bluuebunny/crossref_metadata_2025 huggingface dataset:
P94Fetal cerebrovascular response to chronic hypoxia
Authors: Jugovic D. , Laurini R. , Judaš M. , Arbeille PH. , Kurjak A. , Salihagić A.
Published: March 2003

Objective

To study the cerebral and umbilical hemodynamics changes in hypoxic and growth‐retarded fetuses. To determine if at long‐term, fetal brain hyperperfusion with loss of cerebral vascular flow velocity variability is associated with brain damage and poor fetal outcome.

Methods

The fetal blood flow redistribution was assessed by using Doppler cerebral‐umbilical ratio in 8 growth‐retarded fetuses, mainly every day. The evolution of the fetal hemodynamics was interpreted according to the clinical, anatomical and histological data.

Results

All 8 fetuses had poor fetal outcome including fetal death (n = 5). Fetal blood flow redistribution with brain hyperperfusion was detected in all fetuses during the whole period of observation. The early phase of fetal deterioration was characterized by the development of oligohydramnios and the disappearance of the cerebral flow velocity variability. During the later phase of deterioration, fetal heart rate decelerations and the increase of cerebral vascular resistance with reduction of brain perfusion were detected. Histological study of the brains showed hypoxic lesions.

Conclusion

The loss of variability of the cerebral resistance index, in the cases of absent umbilical end diastolic flow, and the loss of variability of the cerebral‐umbilical ratio in the other cases, identifies the beginning of the period of very high risk for the fetus. Such a pattern may be considered as a predictor of brain lesion and poor fetal outcome. These results also indicate the existence of two phases in the fetal cerebrovascular response to chronic hypoxia.
P100IUGR fetuses with abnormal umbilical artery Doppler and elevated S100B protein levels
Authors: Bruschettini M. , Grondona C. , Marinoni E. , Di Iorio R. , Lituania M. , Bruschettini P. L. , Michetti F. , Gazzolo D.
Published: March 2003

Maternal and umbilical blood samples were collected in IUGR pregnancies with abnormal umbilical artery Doppler findings and in controls. S100B protein levels were measured by means of a specific radioimmunoassay and flow velocimetry waveforms were recorded from uterine, umbilical and fetal middle cerebral arteries. We studied the correlation between S100B protein, an acidic calcium binding protein previously demonstrated as a reliable indicator of brain lesion, and the degree of fetoplacental blood flow impairment to examine whether S100B could be helpful in the detection of brain sufference in intrauterine growth retarded (IUGR) fetuses. Mean S100B protein in umbilical plasma were higher (P < 0.05) in IUGR patients (113.5 ± 65.9 fmol/mL) than in controls (52.7 ± 34.8 fmol/mL), and particularly in those cases in which brain sparing was present (169.6 ± 67.8 fmol/mL). Fetal S100B concentrations were correlated with middle cerebral artery PI (r = −0.50, P < 0.05) and with umbilical artery PI/middle cerebral artery PI ratio (r = 0.51, P < 0.05). This study provides evidence that fetal S100B protein is increased in IUGR and suggests that it may play.
Posters Early pregnancy P01First trimester normograms for a wide variety of ultrasound, hemodynamic and serum parameters
Authors: Serra‐Serra V. , Serrano J. E. , Ballester M. J. , Lara C. , Bellver J. , Bonilla‐Musoles F.
Published: March 2003

Background

The aim of the study was to assess prospectively the evolution of multiple clinical parameters throughout the first trimester of pregnancy.

Method

A transvaginal ultrasound examination and a blood test was weekly performed until the 13th gestational week in a group of healthy volunteers. A total of 25 spontaneously conceived singleton pregnant women with good pregnancy outcome finally completed the study. The evolution of 10 transvaginal ultrasound parameters, 5 Doppler measurements and 6 serum parameters was studied.

Results

An increasing trend with advancing gestation was evident for the mean gestational sac (MSD) and amniotic sac (AS) diameters, trophoblastic rim, CRL and serum progesterone. The uterine, umbilical and fetal cerebral arteries PI decreased with advancing gestation. The FM yolk sac (YS) diameter and β‐hCG levels showed an initial rise and a final decrease. A great interindividual variation was evident for the β‐hCG titer. The YS/CRL progressively approached to 0, whereas the MSD/CRL and the AS/MSD progressively approached to 1. The corpus luteum diameter, corpus luteum arteries PI, subehorionic arteries PI, complement levels (C3 and C4), platelet count and activated partial thromboplastin time experienced minimal changes.

Conclusion

First trimester normograms for multiple clinical parameters are provided.
WS15‐08Physiologic change of spiral arteries – what ultrasound can add?
Authors: Matijevic R.
Published: March 2003

Physiologic change of spiral arteries is important adaptation of maternal vascular network for ongoing pregnancy. It is characterised by destruction of muscular layer of these vessels changing them to a low resistance vascular channels. Physiologic change was found to be incomplete in pregnancies complicated by pregnancy induced hypertension (PIH) and intrauterine growth retardation (IUGR). These changes were detected in vitro in histrologic studies but recently were investigated in vivo using Doppler ultrasound. In normal pregnancy the impedance to blood flow in spiral arteries measured by resistance (RI) and pulsatility (PI) indices significantly decrease toward the mid trimester (P < 0.05) and then remains stable. Similar observation was found in pregnancies complicated by PIH and IUGR. Both of these represent the second wave of trophoblastic invasion of spiral arteries. In pregnancies complicated by PIH and IUGR measured impedance indices were significantly higher compared to the matched normotensive women with normal fetal growth (P < 0.05), representing ht failure of the complete physiologic change of the spiral arteries. This is in concordance with histologic studies. Comparing the significance levels of blood flow in proximal and distal parts of uteroplacental circulation between investigated groups, the higher significance levels were obtained in terminal parts. This can have serious implication in designing further research protocols of the screening programmes for the PIH and IUGR based on the blood flow in uteroplacental circulation.
WS16‐04Doppler ultrasound: potential in early pregnancy
Authors: Zalud I.
Published: March 2003

Remarkable changes and continuous growth and development of the early maternal‐fetal circulation could be studied by Doppler ultrasound. This approach seems to give more light in understanding of the early pregnancy development. Doppler ultrasound was reported accurate to separate different segments of uterine blood flow during pregnancy. Color flow is used to anatomically locate arcuate, radial and spiral arteries. Pulsed Doppler is then used to study different flow patterns of visualized vessels. Studies of maternal‐fetal circulation in early pregnancy may help for better understanding of physiological and pathophysiological hemodynamic changes in the circulation. Investigation of maternal (main uterine, arcuate, radial and spiral) arteries; placental (umbilical, chorionic arterioles) vessels and embryonic/fetal (heart, aorta and intracranial circulation) arteries flow patterns may help to diagnose abnormal implantation and embryonic development. More studies are necessary in order the Doppler technique to be used for clinical assessment in early pregnancy. Safety aspects should also be considered. However, potentials of this technique are promising in study of early pregnancy failure, chromosomal abnormalities, development of pre‐eclampsia and IUGR.
WS17‐04Operative histeroscopy in treating intrauterine abnormalities as a factor in marital infertility
Authors: Izetbegovć S.
Published: March 2003

We have researched operative histeroscopy in treating endometrial abnormalities as a cause of marital infertility. A group of 320 infertile patients was included in the study. Color Doppler examination detected endometrial abnormalities (subseptus, polyp, synechiae, myoma, uterus bicornuate, and uterus arcuate). The controlling group consisted of 100 patients suffering endometrial abnormalities, who have not underwent the operation. In research group, there were 9 pregnancies following operative histeroscopy over a period of 18 months. That is 34.6%, out of which 89 (27.8%) have been carried out and delivered. We have also studied the surgical risk of operative histeroscopy. According to the results, operative histeroscopy is minimally invasive, surgically comfortable, economically acceptable. The influence of histeroscopy on the endometrium during pregnancy and delivery is such that there is no significant difference in comparison to the patients that were not operated. The pregnancy following operative histeroscopy is phsysiological. The delivery has no implication of pathological nature, nor difference in duration, type, or any other component. The enonathological parameters do not differ from physiological
WS17‐06Three‐dimensional power Doppler ultrasound as a second line screening tool in ovarian cancer screening – preliminary results
Authors: Zodan T. , Gregov M. , Sparac V. , Kurjak A. , Kupesic S. , Ilijas M.
Published: March 2003

Introduction

In this screening program, 2D color Doppler (2D CD) was used as the first, and CA‐125 and 3D power Doppler (3D PD) were used as second‐line screening tools when 2D scoring system indicated possible malignancy. The study was designed to show whether early stages of ovarian cancer can be correctly diagnosed by 3D PD and whether 3D would perform better than CA‐125.

Methods

All patients were either postmenopausal, or premenopausal with positive family history, or they had a persistent ovarian cyst. They were all examined by 2D CD and if values of scoring system were over cut‐off point, 3D PD analysis was performed and CA‐125 was tested.

Results

A total of 108 patients (97 postmenopausal and 11 premenopausal with family history) had a 2D scan. In 5 cases 2D scoring indicated possible malignancy after which 3D analysis was done as well as test for CA‐125. In 2 cases 3D PD scoring was negative, as well as CA‐125 and the lesions were simple cyst surrounded by chronic inflammatory process in the first patient and ovarian fibroma in the second. In 3 cases 3D PD scoring was positive while CA‐125 measurement showed increased values only in 1 case. PHD analysis confirmed the diagnosis of ovarian carcinoma in all three lesions. 3D PD correctly predicted benign or malignant nature of the lesion, while CA‐125 failed to do so in two stage 1 ovarian cancers.

Conclusion

Although now expensive and in most hospitals unavailable, 3D power Doppler is a future screening tool in ovarian cancer screening programs. However, a lot more women should be screened before proper statistical analysis could be done.
WS17‐07Fetal and neonatal echocardiographic features in twin‐to‐twin transfusion syndrome
Authors: Murakoshi T. , Seguchi  , Naruse H. , Torii Y. , Maeda K.
Published: March 2003

Background

Twin‐to‐Twin transfusion syndrome (TTTS) is a severe complication in monochorionic twin pregnancies. Particularly severe fetal and neonatal cardiac dysfunction is complicated in recipient twin and attended with high perinatal morbidity and mortality. The aim of this study was to evaluate the abnormal echocardiographic features and clinical complications of cardiac disease in TTTS.

Method

We studied 20 pregnancies complicated with TTTS. Serial fetal and neonatal echocardiography were carried out and evaluated the following parameters: cardiothoracic area ratio, aortic and pulmonary artery Doppler peak velocities, umbilical arterial resistance index, preload index of inferior vena cava, ventricular valve regurgitation and structural heart abnormalities.

Result

In recipients, all features had cardiomegaly, tricuspid valve regurgitation and high preload condition with increased preload index of inferior vena cava. Aortic and pulmonary artery peak velocities were increased in the recipients than those in the donors. Three cases of recipients had pulmonary valve stenosis and received balloon pulmonary valvuloplasty. Furthermore, three cases of donors had coarctation of aorta and also received surgical repair.

Conclusion

In addition to the severity of cardiac dysfunction, pulmonary stenosis and coarctation of aorta would be the important factors to evaluate perinatal prognosis of TTTS.
WS17‐08Fetal biochemical markers in severe placental insufficiency – comparison with fetal Doppler findings
Authors: Räsänen J. , Mäkikallio K. , Vuolteenaho O. , Jouppila P.
Published: March 2003

Background

The aims of this study were to assess the activity of the human fetal atrial natriuretic peptide system in hypertensive pregnancies with and without signs of increased fetal systemic venous pressure and to investigate the association between severe placental insufficiency and fetal myocardial cell destruction.

Method

Control group consisted of 50 newborns with uncomplicated pregnancy and labor. In group 1, 22 newborns after hypertensive pregnancies were included. Doppler ultrasonography revealed abnormal umbilical artery (UA) blood velocity waveform in five cases, and normal nonpulsatile umbilical vein (UV) blood velocity profile in every case. Group 2 consisted of five newborns after pregnancies complicated by maternal hypertensive disorder. Atrial pulsations in the UV and retrograde diastolic blood velocity pattern in the UA were detected in every case. Immediately after birth blood samples were collected from the UA and plasma N‐terminal peptide of proatrial natriuretic peptide (NT‐proANP) and serum cardiac specific troponin‐T concentrations were measured.

Results

In group 1, nt‐proANP concentrations were higher (P < 0.001) than in the control group. In group 1, newborns with abnormal UA blood velocity pattern had higher (P < 0.006) NT‐proANP concentrations than newborns with normal UA Doppler findings. Troponin‐T concentrations in group 1 did not differ from the control group. In group 2, NT‐proANP (P < 0.002) and troponin‐T (P < 0.0001) concentrations were higher than in the control group and study group 1.

Conclusion

Maternal hypertensive disorder stimulates fetal atrial natriuretic peptide production, being greatest in fetuses with severe placental insufficiency and a rise in systemic venous pressure. These fetuses also have evidence of myocardial cell destruction.
WS03‐07Which information about follicular development in unstimulated cycles can be obtained by ultrasound?
Authors: Vlaisavljević V.
Published: March 2003

Unstimulated cycles offer a simpler, quicker and less invasive form of IVF and ICSI than the most conventional stimulated cycles. The objective of the study was to evaluate the effectiveness of different approaches for follicle monitoring in unstimulated cycles. This monitoring includes studies of follicle growth during the follicular and luteal phase of the cycle, measurements of blood flow in perifollicular vessels and studies of perifollicular perfusion in vascular network using power Doppler. These studies include 3D analysis of follicular growth, development and its vascularization.

A retrospective chart review of all patients undergoing IVF and ICSI in unstimulated cycles at our institution was performed. The outcome measurements used were oocyte recovery rate, fertilization rate, implantation and delivery rate.

Unstimulated cycles monitored by ultrasound only were compared with those monitored with different protocols of ultrasound monitoring combined with serum estradiol level and urinary LH.

IVF and ICSI were performed in 708 unstimulated cycles. A higher pregnancy rate and lower cancellation rate was obtained when hCG was applied in lower values of serum E2 and smaller follicle diameter.

The actual pregnancy rate per embryo transfer in IVF cycles was 23.8% and 26.4% in ICSI cycles when embryo transfer was performed on day + 2 or day + 3. When blastocyst stage embryo transfer was performed the implantation rate per embryo transfer was 37.5%.
WS04‐03Doppler assessment of postmenopausal patient
Authors: Battaglia C. , Regnani G. , Volpe A.
Published: March 2003

Menopause is associated with an increase in the incidence of ischemic heart disease and stroke. Loss of ovarian function is characterized by significantly high values of blood and plasma viscosity. After the menopause, thromboxane production increases and correlates with duration of menopause. Large studies have shown that postmenopausal HRT is associated with reduction in the risk of cardiovascular disease. The aim of the study was to evaluate the plasma thromboxane and plasma viscosity in relation with Doppler flow parameters in postmenopausal patients treated with HRT. Thirty‐two postmenopausal (FSH > 40 UI/L and estradiol < 100 pmol/L) women (mean age ± SD, 54.7 ± 2.9 years) participated in the study and were submitted to continuous estradiol transdermal supplementation and 12‐day courses of medroxyprogesterone acetate every second month. Doppler resistances at the level of uterine and internal carotid arteries, thromboxane plasma levels and plasma viscosity were analyzed in basal condition and after 1, 3 and 6 months. During hormone supplementation, the pulsatility index significantly decreased at the level of analyzed arteries. Similarly, plasma thromboxane levels and plasma viscosity were significantly reduced. Significant correlations were found between thromboxane plasma concentrations, plasma viscosity and uterine artery resistances. Thus HRT seems to be responsible for both direct and indirect modifications at the level of the vessel wall physiology.
WS07‐02Treatment for TTS should be done within a trial
Authors: Ville Y.
Published: March 2003

Over a year I invited you here to participate to the rct for treating twin‐to‐twin transfusion syndrome (TTS). Are there any data available to reconsider this? The answer is clearly no, on the contrary. Indeed large series on amniodrainage or laser therapy have become available.

With serial amniodrainage overall survival for both twins is 49% or 71% where at least one baby survive. In cases where one fetus dies in utero, 20% of the survivors die, and in another 20% they have severe neurological morbidity. Laser treatment has now a survival rate of 54% for both twins and 81% for at least one survivor. Neurological morbidity seems to be less than 10%.

Has this larger experience contributed to solve the question whether one or the other therapy is better? No, it only underscores that our estimate of the number of patients needed in a rct was right: 10% difference in survival rate and 15% for severe neonatal morbidity.

All new data, all new studies are an urgent call for randomisation. If not, both patients and their obstetricians will continue to argue based on unsubstantiated views. Further case series will not bring any critically new element.

Results

Over 45 patients have now been included, all but a few in France. If we would extrapolate the number of patients randomised at our centre, only three other groups would have to recruit at the same pace to reach the 142 patients needed by the end of next year.

Discussion

There are many arguments to try to finish the study within a few years. It avoids the obvious bias due to improvements of perinatal resuscitation. It would keep high motivation amongst referring clinicians.

I would dare to say more: at this point it has become unethical not to randomise cases with TTTS. Not laser, neither amniodrainage have become established yet as the best treatment and there is no room for empirical new techniques until the trial is completed.
WS10‐03Down's syndrome screening by NT measurement: women's opinion
Authors: Bilardo C. M. , Müller M. A. , Bonsel G. , Bleker O. P.
Published: March 2003

In the context of an implementation study of nuchal translucency (NT) screening for Down's syndrome special attention was devoided to the psycho‐social aspects. The impact of age, parity, religion, education together with the reasons for opting in or out for the NT measurement were recorded in 5895 patients. On a sample of 800 patients more specific aspects were addressed such as the level of knowledge about prenatal diagnosis before and after screening, the reaction to the offer of NT screening and the general women's opinion on whether this form of screening should be offered to all pregnant women. Questionnaires devised to measure the anxiety and depression produced by screening (hads) were filled before screening, at 20 weeks' gestation and after delivery by the same group of patients and by 200 controls. Preliminary results are available. 80% of the asked women, with no differences in age, religion and parity choose for NT screening. Main reason for having the NT measured was the hope of avoiding invasive testing and the wish of having more information on their pregnancy. The majority of women experienced positively NT screening even in case of an increased measurement and irrespectively of whether they would terminate an affected pregnancy or not. A slight increase in anxiety level produced by the screening normalized by 20 weeks' gestation.
WS12‐06Doppler evaluation of IUGR fetuses
Authors: Mandruzzato G. P. , Meir Y. J. , Natale R. , Maso G. P.
Published: March 2003

Intrauterine growth restriction (IUGR) is now defined as a condition in which the fetus does not reach the optimal condition of his growth. In this situation the birthweight can be reduced below the 10th percentile or can be superior to that threshold especially when the restriction took first place in late part of the pregnancy. Therefore it is possible to identify two groups of IUGR according to the intrauterine observation and the birthweight assessment: SGA and AGA IUGR. The most important complication of IUGR is represented by the hypoxaemia caused by placental vasculopathy. Hypoxaemia is present in about 30% of IUGR fetuses with not significant difference between SGA and AGA IUGR cases, and is the major cause of the poor perinatal outcome. After recognition of the growth restriction it is necessary to apply second level tests in order to assess the presence or absence of hypoxaemia. When hypoxaemia is present the first mechanism of fetal adaptation is represented by the redistribution of the circulation. This phenomenon is easily observable by using Doppler technology. When applying the same technique on the umbilical arteries it is possible to detect an increase in the peripheral resistance proportional to the obliteration of the placental vascular bed that is the cause of the fetal hypoxaemia. By using the information offered by Doppler study on fetal and umbilical vessels it is therefore possible to optimize the clinical management of the IUGR fetuses.
WS13‐04Doppler velocimetry determined brain sparing effect: correlations with neonatal outcome in diamniotic monochorionic and diamniotic dichorionic twins
Authors: Gaziano E. P. , Gaziano C. , Hoesktra R. , Terrell C.
Published: March 2003

Objective

Neonatal outcome was studied in 169 infants from diamniotic monochorionic (DAMC) and diamniotic dichorionic (DADC) twin pregnancies in relation to a measure of blood flow redistribution, the cerebroplacental ratio (CPR).

Study design

Two groups were assessed, 50 infants from DAMC, and 119 infants from DADC twin pregnancies. Targeted ultrasound and Doppler recordings of umbilical artery (UA) and middle cerebral artery (MCA) were obtained. The resistance index (RI) and CPR were calculated for each fetus.

Results

DAMC twins had lower birth weight (1979 vs. 2223 g for DADC, p≤.01) and prolonged lengths of nicu stay (8.5 days vs. 3.5 days for DADC, p≤.05). For total group, DAMC compared with DADC twins spent greater numbers of days on a ventilator. SGA infants were significantly more frequent in DAMC twins compared to DADC twins. Among antenatal Doppler variables only the CPR demonstrated a significant difference between twin types. For DAMC twins CPR was 1.15 vs. 1.21 for DADC twins, p≤.05.

Conclusions

Monochorionic twins from the lower birth weight groups demonstrate a greater number of growth restricted infants and prolonged hospitalizations compared to DADC twins. Among Doppler measures, the CPR is superior to UA‐RI, and/or MCA‐RI for the prediction of adverse events.
WS13‐05Selective photocoagulation of communicating vessels in the treatment of selective growth retardation in monochorionic twins: a functional dichorionization procedure
Authors: Quintero R. A. , Bornick P. W. , Morales W. J. , Allen M. H. , Johnson P. K.
Published: March 2003

Background

Intrauterine fetal demise (IUFD) of a selectively growth‐retarded (IUGR) monochorionic (MC) twin is associated with high morbidity/mortality in the appropriately grown (AGA) twin. Selective laser photocoagulation (SLPCV) allows precise separation of the circulations of both twins. The aim of this study was to assess SLPCV in the treatment of MC‐IUGR.

Methods

Patients with previable MC‐IUGR were offered SLPCV. Absent or reverse end‐diastolic velocity in the umbilical artery of the IUGR twin was also required for entry.

Communicating vessels were identified endoscopically as deep artery‐to‐vein or superficial artery‐to‐artery or vein‐to‐vein as previously described. The communications were photocoagulated with Nd:YAG laser.

Results

SLPCV was performed in 11 patients (GA mean = 20.9 weeks). Survival of both fetuses was n = 5 (45%), IUFD of the IUGR twin alone was n = 4 (36%) and IUFD of the AGA twin alone was n = 2 (18%). There were no dual losses, or adverse effects of an IUFD on the surviving twin. Previously undescribed superficial artery‐to‐vein anastomosis occurred in three patients.

Conclusions

SLPCV can effectively create a ‘functionally dichorionic’ placenta. SLPCV allows the AGA twin to avoid the adverse effects associated with IUFD of the IUGR twin.

Unexpected IUFD of the AGA twin may reflect more complex placentation. A new type of vascular communication, superficial artery‐to‐vein, may have important pathophysiologic implications.
WS13‐06Multiple pregnancy‐considerations of antenatal diagnostics
Authors: Hodek B. , Košec V. , Tučkar N.
Published: March 2003

The aim of this study is to retrospectively evaluate the complications, safety and accuracy of midtrimester amniocentesis (MTAcz) in multiple pregnancy (MP). The indications and complications of MTAcz are the same for singleton pregnancies (SP) and MP, but what's different is the technique of the procedure and frequency of complications. Various techniques are here quoted, the purpose of which is to prove that samples have been taken from separate sacs. In general, the efficacy in amniotic fluid collection is 92–98%, and 95.6% in autors' cases. The number of insertion needles may have the influence on the abortion rate, but the opposite opinion also exists. The rate of spontaneous abortions has been analysed retrospectively in a group of SP with and without amniocentesis. The same parameters were also evaluated for MP. The risk of spontaneous abortions following MTAcz is nearly 2.5 times higher in MP (1.7% vs. 3.89%) than in SP, but is still within the range of normally elevated biological risk (4.5%) of this group of subjects.
WS01‐09Diagnostically critical fetal imaging artifacts: identification and management
Authors: Pretorius D. H. , Nelson T. R.
Published: March 2003

The purpose of this project was to identify sources and clinical significance of 3DUS artifacts on patient diagnosis and to increase clinician and sonographer awareness to reduce misdiagnosis in 3DUS studies. To accomplish this 3DUS data were acquired and reviewed interactively. Artifacts were cataloged according to origin: B‐mode, color/power Doppler or unique to 3DUS (acquisition, rendering or volume editing). Original scan planes, re‐sliced planes and rendered images were evaluated. Overall our results showed a variety of artifacts. B‐mode artifacts included drop‐out, shadowing, etc. and depending on relationships between slice and imaging plane orientation. Color/power Doppler artifacts were related to gain, aliasing, and flash and could add apparent structure or confusion to the volume images. Rendering artifacts were due to parameter adjustment, shadowing and motion.

Important structures could be removed by improper editing. In conclusion 3DUS and 2DUS are prone to similar artifacts plus others unique to 3DUS. Diagnostically significant artifacts can mimick abnormal development, masses, or missing structures thus requiring careful study before reaching a diagnosis.
WS14‐07Volume sonography of the female pelvic floor after childbirth
Authors: Wisser J.
Published: March 2003

Objective

To evaluate the sonomorphologic changes of the female pelvic floor after childbirth. Furthermore the timing of the appearance of these defects labor are examined.

Methods

We examined three groups of patients. 104 primiparae after vaginal delivery, 26 primiparae after elective cesarean section and 77 primiparae after secondary cesarean section within 3–7 days after delivery. To assess the morphology of the pelvic floor we used to examine the anal morphology, whereas the transrectal route was used to assess the paraurethral fixation of the lateral vaginal edges. Paravaginal defect was defined as descent of the lateral vaginal edges below the suburethral portion of the vagina and defects of the internal anal sphincter is defined by anterior vs. posterior thickness‐ratio below 0.5. Clinical symptoms were documented using a standardized questionnaire.

Results

Primiparae after elective cesarean section served as control group. After vaginal delivery 7.3% of women showed urinary and 17.7% anal incontinence. Mode of delivery is significantly associated with anal and urinary incontinence. Paraurethral defect is predictive for urinary incontinence. Morphological defects of the pelvic floor could be documented after dilatation of the cervix to more than 7 cm.

Conclusions

Volume sonography after childbirth allows to document trauma to the pelvic floor due to vaginal delivery. Defects of the anterior compartment are predictive for the development of urinary incontinence. To study the timing of the appearance of pelvic floor defects during the course of vaginal delivery may be helpful for obstetrical decision making.
WS15‐04The value of evaluation of adrenal circulation in predicting hypoxia of the fetus
Authors: Breborowicz G. H. , Dubiel M.
Published: March 2003

From animal studies it is known that fetus during hypoxia redistributes it's blood flow preferentially to the brain, heart and adrenal glands. In animal studies, a three‐fold increase in adrenal blood flow has been demonstrated during hypoxia. The adrenals are relatively large organs in the fetus. Compared to fetal body weight, they are 20 times bigger than in the adult. The fetal adrenals respond to stress, such as hypoxemia by increased production of dihydroandrostendion (DHA), DHA sulfate and their metabolites. The adrenal gland is supplied by three arteries: the superior, coming from the inferior phrenic artery; the middle, from the abdominal aorta and inferior, arising from the renal artery. In the recent studies the Doppler signals were obtained from fetal middle adrenal artery. The normal adrenal PI shows decreasing values with the gestational age, which might suggest lower vascular resistance and high blood flow to the adrenals. From our observations the adrenal Doppler velocimetry is easier to record in fetuses from high‐risk pregnancies than in normals, probably due to the adrenal sparing effect. Recent results suggest that the adrenal artery velocimetry might be useful in fetal assessment and predicting outcome. The ‘adrenal‐sparing’ effect might be maintained at the same time the brain‐sparing signs disappear.
Effects of low‐dose aspirin on uterine and fetal blood flow during pregnancy: results of a randomized, placebo‐controlled, double‐blind trial
Authors: Grab D. , Paulus W.E. , Erdmann M. , Terinde R. , Oberhoffer R. , Lang D. , Muche R. , Kreienberg R.
Published: March 2003

Objective
 This study was conducted to evaluate uteroplacental and fetal hemodynamics in fetuses exposed to low‐dose aspirin (100 mg/d).

Design
 Randomized, placebo‐controlled, double‐blind trial.

Subjects
 The study protocol included singleton pregnancies of less than 20 gestational weeks at risk for pre‐eclampsia or fetal growth restriction. Exclusion criteria were diabetes mellitus, pre‐existing proteinuric hypertension or fetal malformations. Forty‐three pregnant women were randomly allocated to daily treatment with 100 mg aspirin (n = 22) or placebo (n = 21).

Methods Pulsed Doppler measurements of the uterine artery, fetal middle cerebral artery, fetal aorta, ductus arteriosus and atrioventricular valves were performed longitudinally at 14 day intervals starting from 18 gestational weeks until delivery. Results were expressed as group medians (aspirin vs. placebo) and were analyzed by Mann–Whitney U‐test.

Results There was no difference in uterine, umbilical, aortic, middle cerebral and ductus arteriosus blood flow between the aspirin group and controls. Median ductal peak flow velocities increased with gestational age in both groups, but differences between groups did not reach significance. In the third trimester of pregnancy, ductal peak velocities > 140 cm/s were occasionally observed in both groups. However, end diastolic velocities > 35 cm/s or atrioventricular valve regurgitation never occurred.

Conclusions Daily administration of low‐dose aspirin during the second and third trimesters of pregnancy does not alter uteroplacental or fetoplacental hemodynamics and does not cause moderate or severe constriction of the ductus arteriosus.
F107Ultrasonographic diagnosis of spina bifida at 12 weeks: heading towards new indirect signs
Authors: De Keersmaecker B. , Buisson O. , Bernard J. P. , Ville Y.
Published: March 2003

Background

The diagnosis of spina bifida before 14 weeks' remains difficult to achieve.

We believe that the cephalic markers are accessible to an oriented sonogram at 12 weeks' if these signs are specially looked for. Improvements are necessary since prenatal diagnosis is moving towards the first trimester.

Method

Retrospective analysis of ultrasound pictures taken at around 12 weeks in 2 cases of spina bifida diagnosed at 12 and 22 weeks, respectively, and 10 controls.

Results

Cerebral peduncles appear to be parallel and some degree of retraction of the frontal bones give the head an acorn shape. This parallelism might be the first and only sign amenable for prenatal diagnosis. A sagittal plane of the brain and spine can also visualise a large part of the myelencephale on the same plane as the metencephale, which cannot be seen in normal controls.

Conclusion

Very subtle signs as peduncular parallelism and alignment of metencephale and myelencephale could be the earliest signs of spina bifida in first trimester. No special skill is necessary to obtain the diagnosis because the plane of the peduncles is part of the routine examination.
F11Ultrasound evaluation of the uterus after pregnancy
Authors: Van Den Bosch T. , Van Schoubroeck D. , Timmerman D. , Hart A. Z. H.
Published: March 2003

Objectives

To evaluate the sonographic appearance of the uterus after a recent pregnancy, with special attention to the occurrence of placental rests, hyperechogenic lesions, and areas of enhanced vascularity.

Patients and methods

Cross‐sectional observational study on 239 consecutive women presenting at follow‐up visit after pregnancy. The uterus was evaluated using ultrasound with color Doppler. In case of placental rests, blood was sampled. When indicated a D & C was performed.

Results

Hyperechogenic areas were seen in 11.3%, mostly spots (85.2%) localized in the (sub)endometrial region. In 4.6% placental rests were evidenced. In these cases blood sampling revealed βHCG levels below 30 mIU/ml in 64%; serological infection parameters and hemoglobin concentration were within normal range. In 5% of women areas of enhanced vascularity were detected on color Doppler. Most cases were focal areas of one or more vessels perfusing retained placental tissue. There were 2 cases of placenta accreta. In 3 patients abnormal vascularity extended over the whole of the myometrium.

Conclusions

(1) (Sub)endometrial echogenic spots are common in primigravidas without a history of curettage. (2) Serology proved to be of little help in the diagnosis of retained gestational products. (3) Areas of enhanced vascularity of the uterus can be devised in 3 groups: focal vascular pedicle of a placental rest, placenta accreta, and areas of abnormal enhanced vascularity over the whole thickness of the myometrium.
F123Intracardiac echogenic focus: no apparent association with structural cardiac abnormality
Authors: Wolman I. , Diamant S. , Gull I. , Hartoov J. , Fait G. , Amster R. , Lessing J.B. , Jaffa A.J.
Published: March 2003

Objective

The purpose of this prospective study was to evaluate whether intracardiac echogenic foci (ICEF) are related to impairment of ventricular performance.

Study methods

3744 low risk patients were prospectively evaluated by the same ultrasonographer. ICEFs were defined as an hyperechogenicity located on the chordae tendinae. Fetuses with ICEFs underwent further echocardiographic evaluation. After birth, the neonates were referred for an additional echocardiographic evaluation only if a clinical suspicion of cardiac impairment arose. Fetuses with ICEFs were compared to a control group consisting of low‐risk fetuses, with no detectable ICEF, who underwent a similar echocardiographic evaluation.

Results

Of the 3744 patients in the study group, 138 fetuses (3.7%) presented with icefs. The majority of the ICEFs (78%) were located in the left ventricle. Eighteen percent were located in the right ventricle and 4% were bilateral. Of the 138 fetuses in this group, there was one case (0.7%) of pulmonic stenosis in a twin gestation. There was no other cardiac malformation or dysfunction in the other fetuses. Of the 167 fetuses in the control group, there was one case of fetal bicuspid aortic valve there was no statistical significance between the 2 groups.

Conclusions

We conclude that the finding of icefs is not correlated with cardiac dysfunction. However, these lesions should be carefully differentiated from rhabdomyoma or teratoma.
F125Fetal pulmonary venous Doppler flow velocity waveforms in congenital heart defects
Authors: Chaoui R. , Lenz F.
Published: March 2003

Aim of the study

is to analyze blood flow velocity waveforms (FVW) in the pulmonary veins using pulsed Doppler ultrasound in fetuses with a prenatally detected congenital heart defect (CHD).

Methods

In 96 fetuses with various CHD Doppler FVW from the pulmonary veins were assessed. Gestational age varied between 18 and 38 weeks. Following Doppler parameters were analyzed and compared to reference ranges: systolic (S), diastolic (D) peak velocity, end‐diastolic velocity during atrial contraction (A), peak velocity index for veins (PVIV) and Pulsatility Index for veins (PIV).

Results

We could distinguish 5 different patterns of FVW reflecting different stages of pulsatility and preload within the left atrium. Abnormal patterns were mainly observed in fetuses with left atrial obstruction and a restrictive foramen ovale having a reversed A‐wave as well as in mitral regurgitation.

Conclusions

Abnormal FVW in fetal cardiac defects depend from the left atrial pressure rather than on the cardiac defect itself. Patterns of FVW can help in quick differentiation of increased interatrial pressure, which can impair early neonatal outcome.
F131The role of fetal echocardiography during maternal pharmacological treatment
Authors: Krasoń A. , Kaczmarek P. , Janiak K. , Respondek‐Liberska M.
Published: March 2003

Background

The aim of this study was retrospective analysis of fetal tricuspid valve regurgitation (TR) during echo in the second half of pregnancy in 100/5079 (1.98%) fetuses with normal heart anatomy (NHA) and without extracardiac malformations (ECM), beetwen 01.01.1994–31.12.1999.

Method

In this group, 43 (53.75%) cases with TR had treatment: 36 fetuses betamimetics, 4 fetuses indomethacin and 3 fetuses aspirin. In 34 (79.06%) cases trivial TR and in 9 (20.94%) cases holosystolic TR were diagnosed. The mean fetal gestational age was 30.9 ± 4.1 hbd. Twenty neonates (80%) were delivered vaginally and 5 by cesarean section, at mean gestational age of delivery was 37 ± 3.7 hbd. The mean Apgar score was 9 pts.

Conclusions

1. Fetal TR with NHA was diagnosed in 53.7% fetuses with maternal treatment. 2. The most common finding of TR with NHA was exposure on betamimetic. 3. Fetal echocardiography was helpful to confirm the safety and fetal well‐being during maternal pharmacological treatment due to premature labour.
F14Functional ovarian cysts during the use of levonorgestrel releasing intrauterine system
Authors: Ekholm E. , Inki P. , Hurskainen R. , Palo P.
Published: March 2003

Background

We wanted to study the effect of a levonorgestrel‐releasing intrauterine system (Mirena) on ovarian morphology in hypermenorrheic women.

Methods

236 women suffering from menorrhagia participated in this study. The patients were randomized to two groups: 118 women received mirena and 106 went through hysterectomy. All the subjects were 35–49‐year‐old. Transvaginal ultrasound was performed at baseline, and both six months and one year after mirena insertion/hysterectomy.

Results

An ovarian cyst of more than 30 mm in diameter was detected in 13 patients at baseline. The mean diameter of the cyst was 34 mm (SD 8, range 32 × 19 to 62 × 28 mm). At six month control 19 patients had an ovarian cyst of a diameter more than 30 mm and at one year follow‐up an ovarian cyst was detected in 23 and two cysts in two patients using Mirena. In the hysterectomized group the number of ovarian cysts were 3 and 8, respectively. The mean size of the ovarian cysts was similar in both groups. None of the ovarian cysts required surgical intervention during the follow‐up period. At baseline 110 patients (46.6%) were diagnosed as having uterine fibroids with a mean diameter of 22 mm. The size of uterine fibroids did not increase during the study period.

Conclusion

Functional ovarian cysts are more frequent in women using mirena compared to hysterectomized women of similar age. However, the ovarian cysts observed during the study did not lead to surgical intervention.
F15Tubal sterilization by laparoscopic electrocoagulation is not associated with disturbances in pelvic blood flow velocimetry
Authors: Hershkovitz R. , Goldstein D. , Mazor M.
Published: March 2003

Background

Sterilization by laparoscopic tubal electrocoagulation is a well‐known technique. The purpose of the present study was to evaluate pelvic blood flow velocimetry before and after laparoscopic tubal ligation and to determine hormonal profile.

Methods

Sixteen women underwent laparoscopic tubal electrocoagulation. Doppler studies of uterine, arcuate and ovarian arteries was performed at early follicular and midluteal phases at the cycles before and after the laparoscopic procedure. Serum blood samples were obtained concordantly.

Results

Mean maternal age at the time of procedure was 38 ± 8 years. No significant differences were noted between all the following parameters:

Early Follicular Phase
Midluteal Phase

Pre  Ligation
Post  Ligation
Pre  Ligation
Post  Ligation

Rt. Uterine  artery
2.5
2.3
1.9
2.2

 PI‐median   (range)
(1.2–3.5)
(1.4–3.7)
(1.05–3.2)
(1.1–3.5)

Lt. Uterine   artery
2.9
2.7
2.5
2.6

 PI‐median   (range)
(1.5–3.9)
(1.6–3.4)
(1.3–2.9)
(1.4–3.3)

Arcuate artery
2.4
2.6
2.1
2.3

 PI‐median   (range)
(2.0–2.9)
(1.8–3.4)
(1.7–2.7)
(1.8–2.9)

Rt. Ovarian
3.4
3.5
3.2
3.1

 PI‐median   (range)
(2.4–4.1)
(2.5–4.2)
(2.0–3.9)
(2.1–3.8)

Lt. Ovarian
3.7
3.5
3.2
3.1

 PI‐median   (range)
(2.7–4.5)
(2.6–4.4)
(2.3–4.1)
(2.4–3.9)

Estrogen   (pg/ml)   mean ± SD
32.0 ± 15.2
29.0 ± 5.7
209.5 ± 95.2
187 ± 72.0

DHEAS   (µg/dl)   mean ± SD
190.5 ± 90
215.4 ± 105
201.2 ± 48.5
251.1 ± 120

Progesterone   (ng/ml)   mean ± SD
0.5 ± 0.4
0.6 ± 0.5
15 ± 5.4
19 ± 3.9

Conclusion

Laparoscopic tubal electrocoagulation is not associated with changes in the pelvic blood flow velocimetry and the hormonal profile.
F23Reproducibility of transvaginal three‐dimensional endometrial volume measurements during ovarian stimulation using virtual organ computer aided analysis (VOCALTM)
Authors: Salle B. , Affif A. , Bory A. M. , Rudigoz R. C.
Published: March 2003

Background

The aim of this study was to document the reproducibility of endometrial volume measurements by 3D‐ultrasound and VOCALTM.

Materials and methods

One three‐dimensional endometrial measurement was performed on each 79 consecutive infertile patients undergoing IVF. All scans were obtained using the Voluson 530 D (Kretztechnik AG, Zipf, Austria) the day of the oocytes retrieval and stored on a 540 Mbyte with an integrated magneto optical drive. After B mode analysis of the endometrium the system was switched into volume mode. Endometrial volume was calculated with the VOCALTMsoftware. Volume was calculated by two different observers (O1 and O2) and every 15° and 30° in order to appreciate inter and intra observer reliability.

Results

Mean endometrial volume was 4.00 cm3for each observer. Intra observer reproducibility was better for volume calculated at 15° (0.9754 for O1 and 0.9683 for O2) than volume calculated at 30° (0.9303 for O1 and 0.9602 for O2). A paired t‐test showed that there was no statistical difference between the two observers for volume calculated each 15° and significant difference for volume calculated each 30°.

Conclusion

VOCAL permitted an easy and reproducible inter and intra observer calculation of endometrial volume during controlled ovarian stimulation for IVF.
F03Transvaginal sonographic detection of endometrial pathology in postmenopausal women on HRT
Authors: Exacoustòs C. , Carusotti C. , Angelozzi D. , Rinaldo D. , Arduini D. , Romanini C.
Published: March 2003

Background

The aim of this study was to assess the sonographic aspect of the endometrium in postmenopausal patients receiving hormone replacement therapy (HRT) at different phases of the treatment and to identify endometrial pathologies on the basis of abnormal sonographic findings.

Method

The study group was composed of 103 women treated with sequential (82) or combined (21) HRT for at least 6 months. All patients underwent transvaginal sonography (TVS) with evaluation of endometrial thickness and echopattern. Patients on seqential regimes underwent TVS subsequently in the estrogen (phase E) and progestogen phases (phase P) and after withdrawal bleeding or immediately 5 days after the last progestogen administration (phase 0). Patients with an endometrial thickness > 5 mm (in phase 0 for patients on sequential HRT) or with TVS anomalies of the endometrial pattern underwent sonohysterography and/or hysteroscopy.

Results

In the 82 women on sequential HRT regimes mean endometrial thickness was significantly lower in phase 0 (3.8 ± 1.2 mm) compared to phase E (5.8 ± 1.7 mm) and phase P (6.2 ± 2.1 mm). On 20 patients with TVS abnormal endometrial findings sonohysterography identified 8 benign endometrial polyps which were removed by hysteroscopy and 2 simple hyperplasia were diagnosed by histeroscopically guided biopsy.

Conclusions

Sonohysterography is useful in HRT patients to detect endometrial polyps. In case of diffuse or focal endometrial thickness on sonohysterography an office hysteroscopy with guided biopsy could be useful.