bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood flow velocity waveforms from fetal peripheral pulmonary arteries in pregnancies with preterm premature rupture of the membranes: relationship with pulmonary hypoplasia
Authors: Rizzo G. , Capponi A. , Angelini E. , Mazzoleni A. , Romanini C.
Published: March 2003

Objectives To measure fetal peripheral pulmonary artery velocity waveforms by Doppler ultrasonography in pregnancies complicated by premature rupture of membranes under 24 weeks’ gestation and to relate the Doppler indices to the development of fetal pulmonary hypoplasia.

Design A prospective longitudinal study of fetal peripheral pulmonary artery velocity waveforms from premature rupture of membranes to delivery.

Subjects Twenty pregnancies complicated by premature rupture of membranes before 24 weeks of gestation and delivering after 26 weeks.

Methods Peripheral pulmonary artery velocity waveforms were recorded by Doppler technique at weekly intervals until delivery and Pulsatility Index (PI) calculated. Pregnancies were managed conservatively according to an institutional management protocol. Pulmonary hypoplasia was defined at autopsy by lung/body weight ratios and radial alveolar counts. Pulsatility Indices of fetuses developing pulmonary hypoplasia were compared with those with a normal lung development.

Results After premature rupture of membranes PI values were higher than normal reference limits for gestation, but no differences were found between the six fetuses which developed pulmonary hypoplasia and the remaining 14 fetuses with normal lung development. In this latter group PI values progressively decreased with advancing gestation (ANOVA for repeated measurements F = 11.61; P ≤ 0.001), while they increased in fetuses developing pulmonary hypoplasia (F = 8.44; P ≤ 0.001). As a consequence of these opposite trends significant differences in PI values were present between the two groups of fetuses from 2 weeks after the premature rupture of membranes. Two weeks after the premature rupture of membranes a PI value from the peripheral pulmonary arteries above the 95th centile had a sensitivity of 62.5%, specificity of 94.6%, positive predictive value of 83.3%, negative predictive value of 78.5% and relative risk of 3.88 (95th confidence interval 1.34–11.28) for the prediction of pulmonary hypoplasia.

Conclusion The measurement of peripheral pulmonary velocity waveforms may help to establish the risk of developing pulmonary hypoplasia in pregnancies complicated by premature rupture of membranes.
WS16: Early pregnancy WS16‐01The value of first trimester sonography for the diagnosis of structural and chromosomal abnormalities
Authors: Economides D. L.
Published: March 2003

Objectives

To assess the value of first trimester scanning for the diagnosis of structural and chromosomal abnormalities.

Population/methods

An unselected group of 7447 pregnant women who had a first trimester scan in our unit. In all the cases an anatomical survey was performed and the nuchal translucency was measured. Four thousand and 84 women also had second trimester biochemical screening. We assessed the performance of first trimester scanning in the detection of structural and chromosomal abnormalities.

Results

The incidence of anomalous fetuses was 1.4%, including 43 chromosomal abnormalities. The detection rate for structural abnormalities was 59% (37/63). Seventy‐eight percent of chromosomal abnormalities were diagnosed at 11–14 weeks either because of a nuchal translucency measurement above the 99th centile or due to the presence of structural abnormalities. Second trimester biochemical screening detected half of the fetuses with trisomy 21 which were missed by first trimester screening, increasing the sensitivity to 90.5% (19/21; 95%C.I. 69.6% to 98.8%). However, the positive predictive value of the biochemical test was very low (0.5%).

Conclusion

First trimester NT measurement is an effective screening test for the prenatal detection of fetuses with structural and chromosomal abnormalities. Although the measurement of biochemical markers in the second trimester can detect additional affected fetuses this may be out‐weighted by the delay in diagnosis, the extra visits and cost so that the right time for biochemical screening still needs to be determined. Second trimester anomaly scanning should continue to be an essential part of a prenatal screening programme.
WS17: Newcomers WS17‐01Hormone replacement therapy reduces impedance to flow in different vascular beds
Authors: Van Baal W. M. , Kenemans P. , Stehouwer C. D. A. , Van Vugt J. M. G. , Van Der Mooren M. J.
Published: March 2003

An HRT‐associated reduction of the pulsatility index (PI) has been reported in the literature, although cross‐sectional studies have shown conflicting data. In a prospective, controlled study we randomized 30 healthy postmenopausal women (mean age 52 ± 3 years) into two groups. Women in the HRT group (N = 15) received 1 mg micronized 17β‐estradiol daily (E2) sequentially combined with 5 or 10 mg dydrogesterone for 14 days of each 28‐day cycle during 12 months, and, thereafter, 2 mg E2 combined with 10 mg dydrogesterone for a period of 3 months. The control group (N = 15) received no treatment. Color Doppler ultrasound was used to measure the impedance to flow (pulsatility index [PI]) within the uterine, central retinal and ophthalmic arteries in the E2‐phase at baseline and after 3, 12 and 15 months. Compared to controls, 12 months of HRT was associated with a significant decrease in the mean PI of the uterine artery of −39% (HRT −25%, controls +14%) and in that of the central retinal artery of −29% (HRT −9%, controls +20%). After 3 months this effect was already evident. During HRT, the reductions in mean PI of the uterine and central retinal arteries vs. baseline were larger (both P = 0.002) in the women with high pretreatment PI values when compared to those with low pretreatment values. The baseline PI of the uterine artery correlated positively with age and with duration of amenorrhoea (r = 0.42, P = 0.01 and r = 0.48, P = 0.008, respectively). Our 12‐month study expanded on earlier reports of a reduced PI of the uterine artery. We used a combined regimen containing a low‐dose of oestrogens. These results are important because the recent trend is to recommend combined HRT that contain lower dosages of oestrogens than before. Furthermore, a 29% reduction of the PI of the central retinal artery was observed, which suggests that HRT has a positive influence on the impedance of the cerebral circulation. From the point of view of atherothrombotic risk these observations are beneficial and possibly helpful in understanding the decreased risk of cardiovascular disease, and of the impairment of cognitive functions associated with oestrogens in epidemiological data.
WS02‐05Serial in‐utero ultrasonographic measurements of the fetal thyroid: a new complementary tool in the management of maternal hyperthyroidism in pregnancy
Authors: Achiron R. , Sivan E. , Dolizki M. , Lipitz S. , Cohen O.
Published: March 2003

Objective

Treatment of hyperthyroidism during pregnancy is complicated by the lack of readily available measures of the fetal thyroid status. Both hyper‐ and hypo‐thyroidism of the fetus may have short and long‐term detrimental effects and thus should be avoided. We therefore followed the fetal thyroidal size during treatment of maternal thyroid disorders and correlated the data with treatment and thyroidal status in the mother.

Methods

During 24‐month period 20 patients with thyroid disorders were referred for serial fetal thyroid measurements. Thyroid size was measured by transvaginal ultrasonography between 14 and 17 weeks' of gestation and by abdominal ultrasonography between 18 and 38 weeks' gestation.

Results

In five women with Grave's diseases correlation between thionamide dosage and fetal thyroid size were noted. Two fetuses had an increase in the size of thyroid gland above the upper 95% confidence interval, one of them developed neonatal Grave's of which it was the only prenatal sign of fetal thyroid abnormalities. In all other three fetuses changes inthyroidal size aided in determining the dosage of the antithyroidal drugs.

Conclusions

Inutero ultrasonographic measurements of the fetal thyroid size can be used as a noninvasive tool for the proper management of maternal hyperthyroidism.
WS05‐03Ultrasound in the diagnosis of endometrial abnormalities
Authors: Valentin L.
Published: March 2003

There is a potential role of ultrasound examination in the management of women with postmenopausal (PMP) bleeding. Because women with an endometrium = 4 mm at transvaginal ultrasound examination rarely have endometrial pathology, it may be justified not to sample their endometrium. However, endometrial pathology is common among women with endometrium = 5 mm. In our prospective study, 105 consecutive women with PMP bleeding and endometrium = 5 mm underwent hydrosonography, hysteroscopy, D & C, and hysteroscopic resection. 80% of these women had endometrial pathology, including 24% with endometrial malignancy. 94% of the pathological lesions manifested a focal growth pattern. 87% of the focal lesions were only partly removed or remained in situ after D & C, D & C missing 25% of malignancies and 53% of benign pathology. Hydrosonography was as good as hysteroscopy at detecting focally growing lesions in the uterine cavity (agreement between hydrosnography and hysteroscopy being 96%; Kappa 0.77), but neither hysteroscopy nor hydrosnography could reliably discriminate between benign and malignant lesions. In a randomized trial, 49 women with PMP bleeding and endometrium = 4 mm were randomized to D & C and 48 to ultrasound follow up. 14 (29%) women in the D & C group and 22 (46%) in the ultrasound group had either rebleeding or manifested endometrial growth during a 12‐month follow‐up period. Endometrial pathology was not found in women with rebleeding unless the endometrium was = 5 mm.

Conclusion

Women with PMP bleeding and endometrium = 5 mm should undergo hydrosnography. If focal lesions are detected hysteroscopic resection should be carried out. In women with PMP bleeding, rebleeding during the first 12 months is an indication to sample the endometrium only if the endometrium measures = 5 mm at ultrasound examination.
WS06: Fetal echocardiography WS06‐01Human fetal cardiac function during the first trimester of pregnancy
Authors: Jouppila P. , Mäkikallio K. , Räsänen J.
Published: March 2003

Introduction

The hypothesis was tested whether the improvement in the human fetal cardiac diastolic and systolic functions are associated with changes in the cardiac volume blood flow, inflow blood velocity waveform characteristics, systemic venous blood flow parameters, umbilical artery velocimetry and fetal nuchal translucency. By a longitudinal study protocol the inflow and outflow blood velocity waveforms were obtained in 16 uncomplicated pregnancies at 6, 7, 8, 9 and 10 weeks.

Results

The proportion of isovolumetric relaxation time decreased and the proportions of filling and ejection times of the cardiac cycle increased significantly from 6 to 7 weeks. The proportion of isovolumetric contraction decreased between 8 and 9 weeks. Every inflow waveform was monophasic before 9 weeks but it was biphasic in all cases at 10 weeks. Mean velocity of inflow and outflow increased between 6 and 7 weeks and Vmean of inflow increased further after 8 weeks. At 9 and 10 weeks, atrioventriculu valve recurgitation (AVVR) was present in 4 and 7 fetuses, respectively. Nuchal translucency was greater in fetuses with AVVR present at 10 weeks compared with non‐AVVR cases.

Conclusion

Improvement in the diastolic function of fetal heart between 6 and 7 weeks is accompanied by simultaneous increase in the mean velocities across inflow and outflow tracts. Appearance of biphasic inflow pattern is associated with significant change in systolic function between 8 and 9 weeks. AVVR is a common finding at 10 weeks of gestation.
WS06‐02Cardiac anomalies in early pregnancy
Authors: Gembruch U. , Germer U. , Smrcek J.
Published: March 2003

Fetal echocardiography including colour and spectral Doppler facilitates the diagnosis of the great majority of major structural and functional cardiac abnormalities in the late first and early second trimester of gestation.

Based on more than 4000 echocardographic examinations between 10 and 16 weeks of gestation (4/1993–3/2000) following data are demonstrated:

1. The four‐chamber view and cross‐over of the pulmonary trunk and aorta were visualised in 44% of the fetuses at 10 weeks and in 100% at 13 weeks of gestation.

2. Normative biometric data of the fetal heart has been established. The ratio of the right and left ventricle and of the pulmonary trunk and ascending aorta were constant during this period of pregnancy (approximately 1.00 and 1.10, respectively).

3. The detection rate for cardiac malformations was greater than 60%. Colour Doppler increased the detection rate by easier demonstration of the great arteries and of abnormal cardiac blood flow pattern (valvular incompetence and stenosis).

4. In fetuses with increased nuchal translucency (= 3 mm) (30% of those with general hydrops) the rate of aneuploidy was twice as high in fetuses with abnormal echocardiographic findings compared to fetuses with normal echocardiogram. In some aneuploid fetuses with normal cardiac structures transient tricuspid regurgitation was observed.

5. Some complex cardiac malformations were diagnosed which are very rare in later gestation, e.g. absent pulmonary valve syndrome with patent ductus arteriosus, polyvalvular stenoses of the semilunar valves.
WS06‐03Ultrasound‐detected heart defects associated with aneuploidy
Authors: DeVore G. R.
Published: March 2003

In North America second trimester genetic ultrasound is offered to patients at risk for trisomy 21 and other chromosomal abnormalities who decline invasive testing. In most major studies in which the prevalence of ultrasound markers used for genetic ultrasound are reported, congenital heart defects are identified in less than 10% of fetuses. When one considers that over 50% of fetuses with trisomy 21 and 90% of fetuses with trisomies 13 and 18 have structural malformations of the heart, the question should be raised as to why the wide discrepancy in prevalence and detection rate of heart defects in these fetuses. The purpose of this presentation is to review the prevalence of CHD in fetuses with trisomy 21, trisomies 13 and 18, and all fetuses with chromosomal defects that were identified following second trimester amniocentesis. To ascertain the presence or absence of CHD, each fetus underwent a fetal echocardiographic study using real‐time and color Doppler ultrasound at the time of genetic amniocentesis.

The results of the study demonstrated the following: The detection rate for trisomy 21 (n = 80) increased from 62% to 91% when examination of the fetal heart was performed. The detection rate for trisomy 18 (n = 30) increased from 84%% to 97% when the cardiovascular system was evaluated. For fetuses with any chromosomal abnormality (n = 103) advanced maternal age were examined, the examination of the heart increased the detection rate from 61% to 85%.

Given the above findings, the inclusion of the fetal echocardiographic evaluation of the fetus significantly increased the detection rate for the above three groups of fetuses. If physicians and/or sonographers desire to increase the ultrasound detection rate for chromosomal abnormalities, examination of the fetal cardiovascular system must occur.
WS01‐04Fetal lung abnormalities a spectrum of disease: reclassification system based on embryology, 2‐D and Doppler ultrasound
Authors: Achiron R. , Yuval Y. , Lipitz S. , Yagel S.
Published: March 2003

Objective

Fetal lung anomalies are traditionally classified into Congenital Cystic Adenomatoid Malformation (CCAM), and Pulmonary Sequestration (PS). During last years we have detected several cases who presented with bizarre and overlapping findings which could not be fitted into this usual classification. We therefore suggest a new approach for classification based on embryology, 2‐D and Doppler ultrasound.

Method

During 5‐year period, patients with fetal lung lesions who were referred for detailed ultrasound evaluation at the Sheba Medical Center from the data base of this study. All cases were analyzed by 2‐D ultrasound and high resolution Power Doppler technology and were classified into three major categories: I Agenesis of lung; II Lung lesion with normal vascular supply: IIa solid, IIb cystic, IIc mixed; III Lung Lesion with abnormal vascular supply: IIIa chest, IIIb abdomen, IIIc thoracoabdomial. Medical files, natural history and neonatal follow‐up were recorded.

Results

Twenty‐one fetuses were recruited, two fetuses were detected in group one, 14 in group II of normal vascular supply, and five in group III abnormal lung with abnormal vascular involvement.

Conclusions

Based on embryology and ultrasound a new classification system is introduced.
WS06‐07Examination of the fetal heart by five short‐axis views: The optimal screening method for fetal cardiac anomalies?
Authors: Yagel S.
Published: March 2003

‘Classic’ fetal echocardiography is based on 7 transverse planes: the upper abdomen, the traditional four‐chamber view, the five‐chamber view in which the aortic root is visualized, and the fourth transverse view revealing the bifurcation of the pulmonary arteries, and long‐axis views of the outflow tracts and aortic arch. We recently proposed the three vessel and trachea (3VT) plane of insonation be added, to facilitate and expedite fetal heart evaluation.

The (3VT) is the most cephalad transverse view, visualized on a plane crossing the fetal upper mediastinum. It is obtained easily by moving the transducer cephalad and slightly oblique from the FCV, and shows the main pulmonary trunk (MPA) in direct communication with the ductus arteriosus (DA). A transverse section of the aortic arch is seen to the right of the MPA and DA. Cross sections of the superior vena cava (SVC), and posterior to it the trachea, are visualized.

The clinical applicability of the 3VT was demonstrated in a recent study encompassing 1263 low‐and high‐risk cases scanned between 14 and 24 weeks' gestation. We consider one of the greatest advantages of our novel approach the ease with which the examiner can scan the fetal heart, beginning with the caudal upper‐abdomen view. By sliding the transducer cephalad in one continuous motion, all the pertinent views are readily visualized. It was also shown to be effective in the diagnosis of such aortic arch anomalies as right and double aortic arch, among others.

We showed that five short axis views including the 3VT simplified and streamlined fetal cardiac examination, without compromising diagnostic effectiveness.
WS08‐04Fetal brain: cerebral and cerebellar circulation in early fetal jeopardization
Authors: Arduini D. , Giannini F. , Exacoustòs C. , Romanini C.
Published: March 2003

Background

The aim of this study was to investigate with color‐power doppler sonography the arterial and venous circulation in fetal brain, in normal and pathologic circumstances.

Method

We studied 101 appropriate for gestational age (AGA) fetuses, 20 intrauterine growth‐retarded fetuses (IUGR), 10 fetuses with cmv infections and 10 fetuses with supraventricular tachycardia.

In all fetuses we obtained reliable blood flow velocity waveforms of middle cerebral and superior cerebellar artery and trasverse sinus.

The pulsatility index (PI) for arterial vessels and flow velocity for venous vessels were used. Doppler measurements of AGA fetuses were compared with other fetuses.

Results

An increase in fetal middle cerebral PI and cerebral transverse sinus was observed in IUGR and a slightly decrease in case of fetal arrhytmia when compared with AGA fetuses. In 6 of 10 fetuses affected by cmv infection was observed a reduction in PI cerebral and cerebellar, while no difference was found for venous velocities.

A longitudinal study was performed in 30 AGA and 8 IUGR fetuses. The IUGR fetuses showed a characteristic early reduction of cerebellar PI in respect to cerebral PI about 4–8 days prior the evidence of late heart rate (HR) decelerations; however, the two vessels did not differ significantly in the 4 days prior HR decelerations.

Conclusion

Venous and arterial cerebral circulation shown a response to pathological conditions that could affect fetal brain.
WS08‐05Ultrasound evaluation of fetal brain space occupying lesions
Authors: D'addario V. , Pinto V. , Naro E. D. I. , Anfossi A.
Published: March 2003

Objective

To evaluate the accuracy of ultrasound in identifying fetal brain space occupying lesions.

Study design

A retrospective evaluation of 14 cases of fetal brain space occupying lesions has been performed. All prenatal ultrasonographic diagnoses (5 teratomas, 1 choroid plexus papilloma and 8 arachnoid cysts) were compared with the postnatal findings on the aborted fetuses or on the newborns.

Results

In 11 out of 14 cases the antenatal ultrasonographic diagnosis was confirmed postnatally; 1 case of supratentorial arachnoid cyst was mistaken for a teratoma and 2 cases of porencephalic cysts were wrongly diagnosed as arachnoid cysts (specificity = 78.5%). The specificity was better in the subgroup of solid or complex masses (5 out of 6 = 83.3%) than in the subgroup of cystic lesions (6 out of 8 = 75%).

Conclusions

Prenatal ultrasonography is a useful tool to identify any intracranial space‐occupying lesion. In the present study it has shown a 78.5% specificity in the diagnosis of brain masses, with better results in the solid than in the cystic lesions. The distinction between the different causes of fetal brain space occupying lesions is clinically relevant, as each one carries different prognostic implications.
WS08‐07Brain plasticity after perinatal damage—prospective neurodevelopmental and ultrasonographic/magnetic resonance study
Authors: Mejaški‐Bošnjak V.
Published: March 2003

Objective

To assess long‐term neuodevelopmental outcome and structural reorganisation of children suffering hypoxic‐ischemic (H‐I) and/or haemorrhagic perinatal brain damage; To test the hypothesis of more successful recovery of prematures and/or unilateral lesions after perinatal brain damage; To estimate prenatal events, in particularly value of pathological findings of Color Doppler (CD) in the pathogenesis of perinatal brain damage;

Study design

68 children suffering perinatal brain H‐I (10) and/or haemorrhagic lesions (58) diagnosed by ultrasonography (US) underwent neurologic and psycho‐linguistic examinations by age 16. High resolution 2 T MRI was used to assess structural reorganisation; 20 children suffering unilateral perinatal brain damage (MCA infarct.) were followed up (neurodevelopmentally, transcranial CD and US/CT, MRI); 25 children with CD findings (C/U ratio < 1) during pregnancy underwent prospective follow‐up postnatally by age 2.

Results

All children with H‐I lesions have still at age 16 one or more severe handicaps, while 39 children with mild grade of hemorrhage had minor neurological dysfunction, 15 were normal. MRI revealed destructive and/or atrophic lesions in all children with H‐I lesions and mild atrophy and/or signs of preiventricular haemorrhage in rest children. 20 children with unilateral perinatal brain damage have contralateral hemiparesis and various accompanying neurodevelopmental disorders. There were no strict correlation between size, site, hemispheral involvement gestational age and neurodevelopmental outcome of children examined. Out of the 25 children having pathological CD findings during pregnancy, 7 revealed mild grade (I–II) of peri‐intraventricular haemorrhage, 10 children isolated or combined H‐I and haemorrhagic lesion, 7 children have no apparent perinatal brain damage. Short‐term neuro‐developmental outcome revealed mild delay and/or disorders in 10 infants and in the rest normal status.
WS09: Adnexal masses WS09‐01Role of imaging modalities in pelvic tumor practice
Authors: Nakano H. , Satoh S.
Published: March 2003

Background

To clarify the diagnostic usefulness of imaging modalities in pelvic tumor practice, inpatients having pelvic neoplastic disorders in our Institute were reviewed.

Methods

For a total of 1506 cases undergoing ultrasonography (US) only, those receiving a combined usage of computed tomography (CT) and US, magnetic resonance imaging (MRI) and US, and all three modalities, we compared the indications and selected imaging modalities in relation to the stream of therapeutic procedure.

Results

324 cases (21.5%) judged to have no structural disease through imaging techniques at previous Hospitals underwent no further imaging examination. 420 cases (27.9%), most of which underwent surgery and/or radiation due to malignant lesions in the ovary and/or uterus, had US alone, and 564 cases (37.5%) had CT in addition to US. The main indications for ordering additional CT were suspected distant metastasis, including pelvic and paraaortic lymphnodes. 95 patients (6.3%) had US and MRI under indication of tissue characterization in tumors. 103 cases (6.8%) with difficulties in diagnosis had all modalities; US, CT and MRI. In 324 cases without imaging modalities, 60 cases (18.5%) undergoing operative procedure were those with cervical neoplasm, and 70.0% of the cases followed by chemotherapy were for ovarian cancer. Such will be further discussed in detail.
WS09‐03Association of color Doppler with molecular biology in ovarian tumors
Authors: Hata K. , Miyazaki K.
Published: March 2003

Color Doppler imaging and pulsed Doppler spectral analysis ultrasonography were used to scan 44 patients with an overt ovarian mass immediately before laparotomy. Sections of malignant tumors were analyzed for the cellular expression of TP and the intratumoral density of microvessels by immunohistochemistry using antibodies to TP and Factor VIII related antigen, respectively. Moreover, apoptotic index (AI) was evaluated by the terminal deoxynucleotidyl transferase‐mediated dUTP‐biotin nick end labeling methods. The proportion of Stage I tumors that was TP positive (16%) was significantly lower (P = 0.022) that the corresponding value for Stages II–IV (44%), although the values for microvessel count, AI, and peak systolic velocity (PSV) were similar. AI was significantly lower in TP‐positive tumors than that in TP‐negative tumors (P = 0.015). The PSV was significantly higher in TP‐positive tumors (P = 0.02). There was a significant correlation between the microvessel count and the PSV (r = 0.34, P = 0.024). Moreover, AI was significantly inversely related to the PSV (r = 0.35, P = 0.023). The PSV in a subgroup with a high microvessel count and low AI was significantly higher than that in a subgroup with a low microvessel count and high AI (P = 0.0006). These findings significantly associated with TP expression (P = 0.024). The intratumoral PSV, as determined by color Doppler imaging and spectral analysis might reflect the coordination of angiogenesis and apoptosis, associating with TP expression in epithelial ovarian cancer.
WS12‐02Systematic screening with a uterine Doppler in low‐risk pregnant women followed by low‐dose aspirin in cases with abnormal results: results of the two French multicenter randomised controlled trial
Authors: Goffinet F. , Aboulker D. , Subtil D. , Uzan  , Bréart G. , Uzan S.
Published: March 2003

Objectives

Two large multicenter randomised trials were performed in France to assess whether systematic screening with an artery uteroplacental Doppler (AUD) in low‐risk pregnant women followed by the prescription of low‐dose aspirin in cases with abnormal results reduced the incidence of intrauterine growth restriction (IUGR) and of preeclampsia.

Study design and population

The first trial ‘Seine Saint‐Denis’ (SSD) trial included 3317 low‐risk pregnant women (multi and primigravidae) in 17 French maternity Hospitals and the second ‘Erasme’ trial included 1869 primigravidae in 12 centres. In the Doppler group, the AUD was performed between 20 and 24 weeks, and women with abnormal results received 100 mg of aspirin daily until the 35th week.

Results

In the Doppler group, 232 patients (15.7%) had an abnormal result in the SSD trial and 20% in the ERASME trial. The predictive value of the AUD was comparable to that reported in the studies of low‐risk populations, but with a low sensitivity. Finally, IUGR, whether defined by the third or tenth percentile, and preeclampsia did not differ significantly between the treatment groups in both trials.

Conclusions

There is no proof justifying the recommendation of a systematic AUD in a low‐risk population, even if abnormal results are followed by aspirin treatment and increase in prenatal surveillance. Future studies must assess predictive tests that can be performed early in pregnancy and can identify populations at very high risk of preeclampsia and IUGR. Only when all of these conditions are fulfilled can aspirin prove its efficacy.
WS12‐09Absent or reversed end diastolic flow: clinical implications
Authors: Mandruzzato G. P. , Meir Y. J. , Natale R. , Maso G. P.
Published: March 2003

The acronym ared indicates two characteristic patterns of the Doppler Velocity Waveform (DVWF) namely the observation of absence (EDFA) or reverse (RF) blood flow in diastole. ARED flow are usually observed in fetuses presenting severe intrauterine growth restriction (IUGR) or sometime are concomitant to fetal abnormalities like hydrops. The fetal condition is always severely affected mainly by hypoxaemia and/or acidaemia but at different levels according to the two patterns that are observed. Usually in the literature ared cases are presented and discussed without making difference between the two possible conditions. This approach cannot be considered correct because large differences in many clinical aspects are evident when evaluating separately EDFA or RF in 94 cases observed in our Institute. Gestational age, mean birth weight are significantly lower while perinatal mortality rate and prevalence of handicaps among survivors are significantly higher in the group presenting RF as compared to EDFA cases. As a consequence the clinical management is also different. In case of EDFA the timing of the delivery should be taken into consideration but it is not always urgent. On the contrary when RF is observed intrauterine death has to be expected within few days. Therefore the delivery should be immediate at the first observation of RF. The critical point is that also applying this policy the prevalence of handicaps among survivors is very high (35%). As a consequence when facing those clinical condition a careful and complete information must be offered to the family before choosing, if no maternal indications are present, an aggressive management.
WS13: Multiple pregnancy WS13‐01The effect of treatment of twin‐to‐twin transfusion syndrome on the diagnosis to delivery interval
Authors: Skupski D. , Gurushanthaiah K. , Chasen S.
Published: March 2003

Purpose

No randomized controlled trials of treatment of twin‐to‐twin transfusion syndrome (TTTS) exist. Since severely preterm neonatal survival has increased over time, survival as an outcome measure is confounded by calendar time. The diagnosis‐to‐delivery interval is a calendar year independent measure of success of treatment. We wished to evaluate whether treatment of TTTS is associated with a lengthening of the diagnosis‐to‐delivery interval.

Methods

MEDLINE search supplemented by careful reference review. All TTTS series were included where the following information on each patient was available: survival, fetal demise, gestational age (GA) at diagnosis and diagnosis to delivery interval in days.

Inclusion criteria

GA ≤ 29 weeks and diagnosis by ultrasound in the absence of maternal symptoms. Cases undergoing multiple types of treatment were excluded. Data were evaluated by Kruskal–Wallis anova, logistic regression & Wilcoxon rank sum testing.

Results

The 8 publications used included the following cases: controls (n = 16), amnioreduction (n = 61), septostomy (n = 12), and fetoscopic laser occlusion of chorioangiopagus vessels (FLOC) (n = 51). FLOC therapy showed a significantly longer diagnosis‐to‐delivery interval compared to amnioreduction (median 75 vs. 56 days) (p = 0.01). There was no difference in overall survival, at least one survivor, or number of fetal deaths between the 4 groups. Logistic regression using at least one survivor as the dependent variable revealed a positive association with GA at diagnosis and with diagnosis to delivery interval, a negative correlation with fetal death, and no correlation with treatment group.

Conclusions

FLOC therapy for TTTS is associated with a longer diagnosis‐to‐delivery interval compared to amnioreduction without a significant increase in survival. The lack of increase in survival appears to be due to a small sample size.
WS14‐04Improved fetal weight estimation by three‐dimensional ultrasound
Authors: Schild R. L. , Hansmann M.
Published: March 2003

Aim

To investigate the value of 3D‐ultrasound in predicting fetal weight at delivery.

Patients and methods

The study group consisted of 251 pregnant women (formula‐finding group: n = 125; evaluation group: n = 126) with a singleton pregnancy and an ultrasound examination within seven days of delivery. Pregnancies with major structural or chromosomal anomalies were excluded. Ultrasound examinations included standard biometry as well as three‐dimensional volumetry of the upper arm, the thigh and the abdomen of the fetus. All examinations were performed with a Voluson 530D MT system (Kretztechnik, Zipf, Austria). The results were compared with commonly used weight formulas.

Results

All measurements were completed successfully. Polynomial regression analysis with standard biometric parameters and volumes of the upper arm, the thigh and the abdomen was employed to yield the best‐fit formula for prediction of fetal weight at birth. The new 3D formula (Estimated fetal weight (EFW) = – 1478.557 + 7.242 * thigh volume + 13.309 * upper arm volume + 852.998 * lg abdominal volume + 0.526 * BIP3) proved to be superior to established two‐dimensional equations with the lowest mean error (25.8 ± 194.4 g), the lowest mean absolute error (155.2 ± 118.2 g) and the lowest mean absolute percentage error (6.1 ± 5.0%) when studied prospectively in the evaluation group.

Conclusion

Fetal weight estimation by 3D–ultrasound compares favourably with conventional 2D–formulas.
WS14‐06Implemented three‐dimensional power Doppler for evaluation of fetal and placental circulation: implications for clinical management
Authors: Shih Jin‐Chung , Chen Hsi‐Yao , Hsieh Fon‐Jou
Published: March 2003

Background

The study of fetal and placental circulation has focused on the interaction betweens fetal hypoxia and abnormal flow regulation. The assessed methods including spectral and color Doppler US. However, their uses in the depiction of angioarchitecture to make the specific diagnosis are limited.

Methods

We use three‐dimensional (3D) power Doppler sonography (Voluson 530D, Medison; and HDI 3000, ATL) a to detect and visualize the fetal vasculature since 8 weeks gestation. We also use the same method to render the angioarchitecture of placenta as early as 5 weeks gestation. The scanning methods were using either free‐handed or built‐in mechanical probe. We also assess its application in decision making for difficult cases.

Results

Power Doppler provides excellent visualization of fetal circulation (including umbilical vein, portal vein systems, ductus venosus, hepatic veins, etc.). Furthermore, these data can be rendered in 3D perspectives, which is more comprehensive for understanding the complicated vasculature of fetus. It can correlates the embryonic findings in vivo, therefore can confirm the normalcy and also contribute in the diagnosis of pathological state.

Conclusion

Our results indicate 3D power Doppler is a promising tool in evaluation of complicated fetal and placental anatomy, and might help to make decision in clinical dilemmas.
WS15‐05Fetal venous Doppler: is it helpful in timing of delivery of hypoxic fetus?
Authors: Latin V. , Hafner T.
Published: March 2003

Background

The aim of this study was to investigate the potential of fetal venous Doppler in detection of fetal hypoxia and timing of the delivery.

Methods

The study group consisted of patients with increased risk for developing fetal hypoxia. These were patients with diagnosed fetal intrauterine growth retardation (IUGR) and patients with pregnancy induced hypertension (PIH), or a combination of both problems. All patients had Doppler assessment of fetal arterial (umbilical artery, aorta, middle cerebral artery) and venous circulation (ductus venosus and umbilical vein), and cardiotocography 24 h before delivery. Collection of postnatal data included pH of umbilical chord blood, admission in neonatal intensive care unit, and perinatal death.

Results

A total of 360 patients were included in the study (IUGR 48%, PIH 20%, IUGR + PIH 32%). Deterioration in fetal venous return developed after fetal arterial circulation had been severely compromised. The decrease in end‐diastolic flow in ductus venosus anticipated development of umbilical vein pulsatile flow. Patients with pulsations in umbilical vein blood flow had high incidence of perinatal acidosis, morbidity, and mortality.

Conclusion

Delivery should be performed before umbilical vein pulsations develop. Careful monitoring of ductus venosus blood flow is helpful predictor of this event.
WS15‐07Assessment of a formula using Doppler velocimetry to calculate fetal hemoglobin (Hb)
Authors: Voto L. S. , Mulki O. B. , Zapaterio J. L. , Falco A. , Mathet E. R. , Lede R. L. , Margulies M.
Published: March 2003

Aim

To assess agreement between fetal cord blood Hb concentration by Doppler velocimetry and a formula (Oepkes et al, Br J Obstet Gynaecol 1994; 101:680–4), and the actual Hb concentration by cord blood sampling.

Material and methods

A prospective cohort of 31 Rh isoimmunised fetuses undergoing Doppler cord blood velocity measurements within the 24 hs previous to cordocentesis or delivery was included. Mean aortic velocity at descent fetal aorta and maximum umbilical vein flow at intrahepatic portion were measured blindly by a single operator with pulsed Doppler and a 3.5 Mhz transducer. Cord Hb was the gold standard. Abnormality and normality were defined as a Hb level lower and higher, respectively, than the cut‐off point (<7, <8, <9, <10, <11 and <12 g/dL were tested). Likelihood ratio was also calculated.

Results

Interval between Doppler study and cordocentesis/delivery was 24–48 hs. Fetal blood sampling was performed by cordocentesis in 4 cases, following a C‐section in 24, and following vaginal delivery in 3.

Distribution of cases according to results obtained (n cases)

Cut‐off point
<7g
<8g
<9g
<10g
<11g
<12g

True+
1
5
7
14
23
26

False+
1
1
7
7
6
5

True–
29
25
15
7
2
0

False–
0
0
2
3
0
0

Agreement at different cut‐off points in the diagnosis of abnormality and normality [point estimate (CI)]

Cut‐off
<7
<8
<9
<10
<11
<12

Abn.
50(5–100)
83(36–99)
43(21–69)
58(37–77)
79(60–91)
84(66–94)

Norm.
97(81–100)
96(78–100)
62(41–80)
41(17–67)
25(4–64)
0(0–54)

LR
30(2.3–129.8)
26(4.2–132.4)
2.7(1.2–5.9)
1.6(1–3)
1.3(1–2.4)
1(0.9–2)

Conclusion

An acceptable agreement was found. Further population‐based studies are required to corroborate its clinical significance.
F102The prenatal ultrasonographic diagnosis of migrational disorders
Authors: Malinger G. , Lerman‐Sagie T. , Ben‐Sira L. , Glezerman M.
Published: March 2003

Background

Neuronal migration occurs between the third to fifth month of pregnancy, during this time neurons migrate from the ventricular zone to the cortical mantle. The hallmark of the migrational disorders is an aberration of gyral and sulcal development. The aim of this study was to report on prenatal diagnosis, management and outcome of 6 cases with migrational disorders.

Method

The records of all the fetuses that were scanned for a possible migrational disorder during a 7‐year period ending in May 2000 were reviewed.

Results

Six fetuses with migrational disorders were identified at a gestational age ranging from 22 to 34 weeks (mean 27.5 weeks), one with lissencephaly, one with pachygyria, two with polymicrogyria and two with neuronal heterotopia. In 3 cases corpus callosum hypoplasia was also present. One of the fetuses had 2 magnetic resonance studies performed in utero and only the second one performed 4 weeks after the index US was diagnostic.

Conclusion

Migrational disorders, although uncommon may be diagnosed prenatally. The very bad prognosis in most cases justifies the effort of early detection.
F105Transvaginal sonographic appearance of the cerebellar vermis at 14–16 weeks' gestation
Authors: Perlitz Y. , Peleg D. , Ben‐Ami M.
Published: March 2003

Background

The aim of this study was to evaluate the normal development of the fetal cerebellum at 14–16 weeks' gestation using transvaginal sonography (TVS).

Method

195 low risk women who had structurally normal fetuses determined by a detailed anomaly scan, were included in the study. The sonographic image of the cerebellar hemispheres and the vermis was evaluated by the modified axial view of the fetal head. All women underwent a follow up scan at 20–24 weeks' gestation to determine the status of the cerebellar vermis.

Results

All fetuses had an open vermis at 14–16 weeks' gestation. On the follow up scan at 20–24 weeks' gestation, closure of the vermis was demonstrated in all fetuses.

Conclusions

At 14–16 weeks' gestation the cerebellar vermis is demonstrated to be open by TVS. This is a normal finding, and therefore, the prenatal diagnosis of Dandy‐Walker variant should be made only later than 16 weeks' gestation.
F124Prenatal diagnosis of congenital heart disease and postnatal outcome in a tertiary care center
Authors: Toth B. , Römer U. , Schulze A. , Strauss A.
Published: March 2003

Background

Prenatal sonographic diagnosis of congenital heart disease (CHD) is important for proper perinatal and neonatal management as CHD occurs in approximately eight of 1000 live birth.

Method

All fetal echocardiograms obtained in the department of obstetrics and gynecology between January 1994 and June 2000 and postnatal echocardiograms obtained in the department of pediatric cardiology were reviewed.

Results

A CHD was found in 63 fetuses prenatally and in 116 newborns postnatally. The prenatal diagnosis was confirmed in 82%. Most of the false‐negative diagnosis were septal defects.

Thirty‐three of the 116 neonates with a CHD died in the first year of life (28.4%). Eight (7%) needed a surgical intervention. Regarding only the neonates with a septal defect 64 (92%) showed normal developing, without surgical or medical intervention.

Conclusion

Echocardiographic diagnosis of CHD can be achieved with accuracy in fetal life. Septal defects are the most unrecognized CHD prenatally but did not influence the postnatal hemodynamic circulation in most neonates. Nearly one third of the children with a CHD died and around 10% needed a surgical intervention in the first year of life. 59% were in good clinical condition and showed normal developing.
F130The importance of the fetal echocardiography in nonimmunological hydrops fetalis (analysis of the 156 cases)
Authors: Kaczmarek P. , Krasoń A. , Janiak K. , Respondek‐Liberska M.
Published: March 2003

Background

The aim of the research was to assess the usefulness of fetal echocardiography in nonimmunological hydrops (NIHF).

Method

156 fetuses with NIHF had echocardiography in 1994–99.

Results

The most common cause of NIHF were structural abnormalities 99/156 (63%), especially congenital heart defects (CHD) 30/156 (19%). The fetal congestive heart failure was present in approx. 50% cases.

Conclusion

Fetal echocardiography in NIHF allows not only the precise diagnose but also helps to establish a prognosis and qualification for ongoing procedures. Fetal echocardiography should become the recommended procedure in diagnostic/therapeutic algorithm in cases with NIHF.
F13The influence of angiotenzin converting enzyme inhibitors on adnexal tumor vascularization
Authors: Jurisic A. , Antic N. , Maglic R. , Tajfl P. , Jankovic S.
Published: March 2003

Background

The aim of this study was to investigate the influence of antihypertensive therapy with angiotenzin converting enzyme inhibitors (ACE) on adnexal tumor hemodynamic parameters.

Method

Patients were classified into the four groups: ace benign (29), ACE malignant (17), benign (188), malignant (71). Hemodynamic studies of tumor vascularization were performed by transvaginal color/power Doppler and Pourcelot resistance indices (RI) were measured in tumor tissue. Statistical analysis was performed by analysis of variance (ANOVA).

Results

A total of 305 patients were examined and 1411 blood vessels were analyzed. In ACE benign group 125 resistance indices were analyzed; in ACE malignant group 136 RIs; in benign group 644 RIs and in malignant group 506 RIs were measured. Mean RI values were BACE = 0.469 ± 0.124, MACE = 0.409 ± 0.096, B = 0.564 ± 0.121 and M = 0.390 ± 0.095. Analysis of variance showed high statistical significance between the groups, where RI in ACE benign group was significantly lowered.

Conclusion

The analyzed data in our study indicate that antihypertensive therapy with angiotenzin converting enzyme inhibitors may significantly reduce vascular resistance indices (RI) in patients with benign adnexal tumors who received that therapy at the time of ultrasonographic examination.
F17Expectant management of ectopic pregnancy: is it possible to predict successful outcome
Authors: Elson J. , Banerjee S. , Lawrence A. C. , Wölfer B. , Jurkovic D.
Published: March 2003

Background

The aim of this study was to examine the value of different clinical, ultrasound and biochemical parameters for the prediction of final outcome in women with ectopic pregnancies which are managed expectantly.

Method

Clinically stable women with ultrasound diagnosis of tubal ectopic pregnancy were offered expectant management. In all cases the gestational age, morphology, pregnancy size, serum hCG and progesterone levels were recorded. Surgery was indicated in women with a deterioration of clinical symptoms or rising/nondeclining hCG levels.

Results

51 out of 114 (45%) tubal ectopic pregnancies were managed expectantly. The ectopic pregnancy resolved spontaneously in 33 cases (65%). None of the patients suffered tubal rupture and one patient with low pretreatment haemoglobin received blood transfusion. There were no significant differences in the length of gestation, morphological appearances and mean pregnancy diameter between pregnancies which resolved spontaneously and those requiring surgery. However, both serum hCG and progesterone were significantly lower in tubal pregnancies that resolved spontaneously. By combining serum progesterone at cut‐off level of < 10 nmol/L and serum hCG at < 1000 IU/L a successful resolution of the ectopic pregnancy could be predicted with a sensitivity of 63% and specificity of 93%. The positive predictive value of this test was 79% and the accuracy 85%.

Conclusions

Serum hCG and progesterone measurements could be used to predict the likelihood of successful expectant management of tubal ectopic pregnancies.