bluuebunny/crossref_metadata_2025 huggingface dataset:
Benefit Groups and Resource Groups for Adults with Intellectual Disabilities in Residential Accommodation
Authors: Comas‐Herrera Adelina , Knapp Martin , Beecham Jennifer , Pendaries Claude , Carthew Richard
Published: March 2003

Service commissioning is now a more formalized activity, and both purchasers and providers employ a variety of tools to inform their decision‐making. The present paper examines whether ‘benefit groups’ and ‘resource groups’ can be developed so as to assist these decision‐making processes by using a survey of the characteristics of 2093 adults with intellectual disabilities (IDs) in residential accommodation (mainly National Health Service trusts), and a supplementary collection of data on service utilization and costs (for a subsample of 930 clients). The clients were classified, according to their needs benefit groups (BGs), and the services which they used were classified in terms of coherence as likely packages of care and similar consumption of resources as resource groups (RGs). It proved possible to construct nine BGs and 96 possible RGs which had both intuitive meaning and explanatory power. Statistical analysis showed that the resulting BGs and RGs are meaningful ways of classifying ID and challenging behaviour needs and costs.
A Psychoeducational Group for Men with Intellectual Disabilities Who Have Sex with Men
Authors: Withers Paul , Ensum Ian , Howarth Daniel , Krall Patrick , Thomas Damian , Weekes Donald , Winter Charles , Mulholland Andrew , Dindjer Tim , Hall John
Published: March 2003

The sexuality and sexual behaviour of people with intellectual disabilities (IDs) is one of the most complex and unresolved issues faced by service providers. Despite much evidence suggesting the disproportionately high risks faced by men with IDs who have sex with men, no epidemiological research has been conducted on the prevalence of HIV within this population. Current thinking suggests that self‐help groups are efficacious in helping participants to develop positive sexual identities and to share information about safer sexual practices. The present study is a qualitative evaluation of a pilot support group for men with IDs who have sex with men. Themes relating to the formation of sexual identity and safety issues were extrapolated using content analysis from a transcript of the final group session. The implications for service delivery are discussed. The evaluation was conducted by a clinical psychologist external to the group and the members of the group.
Physical Interventions for People with Intellectual Disabilities: Initial Survey of Training and Evaluation of a Policy Framework
Authors: Murphy Glynis , Kelly‐Pike Amanda , McGill Peter
Published: March 2003

Background.  Physical interventions for people who have intellectual disabilities are sometimes necessary, even though they are known to present dangers to both service users and staff. The present report concerns an initial study of training in physical interventions amongst a group of senior staff and their views on a recent policy framework on physical interventions developed by the British Institute of Learning Disabilities (BILD) and National Autistic Society (NAS).

Method.  The participants in this initial study included those who had attended conferences on the policy and those who had purchased the policy document. All participants were sent a questionnaire asking them about their training in, and use of, physical intervention methods, and their opinions on the policy document.

Results.  The participants came from a variety of services and were relatively well qualified and senior because of the way the sample was derived. They mostly had some training in physical intervention methods, although the type of training varied somewhat with their employing organization. Most participants were very positive about the BILD and NAS policy framework, and about two‐thirds of the participants said that their services had, or were developing, a written policy on physical interventions.

Conclusions.  This group of staff, many of whom were trained in physical interventions, rated the BILD and NAS policy framework as very helpful. There remained a clear need for guidance with respect to the advantages and disadvantages of the many available methods, and an evidence base on which to judge the effectiveness of different methods of physical interventions.
Community Integration as Acculturation: Preliminary Validation of the AIMS Interview
Authors: Minnes Patricia , Buell Katherine , A. Feldman Maurice , McColl Mary Ann , McCreary Bruce
Published: March 2003

Background  This paper introduces the Assimilation, Integration, Marginalization, Segregation (AIMS) interview, a new measure of community integration (defined as acculturation) and reports validation data supporting the use of AIMS with individuals with developmental disabilities.

Methods  Caregivers acted as informants for 66 adults with moderate‐to‐mild developmental disabilities. All participants were living in the community.

Results  The data gathered using AIMS provide evidence of sound psychometric properties including content, concurrent and construct validity. AIMS data for participants with developmental disabilities indicated that integration efforts have been relatively successful in the medical, dental, housing, social and community domains; however, education, employment, volunteer and spiritual activity require attention.

Conclusions  In addition to use as a research tool and outcome measure, AIMS can be used to inform service delivery by providing information regarding the supports available to individuals with disabilities in a number of domains.
Puncture procedures utilizing transvaginal ultrasonic guidance
Authors: Timor‐Tritsch I. E. , Peisner D. B. , Monteagudo A.
Published: March 2003

The introduction of transvaginal sonography has enabled the use of this scanning method for guided puncture procedures. A total of 102 puncture procedures are described: 63 fetal reductions, eight punctures of ectopic pregnancies, 19 drainages of pelvic contents, seven punctures of ovarian cysts, four diagnostic culdocenteses and one injection of a cervical pregnancy.

Every procedure is discussed in detail. There was only one procedure‐related complication. The advantages of the ultrasound‐guided vaginal puncture procedure are its performance under real‐time imaging, a low complication rate, a better pregnancy outcome when considering the reduction of multifetal gestations, and, most importantly, the fact that abdominal surgery can be avoided in several cases. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound measurement of the fetal head: computer versus operator
Authors: Zador I. E. , Salari V. , Chik L. , Sokol R. J.
Published: March 2003

In obstetrical ultrasound practice, biparietal diameter, occipito‐frontal diameter and head circumference are among the most commonly used fetal measurements. To minimize the limitations associated with manual measurement, we have undertaken an investigation with a focus on (1) the design of a personal computer‐based system for automated measurements of biparietal diameter, occipito‐frontal diameter and head circumference, and (2) integration of such a system (including measurements of abdomen and femur) into the routine obstetrical ultrasound examination. This report presents preliminary results of a comparison of computer‐determined fetal head measurements with those obtained by an operator. Data were obtained from 75 consecutive singleton fetal ultrasound examinations free of any obvious structural anomalies. The computer obtained acceptable measurements of biparietal diameter, occipito‐frontal diameter and head circumference from 74 images and failed on one image. There was a highly significant correlation between computer‐determined measurements of biparietal diameter (r = 0.986), occipito‐frontal diameter (r = 0.958) and head circumference (r = 0.972) and those obtained by the operators. The mean measurement difference (computer minus operator) was 1.87 ± 1.94 mm for biparietal diameter, 2.82 ± 4.13 mm for occipito‐frontal diameter and −0.36 ± 9.87 mm for head circumference. These differences were independent of the operator's identity, the instrument used and gestational age. The key finding of this study is that, with the use of inexpensive personal computer technology, it is possible to design and implement a system that can give fetal head measurements which correlate highly with manual determination by a skilled operator and which take a fraction of the time. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Depth of myometrial invasion in endometrial cancer: preoperative assessment by transvaginal ultrasonography and magnetic resonance imaging
Authors: Cagnazzo G. , D'Addario V. , Martinelli G. , Lastilla G.
Published: March 2003

Depth of myometrial invasion in endometrial cancer correlates with pelvic lymph node metastases and tumor recurrence. Thirty patients diagnosed as having FIGO stage I endometrial carcinoma on the basis of D&C were evaluated preoperatively by magnetic resonance imaging (MRI); 14 cases of the same group were also evaluated by transvaginal ultrasound. The degree of invasion evaluated by MRI and transvaginal sonography was compared to the pathological specimens. MRI was successful in evaluating myometrial invasion in 2.5 of 30 cases (accuracy 83%, sensitivity 87%, specificity 78%, positive predictive value 82%, negative predictive value 84%). Evaluation with transvaginal sonography was accurate in 11 of 14 cases (accuracy 78%, sensitivity 80% specificity 77%, positive predictive value 87%, negative predictive value 66%). Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Investigation of the human corpus luteum by ultrasonography: a proposed scheme for clinical investigation
Authors: Nakata M. , Selstam G. , Olofsson J. , Bäckström T.
Published: March 2003

The corpus luteum was investigated in 18 women undergoing hysterectomy. Preoperative ultrasonography with measurements was performed before the corpus luteum was extirpated, weighed, inspected and the diameters were measured. The concentrations of progesterone and estradiol were also determined in peripheral serum. The ultrasound pictures show that the corpus luteum has a slightly cloudy central part, which can vary from hypoechoic to hyperechoic. The peripheral part (corpus luteum ‘wall’) has a stronger echo and the maximal and minimal thicknesses can be measured. The results showed correlations between ultrasound measurements and anatomical measurements for wall thickness, outer diameter, inner diameter and wall area of the corpus luteum (n = 12, p < 0.02–0.0001). Moreover, all mid‐luteal corpora lutea with a hypoechoic central part (five of 13 women) on ultrasound scan had a cystic central structure. Based on these findings, we suggest that an ultrasound investigation of the corpus luteum in the mid‐luteal phase should use the following criteria to classify it into four types. Type a: hypoechoic central part with wall of < 3 mm; type b: hyperechoic central part with wall of < 3 mm; type c: hypoechoic central part with wall of ≥ 3 mm; and type d: hyperechoic central part with wall of ≥ 3 mm. The finding of a hypoechoic central region with a thin wall (< 3 mm) may indicate corpus luteal insufficiency, since significantly lower serum progesterone levels were found in women with this type of corpus luteum. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of placenta previa/accreta with color Doppler ultrasound
Authors: Chou M. M. , Ho E. S. C. , Lu F. , Lee Y. H.
Published: March 2003

A case of placenta previa/accreta was diagnosed at 23 weeks' gestation using color Doppler ultrasound. Imaging showed an unusually intense blood flow within the placental sonolucent spaces and the hypervascularization patterns within the placental and the non‐placental tissues. Highly pulsatile venous flow patterns were detected within the placental blood lakes and the subplacental venous complex. A strong association between the lacunar flow pattern and the abnormally adherent placentation was confirmed by the color Doppler sonographic findings. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Intrathoracic cardiac position in the fetus
Authors: Allan L. D. , Lockhart S.
Published: March 2003

In a 4‐year period, 83 fetuses have been noted to have an abnormal fetal heart position within the thorax on fetal echocardiography. In 55 cases where the heart lay in the right chest, this was due to the presence of a left‐sided diaphragmatic hernia; in one case, the heart was abnormally far into the left chest because of a left‐sided diaphragmatic hernia. Of the remaining 27 cases, the heart lay in the right chest in 16 cases. In seven of those 16, there was a congenital heart malformation; in six, there were lung anomalies; a hiatus hernia was present in one; both congenital heart disease and lung abnormality were present in one and one fetus had isolated dextrocardia. In nine cases, the heart lay in the center of the chest and in three, the heart lay further to the left than normal. Congenital heart disease was found in nine of these 12. Chromosomal anomalies were found in four of the 27 cases with an abnormal heart position but an intact diaphragm. In summary, it is important to be familiar with the normal cardiac orientation within the thorax and to investigate abnormalities of position. A diaphragmatic hernia will be the most common underlying cause but, where the diaphragm is intact, other explanations must be sought in order to counsel correctly or plan appropriate perinatal management. Lung disorders, congenital heart disease and chromosomal anomalies will be the principal differential diagnoses. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal diagnosis of vasa previa by transvaginal color Doppler sonography
Authors: Arts H. , van Eyck J.
Published: March 2003

Vasa previa is a rare complication of pregnancy with a high perinatal mortality, which has virtually not changed over the last 200 years. In this case report we describe the use of color Doppler ultrasonography to make a correct antepartum diagnosis of vasa previa. The baby was delivered by Cesarean section. A strategy is presented which may reduce the high mortality rate from this condition. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal detection of heart defects at the routine fetal examination at 18 weeks in a non‐selected population
Authors: Tegnander E. , Eik‐Nes S. H. , Johansen O. J. , Linker D. T.
Published: March 2003

Few studies have addressed the prenatal detection rate of congenital heart defects in a non‐selected population at 18 weeks of gestation. Our objective was to assess the change in the prenatal detection rate of congenital heart defects in such a population that resulted from incorporating the four‐chamber view at the second‐ trimester routine ultrasound examination. The prenatal detection rate of heart defects was prospectively compared between 4435 fetuses in Phase I who were stunned without special attention to the heart, and 7459 fetuses in Phase II who were scanned incorporating the four‐chamber view. Of the 49 heart defects in Phase I, 17 (35%) were critical and three (18%) of these were detected prenatally. Of the 90 heart defects in Phase II, 23 (26%) were critical, six (26%) of these were detected prenatally at the 18 weeks' routine stun, and three were detected in the third trimester, providing a total prenatal detection rate of 39%. A defect was classified as critical when a surgical repair was likely to be required because of gross structural complexity having a functional significance, e.g. transposition of the great arteries, hypo‐plastic left heart syndrome, atrioventricular septal defect, coarctation of the aorta, and large ventricular septal defect. No non‐critical heart defects were detected prenatally in either of the phases. The incidences in the total population were 11 and 12/1000 in Phases I and II, respectively. Thirty‐two per cent of the critical and 16% of the non‐critical defects had associated abnormalities and/or abnormal karyotype. Implementation of the four‐chamber view increased the prenatal detection rate of critical heart defects. To improve the results significantly, education and an extended fetal heart examination are necessary. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Changes of venous blood flow velocity waveforms in fetuses with supraventricular tachycardia
Authors: Gembruch U. , Krapp M. , Baumann P.
Published: March 2003

Studies in the fetal lamb have shown that atrial pacing beyond a rate of 300–320 beats/min may be associated with dramatic changes of venous blood velocity waveforms, an increase of venous pressure by up to 75%, hydrops, polyhydramnios and placental edema. The aim of our study was to determine the ‘critical’ heart rate frequency in the human fetus. In 11 fetuses (five with and six without hydrops) with supraventricular tachycardia, pulsed wave Doppler analysis of flow velocity waveforms of the inferior vena cava, the ductus venosus and the left hepatic vein were performed before and after drug treatment.

In ten cases cardioversion was achieved by in utero antiarrhythmic drug therapy; in one case treated with digoxin and flecainide the supraventricular tachycardia was decreased to 160–190 beats/min with disappearance of hydrops.

Before intrauterine treatment of supraventricular tachycardia, pulsatile reversal of blood flow in the inferior vena cava, ductus venosus and left hepatic vein was visible, with monophasic forward flow during systole and reversed flow during diastole in ten of 11 fetuses. One fetus with supraventricular tachycardia of 195 beats/min showed a normal biphasic forward flow pattern. During drug‐induced sinus rhythm, a normal biphasic forward venous bloodflow pat tern was shown in all ten cases.

In five cases pulsatile reversal was demonstrated during a drug‐induced reduction of the heart rate from 280 to 210 beats/min and a normal biphasic forward flow velocity waveform appeared during supraventricular tachycardia below 210 beats/min.

From our results it appears that pulsatile venous flow velocity waveform changes to a biphasic forward pattern below a ‘critical’ heart rate of approximately 210 beats/min in the human fetus. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Fetal intracerebral hemorrhage in the second trimester: diagnosis by sonography and magnetic resonance imaging
Authors: Reiss I. , Gortner L. , Möller J. , Gehl H.‐B. , Baschat A. A. , Gembruch U.
Published: March 2003

Germinal matrix intraventricular hemorrhage has rarely been observed in the fetus. In most cases the etiology is clear. We report one case of prenatal diagnosis of a periventricular hemorrhage of uncertain etiology in a fetus of 22 weeks' gestation. For confirmation of the ultrasound diagnosis, antenatal magnetic imaging was performed. A male child was delivered in good condition at 37 weeks by Cesarean section. Postnatal ultrasound examination showed a cystic lesion in the right frontal lobe (10 × 10 mm) connecting with the right lateral ventricle. The development of the child at 18 months of age has been normal without any neurological impairment. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Intrauterine lethality of trisomy 21 fetuses with increased nuchal translucency thickness
Authors: Hyett J. A. , Sebire N. J. , Snijders R. J. M. , Nicolaides K. H.
Published: March 2003

This study investigates whether first‐trimester screening for trisomy 21 by fetal nuchal translucency thickness preferentially identifies those fetuses destined to die in utero and examines the potential impact of such a method of screening on the live birth incidence of trisomy 21. In 70 pregnancies, trisomy 21 was diagnosed at 12 (range 1l–l4) weeks of gestation and the parents opted for elective termination which was carried out at 14 (12–20) weeks. In all cases, viability was established by ultrasound scan at the time of chorion villus sampling (CVS) and just before termination of pregnancy. Eight (11.4%) fetuses died in the interval between CVS and termination of pregnancy and this rate of lethality was higher than the 6.9% estimated rate for an unselected population of trisomy 21 fetuses. This 4.5% increase may, in part, be attributed to the effects of CVS and may also be due to patient selection on the basis of increased nuchal translucency. The rate of lethality increased with translucency thickness from 5.3% for those with translucency of 1–3 mm to 23.5% for translucency of > 7 mm. In trisomy 21, the rate of Intrauterine lethality is associated with nuchal translucency thickness. Nevertheless, a policy of screening by maternal age and fetal nuchal translucency followed by selective termination of affected fetuses would still result in a more than 70% reduction in the live birth incidence of trisomy 21. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic endometrial thickness: a useful test to predict atrophy in patients with postmenopausal bleeding. An Italian multicenter study
Authors: Ferrazzi E. , Torri V. , Trio D. , Zannoni E. , Filiberto S. , Dordoni D.
Published: March 2003

Eighteen centers took part in this prospective study into which 930 eligible patients were recruited. The selection criteria for admission were atypical bleeding after at least 6 months of postmenopausal amenorrhea, and absence of hormonal therapies for at least 6 months. The sonographic measurement of the maximum bi‐endometrial thickness was made in a longitudinal plane. Sonographic measurements were always performed within 3 days prior to histological evaluation.

In these patients the mean number of years from menopause (25–75th centile) was 6 (range 2–l6). The prevalence of endometrial carcinoma was 11.5% and the prevalence of atrophy was 49.2%. The area under the receiver operator characteristic curves generated by sonographic thickness measurements reached the level of 85%, both for cancer and atrophy. The likelihood ratio for cancer, yielded by an endometrial thickness of ≤ 4.0 mm, was 0.05, and for atrophy it was 7.1. This cut‐off of > 4.0 mm yielded a sensitivity for the detection of cancer of 98% and a negative predictive value of 99%. The overall sensitivity and positive predictive value for atrophy achieved by this cut‐off were 57.2% and 87.3%, respectively. A multivariate logistic model showed that age and body mass index were independent variables associated with a significantly higher risk of endometrial cancer. The post‐test probabilities for cancer and atrophy were recalculated on the basis of the integration of age, body mass index and endometrial thickness. The estimated reduction of invasive procedures on the basis of this integration was 31%.

Transvaginal sonographic measurement of endometrial thickness, integrated with individual risk factors, can help in the management of postmenopausal patients with atypical bleeding, with regard to either the need for histological evaluation in high risk cases, or the choice of possible expectant management. We have shown that an endometrial thickness of ≤ 4.0 mm safely predicts endometrial atrophy and justifies expectant management when the patient understands the need for proper follow up. This could be achieved with a reduction in the use of invasive procedures without unwonted delay in cancer diagnosis. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Venous circulation in the maternal lower limb: a Doppler study with the Valsalva maneuver
Authors: Palmgren J , Kirkinen P.
Published: March 2003

In order to evaluate the normal physiology of the maternal venous circulation, Doppler examinations of the venous system in the right inferior extremity and suprainguinal part of the common femoral vein were carried out in 38 healthy pregnant women, in 12 non‐pregnant controls and in 16 women at early puerperium. Examinations were carried out when the mother was lying in a left semi‐recumbent supine position. Blood flow velocities in the suprainguinal femoral and deep femoral veins decreased significantly in the first trimester and were almost normalized by the third postpartum day. Continuous forward venous flow with respiratory fluctuation was maintained in the femoral veins over the whole gestational period. The response to the Valsalva maneuver was similar in the pregnant and non‐pregnant women. Our findings provide evidence that the venous valvular system and wall distensibility in the femoral area and the inferior extremity are in vivo not greatly changed in pregnancy. A more important reason for decreased velocities is probably the pregnancy‐associated decrease of the arterial input to this area. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Absence of significant hemodynamic changes in the fetus following maternal betamethasone administration
Authors: Cohlen B. J. , Stigter R. H. , Derks J. B. , Mulder E. J. H. , Visser G. H. A.
Published: March 2003

Maternal betamethasone administration causes a transient but considerable reduction in fetal body and breathing movements and in fetal heart rate variation. The aim of the present prospective study was to investigate whether there is evidence of circulatory changes in fetal, placental or uterine arteries, consistent with hypoxemia. Eighteen women at risk for preterm delivery received betamethasone to enhance fetal lung maturation. Doppler studies were performed before treatment, and 24 and 72 h after the second dose of betamethasone. Blood flow velocity waveforms were obtained from both uterine arteries, umbilical arteries, fetal descending aorta, fetal renal artery, and fetal cerebral arteries. No significant changes occurred in the pulsatility index of any of these blood vessels, suggesting that the transient reduction in fetal heart rate variation and fetal body and maternal betamethasone through fetal bypoxemia. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Incorporating sonographic cheek‐to‐cheek diameter, biparietal diameter and abdominal circumference improves weight estimation in the macrosomic fetus
Authors: Abramowicz J. S. , Robischon K. , Cox C.
Published: March 2003

The objective of this study was to improve the accuracy of sonographic fetal weight estimation in macrosomic (> 4000 g) fetuses by combining the cheek‐to‐cheek diameter (CCD), an indicator of subcutaneous tissue mass, with the biparietal diameter (BPD) and abdominal circumference (AC) in generating a new weight formula.

Three hundred well‐dated, uncomplicated singleton pregnancies > 32 weeks' gestational age (GA) were analyzed. Sonographic fetal measurements obtained in every case included BPD, head circumference, AC, femur length and CCD. Sonographic estimation of fetal weight (EFW) was derived by using BPD and AC. Actual birth weights (BW) of fetuses delivered within 7 days of the last sonographic examination and weighing over 1500 g (n = 123) were compared to EFW. A formula was derived by correlating BPD, AC and CCD with BW in these 123 fetuses using multiple regression analysis. A second formula was derived from the data of 39 macrosomic fetuses. The two formulae were then tested for accuracy of prediction of fetal weight in 157 other fetuses delivered within 7 days and grouped by birth weight, 44 of them weighing > 4000 g.

The new formula for macrosomic fetuses was: EFW (g) = 1065 + 84.5 BPD (cm) + 41.29 AC (cm) + 111.0 CCD (cm). In the macrosomic fetuses, a difference of < 10% between EFW and BW was demonstrated in 72.7% by the BPD‐AC formula and 95.5% when incorporating CCD. In this group, the mean percentage error was significantly smaller: 4.14 vs. 7.97% (p = 0.0005). In the regression analysis, the contributions of BPD, AC and CCD to the variance in BW were 5.5%, 16%, and 18.3%, respectively (p = 0.008). In the non‐macrosomic fetuses, CCD improved prediction of BW, but the trend did not reach statistical significance.

Our results demonstrate that, in the macrosomic fetus, CCD explains more of the variance in BW than other parameters and incorporating it in the sonographic weight estimation greatly improves its accuracy. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Cerebro—costo—mandibular syndrome: early sonographic prenatal diagnosis
Authors: Ibba R. M. , Corda A. , Zoppi M. A. , Floris M. , Todde P. , Monni G.
Published: March 2003

In this case report the sonographic appearance of cerebro—costo—mandibular syndrome is described. Increased fetal nuchal translucency (at 11 weeks), micrognathia (at 12 weeks) and failure of ultrasound to identify the ribs (at 18 weeks) were revealed with serial scanning. These cardinal findings allowed the prenatal diagnosis of cerebro—costo—mandibular syndrome to be made at 18 weeks' gestation. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Does a prenatal diagnosis of congenital heart disease alter short‐term outcome?
Authors: Copel J. A. , Tan A. S. A. , Kleinman C. S.
Published: March 2003

Congenital heart disease (CHD) is the most common fatal congenital anomaly in the first year after birth. Fetal echocardiography has become accepted as a method of diagnosing CHD in utero, but the benefits of prenatal diagnosis have not been evaluated.

We performed a cohort analysis of neonates with CHD in the absence of other life‐threatening conditions. One group (I) consisted of neonates who had been diagnosed as fetuses to have CHD and who were delivered at Yale‐New Haven Hospital. The other group (II) consisted of neonates who were not diagnosed to have CHD until after birth, and were either delivered at, or transferred to, the same hospital. Costs of initial hospitalization, length of hospitalization, and survival to discharge home with the parents were primary outcome measures. Our primary hypothesis was that all outcome measures would be improved by prenatal diagnosis. We also examined secondary hypotheses that these same measures would be improved among selected subgroups, including those requiring univentricular management, those amenable to biventricular repair, those with ductal dependent lesions, and those requiring any surgery during the primary admission.

From January 1, 1991 to June 30, 1996 we identified 45 antenatal cases and 54 postnatal cases of CHD that met the study entry criteria. The median length (± SE) of initial hospitalization was 16 ± 3.8 days in group I, and 11 ± 3.8 days in group II (p < 0.08). The median cost of initial hospitalization was $57 678 ± 12 340 vs. $53 604 ± 7249 (not significant). Eighty percent of group I survived to hospital discharge compared with 67% of group II (p = 0.14). There was no difference in survival among those requiring univentricular management (64 vs. 44%), but costs and length of hospitalization were greater in group I, regardless of whether or not surgery was performed post‐natally. Surgery was undertaken more often among the prenatal diagnosis group with univentricular hearts (86 vs. 56%, p < 0.05). Among those fetuses amenable to biventricular repair, survival was better (96 vs. 76%, p < 0.05) and the cost of hospitalization was lower ($30 277 ± 16 869 vs. $64 616 ± 9441, p = 0.06) in the prenatal diagnosis group.

Prenatal diagnosis of CHD does not result in the expected savings in cost, length of hospitalization or survival in the overall group of patients. The prenatal diagnosis group showed a skew towards single ventricle physiology. Within that group a high rate of pregnancy termination results in a group of parents who are likely to choose postnatal surgery despite high short‐ and long‐term mortality risks. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Successful thoracoamniotic shunting using a double‐flower catheter in a case of fetal cystic adenomatoid malformation associated with hydrops and polyhydramnios
Authors: Ryo E. , Okai T. , Namba S. , Okagaki R. , Kikuchi A. , Kozuma S. , Yoshikawa H. , Taketani Y.
Published: March 2003

We describe a case of congenital cystic adenomatoid mal‐formation treated by thoracoamniotic shunting using a double‐flower catheter. An ultrasound examination at 25 weeks' gestation revealed a cystic mass within the fetal thoracic cavity, hydrops and polyhydramnios. Thoracoamniotic shunting under ultrasound guidance using a double‐flower catheter was performed at 27 weeks. The procedure not only decompressed the lung cyst but also improved the secondary physiological changes, i.e. mediastinal shift, hydrops and polyhydramnios. A 2438‐g male neonate was delivered at 37 weeks with no respiratory problems and resection of the right lower pulmonary lobe was successfully performed 24 h after birth. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis and perinatal management of a lingual lymphangioma
Authors: Paladini D. , Morra T. , Guida F. , Lamberti A. , Martinelli P.
Published: March 2003

We describe the prenatal ultrasonographic features that led to the diagnosis of a lingual lymphangioma. The risk of upper airway obstruction, which is associated with this rare abnormality, prompted us to plan careful perinatal management. We believe that, in cases of suspected lymphangioma of the tongue or other oropharyngeal tumors, elective delivery should be carried out in a tertiary referral center in which emergency ventilation and tracheostomy are possible. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Doppler echocardiography of the main stems of the pulmonary arteries in the normal human fetus
Authors: Chaoui R. , Taddei F. , Rizzo G. , Bast C. , Lenz F. , Bollmann R.
Published: March 2003

The objective of this study was to describe the normal blood flow velocity waveforms in the main branches of the right and left pulmonary arteries in the human fetus and to establish reference ranges for different Doppler parameters during the second half of pregnancy. Cross‐sectional data were collected from 86 healthy human singleton fetuses between 18 and 38 weeks of gestation. With advancing gestation a significant increase (p < 0.001) in the peak systolic velocity, time averaged velocity and time velocity integral was observed. The pulsatility index decreased significantly (p < 0.05) in the same period, suggesting a decrease in the pulmonary arterial vascular resistance. The acceleration time (AT) and the ratio of AT to ejection time (AT/ET), described in postnatal cardiology as having an inverse correlation with mean arterial pressure, increased significantly (p < 0.001). This is possibly the result of decreased pulmonary arterial pressure.

The data show that Doppler examination of blood flow in the main stem of both the right and the left pulmonary arteries of the fetus is feasible, and increases insight into the lung perfusion of the human fetus. The observed changes throughout gestation are in accordance with animal experiments showing an increase in perfusion as well as a decrease in the vascular resistance and pressure. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Maternal middle cerebral artery velocity changes in HELLP syndrome versus pre‐eclampsia
Authors: Williams K. P. , Wilson S.
Published: March 2003

Our objective was to determine whether there is a difference in middle cerebral artery blood flow velocity in patients with the syndrome of hemolysis, elevated liver enzymes and low platelet counts (HELLP syndrome) compared to a matched controlled group of patients with pre‐eclampsia and without HELLP syndrome.

Six pre‐eclamptic patients with HELLP syndrome and 12 pre‐eclamptic women without HELLP syndrome had maternal middle cerebral artery blood flow velocity assessed antepartum and at 24 and 48 h postpartum. We compared the effect of the development of HELLP syndrome on middle cerebral artery blood flow velocity changes using non‐parametric tests.

Patients with HELLP syndrome showed no significant differences in diastolic, systolic, mean middle cerebral artery blood flow velocity or pulsatility index in either the antepartum or 24‐h and 48‐h postpartum phases when compared to non‐HELLP pre‐eclamptic patients. Our data suggest that there is no difference in the blood flow velocity waveform of the maternal middle cerebral artery between patients with pre‐eclampsia and those with HELLP syndrome. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Defects and syndromes in chromosomally normal fetuses with increased nuchal translucency thickness at 10–14 weeks of gestation
Authors: Souka A. P. , Snijders R. J. M. , Novakov A. , Soares W. , Nicolaides K. H.
Published: March 2003

Increased fetal nuchal translucency thickness at 10–14 weeks of gestation is a common phenotypic expression of fetal chromosomal defects, structural abnormalities and genetic syndromes. This study reports on the prevalence of structural abnormalities and genetic syndromes in 4116 chromosomally normal pregnancies with increased fetal nuchal translucency thickness and reviews the relevant literature. In fetuses with increased nuchal translucency thickness, the prevalence of major cardiac defects, diaphragmatic hernia, exomphalos, body stalk anomaly and fetal akinesia deformation sequence is substantially higher than expected in the general population. In addition, there may be an association between increased nuchal translucency thickness and a wide range of rare skeletal dysplasias and genetic syndromes that are usually found in less than one in 10 000 pregnancies; however, the number of affected cases, both in the present and in previous series of fetuses with increased nuchal translucency thickness, is too small for definite conclusions to be drawn. The rates of miscarriage and perinatal death increase, whereas the rate of survival and the prevalence of live births with no obvious abnormalities decrease with increasing nuchal translucency thickness. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Fetal hepatosplenomegaly: an isolated sonographic sign of trisomy 21 in a case of myeloproliferative disorder
Authors: Hartung J. , Chaoui R. , Wauer R. , Bollmann R.
Published: March 2003

Enlargement of the fetal liver and spleen as well as oligo‐hydramnios were the only pathological sonographic signs detected in a pregnant woman presenting because of decreased fetal movements at 31 weeks' gestation. Doppler examination of fetal vessels revealed pathological values (absent or reversed flow in the umbilical artery, centralization of fetal circulation). No hydrops development or any further malformations were seen. The association of pathological Doppler findings with hepatosplenomegaly roused the suspicion of fetal infection. The infant had to be delivered because of deterioration of fetal heart rate patterns 2 days later. The newborn had Down's syndrome and the confirmed hepatosplenomegaly was found to be due to a transient myeloproliferative disorder with severe leukocytosis and predominance of immature blast forms. Hematological parameters normalized without specific therapy within 3 weeks.

Although transient leukemic reactions have been diagnosed prenatally in cases of Down's syndrome associated with non‐immune hydrops, to our knowledge this is the first reported case of isolated hepatosplenomegaly visualized by prenatal ultrasound as a sign of trisomy 21. The presence of fetal hepatosplenomegaly has to be taken into consideration as a possible marker for trisomy 21 and not only for infectious or metabolic diseases. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonographic markers of tubal inflammatory disease
Authors: Timor‐Tritsch I. E. , Lerner J. P. , Monteagudo A. , Murphy K. E. , Heller D. S.
Published: March 2003

Objectives

Since the introduction of transvaginal sonography (TVS), clear pictures of the female reproductive tract have been obtained. These images enable the accurate description of Fallopian tube pathology. However, the current literature on the ultrasound diagnosis of pelvic inflammatory disease (PID) is confusing and contradictory. The goal of our study was to identify sonographic markers of inflammatory disease of the pelvis and to place these in a clinical context.

Patients and methods

Seventy‐seven patients were scanned by TVS. They were divided into two groups, according to their clinical picture, the first group with acute PID and the second with a history of chronic PID or no history at all. The sonographic markers studied were shape, wall structure and wall thickness of the Fallopian tube. Ovarian involvement and the presence of pelvic fluid were also evaluated.

Results

The best marker of tubal inflammatory disease, either acute or chronic, was the presence of an incomplete septum of the tubal wall, which was present in 92% of the total cases. A thick wall and the ‘cogwheel’ sign were sensitive markers of acute disease, whereas a thin wall and ‘beads‐on‐a‐string’ sign were indicators of chronic disease. Palpable findings and surgical history were not discriminatory, but were present in three‐quarters and one‐third of the study population, respectively. Three false‐positive cases are presented: an ovarian cystadenoma, an appendiceal mucocele and one case with periovarian fluid accumulation.

Conclusions

The tubo–ovarian complex and the tubo–ovarian abscess should be considered separate entities that differ in their clinical implications. TVS allows one to distinguish between them. Distinguishing characteristics of acute and chronic salpingitis are presented. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Growth of the fetal orbit and lens in normal pregnancies
Authors: Goldstein I. , Tamir A. , Zimmer E. Z. , Itskovitz‐Eldor J.
Published: March 2003

Objective

To construct nomograms of the size of the fetal orbit and lens during gestation.

Subjects

The study group included 349 normal pregnant women at 14–36 weeks' gestation.

Methods

Routine biometric measurements were obtained in all the participants; these included biparietal diameter, head and abdominal circumferences, measurements of the long bones and the diameters of the fetal orbit and lens. The orbital and lens circumference measurements were also related to gestational ages.

Results

A linear growth function was observed between gestational age (GA) and orbital diameter (r = 0.94; p < 0.00001; y = −0.66 + 0.5 × GA), orbital circumference (r = 0.94; p < 0.00001; y = −2.1 + 1.5 × GA) and orbital area (r = 0.94; p < 0.00001; y = −98.1 + 8.3 × GA). Significant correlation was also found between femoral length (FL) and orbital diameter (r = 0.95; p < 0.00001; y = 3.3 + 1.9 × FL), orbital circumference (r = 0.95; p < 0.00001; y = 10.3 + 5.9 × FL) and orbital area (r = 0.93; p < 0.00001; y = −28.2 + 32.2 × FL). A linear growth function was observed between orbital circumference and biparietal diameter (r = 0.94; p < 0.00001) and head circumference (r = 0.95; p < 0.00001). A linear growth function was also observed between gestational age and the diameter of the lens (r = 0.89; p < 0.00001; y = 0.88 + 1.4 × GA) the circumference of the lens (r = 0.89; p < 0.00001; y = 2.78 + 0.4 × GA) and the area of the lens (r = 0.89; p < 0.00001; y = −7.95 + 1.0 × GA). The correlation was found between the ratios of the diameters, circumferences and areas of the lens and the orbit.

Conclusions

These results provide normative data of the growth of the fetal orbit and lens and may aid future studies relating to fetal eye anomalies. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Pregnancy outcomes in women treated with elective versus ultrasound‐indicated cervical cerclage
Authors: Guzman E. R. , Forster J. K. , Vintzileos A. M. , Ananth C. V. , Walters C. , Gipson K.
Published: March 2003

Objective

To compare pregnancy outcomes in women at risk for pregnancy loss treated with elective versus ultrasound‐indicated placement of cerclage.

Methods

A retrospective cohort study was performed on two groups of patients with singleton gestations. The first group consisted of women at risk for pregnancy loss who were treated with an elective cerclage, while the second group was managed conservatively and followed with serial transvaginal cervical sonography and transfundal pressure. An emergency cerclage was placed in women in the second group when the endocervical canal length shortened to < 20 mm, either spontaneously or in response to transfundal pressure. The two groups were compared with respect to maternal demographics, obstetric and gynecological history, and gestational age, both at time of cerclage placement and delivery.

Results

A total of 138 patients were identified. Eighty‐one patients were treated with an elective cerclage and 57 with an ultrasound‐indicated cerclage. Patients treated with elective cerclages were older (32 versus 27 years, p = 0.0003), more commonly white (56.8% versus 38.6%, p = 0.0380), less commonly nulliparous (23.5% versus 43.9%, p = 0.0063), and more often private patients (92.6% versus 28.1%, p < 0.0001). A history of previous treatment with cerclage (45.7% versus 10.5%, odds ratio (OR) 0.2, 95% confidence interval (CI) 0.1–0.4) and one prior midtrimester loss (53.1% versus 33.3%, OR 0.4, 95% CI 0.2–0.9) were also more common in the elective versus ultrasound‐indicated cerclage group. However, there was no difference in the rates of previous preterm delivery, two midtrimester losses, two terminations of pregnancy, in utero diethylstilbestrol exposure, uterine anomalies, history of cone biopsy or parity. As expected, gestational age at placement of cerclage was significantly earlier in the elective group (13.0 versus 20.0 weeks, p < 0.0001). The median (range) gestational age at delivery (37 (15–41) versus 37 (17–41) weeks, p = 0.90), the number of early (< 25 weeks) losses (9.9% versus 8.8%, OR 1.6, 95% CI 0.3–7.9), and preterm deliveries (< 37 weeks) (35.8% versus 36.8%, OR 1.1, 95% CI 0.4–3.2) were similar in the elective and ultrasound‐indicated cerclage patients, respectively.

Conclusion

In patients at risk for pregnancy loss, placement of cervical cerclages in response to ultrasono‐graphically detected shortening of the endocervical canal length is a medically acceptable alternative to the use of elective cerclage. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of prune belly syndrome at 12 weeks of pregnancy: case report and review of the literature
Authors: Hoshino T. , Ihara Y. , Shirane H. , Ota T.
Published: March 2003

We present a case of prune belly syndrome in a 12‐week fetus whose previous anomaly scan at 10 weeks had been normal. The ultrasound diagnosis was based on the findings of a lower abdominal cystic echo caused by abnormal dilatation of the bladder. Termination was performed at 14 weeks and autopsy confirmed the distended bladder. In addition, there was bilateral hydronephrosis and an absence of abdominal muscles, liver, spleen and diaphragm. A review of the literature indicates that ours may be the earliest reported case of prune belly syndrome. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology