bluuebunny/crossref_metadata_2025 huggingface dataset:
P152Post‐cesarean sonographic evaluation of subfascial hematoma in Joel‐Cohen and pfannenstiel laparotomies: 5 years of experience
Authors: Malvasi A. , Baldini D. , Traina V.
Published: March 2003

Background

In this prospective randomized study, some elements of morbidity between Joel‐Cohen laparotomy (J.‐C.‐l.) and Pfannenstiel laparotomy (P.‐l.) have been evaluated. Using transabdominal sonography pathologic subfascial hematomas have been searched for in 258 cesarean section (c.s.) with J.‐C.l. and in 292 c.s. with P.l. We've examined 238 first c.s. (83.50%) and 47 repeat c.s. (16.49%) carried out through J.‐C.l., while 253 first c.s. (86.05%) and 39 repeat (13.26%) through P.l.

Result

The abdominal wall of the patients who underwent c.s. was examined sonographically on the 3rd and 10th postoperative day, considering anechogenic areas, with clear wall, with interior echoes, both subfascial with a diameter more than 3 centimetres long. At c.s. through J.C.l. we have observed 3 subfascial hematomas (1.75%) (2 surgical treatment) compared to 5 (2.72%) through P.l., (3 surgical treatment) with no statistical significancy. On the contrary statistically significant differences have been observed whith regard to opening and closing time of abdominal wall; 4.9 min for J.‐C.l. and 14.7 min for P.l. (P < 0.05), as all operating time.

Conclusion

In conclusion, in our clinical and sonographic experience, at first c.s. P.l. does not cause a greater formation of abdominal wall hematomas compared to J.‐C.l. as Stark refers, it is clear that surgical and anaesthesiological time lengthens, suture materials increase with P.l. At repeat c.s. stretching is not always easy, because of the cicatricial condition of the muscles besides an exaggerate manipulation of the tissues may favour subfascial hematomas. In the J.‐C.l. the subfascial‐hematoma occurs the blood invades the peritoneal cavity changing the clinical and sonographic situation compared to classic subfascial hematoma with closed peritoneum.
P19Evaluation of fetal lung maturity by the gray level histogram width
Authors: Serizawa M. , Maeda K.
Published: March 2003

Maeda has normalized gray level histogram width (GLHW) of fetal lung and liver. The fetal lung GLHW was less than 30% and smaller than the liver in 24–29 weeks. However the fetal lung GLHW was similar to the liver and over 30% after 30 weeks. We suggest this change of GLHW have relation to fetal lung maturity.

Method

The histogram was described with Aloka SSD‐1200, the 1250pixels were set at fetal lung and liver. GLHW is obtained by the histogram base length is divided by the full gray scale length. The 10 fetuses lung and liver were recorded in 24–31 weeks, and amniotic fluid samplings by transvaginal or amniocentesis were examined microbubble test. They were delivered during 1–3 days later, we diagnosed RDS or nonRDS by clinically.

Result

The GLHW of fetal lung/liver was 32.45/34.03 in 5 fetuses less than 10 microbubble rate and nonRDS (Group 1), no significant difference. The GLHW of fetal lung/liver was 30.23/34.44 in 5 fetuses over 10 microbubble rate and RDS (Group 2), significant difference (PÅÅ0.016). The fetal lung GLHW was no significant difference in group 1 and 2 (32.45/30.23) (P = 0.064), however, in the over 30 fetal lung GLHW, 5 were nonRDS and 2 were RDS, in less than 30 fetal lung GLHW, all are RDS, significant difference (P = 0.04).

Conclusion

The fetus of fetal lung GLHW is smaller than liver and less than 30 is almost RDS, the case of fetal lung GLHW is larger than liver and over 30 is almost nonRDS.
P29The effectiveness of antenatal ultrasound in the detection of facial clefts
Authors: Cash C. , Set P. , Coleman N.
Published: March 2003

Objective

The aim of this study was to assess the sensitivity and specificity of antenatal ultrasound in the detection of facial clefts in a low risk screening population.

Design

This retrospective study covered a five year period from January 1993 to December 1997. From the study of antenatal, postnatal surgical and pathological records, a complete number of second trimestre fetuses with a cleft defect was identified. Correlation was made with the routine 18–20 week anomaly ultrasound examination in order to assess accuracy of diagnosis.

Results

After necessary exclusions there were 26 fetuses with cleft defects out of 23 577 live and stillbirths. The defect was detected in 17 of these 26 cases (65%). In 12 of these 17 (70.5%) the antenatal diagnosis was completely accurate, in the remaining 5 cases part of the defect was not detected.

Conclusion

In a low risk population it is possible to detect approximately two thirds of all fetuses with a cleft lip or palate. With the increasing emphasis on clinical governance, this study helps to set an achievable standard.
P32Early prenatal diagnosis of axillary cystic limphangioma
Authors: Sancho‐Leza G. , Morales Utrillas P. , Guerra I. , Marín Mesa J. M. , Fernández Sepúlveda R.
Published: March 2003

We present the rare occurrence of a progressive fetal axillary cystic limphangioma. A 37‐year‐old woman was referred at 13 weeks' gestation for fetal karyotyping because of the maternal age. At this moment the sonographic examination revealed a single live fetus with a 30 × 23 × 27 mm right axillary multilobulated mass without colour‐flow imaging. At 15 weeks' gestation the amniocentesis was carried out. At this moment the size of the mass was 45 × 33 × 40 mm. Cytogenetic analysis revealed a normal 46, XY karyotype, At 18 weeks' gestation the ultrasound examination indicated progressive enlargement of the mass and its size was 78 × 80 × 80 mm. The patient was counselled regarding the diagnosis of limphangioma. Although the prognosis appears to be good the couple opt to terminate the pregnancy. Pathological examination confirmed the diagnosis of cystic limphangioma. The different types, the prognosis and management of the fetal limphangioma are discussed.
P45Amnioinfusion and CFM in prenatal diagnosis of bilateral renal agenesis
Authors: Ferianec V. , Holá M. , Pohlodek K.
Published: March 2003

Background

Absence of ureteral bud formation during embryogenesis causes bilateral renal agenesis and occurs approximately 1:4000–5000 births. Severe oligohydramnios causes difficulties in apparent visualization. To improve the sonographic conditions the amnioinfusion and CFM of the renal arteries permits the accurate diagnosis.

Methods

We present the case report of 18 weeks' gestation fetus. Sonography was extremely difficult because of anhydramnion, but fetal cardiac arrhythmia was confirmed and congenital renal agenesis was suspected. In order to facilitate visualization transabdominal amnioinfusion – instillation of cca 350 ml saline solution was successfully performed.

Results

After amnioinfusion fetal cardiac arrhythmia disappeared, fetal movements appeared. Amnioinfusion enhanced sonografic resolution of renal fossae, which confirmed bilateral renal agenesis and bilateral adrenal hyperplasia. CFM did not confirm renal arteriae in abdominal part of aorta.

Conclusion

Technique of transabdominal amnioinfusioin enable to define the specific cause of severe oligohydramnios or anhydramnios. Improvement in vizualisation after this procedure is very important for exact final diagnosis which can be enhanced by CFM.
P05Use of prognostic biophysical test in the prediction of spontaneous abortion risk in early pregnancy
Authors: Błaszczyk K. , Wojcieszyn M. , Łukasik A. , Biemat M. , Porqba R.
Published: March 2003

Background

The aim of the study was to introduce Prognostic Biophysical Test (PBT) in ultrasound diagnostic practice to evaluate spontaneous abortion risk in the first trimester of pregnancy. PBT consists of 3 routine USG parameters estimated together: Crown Rump Length and Yolk Sac (YS) measurement and visualization of Fetal Heart Rate (FHR).

Method

USG examination with, 7.0 MHz transvaginal Bruel & Kjaer transducer was performed in 199 pregnant women between 5 and 12 weeks of pregnancy. YS diameter and cram‐rump length were measured and compared to nomograms. FHR presence or absence was stated. PBT score was 1 point for correct value off each parameter, and 0 for incorrect one. PBT score of 3–2 points were considered to be good prognostic value, 0–1 points as poor prognostic value. PBT results were compared with pregnancy outcome.

Results

PBT allowed prediction of spontaneous abortion with a sensitivity of 97%, specificity of 67%, false positive of 33%, false negative of 3% and positive predictive value of 72%.

Conclusion

The test called by the authors PBT seems to be a simple and sensitive option in prediction of spontaneous abortion risk in the first trimester of pregnancy using ultrasound examination.
Chromosomopathies P62First trimester ultrasound measurement of nuchal translucency thickness in predicting chromosomal abnormalities. I. Normal ranges of nuchal translucency thickness
Authors: Sieroszewski P. , Suzin J. , Surkont G. , Karowicz‐Biliñska A.
Published: March 2003

Objective

1. To establish the usefulness of nuchal thickness to predict chromosomal abnormality.

I. Normal ranges of nuchal translucency thickness.

Design and methods

After evaluating detailed length of pregnancy NT was measured. We included pregnancies which resulted in healthy borned babies.

Results

715 ultrasouns exams were performed between 9 and 15 weeks of normal pregnancy. Mean NT value in 9th week was 1.37 mm, in 15th week – 3.09 mm (P < 0.005).

Conclusions

1. There is an increase in NT measurement with the progress of pregnancy.

The project is ongoing (KBN nr 4 P05E 01817 i 4 P05E 05116).
P71Isolated choroid plexus cysts: a controversial morphologic sonographic marker for chromosomal abnormalities. Our experience in seven years (1993–1999)
Authors: Totaro P. , Malvasi A. , Caringella G. , Baldini D. , Traina V. , Chiella M.
Published: March 2003

First reported by Chudleigh and colleagues in 1984 and considered ‘benign transient findings with no harmful sequelae’, an association between choroid plexus cysts and trisomy 18 was described by several following publications. Later on further studies have also suggested a significant risk for other chromosomal abnormalities, trisomy 21 in particular, so that literature data report an association between choroid plexus cysts and chromosomal abnormalities in about 8% of cases, more specifically in 1% if isolated and in 46% if associated with other malformations. As a consequence there are now different opinions on clinical significance and management, with some authors advocating karyotyping and others not. The aim of this study was to define the incidence of choroid plexus cysts in an unselected population and describe their association with aneuploidy. In the years 1993–99 a total of 10743 women from an unselected population attending a routine second‐trimester scanning were studied. Everyone underwent a detailed assessment of fetal anatomy by transabdominal sonography. In this period there were 27 fetuses in which choroid plexus cysts were the only sonographic abnormality, giving an incidence of 0.25% (in literature between 0.2 and 3.6%). Karyotyping was performed in only 12 cases, 11 normal and one trisomy 18. At birth the other 15 fetuses were normal. The incidence of aneuploidy was 3.70% (in according with literature review). We did not found association with other chromosomal abnormalities, trisomy 21 in particular. In the majority of cases the final risk remains small, but the presence of choroid plexus cysts increases the risk for aneuploidy, mainly trisomy 18. A need for further and wide studies about soft morphologic sonographic markers it’s necessary to better define their association with chromosomal abnormalities and as a consequence to better select the patients who need karyotyping, not underestimating that they appear in a large percentage of normal fetuses.

To combine all the well‐known parameters (maternal and gestational age, serum biochemical screening, soft markers and nuchal translucency) seems to be the better way to adjust the risk of trisomy 21 and that of other chromosomal abnormalities, taking their different natural history into consideration.
Second and third trimester Doppler P75Uterine artery Doppler velocimetry in low risk nulliparous women
Authors: Daskalakis G. , Paouleskou D. , Kitmirides S. , Papantoniou N. , Mesogitis S. , Antsaklis A.
Published: March 2003

Background

The aim of this study was to assess how placental position and gestational age can influence the value of a diastolic notch of the uterine arteries as a screening test for pre‐eclampsia, in a low risk population of healthy nulliparous women.

Methods

Color Doppler ultrasound was used to examine both uterine arteries in 654 healthy nulliparas at four‐weekly intervals between 20 and 32 weeks (wks). The only criterion for an abnormal result was the presence of an early diastolic notch. In each subject the placental position was also recorded.

Results

Twenty‐one out of 654 women developed pre‐eclampsia (3.2%). The sensitivity of the test becomes lower as gestational age advances and ranged from 81% at 20 wks, to 71.4% at 32 wks. In contrast the specificity and positive predictive value increase significantly. Eleven out of 12 women who delivered before 34 wks had abnormal waveforms at 24 wks. In women with a full lateral placenta the predictive value of the test was extremely low.

Conclusion

Pre‐eclampsia can be more accurately predicted if along with the presence of a notch, both gestational age and placental position are taken into account.
P78Second trimester uterine artery Doppler velocimetry in the prediction of poor perinatal outcome
Authors: Muñoz H. , Veloso D. , Leible S. , Jankelevich J. , Vonmullenbrock R. , Puga M. , Villa S.
Published: March 2003

Background

The patients with an increase of resistance of uterine arteries in second trimester has between 5 and 8 times increased the risk of presenting adverse perinatal outcome. The objective is to evaluate the utility of uterine artery Doppler velocimetry in the prediction of poor perinatal outcome.

Method

We performed a prospective study, in 512 consecutives pregnant women between 22 and 24 +6 weeks of pregnancy. Uterine artery Doppler velocimetry was done in all patients using color Doppler duplex technique. The presence of notch or resistance index over 95 centile was defined as abnormal. Adverse perinatal outcome was defined as presence of preeclampsia, intrauterine growth retardation, and preterm delivery before 34 weeks of pregnancy. For statistical analysis non parametrics test and meta analisis model was used.

Results

Uterine artery Doppler velocimetry was carried out in 512 patients, 198 was delivered. Resistance index was significantly higher in poor perinatal outcome group than in normal perinatal outcome group (Pulsatility index 1.38 vs. 0.9; P < 0.001). The relative risk of presenting adverse perinatal outcome was 3.8 times higher in patients with abnormal uterine artery Doppler velocimetry compared with those that has normal uterine artery Doppler velocimetry (ic 95%; 1.8–7.7; P < 0.0006).

Conclusion.

Uterine artery Doppler velocimetry evaluated in the second trimester of pregnancy is able to identify high risk patients of poor perinatal outcome.
P87Cardiotocography in pregnancies with absent or reversed end‐diastolic velocity in the umbilical artery: a mathematical model for estimating the probability for fetal acidosis at birth
Authors: Yamamoto R. M. , Francisco R. P. V. , Chuba C. C. , Miyadahira S. , Zugaib M.
Published: March 2003

Background

A study of cardiotocographic (CTG) variables and acidosis at birth (umbilical arterial pH < 7.20) in AREDV.

Methods

The last CTGs of 127 AREDV cases were studied. The variables analyzed by the Logistic Regression model were: baseline, accelerations, variability (variab.), sinusoidal pattern, bradycardia, late and variable (var.) decelerations (mild, moderate and severe).

Results

The maximum likelihood estimates are shown below:

Variable
Parameter  estimate
Standard  error
P
Odds  ratio

Intercept
−2.1210
2.0741
0.3065
–

GA (weeks)
0.0329
0.0654
0.6150
1.033

variab. 5–9 bpm
0.5987
0.5118
0.2421
1.820

Variab. < 5 bpm
1.9443
0.7576
0.0103
6.989

Late decel.
1.4429
0.4823
0.0028
4.233

Mild var. decel.
−0.4138
0.5239
0.4296
0.661

Mod. var. decel.
−0.2440
0.6991
0.7271
0.783

Sev. var. decel.
1.2156
0.6260
0.0522
3.372

Conclusion

The results made it possible to develop a mathematical model for estimating the probability of acidosis at birth, through the analysis of cardiotocographic variables.
P91The influence of maternal exercise on placental blood flow measured by simultaneous multigate spectral Doppler imaging (SM‐SDI)
Authors: Degani S. , Feiner B. , Leibovich Z. , Shapiro I. , Ohel G.
Published: March 2003

Objective

To evaluate the effect of maternal isometric exercise on the placental blood flow as reflected by the velocimetric indices PI and RI derived from placental arteries.

Subjects

Thirty‐four healthy women with normal singleton pregnancies between 22 and 35 weeks of gestation.

Methods

All subjects underwent an isometric handgrip exercise test. Maternal blood pressure and heart rate together with placental PI and RI were measured at rest, during the exercise and in the postexercise recovery phase. All Doppler measurements were obtained using the Simultaneous Multigate Spectral Doppler Imaging (SM‐SDI) technique, a new ultrasound modality that enables a Doppler study of multiple locations to take place within a very short time.

Results

There was a significant increase in the mean values of the maternal blood pressure and heart rate during the exercise, and a significant decline in the recovery phase. There was no significant change in the mean value of the Doppler indices throughout the examination.

Conclusion

Maternal isometric exercise of a similar degree of effort does not affect the impedance of the placental circulation.
P93Comparison of renal artery blood flow velocity waveform and renal volume in normal and growth‐retarded fetuses
Authors: Lee K. S. , Park M. Y. , Woo B. H.
Published: March 2003

Objective

The purposes of this study are to evaluate renal artery blood flow velocity waveform and renal volume in growth‐retarded fetuses compared with normal fetuses.

Method

Doppler flow velocity waveform of renal artery and renal volume measured by three‐dimensional ultrasonography were obtained in 78 normal fetuses at gestational age from 25 to 39 weeks and 18 cases of IUGR fetuses weighted below the tenth percentile at birth.

Results;

Fetal renal artery pulsatility index (PI) decreased throughout the gestational period (r = 0.703, p 0.0001). In growth‐retarded fetuses, although all of them had abnormal Doppler velocity waveform of middle cerebral artery, renal pi was not increased significantly. Fetal renal volume increased throughout the gestational period (r = 0.834, p 0.0001). and in growth‐retarded fetuses, renal volume of all was below the fifth percentile of normal fetuses.

Conclusion

Fetal renal volume measured by three‐dimensional ultrasonography may be the helpful parameter in the evaluation of growth‐retarded fetus.
P95Doppler velocimetry in M1 and M2 segments of middle cerebral artery (MCA) in prediction of fetal hypoxia in normal and growth‐restricted fetuses
Authors: Bednarek M. , Dubiel M. , Brêborowicz G. H.
Published: March 2003

Background

The aim of the study was to evaluate the prognostic value of the examination of PI of two segments of MCA in the prediction of hypoxia in normal and growth‐restricted fetuses.

Method

Doppler examination was performed in 98 normal and 64 growth‐restricted fetuses. A combined color coded pulsed Doppler and two‐dimensional real time ultrasound equipment with transabdominal 3.5 MHz transducer was used (Acuson 128XP). A fetal/neonatal hypoxia was defined as: late decelerations during the delivery, Apgar score in 5′ < 7, pH of umbilical artery below 7.15, neonatal respiratory disorders leading to artificial ventilation.

Results

The prognostic values (sensitivity, specificity, positive and negative predictive values) of PI estimated during 7 days before delivery were as follow: for M1 – 31%, 83%, 67%, 52% and for M2 34%, 88%, 75%, 55%, respectively. Using stronger criteria for the recognition of fetal/neonatal hypoxia (pH and BE of umbilical artery < 7,10 and < − 12 mmol/l, respectively) the prognostic values of PI were as follow: for M1 – 40%, 89%, 70% and 70%; for M2 – 48%, 87%, 69% and 72%, respectively.

Conclusion

PI of M1 and M2 segments of the MCA seems to be a good predictor of fetal hypoxia during the second half of pregnancy complicated by growth restriction.
P97Elevated maternal midtrimester chorionic gonadotropin is associated with fetal cerebral blood flow redistribution
Authors: Hershkovitz R. , Erez O. , Mankuta D. , Mazor M.
Published: March 2003

Background

Elevated midtrimester human chorionic gonadotropin (hCG) is associated with adverse maternal and perinatal outcome. The aims of the study were to evaluate the association between elevated hCG and fetal arterial circulation and to determine the relationship between maternal and perinatal complications and elevated hCG.

Methods

Pulsatility indices (PI) of middle cerebral artery (MCA) and umbilical artery (UA) were determined prospectively in 72 consecutive patients with abnormal maternal serum hCG (> 2.5 MoM). Each patient had between two to four US scans during pregnancy. Patients with known structural or chromosomal anomalies were excluded from the study.

Results

Out of 72 women with hCG > 2.5 MoM, 48% (35/72) had hCG > 3.5 and 24% (17/72) had. hCG levels > 4.5 MoM. MCA PI was lower in women with hCG > 4.5 MoM between 28 and 36 wks' gestation, but not between 18 and 27 wks' gestation (fig). No differences of MCA PI were found when the cutoff point of hCG was 3.5. PI of the UA was not different between the groups.

Women with hCG levels > 4.5 MoM had a higher prevalence of PIH and preeclampsia, preterm deliveries and cesarean sections in comparison to women with hCG < 4.5 MoM. Birthweight was lower and the rate of Apgar score < 7 was higher. No differences were not found with cutoff 3.5MoM.

Conclusions

Maternal midtrimester hCG > 4.5 mom is associated with cerebral blood flow redistribution and with higher rates of maternal and perinatal complications in comparison to maternal hCG of 2.5–4.5 MoM.
P98Effects of maternal betamethasone administration on fetal Doppler flow velocity waveforms
Authors: Kaehler C. , Schleußner E. , Möller A. , Möller U. , Seewald H. ‐J.
Published: March 2003

Background

To investigate the effect of maternal betamethasone administration on fetal arterial, venous and cardiac Doppler flow velocity waveforms.

Method

Patients: 13 women with singleton pregnancies considered at risk of preterm labour received an intravenous dosis of 2 × 8 mg betamethasone. Study design: Prospective study. Main outcome measures: Doppler studies were performed from the umbilical artery, middle cerebral artery, both uterine arteries, from the ductus venosus, inferior vena cava, right hepatic vein, form the av‐valves, right and left ventricular outflow tract and the ductus arteriosus before and after (30 min, 24, 48 and 72 h) betamethasone administration. Peak systolic velocities and maximum end‐diastolic velocities were recorded. Calculation of the resistance index (RI) for the arterial system, the peak velocity index for veins (PVIV) for the venous system and the E/A ratio for the av‐valves.

Results

No significant variation was noted in the Doppler measurements before and after betamethasone administration. A slight and reversible increase of the peak systolic velocity of the ductus arteriosus and the right ventricular outflow tract was observed at 30 min after betamethasone administration.

Conclusion

Betamethasone administration does not cause a significant change of the arterial, venous and intracardiac Doppler flow velocity waveforms in healthy fetuses.
WS16‐03Three‐dimensional‐ultrasound in the assessment of embryonic anatomy
Authors: Blaas H.‐G. K.
Published: March 2003

Diagnostic ultrasound in the early pregnancy deals with the recognition of normal anatomy and/or the detection of anomalies in very early viable pregnancies. There are clinical situations where the position of the embryo does not allow imaging of the optimal section of a certain organ. This is often the case with the transvaginal approach, where movements of the transducer are limited.

Deriving new 2D images by anyplane slicing is an important presentation mode of embryonic 3D ultrasound. Geometric 3D reconstructions can also be helpful for the understanding of the embryonic anatomy. High quality 2D tomograms are the prerequisite of 3D imaging of the tiny embryo and its organs. Such ultrasound tomograms can be achieved by using annular array transducers, which have a thin elevation plane due to symmetric focussing.

Examples of multiplane imaging and geometric volume reconstructions in the assessment of the embryonic anatomy will be presented, and the limitations will be discussed.
WS02‐02Management of premature rupture of the membranes by ultrasound
Authors: Rizzo G. , Capponi A. , Angelini E. , Grassi C. , Romanini C.
Published: March 2003

Objective

In pregnancies complicated by preterm premature rupture of the membranes (pPROM) there are essentially two causes of perinatal death: prematurity and lung hypoplasia. We used ultrasound to try to predict these complications.

Design and methods

The cervical length was measured by transvaginal ultrasound in 167 pregnancies complicated by pPROM < 32 weeks of gestation. Further in 20 pregnancies with pPROM before 24 weeks of gestation peripheral pulmonary artery (PPA) waveforms were recorded by Doppler technique at weekly interval until delivery and the Pulsatility Index (PI) calculated. Pregnancies were managed conservatively according to an Institutional management protocol. The occurrence of preterm delivery and pulmonary hypoplasia was evaluated and related to ultrasound findings.

Results

The cervical length at admission predicts the time interval elapsing between pPROM and delivery. Significant differences in PI values from PPA were present from 2 weeks onwards the pPROM between the fetuses who developed pulmonary hypoplasia and those with a normal outcome.

Conclusion

The measurement of the cervical length and of PPA velocity waveforms may help to establish the risk of developing prematurity and pulmonary hypoplasia in pregnancies complicated by pPROM.
WS17‐11Amniotic fluid erythropoietin concentration and cerebro‐umbilical Doppler flow ratio in diabetic pregnancies and pregnancies complicated by hypertension, pre‐eclampsia or/and intrauterine growth restriction
Authors: Stefanovic V. , Markkanen H. , Teramo K.
Published: March 2003

Subacute or chronic fetal hypoxia is associated with an increase in fetal erythropoietin (EPO) synthesis irrespective of the etiology of hypoxia. Amniotic fluid (AF) EPO level is often elevated in diabetic pregnancies (especially in macrosomic fetuses), and in pregnancies complicated by hypertension (HT), pre‐eclampsia (PE) or/and intrauterine growth restriction (IUGR). It is shown that cerebro‐umbilical arterial flow ratio (RIC/RIU) is often abnormal (less than 1) in the case of fetal hypoxia. We studied AF EPO levels in 29 diabetic pregnancies, 18 pregnancies with HT, PE or/and IUGR and 19 healthy controls. The samples were obtained during the elective amniocenteses in the case of suspected fetal hypoxia or during caesarean sections. Doppler measurements were performed not more than 24 h before amniocenesis. AF EPO levels were significantly elevated in diabetics with abnormal fetal growth (either macrosomia or IUGR) and nondiabetics with HT, PE or/and IUGR as compared with healthy controls or diabetics with normal fetal growth. AF EPO levels of fetuses with normal fetal growth in diabetic mothers were not different from those of healthy controls. There was no correlation between AF EPO levels and RIC/RIU in any of the diabetic or nondiabetic group. However, 5 fetuses had either absent end‐diastolic or reversed umbilical flow. All had elevated AF EPO levels (range 16–15 800 mU/ml). We conclude that both fetal macrosomia and IUGR in diabetic pregnancies seem to cause chronic fetal hypoxia. Normal fetal growth in diabetic pregnancies is not associated with chronic fetal hypoxia. Single measurement of RIC/RIU is of little value in the diagnosis of chronic fetal hypoxia in abnormal pregnancies.
WS18: Breast WS18‐01Ultrasounds of the breast – the role of the gynecologist
Authors: Cosmi E. V. , Cascialli G. L. , Nusiner P. , Meggiorini L. , Patella A.
Published: March 2003

Early detection of breast cancer is of paramount importance for its management. Therefore, new diagnostic tools are continously searched, including 3D‐US and 3D Power Doppler, and for later management, the study of the sentinel node.

3D ultrasonography (3‐D US) may be of value in the differential diagnosis of the following conditions.

Cysts

Not all cysts display a typical US appearance. Small cysts may lack the distal sound enhancement. Inflammatory cysts may exhibit a thickened wall. However, the major problem it the not so rare presence of intracystic echoes, which may be either real or artifactual.

Fibroadenomas

A refraction artifact (edge shadowing) is often noted at each lateral margin of smooth‐marginated fibroadenomas. Contours are irregular in about 25% of cases, and in about 5% shadowing makes it impossible to rule out malignancy.

Carcinomas

Shadowing is associated only with those carcinomas that have a significant amount of fibrosis (< 50% of cases in our experience). Some partial shadowing seen with some carcinomas may also be caused by beam scattering by jagged margins, with 3D scan potentially useful for diagnosis. The sentinel node. Axillary lymph node status is the most important pathological determinant of prognosis in early breast cancer, whereas local axillary lynphadenectomy is the most reliable staging procedure. However, routine axillary dissection does not benefit the majority of patients with early breast cancer who are node‐negative, thereby sustaining the potential morbidity of the procedure. Sentinel node is the first regional node to receive lymph from the breast and accurately represents the metastatic status of the primary cancer. Sentinel node biopsy appears to offer an alternative to routine axillary lymph node dissection for staging patients with breast cancer. (Supported in part my MURST and CNR, Italy)
WS18‐02Modern breast ultrasound
Authors: Hackeloer B.‐Joackhim
Published: March 2003

Development during the past 5 years increased significantly the quality of ultrasound mammography. After trying to receive better image quality by using higher and higher frequencies up to 20 Mhz the todays breakthrough was reached by better scan converter and transducer technology. Broadband tranducers, harmonic imaging, Siescape, Angio‐powerdoppler, SonoCT, 3‐D imaging and the use of contrast agent improved not only image but diagnostic quality of the method. The better scin, nipple, ductal an microcalcification visualization in combination with better mass delineation allowed a diagnostic accuracy equally or better than X‐ray mammography. Ultrasound mammography is the logical examination following breast palpation, can complement mammography in all patients, substitute too frequent mammography controls and save unnecessary MRIs. Unfortunately the method suffers from lack of qualified education & training, qualified users and qualified payment. Gynecologists, radiologists and surgeons should struggle together to establish the method in a appropriate way – in the interest of all women.
WS03‐05Ultrasound based simplified infertility investigation
Authors: Granberg S. , Hauge K. , Flo K. , Riedhart M.
Published: March 2003

Objectives

To compare the use a simplified ultrasound based infertility investigation of the infertile couple with the current use of laparoscopy and hysteroscopy.

Study design

Thirty‐three infertile couples underwent transvaginal ultrasound and hystero‐salpingo‐contrast‐sonography. A diagnosis was formulated based on the results of the ultrasound investigations, a semen analysis and endocrine parameters. The following day all subjects underwent a laparoscopic chrompertubation and hysteroscopy by a surgeon unaware of the ultrasound findings. A diagnosis based on the findings at laparoscopy and hysteroscopy, the same semen analysis and endocrine parameters, was then made. The two diagnoses were compared.

Results

A 90.9% agreement was found between the diagnoses made from the two methods used. When considering laparoscopic diagnosis the Gold Standard of tubal patency, the sensitivity to diagnose occluded tubes using hystero‐contrast‐sonography was 92.8%. The corresponding figures for specificity, PPV and NPV were 96.2%, 92.8% and 98.1%, respectively.

Conclusions

A simple, ultrasound based approach to investigate the infertile couple, can be used effectively as an initial examination modality during the couple's work‐up. However, there is a need for a larger study to confirm these results.
WS01‐02Color Doppler in the diagnosis of fetal malformations
Authors: Margulies N. D.
Published: March 2003

The color and Power Doppler gives us the opportunity to investigate the vascular anatomy as an angiography and furthermore lets us ‘see’ hydro jets. This singular ability leads us to make some diagnosis and confirm others.

During this lecture we will show our experience in the diagnosis of some fetal anomalies such as renal agenesis, urachal cysts, megacystis microcolon Hypoperistalsis syndrome, renal displasia, Galeno vein aneurysm, anterior wall defects such as omphalocele and gastroschisis, diaphragmatic hernia, duodenal atresia, coartation of the aorta, single umbilical artery Dandy Walker Malformation, and some fetal tumors.
WS05‐02Sonohysterography in patient treated with SERMs
Authors: Fleischer A. C.
Published: March 2003

Sonohysterography (SHG) is an established method for detection of polyps, evaluation of submucosal intracavitary fibroids and adhesions as well as abnormal areas of endometrial thickening. This presentation will describe SHG findings for evaluation of punctate cysts both within and adjacent to the endometrium seen in women on selective estrogen receptor modulators (SERMS) Tamoxifen®, and Roloxifene®. The clinical significance of these findings will be discussed. Cystic endometrial atrophy and focal adenomyosis of patients receiving SERMS may the histologic correlate of abnormal sonographic appearances.
WS06‐06A novel sonographic approach to the fetal echocardiogram
Authors: Bronshtein M.
Published: March 2003

At present there are four concepts guiding the sonographic examination of the fetal heart: (1) the fetal echocardiogram (FEC) is difficult to perform and time‐consuming, (2) FEC should be performed only in high risk pregnancies, (3) the optimal time to perform FEC is 18–22 weeks gestation, (4) FEC relies on several sonographic still views. In our lecture, we will present a new systemic ‘video’ approach to the great vessels and the four chambers in early pregnancy using transvaginal sonography.

Transvaginal ultrasound examination of the cardiovascular system was performed in 36 323 consecutive fetuses using a dynamic ‘video’ multidirectional approach. Cardiovascular anomalies were detected in 173 fetuses giving an overall incidence of 1 in 210 pregnancies and 1 in 238 low‐risk pregnancies. Fifty‐six percent of the fetuses had associated anomalies. The prenatal diagnosis was confirmed in 90 cases. In 10 fetuses a different cardiac anomaly was observed. In four fetuses the cardiovascular anomaly was not detected in early pregnancy. In the remaining cases, postmortem examination was not performed. Early fetal heart examination is suggested in all pregnancies.

Conclusions

Fetal ECC should be performed: (a) transvaginally, (b) in early pregnancy (14–16 weeks), (c) in every pregnancy , (d) using the video multidirectional approach.
WS06‐09Prenatal detection of congenital heart disease: the need for a cost‐effectiveness analysis
Authors: Paladini D. , Teodoro A. , Lamberti A. , Arienzo M. , Martinelli P.
Published: March 2003

Background

Recent reports have shown a significantly improved survival for complex congenital heart disease (CHD) when detected antenatally. This has further substantiated the need to detect CHD in utero. Since the performance of the 4‐chamber view as a screening tool is rather insufficient, the issue is now to find more effective and not too expensive alternative methods to reach this aim.

Method

The cost‐effectiveness analysis (CEA) is an efficient method to assess health outcomes and resource costs of health interventions. We have applied this tool to prenatal detection of CHD, comparing 3 models: (1) 4‐chamber view at level I; (2) outflow tracts at level I; (3) Outflow tracts at level II. To perform the analysis we have made the following assumptions: (1) the incidence of CHD at 20 weeks is 10/1000; (2) the percentage of severe CHD is 40%; (3) the monthly salary are 2500 USD and 3500 USD for level I and level II operators, respectively; (4) detection rate for CHD detectable on the 4‐chamber view and on outflows only are 35%/20%, 60%/60%, and 90%/90% for the three options (level I 4‐chamber, level I outflows, level II outflows).

Results and conclusions

Based on the forementioned assumptions, the costs for (1) a diagnosis of CHD; (2) a diagnosis of severe CHD; (3) TOP of any CHD; TOP of a severe CHD are reported below. These results, which were also submitted to sensitivity analyses, will be discussed.

Costs

Outcome
Level I 4‐ch.
Level I  Outflows
Level II  Outflows

Det. Any CHD
1796 USD
1157 USD
324 USD

Det Severe CHD
6510 USD
2894 USD
810 USD

TOP Any CHD
5314 USD
2893 USD
810 USD

TOP Severe CHD
9300 USD
4133 USD
1157 USD
WS08‐02Three‐level view (TLV) of fetal brain imaging in the prenatal diagnosis of congenital anomalies
Authors: Goldstein I. , Reece E.
Published: March 2003

The purpose of this study was to determine whether a systematic stream‐lined approach could be routinely used in the evaluation of the fetal intracranal anatomy, and which could be used to effectively and efficiently exclude all major intracranial malformation.

Three planes were determined to be independent without overlay. Following the establishment of these three independent oblique planes across the intracranial anatomy, there were applied clinically to determine whether such planes would be sufficient to diagnose the major intracranial abnormalities.

After retrospectively examining the various imaging levels taken, it was independently determined that three levels of intracranial imaging provided the greatest anatomic view of the entire fetal brain: the lateral ventricular level (Level I); the medial‐thalamic level (Level II); and the inferior‐posterior fossa view (Level III).

We examined 131 cases of intracranial abnormalities that were prenatally diagnosed between 14 and 24 weeks gestation. One investigator was given the three‐level view protocol to determine if the anomalies could be identified using this system. It was determined that, of the 131 abnormal cases, 126 (96.2%) were diagnosed using Levels I, II or III, independently or in combination. There were no false‐positive test results.

The present study investigated the efficacy of a three level view (TLV) imaging of the fetal brain representing a complete 2‐D examination. We found this approach to be applicable throughout pregnancy and suitable for visualization of normal intracranial structures as well as the identification of abnormalities.
WS08‐03Prenatal diagnosis of congenital and acquired brain abnormality
Authors: Pooh R. K.
Published: March 2003

The intrauterine development of the central nervous system (CNS) is one of the most interesting fields in perinatology. The brain has three‐dimensional structure and rapidly changes its appearance during pregnancy. Therefore, the fetal brain should be evaluated three‐dimensionally with consideration of gestational age.

Sonoembryology has been established by high‐frequency transvaginal sonography. Premature brain structure and ventricular system of early fetuses can be clearly demonstrated and prenatal diagnosis of congenital anomalies has been done earlier and earlier. Application of transvaginal approach to the fetal brain in the second and third trimesters has enabled brain imaging from fetal parietal direction through fontanelles and cranial sutures, and ‘neurosonography’ has been established. Recent introduction of 3D ultrasound in neurosonography produced skull imaging, serial parallel images of the brain structure, volume extraction of target organ and brain circulatory images. Furthermore, advanced technology of magnetic resonance imaging (MRI) can demonstrate CNS morphology including the brain stem, which is not clearly depicted by sonography. By using all those technologies, prenatal diagnosis of CNS abnormalities has been more objective and accurate. Intracranial changes in cases with CNS anomalies have been objectively demonstrated in vivo. Furthermore, intrauterine acquired brain damage such as periventricular leukomalacia, which is one of the controversial issues in perinatology, has been proven by sonography in a few cases. Further case studies will be required for investigation of CNS pathology in utero.
WS01‐05Genitourinary anomalies – is there anything new?
Authors: Meizner I.
Published: March 2003

Background

Ultrasound malformations of the fetal genitourinary tract are well documented in the sonographic literature. However, we would like to report on some specific observations. These will include a survey of fetal pelvic kidneys, an association between single umbilical artery (SUA) and absence of one of the kidneys, and the ‘Tulip sign’– an ultrasonic marker for severe penoscrotal hypospadias.

Method

All records of patients with ectopic kidneys over a 5‐year period (1995–99) have been perused. Sonographic parameters of ectopic kidney have been evaluated.

The same was done for cases of SUA and agenesis of one kidney and for cases with severe penoscrotal hypospadias.

Results

Pelvic kidney was diagnosed prenatally in 35 cases, of which, bilateral pelvic kidney was detected in 2 cases. There was no predilection for fetal gender, and no tendency to side of appearance. Most cases were diagnosed in late 2nd trimester of pregnancy. The association of SUA and absent kidney was detected in 6 cases. In all cases the diagnosis was made in the 2nd trimester of pregnancy. In 6 cases, the specific ‘Tulip sign’ was detected prenatally and proven postnatally.

Conclusions

Unique presentations of renal anomalies can be detected prenatally. Pelvic kidney is easily dealt with, however, the association of SUA and absent kidney requires further evaluation of the fetus to exclude the VATER association. The ‘Tulip sign’ is helpful in diagnosing severe hypospadias.
WS08‐06Fetal hemodynamics, hypoxia index and brain damage
Authors: Salihagić A. , Jugović D. , Tumbri J. , Latin V. , Kos M. , Kurjak A. , Arbeille P. H.
Published: March 2003

Objective

To estimate the value of a new vascular score, hypoxia index (HI), in prediction of functional and/or structural brain lesions caused by fetal hypoxia and to examine the relationship between this index, Doppler cerebral‐umbilical ratio (C/U) and neonatal neurosonography in growth retarded and hypoxia fetuses.

Study design

In the prospective study 41 growth retarded fetuses were included from 29 to 40 weeks of gestation. Flow velocity waveforms the umbilical and middle cerebral arteries were recorded each other day, at least two weeks. The C/U ratio and HI were calculated. After the birth, obstetric parameters and ultrasound of neonatal brain were used as outcome parameters.

Results

Doppler C/U ratio < 1 as well as HI > 150 were associated with poor perinatal outcome. The neonatal brain damage was detected in 16 growth‐retarded and hypoxic fetuses. Hypoxia index had greater statistic significance in the prediction of neonatal brain lesions. Also, specificity and sensitivity of HI was better than the last value of C/U ratio measured before delivery.

Conclusions

The C/U ratio and HI represent the best indicators for early detecting and assessment of fetal hypoxia. Furthermore, they may also be parameters for the prediction of poor neurological outcome in pregnancies with growth retardation. So, the use of HI would represent a significant advance in prevention of hypoxic brain lesions, which are one of the most frequent causes of perinatal morbidity and mortality.
WS09‐02Ultrasound diagnosis of adnexal masses
Authors: Valentin L.
Published: March 2003

The basis of ultrasound diagnosis of adnexal masses is the gray scale ultrasound image. In our prospective study of 173 patients scheduled for laparotomy because of an adnexal mass, an experienced examiner correctly discriminated between benign and malignant masses in 95% of cases on the basis of subjective evaluation of the gray scale ultrasound image (sensitivity 92%, i.e. 22/24, specificity 96%, i.e. 143/149). A correct specific diagnosis (e.g. dermoid cyst, endometrioma, etc.) was made in 72 of the 173 women, i.e. in 42%. Adding Doppler ultrasound examination to gray scale imaging did not change the diagnostic accuracy, but it increased the confidence (as rated on a visual analogue scale) with which a correct diagnosis was made in 14% of cases. Increased diagnostic confidence was observed most often in stage I ovarian malignancies (83%, i.e. 5/6). Doppler ultrasound examination was not helpfull in the diagnosis of borderline tumors. For less experienced ultrasound examiners the use of mathematical models to calculate an individual risk of malignancy might be an alternative to subjective evaluation of the the gray scale ultrasound image. In a study of 136 consecutive women scheduled for laparotomy because of an adnexal mass, two mathematical formulas were cross‐validated prospectively: that of Tailor et al. (Ultrasound in Obstetrics and Gynecology 1997; 10 : 41–7) and that of Timmermann et al. (Am J Obstet Gynecol 1999; 181: 157–65). Both models performed less well than in the studies where they were created, the sensitivity and specificity of the first model being 71% and 82%, respectively, and the sensitivity and specificity of the second model 72% and 68%, respectively.

Conclusion

Subjective evaluation of the gray scale ultrasound image is an excellent method for discrimination between benign and malignant adnexal masses. Mathematical models hold promise but must be fine tuned on the basis of information from a very large number of tumors.