bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the upper uterine cervix by the location of the vesicocervical fold of the urinary bladder to rule out cervical shortening during pregnancy with and without premature contractions
Authors: Shalev J. , Meizner I. , Orvieto R. , Mashiach R. , Vardimon D. , Hod M. , Ben‐Rafael Z.
Published: March 2003

Objectives

To measure the length of the upper and lower cervix, as demarcated anatomically by the lowermost edge of the urinary bladder, in second‐ and third‐trimester pregnancies with and without premature contractions. We hypothesized that patients with active premature contractions have a shorter upper cervix, placing them at greater risk of preterm delivery.

Methods

The lengths of the total cervix and of the upper and lower cervix, separately, and funnelling of the internalos, were assessed by endovaginal ultrasonography. In 120 women with normal pregnancy (43 of which with premature contractions), cervical dilatation and effacement were determined by digital examination. The correlation of cervical variables with the course of pregnancy was analyzed by the Wilcoxon test.

Results

The mean lengths of the upper and lower cervix were 15.9 ± 1.7 mm (median 16.0 mm) and 26.4 ± 3.7 mm (median 27.0 mm), respectively, in patients without premature contractions and 6.9 ± 3.7 mm (median 6.0 mm) and 24.7 ± 4.7 mm (median 25.0 mm), respectively, in patients with premature contractions. In the latter subgroup, the upper cervix was significantly shorter (p = 0.0001) but the lower cervix remained almost unchanged. Digital palpation was less accurate than transvaginal sonography for evaluating total cervical length.

Conclusions

Transvaginal sonography is the method of choice for assessing cervical changes during pregnancy. In this prospective study, upper cervical length was the best predictor of preterm labor of all cervical parameters studied. Its length could be accurately determined by the location of the lowermost edge of the urinary bladder (vesicocervical fold of the bladder). Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
A new photogrammetric method to measure fetal breathing movements
Authors: Florido J. , Cortés E. , Soto V. , Gutiérrez M.
Published: March 2003

Objectives

In most recent studies, fetal respiratory movements have been measured with real‐time and Doppler echography. We describe an alternative approach using photogrammetry that provides more objective measurements.

Methods

Respiratory movements were studied in 28 women with uncomplicated pregnancies of 30–38 weeks' gestation. Fetal echographic images were recorded on videotape and digitized to obtain coordinates of the reference point (midpoint on the anterior abdominal wall of the fetus between the xiphoid process and the insertion of the umbilical vessels) and generate graphic representations of fetal movements in the anterior abdomen.

Results

The mean duration of a complete respiratory cycle was 1.194 s, the mean distance representing the extent of movement was 2.92 mm, the mean inspiratory velocity was 5.52 mm/s and the mean expiratory velocity was 5.06 mm/s.

Conclusions

Photogrammetric analysis of images obtained with real‐time echography provided accurate measurements of fetal breathing movements. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Fetal cardiac development and hemodynamics in the first trimester
Authors: Leiva M. C. , Tolosa J. E. , Binotto C. N. , Weiner S. , Huppert L. , Denis A. L. , Huhta J. C.
Published: March 2003

Objective

To describe fetal cardiac and hemodynamic development in the first trimester of pregnancy.

Subjects and methods Forty‐eight pregnancies were prospectively studied with transvaginal ultrasound and color Doppler. Fetal heart rate and size were documented together with the presence of inflow and outflow waveforms and valve signals.

Results

Heart rate and size showed a positive correlation, with gestational age. At 6 weeks of gestation, 20% of the cardiac cycle was occupied by the isovolumic contraction time (ICT); the isovolumic relaxation time (IRT) occupied 16% and remained unchanged, while the ICT progressively shortened and was not measurable after 12 weeks. The peak inflow velocities had changed from monophasic to biphasic by 10 weeks of gestation. At 7 weeks of gestation, semilunar valves were detected in 10% of examinations and the atrioventricular valves in 3%. The detection rate for both valves at 12 weeks was ≥ 90%. In pregnancies that miscarried, the detection rate for both was < 25%.

Conclusions

The Doppler signals that characterize the heart during the first trimester suggest effective heart compliance by 12 weeks. Normal valve development can be inferred from non‐invasive Doppler recordings. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
P72Prenatal assessment of the thymus in detecting fetuses with del.22q
Authors: Chaoui R. , Körner H. , Bommer C.
Published: March 2003

Background

Some congenital heart defects (CHD) were found to be associated with a deletion 22q11 and grouped as catch‐22 an acronym for Cardiac anomaly, Abnormal facies, Thymus hypo‐ or aplasia, Cleft palate and Hypothyreoidism with del.22q.11. It is still discussed whether all fetal CHD or only conotruncal anomalies (CTA) should get the targeted del.22q11 evaluation. Aim of the study was to find out the importance of thymus visualization in the prenatal detection of these affected fetuses.

Method

During a period of 3 years only fetuses with CHD undergoing invasive procedure for determination of the karyotype and fish for del.22q11 were included in the study. Fetal thymus was visualized as the structure in front of the great vessels as seen in the three‐vessels‐trachea view.

Results

95 fetuses with different CHD were evaluated including 31 with conotruncal anomalies. Seven fetuses were found to have a del.22q11 (7.3% of all CHD, 22.5% of CTA). Six of these 7 (85.7%) had no or a hypoplastic thymus. A false positive result was found in two further cases.

Conclusions

Fetal thymus can be assessed on prenatal ultrasound. In fetuses with CHD especially in CTA the absence or hypoplasia of the thymus can be a hint in the targeted examination for del.22q11.
WS12‐08Pulmonary arterial and venous flow velocity waveforms in growth restricted fetuses
Authors: Rizzo G. , Capponi A. , Angelini E. , Muscatello A. , Grassi C. , Romanini C.
Published: March 2003

Objective

To measure peripheral pulmonary artery (PPA) and pulmonary vein (PV) velocity waveforms in growth restricted fetuses (IUGR) and to relate them to different Doppler indices fetal circulation and to pregnancy outcome.

Design and methods

108 IUGR fetuses from singleton pregnancies (gestational age median 28.4 range 25–32) were prospectively considered for this study. Entry criteria were an ultrasonographic extimated fetal weight < 5th centile, the absence of structural and chromosomal abnormalities, and a Pulsatility Index (PI) in umbilical artery > 95th centile of our reference limits for gestation. Velocity waveforms were recorded from the PPA and in one of the PV in proximity of the inflow in the left atrium. The PI from PPA and the Pulsatility Index for the vein from PV (PIV = [S − D]/m) were calculated. Values obtained were compared to our reference limits for gestation and related to other Doppler indices from arterial, cardiac and systemic venous circulation and to fetal outcome.

Results

In IUGR fetuses both the PI from PPA (P < 0.001) and the PIV from the PV (P < 0.001) were increased when compared to control fetuses. An inverse relationship was found between PPA and middle cerebral artery PI. Changes in PV were present when abnormal velocity waveforms are present in the systemic venous circulation. Reverse flow during atrial contraction is present in pulmonary vein in the most severely compromised fetuses and are associated with fetal distress and imminent fetal death.

Conclusions

Abnormalities in arterial and pulmonary flows are present in IUGR fetuses. Changes in arterial circulation occur at an early stage of the disease while modifications in venous flows occurs later and may be the expression of an impaired function of the left ventricle close to fetal jeopardize.
Prenatal ultrasonographic diagnosis of posteromedial bowing of the leg: two case reports
Authors: Zollinger P.E. , Wessels M.W. , Wladimiroff J.W. , Diepstraten A.F.M.
Published: March 2003

Congenital posteromedial bowing of the leg was prenatally detected in two pregnancies, at 20 and 31 weeks of gestation. Posteromedial bowing is a rare anomaly of unknown etiology. The prenatal course, monitored by ultrasonography, and the postnatal clinical and radiographic outcomes are discussed and show a complex differential diagnosis. The initial postnatal therapy is conservative. Leg length discrepancy can eventually be treated by lengthening or epiphysiodesis on the contralateral side.
The detection of spina bifida before 10 gestational weeks using two‐ and three‐dimensional ultrasound
Authors: Blaas H.‐G. K. , Eik‐Nes S. H. , Isaksen C. V.
Published: March 2003

We present three cases of spina bifida during the embryonic period detected by ultrasound before 10 weeks' gestational age. The last‐menstrual‐period‐based ages ranged from 9 weeks 1 day to 9 weeks 4 days and the crown rump lengths ranged from 22 mm to 28 mm. The cases were identified prospectively in a program of targeted ultrasound examination of high‐risk pregnancies, using a 7.5 MHz annular array transvaginal transducer. The use of 3D ultrasound made additional diagnostic ultrasound tomograms possible, but was not necessary for the definite diagnosis. The scalloping of the frontal bones and the Arnold Chiari malformation did not occur before 12 weeks. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Integrated obstetric curriculum for obstetrics and gynecology residency, radiology residency and maternal–fetal medicine fellowship program at an Accredited American Institute of Ultrasound in Medicine Diagnostic Ultrasound Center
Authors: Calhoun B. C. , Hume R. F.
Published: March 2003

Objective

The purpose of this work was to demonstrate the approach to developing an integrated curriculum for obstetric ultrasound training by utilizing an accredited American Institute of Ultrasound in Medicine teaching platform

Methods

During the 1996–98 academic years, the American College of Obstetricians and Gynecologists and American Institute of Ultrasound in Medicine guidelines for ultrasound performance and training were integrated into a multifaceted training program for obstetric and radiological residents and maternal–fetal medicine fellows consisting of a structured reading program, self study of a 35‐mm slide program of normal/abnormal anatomy, a basic ultrasound and fetal echocardiography interactive CD program, hands‐on supervised scanning program and practical and certificate‐bearing fetal echocardiography courses for fellows. All obstetric residents were given pretests and post‐tests to measure learning performance in the program. The results from these tests were analyzed for statistical significance.

Results

Thirteen obstetric residents completed the training program. The locally developed pretest showed a mean of 16/40 correct questions with an SD of 1.85. After completing the training, the mean obstetric resident scores on the post‐test were 32/40 with an SD of 5.9. This difference was statistically significantly different, P < 0.009. Radiology residents showed an improvement from no residents passing the obstetric ultrasound portion on the 1996 Radiology Boards to 100% pass rate in 1997 (four residents per year) after completing the course. Maternal–fetal medicine fellows progressed from inability to perform acceptable fetal echocardiography to full ability to perform fetal echocardiographic examinations.

Conclusion

An integrated approach to obstetric ultrasound training for obstetric and radiologic residents and maternal–fetal medicine fellows with multifaceted learning methods is easily achieved with available guidance from the American College of Obstetricians and Gynecologists and American Institute of Ultrasound in Medicine. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The increase of renal pelvis dilatation in the fetus and its significance
Authors: Aviram R. , Pomeran A. , Sharony R. , Beyth Y. , Rathaus V. , Tepper R.
Published: March 2003

Objective

To determine the effects of the changes in fetal renal pelvis dilatation on post‐natal diagnosis and outcome.

Methods

Prenatal sonographic fetal renal anteroposterior diameters of ≥4 mm in the second trimester, which persisted to ≥7 mm in the third trimester, were the inclusion criteria. Fifty‐six fetuses and 73 renal units with normal karotypes and a solitary sonographic finding of renal pyelectasis, which met the inclusion criteria, were followed, post‐natally, until the age of 30 months. The neonates were categorized into three groups, according to their final diagnosis: No hydronephrosis, pelvi‐ureteric junction obstruction and hydronephrosis from other causes. The neonates were also categorized according to their outcome: no treatment, follow‐up only and surgical treatment.

Results

In 17 neonates (30.4%), and 19 renal units, the diagnosis of hydronephrosis was excluded post‐natally. In 39 neonates (69.6%), and 54 renal units, an urinary tract pathology was confirmed. The dynamics of pyelectasis in the second and third trimesters of pregnancy differed significantly among the neonates when categorized according to the final diagnosis (P < 0.05), or according to outcome (P < 0.05).

Conclusion

It is possible to predict, and distinguish between, long‐term conservative and surgical treatments of renal pelvis dilatation in the third trimester of pregnancy. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Serial fetal lung volume measurement using three‐dimensional ultrasound
Authors: Bahmaie A. , Hughes S. W. , Clark T. , Milner A. , Saunders J. , Tilling K. , Maxwell D. J.
Published: March 2003

Objective

To establish reference intervals for fetal lung growth.

Design

Longitudinal observational study.

Subjects

Fifty‐eight women with initially uncomplicated singleton pregnancies were recruited from the antenatal population of a teaching hospital. Four women were excluded from the final analysis because of complications arising in their pregnancy.

Methods

Each subject was serially scanned at monthly intervals. At each visit lung volume was measured using an ultrasound‐based computerized three‐dimensional imaging system. Multilevel models were used to determine conditional and unconditional reference intervals.

Results

Reference intervals for fetal lung growth were derived. Fetal lung volume increases in a non‐linear way with gestation.

Conclusions

Our computerized system has the capacity to be used in conjunction with any standard two‐dimensional ultrasound scanner in order to measure volume. Lung volume measurement may be useful in predicting pulmonary hypoplasia. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Urorectal septum malformation sequence: prenatal sonographic diagnosis in two sets of discordant twins
Authors: Achiron R. , Frydman M. , Lipitz S. , Zalel Y.
Published: March 2003

Urorectal septum malformation sequence (URSMS) is a rare congenital malformation, which includes ambiguous genitalia, a phallus‐like structure, imperforate anus, bladder, vaginal and rectal fistulas and Müllerian duct defects. We report two cases of prenatally diagnosed URSMS, both occurring in two sets of discordant twins. To the best of our knowledge, this is the first antenatal description of such an anomaly. The first fetus, one of a set of monochorionic, monoamniotic twins was detected sonographically at 21 weeks of gestation due to an enlarged phallus‐like formation. The second fetus, one of dichorionic, diamniotic twins, was suspected of having an abnormally enlarged rectum at 13 weeks of gestation. The diagnosis of URSMS was established at 29 weeks of gestation by showing abnormal female external genitalia, with a dilated bowel that contained echogenic foci due to enterolithiasis. The diagnosis of both cases was confirmed postnatally. Sonographic findings and differential diagnosis are presented. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of familial absent pulmonary valve syndrome: case report and review of the literature
Authors: Becker R. , Schmitz L. , Guschmann M. , Wegner R.‐D. , Stiemer B. , Entezami M.
Published: March 2003

We report on a case of absent pulmonary valve syndrome in a woman with a history of one healthy child and one child with tetralogy of Fallot with absent pulmonary valve. The diagnosis was missed at the first ultrasound examination performed at 13 + 5 weeks of gestation and correctly diagnosed at 21 + 5 weeks. Re‐evaluation of the ultrasound examination recorded at 13 + 5 weeks exhibited severe insufficiency of the pulmonary valve at this time. However, neither dilatation of the right and left pulmonary arteries nor asymmetry of the ventricles were present at that time. The pregnancy was terminated at 22 + 1 weeks of gestation when autopsy confirmed the diagnosis of absent pulmonary valve syndrome. Karyotyping of the fetus after termination of pregnancy revealed normal chromosomes. Echocardiography of the parents and the healthy sibling revealed normal results. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
First trimester prenatal diagnosis of chondroectodermal dysplasia (Ellis–van Creveld syndrome) with ultrasound
Authors: Dugoff L. , Thieme G. , Hobbins J. C.
Published: March 2003

Chondroectodermal dysplasia (Ellis–van Creveld syndrome) is an autosomal recessive condition characterized by short‐limb dwarfism, postaxial polydactyly, ectodermal defects, and congenital heart disease. This condition is most prevalent in the Amish population of Lancaster, Pennsylvania, USA, occurring in 1/5000 births and in 1/60 000 births in the general population. This report presents a case of ultrasonographic detection of chondroectodermal dysplasia at 12 weeks of gestation. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Application of three‐dimensional power Doppler ultrasound in prenatal diagnosis
Authors: Chaoui R. , Kalache K. D. , Hartung J.
Published: March 2003

Objective

To assess the fetal cardiovascular system using three‐dimensional power Doppler ultrasound (3D‐PDU) in normal and abnormal conditions during the second half of gestation.

Subjects

Forty‐five normal fetuses and 87 selected pregnancies with different abnormalities involving the vascular system were examined.

Methods

The following regions of interest were assessed: placental, umbilical, abdominal, renal, pulmonary and intracranial vessels together with the heart and great arteries. Equipment used was a commercially available HDI‐3000 and 5000 ultrasound system with integrated 3D‐Color Power Angio® software. Data acquisition was performed by the free‐hand technique. Images were reconstructed online. In pathological cases, a maximum of three attempts of 3D reconstruction was allowed to obtain the information needed.

Results

Satisfactory visualization of the fetal vascular system using 3D‐PDU could be achieved in normal pregnancies. The main difficulty during the learning curve was the optimization of the power Doppler image prior to 3D data acquisition. Despite good visualization conditions, the reconstruction of satisfactory images was only possible in 56 out of the 87 (64%) pregnancies with abnormal vascular anatomy. These were abnormalities of placenta and umbilical vessels (n = 26), intra‐abdominal and intrathoracic anomalies (n = 12), renal malformations (n = 9), central nervous system (n = 4) and cardiac defects (n = 5). The main reasons for the lack of information were fetal position and movements, overlapping with signals from neighboring vessels as well as technical limitations of the online system. Details and figures of the potential field of interest in prenatal diagnosis are presented.

Conclusion

The study shows that 3D‐PDU can be applied in prenatal diagnosis. The method enables the visualization of the main parts of the fetal vascular system under normal and pathological conditions. The main fields of interest are the same as those where color Doppler provides information with the exception of the fetal heart where a trigger system is still needed. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonography of the peri‐ and intraventricular areas of the fetal brain between 26 and 36 weeks' gestational age; a comparison with neonatal ultrasound
Authors: van Gelder‐Hasker M. R. , van Wezel‐Meijler G. , van Geijn H. P. , De Vries J. I. P.
Published: March 2003

Objectives

To determine to what extent the peri‐ and intraventricular areas of the fetal brain can be visualized in coronal and sagittal planes using high‐frequency transvaginal ultrasound.

Design

In a longitudinal study, fetuses of 30 low‐risk pregnancies were studied at 26, 28, 30, 32, 34 and 36 weeks' gestational age. The neonates were examined within the first week of life. Visualization of the peri‐ and intraventricular areas was systematically scored in six coronal and five sagittal planes. The degree of echogenicity of the periventricular area was assessed. Inter‐ and intra‐observer agreements were calculated.

Results

For fetuses in the cephalic position, the highest percentages of visualization of the planes were obtained between 26 and 32 weeks' gestational age (>70% in four coronal and three sagittal planes). Transient periventricular echodensities were observed at 26 and 28 weeks' gestational age in 6/39 observations in the cephalic position. Small choroid plexus cysts were found in three fetuses with the changes persisting in two until after birth. Seven neonates developed mild periventricular echodensities/translucencies not present during fetal development. The mean interobserver agreement was 0.77 (95% confidence interval (CI) 0.73–0.81). The intra‐observer agreement varied between 0.48 and 0.72 (mean 0.6, 95% CI 0.47–0.75).

Conclusions

Transvaginal ultrasonography can be applied as a diagnostic tool to evaluate the peri‐ and intraventricular areas of the fetal brain. Transient periventricular densities can be encountered between 26 and 28 weeks. Term low‐risk neonates may develop transient periventricular densities or translucencies. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Relationship between fetal nuchal translucency and crown–rump length in an Asian population
Authors: Jou H.‐J. , Wu S.‐C. , Li T.‐C. , Hsu H.‐C. , Tzeng C.‐Y. , Hsieh F.‐J.
Published: March 2003

Objectives

To investigate the relationship between the nuchal translucency (NT) thickness and crown–rump length (CRL) in normal Asian fetuses during the first trimester.

Design

A prospective observational study was conducted. Ultrasound measurement of NT and CRL was offered in 879 consecutive Taiwanese fetuses between 9 weeks and 14 weeks of gestation. Regression analysis was used to analyze the relationship between the NT thickness and CRL. Fetal sex was also considered in the analysis. The distribution of multiple of median (MoM) values of the NT measurements with CRL in 10‐mm intervals and the 95th centile of MoM were also calculated.

Results

The present study shows that NT measurements increase with increasing CRL. A fixed cut‐off point through the first trimester is not appropriate. The NT thickness has no relationship with fetal sex. Expressing the NT thickness by MoM values provides a simple method for clinical practice.

Conclusions

The present study offers normative data of the fetal NT thickness in an Asian population, which may improve the performance of NT measurement during the first‐trimester as a screening tool for chromosomal aberrations or other congenital abnormalities in the first trimester. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Sonography and neuropathology of a congenital brain tumor: report of a rare incident
Authors: Leins A. M. , Kainer F. , Weis S.
Published: March 2003

A rare case of a congenital brain tumor was diagnosed by sonography in a fetus at 33 weeks' gestation. The ultrasound examination showed a large area of both increased echogenicity and echolucency in one hemisphere suggestive of brain tumor or hemorrhage. The neuropathological examination revealed an undifferentiated glial tumor with large areas of necrosis. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Correlation between fetal cardiac diagnosis by obstetric and pediatric cardiologist sonographers and comparison with postnatal findings
Authors: Meyer‐Wittkopf M. , Cooper S. , Sholler G.
Published: March 2003

Objective

To assess the level of agreement between obstetric and pediatric cardiologist sonographers' diagnosis of fetuses with suspected congenital heart disease and to compare this with the final postnatal diagnosis.

Design

We retrospectively reviewed the notes of 1037 patients undergoing fetal echocardiography over a 5‐year period (1995–99) at the principal tertiary referral center for fetal cardiology in New South Wales, Australia. The median gestational age at presentation was 21 weeks (range 17–38) with 49% of the scans performed at < 21 weeks and a further 17% performed at 21–24 weeks. The accuracy of the fetal cardiac diagnosis was validated by neonatal cardiac investigation or autopsy.

Results

A total of 249 cases of congenital heart disease were identified antenatally during this 5‐year period with the majority (84%) referred because of suspicion of a cardiac malformation during an obstetric scan. Of the 268 fetuses with congenital heart disease suspected by obstetric sonographers, 209 had confirmed cardiac defects. Complete correlation between obstetric sonographers' and pediatric cardiologists' prenatal cardiac findings was achieved in 62% of cases. There were major differences involving the atrioventricular morphology in 18% of cases and the outflow tract anatomy in 20%. Complete agreement between prenatal and postnatal diagnosis in fetuses with complex congenital heart disease was achieved in 59% of cases for obstetric sonography (17% false positive; 41% false negative) and 95% for fetal echocardiography by pediatric cardiologists (2% false positive; 5% false negative).

Conclusions

Improved accuracy in diagnosis can be achieved through a pediatric cardiologist with special skills in fetal echocardiography working collaberatively with obstetric sonographers to optimize the details of diagnosis. This may influence management and counseling. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of an ectopic intrathoracic kidney in right‐sided congenital diaphragmatic hernia using color Doppler ultrasonography
Authors: Masturzo B. , Kalache K. D. , Cockell A. , Pierro A. , Rodeck C. H.
Published: March 2003

The prenatal sonographic features of a fetus with right‐sided congenital diaphragmatic hernia diagnosed at 33 weeks are presented. Color Doppler demonstrated an abnormal course of the right renal artery, arising from the aorta and feeding the intrathoracic right kidney. This case report stresses the role of color Doppler in defining which organs have herniated in fetuses with diaphragmatic hernia. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal sonographic diagnosis of a twinning epigastric heteropagus
Authors: Petit T. , Raynal P. , Ravasse P. , Herlicoviez M. , Delmas P.
Published: March 2003

Epigastric heteropagus is a rare type of conjoined twinning which results from an ischemic atrophy of one fetus at an early stage of gestation. We present what we believe to be the first case diagnosed antenatally at 22 weeks' gestation. The pelvis and lower limbs of the ischemic fetus (the parasite) were attached to the epigastrium of the well‐developed fetus (the autosite), which had a small omphalocele. Antenatal sonography provided an accurate diagnosis, enabling unnecessary abortion to be avoided. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional (3D) echocardiographic analysis of congenital heart disease in the fetus: comparison with cross‐sectional (2D) fetal echocardiography
Authors: Meyer‐Wittkopf M. , Cooper S. , Vaughan J. , Sholler G.
Published: March 2003

Objective

We attempted to assess the ability of Doppler‐gated three‐dimensional (3D) fetal echocardiography to reconstruct and display specific cardiac structures in fetuses with cardiac anomalies and to determine whether any advantage is offered by 3D sonographic cardiac examination over conventional fetal echocardiography.

Design

After 2D fetal echocardiographic examination, 3D cardiac data were collected prospectively in 22 fetuses with various congenital heart defects. Their ages ranged from 19 to 35 weeks' gestation. Basic echocardiographic key views of the venoatrial, atrioventricular and ventriculoarterial connections were derived from volume data sets and selected for 3D reconstruction and analysis. Comparisons were made with 2D echocardiographic imaging of the fetal hearts and the diagnostic image quality of visualized structural details was evaluated.

Results

The underlying cardiac malformation was well or satisfactorily visualized in 20 fetuses using 2D imaging. Gated 3D volume data sets enabled diagnostically acceptable visualization of all affected cardiac structures in 7 of 22 fetuses. High‐quality 3D reconstruction of the site and spatial orientation of ventricular septal defects was obtained in 9 of 13 patients. Two‐dimensional imaging remained the principal diagnostic modality in all cases with additional structural detail being obtained by 3D imaging in only two fetuses.

Conclusions

Three‐dimensional imaging of fetal heart disease is feasible for a wide range of lesions, and may provide additional information of clinical value in a small number of cases when compared with 2D imaging. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
A comparative study of multifetal pregnancy reduction from triplets to twins in the first versus early second trimesters after detailed fetal screening
Authors: Lipitz S. , Shulman A. , Achiron R. , Zalel Y. , Seidman D. S.
Published: March 2003

Objectives

To compare the outcome of multifetal pregnancy reduction from triplets to twins performed either early (at 11–12 weeks' gestation) or late (at 13–14 weeks).

Methods

Ninety‐five high‐order pregnancies following assisted conception were studied. Transabdominal sonographically guided multifetal pregnancy reduction was performed early in 46 women, while 49 women first underwent a sonographic fetal anomaly scan before undergoing selective reduction.

Results

Sonographic screening led to selective termination of a specific fetus in nine cases due to increased nuchal translucency and relative intrauterine growth restriction in three cases each, and meningomyelocele, abdominal cyst and cystic hygroma in one case each. In the early reduction group a diagnosis of hypoplastic left heart in the two remaining twins was subsequently made, and one pair of twins suffers from cerebral palsy. The rate of pregnancy loss was not statistically different between the early (4.3%; 2/46) and late (4.0%; 2/49) termination groups. The birth weight and gestational age at birth were not statistically different between the early (n = 85) and late (n = 94) groups (2110 ± 580 vs. 2140 ± 490 g, and 35.8 ± 3.0 vs. 35.7 ± 3.5 weeks). Similarly there was no statistically significant difference between early and late groups in the incidence of very premature (24–32 weeks; 9.3 vs. 8.3%) and premature (33–36 weeks; 46.5 vs. 47.9%) births.

Conclusions

Early second‐trimester multifetal pregnancy reduction from triplets to twins may allow more selective termination of abnormal fetuses without an adverse effect on the outcome of pregnancy. However, further studies are needed in order to confirm our observations in a larger series. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Cardiac function in fetuses with intracardiac echogenic foci
Authors: Degani S. , Leibovitz Z. , Shapiro I. , Gonen R. , Ohel G.
Published: March 2003

Objective

To evaluate cardiac dimensions and function in euploid fetuses with intracardiac echogenic foci.

Study design

Forty‐eight fetuses with a single cardiac echogenic focus situated in the left ventricle had echocardiography performed at 22–24 weeks of gestation. Fifty normal fetuses at 22–24 weeks' gestation served as controls. Two‐dimensional and M‐mode directed fetal echocardiography were used to exclude cardiac anomalies and measure right and left ventricular free walls and interventricular septal thickness and ventricular systolic and diastolic dimensions. Cardiac size was expressed as a ratio of ventricular wall thickness/biparietal diameter, and cardiac function was expressed as ventricular shortening fraction. Doppler fetal echocardiography measurements included pulmonary and aortic maximum systolic velocities and time to peak velocities as indices of ventricular systolic function, and the ratio between early ventricular filling (E‐wave) and active atrial filling (A‐wave) peak velocities at the level of the atrioventricular valves as an index of ventricular diastolic function.

Results

Early ventricular filling/active atrial filling peak velocity ratios were significantly lower in fetuses with intracardiac echogenic foci than in control fetuses. In the mitral valve the ratio was 0.37 ± 0.14 (0.039) (mean ± SD (95% confidence interval for difference between the means)) vs. 0.59 ± 0.19 (0.052) and in the tricuspid valve it was 0.42 ± 0.16 (0.045) vs. 0.62 ± 0.21 (0.058). No significant differences were found in cardiac dimensions, ventricular shortening fraction and Doppler systolic indices.

Conclusion

Euploid fetuses with intracardiac echogenic foci show low E/A ratio values in midtrimester echocardiography. This finding might indicate cardiac diastolic dysfunction. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Ventriculovascular physiology of the growth‐restricted fetus
Authors: Gardiner H. , Brodszki J. , Maršál K.
Published: March 2003

Objectives

To examine the mechanisms by which intrauterine growth restriction may influence later cardiovascular risk by comparing the ventriculovascular physiology of gestational age‐ and weight‐matched growth‐restricted and normal fetuses.

Design

A prospective longitudinal observational study of 20 normal fetuses studied from 20 weeks to term at monthly intervals was compared with a growth‐restricted cohort examined in the interval between diagnosis and delivery. The last values before delivery of the growth‐restricted cohort were compared with the normal cohort in two analyses matched for weight and for gestation. Arterial and venous vessel wall physiology and aortic pulse wave velocity were examined longitudinally in the thoracic descending aorta and inferior vena cava using an ultrasonic phase‐locked echo‐tracking system. Serial echocardiographic examinations were performed assessing structure, ventricular dimensions, function and Doppler flows.

Results

There was a linear increase in cardiac preload and relative pulse amplitude in the inferior vena cava with gestation. In normal fetuses, the aortic pulse wave velocity, maximum incremental and late decremental velocities increased with gestation whilst the relative pulse amplitude decreased reflecting falling distal impedance. In both age‐ and weight‐matched analyses, the growth‐restricted fetuses showed significantly reduced values reflecting the chronic fetal ventriculovascular responses to increased placental impedance. Pulse wave velocity increased with gestation and was significantly less in the growth‐restricted cohort.

Conclusions

Growth restriction is associated with abnormal ventriculovascular physiology that represents a successful adaptive response to raised placental impedance and reduction in wall stress as evidenced by the lower fetal pulse wave velocity in growth‐restricted fetuses. However, whilst fetal adaptive mechanisms may aid survival they may result in cerebral and vascular abnormalities that prejudice later cardiovascular health. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Sequential screening for trisomy 21 by nuchal translucency measurement in the first trimester and maternal serum biochemistry in the second trimester in a low‐risk population
Authors: Schuchter K. , Hafner E. , Stangl G. , Ogris E. , Philipp K.
Published: March 2003

Objective

To evaluate screening for trisomy 21 in a low‐risk population utilizing a combination of nuchal translucency measurement in the first trimester and the triple test in the second trimester.

Methods

This was a retrospective study of 9342 women with singleton pregnancies who booked for delivery in our hospital over a period of 5 years. A nuchal translucency scan was carried out at 10–13 weeks' gestation and for those with a measurement of 3.5 mm or more chorionic villus sampling was performed. All other women were asked to return for the triple test at 16 weeks' gestation. Amniocentesis was offered to women in whom the nuchal translucency was 2.5–3.4 mm, the triple test showed a risk of ≥ 1: 250 and in women aged ≥ 35 years.

Results

The detection rate using the combined screening method was 95% (18/19) with a screen‐positive rate of 7.2%. In comparison, screening by maternal age alone would have identified nine (47%) trisomy 21 pregnancies with a screen‐positive rate of 10.7%.

Conclusion

Our data suggest that the combination of nuchal translucency measurement in the first trimester and the triple test in the second trimester is associated with a very high detection rate of trisomy 21 at a relatively low screen‐positive rate. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of de novo mosaic deletion 13q associated with multiple abnormalities
Authors: Widschwendter A. , Riha K. , Duba H. C. , Kreczy A. , Marth C. , Schwärzler P.
Published: March 2003

A case of prenatal diagnosis of de novo mosaic deletion of the long arm of chromosome 13 (del(13)(q13.3)) is presented. Routine scanning in a 27‐year‐old primigravida at 25 weeks' gestation showed fetal bilateral hydronephrosis. Detailed anomaly scanning in our tertiary referral center further demonstrated posterior meningoencephalocele, sloping forehead, microcephaly, syndactyly and hypoplastic thumbs. Both genetic amniocentesis and cordocentesis revealed a mosaic karyotype, 46,XY/46,XY,del(13)(q13.3). Sonographic findings were confirmed by postmortem autopsy and additional abnormalities such as agenesis of corpus callosum, hypoplastic cerbellum and macroglossia were diagnosed. Detailed sonography in this case thus revealed multiple malformations that prompted fetal karyotyping at 25 weeks' gestation. Copyright © 2002 ISUOG
Antenatal diagnosis and treatment of a case of fetal goitrous hypothyroidism associated with high‐output cardiac failure
Authors: Morine M. , Takeda T. , Minekawa R. , Sugiyama T. , Wasada K. , Mizutani T. , Suehara N.
Published: March 2003

A case of fetal goitrous hypothyroidism associated with high‐output cardiac failure is presented. At 32 weeks of gestation, the antenatal diagnosis of goiter was made based on ultrasound examination, and the fetal thyroid function was examined by amniocentesis and cordocentesis. Color and pulsed Doppler examinations demonstrated a high vascular flow pattern in the goiter and marked elevation of the maximum velocity in the common carotid artery at the level of the neck. It was suspected that arteriovenous shunting through the large goiter resulted in high‐output cardiac failure with cardiomegaly and pleural effusion. The fetus was treated by injection of levothyroxine sodium into the amniotic fluid at 33 weeks of gestation and the goiter thereafter decreased in size, with subsequent improvement of the high‐output cardiac failure. The maximum velocity in the common carotid artery fell rapidly before the shrinkage of the fetal goiter and in parallel with the fetal level of thyroid stimulating hormone. Copyright © 2002 ISUOG
Prenatal diagnosis and management of fetuses with liver hemangiomata
Authors: Gembruch U. , Baschat A. A. , Gloeckner‐Hoffmann K. , Gortner L. , Germer U.
Published: March 2003

Objectives

To study the relationship between prenatal appearance and perinatal outcome of fetuses with hepatic hemangiomata with special emphasis on criteria that may help to improve perinatal management.

Methods

In a tertiary referral center six fetuses with hepatic hemangiomata were evaluated by gray‐scale, color, and pulsed wave Doppler ultrasound between 1994 and 2000. Fetal blood sampling was performed in four cases. All data (computerized files and video tapes) were analyzed retrospectively.

Results

Two fetuses showed very similar sonographic findings. They had an isolated large (‘giant’) round hepatic hemangioma (diameter 43 and 68 mm, respectively) supplied by one hepatic artery and drained by one hepatic vein, both of them showing high velocity and low pulsatility blood flow. Fetal blood count and coagulation parameters were normal in one case, whereas the other fetus showed a Kasabach–Merritt sequence with severe thrombocytopenia (10 platelets/nL) and mild disseminated intravascular coagulation. Intrauterine platelet transfusion was performed immediately prior to planned Cesarean delivery. Rapid platelet consumption continued postnatally, requiring several thrombocyte transfusions. Platelet counts stabilized only after tumor resection on the second day of life. One fetus with diffuse neonatal hemangiomatosis developed high‐output cardiac failure with hydrops in addition to Kasabach–Merritt sequence (15 platelets/nL), and died following premature delivery. Three fetuses, however, showing an isolated small hyperechogenic hepatic hemangioma (5, 5, and 6 mm in diameter, respectively) did not develop any perinatal complications.

Conclusion

Large fetal liver hemangiomata and diffuse hemangiomatosis may cause severe perinatal complications, particularly high‐output cardiac failure and/or Kasabach–Merritt sequence with severe consumption of platelets and clotting factors and hemolytic anemia. Fetal blood sampling enables the prenatal detection of these potential complications, allowing critical modification of perinatal management such as intrauterine platelet transfusion, especially directly before delivery. In contrast, isolated small hyperreflexic hepatic hemangiomata do not appear to be associated with any of these fetal and postnatal sequelae. Copyright © 2002 ISUOG
Clinical implications of fetal magnetocardiography
Authors: Quartero H. W. P. , Stinstra J. G. , Golbach E. G. M. , Meijboom E. J. , Peters M. J.
Published: March 2003

Objectives

To test the usefulness and reliability of fetal magnetocardiography as a diagnostic or screening tool, both for fetuses with arrhythmias as well as for fetuses with a congenital heart defect.

Methods

We describe 21 women with either a fetal arrhythmia or a congenital heart defect discovered during prenatal evaluation by sonography. Four fetuses showed a complete atrioventricular block, two an atrial flutter, nine ventricular extrasystole, and one a complete irregular heart rate. Five fetuses were suspected to have a congenital heart defect. In all cases magnetocardiograms were recorded.

Results

Nine fetuses with extrasystole showed a range of premature atrial contractions, premature junctional beats or premature ventricular contractions. Two fetuses with atrial flutter showed typical flutter waves and four fetuses with complete atrioventricular block showed an uncoupling of P‐wave and QRS complex. One fetus showed a pattern suggestive of a bundle branch block. In three of four fetuses with confirmed congenital heart defects the magnetocardiogram showed abnormalities.

Conclusion

Fetal magnetocardiography allows an insight into the electrophysiological aspects of the fetal heart, is accurate in the classification of fetal arrhythmias, and shows potential as a tool in defining a population at risk for congenital heart defects.
Transvaginal sonography in the diagnosis of acute appendicitis
Authors: Molander P. , Paavonen J. , Sjöberg J. , Savelli L. , Cacciatore B.
Published: March 2003

Objectives

To evaluate transvaginal sonography with power Doppler capacity in the diagnosis of acute appendicitis and in discriminating appendicitis from pelvic inflammatory disease.

Patients and methods

We describe transvaginal sonographic findings of six women with acute appendicitis selected from 31 women seen in an emergency room setting for clinically suspected pelvic inflammatory disease. The study population underwent gray‐scale transvaginal sonography, and specific sonographic landmark findings for acute appendicitis and pelvic inflammatory disease were used. Hyperemia of any infectious complex was identified by power Doppler. Laparoscopy was performed after transvaginal sonography and was used as the gold standard.

Results

Laparoscopy showed acute appendicitis in six (19%) of the 31 patients. A thick walled non‐compressible gas‐containing tubular structure with a diameter exceeding 6 mm was seen by transvaginal sonography in four of the six cases, consistent with uncomplicated appendicitis. A heterogeneous complex with surrounding hyperechogenic soft tissue was seen in two cases with gangrenous appendicitis. Power Doppler detected hyperemia in all six cases. Normal adnexal structures were imaged next to the inflamed appendix. The sonographic criteria consistent with acute appendicitis were clearly different from those of acute pelvic inflammatory disease.

Conclusions

Transvaginal sonography provides an opportunity to distinguish between appendicitis and acute pelvic inflammatory disease. Prospective trials are needed in order to evaluate the impact of transvaginal sonography in the diagnosis of acute appendicitis. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology