bluuebunny/crossref_metadata_2025 huggingface dataset:
Transvaginal sonography of the uterine cavity following curettage for early pregnancy failure
Authors: Haines C. J. , Shand K. L. , Leung D. Y. L.
Published: March 2003

In a study of 50 women presenting with sonographically confirmed early pregnancy failure, the uterine contents were measured in both sagittal and transverse planes before proceeding with evacuation of the retained products of conception. A repeat sonographic study of the empty uterine cavity was performed on the day after curettage and similar measurements were made, the subjects having been divided into four groups according to gestational age. There was no significant difference between the groups in the postoperative measurements of either uterine cavity width or area, nor was the size of the empty uterine cavity influenced by the volume of tissue within the uterus before evacuation. Whilst the measurement of width was similar both before and after evacuation of the uterus in all groups, the sagittal area was significantly smaller postoperatively. There was no evidence of retained tissue at any of the postoperative sonographic examinations, nor did any of the subjects in the study develop subsequent complications. Assuming the dimensions of the uterine cavity following curettage are representative of an empty uterus, this will form the basis of a prospective study to determine whether spontaneous abortion can be safely managed without curettage in selected cases, if the preoperative sonographic measurements fall within a specified range. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Changes in inferior vena cava blood flow velocity and diameter during breathing movements in the human fetus
Authors: Huisman T. W. A. , van den Eijnde S. M. , Stewart P. A. , Wladimiroff J. W.
Published: March 2003

Breathing movements in the human fetus cause distinct changes in Doppler flow velocity measurements at arterial, venous and cardiac levels. In adults, breathing movements result in a momentary inspiratory collapse of the inferior vena cava vessel wall. The study objective was to quantify the inferior vena cava flow velocity modulation during fetal breathing movements and to evaluate possible inferior vena cava vessel diameter changes in normal third‐trimester pregnancies.

We studied 57 women after oral administration of dextrose (50 g). In 40 fetuses (n = 19, 27–32 weeks and n = 21, 36–39 weeks), fetal inferior vena cava waveforms were obtained during apnea and fetal breathing activity. In 30 fetuses (27–39 weeks) inferior vena cava vessel diameter changes were studied using the M‐mode during apnea and breathing movements. Peak and time‐averaged velocities of inferior vena cava flow velocity waveforms showed a gestational age‐independent increase of 60–160% during breathing activity. A temporary inferior vena cava vessel wall collapse (range, 50–83%) was recorded, which was significantly different from vessel diameter changes during apnea (range, 11–19%). The marked increase of inferior vena cava flow velocities is due to a raised thoraco‐abdominal pressure gradient, which may cause a reduction in vessel size and additional volume flow into the right atrium. The significance of the caval index for recognition of elevated right atrial pressure in abnormal human fetal development needs further investigation. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Trends in sonographic fetal organ visualization
Authors: Wolfe H. M. , Zador I. E. , Bottoms S. F. , Treadwell M. C. , Sokol R. J.
Published: March 2003

In order to assess changes in sonographic visualization over the last 6 years, 7092 second‐ and third‐trimester ultrasound examinations from separate pregnancies in three individual years (1451 in 1985, 3016 in 1988, and 2625 in 1991) were compared. Overall, visualization across all gestational ages improved from 63.9% (1985) to 85.8% (1988) to 87.3% (1991), with the year in which the scan was performed explaining 19.6% of the variance in visualization. Maternal size (as determined by body mass index) remained the major determinant of ultrasound visualization in 1991 (r² = 11.2%), with gestational age explaining only 5.2% additional variance. Overall organ visualization was maximal at 21–23 weeks' gestation, with the decline in later gestation primarily accounted for by worsened visualization of fetal extremities and spine. Improved fetal visualization earlier in the second trimester and the advent of embryonic visualization in the first trimester may allow a continuum of prenatal sonographic diagnosis. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Fetal echocardiography: the identification of two of the pulmonary veins from the four‐chamber view during the second trimester of pregnancy
Authors: Anteby E. Y. , Shimonovitz S. , Yagel S.
Published: March 2003

Identification of two of the pulmonary veins as they enter the left atrium is important to the diagnosis of the visceroatrial situs for fetuses with normal and abnormal echocardiographic findings. In this study, we investigated the ability to demonstrate these veins in 734 fetuses varying in gestational age from 13 to 21 weeks.

Transvaginal and transabdominal B‐mode ultrasound and color flow Doppler were used for the examination. With the use of the transvaginal route, the highest visualization rate, 85–95%, was achieved in fetuses of 14–15 weeks of gestation. With the use of the transabdominal route, the highest visualization rate, 95–97%, was achieved in fetuses of 20–21 weeks of gestation. This examination enabled the correct diagnosis to be made of complex cardiac anomaly.

Visualization of the pulmonary veins with B‐mode ultrasound aided by color flow Doppler can be accomplished in the majority of fetuses, while the four‐chamber view is studied. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Arteriovenous malformation of the uterus associated with a missed abortion
Authors: Ginsberg N. A. , Hammer R. , Parihk S. , Tamura R. , Sabbagha R. E.
Published: March 2003

Arteriovenous malformation of the uterus is a rare uterine abnormality. This entity is generally associated with the presence of molar disease, choriocarcinoma and uterine surgery, but may be congenitally acquired. The presence of an arteriovenous malformation generally leads to unexplained profuse uterine bleeding. The diagnosis of this entity has traditionally been made by arteriography, and the treatment is usually hysterectomy. We present a patient with an arteriovenous malformation of the uterus whose prior delivery was by Cesarean section. The patient experienced episodes of heavy vaginal bleeding in the first month following the procedure of suction curettage for a first‐trimester pregnancy loss. Chorionic villus sampling performed prior to the procedure showed a chromosomally normal fetus. The diagnosis of an arteriovenous malformation was made by color Doppler velocimetry and confirmed with arteriography. The patient desired to maintain her fertility. Interventional radiological techniques were successfully utilized to obliterate the arteriovenous malformation with the use of polyvinyl alcoholparticles (250 µm) and gelfoam. Discussion includes the presenting signs and symptoms along with the method of both diagnosis and conservative management. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
First‐trimester diagnosis of hydrolethalus syndrome
Authors: Ämmälä P. , Salonen R.
Published: March 2003

At 12 weeks of gestation, a combination of atypical hydrocephalus with absent mid‐line structures and club foot was detected during transvaginal ultrasound examination. These findings were diagnostic of hydrolethalus syndrome and were confirmed after subsequent termination of the pregnancy. This is the first known case of first‐trimester prenatal diagnosis of hydrolethalus syndrome. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal diagnosis of lethal osteopetrosis
Authors: Sen C. , Madazli R. , Aksoy F. , Ocak V.
Published: March 2003

We describe a case of the lethal form of osteopetrosis diagnosed prenatally by ultrasonography. Anomalies detected on ultrasound examination at 18 weeks' gestation included skeletal hyperdensity, communicating hydrocephalus and short long bones. At 21 weeks' gestation, cordocentesis was performed to measure the levels of calcium, phosphorus and alkaline phosphatase. The fetus was aborted at 22 weeks' gestation. The diagnosis of osteopetrosis was confirmed by postmortem radiological and histopathological analysis. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Repeatability of measurement of fetal nuchal translucency thickness
Authors: Pandya P. P. , Altman D. G. , Brizot M. L. , Pettersen H. , Nicolaides K. H.
Published: March 2003

The aim of this prospective study was to assess the repeatability of measurement of fetal nuchal translucency thickness at 10–14 weeks' gestation. The nuchal translucency was measured by two of four operators in 200 pregnant women attending the Harris Birthright Research Centre for Fetal Medicine at 10–14 weeks' gestation. To assess repeatability of different components of variability, six measurements of nuchal translucency were made on each fetus, with a total of 1200 measurements. The data of this study demonstrate that 95% of the time the intraobserver, interobserver and caliper placement repeatability of measuring fetal nuchal translucency were less than 0.54 mm, 0.62 mm and 0.58 mm, respectively. In addition, the repeatability was unrelated to the size of the nuchal translucency. The findings of this study demonstrate that, when the nuchal translucency thickness is measured by well‐trained operators, the measurement is highly reproducible. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Endometrial blood flow response to estrogen replacement therapy and tamoxifen in asymptomatic, postmenopausal women: a transvaginal Doppler study
Authors: Achiron R. , Lipitz S. , Frenkel Y. , Mashiach S.
Published: March 2003

This study was conducted to evaluate endometrial blood flow characteristics in response to estrogen replacement therapy (ERT) and tamoxifen in asymptomatic postmenopausal women, and to correlate the resistance index (RI) with plasma estradiol levels. Transvaginal color Doppler ultrasound examinations were performed in 30 asymptomatic, postmenopausal women who demonstrated thin endometria (< 0.5 cm). Ten healthy women receiving ERT and ten women with breast cancer receiving tamoxifen comprised the study groups. Ten postmenopausal women free of any hormonal treatment comprised the control group. Blood flow response was assessed by visualization of arterial waveforms in the endometrial region. Resistance indices were calculated for analysis and correlated with peripheral blood levels of estradiol. All postmenopausal women treated with tamoxifen or ERT showed continuous forward end‐diastolic flow velocities, while the menopausal women without treatment demonstrated partial forward end‐diastolic flow. Resistance index values of non‐treated women were invariably higher (mean 0.89, range 0.85–0.91) than in those on tamoxifen (mean 0.79, range 0.54–0.90; p < 0.05), while the lowest RI was obtained in women taking ERT (mean 0.66, range 0.54–0.90; p < 0.05). The plasma concentrations of estradiol in women on ERT were found to be significantly higher than those of the tamoxifen and control groups. The observed data suggest that ERT and tamoxifen modify normal postmenopausal endometrial perfusion. Tamoxifen had a weaker estrogenic effect on the endometrial blood flow resistance, and ERT enhanced endometrial blood perfusion through vasodilatation. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Endometrial evaluation in postmenopausal breast cancer patients receiving tamoxifen: an ultrasound, color flow Doppler, hysteroscopic and histological study
Authors: Exacoustòs C. , Zupi E. , Cangi B. , Chiaretti M. , Arduini D. , Romanini C.
Published: March 2003

The purpose of this study was to evaluate the effect of tamoxifen therapy on the endometrium by transvaginal color Doppler sonography, hysteroscopy and endometrial sampling. The study group (tamoxifen group) was composed of 38 asymptomatic postmenopausal women. All had been treated with tamoxifen (20–30 mg/day) for breast cancer for at least 1 year. The patients of the tamoxifen group underwent transvaginal color Doppler sonography, hysteroscopy and, if necessary, endometrial biopsy. Thirty asymptomatic post menopausal women (control group) and 25 asymptomatic postmenopausal breast cancer patients not on tamoxifen therapy (no‐tamoxifen group) served as the control groups. The endometrium was scanned by transvaginal ultrasound to evaluate thickness, echotexture, border and intraluminal fluid. Color and pulsed Doppler were used to evaluate the pulsatility (PI) and resistance (RI) indices of the uterine and endometrial arteries when possible. The patients receiving tamoxifen had a significantly thicker endometrium compared to the control groups. Endometrial pathology was observed in 61% (23/38) of cases and an endometrial thickness of ⩾ 10 mm was always associated with an endometrial lesion. Nineteen benign endometrial polyps were found, most of them having a typical sonographic endometrial pattern with regular borders and small hypoechoic cystic areas which we define as polypoid. Four endometrial hyperplasias, one of these atypical were observed. There were no endometrial cancers. The mean PI and RI of the uterine arteries in the tamoxifen group were 2.04 ± 0.77 and 0.82 ± 0.1, respectively and were significantly lower than those of the control group (2.93 ± 0.9 and 0.93 ± 0.06) and the no‐tamoxifen group (2.53 ± 0.7 and 0.89 ± 0.1). The blood velocity changes were very similar to those described in postmenopausal women receiving estrogen replacement therapy. A correlation between the time of beginning tamoxifen therapy after menopause and development of endometrial pathology was observed: in patients who started therapy many years after the onset of menopause, the risk of developing endometrial pathology was higher than in those who began therapy a few years after the onset of menopause. Patients receiving tamoxifen, particularly those who start therapy many years after the onset of menopause, should be closely monitored by transvaginal ultrasound and color Doppler imaging to detect endometrial lesions. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Intraobserver reproducibility of transvaginal Doppler measurements in uterine and intraovarian arteries in regularly menstruating women
Authors: Tekay A. , Jouppila P.
Published: March 2003

The intraobserver reproducibility of the pulsatility index (PI), resistance index (RI) and maximum peak systolic velocity (MPSV) measurements in uterine and intraovarian arteries was assessed in ten regularly menstruating women by means of transvaginal pulsed Doppler ultrasound. Three different sources of variation in repeat measurements, i.e. beat‐to‐beat, between‐frame and temporal variability, were studied using the coefficient of variation (CV) and intra‐class correlation coefficients. Beat‐to‐beat and between‐frame variabilities in all Doppler parameters were negligible. The following figures were obtained from the assessment of temporal variability. The uterine artery PI and MPSV measurements had a CV of 10% and 15%, respectively. Intra‐class correlation coefficients for these parameters were 0.99 and 0.88, respectively. In the intraovarian arteries, the CV was between 15 and 19% for the PI and between 8 and 12% for the RI. The CV values for intraovarian MPSV measurements were 14 and 16%. In contrast, the intra‐class correlation coefficients for the intraovarian MPSV measurements showed considerable variation, from 0.63 to 0.68. Uterine artery Doppler velocimetry proved to be a reliable method. The PI and RI measurements in the intraovarian arteries were also reproducible. In contrast, the inconsistency observed in velocity measurements in the intraovarian arteries raises some doubt as to the reliability of these measurements. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Detection of appendicitis by transvaginal ultrasound: a case report
Authors: Larcos G.
Published: March 2003

Transvaginal ultrasound was performed in a 35‐year‐old woman with right iliac fossa discomfort in whom initial transabdominal images revealed no abnormality. A thickened hyperemic appendix with appendicolith was identified; subsequent surgery and pathological examination confirmed appendicitis. Transvaginal ultrasound may be valuable in women with suspected appendicitis when standard views are normal or equivocal. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Choroid plexus cysts: not associated with Down syndrome
Authors: Bromley B. , Lieberman E. , Benacerraf B. R.
Published: March 2003

We sought to determine whether there is an association between choroid plexus cysts identified in the second‐trimester fetus and trisomy 21. Over a 7‐year period, fetuses scanned between 14 and 22 weeks were prospectively evaluated for the presence of choroid plexus cysts. Follow‐up on fetuses with choroid plexus cysts was obtained by review of the medical records. Over the same time period, the scans and reports of all fetuses with trisomy 21 detected in our laboratory by mid‐trimester amniocentesis were reviewed. The prevalence of choroid plexus cysts in fetuses with and without trisomy 21 were compared by means of χ2 analysis. A total of 473 fetuses with choroid plexus cysts were identified among 32 053 second‐trimester fetuses. Sixteen fetuses were lost to follow‐up, three had structural defects and normal karyotypes and 21 had abnormal karyotypes, two of which were trisomy 21. Other abnormal karyotypes included trisomy 18, unbalanced translocation and triploidy, previously reported elsewhere. The remaining 433 fetuses either had normal karyotypes or were normal newborns. The prevalence of choroid plexus cysts (excluding fetuses with trisomy 18) was 1.38% in our general population. During the study period, 143 fetuses with trisomy 21 were karyotyped in our laboratory, and two of these (1.40%) had choroid plexus cysts. Both had other sonographic abnormalities suggesting trisomy 21. The difference in prevalence of fetuses with choroid plexus cysts and trisomy 21 vs. those without trisomy 21 was not statistically significant (χ2 = 0.98; relative risk (RR) = 1.02; 95% CI = 0.26, 4.03). We conclude that choroid plexus cysts occur with similar frequency in fetuses with trisomy 21 to that in fetuses from the general population. The finding of choroid plexus cysts should not be used to increase the patient's calculated risk of having a fetus with trisomy 21. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional saline contrast hysterosonography and surface rendering of uterine cavity pathology
Authors: Weinraub Z. , Maymon R. , Shulman A. , Bukovsky J. , Kratochwil A. , Lee A. , Herman A.
Published: March 2003

A new technique that combines saline contrast hysterosonography with three‐dimensional surface rendering for the visualization of uterine intracavitary pathologies is described. A total of 32 patients suspected of having uterine cavity pathologies on the basis of previous ultrasonography, hysterosalpingography or hysteroscopy were involved in the study. They were examined by three‐dimensional high‐frequency endovaginal probes (Combison 530, Kretztechnik, Zipf, Austria), with normal saline used as an expander and contrast medium. Three perpendicular planes could be evaluated simultaneously, and surface renderings were readily available. Following the instillation of normal saline, the uterine cavity appears as an echo‐free, well‐defined structure, and the endometrium appears as an echogenic homogeneous lining around the cavity. Data acquisition time is short and images can be stored for later evaluation.

Surface rendering of polypoid structures shows ecbogenie masses on a pedicle protruding into the uterine cavity. Submucous fibroids appear as mixed echogenic sites bulging into the cavity. Intrauterine synechiae appear as bands of varying thickness traversing the uterine cavity.

Simultaneous display of the zone of interest in three perpendicular planes enhances imaging capabilities, while surface rendering provides a comprehensive overview of the surface area of the findings and their topographical orientation. Further research using this new technique is required to document its real contribution to ultrasonographic imaging. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
A comparative analysis of second‐trimester ultrasound dating formulae in pregnancies conceived with artificial reproductive techniques
Authors: Mul T. , Mongelli M. , Gardosi J.
Published: March 2003

A dataset of 64 pregnancies conceived by artificial reproductive techniques was studied to assess the accuracy of second‐trimester dating formulae when these were applied in routine ultrasound clinics in different centers. Dating formulae for biparietal diameter (BPD) and femur length (FL) were derived for a gestational age range of 14–23 weeks. The best fit curves represented linear equations: gestational age (days) = 44.2 + 2 × 13PD; and gestational age (days) = 67.4 + 2.3 × FL.

Twelve published formulae for biparietal diameter and femur length were reviewed and systematic and random errors were calculated for these formulae when they were applied to second‐trimester scan measurements in precisely dated pregnancies. Overall, published dating formulae performed well in predicting gestational age. The 95% confidence interval was 8.3 days for biparietal diameter and 10.2 days for femur length. The study confirms the accuracy of ultrasound dating in routine ultrasound clinics and supports the use of ultrasound measurement alone in preference to menstrual history for dating pregnancy. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonographic and radiologic visualization of the developing embryonic skeleton
Authors: van Zalen‐Sprock R. M. , Brons J. T. J. , van Vugt J. M. G. , van der Harten H. J. , van Geijn H. P.
Published: March 2003

We investigated the development of the skeleton in the embryonic and early fetal period both with ultrasonography and radiology. Eight normal embryos/fetuses were studied weekly with real‐time transvaginal sonography between 8 and 16 weeks of gestation to establish the ultrasonographic characteristics of normal ossification. Additionally, ossification was studied in radiographs obtained from five embryos/fetuses between 9 and 14 weeks of gestation.

Ossification centers, visualized as increased echogenicity of the bones, were recognized with ultrasonography from 9 weeks onwards. The appearance of primary ossification centers as observed by transvaginal ultrasonography was at the same gestational age or at most 1 week later than when obtained with radiography or whole‐specimen staining techniques.

Transvaginal ultrasonography enables early visualization of ossification centers in the embryo and fetus. Detailed knowledge of the development of ossification of the skeleton may contribute to early prenatal diagnosis of skeletal dysplasias. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
New charts for ultrasound dating of pregnancy
Authors: Altman D. G. , Chitty L. S.
Published: March 2003

We describe new charts and tables for dating pregnancies derived from data collected in a study designed to enable the construction of these and charts of fetal size. This was a prospective study in which 663 fetuses seen in the routine ultrasound clinic in a London teaching hospital were scanned once only for the purpose of this study.

We discuss the statistical methodology in detail and compare the new charts with other published charts. We suggest that the differences seen may be due to variation in study methodology. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
How to construct ‘normal ranges’ for fetal variables
Authors: Royston P. , Wright E.M.
Published: March 2003

A method to estimate reference intervals which depend on gestational age is described. The approach is based on standard statistical techniques, so implementation should be straightforward with most statistical packages. The reference limits are defined by simple formulae which may be plotted as smooth curves. The method is illustrated with analyses of three real datasets arising from different aspects of fetal monitoring. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The use of transvaginal ultrasound and saline infusion sonohysterography for the evaluation of asymptomatic postmenopausal breast cancer patients on tamoxifen
Authors: Schwartz L.B. , Snyder J. , Horan C. , Porges R.F. , Nachtigall L.E. , Goldstein S.R.
Published: March 2003

Tamoxifen has been shown to decrease the recurrence rate of breast cancer. Evidence that tamoxifen use may be associated with an increased risk of endometrial cancer has caused investigators to recommend routine invasive sampling. We have assessed a minimally invasive alternative for endometrial surveillance of tamoxifen‐treated patients utilizing transvaginal ultrasound and saline infusion sonohysterography.

Asymptomatic women (n = 44) with breast cancer on postoperative tamoxifen treatment were referred to our gynecological ultrasound unit. Initially, the endometrial echo was measured with unenhanced transvaginal ultrasound. If a distinct echo measured ≤ 5 mm, no further procedure was performed. For thickened or inadequately visualized echoes, sonohysterography was performed. If a thin echo was noted on sonohysterography, no further procedure was performed. If focal changes were detected, hysteroscopy/dilatation and curettage (D&C) was performed. For generalized symmetrically thickened echoes, a blind biopsy was done. If sonohysterography was unsuccessful, hysteroscopy/D&C was performed.

Eleven (25%) patients had thin unenhanced echoes of ≤ 5 mm. Twenty‐five (57%) patients had thickened endometrial echoes. Three (7%) had naturally occurring endometrial fluid outlining a polyp. An endometrial echo could not be visualized in five (11%) patients. Sonohysterography was successfully performed in 21 out of 30 (70%) patients with either thickened or non‐visualized unenhanced echoes. Of these, two patients had thin endometria with coexisting myomas; seven had thin endometria with typical tamoxifen‐induced subendometrial changes; and seven had focal polypoid thickening confirmed by hysteroscopyl/D&C. Histology revealed carcinoma associated with two, proliferation in one and four polyps. Five patients had thickened unenhanced echoes with symmetrically thickened single‐layer measurements on sonohysterography. Histology revealed that three were proliferative, one was inactive and one was hyperplastic. In the nine patients with unsuccessful sonohysterography, hysteroscopy/D&C revealed inactive endometria in six, and three Polyps.

Our paradigm of evaluating the endometrial response to tamoxifen is concluded to overcome the shortcomings of either unenhanced transvaginal ultrasound or blind biopsy alone while it kept the number of invasive sampling procedures to 5.5% (24 out of 44). Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Recurrent bilateral theca lutein cysts in association with normal pregnancy
Authors: Al‐Harbi O. , Al‐Saleem A. , Al‐Tayeb O. , Baez Giangreco A.
Published: March 2003

We describe a case of a 28‐year‐old Saudi patient, gravida 6, para 5, at 14 weeks' gestation, who had recurrent bilateral theca lutein cysts during her last three pregnancies. The cysts were treated surgically during her fourth pregnancy because of acute abdomen at 20 weeks' gestation. Ovarian biopsy confirmed the diagnosis of theca lutein cysts and her pregnancy continued until term. In the last two pregnancies, the theca lutein cysts were managed conservatively by serial ultrasound examination and they resolved spontaneously. There was no history of molar pregnancy or use of ovulation‐inducing drugs. The possibility that there was increased sensitivity of the ovarian tissue to human chorionic gonadotropin is discussed. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Inter‐twin membrane folding in monochorionic pregnancies
Authors: Sebire N. J. , D'Ercole C. , Carvelho M. , Sepulveda W. , Nicolaides K. H.
Published: March 2003

This study examines the value of assessing inter‐twin membrane folding in monochorionic twin pregnancies in the prediction of twin‐to‐twin transfusion syndrome. In 83 monochorionic twin pregnancies ultrasound scans were carried out at 10–14, 15–17 and 19–21 weeks to investigate folding of the inter‐twin membrane as an early sonographic feature of inter‐twin discrepancy in amniotic fluid volume. There were 23 (28%) cases of membrane folding, which was first observed in one case at 10–14 weeks, in 21 cases at 15–17 weeks and in another case at 24 weeks. In 12 (52%) of the 23 cases the pregnancy progressed to severe twin‐to‐twin transfusion syndrome and 10 of these were treated by endoscopic laser coagulation of the placental vascular anastomoses. In the other 11 cases there was a moderate syndrome with large discrepancies in amniotic fluid volume and fetal size, persisting throughout pregnancy. In the severe group, five pregnancies resulted in live birth of both babies, three in live birth of one and intrauterine death of the other twin and in four cases there were no survivors. In the moderate group, all babies survived and the inter‐twin disparity in birth weight was more than 20%. Similarly, all 60 pregnancies with no membrane folding resulted in live births. In all three groups there was an increase in inter‐twin disparity in fetal size with gestation and the greatest inter‐twin disparities were in those with moderate twin‐to‐twin transfusion syndrome from as early as the 10–14‐week scan. These findings demonstrate that folding of the inter‐twin membrane occurs in about one‐quarter of monochorionic twins and in about half of these there is subsequent development of severe twin‐to‐twin transfusion syndrome. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Fetal coronary and cerebral blood flow in acute fetomaternal hemorrhage
Authors: Baschat A. A. , Harman C. R. , Alger L. S. , Weiner C. P.
Published: March 2003

A fetal heart rate tracing with absent variation and a sinusoidal pattern led to the diagnosis of acute fetomaternal hemorrhage at 29 + 2 weeks' gestation. The middle cerebral artery had increased peak blood flow velocity with reversed end‐diastolic flow. Fetal coronary arteries visualized by color‐coded and pulsed wave Doppler sonography showed slight decrease of time‐averaged maximum velocities after oxygen administration, while cerebral flows remained unchanged. After administration of 50 ml blood (pre‐transfusion hematocrit < 11%) the middle cerebral artery flow normalized and coronary artery velocities decreased further until coronary blood flow could no longer be visualized within 30 min of the transfusion (post‐transfusion hematocrit 27%). Evidence of successful fetal resuscitation also included normalization of the fetal heart rate tracing and resumption of fetal activity (biophysical profile score 8/10). This was also observed after a second transfusion of 38 ml blood. Deterioration from repeated fetomaternal hemorrhage led to delivery of a severely anemic neonate (cord hematocrit 7%) by Cesarean section. Postnatally, a single seizure, moderate severity respiratory distress syndrome and grade III intraventricular hemorrhage were noted.

Increased peak blood flow velocity with reversed end‐diastolic flow may be observed in the middle cerebral artery of fetuses with acute anemia. Correction of this phenomenon with transfusion suggests that hypovolemia and low blood viscosity are major contributing factors. Furthermore, decreasing coronary artery blood flow velocities with supplemental oxygen and blood replacement confirm functional autoregulation of the fetal coronary circulation. Observation of these acute flow changes during fetal surveillance warrants investigation for a potentially serious underlying condition. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The significance of choroid plexus cysts in an unselected population: results of a multicenter study
Authors: Chitty L. S. , Chudleigh P. , Wright E. , Campbell S. , Pembrey M.
Published: March 2003

Objectives

Choroid plexus cysts are commonly found at the time of a routine second‐trimester scan, but there is much debate as to their clinical significance. The aims of this study were to define the incidence of choroid plexus cysts in an unselected population and describe their association with aneuploidy.

Design

This was a prospective, observational multicenter study.

Subjects

Subjects were all fetuses found to have choroid plexus cysts with a maximum diameter of 3 mm or greater and who were between 14 and 24 weeks' gestation when scanned in the routine ultrasound department at any of the 13 participating hospitals.

Results

There were 658 fetuses with choroid plexus cysts in a total of 101 600 births. The overall incidence of aneuploidy was 2.1%, but in fetuses with isolated choroid plexus cysts the incidence of proven aneuploidy was 0.5% (95% confidence interval (CI), 0.1–1.4%). If age is taken into consideration, then the incidence of aneuploidy in fetuses with isolated choroid plexus cysts where the mother is under the age of 36 years was 0.36% (95% CI, 0.04–1.3%), and 2.4% (95% CI, 0.06–12.6%) in older women.

Conclusions

We conclude that the presence of choroid plexus cysts increases the risk for aneuploidy, mainly trisomy 18. In the majority of cases, the final risk will remain small, but will increase as maternal age increases. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
A strategy for reducing the mortality rate from vasa previa using transvaginal sonography with color Doppler
Authors: Oyelese K. O. , Schwärzler P. , Coates S. , Sanusi F. A. , Hamid R. , Campbell S.
Published: March 2003

Vasa previa is a cause of sudden unanticipated fetal death, with a fetal mortality of 33–100%. Transvaginal sonography (TVS) and color Doppler may aid in making the diagnosis antenatally, allowing elective Cesarean delivery, thereby avoiding fetal death from exsanguination which would occur if the membranes were allowed to rupture in labor. Whilst it is not feasible to screen all pregnant women for vasa previa, antenatal examination with TVS and color Doppler of women at risk, specifically those with low‐lying placentas, bi‐lobed, multi‐lobed and succenturiate‐lobed placentas, multiple pregnancies and pregnancies resulting from in vitro fertilization may lead to antenatal diagnosis of the condition. We present the last three cases of vasa previa to have occurred in our institution, two of which were diagnosed antenatally using TVS and color Doppler. In all three cases, routine 20‐week obstetric sonography revealed low‐lying placentas; in only one of these did the placenta remain low at term. A low‐lying placenta at 20 weeks may be a risk factor for vasa previa; we suggest that further studies be carried out to ascertain this. Judicious use of TVS and color Doppler in women considered at risk of vasa previa may help to reduce the mortality from this condition. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Cardiac blood flow studies in fetuses with homozygous α‐thalassemia‐1 at 12–13 weeks of gestation
Authors: Lam Y. H. , Tang M. H. Y. , Lee C. P. , Tse H. Y.
Published: March 2003

Objective

Fetuses affected by homozygous α‐thalassemia‐1 develop anemia as early as the first trimester. Our objective was to study hemodynamic indices in affected fetuses at 12–13 weeks of gestation to determine whether these would be useful in the prediction of anemia.

Design

Prospective observational study.

Subjects

Women referred before 14 weeks of gestation for the prenatal diagnosis of homozygous α‐thalassemia‐1.

Methods

Transabdominal and/or transvaginal Doppler sonography was performed to measure the flow velocities in the fetal ascending aorta and pulmonary artery at 12–13 weeks. The Doppler indices were compared between those that were subsequently confirmed to be affected by homozygous α‐thalassemia‐1 and those that were unaffected.

Results

Between June 1997 and April 1998, 60 eligible women were recruited. Doppler examination was successful in 58 fetuses. Of these, 22 were subsequently confirmed to be affected by homozygous α‐thalassemia‐1. The diagnosis was made by chorionic villus sampling and DNA analysis in two affected fetuses and by cordocentesis and hemoglobin evaluation in 20 affected fetuses. Hemoglobin concentrations could be measured in ten fetuses and these ranged from 4 to 8 g/dl. The affected fetuses had significantly higher peak velocities at the pulmonary valve and ascending aorta and a larger inner diameter of the pulmonary valve than that in unaffected fetuses. The total cardiac output was increased by one‐third in affected fetuses and was mainly due to an increase of the right‐side cardiac output.

Conclusion

In the early stage of anemia, the fetus responds mainly by increasing its right‐side cardiac output. However, there is extensive overlap of the values of cardiac output between the affected and the unaffected fetuses, precluding its use in the prediction of anemia. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Individual growth patterns in the first trimester: evidence for difference in embryonic and fetal growth rates
Authors: Deter R. L. , Buster J. E. , Casson P. R. , Carson S. A.
Published: March 2003

Objective

To evaluate individual fetal growth during the first trimester in pregnancies resulting from spontaneous and fertilization (IVF).

Methods

The growth of 11 fetuses conceived by spontaneous fertilization (known dates of ovulation) in nine patients and 15 fetuses conceived by IVF in 12 patients were evaluated at weekly intervals from 6 weeks, menstrual age, to 14 weeks. Fetal length was determined at each examination. Measures of fetal length included the crown‐rump length (CRL), maximum straight line length (MSLL) and maximum axial length (MAL). Comparisons of CRL and MSLL to MAL were carried out. The MSLL was used as the measure of length except when the MAL was available. Linear and quadratic functions were fitted to the complete data sets of individual fetuses in the two groups. Individual data sets from ten fetuses in each group were then divided into early and late growth phases, and linear functions were fitted to each data subset. Start points and pivotal points for each fetus were estimated from the coefficents of these two functions. Growth in these two groups of fetuses was compared, on the basis of slope values.

Results

Evaluation of length measures indicated that, before 8 weeks, only MSLL could be measured. After 8 weeks, all three measures could be obtained, with the MAL being the largest. Both the linear and quadratic models performed well with individual data sets (mean R
2(± SD): linear 98.1 (1.0)%; quadratic 99.4 (0.4)%), with no differences found between spontaneous and IVF groups (maximum possible differences in mean slopes (95% probability): 5–8%). Similar findings were obtained for the early and late growth phase data subsets. Slope values in the early and late growth phases showed low variability (CV: early 13.5%; late 11.6%), but were significantly different (early 0.72 (± 0.10 SD) cm/week; late 1.21 (± 0.14 SD) cm/week). The mean start point was 5.9 (± 0.3 SD) weeks' menstrual age, while the mean pivotal point was 9.2 (± 0.7 SD) weeks, menstrual age.

Conclusions

First‐trimester growth studies in individual fetuses indicate that there is a change in length growth rate between 9 and 10 weeks, menstrual age. This is consistent with a shift in development from organogenesis to growth. These results can be used for more accurate assessment of first‐trimester growth and may aid in the detection of fetal problems that manifest themselves as growth abnormalities. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound during pregnancy and subsequent childhood non‐right handedness: a meta‐analysis
Authors: Salvesen K. Å. , Eik‐Nes S. H.
Published: March 2003

Objective

A possible association between ultrasound during pregnancy and subsequent non‐right handedness among children has been suggested. The association has been reported to be stronger among boys. The aim of the present study was to explore this further through a meta‐analysis of two follow‐up studies of three randomized controlled trials of routine ultrasonography during pregnancy.

Design

Handedness was assessed through a questionnaire to the parents, and 4715 children at the age of 8–9 years were included in the meta‐analysis.

Results

There was no statistically significant difference in the prevalence of non‐right handedness between the ultra‐sound‐screened children and the controls, but there was a statistically significant difference in a subgroup analysis among the boys. Exploratory analyses according to exposure or non‐exposure indicated an even stronger association between ultrasound and non‐right handedness.

Conclusions

A conservative analytical approach indicates no association between ultrasound and subsequent non‐right handedness. The results from the exploratory analyses must be interpreted with caution. There is still a need for further research. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Direct intrauterine fetal therapy in a case of bronchopulmonary sequestration associated with non‐immune hydrops fetalis
Authors: Anandakumar C. , Biswas A. , Chua T. M. , Choolani M. , Chia D. , Wong Y. C. , Gole L.
Published: March 2003

Bronchopulmonary sequestration associated with non‐immune hydrops fetalis is generally recognized as a uniformly fatal fetal condition without fetal surgical intervention. We describe here the first case of such a condition treated successfully with direct intrauterine fetal therapy using digoxin and frusemide. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
The value of echogenic foci (‘golfballs’) in the fetal heart as a marker of chromosomal abnormalities
Authors: Bettelheim D. , Deutinger J. , Bernaschek G.
Published: March 2003

Objective

The aim of our study was to determine the significance of antenatally detected hyperechogenic foci in the fetal heart.

Design

Prospective study.

Subjects and methods

During a 21‐month period, 6995 women underwent a sonographic screening investigation. A detailed structural survey was performed on each fetus according to our sonography protocol, including a four‐chamber view and an evaluation of the great vessels, as permitted by gestational age. We prospectively identified each fetus with an echogenic intracardiac focus.

Results

A total of 150 fetuses with this sonographic finding were identified. The incidence rate was 2.15%. In 114 patients (76%), prenatal karyotyping was performed. The aneuploidy rate was 4.4%

Conclusions

The echogenic intracardiac focus can be easily diagnosed in most cases. This should prompt an extensive search for other ‘soft’ markers. The presence of an echogenic intracardiac focus as a single soft marker should raise the question of prenatal karyotyping. It might help in the decision‐making regarding invasive prenatal testing in cases with an otherwise low risk for chromosomal abnormality. In cases with other markers for chromosomal abnormality (advanced maternal age, sonographic signs, positive serum marker screening), the presence of an echogenic intracardiac focus should be an additional incentive for a chromosomal examination. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Women's knowledge, concerns and psychological reactions before undergoing an invasive procedure for prenatal karyotyping
Authors: Cederholm M. , Axelsson O. , Sjödén P.‐O.
Published: March 2003

Objectives

To evaluate women's reasons for having an invasive procedure, their knowledge, how information was obtained, their satisfaction with this information, their concerns about complications and psychological reactions and distress evoked by the procedure.

Methods

Ninety‐four pregnant women undergoing early amniocentesis or chorionic villus sampling (CVS) at 10–13 weeks' gestation participated in a questionnaire study. The women could choose between early amniocentesis (n = 38) and CVS (n = 31), or to be randomized to either of them (n = 25).

Results

Apart from two items, no differences were found between the groups. Age was the main reason for testing, and anxiety was stated as a reason by 38.3%. The women knew more about methods for fetal karyotyping, what the tests can reveal and how they are performed, than about the risks and reliability of the tests. The main source of information had been doctors and midwives at the antenatal care center. For a majority of women (64.9%) the decision to have the test was made together with their partner. The women's concerns were focused on worry about fetal injury, miscarriage and waiting for the result. The test did not have a major psychological impact on the women in general, but a substantial minority reacted with anxiety and distress.

Conclusions

Knowledge of factors important to women and their concerns is essential for professionals working with genetic counselling and performance of invasive procedures. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Fetal intracranial tumors detected by ultrasound: a report of two cases and review of the literature
Authors: Schlembach D. , Bornemann A. , Rupprecht T. , Beinder E.
Published: March 2003

Two cases of fetal intracranial tumors detected prenatally by ultrasound, together with a review of the literature on this rare disease, are presented. Sonographic features, histopathological type and location of the tumors, sex distribution, associated anomalies and overall prognosis are described as well as obstetric and postnatal therapeutic management. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology