bluuebunny/crossref_metadata_2025 huggingface dataset:
Doppler ultrasonography in early pregnancy does not predict adverse pregnancy outcome
Authors: Arduini D. , Rizzo G. , Romanini C.
Published: March 2003

A transvaginal color and pulsed Doppler study was performed on 330 pregnancies at 7–16 weeks of gestation. Blood flow velocity waveforms were recorded from the main uterine arteries and their branches (arcuate and trophoblastic vessels) and from the umbilical arteries. The systolic/diastolic velocity ratio and the pulsatility index were calculated as indices of vascular resistance, respectively, at uterine and umbilical levels. A total of 282 patients had an uneventful pregnancy outcome, 19 developed an early pregnancy failure (missed abortion, n = 8; anembryonic pregnancy, n = 11) and 29 developed later complications such us hypertension (n = 10), fetal growth retardation (n = 13) or both n = 6). In normal pregnancies, Doppler‐measured vascular resistances significantly decreased with advancing gestation at the level of both uterine and umbilical circulations. When the Doppler indices of the patients with early pregnancy failure or with later complications were compared to those of normal pregnancies, no evident differences were found in either of the vascular districts considered. However, in the patients who developed hypertension and/or fetal growth retardation, abnormal velocity waveforms were frequently present in uterine and umbilical arteries during second‐ or third‐trimester examinations. Our results suggest a limited clinical value of Doppler velocimetry in early pregnancy. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Increased middle cerebral artery blood flow impedance in fetal subdural hematoma
Authors: Ben‐Chetrit A. , Anteby E. , Lavy Y. , Zacut D. , Yagel S.
Published: March 2003

This case describes the prenatal diagnosis at 30 weeks' gestation of a posterior fossa subdural hematoma. Doppler velocimetry studies of the middle cerebral artery at that time showed an abnormally high resistance pattern with reverse end‐diastolic flow. Ultrasonic assessment of the fetus indicated that there was associated quadriplegia. No cause for the lesion was demonstrated. A fetal blood sample, obtained by cordocentesis, revealed a normal karyotype. Fetal blood gas analysis was also normal. The pregnancy was terminated at the parents' request. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
The assessment of bladder neck movement in postpartum women using perineal ultrasonography
Authors: Wise B. , Cutner A. , Cardozo L. , Abbott D. , Burton G.
Published: March 2003

Twenty‐three postpartum women underwent perineal ultrasonography to determine bladder neck position at rest, on Valsalva and during pelvic floor contraction. On Valsalva, significant descent of the bladder neck and apposition to the symphysis pubis occurred. During pelvic floor contraction, there was significant elevation of the bladder neck; however, in approximately one‐third of cases no movement was demonstrated. The bladder neck was shown to move through the arc of a circle whose center is the inferior border of the symphysis pubis. Perineal ultrasound provides a simple, objective way of measuring bladder neck elevation during pelvic floor contraction. This may be a more appropriate means of determining treatment outcome, in women undergoing conservative treatment for genuine stress incontinence, than measures of vaginal squeeze pressure. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Color Doppler imaging of the uterine artery in pregnancy: normal ranges of impedance to blood flow, mean velocity and volume of flow
Authors: Bower S. , Vyas S. , Campbell S. , Nicolaides K. H.
Published: March 2003

In a cross‐sectional study of 215 healthy women with singleton pregnancies at 18–42 weeks' gestation, color Doppler imaging was used to identify the main uterine arteries for subsequent pulsed Doppler studies. Flow velocity waveforms were obtained and indices of impedance, mean blood velocity and vessel diameter were measured, and the total volume of blood flow to the uterus was calculated. Impedance to flow decreased, I whereas blood velocity and volume flow increased significantly with gestation. Furthermore, impedance to flow was lower and velocity higher in the placental uterine artery, i.e. closest to the main bulk of the placenta, than in the non‐placental artery. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Successful outcome after Nd : YAG laser separation of chorioangiopagus‐twins under sonoendoscopic control
Authors: Ville Y. , Hecher K. , Ogg D. , Warren R. , Nicolaides K.
Published: March 2003

Endoscopic laser coagulation of the chorioangiopagus was successfully performed at 25 weeks' gestation in a pregnancy presenting with acute polyhydramnios due to twin transfusion syndrome. Under local anesthesia, a rigid fetoscope housed in a 2.7 mm diameter cannula was introduced transabdominally into the amniotic cavity and the communicating vessels were coagulated by Nd : YAG laser through a fiber that was passed down the side‐arm of the cannula. There was rapid normalization of urine output in both fetuses and resolution of the oligo‐ and polyhydramnios in the donor and recipient twins, respectively. Furthermore, there was normalization in both fetal circulations, as assessed by Doppler velocimetry, and there was gradual resolution of the hydrops in the recipient. Two healthy babies were born 9 weeks after the procedure. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Fetal mild idiopathic lateral ventriculomegaly: is there a correlation with fetal trisomy?
Authors: Achiron R. , Schimmel M. , Achiron A. , Mashiach S.
Published: March 2003

Mild idiopathic lateral ventriculomegaly in the mid‐trimester fetus can be accurately detected using modern prenatal ultrasonography. Since an abnormal karyotype has been reported in some of these cases, the present prospective study was designed to evaluate, first, the prevalence of mild idiopathic lateral ventriculomegaly in the general obstetric population and, second, to determine the incidence of abnormal fetal karyotype associated with mild idiopathic lateral ventriculomegaly. Eight cases of mild idiopathic lateral ventriculomegaly (0.15%) were detected among 5400 routine prenatal sonographic examinations, between 16 and 22 weeks' gestation. Three newborn infants were found to be normal; in one baby, spontaneous resolution of the lesion occurred in utero, and, among the other five cases, two had an abnormal karyotype: one had Down's syndrome, and one trisomy 18. A review of the English literature revealed that 12% of fetuses with mild idiopathic lateral ventriculomegaly have an abnormal karyotype. Since 3% of the fetuses with Down's syndrome can be visualized in utero with mild idiopathic lateral ventriculomegaly, the calculated risk for Down's syndrome when such lesions appear is about 3%. We, therefore, conclude that karyotypic study is warranted in the mid‐trimester fetus with incidental findings of mild idiopathic lateral ventriculomegaly. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Sonography of fetal agenesis of the corpus callosum: a survey of 35 cases
Authors: Pilu G. , Sandri F. , Perolo A. , Pittalis M. C. , Grisolia G. , Cocchi G. , Foschini M. P. , Salvioli G. P. , Bovicelli L.
Published: March 2003

Agenesis of the corpus callosum was identified by ultrasound examination in 35 fetuses between 19 and 37 weeks' gestation. The ultrasound findings included absence of the corpus callosum and cavum septum pellucidum (hypoplasia in one case of partial agenesis of the corpus callosum), a typical ‘teardrop’ configuration of the lateral ventricles, distension of the interhemispheric fissure, upward displacement of the third ventricle, radiate arrangement of the medial cerebral gyri, and abnormal branching of the anterior cerebral artery. Associated anomalies were identified in 20 fetuses, including heterogeneous malformations and chromosomal aberrations (mosaic‐trisomy 8 in three, trisomy 18 in two and partial duplication 8p in one). Five cases of agenesis of the corpus callosum were identified in a population of pregnant patients prospectively investigated because of genetic risk for agenesis of the corpus callosum or related syndromes. In this group, no diagnostic errors were made. Long‐term neurological follow‐up (6 months to 11 years) was available in 11 infants with antenatal diagnosis of isolated agenesis of the corpus callosum. Normal intellectual development was present in nine, and a low intellect (developmental quotient between 70 and 85) was found in two. It is concluded that fetal agencies of the corpus callosum is associated with elusive sonographic findings that can, however, be accurately identified by targeted examinations. In routine sonograms, an increased atrial width and/or failure to visualize the cavum septum pellucidum should arise the suspicion of fetal agencies of the corpus callosum. Given the high frequency of associated anomalies, prenatal diagnosis of agencies of the corpus callosum dictates the need for a careful survey of fetal anatomy and karyotyping. The prognosis is isolated agencies of the corpus callosum remains uncertain, although it is expected that a normal or boarderline intellectual development will occur in many cases. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Detection of ovaries by transvaginal sonography in postmenopausal women
Authors: Gollub E. L. , Westhoff C. , Timor‐Tritsch I. E.
Published: March 2003

A total of 230 apparently healthy postmenopausal women underwent transvaginal sonography and pelvic examination. The mean ovarian volume was 3.1 cm³ with a range of 0.4–57.4 cm³ and fewer than 5% (4.8%) of the subjects had a mean volume exceeding two standard deviations of the sample mean. Transvaginal sonography successfully imaged 64% of reported ovaries overall, although the proportion of ovaries imaged varied by sonographer. The poorer imaging rates found in this study, as compared with some previous investigations using transabdominal sonography, could be due to several factors including the type of sonography, the type of sample, the scanning time, and/or the criteria used to identify an ovary. Transvaginal sonography offers practical advantages over transabdominal sonography, but the potential loss in sensitivity, due to non‐visualization of a substantial proportion of ovaries, must be formally assessed before adopting transvaginal sonography more widely as the primary screening modality. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Presence of pulsations and reproducibility of waveform recording in the umbilical and left portal vein in normal pregnancies
Authors: van Splunder I. P. , Huisman T. W. A. , Stijnen T. , Wladimiroff J. W.
Published: March 2003

Reproducibility and inter‐observer variability of intra‐ and extra‐abdominal umbilical venous flow velocity and left portal venous flow velocity as well as heart‐synchronous waveform pulsations in these vessels were studied in 23 women at 34–38 weeks of normal pregnancy.

Limited reproducibility, expressed by large intra‐patient coefficients and limits of agreement between two observers, was established for all standardized recording sites. Pulsations, defined as negative venous deflections of at least 10% of the mean velocity, were demonstrated at all locations ranging from 19.6% of the measurements at the free‐floating loop of the umbilical vein to 78.4% of the measurements at the left portal vein.

The present study shows that the limited reproducibility of venous flow velocity waveforms should be taken into consideration, and that the presence of pulsations can be demonstrated in normal late pregnancy. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Fetal cardiac and extracardiac flows preceding intrauterine death
Authors: Rizzo G. , Capponi A. , Pietropolli A. , Bufalino L. M. , Arduini D. , Romanini C.
Published: March 2003

Extracardiac and cardiac flow velocity waveforms were recorded in a severely growth‐retarded fetus 1 day and a few hours before fetal death. At the first scan, the typical Doppler patterns of a growth‐retarded fetus were found, but the brain‐sparing effect was lost at the last examination and a huge tricuspid insufficiency was demonstrated. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Doppler study of the uterine artery in patients using an intrauterine contraceptive device
Authors: Momtaz M. , Zayed M. , Rashid K. , Idriss O.
Published: March 2003

A Doppler flow study of the uterine artery was performed using transvaginal sonography in 68 women, including 44 using an intrauterine contraceptive device (IUCD) and 24 control women who were not using any method of contraception. Both the pulsatility index (PI) and resistance index (RI) were significantly lower in women with IUCD‐induced bleeding than in those without abnormal vaginal bleeding (p < 0.001) or in women not using any method of contraception (p < 0.001). No significant variations in PI and RI levels (p > 0.05) were found with the duration of IUCD application or the duration of IUCD‐induced bleeding in patients using the device. Also, no significant changes in blood flow indices were demonstrated between women using the device without abnormal vaginal bleeding and the control group. These preliminary results suggest that some women are more prone to develop IUCD‐induced bleeding than others, and this bleeding may be due to decreased vascular resistance in the uterine artery. Transvaginal Doppler study of the uterine artery may be a helpful technique to identify such women. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Endometrial thickness as measured by transvaginal sonography: interobserver variation
Authors: Karlsson B. , Granberg S. , Ridell B. , Wikland M.
Published: March 2003

Transvaginal sonography of the uterus has become an important tool for diagnosing endometrial pathology in women with postmenopausal bleeding. One parameter that has been claimed to be important for curly detection of endometrial pathology in this group of women is the endometrial thickness. The purpose of this study was to evaluate the reproducibility of measurements of endometrial thickness as performed by five inexperienced doctors and one doctor experienced in the transvaginal sonography technique. The endometrial thickness as measured by the experienced doctor was regarded as the ‘true measurement’, and the mean discrepancy from this true measurement was 1.5 mm for the inexperienced doctors. No endometrial pathology was found at the histopathological examination after dilatation and curettage (D & C) when the endometrial thickness was measured as ≤ 4 mm by both the inexperienced and the experienced doctors. However, there were considerable differences between the results obtained by the five inexperienced doctors. If this method is to be used for identifying those women who will not have a D & C performed, based on the findings of a thin endometrium (≤ 4 mm), training is needed in order to minimize the error. We believe that this will make measurement more accurate and it may then be used to exclude endometrial abnormality in women with postmenopausal bleeding.
Antenatal diagnosis and treatment of fetal hydrops secondary to pulmonary extralobar sequestration
Authors: Favre R. , Bettahar K. , Christmann D. , Becmeur F.
Published: March 2003

Bronchopulmonary sequestration with associated non‐immune hydrops has been previously reported with generally poor prognosis for the neonate. The vast majority of sequestrations are discovered postnatally, and less than half are correctly identified as sequestration before birth.

Until recently, treatment for pulmonary sequestration was limited to postnatal respiratory support and resection of the sequestered lung. But aggressive respiratory support does not succeed in salvaging infants with underlying pulmonary hypoplasia. In our report, we describe the antenatal treatment of pleural effusions complicated by hydrops fetalis secondary to a bronchopulmonary sequestration, successfully managed with a transthoracic catheter placement. This therapy resulted in the resolution of pleural effusion, polyhydramnios and hydrops, with a good fetal outcome.
Color Doppler imaging of the uteroplacental circulation in the middle trimester: observations on the development of a low‐resistance circulation
Authors: Fay R. A. , Ellwood D. A. , Bruce S. , Turner A.
Published: March 2003

We aimed to study the changes in the flow dynamics of the uteroplacental and umbilical circulations in the middle trimester of normal pregnancy, and establish normal ranges for indices of the Doppler flow velocity waveforms (FVWs) from both circulations at 14, 18 and 24 weeks. A longitudinal study was conducted with the use of color Doppler imaging to localize both uterine arteries and umbilical arteries and obtain FVWs from 106 healthy nulliparous women with a singleton pregnancy. Of these, 70 did not have a complicated pregnancy outcome, defined as hypertension, growth retardation, preterm delivery or perinatal death. We measured the resistance index (RI), pulsatility index (PI), systolic/diastolic (S/D) ratio and presence of early diastolic notching in both uterine arteries, and RI, PI and S/D in one umbilical artery. The results showed a fall in all measured indices of blood flow impedance in the uteroplacental and umbilical circulations and a marked reduction in the incidence of the early diastolic notch in the uterine artery FVWs during the mid‐trimester. Our conclusion was that color Doppler imaging allows for the accurate localization of both uterine and umbilical arteries. Doppler FVWs then obtained confirm the development of the low‐resistance uteroplacental and umbilical circulations in the mid‐trimester. Diastolic notching is common at 14 weeks in normal pregnancy but uncommon at 24 weeks. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Fetal umbilical cord ligation under ultrasound guidance
Authors: Lemery D. J. , Vanlieferinghen P. , Gasq M. , Finkeltin F. , Beaufrere A. M. , Beytout M.
Published: March 2003

In a patient with severe twin‐to‐twin transfusion syndrome, ultrasound‐guided umbilical cord ligation of the hydropic recipient twin was performed at 27 weeks' gestation. The procedure was successful in arresting the blood flow and was associated with improvement in the condition of the severely compromised donor fetus. At 29 weeks' gestation, premature onset of labor occurred and a healthy baby was delivered by emergency Cesarean section. This report demonstrates the feasibility of ultrasound‐guided cord ligation for selective feticide in a case of severe twin‐to‐twin transfusion syndrome. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Low β‐hCG is associated with poor prognosis in association with an embryo with positive cardiac activity
Authors: Christodoulou C. N. , Zonas C. , Loukaides T. , Maniatis A. , Giannikos L. , Giannakopoulos C. , Fassoula M.
Published: March 2003

Seven pregnancies with positive fetal heart activity and low or very low serum β‐human chorionic gonadotropin (β‐hCG) levels were investigated. The gestational age by dates was between 6 weeks 3 days and 8 weeks 4 days at the time of the first ultrasound scan and β‐hCG ranged between 282 and 10 000 mIU/ml of the Second International Standard. The crown‐rump lengths ranged between 6 and 13 mm and heart activity was always detected. Four cases were scanned because β‐hCG was lower than that expected for the gestational age; in these cases the yolk sac was present but the gestational sacs were small, with a trophoblastic ring that looked thin and subjectively seemed abnormal. The β‐hCG level was measured in the other three cases, because the gestational sacs were small and had a thin trophoblastic ring. In these cases, fetal heart activity was clearly imaged. All cases were scheduled for a repeat ultrasound scan 2 weeks later.

Three cases aborted spontaneously the following week, whereas in the other four no heart activity was detected in a repeat sonogram 2 weeks later. Low serum β‐hCG levels indicate a poor prognosis even when associated with an embryo with positive cardiac activity detected ultrasonographically. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Circadian variation in uterine artery blood flow indices during the follicular phase of the menstrual cycle
Authors: Zaidi J. , Jurkovic D. , Campbell S. , Okokon E. , Tan S. L.
Published: March 2003

We investigated for the presence of circadian variation in uterine artery blood flow indices during the fate follicular phase of the menstrual cycle. Twenty women with regular menstrual cycles underwent transvaginal color Doppler assessment of blood flow in the uterine arteries on two occasions precisely 12 h apart on the same day in the follicular phase. Ultrasound examinations were performed between 06.00 and 10.00 and repeated between 18.00 and 22.00. Indices of uterine artery blood flow included the pulsatility index (PI) and the time‐averaged maximum velocity (TAMX). The changes in PI and TAMX were related to variations in serum concentrations of estradiol and luteinizing hormone (LH).

We noted a significantly higher PI and lower TAMX in the evening compared to the morning values, p < 0.001 and p = 0.01, respectively. There was no significant change in estradiol or LH concentrations between morning and evening (p > 0.05). There appears to be a circadian rhythm in uterine artery blood flow occurring independently of these hormonal parameters. The circadian changes in PI and TAMX may be larger than the previously described effects of hormones on these parameters. The accurate interpretation of uterine artery blood flow indices should take these time‐related fluctuations into account. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Fetal lung hyperechogenicity: prenatal ultrasonographic diagnosis, natural history and neonatal outcome
Authors: Achiron R. , Strauss S. , Seidman D. S. , Lipitz S. , Mashiach S. , Goldman B.
Published: March 2003

The ultrasonographic appearance of fetal lung hyperechogenicity is most commonly associated with congenital bronchopulmonary abnormalities, such as cystic adenomatoid malformation or pulmonary lobar sequestration. Spontaneous disappearance of echogenic lung lesions has rarely been reported, mainly due to in utero resolution of cystic adenomatoid malformation. We describe four fetuses with echogenic lungs detected prenatally, none of them having been proved to have adenomatoid malformation or pulmonary sequestration of the lungs. Color Doppler sonography was used prenatally in all cases to rule out pulmonary sequestration. Three of the four fetuses showed complete resolution of the lung lesions during gestation, with normal neonatal outcome, but in one where the lesion decreased in size, intrauterine demise occurred at 28 weeks' gestation before complete resolution, and pneumonia was found at autopsy. We suggest that fetal lung hyperechogenicity may result from in utero bronchial tree obstruction with retention of mucoid fluid distal to the obstruction. With advancing gestation, in some cases the relative obstruction may be relieved, and the sonographic appearance of the lungs may return to normal. A retention of mucus in the bronchial tree should be added to the differential diagnosis of hyperechogenic lung lesions detected by antenatal ultrasound examination. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Doppler parameters of the ovarian and uterine blood circulation in ovarian hyperstimulation syndrome
Authors: Tekay A. , Martikainen H. , Jouppila P.
Published: March 2003

Nine in vitro fertilization (IVF) patients with moderate or severe ovarian hyperstimulation syndrome (OHSS) were recruited for a longitudinal study. Twenty‐four unselected, asymptomatic patients undergoing similar IVF treatment were used as controls. OHSS was diagnosed 8–13 days after oocyte retrieval. All subjects were examined with pulsed color Doppler ultrasound. The pulsatility index (PI) and the maximum peak systolic velocity of the uterine and the intra‐ovarian arterial blood flow were measured. There were no significant differences in the mean PI or the maximum peak systolic velocity of the uterine and intra‐ovarian arterial blood flow between symptomatic patients and controls during the first examination. At the resolution of symptoms, however, the mean PI of the uterine artery was significantly lower in pregnant patients with OHSS than in pregnant controls (p < 0.01). The development of the OHSS could not be explained by the circulatory conditions observed in the intra‐ovarian and uterine arteries. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Abnormalities of the intra‐abdominal fetal umbilical vein: reports of four cases and a review of the literature
Authors: Moore L. , Toi A. , Chitayat D.
Published: March 2003

Anomalies of the fetal umbilical vessels are rare, excepting single umbilical arteries which occur in 0.2–1.0% of pregnancies1. Abnormalities of the intra‐abdominal umbilical vein may be categorized into three main groups: (1) the ductus venosus is patent but the right umbilical vein persists; (2) the ductus venosus is not patent, and there is extrahepatic continuation of the umbilical vein; and (3) the umbilical vein takes a normal course but is abnormally dilated. We describe cases of each of these types of anomaly, including the first report of prenatal diagnosis of insertion of the umbilical vein into the iliac vein, and review the literature on this subject. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Is isolated second‐trimester hyperechogenic bowel a predictor of suboptimal fetal growth?
Authors: Sepulveda W. , Nicolaidis P. , Mai A. M. , Hassan J. , Fisk N. M.
Published: March 2003

Hyperechogenic bowel has been described as a normal variant in second‐trimester fetuses, but also in association with cystic fibrosis, chromosomal abnormalities, congenital infection, intestinal obstruction and intra‐amniotic bleeding. These fetuses are also at risk for poor perinatal outcome, mainly due to intrauterine growth retardation. In this report we examine the potential of ultrasonographic detection of isolated fetal hyperechogenic bowel in the second trimester as a marker of subsequent suboptimal fetal growth. Second‐trimester fetuses with hyperechogenic bowel in comparison to controls had a greater incidence of birth weight below the 10th centile (6/48, 12.5% vs. 4/l49, 2.7%, respectively; p = 0.01) and lower mean birth weight (3176 g (SD 741 vs. 3499 g (SD 493)), respectively; p = 0.001). There was no difference in the prevalence of preterm delivery in both groups (3/48, 6.3% vs. 8/149, 5.4%, respectively; p = 0.7). This study suggests that second‐trimester fetuses normally‐grown with isolated hyperechogenic bowel are at risk for suboptimal fetal growth. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Fetal echocardiography guidelines to predict survival of fetuses with ascites
Authors: Respondek M. , Kaczmarek P. , Pertyński T.
Published: March 2003

In a retrospective analysis of the standard protocols for fetal echocardiographic examination, 27 fetuses (mean gestational age 29 ± 5.4 weeks) with ascites were evaluated. Fetal cardiomegaly (increased heart area/chest area ratio), the presence or absence of atrioventricular valve regurgitation, inferior vena cava and ductus venosus Doppler flow velocity and umbilical vein pulsation were evaluated quantitatively in a group of survivors and non‐survivors. A statistically significant difference between the two groups was found for the presence of atrioventricular valve regurgitation (p = 0.003), and for cardiomegaly (p = 0.009). There was no statistical difference for the presence of abnormal venous flow and umbilical pulsation (p > 0.05). Abnormal venous Doppler flow velocities in the inferior vena cava and ductus venosus were observed more frequently than umbilical vein pulsation. The mean heart area/chest area ratios in the group of survivors and in the group of non‐survivors were 0.34 ± 0.09 and 0.48 ± 0.08, respectively (p < 0.001).

The mean gestational ages at the time of diagnosis of ascites in the groups of survivors and non‐survivors were 33 ± 3.3 weeks and 28 ± 5.1 weeks, respectively (p < 0.05); the mean gestational ages at the time of delivery were 35.6 ± 2.3 weeks and 33.3 ± 4.9 weeks, respectively (p = 0.33).

In terms of different echocardiographic features as well as the gestational age of the unborn patient with ascites, there is apparently no single indicator of a poor prognosis. Our results suggest that the prognosis is usually poor in a fetus with ascites, when cardiomegaly is detected, as well as the presence of tricuspid and mitral valve regurgitation. This is regardless of the type of venous flow and regardless of the etiology of the ascites. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Venous Doppler in the fetus with absent end‐diastolic flow in the umbilical artery
Authors: Gudmundsson S. , Tulzer G. , Huhta J. C. , Marsal K.
Published: March 2003

High perinatal mortality has been reported in association with the finding of absent end‐diastolic flow velocities in the umbilical artery. The fetus is known to centralize its circulation during hypoxemia and abnormal venous blood flow velocities have been reported in cases of heart failure and imminent asphyxia. The aim of this study was to evaluate blood flow velocities recorded with Doppler ultrasound in the umbilical vein, inferior vena cava and middle cerebral artery as predictors of survival in 17 fetuses with absent or reversed end‐diastolic flow in the umbilical artery.

There were five perinatal deaths, all having abnormal umbilical cord venous pulsations. An increased proportion of diastolic blood flow velocity in the middle cerebral artery as a sign of hypoxia was found in 12 fetuses without a relationship to perinatal mortality. An increased proportion of retrograde blood flow in the inferior vena cava was recorded in only one fetus, which died on the same day of congestive heart failure, suggesting fetal heart sparing in the remaining complicated pregnancies. The results suggest that abnormal end‐diastolic umbilical venous pulsation in the cord is a late and ominous sign of a severely compromised fetus, while abnormal blood flow velocimetry in the middle cerebral artery might be an earlier sign of fetal hypoxia, with a better prognosis. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Ovarian morphology as a predictor of hormonal values in polycystic ovary syndrome
Authors: van der Westhuizen S. , van der Spuy Z. M.
Published: March 2003

The objective of this investigation was to correlate the severity of ultrasound abnormality in the ovaries of women suspected of having the polycystic ovary syndrome (PCOS) with their endocrinopathy in an attempt to establish which anatomical abnormalities best predict endocrine dysfunction.

There were 90 patients in the study group – all suspected clinically of having PCOS – and 12 control subjects. Of the study patients, 74 were classified ultrasonically as having polycystic ovaries, whereas 16 demonstrated no ovarian abnormality.

On ultrasound examination of the ovaries, the follicular size, the number and type of distribution of follicles, ovarian volume and echogenicity of the stroma were assessed. Levels of the following serum hormones were measured: luteinizing hormone (LH), follicle stimulating hormone (FSH), estrone, estradiol, 17α‐OH‐progesterone, androstenedione, dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin and testosterone. Calculations were made using these results to obtain the LH : FSH ratio and the free androgen index.

Endocrine assessment of these 90 patients demonstrated significantly lower LH levels, lower LH : FSH ratio and lower testosterone levels in the women without ovarian abnormality, compared to those with polycystic ovaries. The women with ultrasound evidence of polycystic ovaries had high LH levels, a raised LH : FSH ratio and higher testosterone, DHEAS and androstenedione levels than the control subjects.

Although a number of multivariate regressions of biochemistry on ovarian morphology were statistically significant, ovarian morphology predicted only a small proportion of the variability in the hormone levels. Multivariate regression models predicting androstenedione and the LH : FSH ratio had the best overall fit with ovarian volume and a rosary follicular pattern as factors, but even for these variables the adjusted R2 value was very low (0.23 for androstenedione and 0.20 for the LH : FSH ratio).

It is therefore concluded that, although ovarian morphology may accurately diagnose polycystic ovaries, it does not predict the severity or presence of endocrine dysfunction. Management and prognosis must be determined on an individual basis against the background of a combination of the clinical, biochemical and ultrasound findings. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal color Doppler sonography in adnexal masses: which parameter performs best?
Authors: Alcázar J. L. , Ruiz‐Perez M. L. , Errasti T.
Published: March 2003

The aim of this study was to establish which of several commonly used parameters performs best in the evaluation of adnexal masses by transvaginal color Doppler sonography. A total of 79 adnexal masses in 73 consecutive patients were included in the study. There were 43 (58.9%) premenopausal and 30 (41.1%) postmenopausal patients. The median age was 45 years (range 20–78 years). The parameters compared were: number of vessels detected in each tumor, tumor vessel location (central vs. peripheral), peak systolic velocity (PSV), lowest resistance index (RIlowest), mean resistance index (RImean), lowest pulsatility index (PI lowest) and mean pulsatility index (PImean). Receiver operating characteristic (ROC) curves were plotted to analyze the test performance of the parameters, except for tumor vessel location, and to estimate the best cut‐off value of the parameters studied to differentiate between malignant and benign tumors. Definitive histopathological diagnosis was obtained in every case and used as the ‘gold standard’. There were 20 (25.3%) malignant and 59 (74.7%) benign masses. Color Doppler signals were detected in 100% of the malignant masses (20 out of 20) and 74.6% (44 out of 59) of the benign masses, and the difference was found to be statistically significant (p < 0.001). Tumor vessel location was central in 18 out of 20 (90%) malignant masses, whereas it was peripheral in 39 out of 44 (88.6%) benign masses. ROC analysis showed that the best cut‐off values for number of vessels, PSV, RIlowest, RImean, PIlowest and PImean were three vessels, 2.5 cm/s, 0.45, 0.55, 0.90 and 1.50, respectively. However, for all these parameters except RIlowest, there was a considerable overlap between benign, and malignant tumors, with a high false‐positive rate. In conclusion, in our experience, the parameters that performed best were the RIlowest with a cut‐off value of 0.45 (sensitivity 100%; false‐positive rate 11.4%) and central tumor vessel location (sensitivity 90%; false‐positive rate 11.4%). Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal sonographic findings associated with scimitar syndrome
Authors: Grisaru D. , Achiron R. , Lipitz S. , Yahav J. , Hegesh J. , Rotstein Z.
Published: March 2003

Scimitar syndrome is a rare congenital anomaly that consists of secondary dextroposition in situs solitus, due to right pulmonary hypoplasia. The prenatal sonographic findings of this abnormality have not been previously described. We describe early sonographic findings in a fetus that included isolated cardiac dextroposition with normal abdominal situs, hydramnios and mild narrowing of the right pulmonary artery. Postnatally, the infant developed heart failure, and a right hypoplastic lung was found. Catheterization revealed collateral supply to the right lung arising from the descending aorta and anomalous drainage of right pulmonary veins to the inferior vena cava. The diagnosis of scimitar syndrome was therefore established. A coil embolization of arterial collaterals to the right lung was performed. Scimitar syndrome should be considered in a fetus with the sonographic findings of a right shift of the mediastinal structures, an intact diaphragm and narrow right pulmonary artery. This may allow early neonatal stabilization and treatment. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
The significance of echogenic foci in the fetal heart: a prospective study of 228 cases
Authors: Simpson J. M. , Cook A. , Sharland G.
Published: March 2003

The purpose of this study was to determine the pathological significance of echogenic foci in the heart of fetuses with no other sonographic abnormalities and in the absence of other risk factors for chromosomal abnormality. A total of 228 fetuses were identified with single or multiple echogenic foci. This represents 6.9% of the total number of fetuses scanned. The most frequent finding was a single echogenic focus in the left ventricle (n = 136; 60%) but multiple foci were observed in 33%. An echogenic focus in the right ventricle occurred in 16 cases (7%). Karyotypic abnormalities were diagnosed postnatally in two fetuses. One of these fetuses, with an echogenic focus in each ventricle, had trisomy 21, and the other, with two echogenic foci in the left ventricle, had an unbalanced translocation. The vast majority of fetuses which had echogenic foci were normal, but there was a risk of karyotypic abnormality of 1%. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal detection of congenital inherited cataracts
Authors: Drysdale K. , Kyle P. M. , Sepulveda W.
Published: March 2003

In a high‐risk pregnancy for ocular defects, routine second‐trimester ultrasonography revealed a highly echogenic area within the fetal left eye with no other associated abnormalities. The diagnosis of congenital cataracts was confirmed after birth. Examination of the fetal face is an important part of prenatal ultrasonography., and visualization of the fetal eyes and lenses should be included in the routine assessment of facial anatomy. This is especially important in pregnancies at risk for congenital cataracts or for other anomalies affecting the fetal eye. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Late prenatal ultrasound features of hydrometrocolpos secondary to cloacal anomaly: case reports and review of the literature
Authors: Odibo A. O. , Turner G. W. , Borgida A. F. , Rodis J. F. , Campbell W. A.
Published: March 2003

Cloacal anomalies are extremely rare and have variable presentations. Prenatal diagnosis can be difficult especially if they present in late gestation. Here we present two cases diagnosed in the late third trimester and review the literature regarding prenatal diagnosis of cloacal anomalies. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Increased nuchal translucency thickness at l0–14 weeks of gestation as a predictor of severe twin‐to‐twin transfusion syndrome
Authors: Sebire N. J. , D'Ercole C. , Hughes K. , Carvalho M. , Nicolaides K. H.
Published: March 2003

This study examines a possible association between increased nuchal translucency thickness at 10–14 weeks of gestation in monochorionic twin pregnancies and the subsequent development of severe twin‐to‐twin transfusion syndrome (TTS). In 132 monochorionic twin pregnancies, including 16 that developed severe TTS at 15–22 weeks of gestation and 116 that did not develop TTS, crown‐rump length, nuchal translucency thickness and fetal heart rate were measured at 10–14 weeks. In those that developed severe TTS, the prevalence of nuchal translucency thickness above the 95th centile of the normal range and the inter‐twin difference in nuchal translucency thickness and fetal heart rate were significantly higher than in the non‐TTS group; there were no significant differences between the groups in the inter‐twin difference in crown‐rump length. For fetal nuchal translucency above the 95th Gentile, the positive and negative predictive values for the development of TTS were 38% and 91%, respectively; the likelihood ratios of nuchal translucency above or below the 95th centile for the development of severe TTS were 4.4 (1.8–9.7) and 0.7 (0.4–0.9), respectively. These findings demonstrate that the underlying hemodynamic changes associated with TTS may manifest as increased fetal nuchal translucency thickness at 10–l4 weeks of gestation. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Increased nuchal translucency at 10—14 weeks of gestation as a marker for major cardiac defects
Authors: Hyett J. A. , Perdu M. , Sharland G. K. , Snijders R. S. M. , Nicolaides K. H.
Published: March 2003

Screening for fetal cardiac defects is traditionally based on the ultrasonographic examination of the four‐chamber view of the fetal heart at mid‐gestation, which has been shown to identify 26% of major cardiac defects. Pathological studies in fetuses with increased nuchal translucency at 10–l4 weeks of gestation, a sonographic marker for chromosomal abnormalities, have shown an association between increased nuchal translucency and congenital abnormalities of the heart. This study reports the prevalence of cardiac defects in 1427 chromosomally normal fetuses with increased nuchal translucency thickness, and examines the potential value of this sonographic marker in screening for major cardiac defects. The diagnosis of cardiac defects was made either by postmortem examination in terminations of pregnancy and intrauterine or neonatal deaths or by clinical examination and appropriate investigations in live births. The prevalence of major cardiac defects was 17 per 1000 (24 of 1427 fetuses) and increased with translucency thickness from 5.4 per 1000 for translucency of 2.5–3.4 mm to 233 per 1000 for translucency of ≥ 5.5 mm. These findings suggest that measurement of nuchal translucency thickness at 10–l4 weeks may prove to be a useful method of screening for abnormalities of the heart and great arteries in addition to its role in screening for chromosomal defects. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
A cross‐sectional study of platelet volume in healthy normotensive women with bilateral uterine artery notches
Authors: Lees C. C. , Brown A. S. , Harrington K. F. , Beacon H. J. , Martin J. F. , Campbell S.
Published: March 2003

High uterine artery resistance characterized by bilateral notches seen on Doppler ultrasound in the second half of pregnancy is associated with an increased risk of adverse outcome related to pre‐eclampsia and intrauterine growth retardation. We sought to establish whether there was a difference in platelet volume in healthy, normotensive women with high‐resistance uterine artery Doppler findings compared to those with normal uterine artery Doppler findings.

Forty‐seven women were allocated prospectively into ‘bilateral notch’ and ‘no notch’ groups at color Doppler imaging of the uterine arteries carried out at a mean of 26 weeks' gestation. The difference in platelet volume between the two groups and the relationship of adverse outcome with raised platelet volume and high‐resistance uterine artery Doppler findings was investigated. Twenty‐three women had no evidence of uterine artery notches and 24 had bilateral uterine artery notches. Platelet volume in the women with bilateral notches was greater than in those with no notches (8.28 fl vs. 7.46 fl; p = 0.01). However, unlike high‐resistance uterine artery Doppler findings, increased platelet volume was not associated with adverse outcome.

Uterine artery Doppler flow abnormalities have not previously been studied in combination with hematological or biochemical markers. Our findings show, for the first time, that women with bilateral uterine artery notches have an increased platelet volume compared to those with normal uterine artery Doppler findings many weeks before clinical signs of pre‐eclampsia or fetal growth retardation are evident. Women with abnormal uterine artery flow at this gestation may have other cardiovasctilar and hematological differences compared to those with normal flow. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Neural tube defects in chromosomally normal and abnormal human embryos
Authors: Coerdt W. , Miller K. , Holzgreve W. , Rauskolb R. , Schwinger E. , Rehder H.
Published: March 2003

Neural tube defects (NTDs) were recognized in eight out of 91 intact embryos from spontaneous abortions and in one case of an induced abortion following prenatal diagnosis of a chromosomal disorder. Five of the nine cases showed chromosomal abnormalities. Trisomy 18 and triploidy were associated with spina bifida in three cases, trisomy 7 with parieto‐occipital encephalocele and monosomy X with spina bifida and iniencephaly in one case. A sixth anencephalic embryo in which chromosomal analysis was not performed showed a malformation pattern highly suggestive for trisomy 18. Discussion focuses on the high rate and the type of chromosomal abnormalities among spontaneously aborted NTD embryos, on the contrasting phenotype of 45,X conceptions and on the morphogenesis of the different neural tube defects in early development. In view of future early endovaginal ultrasound diagnosis, the changing morphological pattern is exemplified, and ranges from apparently hyperplastic to degenerative alterations of the exposed neural tissue. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Fetal lung volumetry by three‐dimensional ultrasound
Authors: Pöhls U.G. , Rempen A.
Published: March 2003

The aim of this study was to establish a method for determination of fetal lung volume by three‐dimensional ultrasound. The thoraces of a total of 113 fetuses (singleton pregnancies, 11–41 weeks of gestation without any signs of malformation or oligohydramnios) were examined by three‐dimensional ultrasound. Volumetric evaluation of each lung was performed in each of three perpendicular planes (six measurements in total). There were significant differences in all three measurements between the left and right lungs. Especially in the second and third trimesters, measurement of the frontal and the sagittal planes was sometimes prevented by poor imaging conditions. The scan volume was always too small for fetuses above 34 weeks. With these problems considered, nomograms of fetal lung volume for the left and the right lung were calculated. Lung volumes in the present study showed good correlation with published autopsy findings. Three‐dimensional ultrasonographic volumetry is a useful method for determining fetal lung volume and may have a role to play in the detection of pulmonary hypoplasia. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology