bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively
Authors: Jurkovic D. , Hacket E. , Campbell S.
Published: March 2003

We report two cases of cervical pregnancy which were diagnosed by ultrasound at 5 and 8 weeks' gestation. In both cases a gestational sac was visualized below the internal OS and color Doppler examination demonstrated peritrophoblastic blood flow characteristic of early implantation. Both patients were successfully treated with systemic methotrexate. Including these two cases, a total of 83 early cervical pregnancies have been reported in the literature over the last 10 years. Of these, 40 patients were primarily treated by conservative surgery, 40 by non‐surgical methods using methotrexate or potassium chloride, and the remaining three by other chemotherapeutic agents. The likelihood of being cured was similar in the surgical and non‐surgical groups (odds ratio 1.1; 9.5% confidence interval 0.4–3.2). However, patients who were primarily treated by surgery were more likely to sustain major hemorrhage (odds ratio 8.0; 95% confidence interval 2.4'26.5) and to require hysterectomy (odds ratio 7.4; 9.5% confidence interval 0.9'63.8) than those treated medically. This indicates that non‐surgical methods should be used for primary treatment of cervical pregnancy, while surgery should be reserved for those patients in whom medical therapy is not successful. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Early prenatal diagnosis of oculoauriculovertebral dysplasia or the Goldenhar syndrome
Authors: De Catte L. , Laubach M. , Legein J. , Goossens A.
Published: March 2003

We report a case of the sonographic detection of oculoauriculouertebral dysplasia in a fetus at 1.5 weeks' gestation. An early diagnosis was suggested by observation of a maxillar cleft in association with unilateral microphthalmia. In the presence of microphthalmia the syndrome is likely to include mental retardation. When the diagnosis is made in the perinatal period, management generally involves cosmetic surgery. If; however, the condition is recognized in the early stages of gestation, termination of pregnancy may be an option. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Development of the fetal tongue between 14 and 26 weeks of gestation: in utero ultrasonographic measurements
Authors: Achiron R. , Ben Arie A. , Gabbay U. , Mashiach S. , Rotstein Z. , Lipitz S.
Published: March 2003

Our objective was to establish nomograms for fetal tongue measurements from 14 weeks until mid‐gestation by using transvaginal and transabdominal high‐resolution ultrasound techniques. A prospective, cross‐sectional study was performed on 120 normal singleton pregnancies between 14 and 26 weeks of gestation. Tongue circumference was measured by transvaginal ultrasonography between 14 and 17 weeks, and by abdominal ultrasound between 18 and 26 weeks of gestation. Fetal tongue circumference, as a function of gestational age, was expressed by the regression equation: tongue circumference (mm) = −23.9 + 3.75 × gestational age (weeks). The correlation,r
2 = 0.95, was found to be highly statistically significant (p < 0.0001). The normal mean of tongue circumference per week and the 95% prediction limits were defined. During the study period we evaluated two cases with tongue circumference outside these 95% confidence limits: one had microglossia, the other macroglossia, and both were found to be associated with abnormal fetal karyotype. The presented normative data may be helpful in the prenatal diagnosis of suspected congenital syndromes that include, among their manifestations, tongue growth disturbances. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Abnormal fetal cardiac axis in the detection of intrathoracic anomalies and congenital heart disease
Authors: Crane J. M. , Ash K. , Fink N. , Desjardins C.
Published: March 2003

In a 14‐month period, 409 women with singleton gestations referred for perinatal ultrasound consultation underwent evaluation of the fetal cardiac axis. Cardiac and intrathoracic anomalies were confirmed either by neonatal echocardiography or autopsy. Overall, 32 fetuses had an abnormal axis (nine, smaller axis than normal; 23, larger axis than normal). Of the 29 found to have cardiac (n = 24) or intrathoracic (n = 5) anomalies, 23 had an abnormal axis. The median cardiac axis of the normal group (44.0°) was significantly smaller than that of the cardiac/intrathoracic anomaly group (60.0°) (p = 0.002). The cardiac axis was independent of gestational age. The mean interobserver variation was 1.3 ± 1.8°. The sensitivity of an abnormal axis (< 28° or > 59°) in detecting congenital heart disease or intrathoracic anomalies was 23/29 (79.3%), with specificity of 371/380 (97.5%), positive predictive value of 23/32 (71.9%), and negative predictive value of 371/377 (98.4%). Of those with a cardiac anomaly and an abnormal axis (n = 18), five were felt to have an initial normal four‐chamber view. An abnormal fetal cardiac axis, either larger or smaller than normal, is suggestive of a cardiac or intrathoracic anomaly and requires further investigation, such as fetal echocardiography. The cardiac axis should be considered with the four‐chamber view in fetal ultrasound evaluation. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Dandy–Walker malformation diagnosed before 21 weeks of gestation: associated malformations and chromosomal abnormalities
Authors: Ulm B. , Ulm M. R. , Deutinger J. , Bernaschek G.
Published: March 2003

This study examined rates of concomitant structural and chromosomal abnormalities in 14 fetuses with a diagnosis of Dandy‐Walker malformation or Dandy‐Walker variant before 21 weeks' gestational age, compared to 14 fetuses with a diagnosis of Dandy–malformation or variant between 21 weeks' gestation and delivery. A total of 24 fetuses had Dandy–malformation and four had Dandy–variant. Eight of the fetuses with the malformation had ventriculomegaly: one of the fetuses with early diagnosis and seven with later diagnosis (p = 0.027). None of the fetuses with Dandy‐Walker variant had ventriculomegaly. The overall prevalence of concomitant structural abnormalities was 13/28; 8/l4 for fetuses with early prenatal diagnosis and 5/l4 for fetuses with late prenatal diagnosis of the malformation or the variant. Chromosomal abnormality rates were significantly higher among fetuses with early prenatal diagnosis (7/l 4) than among those with later prenatal diagnosis (l/l4; p = 0.032). Abnormal karyotypes were more prevalent among fetuses without ventriculomegaly (7/20), compared to fetuses with ventriculomegaly (l/8).

We conclude that fetuses with an antenatal diagnosis of Dandy‐Walker malformation or Dandy‐Walker variant before 21 weeks' gestational age have worse prognosis than fetuses with a later prenatal diagnosis of the same defect. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Screening for fetal anomalies by ultrasound at 14 and 21 weeks
Authors: D'Ottauio G. , Meir Y. J. , Rustico M. A. , Pecile V. , Fischer‐Tamaro L. , Conoscenti G. , Natale R. , Mandruzzato G. P.
Published: March 2003

A prospective study of screening for fetal abnormalities and chromosomal defects was carried out by ultrasound examination at 13–l5 weeks of gestation and 20–22 weeks; the first scan was performed transvaginally and the second transabdominally. During a 4‐year period (1991–95), 3490 unselected consecutive pregnancies with a total of 3514 fetuses were examined. There were 21 chromosomally abnormal fetuses, including ten with trisomy 21, and, in 19 (90.5%), fetal defects were detected at the first and/or second ultrasound examination. The most effective marker for chromosomal defects was increased nuchal translucency thickness (≥ 4 mm) at the 13–15‐week scan, which was present in seven of the ten fetuses with trisomy 21 and in six of the 11 with other chromosomal abnormalities. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Cystic hygrolma as an early first‐trimester ultrasound marker for recurrent Fryns' syndrome
Authors: Hösli I. M. , Tercanli S. , Rehder H. , Holzgreve W.
Published: March 2003

We present a case of a fetus who at a 12‐week ultrasound examination was shown to have a large cystic hygroma. Fryns' syndrome was suspected because the mother's previous pregnancy had been affected by the condition. Pathological examination confirmed the diagnosis at this early stage of gestation. In families with increased risk for Fryns' syndrome, first‐trimester ultrasound screening should be offered to exclude cystic hygroma as an ultrasound marker for this most often lethal malformation. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Normal fetal thyroid volume
Authors: Ho S. S. Y. , Metreweli C.
Published: March 2003

A prospective study of 289 normal fetal thyroids was undertaken between 20 and 36 weeks of gestation in 289 mothers without any history of thyroid disease or maternal disease that could cause intrauterine growth restriction. The fetal thyroid volume was calculated by the ellipsoid equation, with the assumption that each lobe was an ellipse. A nomogram relating fetal thyroid volume to gestational age was established. The mean fetal thyroid volume was found to be 0.23 ± 0.18 cm3 (median 0.17 cm3; range 0.022–0.85 cm3 ). The ratio of fetal thyroid volume to estimated fetal weight (V/W ratio) (at 0.163 ± 0.079 cm3 /kg) was constant throughout gestation. The value was smaller than those of the child and the adult reported in other studies, indicating that fetal thyroid enlargement is likely to be underestimated if based on postnatal criteria. It was found that the mean fetal thyroid volume was significantly correlated with estimated fetal weight and gestational age, in which the former dominated the effect. The fetal thyroid increased in size much faster after 32 weeks, suggesting that evaluation of possible fetal goiter should take into account gestational age and the nomogram developed in this study. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The upper neck pouch sign: a prenatal sonographic marker for esophageal atresia
Authors: Kalache K. D. , Chaoui R. , Mau H. , Bollmann R.
Published: March 2003

Prenatal suspicion of esophageal atresia is usually based on the finding of a small or absent fetal stomach in association with polyhydramnios. As similar findings may be generated by other abnormalities, confirmation of the diagnosis is generally not possible until birth. We present a case in which the suspicion of esophageal atresia was raised in the 22nd week of pregnancy in the presence of a small stomach bubble associated with a persistent left superior vena cava. The diagnosis was confirmed 4 weeks later by direct visualization of the fluid‐filled blind‐ending esophagus during fetal swallowing, which we called the upper neck pouch sign. This is the first case in which the onset of this sonographic entity was specifically observed on serially repeated sonograms as early as the 22nd week. The appearance of this direct sign of esophageal atresia is described, and the literature is reviewed. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal diagnosis and management of a ranula
Authors: Fernandez Moya J. M. , Cifuentes Sulzberger S. , Díaz Recaséns J. , Ramos C. , Sanz R. , Perez Tejerizo G.
Published: March 2003

We describe a case of congenital ranula or retention salivary cyst diagnosed at 26 weeks of gestation. The fetal karyotype was obtained by amniocentesis and chorionic villus sampling, and was normal. Follow‐up ultrasound scans revealed no changes in the size or the position of the cyst. Surgical treatment was performed 2 days after a normal vaginal delivery, with excellent results. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Anomalous fetal venous return associated with major chromosomopathies in the late first trimester of pregnancy
Authors: Matias A. , Montenegro N. , Areias J. C. , Brandão O.
Published: March 2003

We report three cases of increased nuchal translucency at 12–13 weeks of gestation in three fetuses with trisomies 13, 18 and 21. All three fetuses were associated with anomalous venous return evaluated by Doppler ultrasonography. Complete pathological examination was performed following termination in each case. We suggest that alterations in the venous compartment can be an early sign of poor outcome and should prompt a detailed search for cardiac defects early in gestation. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Maternal ophthalmic artery Doppler velocimetry in normotensive pregnancies with small‐for‐gestational‐age infants
Authors: Hata T. , Miyazaki K.
Published: March 2003

Our purpose was to evaluate whether the maternal ophthalmic artery pulsatility index in normotensive pregnancies with small‐for‐gestational‐age (SGA) fetuses is different from that in normotensive pregnancies with appropriate‐for‐gestational‐age (AGA) fetuses. The cross‐sectional study involved a group of normotensive pregnant women at > 34 weeks' gestation; 16 had fetuses that were AGA and 13 had fetuses that were SGA. Color and pulsed Doppler ultrasonography was performed in the ophthalmic arteries in each case and the pulsatility index and mean velocity were calculated. The heart rate and mean arterial blood pressure were also recorded. The pulsatility index of the ophthalmic artery (2.04 ± 0.39) in normotensive pregnant women with SGA fetuses was significantly lower than that (2.87 ± 0.64) in normotensive pregnant women with AGA fetuses (p < 0.05). The mean velocity (15.0 ± 2.7 cm/s) in the women with SGA fetuses was significantly higher than that (10.2 ± 2.7 cm/s) in the women with AGA fetuses (p < 0.05). There was no significant difference in maternal heart rate or mean arterial blood pressure between the groups. These results suggest that vascular resistance in the maternal orbital circulation is reduced in pregnancies that are normotensive but which are associated with SGA fetuses. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Alternative technique for Nd : YAG laser coagulation in twin‐to‐twin transfusion syndrome with anterior placenta
Authors: Deprest J. A. , Van Schoubroeck D. , Van Ballaer P. P. , Flageole H. , Van Assche F. A. , Vandenberghe K.
Published: March 2003

Nd : YAG laser coagulation is used to treat severe twin‐to‐twin transfusion syndrome (TTS). Success of the technique depends on visualization of the placenta, the fetal membranes and the targeted vessels, as well as obtaining an optimal inclination angle for laser coagulation. In the rare case of an extensive anterior placenta, it may be difficult to achieve these conditions using the percutaneous approach. Here, we propose an alternative to the percutaneous procedure. Modifications involve an open access and the use of a flexible cannula and bent scope. An extraplacental area, usually at the fundus, is identified by B‐mode and color Doppler imaging. A mini‐laparotomy is made under general anesthesia. The viscera are retracted and the cannula is inserted under direct view and ultrasound control by the Seldinger technique. The curved fiberscope is passed through the flexible cannula, allowing adequate inspection of the placenta, and target vessels can be coagulated at an angle close to 90°. After the procedure, the uterus is closed primarily to prevent postoperative leakage of amniotic fluid or hemorrhage. This technique has been successfully used in six patients with TTS and a completely anterior placenta, with a gestational age between 18.5 and 22.0 weeks. In all patients, the amniotic cavity was accessed without hemorrhage. The outcomes are similar to those published previously for laser coagulation. The mean interval from intervention until delivery was 10.5 weeks. All 12 fetuses were live born but four died from complications of extreme prematurity. No maternal complications occurred. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
An unusual presentation of ectopic pregnancy
Authors: Zaki Z. M. S.
Published: March 2003

Abdominal pregnancy is a rare form of ectopic gestation. When it occurs, its early diagnosis is difficult, owing to the atypical presentation and the low index of suspicion for the condition. The characteristic history is that of abdominal pain, vaginal bleeding and symptoms related to the gastro‐intestinal tract. These symptoms are occasionally over‐looked and the diagnosis is often missed. The following report describes a case of a 12‐week abdominal pregnancy presenting as an acute abdomen with placental attachment to the anterior abdominal wall muscle. Transabdominal ultrasound was successfully used to make the diagnosis preoperatively. Surgical intervention resulted in removal of the complete sac together with the placental disc in toto. The important features of this rare but morbid condition are discussed, and the important role of sonographic imaging in cases of acute abdomen in pregnancy is stressed. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Low‐field dedicated magnetic resonance imaging: a potential tool for assisting perinatal autopsy
Authors: Langer B. , Choquet P. , Ravier S. , Gasser B. , Schlaeder G. , Constantinesco A.
Published: March 2003

Although the practice of perinatal autopsy has increased in recent years, examination of the fetus and especially of the fetal brain during the first trimester or the beginning of the second trimester remains difficult. Postmortem high‐resolution images of the brain of a normal and an abnormal fetus of the same gestational age (22 weeks) were obtained with a low‐field (0.1 T) dedicated magnetic resonance imaging (MRI) system. We demonstrated that a small MRI machine supplemented data from classical necropsy and may help in the interpretation of in utero ultrasound and magnetic resonance images for the antenatal diagnosis of fetal malformations. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal diagnosis of isolated lissencephaly by ultrasound and magnetic resonance imaging
Authors: Greco P. , Resta M. , Vimercati A. , Dicuonzo F. , Loverro G. , Vicino M. , Selvaggi L.
Published: March 2003

Lissencephaly (agyria) is a cortical dysplasia associated with a disturbance in the migration of neocortical neurons. Because of abnormal sonographic findings in the brain of a 24‐week fetus, we carried out serial magnetic resonance imaging (MRI) examinations which raised the suspicion of isolated lissencephaly. In the second trimester, an area of damage depicted as low‐intensity signals was identified by MRI inside the cortical parenchyma. In the same cortical area, agyria was detected later in pregnancy, and post‐natally calcification was observed by computerized tomography (CT) scan. We believe that ultrasound and targeted MRI examination can improve our understanding of some disorders of neuronal migration and that earlier diagnosis is feasible if both methods are employed and interpreted by sound criteria. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Abnormal ductus venosus blood flow: a clue to umbilical cord complication
Authors: Bäz E. , Zikulnig L. , Hackelöer B.‐J. , Hecher K.
Published: March 2003

We report a case of umbilical cord complication causing fetal hypoxemia and acidemia. At 30 weeks of gestation, the patient was referred because of slightly increased amniotic fluid volume and a non‐reactive cardiotocogram. Biometry was appropriate for gestational age. Umbilical artery and fetal aortic Doppler findings were normal, whereas diastolic blood flow velocities in the middle cerebral artery were increased and the ductus venosus showed severely abnormal flow velocity waveforms with reversal of flow during atrial contraction. Since other reasons for fetal hypoxemia could be excluded, careful examination of the umbilical cord was performed. Traction of the hypercoiled umbilical cord due to its course around the fetal neck and shoulders was suspected. Cesarean section confirmed the sonographic findings and fetal blood gases revealed fetal acidemia. This case indicates that investigation of fetal venous blood flow may also help to identify fetal jeopardy due to reasons other than increased placental vascular resistance. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
The effect of the menstrual cycle on human cerebral blood flow: studies using Doppler ultrasound
Authors: Brackley K. J. , Ramsay M. M. , Broughton Pipkin F. , Rubin P. C.
Published: March 2003

Objective

Previous studies have demonstrated hemodynamic changes at different phases in the menstrual cycle, but the cerebral circulation has not been investigated. Our aim was to study carotid and cerebral blood flow during the menstrual cycle using Doppler ultrasound. Two different techniques of Doppler waveform analysis were used: standard Doppler indices and Laplace transform analysis (LTA), which may provide additional hemodynamic information.

Design

This was a prospective study of healthy volunteers who were providing pre‐conception data for a subsequent longitudinal study set in the Department of Obstetrics and Gynaecology, Nottingham University Hospital. Nineteen women were studied in the mid‐follicular and mid‐luteal phases of 27 ovulatory menstrual cycles. Doppler recordings were obtained from the internal and external carotid and middle cerebral arteries. The standard Doppler indices (systolic/diastolic ratio, pulsatility index and resistance index) and LTA parameters were calculated.

Results

The standard Doppler indices were all significantly higher in the luteal compared to the follicular phase in the right middle cerebral artery (p < 0.05). However, no changes were seen in the standard indices in the carotid arteries or in any of the LTA parameters in any artery. Using the LTA, vessel wall stiffness was greater and absolute velocity of flow lower in the middle cerebral compared to the carotid arteries.

Conclusions

Increased ventilation and a subsequent lowering of alveolar CO2 pressure secondary to a raised progesterone level in the mid‐luteal phase could account for the observed changes within the middle cerebral artery. Under the conditions of this study the LTA appears less sensitive at detecting alterations in downstream resistance compared to the standard Doppler indices. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Echogenic bowel in fetuses with homozygous α‐thalassemia‐1 in the first and second trimesters
Authors: Lam Y. H. , Tang M. H. Y. , Lee C. P. , Tse H. Y.
Published: March 2003

Objective

Fetal echogenic bowel has been observed in fetuses with meconium peritonitis, cystic fibrosis, aneuploidy, congenital viral infection and intrauterine growth restriction. The pathogenesis of echogenic bowel is unknown, but it may be attributed to bowel ischemia. Fetuses affected by homozygous α‐thalassemia‐1 are severely anemic and hypoxic. We investigated the incidence of echogenic bowel in these hypoxic fetuses in the first and second trimesters.

Design

Prospective observational study.

Subjects

Women referred for the prenatal diagnosis of homozygous α‐thalassemia‐1 before 24 weeks' gestation.

Methods

All subjects had one or more abdominal and/or vaginal ultrasound examination between 12 and 24 weeks' gestation. Echogenic bowel was diagnosed if the bowel appeared either isoechogenic or more echogenic than the bone.

Results

Between March 1997 and July 1998, 126 preg‐nancies were studied. Thirty‐six fetuses were confirmed to be affected by homozygous α‐thalassemia‐1, and 11 of them (31%, 95% CI 16–48%) had echogenic bowel. These observations were made before the invasive test results were available. None of the fetuses unaffected by homozygous α‐thalassemia‐1 had echogenic bowel.

Conclusion

There is a strong association between homozygous α‐thalassemia‐1 and echogenic bowel. The pathogenesis is unknown. Speculations include bowel hypoperistalsis or bowel wall edema due to severe anemia and hypoxia. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Pattern recognition of pelvic masses by gray‐scale ultrasound imaging: the contribution of Doppler ultrasound
Authors: Valentin L
Published: March 2003

Objective

To determine the extent to which Doppler ultrasound examination contributes to a correct specific diagnosis of a pelvic mass when the preliminary diagnosis is based on subjective evaluation of the gray‐scale ultra‐sound image (pattern recognition).

Methods

In 173 consecutive cases, women scheduled for surgery because of a pelvic mass judged clinically to be of adnexal origin underwent preoperative gray‐scale and color Doppler ultrasound examination. On the basis of subjective evaluation of the gray‐scale ultrasound image, the ultrasound examiner classified each tumor as probably benign or malignant. If possible, a specific diagnosis was made, e.g. ‘endometriosis’ or ‘dermoid cyst’. The confidence with which the diagnosis was made was rated subjectively on a visual analog scale. The diagnosis based on gray‐scale imaging was re‐evaluated after color Doppler examination, the diagnostic confidence after Doppler examination also being rated on a visual analog scale. ‘Malignancy’ was not considered a specific diagnosis.

Results

Pattern recognition of the gray‐scale ultrasound image resulted in no unequivocal specific diagnosis in 51% (88/173) of cases, a correct specific diagnosis in 42% (72/173) and an incorrect specific diagnosis in 7% (13/173). Doppler examination added to a correct specific diagnosis in only 5% (8/173) of cases, either by changing an incorrect specific diagnosis to a (more) correct one (five tumors), or by increasing the confidence with which a correct specific diagnosis was made (three tumors). Doppler examination was misleading in one tumor.

Conclusion

By using pattern recognition of the gray‐scale ultrasound image, a correct specific diagnosis can be made in almost half of adnexal tumors scheduled for surgery. Subjective assessment of the color content of the tumor scan contributed little to the specific diagnosis of pelvic tumors. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Intravascular contrast agent in the ultrasonography of ectopic pregnancy
Authors: Ordén M.‐R. , Gudmundsson S. , Helin H.‐L. , Kirkinen P.
Published: March 2003

Objective

The aim of this study was to characterize the effect of an intravascular ultrasound contrast agent in the adnexal circulation and to evaluate the applicability of the contrast agent in imaging ectopic trophoblastic blood flow.

Design

Thirty‐three color Doppler and 13 power Doppler examinations were performed among 30 patients with ectopic pregnancy, first without and then with galactose‐based contrast agent enhancement. The effect of the contrast agent was evaluated both visually (color Doppler) and with computerized power Doppler signal intensity measurements.

Results

The Doppler signal intensity from the adnexal blood circulation increased within 30 s after antebrachial injection, yielding an effect that was recognizable up to 2–4 min later. There was a clear enhancement of trophoblastic flow after addition of the contrast agent in all except one of the ectopic pregnancies. In 12% of the cases, trophoblastic flow could be imaged only by using the contrast agent. The contrast agent increased the amount of recognizable vascular areas around the trophoblastic mass in 91% of the examinations, resulting in a more complete peritrophoblastic ring. The increase in the mean intensity of the power Doppler signal was 7.8% (p < 0.01).

Conclusion

The intravascular ultrasound contrast agent has a recognizable effect on Doppler ultrasonographic examination of the adnexal circulation. It appears to be of help when examining ectopic pregnancies where the finding in color flow imaging is ambiguous. The use of a contrast agent may also facilitate localization of trophoblastic tissue in a hemorrhagic adnexal mass. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Assessment of fetal heart rate variability and velocity variability by Doppler velocimetry of the descending aorta at 10–20 weeks of gestation
Authors: Ursem N. T. C. , Clark E. B. , Keller B. B. , Hop W.C.J. , Wladimiroff J. W.
Published: March 2003

Objectives

Determination of gestational age‐related modulations in fetal heart rate and descending aorta blood flow velocity in the early human fetus and comparison of aortic variability data with data obtained from the umbilical artery. It is hypothesized that these modulations present in the umbilical artery also occur in the descending aorta.

Methods

Doppler studies of descending aorta velocity waveforms were performed at 10–20 weeks in 55 normal pregnant women. In 24 of the 55 women, Doppler recordings from both the descending aorta and the umbilical artery were collected. Absolute values and variability of fetal heart rate, peak systolic and time‐averaged velocities were determined from flow velocity waveforms of at least 18 s in duration.

Results

From 10 to 20 weeks of gestation, the descending aorta peak systolic and time‐averaged velocities increased, whereas the fetal heart rate decreased. The descending aorta peak systolic variability also increased. However, the time‐averaged velocity variability and fetal heart rate variability remained constant during the study period. In the subset of 24 women, the fetal heart rate variability and velocity variability data from the descending aorta and umbilical artery were not significantly different.

Conclusions

Reproducible fetal heart rate and velocity variability data can be derived from the descending aorta and umbilical artery. The increase in heart rate variability observed in the umbilical artery was not seen in recordings obtained from the descending aorta. Different fetal activity states may be the underlying mechanism for these heart rate variability discrepancies. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
F79Real‐time three‐dimensional fetal echocardiography
Authors: Tutschek B. , Buck T. , Reihs T. , Staiger H. F. , Henrich W. , Bender H. G. , Erbel R.
Published: March 2003

Background

Fetal echocardiography employs high resolution two‐dimensional ultrasound (2DE) to detect structural heart disease. Three‐dimensional echocardiography (3DE) using reconstruction of a series of 2D images of the fetal heart has been hampered by technical problems. Real‐time 3DE (rt3DE) acquires volume data sets rather than 2D images.

Method

The rt3DE system (Volumetrics, Durham) uses a 2.5‐MHz matrix phased‐array transducer scanning a pyramidal volume. A multipanel screen displays cross‐sectional images of the same volume in real‐time: two perpendicular 2D images that can be freely oriented throughout 3‐D space plus up to three calculated sections not obtainable by 2DE.

Results

rt3DE could visualize the fetal heart satisfactorily. Due to real‐time volumetric scanning gating with the fetal cardiac cycle was not necessary. The image quality with regard to resolution was inferior to current high end 2D machines, but is bound to improve with technology. Volumes can also include color Doppler, but at the cost of low frame rates.

Conclusion

With advancing technology volume rather than 2D data acquisition may emerge as a standard in fetal echocardiography. While examining one or two technically and physically optimized 2D views, the entire pyramidal volume surrounding these planes is acquired in real time. The dissociation of rapid data acquisition from its interpretation may be advantageous, enabling ‘virtual scanning’ for different aspects even without the patient present.
Combined ultrasound biometry, serum markers and age for Down syndrome risk estimation
Authors: Bahado‐Singh R.O. , Oz A.U. , Gomez K. , Hunter D. , Copel J. , Baumgarten A. , Mahoney M.J.
Published: March 2003

Objective To compare Down syndrome screening efficiency of the standard serum triple analyte screen to that of a four‐component screen consisting of ultrasound biometry and serum markers in the second trimester.

Methods The Down syndrome screening efficiency of the triple screen, i.e. alpha‐fetoprotein (AFP), unconjugated estriol (E3), hCG and maternal age, was compared with the four‐marker algorithm, i.e. humerus length, nuchal thickness, AFP and hCG plus maternal age. A quadrivariate Gaussian algorithm was used to calculate individual Down syndrome odds. Receiver operating characteristic (ROC) curves plotting sensitivity against false‐positive rate were constructed for each algorithm and the areas under the curves were compared to determine which was superior. Sensitivity and false‐positive rates at different Down syndrome risk thresholds were also compared.

Results There were 46 cases of Down syndrome (1.9%) with 2391 normal singleton pregnancies in a referral population in which triple screen, fetal biometry and karyotype had been done. The gestational age range for the study was 14–24 completed weeks. The median maternal age for the study group was 35.0 years (14.0–46.0 years). The areas (SE) under the ROC curves were 0.75(0.04) and 0.93(0.02) for the standard triple and the four‐marker screen, respectively (P < 0.001). At a 10% false‐positive rate, detection was 45.7% for the triple and 80.4% for the four‐marker screen.

Condusions A new algorithm combining humerus length and nuchal thickness measurement with serum AFP, hCG and maternal age substantially improved Down syndrome screening efficiency compared with the traditional triple screen. The model appears promising and should be evaluated in an independent data set.
Prenatal diagnosis of intrahepatic arteriovenous shunts
Authors: Tseng J. J. , Chou M. M. , Lee Y. H. , Ho Esther S. C.
Published: March 2003

A case of mixed intrahepatic arteriovenous shunts in a fetus diagnosed at 35 weeks' gestation is presented. Color Doppler ultrasonography in the fetal liver demonstrated complicated vascular connections fed by the hepatic arterial branches and drained into the portal and middle hepatic veins. Pulsed Doppler ultrasonography identified a high cardiac output state by the detection of increased flow velocities of the great vessels. The contribution of Doppler ultrasonography to hemodynamic changes is highlighted. The management is briefly discussed. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional targeting: a new three‐dimensional ultrasound technique to evaluate needle position during breast biopsy
Authors: Weismann C. F. , Forstner R. , Prokop E. , Rettenbacher T.
Published: March 2003

Objective

To evaluate the role of three‐dimensional (3D) ultrasound (US) following needle breast biopsy under two‐dimensional (2D) needle guidance.

Methods

A total of 188 core‐needle biopsies and 24 fine‐needle aspiration biopsies were 3D US correlated after typical ‘freehand’ US needle guidance. All cases were examined with a linear 3D US volume scanner (5–13 MHz, Voluson 530D, Medison‐Kretztechnik, Zipf, Austria). After core‐needle stroke or localization of fine needle, a 3D US data volume set was acquired and a multiplanar analysis performed. This needle position check in all three planes is called ‘3D targeting’. 66 women with a mean age of 51 years (range, 27∼80 years) showed 77 breast lesions (55 solid lesions, 22 cysts) with a mean diameter of 1.5 (range, 0.3∼5.0) cm.

Results

In 49 women with 55 solid breast lesions, 16 lesions were malignant and 39 lesions benign. In 53 solid breast lesions 188 core‐needle biopsies were performed (mean 3.6 biopsies/lesion). After core‐needle biopsy 23 lesions (16 malignant, seven benign) were surgically removed. In 22 cases final histology confirmed results of the core‐needle specimen. In one case a core‐needle specimen of a 5 mm lesion showed atypical lobular hyperplasia. The definitive histology after surgery was invasive lobular carcinoma. Twenty‐two cysts and two benign solid lesions were punctured with a fine needle followed by aspiration biopsy. The overall sensitivity of core‐needle results in this study was 94% (specificity 100%, accuracy 0.98, positive predictive value 1, negative predictive value 0.97). In 117 core‐needle strokes of benign (21) and malignant (12) lesions 3D targeting prospectively revealed 95 lesion hits, Twelve marginal lesion hits and nine out‐of‐lesion hits. In one case after the initial large core‐needle path a 5‐mm lesion was disguised by air bubbles, therefore 3D targeting failed during the second biopsy procedure.

Conclusion

3D US combined with 3D targeting technique is a reliable and objective tool demonstrating exact spatial positioning of core and fine needle during biopsy procedure. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Networking of three dimensional sonography volume data
Authors: Kratochwil A. , Lee A. , Schoisswohl A.
Published: March 2003

Three‐dimensioned (3D) sonography enables the examiner to store, instead of copies from single B‐scan planes, a volume consisting of 300 scan planes. The volume is displayed on a monitor in form of three orthogonal planes – longitudinal, axial and coronal. Translation and rotation facilitates anatomical orientation and provides any arbitrary plane within the volume to generate organ optimized scan planes. Different algorithms allow the extraction of different information such as surface, or bone structures by maximum mode, or fluid filled structures, such as vessels by the minimum mode. The volume may contain as well color information of vessels.

The digitized information is stored on a magnetic optical disc. This allows virtual scanning in absence of the patient under the same conditions as the volume was primarily stored. The volume size is dependent on different, examiner‐controlled settings. A volume may need a storage capacity between 2 and 16 MB of 8‐bit gray level information.

As such huge data sets are unsuitable for network transfer, data compression is of paramount interest. 100 stored volumes were submitted to JPEG, MPEG, and bi‐orthogonal wavelet compression. The original and compressed volumes were randomly shown on two monitors. In case of noticeable image degradation, information on the location of the original and compressed volume and the ratio of compression was read. Numerical values for proving compression fidelity as pixel error calculation and computation of square root error have been unsuitable for evaluating image degradation. The best results in recognizing image degradation were achieved by image experts. The experts disagreed on the ratio where image degradation became visible in only 4% of the volumes.

Wavelet compression ratios of 20 : 1 or 30 : 1 could be performed without discernible information reduction. The effect of volume compression is reflected both in the reduction of transfer time and in storage capacity. Transmission time for a volume of 6 MB using a normal telephone with a data flow of 56 kB/s was reduced from 14 min to 28 s at a compression rate of 30 : 1. Compression reduced storage requirements from 6 MB uncompressed to 200 kB at a compression rate of 30:1. This successful compression opens new possibilities of intra‐ and extra‐hospital and global information for 3D sonography. The key to this communication is not only volume compression, but also the fact that the 3D examination can be simulated on any PC by the developed 3D software. PACS teleradiology using digitized radiographs transmitted over standard telephone lines.

Systems in combination with the management systems of HIS and RIS are available for archiving, retrieval of images and reports and for local and global communication. This form of tele‐medicine will have an impact on cost reduction in hospitals, reduction of transport costs. On this fundament worldwide education and multi‐center studies becomes possible. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonic diagnosis of ureteral injury after laparoscopically‐assisted vaginal hysterectomy
Authors: Hung M. J. , Huang C. H. , Chou M. M. , Liu F. S. , Ho E. S. C.
Published: March 2003

Ureteral injuries are uncommon but serious complications of laparoscopically‐assisted vaginal hysterectomy. The ureter is particularly at risk for inadvertent injury when the cardinal‐uterosacral ligament complex is coagulated and divided below the uterine vessels. We present two recent cases which describe the application of transabdominal ultrasound including color Doppler mapping in the diagnosis of ureteral injury after laparoscopically‐assisted vaginal hysterectomy. Transabdominal ultrasound including color Doppler mapping has great diagnostic potential as a method for non‐invasive evaluation of post‐operative ureteral conditions. Ultrasonic triads (absence of a ureteric jet, ascites, and the presence or absence of hydronephrosis) are capable of differentiating diagnosis of complete, partial, or nonobstructive surgical ureteral injuries. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Fetal adrenal artery velocimetry measurements in appropriate‐for‐gestational age and intrauterine growth‐restricted fetuses
Authors: Tekay A. , Jouppila P.
Published: March 2003

Objective

To investigate adrenal artery blood flow in the fetus.

Design and method

Sixty‐two appropriate‐for‐gestational‐age (AGA) and 20 intrauterine growth‐restricted (IUGR) fetuses were recruited to this cross‐sectional study between 22 and 42 weeks of pregnancy in a tertiary referral fetal medicine unit of a university hospital.

Endpoints

Doppler velocimetry of the fetal adrenal, umbilical (UA), renal and middle cerebral arteries (MCA). Pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV), time‐averaged maximum velocity (TAMXV) and cerebroplacental ratio (MCA RI/UA RI; CPR). Obstetric outcome.

Results

The adrenal artery was detected in 82% of the fetuses. All flow velocity waveforms obtained from the adrenal artery indicated low impedance blood flow. No significant changes in PI, RI, PSV and TAMXV occurred with advancing gestation. The blood flow parameters of the adrenal artery did not differ between AGA and IUGR fetuses. In five IUGR fetuses with signs of redistribution of cardiac output in favor of the brain, the adrenal artery velocimetry results were unremarkable. The adrenal artery PI, RI, PSV and TAMXV values were higher in female fetuses than in male fetuses (P < 0.05). A relationship was observed between the velocity measurements and the estimated fetal weight (P < 0.01).

Conclusions

The fetal adrenal artery could be readily detected. We observed no redistribution of blood flow in favor of the fetal adrenals in IUGR fetuses which were not severely compromised. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of intrahepatic communications of the umbilical vein with atypical arteries (A–V fistulae) in two cases of trisomy 21 using color Doppler ultrasound
Authors: Hartung J. , Chaoui R. , Kalache K. , Tennstedt C. , Bollmann R.
Published: March 2003

We report on two cases of the prenatal diagnosis of arterio‐venous communication between the intra‐abdominal umbilical vein and atypical arteries. The diagnosis was made by color and spectral Doppler and ‘color power angiography’. Both cases presented with hydrops fetalis, one at 14 and the other at 31 weeks of gestation. In the first case, color Doppler demonstrated an atypical arterial vessel connecting the umbilical vein with the aorta; the ductus venosus was patent. Echocardiography showed a so‐called atrioventricular canal. In the second case, a complex intrahepatic vascular malformation was found. Color Doppler demonstrated communications between the umbilical vein and the hepatic artery and an atypical artery; the ductus venosus was patent. In the latter case polyhydramnios, duodenal atresia and macroglossia were additionally detected. In both cases, fetal karyotyping revealed trisomy 21. The first case resulted in a missed abortion, the second in a stillbirth. All findings were confirmed on autopsy.

Of interest is that both fetuses were affected with trisomy 21. The increasing use of color Doppler in prenatal diagnosis, especially in hemodynamically compromised fetuses, will help to determine the actual incidence of complex vascular malformations of the umbilical vein and to elucidate the impact of such malformations on fetal outcome. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Sono‐endoscopic delineation of the placental vascular equator prior to selective fetoscopic laser ablation in twin‐to‐twin transfusion syndrome
Authors: Thilaganathan B. , Gloeb D. J. , Sairam S. , Tekay A.
Published: March 2003

Objective

To assess the safety and efficacy of a new fetoscopic technique in the management of twin‐to‐twin transfusion syndrome.

Study design

Prospective study of fetoscopic treatment and outcome in 10 pregnancies complicated by severe twin‐to‐twin transfusion syndrome before 24 weeks' gestation. The sono‐endoscopic approach was used to identify the placental vascular equator and photocoagulate any vessels crossing this threshold.

Results

The mean gestation at treatment was 20 weeks and 3 days. An average of three to four vessels were ablated during each procedure, with a mean operative time of 24 min (range, 14–31 min). The overall survival rate was 55% (11 of 20) with at least one survivor in 70% (seven of 10) of pregnancies.

Conclusions

Fetoscopic laser ablation is a safe and effective form of treatment in the management of severe twin‐to‐twin transfusion syndrome. This technique, where vessels crossing the placental vascular equator are identified and photocoagulated fetoscopically, is an alternative to the non‐selective and selective methods described previously. This new approach is associated with a shorter operating time, less damage to the normal placental surface vasculature and with survival results that are at least as promising as previously reported techniques. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Reference values of fetal peak systolic blood flow velocity in the middle cerebral artery at 19–40 weeks of gestation
Authors: Kurmanavicius J. , Streicher A. , Wright E. M. , Wisser J. , Müller R. , Royston P. , Huch R. , Huch A. , Zimmermann R.
Published: March 2003

Objectives

The objectives of this prospective study were (i) to establish new reference values of peak systolic blood flow velocity measurement in the fetal middle cerebral artery (MCA‐PSV) following validated methodological guidelines and (ii) to develop a method to calculate Z‐scores of MCA‐PSV.

Patients and Methods

Cross‐sectional data were obtained from 331 pregnant women between 19 and 40 weeks' gestation. Reference ranges for MCA‐PSV were constructed and for each measurement linear regression models were fitted separately to the mean and standard deviations (SD) as a function of gestational age. An application to calculate Z‐scores was developed. A comparison was made between the reference ranges produced in our study and those of a previous one.

Results

A new chart, table of centiles and regression equations of MCA‐PSV are presented. Comparison of our reference ranges with ones produced in a previous study showed similar 5th centile values. However, the values for the 50th and 95th centiles between 19 and 28 gestational weeks were lower in our study.

Conclusions

We have constructed reference ranges for MCA‐PSV which, because they are derived from a larger number of examinations in the 15–20‐week period and because the methodological flaws of the previously published study have been eliminated, we consider to be more accurate and therefore more useful for clinical practice. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology