bluuebunny/crossref_metadata_2025 huggingface dataset:
Fetal and uteroplacental blood flow in prolonged pregnancies. A clinical study
Authors: Malcus P. , Maršál K. , Persson P‐H.
Published: March 2003

In a prospective study during 1 year, 102 women with prolonged pregnancies (more than 294 completed gestational days) were followed with serial pulsed Doppler blood flow examinations every 2nd day, either to spontaneous onset of labor (n = 82) or to induction of labor due to subsequently occurring complications (n = 20). Mean aortic blood velocity did not change significantly with gestational age beyond 294 days either in fetuses with normal outcome or in fetuses that developed asphyxia at birth. The flow velocity waveforms in the descending aorta, the umbilical artery, the common carotid artery and the uterine artery did not change significantly compared to the values at term. Abnormal flow velocity waveforms in the fetal descending aorta, umbilical artery or uterine artery had no significant relationship to fetal asphyxia. Absence of diastolic flow velocities was not found in any of the vessels examined, indicating that the fetuses did not suffer from chronic hypoxia in utero and that aging of the placenta did not alter fetal and uteroplacental blood flow. Notching of the aortic flow velocity waveform was a common finding among prolonged pregnancies. The hemodynamic implications and consequences of this phenomenon are discussed. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Doppler study of the fetal circulation during long‐term maternal hyperoxygenation for severe early onset intrauterine growth retardation
Authors: Bilardo C. M. , Snijders R. M. , Campbell S. , Nicolaides K. H.
Published: March 2003

In 21 severely growth‐retarded, hypoxemic fetuses at 22–30 weeks' gestation, the effect of long‐term maternal hyperoxygenation on serial Doppler measurements of the fetal descending thoracic aorta mean velocity (Vm), common carotid artery pulsatility index (PI) and umbilical artery PI was investigated. The treatment was continued on average for 4 weeks and delivery, at 26–34 weeks, was decided for fetal or maternal indications. In the subgroup of 12 fetuses that survived, the mean aortic Vm increased within 72 h of maternal hyperoxygenation. This increase continued for 1–8 weeks, after which there was a decrease to pretreatment values. In the subgroup of neonatal deaths (n = 5)) there was a non‐significant increase in mean aortic Vm. In the subgroup of intrauterine deaths (n = 4), there was a non‐significant trend for continuing deterioration in mean aortic Vm throughout the period of maternal hyperoxygenation. The mean carotid PI did not change significantly in any of the subgroups during maternal hyperoxygenation. However, in the subgroup that survived there was a tendency for improvement and in the subgroup of intrauterine deaths a tendency for deterioration. The mean umbilical artery PI did not change significantly in any of the groups or subgroups during maternal hyperoxygenation. Therefore, measurement of aortic Vm is a useful indicator of fetal response to maternal hyperoxygenation and its increase constitutes a favorable prognostic factor. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
The role of transvaginal sonography in the early detection of congenital heart disease
Authors: Johnson P. , Sharland G. , Maxwell D. , Allan L.
Published: March 2003

The antenatal diagnosis of congenital heart disease by fetal echocardiography is rarely achieved before 18–20 weeks' gestation. Transvaginal sonography allows examination of fetal anatomy at earlier gestations than the transabdominal approach. In a screening study of 270 low‐risk women between 8 and 14 weeks' gestation using a 5 MHz vaginal transducer, it was possible to obtain adequate four‐chamber views in over 70% from 12 weeks. In a second study of 32 women at high risk of congenital heart disease scanned between 14 and 15 weeks' gestation, satisfactory views were obtained transvaginally in 21 women. Seven of the remainder had normal cardiac anatomy confirmed by transabdominal scanning. In three of the four where normal cardiac anatomy could not be demonstrated by either transvaginal or transabdominal scanning, severe congenital heart disease was diagnosed and later confirmed.

It is unlikely that transvaginal sonography will replace abdominal scanning for the screening of low‐risk pregnancies, but it is a valuable addition to the early examination of those women identified as being at high risk of congenital heart disease. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of Klippel—Trenaunay—Weber syndrome: a case report
Authors: Heydanus R. , Wladimiroff J. W. , Brandenburg H. , Gaillard J. L. J. , Stewart P. A. , Niermeijer M. F.
Published: March 2003

At 20 weeks of gestation, a typical combination of a massive enlargement of the right fetal leg and multiple cystic lesions was detected at ultrasound examination. Color‐coded Doppler examination revealed no arteriovenous fistulae.

These findings allowed an in utero diagnosis of the Klippel‐Trenaunay‐Weber syndrome, which was confirmed after subsequent termination of the pregnancy. The severe malformation involved the upper and lower right leg. No arteriovenous fistulae were found. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Routine ultrasonography in utero and subsequent growth during childhood
Authors: Salvesen K. Å. , Jacobsen G. , Vatten L. J. , Eik‐Nes S. H. , Bakketeig L. S.
Published: March 2003

The study was performed to investigate any associations between routine ultrasonography during pregnancy and subsequent growth during childhood. A follow‐up was carried out of children born to women who took part in two randomized, controlled trials of ultrasonic screening during pregnancy. From a total of 2428 eligible children, 2140 (88%) were followed up with measurements of growth at Norwegian maternal and child health centers. The body weight and height were recorded at birth and at 3, 6 and 12 months of age; and subsequently at 2, 4 and 7 years of age. A repeated‐measures analysis of growth was carried out, stratified by maternal smoking in a subsample of 1201 children. No significant differences between ultrasound‐screened children, and their controls, were found in mean body weight, or height, at birth and at all the subsequent visits to the health centers. However, the repeated‐measures analysis of variance in the subsample indicated that growth from birth to 7 years of age differed significantly (p = 0.02) between screened and control children of mothers who reported smoking at the first antenatal visit. We conclude that children who were routinely exposed to ultrasonography in utero showed no statistically significant differences in growth during childhood compared to control children. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Miscarriage diagnosis and gestational age estimation in the early first trimester of pregnancy: transabdominal versus transvaginal sonography
Authors: Ferrazzi E. , Garbo S. , Sulpizio P. , Ghisoni L. , Levi Setti P. , Buscaglia M.
Published: March 2003

A comparison is made between 290 patients examined using transabdominal sonography and 308 patients examined using transvaginal sonography. Patients with suboptimal menstrual histories and threatened miscarriages were excluded from these two groups of patients. The transabdominal and transvaginal sonography examinations were carried out while the patient's bladder was empty, so that there was no delay between the clinical and sonographic examinations. In this way there was no patient discomfort from a full bladder. In normal pregnancies after 42 days of amenorrhea, the percentage visualization rates of the chorionic sac, of the embryo with heart activity and of the yolk sac were measured. There were no significant differences between the two groups. The two techniques were able to provide a reliable diagnosis of miscarriage on embryos ≥ 4 mm or with chorionic sacs ≥ 10 mm mean diameter. However, before 42 days of gestation, transvaginal sonography was better than transabdominal sonography at diagnosing miscarriage. The percentage of anembryonic pregnancies was higher in the transabdominal sonography group (21%) than in the transvaginal sonography group (7%), despite similar gestational ages at the time of a positive diagnosis. Thus, a transabdominal scan can be used after 42 days and borderline cases can be referred for transvaginal sonography for confirmation. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Fetal endocarditis in left atrial isomerism—a case report
Authors: Respondek M. , Kaluzynski A. , Alwasiak J. , Jaszewski P. , Wilczynski J.
Published: March 2003

We report a case of fetal endocarditis coexisting with a congenital heart defect: a common atrium (left atrial isomerism) with complete congenital heart block. The case was studied by echocardiography from 32 to 39 weeks of gestation. A postmortem examination was carried out a few hours after Cesarean section. The autopsy, histopathological and immunohistochemical findings revealed endocarditis. We think that abnormal turbulent systolic and diastolic flow of the semilunar valve, seen in fetal Doppler echocardiography, may be a sign of fetal endocarditis even though clear evidence of vegetations were not seen. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of cavernous lymphangioma of the arm
Authors: Giacalone P. L. , Boulot P. , Deschamps F. , Hedon B. , Laffargue F. , Viala J. L.
Published: March 2003

We present a case of prenatal diagnosis of a fetal cystic hygroma of the arm diagnosed using ultrasound scanning in the 32nd week of gestation. This represents the first reported case of cystic hygroma in this location. Ultrasonography was useful for the assessment of fetal arm mobility and for monitoring the volume of the mass during the pregnancy. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
First‐trimester fetal biometry using transvaginal sonography
Authors: Lasser D. M. , Peisner D. B. , Vollebergh J. , Timor‐Tritsch I.
Published: March 2003

First‐trimester fetal biometry using transvaginal sonography is now feasible and desirable due to improved imaging and probe maneuverability. A study of 144 early normal pregnancies with precise dates is presented. Regression models were constructed for the crown–rump length, biparietal diameter, head circumference and abdominal circumference. Error analysis of the technique and calculations was performed. First‐trimester fetal biometry may be used for obtaining precise estimates of gestational age and may help to detect early fetal maldevelopment resulting in abnormal growth. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Fetal upper respiratory tract function in cases of antenatally diagnosed congenital diaphragmatic hernia: preliminary observations
Authors: Fox H. E. , Badalian S. S. , Timor‐Tritsch I. E. , Marks F. , Stolar C. J. H.
Published: March 2003

Fetal upper respiratory tract function was studied in five cases of antenatally diagnosed congenital diaphragmatic hernia and in 16 cases of uncomplicated pregnancy at gestational ages ranging from 27 to 38 weeks. The evaluation of fetal upper respiratory tract function was performed using ultrasonography combined with color‐flow and spectral Doppler analysis. In all cases with uncomplicated pregnancy, fetal breathing‐related nasal and oropharyngeal fluid flow was seen at the level of the nose. The five cases with congenital diaphragmatic hernia all demonstrated fetal breathing activity by thoracic wall movement. In four of the fetuses, perinasal fluid flow was seen by the Doppler technique. The fetus with no demonstrated perinasal flow during breathing movements died in the early neonatal period and had pulmonary hypoplasia. Observation of the fetal breathing‐related nasal and oropharyngeal fluid flow in cases of antenatally diagnosed congenital diaphragmatic hernia provides a rationale to hypothesize that the absence of this phenomenon is a useful marker for prenatal prediction of pulmonary hypoplasia. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Correlation of Doppler and placental immunohistochemical features in normal and intrauterine growth‐retarded fetuses
Authors: Locci M. , Nazzaro G. , De Placido G. , Nazzaro A. , Colacurci N. , Montagnani S. , Montemagno U.
Published: March 2003

The aim of this study was to correlate and compare Doppler and anatomical placental findings obtained from 48 normal and 35 intrauterine growth‐retarded (IUGR) fetuses. The IUGR group consisted of 19 fetuses from pregnancies complicated by pre‐eclampsia and 16 from healthy mothers. Color Doppler evaluation of umbilical, spiral and uterine arteries was performed. Placental specimens from both normal and growth‐retarded fetuses were obtained at the time of delivery. Placental specimens were evaluated using histochemical and immunohistochemical techniques. A progressive decrease in the pulsatility index was observed in umbilical, spiral and uterine arteries throughout pregnancy in the normal‐growth fetuses. High umbilical artery pulsatility index values were obtained in 29 out of the 35 growth‐retarded fetuses, six of them showing absent or reversed end‐diastolic umbilical artery flow pattern. A total of 13 IUGR fetuses showed high resistance uterine artery flow velocity waveforms. Increased pulsatility index values were obtained from the spiral arteries of 16 growth‐retarded fetuses. Abnormal histological and histochemical placental patterns were observed in all the growth‐retarded fetuses with umbilical artery Doppler abnormalities. The presence of a peculiar dendritic cell subpopulation, strongly resembling the Langerhans cells, expressing the HLA‐DR+/CD1+ phenotype, was detected in all growth‐retarded fetuses, whether there was maternal pathology or not. Our data show uterine and spiral artery data as being ineffective in the monitoring of IUGR fetuses. The placental extracellular matrix seems to play an important role in the regulation of the umbilical circulation. The presence of CD1+ cells as a sign of a possible immunological mechanism in the pathogenesis of the intrauterine growth retardation is discussed. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Fetal hyperechogenic bowel and Down's syndrome
Authors: Nyberg D. A. , Resta R. G. , Mahony B. S. , Dubinsky T. , Luthy D. A. , Hickok D. E. , Luthardt F. W.
Published: March 2003

Hyperechogenic bowel was identified among 55 of 6781 (0.81%) fetuses prior to second‐trimester genetic amniocentesis. Trisomy 21 was found in eight of the 55 (14.5%) fetuses identified with hyperechogenic bowel compared to 60 of 6726 (0.89%) fetuses with normal bowel echogenicity (p < 0.001). Hyperechogenic bowel carried a 16‐fold greater risk for Down's syndrome than normal bowel echogenicity (relative risk 16.8, 95% confidence intervals 8.2–32.5). Chromosome abnormalities other than trisomy 21 were found in four additional fetuses with hyperechogenic bowel (two triploid and one each with 47,XXX; 45,X/47,XXX mosaicisim). Combining these four cases with the eight fetuses having trisomy 21, 21.8% (12 of 55) of fetuses with hyperechogenic bowel proved to have a chromosome abnormality. We conclude that hyperechogenic bowel is associated with chromosome abnormalities, particularly Down's syndrome, when detected during the second trimester. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Doppler studies of uterine arteries in spontaneous and artificially induced menopausal women
Authors: Luzi G. , Coata G. , Cucchia G. C. , Cosmi E. V. , Di Renzo G. C.
Published: March 2003

In the postmenopausal period, women's genital organs undergo several changes and female hormones, as well as modification of vascular reactivity to various stimuli, play a major role in this process. We studied the modification of uterine vascularity consequent to spontaneous or artificially induced menopause, with gonadotropin releasing hormone (GnRH) analogs. Flow velocity waveforms of the uterine arteries were detected using a color Doppler imaging system with a transvaginal probe; the pulsatility index was calculated. The study group consisted of 15 women observed before and after 6 months of treatment with GnRH analogs (triptorelin 3.75 mg depot every 4 weeks intramuscularly) for uterine fibromyomata; 20 women after 5 years of spontaneous menopause; and 20 healthy and normally menstruating women in the late luteal phase. We found a significant difference among the three groups with a progressive increase of the pulsatility index in spontaneous menopausal women. This phenomenon may be due to a different hormonal pattern which exists in spontaneous and artificially induced menopause (increase of gonadotropin level in the former and decrease in the latter), and to a decrease of vascular compliance caused by progressive sclerosis of the vasal walls. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Methotrexate treatment of unilateral twin ectopic pregnancy: case report and pharmacokinetic considerations
Authors: Fernandez H. , Bourget P. , Lelaidier C. , Doumerc S. , Frydman R.
Published: March 2003

We describe a case of spontaneous twin ectopic pregnancy, managed with the combination of local injection under ultrasound control and intramuscular administration of methotrexate. We describe a difference between the area under the curve of declining plasma concentration of methotrexate after intramuscular and local injection. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
The association between an abnormal nuchal skin fold, trisomy 21, and ultrasound abnormalities identified during the second trimester of pregnancy
Authors: DeVore G. R. , Alfi O.
Published: March 2003

Fetal echocardiography and a detailed non‐cardiovascular ultrasound examination were performed prospectively between 14 and 23 weeks of gestation prior to genetic amniocentesis in 2800 consecutive fetuses at increased risk for trisomy 21 due to advanced maternal age or a low maternal serum α‐fetoprotein. An abnormal nuchal skin fold was defined as ≥6 mm. Of 2800 fetuses, 23 (0.82%) had an abnormal nuchal skin fold. Seven of 35 fetuses (20%) with trisomy 21 and one of 12 fetuses (8.3%) with trisomy 18 had an abnormal nuchal skin fold. Of the 23 fetuses with an abnormal nuchal skin fold, seven (30.4%) had trisomy 21, one (4.4%) trisomy 18, one (4.4%), 46,XY,11p+ and 14 (60.8%) had normal karyotypes. The fetuses with trisomy 18 and 46,XY,11p+ had malformations of the cardiovascular and non‐cardiovascular organ systems. Five of seven (71%) fetuses with trisomy 21 and an abnormal nuchal skin fold had abnormalities of both the cardiovascular and non‐cardiovascular organ systems; one of seven (14.5%) had a heart defect only; and one of seven (14.5%) an abnormality of a non‐cardiovascular organ system. Of the 14 fetuses with an abnormal nuchal skin fold and normal karyotype, seven had no additional abnormalities, six an abnormality of the heart, and one a non‐cardiovascular defect. Fetuses with an abnormal nuchal skin fold had a significant increased incidence of trisomy 21 when a combination of cardiovascular and non‐cardiovascular abnormalities were present compared to fetuses with no additional defects or a single defect of the heart or non‐cardiovascular organ system (p = 0.001). In fetuses with an abnormal nuchal skin fold, the incidence of congenital heart disease was 6155, central nervous system defects 17%, hyperechoic bowel 8.7%, and renal abnormalities 17.4%.

These findings would suggest that the fetus identified with an abnormal nuchal skin fold with additional cardiovascular and non‐cardiovascular abnormalities has a greater risk for chromosomal aneuploidy compared to the fetus with an isolated abnormal nuchal skin fold or with one additional abnormality of the heart or a non‐cardiovascular organ system. When an abnormal nuchal skin fold is identified, careful evaluation of the fetal cardiovascular system should be made. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Measurements of fetal limb bones in early pregnancy
Authors: Zorzoli A. , Kustermann A. , Caravelli E. , Corso F. E. , Fogliani R. , Aimi G. , Nicolini U.
Published: March 2003

The fetal humerus, radius/ulna, femur, tibia/fibula and foot were measured in 296 pregnant women at 64–108 days' menstrual age, using vaginal sonography. All limb measurements correlated significantly with gestational age and biparietal diameter independently. Ratios of limb segment lengths did not change with gestation. Reference ranges (mean and 95% data intervals) were constructed for each limb segment. These data may prove useful in prenatal diagnosis of skeletal dysplasias and in the antenatal assessment of patients at risk of chromosomal abnormalities. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Use of intracavity saline instillation and transvaginal ultrasonography to detect tamoxifen‐associated endometrial polyps
Authors: Bourne T. H. , Lawton F. , Leather A. , Granberg S. , Campbell S. , Collins W. P.
Published: March 2003

There is sometimes a discrepancy between the apparent thickness of postmenopausal endometria, as determined by transvaginal ultrasonography, and the examination of endometrial biopsies. We describe a case which showed that tamoxifen (20 mg/day over 12 months) decreased impedance to blood flow in the uterine arteries and increased the apparent thickness of the endometrium. Conversely, the analysis of biopsies suggested the presence of an atrophic endometrium. The introduction of sterile saline into the uterine cavity during a repeat ultrasound scan revealed the presence of a large, free‐floating endometrial polyp, which was subsequently difficult to see by hysteroscopy. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Epignathus: clinical and sonographic observations of two cases
Authors: Gaucherand P. , Rudigoz R. C. , Chappuis J.‐P.
Published: March 2003

The epignathus or mature pluritissued teratoma of the mid‐line of the palate is a benign tumor for which the neonatal prognosis is related to the obstruction of the superior airway. This paper concerns observations of two cases, which developed in different ways.

Echography enables diagnosis of this type of malformation which classically combines a heterogeneous polylobed mass, polyhydramnios and the absence of other morphological anomalies. It enables an accurate differential diagnosis to be made by eliminating the other masses of the cephalic region. Echographic diagnosis also allows a rational management decision to be made, i. e. termination of pregnancy if prognosis is poor, or continuation with multidisciplinary (neonatologist, obstetrician, surgeon) intervention at birth. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Growth of the fetal gall bladder in normal pregnancies
Authors: Goldstein I. , Tamir A. , Weisman A. , Jakobi P. , Copel J. A.
Published: March 2003

Our objective was to obtain dimensions of the fetal gall bladder as a basis, for further studies and to establish normative data to assess deviations in growth. The study group included 183 normal pregnant women from 13 to 40 weeks' gestation. Routine biometric measurements were obtained on all fetuses, including biparietal diameter, head and abdominal circumferences and measurements of the long bones and the two diameters of the fetal gull bladder. The gall bladder area and circumference were calculated for each gestational age.

A linear growth function was observed across the gestational age and a first‐degree correlation was found to exist between gestational age and both the longitudinal (r = 0.77067; p < 0.00001; y = ‐0.41060 + 0.0907 × gestational age) and transverse (r = 0.602; p < 0.00001; y = 0.58567 + 0.01925 × gestational age) diameters of the fetal gall bladder. A significant correlation was also found between gull bladder area and gestational age (r = 0.6878; p < 0.00001), biparietal diameter (r = 0.72768; p < 0.00001), abdominal circumference (r = 0.71363; p < 0.00001) and femoral length (r = 0.72190; p < 0.00001). In addition, a significant correlation was found between gall bladder circumference and gestational age (r = 0.76181; p < 0.00001), biparietal diameter (r = 0.80039; p < 0.00001), abdominal circumference (r = 0.78030; p < 0.00001) and femoral length (r = 0.79694; p < 0.00001).

These results provide normative data of the fetal gall bladder in various dimensions and across gestational age. In addition, the data offer the potential for prenatal diagnosis of additional lesions in the extrahepatic biliary duct system.
Precocious signs of polycystic ovaries in obese girls
Authors: Sampaolo P. , Livieri C. , Montanari L. , Paganelli A. , Salesi A. , Lorini R.
Published: March 2003

As several studies have reported that 35% of patients with polycystic ovary syndrome are obese and that this syndrome seems to originate during the early phase of sexual maturation, we undertook a study of such subjects. We studied ultrasound and hormonal findings in 49 obese girls aged from 7.9 to 19.10 years, with a mean excess weight of 44%; 23 premenarcheal girls and 26 postmenarcheal girls with mean gynecological age of 2.5 years. As controls, we studied 18 girls in the pubertal phase and 17 healthy girls with regular menses, matched for age and gynecological age.

Pelvic ultrasonography was carried out in all girls and estrone, estradiol, progesterone, prolactin, follicle stimulating hormone, luteinizing hormone, sex hormone binding globulin (SHBG), testosterone, free testosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA‐S), androstenedione and 17‐hydroxyprogesterone (17‐OHP) were measured by radioimmunoassay in 11 of the 18 postmenarcheal girls. Five girls (10.2%) with excess weight of > 40% presented with mild or severe hirsutism based on Ferriman and Gallway scores; six (12.2%) presented with acne and 14 (28.5%) presented with acanthosis nigricans.

Hormonal evaluation showed elevated levels of estrone (p < 0.005) and testosterone (p < 0.01) but lower than normal levels of SHBG (p < 0.05) and estradiol (p <0.05). On the basis of our results, 23%) of the postmenarcheal obese subjects showed clinical, hormonal and ultrasonographic signs of polycystic ovaries, and 23% of postmenarcheal obese girls showed multifollicular ovaries. Six of these, at 1 year after menarche, showed a uterine cross‐sectional area larger than normal jar gynecological age (21.92 ± 5.64 cm2 vs. 16.36 ± 2.34 cm2). Further serial echographic studies and a careful follow‐up will demonstrate if both multifollicular ovaries and increased uterine cross‐sectional area in obese girls are precocious signs of polycystic ovaries.
The biophysical profile as a tool for prediction of preterm delivery
Authors: McFarlin B. L. , Baumann P. , Sampson M. B. , Kruger M. , Cotton D. B.
Published: March 2003

Our objective was to determine if any of the following parameters is a predictor of preterm delivery: gestational age, cervical dilatation, or biophysical profile score.

Sixty‐two women with certain dates, intact membranes, and preterm contractions more frequent than 300 min underwent a 30‐min ultrasonographic assessment of fetal breathing movements, fetal tone, fetal movement and amniotic fluid volume, each of which was scored as 0, 1, or 2 before any tocolytics were given. The total score (0–8) was calculated and cervical dilatation was recorded. All women were subsequently placed on tocolytics. Data were analyzed using survival analysis with stepwise regression of the covariates to determine the predictive values of the total score, its individual parameters, gestational age, and cervical dilatation to the outcome variable of hours to delivery. Gestational age, cervical dilatation and time interval to delivery were categorized and entered into a logistic regression model with the total score and its components to determine predictive odds.

Total score (p < 0.0001) and cervical dilatation (p < 0.0001) were the most significant variables associated with time interval to delivery, followed by gestational age (p = 0.035). When the individual biophysical parameters were entered into the model, fetal tone (p < 0.0001), cervical dilatation (p < 0.0001) and gestational age (p < 0.014) were the only variables related to time interval to delivery. Predictive odds of delivery in less than 48 h in relation to fetal tone and cervical dilatation were calculated.

Total score, fetal tone, and cervical dilatation were strongly associated with time interval to delivery. Our study did not support fetal breathing movements as a predictor of preterm delivery. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
The implementation of first‐trimester scanning at 10–13 weeks' gestation and the measurement of fetal nuchal translucency thickness in two maternity units
Authors: Pandya P. P. , Goldberg H. , Walton B. , Riddle A. , Shelley S. , Snijders R. J. M. , Nicolaides K. H.
Published: March 2003

The aim of this prospective screening study was to evaluate the implementation of an additional ultrasound examination, incorporating the measurement of fetal nuchal translucency thickness, at 10–13 weeks' gestation in two maternity units providing routine antenatal care. During the 1 year prior to the introduction of the first‐trimester scan, the major indication for fetal karyotyping was maternal age ≥ 35 years and only two out of the total of 11 cases of trisomy 21 were identified. In the first 5 months of the study, 70% of the women delivering in these hospitals attended for measurement of fetal nuchal translucency thickness and the measurement was obtained in all cases. This was achieved without an increase in the number of sonographers or ultrasound machines. The incidence of fetal nuchal translucency thickness ≥ 2.5 mm was 3.6% (63 of 1763), and this group included three of the four fetuses with trisomy 21. The findings of this study demonstrate the feasibility of introducing scanning at 10–13 weeks' gestation and the measurement of fetal nuchal translucency thickness in routine maternity units. The sensitivity and specificity of this method of screening are at present being evaluated in a large multicenter study. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Cerebellar hypoplasia in the second trimester associated with microcephaly at birth
Authors: Rees A. E. J. , Bates A. , Clarke H.
Published: March 2003

The antenatal diagnosis of microcephaly is most commonly made in the third trimester. Biometric measurements of the head of three or four standard deviations below the mean are suggestive of microcephaly. We report a case of microcephaly where abnormalities in intracerebral architecture, i.e. cerebellar hypoplasia, were noted early in the second trimester. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal gray‐scale and Doppler ultrasound examinations of the uterus and ovaries in healthy postmenopausal women
Authors: Sladkevicius P. , Valentin L. , Maršál K.
Published: March 2003

The aim of this study was to elicit reference data representative of normal findings at transvaginal gray‐scale and Doppler ultrasound examination of the uterus and ovaries in postmenopausal women. A total of 144 asymptomatic postmenopausal women with normal findings at clinical gynecological examination were included in the study. They underwent transvaginal sonography including Doppler measurements of blood flow velocity in the uterine and ovarian arteries. Ninety‐eight (68%) women had a normal uterus and normal or non‐visible ovaries at ultrasound examination, 23 (16%) had small uterine myomas but normal or non‐visible adnexa, 19 (13%) had small adnexal cysts but a normal uterus, and four (3%) had both small myomas and small adnexal cysts. The median time‐averaged maximum velocity (TAMXV) and pulsatility index (PI) values for the right and left uterine artery of normal uteri (n = 117) were 10.4 cm/s (range 2.2–43.0) and 10.6 cm/s (2.9–30.8), and 2.33 (0.97–5.13) and 2.35 (0.98–4.58) respectively. Median volumes of the normal right (n = 93) and left ovaries (n = 90) were 1.3 cm3 (0.4–3.7) and 1.2 cm3 (0.4–3.0)) respectively, and median TAMXV and PI values for the stromal arteries in the normal right (n = 53) and left ovaries (n = 54) were 2.1 cm/s (1.3–4.6) and2.3 cm/s (l.l–7.3), and 1.31 (0.65–2.61) and 1.26 (0.63–1.85), respectively.

Our results provide a basis for gray‐scale and Doppler ultrasound studies of pathological conditions in the female pelvis after the menopause. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
The reliability of transvaginal ultrasonography to detect retained tissue after spontaneous first‐trimester abortion, clinically thought to be complete
Authors: Alcázar J. L. , Baldonado C. , Laparte C.
Published: March 2003

In order to assess the reliability of transvaginal ultrasonography for the detection of trophoblastic tissue retained after spontaneous first‐trimester abortion and clinically thought to be complete, the clinical, sonographic and pathological data of 33 women were retrospectively analyzed. The patients' mean age was 34 years (range 24–48). The mean gestational age at presentation of symptoms was 8 weeks (range 5.1–11.1). Transvaginal sonography showed that in 18 cases retained tissue was absent, and that in 15 patients, retained trophoblastic tissue was suspected. Pathological reports (following dilatation and curettage) confirmed the absence of retained tissue in 17 cases and demonstrated its presence in 16 patients (13 in whom retained tissue was suspected by sonography and three in whom retained tissue was not suspected). Sensitivity, specificity, positive predictive value and negative predictive value in our series were 81%, 94%, 93% and 83%, respectively for the detection of retained trophoblastic tissue. We conclude that transvaginal ultrasonography is a reliable method to detect the presence of retained trophoblastic tissue following spontaneous first‐trimester abortion, clinically thought to be complete. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Prospective study on fetal weight estimation using limb circumferences obtained by three‐dimensional ultrasound
Authors: Favre R. , Bader A.‐M , Nisand G.
Published: March 2003

The aim of this prospective study was to evaluate the usefulness of fetal weight estimation in a prospective study, based on formulae derived from a previous retrospective study, using forward stepwise multiple regression analysis. Three‐dimensional ultrasound was used to make reproducible measurement of limb circumferences, which formed the basis of our models.

A total of 213 women with singleton pregnancies were scanned in the week prior to delivery and the following variables were measured: biparietal diameter, head circumference, transverse abdominal diameter, abdominal circumference, femur length, thigh circumference and arm circumference. The whole population was divided in to three subgroups according to the abdominal circumference (< 10th centile, 10–90th centile, and > 90th centile).

We demonstrated the need for only two models for accurate fetal weight estimation, one for the small‐for‐dates fetuses and a second for the others. The most accurate results were obtained for the macrosomic fetuses with a standard deviation of 8.8%. Our data confirm the usefulness of measurement of fetal thigh circumference for the small‐for‐dates‐fetuses and arm circumference for the other groups.

We concluded that the use of three‐dimensional ultrasound could facilitate the accurate prediction of fetal weight. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Fetal midgut herniation into the umbilical cord: improved definition of ventral abdominal anomaly with the use of transvaginal sonography
Authors: Achiron R. , Soriano D. , Lipitz S. , Mashiach S. , Goldman B. , Seidman D. S.
Published: March 2003

The most common anomalies of the fetal ventral abdominal wall include omphalocele and gastroschisis. Umbilical cord hernia is another abdominal wall defect that is poorly defined and usually mistakenly considered as a small omphalocele. The present report describes the sonographic features and clinical significance off our cases of umbilical cord hernia identified transvaginally in the early second trimester of pregnancy. These cases seemed to present a different entity from that of simple omphalocele. The transvaginal sonographic approach provided a clear image of the midgut protruding into the umbilical cord, precise localization of cord insertion in the region of the umbilical ring, Doppler flow evaluation of the umbilical vessels and their relation to the protruding mass. Serial sonographic observations revealed a stable umbilical cord mass in three fetuses, and an enlarging mass in one. Normal karyotype was determined and no associated malformations were detected prenatally. However, in one case that underwent immediate correction of the hernia after delivery at term, the neonate was subsequently found to have pulmonic stenosis and severe neonatal seizures developed at 4 months of age. In two cases, pregnancy was terminated due to parental request. The fourth fetus was delivered vaginally at term and catastrophic division of the umbilical cord containing a loop of small intestine was avoided only by the diligent observation of the midwife. We suggest that umbilical cord hernia is a distinct anomaly originating at a different stage of embryogenesis, thereby having a unique clinical significance, unlike simple omphalocele. Umbilical cord hernia should therefore be defined and as separate entity. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Micro‐bead embolization of uterine spiral arteries and changes in uterine arterial flow velocity waveforms in the pregnant ewe
Authors: Ochi H. , Suginami H. , Matsubara K. , Taniguchi H. , Yano J. , Matsuura S.
Published: March 2003

The aim of the present study was to simulate the pathological uteroplacental circulation observed in complicated human pregnancies in the pregnant ewe and to analyze its velocimetric changes. Four pregnant ewes at 16–17 weeks of pregnancy were used in the study. Micro‐beads (Gelfoam) were administered stepwise into the uterine artery and changes in the uterine circulation were assessed by Doppler velocimetry. Gelfoam administration successfully embolized the uterine spiral arteries located in the decidual segment. The Gelfoam embolization decreased the uterine bloodflow dose‐dependently from 550 ± 48 ml/min (mean ± SD) to 142 ± 12 ml/min and reciprocally increased the uterine vascular resistance from 139 ± 12 mmHg min l−1 to 540 ± 46 mmHg min l−1 at 0 mg and 30 mg Gelfoam, respectively. It dose‐dependently attenuated the pregnancy‐related physiological elevation in diastolic flow velocity, while the systolic flow velocity was unaffected, resulting in a dose‐dependent increase in the pulsatility index from 0.5 ± 0.2 to 3.2 ± 0.7 at 0 mg and 30 mg Gelfoam, respectively. The pulsatility index linearly correlated with the uterine vascular resistance, giving a high correlation coefficient of r = 0.947. It could be concluded that the uterine arterial pulsatility index is an indicator of uterine vascular resistance. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of gastroesophageal reflux by color and pulsed Doppler ultrasonography in a case of congenital pyloric atresia
Authors: Rizzo G. , Capponi A. , Arduini D. , Romanini C.
Published: March 2003

A case of pyloric atresia diagnosed in the third trimester is described. Real‐time ultrasonographic examination revealed polyhydramnios, enlarged stomach, evident gastric peristalsis and esophageal dilatation. Color and pulsed Doppler studies of the gastroesophageal junction revealed the presence of a biphasic flow pattern that was consistent with gastroesophageal reflux. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic diagnosis of a non‐previa placenta accreta
Authors: Jauniaux E. , Toplis P. J. , Nicolaides K. H.
Published: March 2003

An unusual case of placenta accreta diagnosed before delivery and managed conservatively is reported in a third‐trimester pregnant woman with 120 past obstetric history. Ultrasound revealed a large echo‐poor area where the decidual interface was absent. Uterine vessels immediately under and around the placental abnormal insertion site appeared dilated. In one area, where the myometrium could not be identified at all, the basal plate of the placenta appeared to float inside uterine vessels. A Cesarean section was performed at term and after partial delivery of the placenta a wedge resection of the accreta area was made. Brisk bleeding was controlled by rapid reconstitution of the myometrium. It is suggested that non‐previa placenta accreta can be diagnosed antenatally in a low‐risk population using gray‐scale ultrasound imaging and enabling, in most cases, conservative management. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Blood flow velocity waveforms from peripheral pulmonary arteries in normally grown and growth‐retarded fetuses
Authors: Rizzo G. , Capponi A. , Chaoui R. , Taddei F. , Arduini D. , Romanini C.
Published: March 2003

The objective of this study was to describe blood flow velocity waveforms of fetal peripheral pulmonary arteries in normally grown and growth‐retarded fetuses. Doppler studies were performed in 182 normally grown fetuses (gestational age 18–40 weeks) and in 61 growth‐retarded fetuses (gestational Loge 24–36 weeks) that were free from structural and chromosomal abnormalities and whose umbilical and middle cerebral artery Doppler findings suggested uteroplacental insufficiency as the most likely etiology of the growth defect. The pulsatility index was used to quantify the velocity waveforms. Successful recordings were obtained in 90.1% of the normally grown and 93.4% of the growth‐retarded fetuses. In normally grown fetuses the pulsatility index values significantly decreased with advancing gestation. In growth‐retarded fetuses the pulsatility index values were significantly elevated compared to those of normal fetuses. A significant relationship was observed between the severity of hypoxia and pulsatility index values from the peripheral pulmonary arteries in 29 fetuses in which Doppler recordings were obtained immediately before cordocentesis. In conclusion, these data show that in normal fetuses the Doppler‐measured impedance to flow in the peripheral pulmonary circulation decreases with advancing gestation. Impedance to flow in the lungs is elevated in the presence of growth retardation and this increase is related to the severity of fetal hypoxia. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Doppler echocardiographic assessment of fetal blood flow redistribution during maternal hyperoxygenation
Authors: Almström H. , Sonesson S.‐E.
Published: March 2003

Sixteen normal human fetuses were studied at both 20–23 and 30–33 weeks of gestation to investigate whether hemodynamic changes in the heart and major fetal arteries occurred in response to maternal hyperoxygenation in normal pregnancy. Velocity waveforms from the mitral valve, aortic valve, middle cerebral artery, aortic isthmus and umbilical artery were recorded before and during maternal breathing of 100% oxygen. The cerebral artery pulsatility index (PI) increased with oxygen administration at the first examination (1.56 ± 0.25, mean ± 1 SD, to 1.72 ± 0.28, p < 0.05). At the second examination this increase in cerebral artery PI was more consistent (1.89 ± 0.43 to 2.22 ± 0.43, p <: 0.001) and there was also a decrease in the aortic isthmus PI (2.64 ± 0.43 to 2.40 ± 0.33, p < 0.01) during oxygen administration. The variables determined from the velocity waveforms of the umbilical artery, aortic and mitral value did not show any changes with maternal hyperoxygenation.

Maternal hyperoxygenation resulted in velocity wave form changes suggesting an increase of cerebral vascular resistance and a redistribution of blood flow from the brain to the vascular beds supplied by the descending aorta in the normal human fetus in the third trimester, but this response was less obvious at mid‐gestation. The middle cerebral artery and the aortic isthmus seem to be suitable sites for verification of this response. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
The diagnostic value of endometrial thickness and volume measurements by three‐dimensional ultrasound in patients with postmenopausal bleeding
Authors: Gruboeck K. , Jurkovic D. , Lawton F. , Savvas M. , Tailor A. , Campbell S.
Published: March 2003

We compared endometrial thickness and volume in patients with postmenopausal bleeding, and examined the value of each parameter in differentiating between benign and malignant endometrial pathology. A total of 103 patients with a history of postmenopausal bleeding were recruited into the study. Patients who were taking hormone replacement therapy or other hormonal preparations with a known effect on the endometrium were excluded. Each patient underwent three‐dimensional ultrasonography for the measurement of endometrial thickness and volume. In 97 cases both of these measurements were obtained and the results were compared to the histological diagnosis after endometrial biopsy or dilatation and curettage. Endometrial cancer was diagnosed in 11 patients. The mean endometrial thickness was 29.5 mm (SD 12.59) and the mean volume was 39.0 ml (SD 34.16). In the remaining 86 patients there were eight cases with endometrial hyperplasia and seven with endometrial polyps The endometrial thickness and volume in patients with benign pathology was 15.64 mm (SD 5.26) and 5.47 ml (SD 6.32), respectively. In 71 patients with atrophic or normal endometrium the mean thickness and volume was 5.29 mm (SD 3.97) and 0.91 ml (SD 1.71), respectively. Receiver operating characteristic curves showed endometrial volume to be superior to endometrial thickness for the diagnosis of endometrial cancer. The optimal cut‐off value of endometrial thickness for the diagnosis of cancer was 15 mm, with the test sensitivity of 83.3 % and positive predictive value of 54.5%. With the cut‐off level of 13 ml for endometrial volume measurement the sensitivity was 100% and the positive predictive value 91.7%. Both the thickness and volume were higher in patients with advanced and less differentiated cancers. The measurement of endometrial volume was superior to that of endometrial thickness as a diagnostic test for the detection of endometrial cancer in symptomatic postmenopausal women. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology