moderate to substantial agreement in the interpretation of second‐trimester prenatal ultrasound examinations. Whether the identification of specific ultrasound abnormalities and markers is overall beneficial to patients remains to be determined. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
The role of ultrasound in the expectant management of early pregnancy loss
Authors: Sairam S. , Khare M. , Michailidis G. , Thilaganathan B.
Published: March 2003

Objective

To define the sonographic criteria which best determine the likelihood of successful expectant management of early pregnancy failure (EPF).

Methods

Women with an ultrasound diagnosis of EPF at 7–14 weeks' gestation were offered the option of expectant management or surgical evacuation.

Results

Five hundred and forty‐five women had a diagnosis of EPF; 298 with incomplete miscarriage and 247 with missed miscarriage or anembryonic pregnancy. A total of 305 women opted for expectant management, with an overall success rate of 86%. The success rate for incomplete miscarriage (96%) was significantly better than that for missed miscarriage (62%).

Conclusion

This study demonstrates that EPF can be safely managed expectantly. Ultrasound has an invaluable role in predicting the likelihood of successful expectant management enabling patients to make an informed choice about their medical care. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound diagnosis and Doppler monitoring of a pelvic spleen in pregnancy
Authors: Cobellis L. , Di Pietto F. , Di Pietto L. , Stradella L. , Reis F. M. , Severi F. M. , Petraglia F.
Published: March 2003

We describe a patient with a pelvic spleen diagnosed during pregnancy and monitored through gestation which we believe to be the first reported case. A 40‐year‐old woman was referred at 8 weeks of gestation because of a chronic intense pain in the left iliac cavity which had spread to her lower back. Clinical examination revealed a poorly defined pelvic mass. Pelvic ultrasound demonstrated a gestational sac containing a viable embryo whose size was consistent with the period of amenorrhea. While the splenic area in the left hypocondrium was found to be empty, a homogeneous and elongate mass measuring 152 × 123 mm with a maximum thickness of 53.4 mm was observed in the left iliac cavity above the uterus. This mass, the ectopic spleen, was monitored by Doppler velocimetry at monthly intervals until delivery and no variation throughout gestation was observed; therefore, despite the occasional occurrence of heavy pain, it was possible to exclude circulatory complications such as thrombosis or torsion. Doppler ultrasound proved to be a useful tool for the differential diagnosis of this rare anatomical variation. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Middle cerebral artery Doppler in severe intrauterine growth restriction
Authors: Johnson P. , Stojilkovic T. , Sarkar P.
Published: March 2003

Objective

To examine longitudinal changes in middle cerebral artery blood flow assessed by Doppler in severely growth restricted fetuses.

Methods

Eighteen structurally normal singleton pregnancies complicated by suspected intrauterine growth restriction were monitored by serial measurement of the pulsatility index of the middle cerebral artery over 7 to 72 days. Outcome measures included indication for delivery, umbilical venous pH and admission to and length of stay in neonatal intensive care.

Results

Thirteen fetuses demonstrated severe intrauterine growth restriction based on subsequent birth weights being below the 2.5th centile, two had intrauterine growth restriction (birth weights between the 2.5th and 5th centiles), and three had birth weights between the 5th and 50th centiles. The middle cerebral artery pulsatility index showed rapid and sharp changes between examinations in those severely growth restricted fetuses which required delivery before 34 weeks. This pattern was not obvious in severely growth restricted fetuses delivered after 34 weeks, or in those less severely growth restricted, regardless of the gestation at delivery. Changes in middle cerebral artery pulsatility index contributed to the decision to deliver in three cases. The middle cerebral artery pulsatility index demonstrated greater variation in those fetuses with cord pHs of less than 7.25. The length of stay in neonatal intensive care decreased with increasing gestational age and birth weight.

Conclusions

The difference in the pattern of change in middle cerebral artery pulsatility index in intrauterine growth restricted fetuses may be a reflection of maturity in addition to the degree of fetal compromise. The decision to deliver was multifactorial. The middle cerebral artery pulsatility index only influenced the decision to deliver when changes in other parameters were evident. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic early fetal gender assignment: a longitudinal study in pregnancies after in vitro fertilization
Authors: Mazza V. , Falcinelli C. , Paganelli S. , Contu G. , Mantuano S. M. , Battafarano S. D. , Forabosco A. , Volpe A.
Published: March 2003

Objectives

A longitudinal evaluation by sonography of external genitalia in human embryos/early fetuses with a known time from fertilization is lacking. Our aim was to assign by sonographic evaluation of external genitalia the early fetal gender in a cohort of pregnancies after in vitro fertilization. Sonographic examinations were performed in each case in three subsequent sessions over a period of time early in gestation in order to establish a temporal threshold, expressed in terms of days from fertilization, at which absolute accuracy in gender prediction is achievable.

Methods

Thirty‐two fetuses were included in this prospective longitudinal study. Each was examined three times for gender assignment. The first observation was performed between 65 and 69 days from fertilization, the second between 70 and 74 days and the third between 75 and 79 days. Transvaginal and/or transabdominal sonography was used to detect the ‘sagittal sign’ as a marker of fetal gender. The results of ultrasound examinations were compared with gender at birth or with karyotype obtained from amniotic fluid cells or chorionic villus sampling.

Results

Fetal gender assignment was feasible in 29 out of 32 fetuses (90%) at the first examination and in all cases at the second and third examinations. Fetal gender prediction was correct in 76% of cases in which fetal gender was assigned (22/29) at the first examination; accuracy for males was 46% (6/13) and for females 100% (16/16). At the second and third examinations, accuracy for gender prediction achieved 100% for both genders. Concerning the temporal threshold, absolute accuracy in gender prediction was achieved at 69 days from fertilization, corresponding to 11+6 weeks based on the last menstrual period.

Conclusion

This study provides important information about the earliest stage, expressed in terms of days from fertilization, at which it is possible to make a certain diagnosis of fetal gender by sonography. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of type A1 brachydactyly
Authors: Den Hollander N. S. , Hoogeboom A. J. M. , Niermeijer M. F. , Wladimiroff J. W.
Published: March 2003

Brachydactyly can occur as an isolated malformation or as part of numerous syndromes. Prenatal assessment of brachydactyly may be especially helpful in multiple anomaly syndromes associated with hand and/or finger anomalies. In isolated type A1 brachydactyly, which is an autosomal dominant disorder, all middle phalanges of the fingers and toes are affected. We present a fetus with type A1 brachydactyly inherited from the mother and grandmother. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional hysterosalpingocontrast sonography (3D‐HyCoSy) as an outpatient procedure to assess infertile women
Authors: Kiyokawa K. , Uchida N. , Amemiya K. , Shouka K. , Suzuki K. , Kiyokawa K.
Published: March 2003

Objectives:  This study was aimed to assess the use of three‐dimensional hysterosalpingocontrast sonography (3D‐HyCoSy) as a routine tool for evaluating infertile women in the office.

Methods:  In 25 non‐selected infertile patients, tubal patency and uterine cavity were investigated by 3D‐HyCoSy with saline as a contrast medium. The efficacy of the procedure was evaluated with X‐ray hysterosalpingography (XHSG) as reference.

Results:  The positive predictive value, negative predictive value, sensitivity and specificity of predicting tubal patency by 3D‐HyCoSy were 100, 33.3, 84.4 and 100%, respectively. The full contour of uterine cavity was depicted in 96% of cases by 3D‐HyCoSy and 64% by XHSG (P < 0.005). The uterine cavity area measured on 3D‐HyCoSy correlated well with the volume of contrast media required on XHSG (R2 = 0.8166).

Conclusion:  3D‐HyCoSy provided advantages of better assessment of uterine cavity over XHSG. Compared with conventional XHSG, the efficacy of 3D‐HyCoSy to assess tubal patency was acceptable. In addition, the procedure of 3D‐HyCoSy appears to be better tolerated, requiring no sedation or anesthesia and a reduced examination time. Thus, 3D‐HyCoSy with saline as a contrast medium is feasible and could comprise a routine outpatient procedure in the initial evaluation of infertile women.
Chorionic villus sampling for prenatal diagnosis in Zagreb: experience with 3250 cases
Authors: Podobnik M. , Podgajski M. , Duic Z. , Ciglar S.
Published: March 2003

Background:  This study comprises data from 3250 women allocated to transcervical CVS (TC‐CVS), transabdominal CVS (TA‐CVS) and transvaginal CVS (TV‐CVS). We have assessed the efficacy of transabdominal CVS compared with transcervical CVS and transvaginal CVS, and examined factors that have been implicated in causing spontaneous abortion.

Methods:  Over an 11‐year period, 3250 women underwent chorionic villus sampling at 9–12 weeks of gestation, by transcervical (500 patients) transabdominal (2650 patients) and transvaginal technique (100 patients). Transvaginal color Doppler was used to investigate the uteroplacental and fetal vessels in 500 pregnancies between 11 and 12 weeks of gestation (400 TA‐CVS and 100 TC‐CVS) before and after CVS procedures.

Results:  Five hundred (15.4%) patients underwent TC‐CVS and spontaneous abortion after TC‐CVS occurred in five cases (1.0%). 2650 (81.5%) patients underwent TA‐CVS using a 20 gauge spinal needle and abortion after TA‐CVS occurred in 11 cases (0.4%). One hundred (3.1%) patients underwent TV‐CVS using a 20‐gage needle and abortion after TV‐CVS occurred in three cases (3.0%). The spontaneous abortion rate after CVS procedures was 0.7%. Some 121 (4.6%) cases showed chromosomal aberration. The spontaneous abortion rate was lower among cases allocated to TA‐CVS after 11 weeks of gestation. There were no significant differences in mean pulsatility indices (PI) between maternal, fetal and intraplacental circulation, before and after CVS procedures.

Conclusions:  Transabdominal CVS has lower fetal loss rate than transcervical and transvaginal CVS.
Routine ultrasound screening in 12169 pregnancies
Authors: Chan F.‐Y. , Wong S. , Cincotta R. , Parry A. , Welsh A. , Stone M. , Cooper D.
Published: March 2003

Purpose:  To assess the detection rate for congenital malformations in a routine ultrasound screening program in a tertiary Australian institution.

Methods:  The findings of routine ultrasound screening performed in the Mater Mother's Hospital, Brisbane over a 6‐year period was prospectively collected. Pregnancy and neonatal outcomes were obtained from the obstetric and neonatal database. The presence of major congenital anomalies, as classified according to the Australian National Perinatal Statistics Unit, was checked against the hospital's perinatal database.

Results:  Over the 6‐year period, a total of 26649 obstetric ultrasound scans were performed in the unit, 12169 (45.7%) were routine ultrasound scans. This is the largest Australian cohort study on routine ultrasound screening. A total of 75 major congenital anomalies were detected during the antenatal period. The number of major congenital anomalies in the cohort was 131, giving a sensitivity of 57.3%. The sensitivities according to different organ systems were: central nervous system (78%); urogenital tract (83%); gastro‐intestinal tract (38%); cardiovascular system (27%); skeletal system (50%); respiratory system (67%) and others (63%). These results were significantly better than that from the RADIUS study (P < 0.001), and comparable to those from other tertiary referral centers.

Conclusion:  The sensitivity for detection of congenital anomalies by routine ultrasound screening at Mater Mothers' Hospital is comparable to most published series from tertiary institutions, and significantly better than that reported in the RADIUS study.
Gastroschisis – can prenatal ultrasonography predict neonatal outcome?
Authors: Peter J. R. , Chan F. Y. , Hockey R.
Published: March 2003

Background:  Gastroschisis carries significant neonatal morbidity, and occasionally mortality. Previous studies looking at ways to prognosticate this condition by antenatal ultrasound have shown conflicting results. Small numbers limited the power of most previous studies. The current study is one of the largest so far reported.

Purpose:  To evaluate the usefulness of prenatal ultrasonograpic parameters to predict neonatal outcome for gastroschisis.

Methods:  The charts, photos, and videotapes of all babies with gastroschisis who were assessed during pregnancy at the Mater Mothers' Hospital, Brisbane over an 8.5‐year period (January 1993–May 2001) were reviewed. Bad neonatal outcome was defined as death, severe bowel complications (atresia, perforation, necrotic segments), need for multiple bowel operations, or a combination of these. Various ultrasonographic parameters assessed included: gestation at first diagnosis, maximum bowel diameter, maximum bowel thickness, presence of other anomalies, evidence of growth restriction, and polyhydramnios.

Results:  Forty‐five patients met the entry criteria during the study period. Six neonates died, 12 had severe bowel complications, and 14 had a combination of the bad outcomes. Apart from polyhydramnios, none of the other ultrasound parameters were significantly associated with the bad outcomes. Polyhydramnios was most significantly associated with severe bowel complications (P < 0.001, Fisher’s exact test), with likelihood ratio of 11.7 (P = 0.001).

Conclusion:  The current study show that most standard ultrasound parameters assessed antenatally in fetal gastroschisis were not significantly associated with neonatal outcome, except for polyhydramnios, which is strongly predictive of severe bowel complications in the neonatal period. This information is important both for parents and for health professionals managing pregnancies with fetal gastroschisis.
The assessment of placental blood flow by three‐dimensional color power Doppler ultrasound: preliminary result of a three‐dimensional histogram study
Authors: Yu C.‐H. , Chang C.‐H. , Chang F.‐M. , Liao T.‐P. , Ko H.‐C.
Published: March 2003

Objective:  To assess the placenta blood flow in normal gestation by three‐dimensional color power Doppler ultrasound.

Methods:  We collected normal pregnant women with gestational age between 20 and 40 weeks prospectively, consecutively and cross‐sectionally. Three‐dimensional ultrasound scanner, Voluson, 530D MT (Kretz, Zipf, Austria) was used to assess the placental blood flow in each case. First, we used the 3D transabdominal probe to scan the placenta under the 3D power Doppler mode at a fixed condition. Second, we used the VOCAL software (Kretz, Zipf, Austria) to calculate the histogram indices of fetal placental blood flow obtained from the 3D power Doppler scanning. The histogram indices included vascularization index (VI), flow index (FI), and vascularization‐flow index (VFI).

Results:  One‐hundred singleton pregnant women were enrolled into the program. The best‐fit equations for VI, FI, and VFI are 0.27107 × GΑ − 4.02743, 0.56115 × GΑ + 34.28945, and 0.15663 × GA − 2.53810, respectively. All the P‐values are less than 0.05. All the indices were positively correlated with the fetal gestational age. Besides, The VI, FI, VFI of fetal placenta in third trimester were all higher than those indices of fetal placenta in the second trimester.

Conclusion:  The fetal placental blood flow increases with the advancement of gestational age. Our data may be a useful reference for further studies of fetal placental flow in abnormal gestations.
Quantitative ultrasonic tissue characterization of the cervix – a new predictor for prematurity?
Authors: Tekesin I. , Meyer‐Wittkopf M. , Heller G. , Steinfeldt B. , Sierra F. , Schmidt S.
Published: March 2003

Background:  Since the incidence of premature delivery has remained constant, despite intensive safeguard methods over the last decade, the texture features of the uterine cervix were evaluated using quantitative sonographic gray level analysis at different gestational ages (GA).

Materials and methods:  For this purpose quantitative ultrasonic tissue densitometry of the uterine cervix was obtained from 30 asymptotic female patients (group A, mean: 30.3 GA) and compared with values obtained from 16 symptomatic female patients (group B, mean: 29.5 GA) with uterine contractions and shortening of the cervix at similar gestational ages. Once the two‐dimensional transvaginal sonographic measurement of cervical length was completed a region of interest of constant size was defined in the mid‐section of the posterior wall and the tissue‐specific gray scale distribution was determined.

Results:  Quantitative ultrasonic tissue characterization of uterine cervix was feasible in all 46 patients at all gestational ages. In patients with premature contractions and shortening of cervix, the average gray scale values were found to be statistically reduced in comparison with those obtained from asymptotic patients. These results showed good reproducibility and intraobserver variability and were found to be independent from the measured cervical length.

Conclusion:  Our results prove that quantitative ultrasonic tissue characterization of the uterine cervix might serve as a new parameter for predicting premature delivery in the future.
A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer
Authors: Gull B. E. , Karlsson B. , Milsom I. , Granberg S.
Published: March 2003

Objective:  To evaluate postmenopausal bleeding (PMB) and transvaginal sonographic (TVS) measurement of endometrial thickness (ET) as predictors of endometrial cancer (EC) and atypical hyperplasia (AH) in women during a >10‐year period following a PMB.

Study design:  Women presented with a PMB from November 1987 to October 1990 were included in this study (n = 394). The women underwent TVS with measurement of ET and a dilation and curettage (D & C). It was possible to assess the medical records of 339 of the 394 women (86%) >10 years after referral for PMB. During the follow up period the recurrence of a PMB, the development of EC and mortality were assessed.

Results:  After the primary investigation, 39 of the 339 women were diagnosed as having EC (11.5%) and 5 women had AH (1.5%). The relative risk (RR) of diagnosing an EC in women referred for a PMB was 63.9 (CI 46.0 Ð 88.8) and the corresponding RR for EC and AH together was 72.1 (CI 52.8 Ð 98.5) compared to women of the same age from the same region of Sweden. The reliability of PMB as a diagnostic test for EC was assessed: sensitivity 18%; specificity 100%; positive predictive value 12%; and negative predictive value 100%. None of the women with an ET of 2 × 4 mm were diagnosed as having EC. The reliability of ET (cut‐off 2 × 4 mm) as a diagnostic test for EC was assessed: sensitivity 100%; specificity 60%; positive predictive value 25% and negative predictive value 100%. The incidence of EC or AH in women with an intact uterus followed 3 × 10 years was 5.8%. The corresponding figure for women who had 3 × 1 recurrent bleeding during follow up was 22.7%. No EC was diagnosed in women with a recurrent PMB who had an ET of 2 × 4 mm at the initial scan. No EC was diagnosed in the absence of a recurrent bleeding.

Conclusion:  PMB incurs a 64‐fold increase risk for EC. No EC was missed when ET measurement (cut‐off 2 × 4 mm) was used even if the women were followed 3 × 10 years. About 5.8% of the women referred for a PMB later developed EC or atypia during the 10‐year observation period. There was no increased risk of EC or AH in women who did not have recurrent bleedings whereas women with a recurrent bleeding were a high risk group. A thick endometrium, with histopathological diagnosis of atrophy or insufficient for diagnosis, should be taken seriously and a guided biopsy should be taken or saline instillation sonography performed with ultrasound‐guided biopsy.
Fetal ovarian cysts: development and neonatal outcome
Authors: Mittermayer C. , Ulm B. , Dörfler‐Grassauer D. , Horcher E. , Deutinger J. , Bernaschek G.
Published: March 2003

Introduction:  The aim of the study was to evaluate the outcome of fetal ovarian cysts in relation to their size and ultrasonic appearance.

Methods:  We retrospectively analyzed pre‐ and postnatal charts of 61 infants with a prenatal diagnosis of ovarian cysts between 1991 and 2000. When completely anechoic and with a thin wall, the cyst was defined uncomplicated. Cysts, which presented themselves echogenic, with a fluid‐debris level, a retraction clot, or a septation were defined complicated.

Results:  In a total of 61 fetuses, 65 ovarian cysts were detected by transabdominal ultrasound: 35 (57%) cysts on the left side; 22 (36%) on the right side and four fetuses (7%) had bilateral cysts. Three patients with uncomplicated cysts were lost to follow up and one fetus with bilateral cysts died in the 27th week of gestation. In 17 cysts, treatment was necessary. Fourteen cysts (all complicated) were operated after delivery because of persistence or enlargement. The histological results were either follicular or theca lutein cysts in 12 cases, one lymphangioma and one teratoma. Two cysts were aspirated in utero and one after delivery. In the remaining 40 fetuses, 43 cysts where only controlled by ultrasound. Eight cysts regressed before delivery and 35 cysts after delivery independent of their sonographic appearance. The mean diameter of cysts that required treatment was significantly different from the mean diameter of cysts that resolved spontaneously (6.8 ± SD 2.4 cm vs. 3.3 ± SD 0.8 cm; P < 0.01).

Conclusion:  Complicated cysts which do not regress should be treated either by laparotomy or laparoscopically after delivery. Uncomplicated cysts which exceed 5 cm could be treated by in utero aspiration or aspiration after delivery to avoid further complications. Cysts smaller than 5 cm, presenting the tendency to regress, should be left untouched independent of their sonographic appearance.