bluuebunny/crossref_metadata_2025 huggingface dataset:
First‐trimester nuchal edema as a marker of aneuploidy
Authors: Comas C. , Martinez J. M. , Ojuel J. , Casals E. , Puerto B. , Borrell A. , Fortuny A.
Published: March 2003

Targeted ultrasonographic screening for nuchal fluid accumulation during the first trimester (9–13 weeks) seems to be a recommendable method for the detection of Down's syndrome and other chromosomal anomalies in pregnant women. It compares favorably with current methods of maternal serum screening performed during the second trimester. Using a 4‐mm cut‐off value, the detection rate of aneuploidy among our population was found to be 57.1%, with a false‐positive rate of 0.7% and a positive predictive value of 72.7%. Chromosomal analysis should be considered for fetuses with nuchal translucency equal to or greater than 4 mm in the first trimester. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
First‐trimester ultrasound screening for fetal aneuploidies in women over 35 and under 35 years of age
Authors: Szabó J. , Gelén J. , Szemere G.
Published: March 2003

In a prospective screening study, the utility of the thickness of first‐trimester simple hygroma in sonographic screening for fetal chromosomal aberrations was examined. A total of 3380 women, 1280 of whom were 35 years or over, and 2100 of whom were under 35 years, were screened by ultrasound at 9–12 weeks of gestation. The thickness of fetal nuchal simple hygroma was measured. Women over 35 years of age underwent transabdominal chorionic villus sampling (CVS). In women under 35 years of age, CVS was offered only if the thickness of nuchal hygroma was at least 3 mm, or in cases of parental chromosomal abnormalities. A total of 46 chromosomal anomalies were detected, of which 43 (93.5%) showed simple hygroma. The incidence of first‐trimester simple nuchal hygroma in pregnancies of women over 35 and under 35 years of age was 5.4% (69 cases) and 1.28% (27 cases), respectively, and the percentage of chromosomal abnormalities was 2.9% and 0.43%, respectively. The risks of trisomies and poor pregnancy outcome were increased at larger sizes of first‐trimester simple hygroma. A sensitivity of 93.5% and a specificity of 98.4% of the method were found. Using a measurement of first‐trimester simple hygroma of ≥ 3 mm to identity pregnancies at risk for chromosomal anomalies at 9–12 weeks of pregnancy is a useful method for selection of women with high and low risk for aneuploidy. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
The vanishing fetal intrathoracic mass: consider an obstructing mucous plug
Authors: Meizner I. , Rosenak D.
Published: March 2003

An intrathoracic homogeneous hyperechogenic mass diagnosed in the second trimester of pregnancy represents a challenge to the sonographer. A disappearance of such a finding is an enigma.

We have recently encountered such a case in which a mucous plug obstructing a main bronchus was the causative factor. To the best of our knowledge, this is the first report of such an etiology in cases of vanishing fetal intrathoracic masses diagnosed by ultrasonography. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonographic evaluation of first‐trimester placenta previa
Authors: Hill L. M. , DiNofrio D. M. , Chenevey P.
Published: March 2003

Our objective was to determine the relationship between the placenta and the internal cervical os in the first trimester. This study included ultrasound examinations performed between 9 and 13 weeks' gestation over a 28‐month period. The position of the lower edge of the placenta with respect to the internal cervical OS was recorded for each transvaginal ultrasound examination. A total of 77 out of 1252 (6.2%) patients had a first‐trimester placenta previa; four cases persisted until term. There were no false‐negative diagnoses.

Our conclusion is that approximately 6.2% of patients will have a placenta previa in the first trimester. Transvaginal sonography can exclude a diagnosis of placenta previa after 9 weeks' gestation. The likelihood that a placenta previa will persist until term increases if the placenta covers the internal cervical os by ≥ 1.6 cm. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Fetal size and growth in Bangladeshi pregnancies
Authors: Spencer J. A. D. , Chang T. C. , Robson S. C. , Gallivan S.
Published: March 2003

A longitudinal study of 20 uncomplicated pregnancies in Bangladeshi women was undertaken. Fetal growth was investigated by serial ultrasound scans performed between 26 and 38 weeks of pregnancy. Repeated measurements of abdominal circumference and estimates of fetal weight were best described by a log quadratic equation. The coefficients were not significantly different from those obtained from a previously reported study of fetal growth in 67 uncomplicated pregnancies with healthy outcomes in white Anglo‐Saxon women. Further comparison between the two groups showed that the mean abdominal circumference and estimates of fetal weight of the Bangladeshi fetuses were smaller at 28, 32 and 36 weeks' gestation. These results suggest that, although Bangladeshi fetuses appear to be smaller than Anglo‐Saxon fetuses, they grow at a similar rate during the third trimester. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Fetal and transient neonatal right heart dilatation with severe tricuspid valve insufficiency in association with abnormally S‐shaped kinking of the ductus arteriosus
Authors: Mielke G. , Peukert U. , Krapp M. , Schneider‐Pungs J. , Gembruch U.
Published: March 2003

Alterations of the ductus arteriosus, e.g. occlusion, constriction or aneurysm, can influence the fetal and neonatal circulation. A case of fetal right atrial and ventricular dilatation, severe tricuspid valve insufficiency and transient pulmonary valve regurgitation at 32 weeks of gestation is reported. Structural heart defects and extracardiac diseases (e.g. high output cardiac failure in arteriovenous shunts and anemia) were excluded by Doppler echocardiography and fetal blood sampling. An abnormally S‐shaped kinking of the ductus arteriosus with increased systolic and diastolic flow velocities in the distal part was demonstrated. At 35 weeks' gestation, Cesarean section was performed, because of increased tricuspid valve insufficiency, and a healthy boy was born. After birth, right heart dilatation and tricuspid valve insufficiency decreased. The cardiac changes in relation to the anatomical abnormality of the ductus arteriosus are discussed. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic features of tuberculous peritonitis with female genital tract tuberculosis
Authors: Yapar E. G. , Ekici E. , Karasahin E. , Gökmen O.
Published: March 2003

Our aim was to illustrate the sonographic features of tuberculous peritonitis with female genital tract tuberculosis in an attempt to facilitate the recognition of the disorder preoperatively. Transabdominal and transvaginal sonographic features and the findings from laparotomy/laparoscopy, endometrial biopsy and microbiology were reviewed and compared in 15 patients with tuberculous peritonitis with female genital tract tuberculosis.

Of the 15 patients, 12 had wet tuberculosis and three had dry (adhesive) tuberculosis. Sonographic features of wet tuberculosis were categorized as follows: septated ascites (ten patients), particulate ascites (two patients), loculated fluid (two patients), thickened peritoneum (eight patients), thickened omentum (eight patients), adnexal mass (11 patients), adhesions (seven patients) and endometrial involvement (five patients). Adnexal masses, adhesions and loculated fluid were found to be present in the dry type. When sonographic findings were compared with those of laparotomy and/or laparoscopy and/or endometrial biopsy, ultrasound was able to identify aspects of tuberculosis infection as follows: ascites/loculated fluid, 13/13 (100%); adnexal mass, 12/13 (93%); peritoneal thickening, 943 (69%); omental thickening, 8/13 (61%); and endometrial involvement, 5/6 (83%).

We conclude that awareness of the sonographic changes associated with tuberculosis infection may improve diagnostic accuracy, and avoid clinical mismanagement and surgical explorations in the wet type of tuberculosis. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
The ultrasound diagnosis and clinical significance of varicocele
Authors: Curtis P. , Nicholas O. A. , Berger L. , Shaw R. W.
Published: March 2003

A study was carried out to determine the relationship between clinically diagnosed and ultrasound‐diagnosed varicoceles in I51 men with normal and abnormal semen analysis. In only 60 cases (40%) was the clinical diagnosis confirmed by ultrasound. Of the men with ultrasound‐diagnosed varicocele, 14(% were found to have a normal semen analysis compared to 31% of men without a varicocele, and this difference was statistically significant (p < 0.05). Bilateral varicoceles were associated with an even greater chance of having an abnormal semen analysis (p < 0.01), and with a significantly (p < 0.05) decreased chance of spontaneous pregnancy. These men and also men with unilateral varicocele, whose partners have a relative cause of female subfertility, may benefit from earlier intervention for the treatment of their subfertility. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Accuracy of ultrasound estimation of fetal weight in multiple pregnancies
Authors: Lynch L. , Lapinski R. , Alvarez M. , Lockwood C. J.
Published: March 2003

Our objective was to assess the accuracy of ultrasonographic estimation of fetal weight in twins and triplets as compared to singleton pregnancies. Retrospective analysis was undertaken of ultrasound data of all fetuses who underwent an examination within 1 week of delivery (singletons 1832, twins 518, triplets 51).

At birth weights below 2500 g, there was a significant overestimation of fetal weight in twins as compared to singletons, but the accuracy of the estimate was the same, except in twins between 1500 and 2499 g, when the weight was based on abdominal circumference and femur length alone. At birth weights of more than 2500 g, no difference was detected between twins and singletons. At all birth weights below 2500 g, the accuracy of weight estimation in triplets was equal to that in singletons and there were no triplets above this weight. We conclude that ultrasonographic estimation of fetal weight is as accurate in twins and triplets as it is in singletons. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Screening for fetal trisomy 21 in the first trimester of pregnancy: maternal serum free β‐hCG and fetal nuchal translucency thickness
Authors: Noble P. L. , Abraha H. D. , Snijders R. J. M. , Sherwood R. , Nicolaides K. H.
Published: March 2003

The aim of this prospective study was to measure the contribution of maternal serum free β‐human chorionic gonadotropin (β‐hCG) in a screening program for fetal trisomy 21 based on fetal nuchal translucency in the first trimester of pregnancy. The maternal serum was collected at the time of the ultrasound scan and assayed without knowledge of the nuchal translucency measurement or karyotype. A total of 2529 pregnancies were examined (normal group, n = 2427: trisomy 21 group, n = 102). Maternal serum free β‐hCG was significantly associated with gestational age and maternal weight. In the trisomy 21 group the free β‐hCG was significantly higher than in the normals, being above the 95th centile in 29% of the cases. There was no significant association between the deviation from the mean for free β‐hCG and nuchal translucency thickness in either the normal or the trisomy 21 groups. When maternal serum free β‐hCG was added to a model based on maternal age and fetal nuchal translucency thickness, the detection rate for trisomy 21 was increased from 80% to 85%. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Longitudinal evaluation of uteroplacental and umbilical blood flow changes in normal early pregnancy
Authors: Coppens M. , Loquet Ph. , Kollen M. , De Neubourg F. , Buytaert Ph.
Published: March 2003

The hemodynamic changes in the uteroplacental circulation and the umbilical artery were evaluated in normal pregnancy from 8 to 14 weeks' gestation. A 6–9‐MHZ broad‐band transvaginal sonographic transducer combined with pulsed color Doppler was used to scan 37 healthy volunteer pregnant women at weekly intervals. Vascular impedance to blood flow in all examined vessels decreased significantly throughout the first gestational trimester. Resistance to flow was highest in the main uterine artery and decreased towards the spiral artery. When the flow velocity waveform patterns of the arteries under investigation were analyzed, specific changes were observed. The diastolic notch was present in the spiral artery flow velocity waveform in all cases until 10 weeks' gestation. From then, the diastolic notch disappeared progressively and was absent in 100% of cases at 13 weeks. The diastolic notch in the arcuate artery disappeared within 2 weeks of its disappearance in the spiral artery. We could not detect intervillous blood flow during the first 12 weeks. From then on, intervillous flow was observed in most pregnancies, reaching 100% at 14 weeks' gestation. These changes reflect the growth and development of the uteroplacental circulation. The absence of detectable intervillous flow during most of the first trimester confirms the concept that, during the first 3 months of gestation, blood flow to the intervillous space is inhibited by trophoblastic plugs. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Fetal heart rate in trisomy 21 and other chromosomal abnormalities at 10–14 weeks of gestation
Authors: Hyett J. A. , Noble P. L. , Snijders R. J. M. , Montenegro N. , Nicolaides K. H.
Published: March 2003

Fetal heart rate was measured routinely as part of a prospective study examining the efficacy of screening for trisomy 21 by fetal nuchal translucency thickness and maternal age. In 6903 normal singleton pregnancies the fetal heart rate decreased from a mean of 171 bpm at 10 weeks of gestation to 156 bpm at 14 weeks (r = 0.413, p < 0.0001). In 85 trisomy 22 pregnancies, the mean heart rate was significantly higher than in the normal group (mean difference 0.67 SD, 95% confidence interval 0.42–0.92, t = 5.3, p < 0.00l). The fetal heart rate in trisomy 18 and triploid fetuses was significantly lower and in trisomy 13 and Turner syndrome was higher than normal. There was no significant association between delta fetal heart rate and delta nuchal translucency thickness in either the normal (r = −0.018) or the trisomy 21,(r = −0.031) pregnancies. Consequently, the risk for chromosomal defects can be derived by combining data from maternal age, fetal nuchal translucency and fetal heart rate. The effectiveness of screening by this method was examined in a self‐selected population with completed pregnancies that had undergone first‐trimester scanning. This population contained 6903 normal and 29 trisomy 21 fetuses. For a false‐positive rate of about 5%, the sensitivity for trisomy 21 was 48% by maternal age, 26% by fetal heart rate, 72% by nuchal translucency thickness, 59% by maternal age and fetal heart rate, 76% by maternal age and nuchal translucency thickness and 8.3% by a combination of maternal age, nuchal translucency thickness and fetal heart rate. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Abnormalities of the heart and great arteries in chromosomally normal fetuses with increased nuchal translucency thickness at 1l–13 weeks of gestation
Authors: Hyett J. , Moscoso G. , Papapanagiotou G. , Perdu M. , Nicolaides K. H.
Published: March 2003

Pathological examination of trisomic fetuses with increased nuchal translucency thickness at 1l–13 weeks of gestation demonstrated a high prevalence of cardiac defects and abnormalities of the great arteries. This study reports the pathological findings observed from the examination of the heart and great arteries of 21 chromosomally normal fetuses with increased nuchal translucency. In 19 of the 21 cases there were abnormalities the commonest was narrowing of the aorta at the level of the isthmus and immediately above the aortic valve. This finding is different from that in case of trisomy 21, where narrowing of the isthmus is associated with an increased diameter of the aortic valve. These findings suggest that abnormarlities of the heart and great arteries may be implicated in the pathogenesis of increased nuchal translucency not only in trisomic fetuses but also in chromosomally normal fetuses. It can be implied that increased nuchal translucency thickness at 10–14 weeks of gestation may prove to be a useful marker for the identification of fetal cardiac abnormalities. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Perineal ultrasound: determination of reliable examination procedures
Authors: Schaer G. N. , Koechli O. R. , Schuessler B. , Halley U.
Published: March 2003

This is a report on the fundamentals of perineal ultrasound examination for female incontinenze. The measurement method described here enabled us to determine the position of the bladder neck, the size of the retrovesical angle β and the occurrence of funnelling. In four different investigations, each involving at least 30 patients, we investigated the influence of examination position, bladder filling volume and pressure of the ultrasound probe against the perineum on these measurements and analyzed the difference between coughing and the Valsalva maneuver. The results showed that when the patient is standing, the bladder neck is lower than when the patient is supine. We also observed that excessive pressure on the ultrasound probe displaces the bladder neck cranially and can squeeze the urethra. Increasing the bladder filling volume does not affect the measurement values, but funnelling can be seen better with higher bladder volumes. The best overall image quality was obtained at 300 ml. A comparison between coughing and the Valsalva maneuver showed that during coughing, the bladder neck descends less and remains closer to the symphysis than with the Valsalva maneuver. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Laryngeal atresia: antenatal diagnosis in a twin pregnancy
Authors: Tang P. T. M. , Meagher S. E. , Khan A. A. , Woodward C. S.
Published: March 2003

Congenital laryngeal atresia is a rare malformation almost always incompatiblle with life. Prenatal sonographic diagnosis of this condition has been described on five occasions and all occurred in singleton pregnancies. To our knowledge, this is the first reported case of prenatal diagnosis of laryngeal atresia in a twin pregnancy. A monochorionic diamniotic twin gestation was noted at a routine ultrasound examination at 18 weeks' gestation. One twin was found to have changes consistent with laryngeal atresia with bilateral enlarged hyperechogenic lungs and hydrops fetalis. The other twin appeared normal. A Cesarean section was performed for worsening pre‐eclampsia at 29 weeks' gestation. The abnormal twin died, despite resuscitative measures and autopsy confirmed the diagnosis of laryngeal atresia. The presence of the anomaly in only one twin of a monozygotic gestation supports the theory of a developmental anomaly within the branchial arches. Prenatal diagnosis of laryngeal atresia allows prenatal planning for resuscitation at birth, but its presence in one twin of a twin gestation poses several management dilemmas. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic diagnosis of fetal upper extremity dysmorphology: significance and outcome
Authors: Zelop C. , Benacerraf B.
Published: March 2003

The aim of this study was to determine the etiology, associated anomalies and outcome of fetuses with postural deformities and contractures of the upper extremities detected sonographically. Fifty‐four fetuses with sonographically detected postural anomalies of the upper extremities were identified from our database. Sonographic findings and associated anomalies were tabulated on the basis of the original sonogram. Perinatal follow‐up and/or karyotype were available in 52 cases from a review of the maternal and newborn medical records and pathology reports. Of the 52 fetuses with sonographically detected anomalies of the upper extremities, 44 (85%) were non‐survivors and eight (15%) were survivors. Forty‐three fetuses had associated sonographic abnormalities. Karyotyping performed in 44 cases revealed 26 cases (59%) of aneuploidy, with trisomy 18 accounting for 23/26 (88%). In the setting of a normal karyotype, a variety of genetic disorders were found, including syndromes involving the fetal dyskinesialakinesia sequence. Disturbances in amniotic fluid occurred in 48% of the cases (24 fetuses with polyhydramnios and one with oligohydramnios). In conclusion, the sonographic detection of postural abnormalities of the upper extremities carries a guarded prognosis, with survival in 15% of fetuses and a high incidence of chromosomal defects. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Development of fetal gyri, sulci and fissures: a transvaginal sonographic study
Authors: Monteagudo A. , Timor‐Tritsch I. E.
Published: March 2003

We aimed to determine the feasibility of imaging specific sulci, gyri and fissures using transvaginal sonography and to correlate their first sonographic recognition with gestational age. Retrospectively, 262 fetal brain scans were analyzed from a total of 337 scans. Scans were selected if any of the following structures were seen: in the coronal plane the lateral, callosal and cingulate sulcus and gyrus; in the median plane the parieto‐occipital and calcarine fissures, and the cingulate gyrus and sulcus; and, in an oblique section, the lateral sulcus. The gestational age at which the fissures, sulci and gyri were first imaged was recorded and subsequently compared with similar anatomical studies from the literature.

It was possible to identify all the targeted structures. The gestational ages at which the structures were first imaged were: the callosal sulcus, from 14 weeks; the lateral sulcus, from 18 weeks; the parieto‐occipital sulcus and calcarine fissure, from 18 weeks; and the cingulate gyrus, from 26 weeks.

We concluded that the developmental maturation of the normal fetal brain follows a predictable timetable, and that this maturation can be grossly followed with sonography. The sonographic recognition of the fissures, gyri and sulci lagged behind the observations by anatomical studies. The greatest discrepancy was the first appearance of the cingulate gyrus which, in the anatomical studies, could be seen by 18 postmenstrual weeks and, in our study, was seen after 26 postmenstrual weeks. The one exception was the callosal sulcus, which was first seen at 14 postmenstrual (weeks in both the sonographic and anatomical studies. In conclusion, the recognition of specific structures of the cortical map is possible. Sonography may be used to image the developing cortical surface. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Saline contrast sonohysterography as first‐line investigation for women with uterine bleeding
Authors: Bernard J. P. , Lécuru F. , Darles C. , Robin F. , de Bievre P. , Taurelle R.
Published: March 2003

The objective of this study was to assess the effectiveness of saline contrast sonohysterography (SCSH) as a first‐line investigation for perimenopausal women with uterine bleeding.

A total of 162 women were enrolled in a prospective study. They underwent SCSH indicated for abnormal uterine bleeding. Patients with normal or atrophic endometrium were scheduled for diagnostic hysteroscopy or hormone therapy. Patients with uterine cavity abnormalities were scheduled for surgery (operative hysteroscopy or hysterectomy). A clinical follow‐up was obtained for all the patients after SCSH. Sonohysterographic findings were compared with pathological results.

SCSH was carried out in 159 patients. In all but one case, the procedure was well tolerated by the patients. There were no complications either during or after the examination. Surgical and pathological results were available in 109 cases. SCSH was highly sensitive and specific in the differentiation between women with intrauterine lesions and those with normal or atrophic endometrium (98.9% and 76.4%, respectively). SCSH was also accurate in the diagnosis of polyps and submucosal myomas (sensitivity 87.8 and 89.6%, specificity 90.7 and 95%). SCSH and surgery displayed the same reliability in the measurement and the localization of the lesions. SCSH recognized endometrial cancer in only 40% of cases. However, all these patients had abnormalities at sonohysterography which indicated a surgical exploration, leading to a zero false‐negative rate.

Saline contrast sonohysterography appears to be a reliable tool for the investigation of abnormal uterine bleeding in perimenopausal women. It can distinguish women who only require medical therapy from those who require surgery. The method is easy to learn, and is well tolerated by the patients. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of ectopia cordis at 10 weeks of gestation using two‐dimensional and three‐dimensional ultrasonography
Authors: Liang R.‐I. , Huang S.‐E. , Chang F.‐M.
Published: March 2003

We report here the earliest prenatal diagnosis to date of a case of ectopia cordis using both two‐dimensional and three‐dimensional ultrasound at 10 weeks of gestation. Both two‐dimensional and three‐dimensional ultrasound clearly revealed a thoracoabdominal ectopia cordis and an omphalocele. Histopathological examination confirmed the prenatal ultrasonic findings. In addition to an ectopia cordis, a supraumbilical hepato‐omphalocele, absence of a pericardium and an anterior diaphragmatic defect were seen, although there was a normal sternum. These pathological findings, suggested that our case was a variant of pentalogy of Cantrell. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Cervical funneling: sonographic criteria predictive of preterm delivery
Authors: Berghella V. , Kuhlman K. , Weiner S. , Texeira L. , Wapner R. J.
Published: March 2003

Our objective was to establish sonographic criteria that are predictive of preterm delivery in patients with internal os dilatation (funneling). The study population consisted of patients with cervical funneling identified on translabial or transvaginal ultrasound examination. Funnel length, functional length, percentage funneling and funnel width were evaluated for their predictive values for preterm delivery.

In the 43 patients who met the study criteria, funneling was detected at a mean gestational age of 21.4 weeks (range M‐28). Twenty‐three of 31 patients (74%), manually examined immediately following the ultrasound examination, had a closed cervix. Preterm delivery occurred in 42% of patients. Funnel length of ≥ 16 mm, functional length of ≤ 20 mm, funneling of ≥ 40% and funnel width of ≥ 14 mm correlated significantly with preterm delivery. Patients with funneling of < 25%, 25–50% and > 50% had preterm delivery rates of 17%, 29% and 79%, respectively. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Ovarian steroid cell tumors: sonographic characteristics
Authors: Monteagudo A. , Heller D. , Husami N. , Levine R. U. , McCaffrey R. , Timor‐Tritsch I. E.
Published: March 2003

The goal of the gynecologist is to detect ovarian tumors in their earliest stages. Small virilizing tumors, which barely affect the size of the ovaries, are such lesions. Since the introduction of transvaginal sonography it is technically possible to detect small intraovarian neoplasms. Three cases of virilizing steroid cell tumors in postmenopausal women with ovarian volumes just exceeding the normal sizes for age are presented. High‐frequency transvaginal ultrasound and color Doppler studies to measure flow parameters were used. These small tumors had different echogenicity from the surrounding ovarian tissue and two had low impedance‐to‐flow values. Gray‐scale transvaginal sonography combined with co/or Doppler studies can make the diagnosis of small steroid cell tumors easier and, at times, better than other, more costly imaging modalities. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic localization of abdominal vessels in Chinese women: its role in laparoscopic surgery
Authors: Pun T.C. , Chau M.T. , Lam C. , Tang G. , Leong L.
Published: March 2003

Trauma to abdominal wall blood vessels occurs following 0.2–2% of laparoscopic operations. This prospective observational study assessed the possible role of sonographic localization of abdominal blood vessels prior to laparoscopic surgery in Chinese women and compared the findings reported in a Western group.

The inferior epigastric and superficial circumflex iliac vessels were located by color Doppler imaging. Ultrasonography was 100% and 80% successful in locating the inferior epigastric and the superficial circumflex iliac vessels, respectively. The positions of the inferior epigastric vessels were similar to those reported in the Western population whilst the superficial circumflex iliac vessels were found to be situated 1 cm more medially.

In our study population, a safe area for entry of lateral ports appeared to be 7 cm from the midline and 5 cm above the pubic symphysis.

Sonographic localization of abdominal blood vessels is a potentially useful clinical tool in the prevention of blood vessel trauma. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Assessment of first‐trimester nuchal translucency by daily reference intervals
Authors: Yagel S. , Anteby E. Y. , Rosen L. , Yaffe E. , Rabinowitz R. , Tadmor O.
Published: March 2003

Increased fetal nuchal translucency measured in the first trimester is associated with an elevated frequency of chromosomal abnormalities, yet no reference intervals for transvaginal sonographic measurements of fetal nuchal translucency in that period of development have been established. The aim of the present cross‐sectional study was to construct appropriate gestational age‐specific reference intervals for nuchal translucency. Transvaginal ultrasound was used in 180 normal pregnant women between 9 and 14 weeks of gestation. Reference intervals were constructed by the parametric method.

These reference intervals were then compared to the traditional threshold value of 3 mm, when applied to 287 women scheduled for amniocentesis or chorionic villus sampling (CVS). Both methods had the same sensitivity, 85.7%, and negative predictive value, 99.6%, in predicting fetal chromosomal abnormalities. However, the specificity of the gestational age‐related reference intervals tended to be higher than that of the 3‐mm threshold: 94.6% vs. 87.9%. The positive predictive value of the former method was higher than that of the 3‐mm threshold: 28.6% vs. 15%.

The increased specificity and positive predictive value of these reference intervals are of particular importance when applied to women under the age of 35 years. In those women, the finding of an abnormally thick nuchal translucency can lead to the performance of amniocentesis or CVS. Therefore, using these reference intervals instead of the traditional 3‐mm threshold may save a significant number of unnecessary invasive procedures. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Uterine artery blood flow parameters in women with dysfunctional uterine bleeding and uterine fibroids: the effects of tranexamic acid
Authors: Lakhani K. P. , Marsh M. S. , Purcell W. , Hardiman P.
Published: March 2003

The objective of this study was to investigate the effects of tranexamic acid on uterine vascular resistance in women with dysfunctional uterine bleeding and in women with menorrhagia associated with fibroids.

A longitudinal, prospective study was carried out in premenopausal women referred to a gynecological out‐patient department with a complaint of menorrhagia. We studied 24 women with dysfunctional uterine bleeding (mean age 38.8 years; normal ultrasound examination, hysteroscopy and endometrial biopsy) and 12 women (mean age 42.8 years) with at least one fibroid greater than 2.0 cm on ultrasound examination. None were on any form of oral contraception or other medication which could influence uterine vascular resistance. All women had normal coagulation and thyroid function tests.

Transvaginal scanning was performed using an Aloka SSD 650 machine with a 5‐MHz probe and pulsed Doppler. Pulsatility index (PI) and resistance index (RI) were measured from the left and right uterine arteries before and during the second month of treatment with tranexamic acid (1 g orally three times a day). Menstrual blood loss was assessed using a validated pictorial blood chart.

In women with dysfunctional uterine bleeding, the mean PI and RI fell significantly with treatment (PI 2.20–1.94, p = 0.0001; RI 0.81–0.77, p = 0.003). There was a reduction of approximately 30% in menstrual blood loss with treatment (210.0–137.6 ml, p = 0.0001). In women with uterine fibroids, there was no significant change in either the PI or the RI with treatment and there was no significant reduction in menstrual blood loss.

We conclude that tranexamic acid significantly reduces uterine artery vascular resistance in women with dysfunctional uterine bleeding. This effect is unlikely to be a mechanism for the action of tranexamic acid in reducing menstrual blood loss but may have important implications for women taking this treatment in the long term. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
An evaluation of sonohysterography and diagnostic hysteroscopy for the assessment of intrauterine pathology
Authors: Schwärzler P. , Concin H. , Bösch H. , Berlinger A. , Wohlgenannt K. , Collins W.P. , Bourne T. H.
Published: March 2003

The availability of advanced hysteroscopic surgical techniques has changed the management of abnormal uterine bleeding. The aim of this study was to evaluate the use of transvaginal sonography (TVS), sonohysterography (SH) and diagnostic hysteroscopy (DH) for the preoperative assessment of the uterine cavity. The plan was to investigate 100 patients with abnormal uterine bleeding despite conventional medical treatment. The endpoints were uterine abnormalities detected by operative hysteroscopy and histology, and subjective estimates of discomfort during TVS and SH. A total of 104 patients (aged 26–79 years) were recruited and 98 (94%) underwent all three diagnostic procedures. Uterine abnormalities were present in 52 patients (53%). There were 25 cases with at least one endometrial polyp, 17 with submucous fibroids, seven with endometrial hyperplasia and three with an adenocarcinoma. The overall sensitivity of TVS improved after SH from 67 to 87% and the specificity from 89 to 91%. The positive predictive value increased from 88 to 92% and the negative predictive value from 71 to 86%. The use of SH also improved the quality of information about the location and size of polyps and submucous fibroids. Increased endometrial thickness associated with adenocarcinoma was detected in all cases (three of three) by TVS and in four of seven cases of hyperplasia (five of seven cases after SH). Most patients reported minor discomfort during TVS or SH and no side‐effects were apparent. The sensitivity of DH was 90% (92% for polyps, 88% for fibroids); two cases with a polyp, two with a submucous fibroid and one with endometrial hyperplasia were not detected. The use of saline infusion to enhance visualization of the endometrium increases the diagnostic accuracy of transvaginal sonography to approach that of diagnostic hysteroscopy and also provides some additional information. This development has implications for the management of uterine bleeding disorders. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Comparison of umbilical artery Doppler velocimetry between maternal supine position and complete left lateral position in predicting obstetric complications
Authors: Ryo E. , Okai T. , Takagi K. , Okuno S. , Sadatsuki M. , Kaneko M. , Taketani Y.
Published: March 2003

The aim of this study was to compare the predictive value of umbilical artery Doppler velocimetry in women in the supine position with that in women in the complete left lateral position as a screening test for abnormal obstetric outcomes. Umbilical artery resistance index (RI) was measured at 27–29 weeks and 35–37 weeks in 202 pregnant women. The measurements were performed with the mother in the supine position in 100 cases (supine group), and in the complete left lateral position in 102 cases (lateral group). Predictive values of the tests for abnormal outcomes (small for gestational age, fetal distress, pregnancy‐induced hypertension) were compared between both groups. When abnormal RIs were defined as being greater than the 90th centile in the supine group, the sensitivities for any of the abnormal outcomes at 27–29 weeks were 18% in the supine group and 6% in the lateral group; the positive predictive values were 30% and 25%, respectively. For measurement at 35–37 weeks, the sensitivity and positive predictive value were 29% and 45%, respectively in the supine group, and 0% in both cases in the lateral group. When abnormal RIs were defined as being greater than the 90th centile in the lateral group, the sensitivities at 27–29 weeks were 41% in the supine group and 6% in the lateral group; the positive predictive values were 44% and 8%, respectively. At 35–37 weeks, the sensitivity and positive predictive value were 53% and 43% in the supine group, and 6% and 8% in the lateral group. Umbilical artery Doppler velocimetry when the mother was in the complete left lateral position was of little value as a screening test. However, when the mother is in the supine position, it may serve as a kind of stress test and disclose latent obstetric abnormalities in certain cases. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Age‐adjusted ultrasound risk assessment for fetal Down's syndrome during the second trimester: description of the method and analysis of 142 cases
Authors: Nyberg D. A. , Luthy D. A. , Resta R. G. , Nyberg B. C. , Williams M. A.
Published: March 2003

Objective

To describe and test a method of individual risk assessment for fetal Down's syndrome based on maternal age and second‐trimester ultrasound findings.

Design

A case–control study of 142 fetuses with Down's syndrome was compared with 930 control fetuses with normal karyotype. All patients underwent second‐trimester ultrasound at a single institution with a standardized ultrasound protocol without knowledge of fetal karyotype. Age‐adjusted ultrasound risk assessment (AAURA) for Down's syndrome was performed by multiplying the a priori risk, based on maternal age, with likelihood ratios resulting from the presence or absence of specific ultrasound findings for each patient. Individual ultrasound findings were assigned likelihood ratios (LR) as follows: structural abnormality (LR 25), nuchal thickening (LR 18.6), echogenic bowel (LR 5.5), shortened humerus (LR 2.5), shortened femur (LR 2.2), echogenic intracardiac focus (LR 2), and renal pyelectasis (LR 1.6). A normal ultrasound was assigned a LR of 0.4.

Results

One or more ultrasound markers were identified in 68.3% (97) of fetuses with Down's syndrome compared to 12.5% of fetuses with normal karyotype. Among fetuses with positive ultrasound, 31% of those with Down's syndrome and 80% of those with normal karyotype showed a single non‐structural finding. Using AAURA and a threshold of 1 : 200, 74% (105 of 142) of fetuses with Down's syndrome were identified, including 61.5% (24 of 39) from women aged less than 35 years, 67.2% (45 of 67) from women aged 35–39 years inclusively, and 100% (36 of 36) from women aged 40 years or older. AAURA of 930 fetuses with normal karyotype showed an overall false‐positive rate of 14.7%, including 4% (21 of 519) from women aged less than 35 years, 12.5% (42 of 337) from women aged 35–39 years inclusively, and 100% from women aged 40 years or older.

Conclusions

AAURA permits improved individual counselling regarding the risk of fetal Down's syndrome following a second‐trimester sonogram. For low‐risk women under age 35 years, ultrasound assessment can identify over half of the affected fetuses with Down's syndrome with an acceptable false‐positive rate (4%). For women aged 35–39 years, a normal ultrasound can substantially reduce the risk of unnecessary amniocentesis (12.5% from 100%) but will also miss approximately one‐third of affected fetuses. Biochemical screening of maternal serum is also suggested for this group. Based on their high a priori risk, women aged 40 years or more should consider genetic amniocentesis regardless of a normal ultrasound. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Fetal cardiac measurements derived by transvaginal and transabdominal cross‐sectional echocardiography from 14 weeks of gestation to term
Authors: Shapiro I. , Degani S. , Leibovitz Z. , Ohel G. , Tal Y. , Abinader E. G.
Published: March 2003

Objective

Most of the routine ultrasound screening in our institution consists of early transvaginal examinations at 14–17 weeks. Complete fetal echocardiography is performed in every case. However, normal values for most fetal cardiac structures at this stage of gestation are not available. Our aim was to construct normal ranges for fetal cardiac structures, derived from cross‐sectional echocardiography, at 14–40 weeks of gestation.

Design

A prospective study was performed. The study group consisted of 637 pregnant women referred for a routine sonographic examination. Women with abnormal prenatal or postnatal outcome were not included in the study. Transvaginal examinations were used for 14–17 weeks of gestation. More advanced pregnancies were examined transabdominally.

Results

We constructed normal ranges for the left and right end‐diastolic transverse ventricular diameters (n = 637), left/right ventricular ratio (n = 637), aortic root diameter (n = 637), pulmonary artery diameter (n = 637), aortic/pulmonary ratio (n = 490), left and right transverse atrial diameters (n = 201) and left/right atrial ratio (n = 201).

Conclusions

The results provide the examiner with normal ranges for fetal cardiac structures for the early transvaginal examination. The continuity of all curves from 14 to 40 weeks of gestation allows follow‐up of any specific fetus to term. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound measurement of the fetal cavum septi pellucidi
Authors: Jou H.‐J. , Shyu M.‐K. , Wu S.‐C. , Chen S.‐M. , Su C.‐H. , Hsieh F.‐J.
Published: March 2003

Objectives

To establish normative data for the width of the fetal cavum septi pellucidi at various gestational ages.

Subjects and methods A total of 608 consecutive fetuses between 19 and 42 gestational weeks were included in this prospective study. The largest width of the cavum septi pellucidi was measured by two‐dimensional ultrasound. Piecewise regression analysis was used to study the relationships between the width of the fetal cavum septi pellucidi, gestational age and biparietal diameter.

Results

The fetal cavum septi pellucidi width increased gradually between 19 and 27 weeks of gestation and then plateaued between 28 weeks and term. Regression analysis revealed significant associations between cavum septi pellucidi width and gestational age, and cavum septi pellucidi width and biparietal diameter.

Conclusions

The present study provides normative data for fetal cavum septi pellucidi width and useful information about the development of the midline brain structure in the fetus. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Fetal gallstones: sonographic and clinical observations
Authors: Suma V. , Marini A. , Bucci N. , Toffolutti T. , Talenti E.
Published: March 2003

Fetal gallstones were visualized sonographically in two cases at 30 and 37 weeks' gestation; follow‐up scans at 2 and 3 months, respectively, disclosed their spontaneous resolution. The hypotheses advanced to explain the formation of echogenic material in the fetal gallbladder are reviewed, and the clinical utility of postnatal long‐term sonographic follow‐up is stressed. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The effectiveness of non‐surgical management of early interstitial pregnancy: a report of ten cases and review of the literature
Authors: Hafner T. , Aslam N. , Ross J. A. , Zosmer N. , Jurkovic D.
Published: March 2003

Objective

To assess the effectiveness of non‐surgical management of interstitial pregnancy.

Design

A prospective interventional study.

Subjects

Eleven women with the ultrasound diagnosis of interstitial ectopic pregnancy.

Methods

Women with suspected early pregnancy complications were examined by transvaginal ultrasound. Those with the diagnosis of interstitial pregnancy were offered non‐surgical treatment with methotrexate, which was administered systemically or by local injection. Follow‐up with regular measurements of ß‐human chorionic gonadoropin and ultrasound scans continued until the pregnancy had resolved completely.

Results

Ten women were managed non‐surgically, and one woman opted for surgery. Five women received systemic and five local methotrexate. Local therapy was successful in all five cases (100%), whereas four out of five (80%) women receiving systemic methotrexate were cured. Significant side‐effects were noted in two women following systemic therapy. In comparison, there were no side‐effects in the group of women who received local therapy. There were no significant differences between the two treatment groups in the length of time taken for the pregnancy to resolve.

Conclusions

Non‐surgical treatment of interstitial pregnancy with methotrexate appears to be safe and effective. Local administration appears to be more successful and better tolerated by patients and may be used as the first‐line therapy. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of fetal adrenal masses: differentiation between hemorrhage and solid tumor by color Doppler sonography
Authors: Schwärzler P. , Bernard J.‐P. , Senat M.‐V. , Ville Y.
Published: March 2003

We present four cases of fetal adrenal masses detected by routine prenatal ultrasound, of which three were adrenal hemorrhages and one was a fetal neuroblastoma. The differential diagnoses of fetal adrenal mass include adrenal hemorrhage, neuroblastoma, adrenal and cortical renal cysts, pulmonary sequestrations, duplication of the reno‐ureteral system and Beckwith‐Wiedemann syndrome. These can pose a diagnostic and therapeutic dilemma. A systematic comparison of the pre‐ and postnatal sonographic features including color Doppler imaging may help to differentiate adrenal hemorrhage from neuroblastoma prenatally. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology