bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of placenta accreta using transvaginal sonography and color Doppler imaging
Authors: Lerner J. P. , Deane S. , Timor‐Tritsch I. E.
Published: March 2003

The safe use of transvaginal sonography in patients with placenta previa has been confirmed, and has revolutionized precise placental localization. The aim of our study was to evaluate the efficacy of transvaginal sonography and color‐coded blood flow in the prediction of placenta accreta. Twenty‐one patients with persistent placenta previa were scanned using transvaginal sonography and color‐coded flow. Suspicion for placenta accreta consisted of total placenta previa at term with several placental lacunae exhibiting marked or turbulent blood flow, as seen with color Doppler transvaginal sonography from within the placenta, extending into the surrounding tissues. Five of the patients exhibited sonographic placental patterns suspicious for placenta accreta and one patient exhibited placental and cervical blood flow described as lacunar. Five Cesarean hysterectomies were performed for placenta accreta. Every placenta accreta was correctly diagnosed sonographically by the use of color flow studies. One patient with suspicion of placenta accreta delivered at another institution, a Cesarean hysterectomy was performed, and the pathology was confirmed. The one placenta previa exhibiting turbulent lacunar flow in the cervical area only was not confirmed to be an accreta at Cesarean section, although hemostasis was difficult at the placental bed. The remaining 15 patients with placenta previa and who on sonography were not suspicious for placenta accreta underwent uncomplicated Cesarean section. Transvaginal sonography and color Doppler imaging improve the diagnostic accuracy in the prediction of placenta accreta in patients with persistent placenta previa. A pattern of turbulent blood flow extending from the placenta into the surrounding tissues should alert the physician to the possibility of placenta accreta. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Spontaneous regression of fetal pulmonary sequestration
Authors: Lunger B. , Donato L. , Riethmuller C. , Becmeur F. , Dreyfus M. , Favre R. , Schlaeder G.
Published: March 2003

The prenatal diagnosis of pulmonary sequestration can usually be made by the third trimester of pregnancy, from the combination of an intrathoracic mass and indirect signs such as cardiac deviation, fetal hydrops, pleural effusion and polyhydramnios. We describe four cases in which pulmonary hyperechogenicity was detected before 26 weeks' gestation. In three cases the hyperechogenic mass was isolated. In all cases it had mostly regressed during the pregnancy. A review of the cases of isolated pulmonary sequestration that have been diagnosed during the antenatal period is presented. Antenatal evolution was found to be unpredictable regardless of the type or severity of the case at the first diagnosis. We propose a classification to define more clearly the optimal management of pulmonary sequestration. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Endometrial assessment by transvaginal sonography and histological findings after D & C in women with postmenopausal bleeding
Authors: Conoscenti G. , Meir Y. J. , Fischer‐Tamaro L. , Maieron A. , Natale R. , D'Ottavio G. , Rustico M. , Mandruzzato G.
Published: March 2003

A total of 149 women with postmenopausal bleeding underwent transvaginal sonography, hysteroscopy and dilatation and curettage in order to study the diagnostic accuracy of several ultrasound parameters in assessing endometrial pathology and to determine the most sensitive cut‐off value of endometrial thickness for the exclusion of endometrial lesions. In distinguishing pathological from normal endometrium, transvaginal sonography showed a sensitivity of 69.3%, specificity of 82.7%, positive predictive value of 74.1% and negative predictive value of 72.1%. In detecting premalignant and malignant endometrial pathology, transvaginal sonography showed a sensitivity, specificity, positive predictive value and negative predictive value of 55%, 96.1%, 68.7% and 93.2%, respectively. Considering endometrial thickness as a single parameter, the most sensitive cut‐off for defining normality was 4 mm; nevertheless, in the group of patients that had an endometrial thickness less than 4 mm, there was one case of malignancy (sensitivity, 95.2%, specificity, 49.4%; positive predictive value, 57.3%; and negative predictive value, 93.5%). Transvaginal sonography combined evaluation (morphology, thickness and color Doppler) showed a poor diagnostic accuracy in detecting endometrial pathology and in differentiating between endometrial benign lesions, endometrial polyps and adenocarcinoma in women with postmenopausal bleeding. Endometrial thickness evaluated with transvaginal sonography was preferable but not sensitive enough to exclude endometrial pathology. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Fetal heart screening in low‐risk pregnancies
Authors: Rustico M. A. , Benettoni A. , D'Ottavio G. , Maieron A. , Fischer‐Tamaro I. , Conoscenti G. , Meir Y. , Montesano M. , Cattaneo A. , Mandruzzato G.
Published: March 2003

The aim of this study was to assess whether a screening program for fetal cardiac malformations is justified in a low‐risk population, and which factors influence its accuracy. The fetal heart was evaluated in 7024 pregnant women at 20–22 weeks, and evaluation was repeated at a more advanced gestational age in 9% of cases. Cardiological follow‐up was continued postnatally until 2 years of age. The overall prevalence of cardiac anomaly was 0.93% The incidences of major and minor defects were 0.44% and 0.48%, respectively. There were 23 true positives (0.33%). in 20 cases, the diagnosis was made in the second trimester, and 13 women (6.5%) chose termination of pregnancy. Seventeen of the 20 cases identified in the second trimester were serious malformations. There were 42 false negatives (0.60%). Of these, 12 had signs of cardiac dysfunction at birth or within the 1st month of life, and three of them died as a result of their cardiac anomaly. There were eight false positives (0.11%), all of a minor type. Six abnormal karyotypes, out of a total of 21 performed in the true‐positive group (28.5%) were found. In addition five of 42 newborns in the false‐negative group had trisomy 21. The overall sensitivity was 35.4% and 61.3% for major defects. The accuracy in two distinct periods was estimated because the level of experience of the operators was different: sensitivity was 45.2% in period 1 (1986–88) (77.8% for major defects) and 26.5% in period 2 (1989–92) (52.9% for major defects). We conclude that a fetal heart screening program in the obstetrics population is justified. It defines a high‐risk group for karyotyping, allows planning of delivery in a tertiary center or the choice of terminating the pregnancy for the parents and appears to have a positive cost‐benefit ratio. A crucial factor is the level of training and experience of the operators, who need specific teaching support. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Screening for chromosomal abnormalities in an unselected population by fetal nuchal translucency
Authors: Hafner E. , Schuchter K. , Philipp K.
Published: March 2003

The aim of this prospective study was to examine the value of nuchal translucency measurement for the detection of fetal aneuploidies in an unselected population of an Austrian National Health Service hospital. A total of 1972 women with singleton pregnancies who attended at 10–13 weeks for the initiation of routine antenatal care at our hospital were examined. Chromosomal abnormalities were found in 11 fetuses, four of them with Down's syndrome. Eight of the 11 chromosomally abnormal fetuses, including two of the four with Down's syndrome, were detected by a nuchal translucency thickness of ≥ 2.5 mm. Three of the fetuses with abnormal karyotype had a nuchal translucency thickness of < 2.5 mm. Two of these were fetuses with Down's syndrome, one of which was identified by karyotyping for maternal age, the second one by positive biochemistry testing (triple test). The additional chromosomal abnormality was identified by karyotyping for maternal age. These data suggest that nuchal translucency screening for aneuploidies is efficient even in an unselected population. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Cerebral hemodynamics in pre‐eclampsia/eclampsia syndrome
Authors: Zunker P. , Ley‐Pozo J. , Louwen F. , Schuierer G. , Holzgreve W. , Ringelstein E. B.
Published: March 2003

Pre‐eclampsia and eclampsia represent a syndrome with progressive pregnancy‐induced hypertension. They are associated with considerable morbidity and mortality. The pre‐eclampsia/eclampsia syndrome has been hypothesized to reflect a subtype of hypertensive encephalopathy. Additionally, an endothelial dysfunction with impaired cerebral autoregulation has been proposed. Neurological symptoms in hypertensive encephalopathy have been attributed to marked vasospasm or forced vasodilatation. This study was undertaken to evaluate the changes in cerebral hemodynamics due to this syndrome.

Twelve patients with pre‐eclampsia/eclampsia syndrome, five of them with a concomitant syndrome involving hemolysis, elevated liver enzymes and low platelets (HELLP syndrome), were investigated. Mean blood flow velocities of the middle, anterior and posterior cerebral arteries were assessed bilaterally by means of a 2‐MHZ, pulsed Doppler ultrasound device. After the initial diagnosis, follow‐up examinations were performed twice a week until delivery, and then weekly over a 4‐week period postpartum.

Intracranial arterial blood flow velocities were elevated in ten out of 12 patients. Values of up to twice the normal flow velocities were observed in individual cases. Flow velocities correlated with the systemic arterial blood pressure (r = 0.75, p = 0.008). Eight patients showed pathologically increased flow velocities despite a mean arterial blood pressure below 150 mmHg.

Our preliminary findings suggest that a forced vasodilatation, probably due to passive overdistension of cerebral arterioles and vasogenic edema rather than vasospasm, is responsible for the observed high cerebral flow velocities. We hypothesize that endothelial dysfunction plays a crucial role in the altered cerebral hemodynamics in the pre‐eclampsia/ eclampsia syndrome. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Demonstration of fetal coronary blood flow by color‐coded and pulsed wave Doppler sonography: a possible indicator of severe compromise and impending demise in intrauterine growth retardation
Authors: Gembruch U. , Baschat A. A.
Published: March 2003

We report four cases of uteroplacental insufficiency with severe intrauterine growth retardation in which coronary blood flow was demonstrated by means of color‐coded and pulsed wave Doppler sonography. Intrauterine fetal compromise was indicated by pathological uterine and umbilical flow indices and decreased impedance in the cerebral vasculature. Later, this was followed by normalization of middle cerebral artery Doppler indices in one case. The latter change was associated with abnormal atrial systolic reverse blood flow initially in the inferior vena cava, then in the ductus venosus and finally resulting in pulsatile flow in the umbilical vein. In the late stage of fetal deterioration pulsatile flow in the umbilical vein was replaced by a biphasic flow pattern. In two cases coronary flow was visualized preceding intrauterine fetal death. In the two other cases a severely growth retarded newborn was delivered by Cesarean section. The postnatal course was complicated by a prolonged period of circulatory insufficiency and renal failure and in one case by a persistent ductus arteriosus.

Visualization of fetal coronary blood flow in severe uteroplacental insufficiency could be a preterminal event when urgent delivery may be warranted. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Acute appendicitis: diagnosis by transvaginal sonography
Authors: Caspi B. , Weissman A. , Pfefferman R. , Appleman Z.
Published: March 2003

We present a case of a female patient with right lower quadrant abdominal pain, in whom transvaginal ultrasound facilitated the diagnosis of acute appendicitis. The insertion of the appendix into the cecum was demonstrated with direct continuity between the cecal lumen and the appendix. The inflamed appendix was in close proximity to the right ovary and was distinguished by a thick edematous wall and fluid in the lumen. This combination of findings may comprise a new sonographic sign for the diagnosis of acute appendicitis, particularly when performed by transvaginal sonography. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Prognostic significance of antenatally detected fetal pyelectasis
Authors: Ouzounian J. G. , Castro M. A. , Fresquez M. , Al‐Sulyman O. M. , Kovacs B. W.
Published: March 2003

In order to evaluate the prognostic significance of ultra‐sonographically detected fetal pyelectasis, a retrospective review was performed of patients evaluated for fetal pyelectasis over a 24‐month period.

From 84 patients a total of 98 fetal kidneys with pyelectasis were identified. Fetal pyelectasis was more common in the left kidney and in males. Postpartum evaluation revealed 48 (57.1%) neonates with hydronephrosis. Among these, mean (SD; range) values of antenatal fetal pyelectasis were 17.0 mm (8.4; 5–26) before 33 weeks and 16.9 mm (8.5; 5–34) after 33 weeks in the left kidney and 15.4 mm (3.3; 10–24) and 17.1 mm (5.1; 5–36), respectively, in the right kidney. Thirteen infants (15.4%) with hydronephrosis required surgical pyeloplasties (mean age 6 months; range 3–18 months). It was found, from a receiver‐operating characteristic curve, that fetal pyelectasis of 8 mm was 91% sensitive and 72% specific in predicting subsequent hydronephrosis. Use of a threshold of 5 mm yielded a sensitivity of 100% and a specificity of 24%. On the basis of these findings, we recommend that women with ultrasonographically detected antenatal fetal pyelectasis of ≥ 5 mm at any gestational age have follow‐up ultra‐sound examinations and detailed postnatal evaluation. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Adrenal artery velocity waveforms in the appropriate and small‐for‐gestational‐age fetus
Authors: Mari G. , Uerpairojkit B. , Abuhamad A. Z. , Copel J. A.
Published: March 2003

The purpose of this study was to compare adrenal artery flow velocity waveforms in the appropriately grown and the small‐for‐gestational‐age fetus.

Adrenal artery flow velocity waveforms were prospectively obtained from 131 appropriate‐ and 21 small‐for‐gestational‐age fetuses with pulsed Doppler ultrasonography. The success rate in recording the adrenal artery was 84% (131/155) and 100% in the appropriate‐ and small‐for‐gestational‐age fetuses, respectively. The pulsatility index (PI) was used to quantify the waveforms.

The PI in the appropriate‐for‐gestational‐age fetuses decreased linearly with gestational age (PI = 1.7 − 0.016 × gestational age). In ten small‐for‐gestational‐age fetuses the adrenal artery PI was below the 95% confidence interval. Small‐for‐gestational‐age fetuses with abnormal adrenal artery PI had a significantly higher incidence of fetal heart rate decelerations, preterm delivery and Cesarean sections when compared to small‐for‐gestational‐age fetuses with normal adrenal artery PI.

Our data indicate that the PI of the adrenal artery in the normal fetus decreases with advancing gestation, and they suggest that in the small‐for‐gestational‐age fetus there is an increased blood flow to the adrenal gland. We postulate that management of the small‐for‐gestational‐age fetus may be aided by the study of the adrenal artery flow velocity waveforms. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Demonstration of fetal coronary blood flow by Doppler ultrasound in relation to arterial and venous flow velocity waveforms and perinatal outcome – the ‘heart‐sparing effect’
Authors: Baschat A. A. , Gembruch U. , Reiss I. , Gortner L. , Diedrich K.
Published: March 2003

This longitudinal observational study evaluates the stage at which coronary flow can be visualized by color‐coded and pulsed wave Doppler sonography in fetuses with normal cardiac anatomy. Fetal biometry, echocardiography and Doppler examination of the umbilical and middle cerebral arteries, ductus venosus, inferior vena cava and umbilical vein were performed in 109 cases. Fetuses were divided into five groups based on the Doppler examination of the umbilical artery, birth weight and the ability to visualize coronary blood flow. Coronary blood flow was identified in six of 55 fetuses with normal growth who had normal Doppler studies and perinatal outcome. In these, visualization of coronary blood flow was possible after 31 weeks' gestation at a median gestational age of 37 weeks. Coronary blood flow was also visualized in ten of 54 fetuses with severe intrauterine growth retardation and highly pathological flow velocity waveforms in all vessels soon after a significant increase of venous indices in the inferior vena cava and ductus venosus. In these cases, coronary blood flow was identified at a significantly earlier gestational age (median 27 weeks). These fetuses had a poor perinatal outcome (average birth weight less than 3rd centile, mortality rate 50%, significantly lower umbilical artery blood pH and Apgar scores after 1 and 5 min). Intrauterine fetal death occurred in five fetuses after a median of 3.5 days following visualization of coronary blood flow. Median coronary peak blood flow velocities in the right coronary artery were higher in intrauterine growth‐retarded than appropriate‐for‐gestational‐age fetuses. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Differential diagnosis and outcome of fetal intracranial hypoechoic lesions: report of 21 cases
Authors: Pilu G. , Falco P. , Perolo A. , Sandri F. , Cocchi G. , Ancora G. , Bovicelli L.
Published: March 2003

Our objective was to evaluate the diagnostic and prognostic value of sonography in fetal intracranial hypoechoic lesions. A retrospective study revealed a total of 21 cases diagnosed over a period of 10 years. Most of the diagnoses were made in the third trimester. The presence of fluid‐filled lesions within the brain matter always predicted porencephaly and a poor outcome. In most of these cases (nine out of ten), the lesions were seen to communicate with the cavity of the lateral ventricles. Among the 11 cases of hypoechoic lesions that were external to the brain matter, Doppler ultrasound was always able to distinguish between arachnoid cysts (seven cases) and vein of Galen aneurysms (four cases). Arachnoid cysts were associated with a good outcome in four out of five pregnancies that delivered at term. Three of the four cases of vein of Galen aneurysm were associated with distortion of the cerebral architecture and/or hydrops: one pregnancy was terminated and two resulted in early postnatal death. One pregnancy with vein of Galen aneurysm and normal cerebral structures, without signs of hydrops, had a good outcome. It is concluded that current antenatal ultrasound has the capability of accurate differentiation between different clinical entities resulting in fetal intracranial hypoechoic lesions, and that the sonographic findings have practical clinical implications. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Effect on fetal circulation of low‐dose aspirin for prevention and treatment of pre‐eclampsia and intrauterine growth restriction: Doppler flow study
Authors: Bar J. , Hod M. , Pardo J. , Fisch B. , Rabinerson D. , Kaplan B. , Meizner I.
Published: March 2003

The use of low‐dose aspirin for the prevention and treatment of pre‐eclampsia and intrauterine growth restriction has been studied extensively during the last 10 years. The large clinical trials do not support routine prophylaxis or therapeutic administration of low‐dose aspirin in high‐risk pregnant patients.

We report on 87 Israeli women who were recruited for the CLASP study (a collaborative trial for the prevention and treatment of pre‐eclampsia and intrauterine growth restriction). Of these women, 41 were treated with 60 mg aspirin daily, and 46 with placebo. The fetal circulation was evaluated by repeated Doppler flow waveform measurements of the umbilical artery and descending aorta from 20 to 34 weeks of gestation. The peak‐systolic/lowest‐diastolic velocity ratio, pulsatility index and resistance index were calculated.

No significant differences in Doppler measurements were observed for any of the indices between the aspirin and placebo groups. There were no statistically significant changes in the flow parameters during the course of pregnancy in any of the women studied, nor was there a correlation between waveform analysis and pregnancy outcome. Thus, based on the present results, it appears that low‐dose aspirin does not improve fetal circulation parameters. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Increased fetal nuchal translucency: possible involvement of early cardiac failure
Authors: Montenegro N. , Matias A. , Areias J. C. , Castedo S. , Barre H.
Published: March 2003

The ultrasonographic measurement of nuchal translucency thickness at 10–23 weeks of gestation is accepted as an efficient method of screening for chromosomal abnormalities. However, the underlying mechanism producing increased nuchal translucency thickness is still poorly understood. The purpose of this study was to investigate the possible contribution of impaired cardiac function to such an increase, by studying the venous return in the ductus venosus, using Doppler ultrasound.

In a total of 6.5 fetuses, nuchal translucency thickness was measured at 10–13 weeks of gestation by means of a transvaginal probe. Color‐coded and pulsed Doppler ultra‐sound were also used to evaluate different hemodynamic parameters in the ductus venosus: maximum systolic and diastolic velocities, pulsatility index, lowest forward velocity during atria1 contraction and fetal heart rate.

Fetal nuchal translucency thickness of ≥ 3 mm was found in 17 cases; in five of them there were chromosomal anomalies: four trisomy 21 and one trisomy 18. Of interest is the finding that in the five chromosomally abnormal fetuses with increased nuchal translucency thickness, the forward velocity during atria1 contraction was consistently less than 2 cm/s (p < 0.001).

This impairment of atria1 contraction may well implicate cardiac failure and/or heart defects in the pathogenesis of increased nuchal translucency thickness in the first trimester of pregnancy. Furthermore, nuchal translucency may prove to be a sensitive marker of the early identification of fetal cardiac anomalies. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of 22q11 microdeletion in a fetus with a conotruncal heart defect
Authors: Paladini D. , Pacileo G. , Palmieri S. , Russo M.G. , Conti A. , Piccola B.D. , Martinelli P.
Published: March 2003

A case of prenatal diagnosis of 22q11 microdeletion in a fetus with a conotruncal heart defect is described. This type of chromosomal aberration has been shown to be present in up to 30% of isolated conotruncal anomalies and in most cases of DiGeorge and velocardiofacial syndromes. The implications of such a diagnosis on prenatal counselling are discussed. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The effect of a nitric oxide donor on Doppler flow velocity waveforms in the uterine artery during the first trimester of pregnancy
Authors: Amit A. , Thaler I. , Paz Y. , Itskovitz‐Eldor J.
Published: March 2003

Our objectives were to study the effect of a nitric oxide donor on uterine blood flow velocity waveforms and maternal heart rate and blood pressure during the first trimester of pregnancy. Eleven women were examined at 8–12 weeks' gestation, prior to elective termination of pregnancy. Each woman was randomly given a sublingual tablet containing 5 mg of isosorbide dinitrate or placebo, on two consecutive days. Measurements of maternal blood pressure, heart rate and Doppler flow velocity waveforms of the ascending branch of the main uterine artery were obtained before, and every 2 min (for 20 min) after taking the drug or placebo.

Following administration of isosorbide dinitrate, the mean arterial blood pressure fell from a control value of 82.5 ± 5.6 mmHg to a nadir of 73 ± 4.1 mmHg at 16 min (p < 0.0001). The mean maternal heart rate increased from a control value of 80.9 ± 2.8 beats/min to a peak of 90.4 ± 4.6 beats/min at 10 min (p < 0.001). The mean resistance index in the uterine artery fell from a control value of 0.80 ± 0.02 to a nadir of 0.73 ± 0.03 at 10 min (p < 0.0001). Analysis of covariance was employed to compensate for the effect of heart rate on the resistance index. The drug had a significant effect on the resistance index in the uterine artery, independent of maternal heart rate. These results suggest that drugs such as isosorbide dinitrate may have a potential benefit under such conditions where the production of nitric oxide (i.e. endothelium‐derived relaxing factor) is decreased. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of congenital granular cell epulis
Authors: Pellicano M. , Zullo F. , Catizone C. , Guida F. , Catizone F. , Nappi C.
Published: March 2003

Congenital granular epulis is a benign tumor that has rarely been diagnosed prenatally, although there have been numerous reports on its postnatal diagnosis. We report a case of large granular epulis diagnosed at 31 weeks' gestation in a woman whose previous anomaly scan had been normal. The lesion was 2.5 cm in diameter, pedunculated, and arose from the maxilla. It was completely surgically removed following preterm vaginal birth and histologically examined. The tumor did not prevent deglutition of the amniotic fluid and did not interfere with feeding or respiration, but prevented complete closure of the lips. We discuss the fetal management and the theories of histogenesis, and highlight the importance of early diagnosis and treatment. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of ductus venosus agenesis: a report of two cases and review of the literature
Authors: Gembruch U. , Baschat A. A. , Caliebe A. , Gortner L.
Published: March 2003

Anomalies of venous return due to absence of the ductus venosus have been described in the literature. This is a report of the prenatal diagnosis of two cases of isolated ductus venosus agenesis occurring at 20 and 37 weeks' gestation, confirmed postnatally by color‐coded Doppler sonography. In both cases the hepatic veins assumed the function of the ductus venosus without compromising fetal hemodynamics or causing hydrops. In the first case, a healthy female infant was delivered at term. In the second case, a 46,XY,dup(8) (q21.1q22)[35]/47,idem,+r(8)[15] karyotype was diagnosed by amniocentesis. The male newborn showed facial anomalies, a bell‐shaped thorax and increased intermamillary distance. There was muscular hypotonia, delayed psychomotor development and an inspiratory stridor leading to obstructive nocturnal dyspnea.

On the basis of our observations in these two cases and previous reports from animal studies, we conclude that absence of the ductus venosus may be compatible with normal fetal development without relevant disturbance of circulation and oxygenation. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of testicular torsion
Authors: Devesa R. , Muñoz A. , Torrents M. , Comas C. , Carrera J. M.
Published: March 2003

A case of the prenatal diagnosis of testicular torsion at 39 weeks' gestation is presented. The affected testicle was observed as a small rounded area of hypoechogenicity with a peripheral echogenic ring without hydrocele. The appearance was suggestive of the chronic phase of testicular torsion. The neonatal genital exploration confirmed the diagnosis. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonographic measurement of endometrial thickness during hormonal replacement therapy in postmenopausal women
Authors: Affinito P. , Palomba S. , Pellicano M. , Sorrentino C. , Di Carlo C. , Morgera R. , Arienzo M. P. , Nappi C.
Published: March 2003

The objective of this study was to measure endometrial thickness by transvaginal ultrasonography during two regimens of hormonal replacement therapy (HRT) in post‐menopausal women and to compare these data with endometrial histology.

Transvaginal ultrasonographic evaluation of endometrial thickness and endometrial biopsy were performed in 80 postmenopausal women before and after 6 months of HRT (between the 24th and the 28th day of the cycle). The group was randomized so that 40 women (Group A) were treated with a continuous sequential regimen consisting of 5 μg/day of estradiol continuously and 5 mg/day of medrogestone from the 17th to the 28th day of the cycle; and 40 women (Group B) were given continuous administration of 50 μg/day estradiol and 5 mg/day medrogestone.

Prior to therapy, there was no significant difference in mean endometrial thickness between the groups. After 6 months of therapy, endometrial thickness was significantly increased in comparison with basal values in both groups. The mean value was significantly higher (p < 0.001) in Group A (8.5 ± 3.7 mm) than in Group B (3.6 ± 1.3 mm). In Group A, endometrial thickness was ≤ 4 mm in 16.7% of patients and ≤ 8 mm in 69.5% of patients. In Group B, 91% of patients had an endometrium of ≤ 4 mm. In both groups, the thickness of the atrophic endometrium was less than that of the other histological types of endometrium (4.1 ± 0.3 mm for Group A and 3.5 ± 1.2 mm for Group B). In Group A, the difference in mean endometrial thickness between the proliferative and secretory endometrium was not statistically significant. In both groups, the transvaginal ultrasonographic measurement of endometrial thickness of ≤ 4 mm had a high sensitivity for detecting atrophic endometrium (83.3% for Group A and 93.7% for Group B).

Our data demonstrate the great accuracy of transvaginal ultrasonographic endometrial thickness measurement in the patients treated with continuous combined HRT. Therefore, in these women, measurement of thickness alone may be sufficient for adequate endometrial assessment. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of microcephaly assisted by vaginal sonography and power Doppler
Authors: Pilu G. , Falco P. , Milano V. , Perolo A. , Bovicelli L.
Published: March 2003

In two mid‐trimester fetuses with microcephaly, transvaginal sonography revealed aberrant findings, including large subarachnoid spaces and a rudimentary shape of the lateral ventricles. In one of these fetuses, power Doppler ultrasound demonstrated a discrepancy in the size of the signals generated by the intracranial arteries branching from the internal carotids and those branching from the vertebral arteries, and this was interpreted as the consequence of a reduced blood supply to the undersized cerebral hemispheres. We suggest that evaluation of intracranial anatomy by transvaginal sonography and power Doppler examination of the cerebral vessels may be of value in the diagnosis of fetal microcephaly. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal ultrasound diagnosis of massive subchorionic thrombohematoma
Authors: Richards D. S. , Bennett B. B.
Published: March 2003

Massive subchorionic thrombohematoma is a rare condition in which a large maternal blood clot separates the chorionic plate from the villous chorion. This condition is usually complicated by intrauterine growth restriction, and is often associated with fetal distress and perinatal death. We present a case in which the diagnosis of massive subchorionic thrombohematoma was made at 24 weeks' gestation. Doppler ultrasound helped to confirm the diagnosis and demonstrated severely abnormal umbilical blood flow. Two days after the diagnosis, fetal distress prompted emergency Cesarean delivery of a growth‐restricted infant. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Fetal liver volume measurement by three‐dimensional ultrasonography: a preliminary study
Authors: Laudy J. A. M. , Janssen M. M. M. , Struyk P. C. , Stijnen T. , Wallenburg H. C. S. , Wladimiroff J. W.
Published: March 2003

Objective

To establish the application of three‐dimensional ultrasonography in measuring fetal liver volume during the second half of normal pregnancy.

Design

A prospective cross‐sectional study of normal fetal liver volume at 19–39 weeks of gestation (median 29 weeks).

Subjects

Thirty‐four non‐smoking women with a singleton pregnancy resulting in the delivery of a healthy infant with a birth weight between the 5th and 95th centiles according to the Kloosterman tables adjusted for maternal parity and fetal sex.

Methods

For fetal liver volume measurements, a simultaneous recording of a frontal section of the liver immediately anterior to the stomach and a sagittal section of the liver were obtained using a standard Combison 530 ultrasound machine with a 5‐MHz annular array transducer for volume scanning.

Results

Technically acceptable fetal liver volume measurements were obtained in 25 of 34 participating women. Mean fetal liver volume data (P50) ranged between 8 ml at 20 weeks' gestation and 116 ml at 38 weeks' gestation. A statistically significant increase in normal fetal liver volume was found with advancing gestational age (p < 0.0001) and with increasing estimated fetal weight (p < 0.0001).

Conclusions

Three‐dimensional ultrasound allows measurement of fetal liver volume, and this demonstrated an approximately 14‐fold increase during the second half of pregnancy. It is speculated that three‐dimensional fetal liver volume measurement may identify the fetus at risk of growth restriction. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal sonographic diagnosis of club foot with particular attention to the implications and outcomes of isolated club foot
Authors: Rijhsinghani A. , Yankowitz J. , Kanis A. B. , Mueller G. M. , Yankowitz D. K. , Williamson R. A.
Published: March 2003

Objective

There are no studies to date on the implications and outcomes of antenatally detected isolated club foot. The purpose of this study was to perform a contemporary evaluation of club foot diagnosed in the antenatal period.

Design

We performed a retrospective analysis of all ultrasound examinations performed in 1989–96 in the Fetal Diagnosis and Treatment Unit of the University of Iowa Hospitals and Clinics (n = 23 863).

Subjects and methods All cases of club foot (n = 35) were evaluated for the presence of other detectable abnormalities and karyotype results if available. Postnatal follow‐up was performed until over 1 year of age.

Results

We diagnosed unilateral (n = 18) and bilateral (n = 17) club foot from 17.4 to 37.0 weeks. Defects involving other systems were found in 28 of 35 cases. Of the seven cases considered to be isolated antenatally, three were diagnosed with additional malformations in the neonatal period.

Conclusion

Most cases of antenatally diagnosed club foot were not isolated. Even when they were thought to be isolated on antenatal ultrasound, over half of them were later found to be associated with additional severe abnormalities that were detectable only in the neonatal period. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Gestational age in pregnancies after in vitro fertilization: comparison between ultrasound measurements and actual age
Authors: Wennerholm U.‐B. , Bergh C. , Hagberg H. , Sultan B. , Wennergren M.
Published: March 2003

Objective

To compare gestational age (GA) calculated from oocyte retrieval and from ultrasound measurements in pregnancies after in vitro fertilization (IVF).

Design

In a retrospective study of 253 women with singleton and 84 women with twin pregnancies conceived from IVF, GA calculated from the day of oocyte retrieval was compared with GA calculated in the second trimester of pregnancy from ultrasound measurements of biparietal diameter (BPD) and femur length (FL).

Results

For singletons, the mean GA calculated from ultrasound measurements was significantly shorter than the mean GA estimated from the day of oocyte retrieval. The mean difference was 1.9 days (SD 3.3; 95% CI 1.5–2.4) if only BPD was used and 2.1 days (SD 2.1; 95% CI 1.6–2.5) if BPD and FL were combined.

For twins, the mean GA calculated from ultrasound measurements was also significantly shorter than the mean GA calculated from the day of oocyte retrieval. The mean difference was 1.4 days (SD 2.7; 95% CI 1.0–1.8) if BPD was used and 1.6 days (SD 2.5; 95% CI 1.2–2.0) if BPD and FL were combined.

Conclusions

In IVF pregnancies, term prediction using ultrasound in the second trimester is reliable and may reduce the number of pregnancies subsequently classified as post‐term, thus avoiding unnecessary obstetric interventions. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal ultrasonography at 18–23 weeks in predicting placenta previa at delivery
Authors: Taipale P. , Hiilesmaa V. , Ylöstalo P.
Published: March 2003

Objective

To evaluate whether transvaginal ultrasonography at 18–23 weeks' gestation is useful in predicting placenta previa at delivery.

Design

We performed transvaginal ultrasonography in addition to routine transabdominal ultrasonography in 3696 consecutive non‐selected pregnant women with singleton fetuses and measured the distance from the placental edge to the internal cervical os.

Results

In 57 of 3696 patients (1.5%), the placental edge extended to or over the internal cervical os. In 27 patients (0.7%), the placenta extended ≥ 15 mm over the internal cervical os; in these cases the positive predictive value of placenta previa at delivery was 19% (95% CI, 6–38%) with 100% (95% CI, 48–100%) sensitivity. With ≥ 25 mm used as the cut‐off point, ten cases (0.3%) were screen‐positive and the positive predictive value for previa at delivery was 40% (95% CI, 12–74%) and sensitivity was 80% (95% CI, 28–100%). The frequency of placenta previa at delivery in this population was five of 3696 (0.14%, 95% CI, 0.04–0.31%).

Conclusions

We recommend confirmatory transvaginal ultrasonography if placenta previa is suspected at transabdominal ultrasonography in mid‐pregnancy, and reexamination at 26–30 weeks if the placental edge covers the internal cervical os by 15 mm or more. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Poor perinatal outcome associated with vasa previa: is it preventable? A report of three cases and review of the literature
Authors: Fung T. Y. , Lau T. K.
Published: March 2003

We describe three cases of vasa previa and review the English‐language literature for all cases reported since 1980. Antenatal diagnosis was significantly associated with decreased fetal mortality (p = 0.033). A low‐lying placenta is a risk factor for vasa previa, as it occurred in 81% of patients. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The pattern of changes in ovarian stromal and uterine artery blood flow velocities during in vitro fertilization treatment and its relationship with outcome of the cycle
Authors: Engmann L. , Sladkevicius P. , Agrawal R. , Bekir J. , Campbell S. , Tan S. L.
Published: March 2003

Objectives

To assess the effect of short‐term (2–3 weeks) pituitary suppression and controlled ovarian stimulation on ovarian and uterine artery Doppler measurements during the fertilization (IVF) treatment cycle and to compare the pattern of these changes between conception and non‐conception cycles as well as between patients with normal and those with polycystic ovaries.

Design

Prospective observational study of women undergoing IVF treatment.

Subjects

Women using the long‐treatment buserelin protocol who did not have uterine fibroids, ovarian cysts or endometrioma.

Methods

Serial transvaginal color and pulsed Doppler measurements of ovarian stromal and uterine artery blood flow velocity were carried out in the early follicular phase of the menstrual cycle, on the day of pituitary suppression and on the day of administration of human chorionic gonadotropin (hCG). The main outcome measures were the ovarian stromal and uterine artery blood flow peak systolic velocity (PSV) and pulsatility index (PI).

Results

A total of 105 patients were recruited but six patients were excluded from the analysis because they had only one stage of the measurements performed. There was a significant decline in mean ovarian stromal artery PSV after 2–3 weeks of gonadotropin releasing hormone (GnRH) agonist therapy but no effect on ovarian stromal artery PI. The mean uterine artery PSV or PI did not change significantly after 2–3 weeks of GnRH agonist therapy. There was a significantly higher mean ovarian stromal artery PSV in conception cycles compared to non‐conception cycles in the early follicular phase and on the day of pituitary suppression, but not on the day of hCG administration. There were no differences between conception and non‐conception cycles in the mean uterine artery PSV or PI. Women with polycystic ovaries had a higher mean ovarian artery PSV on all the three occasions of measurement.

Conclusion

These data suggest that assessment of ovarian blood flow before commencement of gonadotropin stimulation may play a role in assessing cycles likely to result in pregnancy. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Fetal growth rate and adverse perinatal events
Authors: de Jong C. L. D. , Francis A. , van Geijn H. P. , Gardosi J.
Published: March 2003

Objective

To study fetal weight gain and its association with adverse perinatal events in a serially scanned high‐risk population.

Subjects and methods A total of 200 pregnant women considered at increased risk of uteroplacental insufficiency had a total of 1140 scans in the third trimester, with a median of six scans in each pregnancy. The average fetal growth rate was retrospectively calculated for the last 6 weeks to birth, and expressed as daily weight gain in grams per day. Adverse pregnancy outcome was defined as operative delivery for fetal distress, acidotic umbilical artery pH (< 7.15), or admission to the neonatal intensive care unit (NICU).

Results

Fetuses with normal outcome in this high‐risk pregnancy population had an average antenatal growth rate of 24.2 g/day. Compared to pregnancies with normal outcome, the growth rate was slower in those that required operative delivery for fetal distress (20.9 g/day, p < 0.05) and those that required admission to the NICU (20.3 g/day, p < 0.05). The growth rate in pregnancies resulting in acidotic umbilical artery pH also seemed lower, but this did not reach statistical significance.

Conclusions

Impaired fetal weight gain prior to birth is associated with adverse perinatal events suggestive of growth failure. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Diagnosis of twin reversed arterial perfusion sequence in the first trimester by transvaginal color Doppler ultrasound
Authors: Schwärzler P. , Ville Y. , Moscosco G. , Tennstedt C. , Bollmann R. , Chaoui R.
Published: March 2003

A case of twin reversed arterial perfusion (TRAP) sequence was diagnosed at 12 weeks' gestation using transvaginal color Doppler ultrasound, which demonstrated the presence of retrograde perfusion in the umbilical artery of the abnormal twin. Ultrasound imaging showed a monochorionic‐diamniotic twin pregnancy with an inappropriately grown second twin, the morphological evaluation of which revealed an abnormal cephalic pole with acrania, diffuse subcutaneous edema and the presence of cardiac activity in an abnormal heart with a single chamber. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of a lean umbilical cord: a simple marker for the fetus at risk of being small for gestational age at birth
Authors: Raio L. , Ghezzi F. , Di Naro E. , Franchi M. , Maymon E. , Mueller M. D. , Brühwiler H.
Published: March 2003

Objective

The purpose of this study was to investigate whether the prenatal diagnosis of a ‘lean’ umbilical cord in otherwise normal fetuses identifies fetuses at risk of being small for gestational age (SGA) at birth and of having distress in labor. The umbilical cord was defined as lean when its cross‐sectional area on ultrasound examination was below the 10th centile for gestational age.

Method

Pregnant women undergoing routine sonographic examination were included in the study. Inclusion criteria were gestational age greater than 20 weeks, intact membranes, and singleton gestation. The sonographic cross‐sectional area of the umbilical cord was measured in a plane adjacent to the insertion into the fetal abdomen. Umbilical artery Doppler waveforms were recorded during fetal apnea and fetal anthropometric parameters were measured.

Results

During the study period, 860 patients met the inclusion criteria, of whom 3.6% delivered a SGA infant. The proportion of SGA infants was higher among fetuses who had a lean umbilical cord on ultrasound examination than among those with a normal umbilical cord (11.5% vs. 2.6%, p < 0.05). Fetuses with a lean cord had a risk 4.4‐fold higher of being SGA at birth than those with a normal umbilical cord. After 25 weeks of gestation, this risk was 12.4 times higher when the umbilical cord was lean than when it was of normal size. The proportion of fetuses with meconium‐stained amniotic fluid at delivery was higher among fetuses with a lean cord than among those with a normal umbilical cord (14.6% vs. 3.1%, p < 0.001). The proportion of infants who had a 5‐min Apgar score < 7 was higher among those who had a lean cord than among those with normal umbilical cord (5.2% vs. 1.3%, p < 0.05). Considering only patients admitted in labor with intact membranes and who delivered an appropriate‐for‐gestational‐age infant, the proportion of fetuses who had oligohydramnios at the time of delivery was higher among those who had a lean cord than among those with a normal umbilical cord (17.6% versus 1.3%, p < 0.01).

Conclusion

We conclude that fetuses with a lean umbilical cord have an increased risk of being small for gestational age at birth and of having signs of distress at the time of delivery. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology