bluuebunny/crossref_metadata_2025 huggingface dataset:
Doppler waveforms from the pulmonary arterial system in normal fetuses and those with pulmonary hypoplasia
Authors: Mitchell J. M. , Roberts A. B. , Lee A.
Published: March 2003

Color, pulsed and power Doppler were used to image the fetal pulmonary vasculature in 150 normal pregnancies and ten pregnancies in which the fetus had bilateral multi‐cystic dysplastic kidney disease (MCDK) and associated pulmonary hypoplasia.

The normal fetuses had a high resistance pattern in the main pulmonary artery vasculature. There were no significant changes in the resistance of the main pulmonary artery, right pulmonary artery and left pulmonary artery, with increasing gestational age. In the peripheral pulmonary arteries the resistance was less with an increase in diastolic flow, with advancing gestation.

All fetuses with MCDK died. This group did not have significantly different Doppler waveforms in the main pulmonary arteries, but Doppler signals from the peripheral pulmonary arteries showed a high resistance pattern quite different from that of normal fetuses.

Doppler measurements of the peripheral pulmonary artery may give additional information useful in diagnosing pulmonary hypoplasia. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Nuchal thickening in Jacobsen syndrome
Authors: McClelland S. M. , Smith A. P. M. , Smith N. C. , Gray E. S. , Diack J. S. W. , Dean J. C. S.
Published: March 2003

A routine detailed ultrasound examination performed at 20 weeks' gestation demonstrated the presence of nuchal thickening as an apparently isolated finding. The concentration of maternal α‐fetoprotein was normal and the risk of Down's syndrome was 1 in 6800. Amniocentesis was performed and chromosome analysis showed the karyotype 46,XY, del(11)(q23) found in Jacobsen syndrome. Fetal autopsy performed following medical termination at 23 weeks confirmed the phenotype and internal abnormalities found in Jacobsen syndrome. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Abnormal prenatal sonographic findings in the posterior cranial fossa: a case of Joubert's syndrome
Authors: Ní Scanaill S. , Crowley P. , Hogan M. , Stuart B.
Published: March 2003

Joubert's syndrome is a well‐documented but rare disorder characterized by a variable combination of central nervous system, respiratory, renal and eye anomalies. The most significant and constant neuropathological finding is partial or complete agenesis of the cerebellar vermis. The syndrome was first described by Joubert and colleagues as a familial agenesis of the cerebellar vermis and appears to be inherited as an autosomal recessive trait. A case of Joubert's syndrome is described in which second‐trimester ultrasonography demonstrated abnormal findings in the fetal posterior fossa with associated renal abnormalities. However, postnatal sonography of the posterior fossa could not confirm the prenatal findings, and the diagnosis of Joubert's syndrome was only later established by computed tomography of the neonatal brain in the knowledge of the characteristic clinical picture. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Intrauterine management of fetal parvovirus B19 infection
Authors: Schild R. L. , Bald R. , Plath H. , Eis‐Hübinger A. M. , Enders G. , Hansmann M.
Published: March 2003

Objectives

The aim of our study was to determine the outcome of pregnancies after intrauterine management of fetal parvovirus B19 infection.

Design

Retrospective study.

Subjects

A total of 37 cases of maternofetal parvovirus B19 infection, 35 of which were associated with hydrops fetalis, were referred to our tertiary level center between 1989 and 1996. With regard to fetal hydrops, no apparent cause other than parvovirus B19 infection was found in any patient.

Methods

In all patients, cordocentesis was performed to assess the degree of fetal anemia. When anemia was pre‐sent, cordocentesis was followed by intrauterine transfusion with packed red cells into the umbilical vein. Further management depended on the degree of fetal anemia and gestational age and included follow‐up fetal blood sampling/transfusion as well as ultrasound examinations as deemed appropriate.

Results

Packed red cell transfusion was performed in 30 patients with significant fetal anemia (Z‐score 1.6–7.8 below the mean for gestational age). The fetal hemoglobin values ranged from 2.1 to 9.6 g/dl. Serum levels of platelets in the transfusion group were 9–228 × 109/l with Z‐scores in the range of < 1 to 3.8 below the mean. During treatment and follow‐up, there were five intrauterine deaths (13.5%), one neonatal death (2.7%) and 31 live births (83.8%).

Conclusions

Fetal parvovirus infection can lead to marked anemia and hydrops formation. Cordocentesis allows precise assessment of fetal anemia which can then be corrected by intravenous transfusion. Under this regimen, the outcome proved favorable in the majority of fetuses, even those that were severely anemic. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Fetal pulmonary venous flow into the left atrium relative to diastolic and systolic cardiac time intervals
Authors: Brezinka C. , Laudy J. A. M. , Ursem N. T. C. , Hop W. C. J. , Wladimiroff J. W.
Published: March 2003

Objective

To establish the nature and gestational age dependency of the pulmonary venous flow velocity pattern into the left atrium relative to systolic and diastolic phases of the cardiac cycle.

Design

This was a cross‐sectional study of Doppler measurements of fetal pulmonary venous inflow velocities, which were correlated with simultaneous recordings of transmitral and aortic flow velocity waveforms based on an equal cardiac cycle length (±5%).

Results

Successful recordings were obtained in 28 out of 60 (47%) normal singleton pregnancies at 20–36 weeks of gestation. Reproducibility of waveform analysis of the various phases of the cardiac cycle was satisfactory, within‐patient variance ranging between 1.7% and 6.5%. A statistically significant increase (p < 0.05) in pulmonary venous time average velocity and velocity integral with advancing gestational age was established. A statistically significant increase (p < 0.05) of the pulmonary flow velocity integral was also found when related to each of the systolic and diastolic segments of the cardiac cycle, with the exception of isovolemic relaxation time. The duration of each of the diastolic and systolic segments of the cardiac cycle, as well as the pulmonary venous velocity integral expressed as a percentage of the cardiac cycle, remained constant with advancing gestational age.

Conclusions

The second half of pregnancy is characterized by pulmonary venous inflow into the left atrium throughout the cardiac cycle. Pulmonary venous inflow into the left atrium occurs predominantly during the filling and ejection phases of the cardiac cycle. Absolute cardiac diastolic and systolic time intervals as well as the percentage distribution of pulmonary venous flow velocity integrals between these cardiac time intervals remain unchanged with advancing gestational age. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Nuchal translucency in fetuses affected by 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 are anemic in the first trimester. We studied their nuchal translucency (NT) measurements at 12–13 weeks of gestation.

Methods

Nuchal translucency was measured prospectively in fetuses at risk of homozygous α‐thalassemia‐1. Measurements of those fetuses subsequently confirmed to be affected by homozygous α‐thalassemia‐1 but with a normal karyotype were compared to those of 440 controls. The controls were from the general obstetric population who had NT measurements at 12 or 13 weeks with known normal outcome. All the NT measurements were expressed as multiples of the median (MoM) for the gestational day.

Results

Between 1996 and 1998, 94 at‐risk pregnancies were studied. Of these, 32 were subsequently confirmed to be affected by homozygous α‐thalassemia‐1. Chromosome study was not carried out in three cases and these were excluded from the analysis. Nuchal translucency MoMs for cases and controls were found to fit a log Gaussian distribution. The log means (standard deviation) for case and control NT MoM were 0.075 (0.156) and 0.0019 (0.091), respectively. The median NT MoM (95% CI) for cases was 1.19 (1.08–1.62) and was significantly higher than that of the controls (p < 0.001). However, there was extensive overlap of NT between cases and controls.

Conclusion

Overall, there was a 19% increase in NT MoM in fetuses affected by homozygous α‐thalassemia‐1. This represents a difference of only 0.3–0.4 mm, which is clinically insignificant. This finding indirectly suggests that the increased NT in trisomic fetuses cannot be explained by fetal anemia. Conversely, the presence of increased NT in a fetus at risk of homozygous α‐thalassemia‐1 should alert one to the possibility of chromosomal abnormality rather than being attributed to fetal anemia. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Fetal craniofacial structure and intracranial morphology in a case of Apert syndrome
Authors: Pooh R. K. , Nakagawa Y. , Pooh K. H. , Nakagawa Y. , Nagamachi N.
Published: March 2003

Apert syndrome is characterized by craniosynostosis, mid‐facial hypoplasia and bilateral syndactyly. We document in detail the intrauterine natural history of Apert syndrome by serial sonographic examination.

Ultrasound examination of a 19‐week fetus revealed an abnormal appearance of the skull. The subsequent examination including transvaginal brain scanning demonstrated a deformed occipital part of the cerebrum and lateral ventricles, frontal bossing, a low nasal bridge and an abnormal appearance of the fetal hands and feet. The distortion of the fetal profile became progressively worse with advancing gestation. Towards the end of pregnancy, anterior prominence of the cerebrum, ventricles and corpus callosum was demonstrated and mild non‐progressive ventriculomegaly was seen. The female 3152‐g newborn with the typical facial appearance of Apert syndrome, bilateral syndactyly of the fingers and toes and isolated cleft palate was delivered at 37 weeks. Postnatal three‐dimensional computed tomography scan demonstrated the fusion of the coronal suture and a wide midline calvarial defect, and cranial magnetic resonance imaging confirmed the prenatal sonographic findings. Although the karyotype was normal, genomic DNA analysis of the fibroblast growth factor receptor 2 revealed Ser252Trp, which is specified in the mutational basis of Apert syndrome.

The time course of the prenatal findings in this case may help increase understanding of the intrauterine natural history of Apert syndrome. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Fetal outcome in pregnancies defined as post‐term according to the last menstrual period estimate, but not according to the ultrasound estimate
Authors: Tunón K. , Eik‐Nes S. H. , Grøttum P.
Published: March 2003

Objective

To study the risk of adverse fetal outcome in fetuses that were post‐term according to the last menstrual period estimate but not according to the ultrasound estimate.

Design

A total of 11 510 women with singleton pregnancies, reliable last menstrual period and delivery after 37 weeks were divided into four groups: women who delivered at term, i.e. within 259–295 days according to both the ultrasound and the last menstrual period estimate; women who delivered post‐term according to the last menstrual period estimate but not according to the ultrasound estimate; women who delivered post‐term according to the ultrasound estimate but not according to the last menstrual period estimate; and women who delivered post‐term according to both the ultrasound and the last menstrual period estimates. Stepwise logistic regression was used to test whether the risk of Apgar score of < 7 after 5 min and transfer to the neonatal intensive care unit increased in any of the post‐term groups.

Results

There was no significant difference in mortality between the term group and the three study groups. There was no significant increase in the risk for Apgar score of < 7 after 5 min or transfer to the neonatal intensive care unit for pregnancies that were defined as post‐term according to the last menstrual period estimate but not according to the ultrasound estimate. There was, however, an increased risk for Apgar score of < 7 after 5 min in the group that was post‐term according to the ultrasound estimate but not according to the last menstrual period estimate. There was also an increased risk for transfer to the neonatal intensive care unit in the group that was post‐term according to both estimates.

Conclusion

The effect of ultrasound in changing the estimated day of delivery to a later date leading to pregnancies becoming post‐term according to the last menstrual period estimate but not according to the ultrasound estimate does not have any adverse consequences for the fetal outcome. However, there seems to be an increased risk for adverse consequences for pregnancies that are post‐term according to the ultrasound estimate. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Fetal peripheral bronchial fluid flow during breathing movement in normal pregnancies: a preliminary study
Authors: Nakai Y. , Nishio J. , Mine M. , Imanaka M. , Ogita S.
Published: March 2003

Objective

To determine the fluid flow velocity waveforms in the fetal peripheral bronchus during fetal breathing movement by means of pulsed Doppler ultrasonography.

Design

A preliminary cross‐sectional study.

Subjects

Twenty‐eight normal pregnant women between 32 and 38 weeks of gestation.

Methods

Velocity waveforms from fetal peripheral respiratory fluid flow were acquired from the segmental bronchus (B6 or B8) which runs along the segmental artery (A6 or A8). The maximum velocity of the intrabronchial fluid flow and duration of inspiratory and expiratory phases were quantified.

Results

The flow velocity signal from the fluid in the fetal segmental bronchus of 17 of the 28 fetuses was detected. We observed two types of fetal breathing movement.

Conclusion

During fetal breathing movement, the fluid in the fetal respiratory tract moves in the fetal segmental bronchus. This movement can be detected by pulsed Doppler velocimetry aided by power Doppler ultrasonography. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
First‐trimester prenatal diagnosis of a thoracic cystic lesion associated with fetal skin edema
Authors: JaunIaux E. , Hertzkovitz R. , Hall J. M.
Published: March 2003

An unusual case of chest cyst diagnosed at the end of the first trimester in a dizygotic twin pregnancy and managed conservatively is reported. Between 11 and 14 weeks of gestation, ultrasound revealed a relatively large echopoor lung cyst occupying the left side of the chest, displacing the mediastinum and the heart. This was associated with increased nuchal translucency thickness and generalized skin edema. Subsequent sonograms showed complete resolution of the cyst together with the skin edema. The fetuses were delivered at term and had an uncomplicated postnatal outcome. This case emphasizes the role of reduced venous return as a cause of early fetal hydrops. Diagnosis and follow‐up of a congenital lung cyst from the end of the first trimester should enable early intervention to be made.
On‐to‐on versus on‐to‐out nuchal translucency measurements
Authors: Herman A. , Dreazen E. , Samandarov A. , Bukovsky Y. , Weinraub Z. , Maymon R.
Published: March 2003

Objective To analyze variables affecting the differences between on‐to‐on and on‐to‐out methods of nuchal translucency measurement.

Design Prospective comparison of two methods of caliper placement.

Subjects A total of 245 women undergoing transabdominal and 37 women undergoing transvaginal nuchal translucency scanning.

Methods Nuchal translucency was measured using both on‐to‐on and on‐to‐out methods of caliper placement on the same frozen images. Differences between the methods were evaluated according to fetal size, nuchal thickness and mode of examination. Regression analysis was performed for the calculation of the expected difference between the methods at various combinations. Results among 1254 singleton pregnancies were used to set 50th, 95th and 97.5th centiles for the on‐to‐on method. The calculated differences were used to set 50th, 95th and 97.5th centiles for the on‐to‐out method.

Results The mean difference between on‐to‐out and on‐to‐on nuchal translucency, using transabdominal scanning, was 0.95 ± 0.14 mm. The differences were shown to correlate directly with fetal size and with nuchal thickness. In addition, scans performed transvaginally exhibited a smaller difference between the methods (0.90 mm vs. 0.94 mm; P < 0.05).

Conclusion The difference between on‐to‐on and on‐to‐out nuchal translucency measurements may have a considerable effect on the calculated risk for aneuploidy.
Klippel–Trenaunay–Weber syndrome presenting as massive lymphangiohemangioma of the thigh: prenatal diagnosis
Authors: Gonçalves L. F. , Muñoz Rojas M. V. , Vitorello D. , Ternes Pereira E. , Pereima M. , Saab Neto J. A.
Published: March 2003

We report a case of Klippel–Trenaunay–Weber syndrome presenting prenatally as a massive congenital lymphangiohemangioma of the thigh. Routine ultrasonographic examination revealed multiple distorted cystic areas extending from the right flank through the right lower extremity of a 30‐week fetus. A diagnosis of cystic lymphangioma of the thigh was suspected prenatally. Neonatal evaluation confirmed the prenatal findings. Neonatal color Doppler imaging revealed blood vessels within the tumor. The differential diagnosis is discussed together with available therapeutic procedures. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Fetal cerebral blood flow redistribution in late gestation: identification of compromise in small fetuses with normal umbilical artery Doppler
Authors: Hershkovitz R. , Kingdom J.C.P. , Geary M. , Rodeck C.H.
Published: March 2003

Objective To evaluate the role of middle cerebral artery Doppler in small fetuses during the late third trimester.

Design Prospective observational study of structurally normal fetuses with an estimated fetal weight < 5th percentile for gestation. Perinatal outcome was determined using a structured datasheet sent to each referring obstetrician.

Subjects Structurally normal fetuses at 35 or more weeks of gestation referred during a 2‐year period to the fetal growth clinic of a regional fetal medicine unit in North London. Fetuses with aneuploidy and/or major structural abnormalities were excluded.

Methods Umbilical artery and middle cerebral artery (MCA) Doppler waveforms were recorded and considered abnormal if above 95th or below 5th percentiles, respectively. Amniotic fluid was considered reduced if the maximum vertical cord‐free pool was < 2 cm. The placenta was considered mature if the Grannum grade was II or III. The head circumference (HC)/abdominal circumference (AC) ratio was considered abnormal if > 95th percentile for gestation. Fetal growth, amniotic fluid, biophysical profile score and umbilical artery Doppler were used to advise the referring obstetrician about fetal well‐being and he/she independently decided both the timing and mode of delivery.

Results Forty‐seven fetuses fulfilled the entry criteria. Thirty‐four (72%) demonstrated normal umbilical artery Doppler waveforms. Sixteen (34%) demonstrated middle cerebral artery redistribution, of which nine (56%) had normal umbilical artery Doppler waveforms. MCA blood flow redistribution was associated with an increased incidence of cesarean delivery and need for neonatal admission. Of all gray‐scale parameters, an elevated HC/AC ratio has the strongest association with MCA blood flow redistribution (15/16 vs. 1/31; P < 0.01).

Conclusions MCA Doppler may be a useful tool to assess the health of small fetuses in the late third trimester. Redistribution may occur in the presence of normal umbilical artery Doppler and should be suspected when the HC/AC ratio is elevated.
Prediction of preterm birth by second trimester cervical sonography in twin pregnancies
Authors: Yang J.H. , Kuhlman K. , Daly S. , Berghella V.
Published: March 2003

Objectives

To determine the predictive value of sonographic cervical length and of funneling for spontaneous preterm delivery (PTD) in twin pregnancies under 26 weeks' gestation.

Methods

Women with twin pregnancies were studied prospectively with transvaginal or translabial ultrasound of the cervix from 18 to 26 weeks' gestation. Exclusion criteria were: signs of preterm labor, prophylactic cervical cerclage, placenta previa, or severe congenital fetal anomaly. The primary outcome was spontaneous preterm birth at < 35 weeks' gestation.

Results

Sixty‐five twin pregnancies were analyzed, of which 23% (15/65) delivered preterm. Cervical ultrasound examination was performed by 22 weeks' gestation in 75% and by 24 weeks' gestation in 91% of women. Cervical length ≤ 25 mm and ≤ 30 mm was associated with sensitivities of 27% and 53%, respectively, and with 67% and 62% rates of PTD, respectively (R.R. 4.6, C.I. 2.0–10.3 and R.R. 3.6, C.I. 1.6–7.8, respectively). A cervical length > 35 mm was associated with only a 4% rate of PTD (R.R 0.13; C.I. 0.02–0.93). Of 10 women (15%) with any cervical funneling, 70% delivered preterm, all under 32 weeks' gestation. By logistic regression analysis, both short cervix ≤ 30 mm and any funneling were strongly predictive of PTD.

Conclusions

Both cervical length ≤ 30 mm and cervical funneling in twin pregnancies under 26 weeks' gestation are independently and strongly associated with high risk for preterm birth. A long cervix, of length > 35 mm, is associated with very low risk (4%) for preterm birth. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Intra‐ and interoperator repeatability of the nuchal translucency measurement
Authors: Pajkrt E. , Mol B.W.J. , Boer K. , Drogtrop A.P. , Bossuyt P.M.M. , Bilardo C.M.
Published: March 2003

Objective

The aim of this study was to assess the repeatability of nuchal translucency measurement by well‐trained sonographers either experienced or inexperienced with the measurement.

Methods

The nuchal translucency was measured three times by two out of nine operators in 161 pregnant women attending two teaching hospitals. Intra‐operator and inter‐operator variation was assessed by calculating the standard deviation (SD). Intraclass Correlation Coefficients (ICC) with a 95% lower confidence limit (95% CL) were calculated for each operator and for pairs of operators. Intra‐and inter‐operator kappa statistics were calculated, after dichotomising the results into a nuchal translucency smaller or larger than 3 mm.

Results

The SD of intra‐operator difference was 0.35 mm. The intra‐operator repeatability showed ICCs varying from 0.83 to 0.95 for the experienced operators and from 0.47 to 0.83 for the inexperienced. The SD of inter‐operator differences was 0.56 mm, 0.46 mm and 0.44 mm, based on one, two and three measurements, respectively. The inter‐operator repeatability showed a variation in ICC from 0.74 to 0.95 in pairs of experienced sonographers to 0.51 in one pair inexperienced with the measurement. The kappa value expressing the intra and inter‐operator repeatability as being > 3 mm or < 3 mm was 0.88 and 0.85, respectively.

Conclusion

This study supports the finding that the nuchal translucency measurement is reproducible, as long as it is performed by sonographers well trained in the technique of this measurement. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Trisomy 21: 91% detection rate using second‐trimester ultrasound markers
Authors: DeVore G. R.
Published: March 2003

Objectives

To examine cardiovascular and non‐cardiovascular prenatal ultrasound markers and determine which markers physicians of varying skill levels could use to identify fetuses with trisomy 21.

Methods

Eighty second‐trimester fetuses with trisomy 21 and 2000 controls underwent real‐time plus color Doppler examination of cardiovascular and non‐cardiovascular systems followed by amniocentesis. Non‐cardiac markers were central nervous system malformations (CNS); choroid plexus cysts (CPC); abnormal nuchal skin fold (NSF); hyperechoic bowel (HB); and pyelectasis (PY). Cardiac markers consisted of ventricular septal defect, right‐to‐left chamber disproportion (RL); tricuspid regurgitation; mitral regurgitation (MR); pericardial effusion; and outflow tract abnormalities (OFT). Multinomial logistic regression was used to identify interactivity between the markers. Logistic regression was utilized to identify which combinations of markers significantly contributed to the identification of fetuses with trisomy 21 and to compute the likelihood ratio.

Results

All but three markers (CPC, MR, OFT) contributed significantly to the identification of 91% of fetuses with trisomy 21 with a false‐positive rate of 14%. When only non‐cardiovascular markers were examined, all but CPC contributed to the identification of 60% of fetuses with trisomy 21 with a false‐positive rate of 5.9%. Combining right‐to‐left chamber disproportion with CNS, NSF, HB and PY identified 75% of fetuses with trisomy 21 with a false‐positive rate of 6.4%. All markers were independent predictors of trisomy 21 except RL and NSF.

Conclusion

Ultrasound can detect between 60 and 91% of fetuses with trisomy 21 depending upon which markers are selected for evaluation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
First trimester diagnosis of monoamniotic twin pregnancies
Authors: Sebire N. J. , Souka A. , Skentou H. , Geerts L. , Nicolaides K. H.
Published: March 2003

This study reports the ultrasound findings and pregnancy outcome for a series of monoamniotic twin pregnancies diagnosed at 11–14 weeks' gestation. Of 315 monochorionic twin pregnancies examined, there were 12 (3.8%) monoamniotic, including four sets of conjoined twins (1.3%). The parents opted for termination of pregnancy in all cases of conjoined twins. In four other cases, there was discordancy for major structural fetal abnormality (kyphoscoliosis, anencephaly, body stalk defect, diaphragmatic hernia), and the co‒twin was structurally normal. In the four cases in which both twins were structurally normal, ultrasound examination demonstrated normal nuchal translucency thickness in all cases but cord entanglement was demonstrated from the first trimester. Two cases were managed expectantly; one resulted in livebirth of both twins at 31 weeks' gestation and the second in intrauterine death of both fetuses at 21 weeks. Two pregnancies were treated with Sulindac; one resulted in a single intrauterine death at 30 weeks and delivery of a normal co‒twin, the other, in intrauterine death of both fetuses at 31 weeks'. Monoamniotic twin pregnancies are associated with a high risk of fetal abnormalities and perinatal death and the mortality rate is higher than previously reported from series with recruitment later in gestation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Limb reduction defects as the sonographic manifestation of hemoglobin Bart's disease at 10 weeks of gestation
Authors: Lam Y.H. , Tang M.H.Y.
Published: March 2003

Fetuses affected by hemoglobin Bart's disease are anemic and hypoxic from the first trimester. They develop cardiac and placental enlargement and have a high incidence of limb reduction defects and hypospadias. We present a fetus at risk for hemoglobin Bart's disease with multiple limb reduction defects detected at 10 weeks of gestation, which allowed a strong presumptive diagnosis of hemoglobin Bart's disease to be made at the time of ultrasound examination. The limb defects were verified by direct visualization via needle embryoscopy. The present case suggests that sonographic identification of limb reduction defects may be a specific marker of hemoglobin Bart's disease at 10 weeks. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Deriving a local normal range for nuchal translucency measurement: implications for practice
Authors: Mulvey S. F. , Thirunavukarasu P. , Shekleton P. , Oldham J. , Edwards A. , Wallace E. M.
Published: March 2003

Purpose:  To derive a local normal range for nuchal translucency (NT) measurement, including exploring possible variations with ethnicity and to compare this with a normal range widely used internationally.

Methods:  All data were recorded as part of an ongoing prospective study (the FaST Study) of first and second trimester Down syndrome screening methods. NT was measured at 11–14 weeks of gestation according to Fetal Medicine Foundation guidelines. The relationship between the largest NT and gestation (CRL) was modelled using a line of best fit applied to a logarithmic transformation of NT. The best fitting equation modelling a linear relationship between NT and gestation: log10(NT) = −0.2844 + 0.006 441CRL. This equation was derived from Caucasian women only. Ethnic comparisons were derived for Vietnamese, Cambodian, Chinese and Indian women by dividing the measured NT value by the expected NT value using the preceding equation. Median NTs from each ethnic group was then calculated and between group differences analyzed using Mann–Whitney U‐test. Significance was accorded if P < 0.05. The local normal range for NT was also compared with published data from the Fetal Medicine Foundation, UK which forms the basis of widely used risk calculation software.

Results:  The median NT MoMs for Caucasian, Vietnamese, Cambodian, Chinese and Indian women were 1.0, 1.04, 1.08, 1.1 and 0.99, respectively. The median NT measurements were significantly higher in Vietnamese, Cambodian and Chinese women when compared with median NT measurements in Caucasian women (P = 0.0019, 0.0005 and <0.0001, respectively). At all gestations, the expected NT in our population was approximately 20% less than that reported by the Fetal Medicine Foundation.

Conclusions:  The significantly higher NT measurements in South‐East Asian women suggest that correction for ethnicity would optimize screening performance in this group. Furthermore, all centers should ensure that the NT normal range used to calculate risks is appropriate for their population.

Acknowledgements:  The FaST Study is a collaborative research project funded by the Department of Human Services, Victoria Government and Monash University.
Influence of acupuncture on Doppler ultrasound in pregnant women
Authors: Zeisler H. , Eppel W. , Husslein P. , Bernaschek G. , Deutinger J.
Published: March 2003

Objective

To evaluate the influence of acupuncture on the blood flow in the umbilical artery (UA), fetal aorta and uterine artery and on the fetal heart rate using two different acupuncture points (SP‐6 (Sanyinjiao) and LI‐4 (Hegu)).

Methods

In group A (n = 50), measurements (Doppler ultrasound and fetal heart rate) were performed at term after an uneventful pregnancy (#1) followed by acupuncture treatment using the acupuncture‐point SP‐6 bilaterally. The treatment time lasted 15 min after which the next measurement (#2) was carried out. The needles were then inserted into the LI‐4 acupuncture point for a further 15 min. A third measurement at the end of acupuncture treatment (#3) completed the session. In group B (n = 25), measurements were made before (#1) and after (#4) acupuncture at LI‐4 acupuncture points only.

Results

In group A, the mean systolic/diastolic (S/D) ratios of UA #1, UA #2 and UA #3 were 2.45, 2.38 and 2.22, respectively (P = 0.0012). The difference in mean S/D ratios between UA #1 and UA #3 as well as that between UA #2 and UA#3 were statistically significant (P = 0.0002 and P = 0.008, respectively). There was no difference between the mean S/D ratios of the uterine artery and between the mean resistance indices of the fetal aorta. In group B, the only significant difference between measurements following acupuncture treatment was in fetal heart rate (139 vs. 143 bpm, P = 0.02).

Conclusion

Our study indicates a positive influence of acupuncture treatment on umbilical artery waveforms when using a combination of SP‐6 (Sanyinjiao) and LI‐4 (Hegu) acupuncture points. Acupuncture performed at these sites either individually or in combination does not seem to affect blood flow in the fetal aorta or uterine artery. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal diagnosis of fetal intra‐abdominal umbilical vein dilatation
Authors: Prefumo F. , Thilaganathan B. , Tekay A.
Published: March 2003

Dilatation of the intra‐abdominal portion of the fetal umbilical vein is a rare abnormality. We describe here a new case diagnosed at 31 weeks of gestation and discuss the clinical features and management of this abnormality. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Perinatal diagnosis of cardiac tumors
Authors: Geipel A. , Krapp M. , Germer U. , Becker R. , Gembruch U.
Published: March 2003

Objective

As fetal cardiac tumors are a rare condition, we report the perinatal diagnosis and ultrasound findings of 12 cases.

Methods

In 10 cases the tumors were identified prenatally by fetal echocardiography; gestational age at detection ranged from 22 to 34 weeks. In two symptomatic infants cardiac tumors were diagnosed on the first day postpartum; prenatal ultrasound evaluation at 26 and 38 weeks of gestation did not reveal a cardiac lesion.

Results

Six fetuses had singular tumors, in six fetuses they were multifocal. The left ventricle was most often affected. Termination of pregnancy was chosen in three cases, one in association with trisomy 21 and tuberous sclerosis. One intrauterine and three neonatal deaths due to cardiac failure occurred. Histopathologic examination revealed cardiac rhabdomyoma in six fetuses and fibroma in one case. In the five surviving fetuses the size of the tumors spontaneously decreased postpartum. Rhabdomyomata were associated with tuberous sclerosis in four out of 11 cases.

Conclusion

Cardiac tumors are detectable as early as 22 weeks of gestation. Presenting symptoms may be arrhythmia, dysfunction of the atrioventricular valves, pericardial effusion and fetal hydrops. The most common perinatal diagnosis is rhabdomyoma, which is often associated with tuberous sclerosis. Sequential examination in high risk patients should be considered as most tumors increase in size during pregnancy and may become evident in late second and third trimester of pregnancy. Postpartum, however, regression of tumor size is common. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Longitudinal survey of blood flow at three different locations in the middle cerebral artery in normal fetuses
Authors: Hsieh Y.‐Y. , Chang C.‐C. , Tsai H.‐D. , Tsai C.‐H.
Published: March 2003

Objectives

To assess vascular impedance at three different locations in the middle cerebral artery (MCA) in normal fetuses throughout gestation.

Materials and methods

Uncomplicated singleton pregnancies at 15–40 weeks' gestation in which Doppler surveys of both MCAs could be obtained were recruited. The pulsatility index (PI) and resistance index (RI) of the proximal, mid and distal sites of both MCAs were measured. The five gestation periods at which the Doppler surveys were performed were (i) 15–19 completed weeks; (ii) 20–24 completed weeks; (iii) 25–29 completed weeks; (iv) 30–34 completed weeks; (v) 35–39 completed weeks.

Results

A total of 42 fetuses were recruited. The average PI/RI values of the proximal, mid and distal MCA were 1.61/0.82, 1.77/0.82, and 1.84/0.84, respectively. The PI value of the proximal MCA was lower than that of the mid and distal MCA. The PI values of the mid and distal MCA showed no difference. The RI value of the MCA from the three locations also showed no difference. The PI/RI values of MCA for each gestational phase were: (i) 1.81/0.87; (ii) 1.79/0.86; (iii) 1.78/0.86; (iv) 1.70/0.81; (v) 1.62/0.77, respectively. Decreased PI/RI values were observed after 30 weeks' gestation.

Conclusions

The PI values of the proximal MCA are lower than those of the mid and distal MCA. A marked decrease in PI/RI values was observed after 30 weeks' gestation. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Fetal cardiac performance in uncomplicated and well‐controlled maternal type I diabetes
Authors: Jaeggi E. T. , Fouron J.‐C. , Proulx F.
Published: March 2003

Objective

To study the impact of well‐controlled, uncomplicated maternal diabetes on fetal cardiac development and performance.

Methods

The following variables were studied in 45 fetuses of type I diabetic women by means of mid‐ and late‐trimester echocardiography: interventricular septal thickness; aortic and pulmonary valve diameters; peak and time‐to‐peak flow velocity of the great arteries; the ratio between peak velocities during early (E) and late (A) ventricular filling at the level of the atrioventricular valves; ventricular fractional shortenings; and output. The findings were compared to age‐matched control groups of normal fetuses.

Results

A significant augmentation of interventricular septal thickness was demonstrated for mid‐trimester fetuses of diabetic women, which progressed further towards the end of pregnancy. However, the indices of diastolic and systolic function remained comparable between the gestational age‐matched groups.

Conclusion

Progressive myocardial thickening occurs commonly in mid‐ and late‐trimester fetuses of uncomplicated and well‐controlled diabetic pregnancies. The observed degree of hypertrophy is generally mild and does not affect age‐related changes in fetal cardiac function. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Fetal transcerebellar diameter and chromosomal abnormalities
Authors: Vinkesteijn A. S. M. , Jansen C. L. R. , Los F. J. , Mulder P. G. H. , Wladimiroff J. W.
Published: March 2003

Objective

To evaluate the association between chromosomal abnormalities and fetal cerebellar size.

Design

A retrospective cross‐sectional study.

Methods

Ultrasound measurements of transcerebellar diameter, head and upper‐abdominal circumference from 88 fetuses with chromosomal abnormalities were analyzed. Abnormalities included trisomy 21 (n = 23), trisomy 18 (n = 17), ‘other numerical chromosomal abnormalities’ (n = 9), sex chromosomal abnormalities (n = 9), mosaicism (n = 12), balanced translocations (n = 9) and unbalanced translocations (n = 9). Multiple regression analysis was performed to compare transcerebellar diameters between the reference group and each of the subsets of chromosomal abnormalities and between trisomies 18 and 21. Also, in the latter two subsets, comparison of the transcerebellar diameter before and after 25 weeks of gestation was carried out.

Results

Fetal transcerebellar diameter was reduced in relation to gestational age but was normal when control was made for fetal size in all chromosomal subsets, except for balanced translocations. The transcerebellar diameter in trisomy 18 was significantly smaller than that in trisomy 21. No difference in cerebellar size was found when comparing the gestational age period before and after 25 weeks in each of these two subsets.

Conclusions

A reduction in fetal transcerebellar diameter was demonstrated in all chromosomal abnormalities with imbalance of genetic material. Cerebellar hypoplasia was more severe in trisomy 18 than in trisomy 21. The degree of reduction in fetal transcerebellar diameter in these subsets seems to be independent of the time period during which the transcerebellar diameter measurement was performed. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound‐indicated cervical cerclage: operative findings and preoperative cervical length predict outcome
Authors: Groom K. M. , Shennan A. H. , Bennett P. R.
Published: March 2003

Objectives:  To relate preoperative cervical length, operative findings, postoperative cervical length and pregnancy outcome in high risk women treated with ultrasound indicated cervical cerclage to establish if it was possible to determine the most appropriate criteria to offer cervical cerclage.

Study design:  A prospective observational study of 305 high risk women undergoing serial transvaginal ultrasonographic assessment of cervical length during the second trimester. Fifty‐four women met criteria for cerclage (cervical length <15 mm, significant progressive shortening to <25 mm or funneling >50%). Data concerning preoperative cervical length, operative findings, postoperative cervical length and pregnancy outcome was collected, and analyzed data is expressed as median values. Statistical analysis was performed using Fisher's exact and Mann–Whitney U‐tests.

Results:  Gestation at delivery was 37 ± 5 weeks, suture insertion to delivery interval was 115 days and overall fetal survival rate was 85.2%. Median preoperative cervical length was 15.0 mm. Median gestation at suture insertion was 19 ± 5 weeks. There was a significant increase in postoperative cervical length 15.0 vs. 25.0 mm (P < 0.0001). Fetal membranes were visible in 19% of cases at the time of surgery, this occurred in 75, 5, and 0% cases with a cervical length <10, 11–15 and >15 mm, respectively. Overall outcome was considerably worse for those cases with visible membranes at the time of surgery than for those with no visible membranes (gestation at delivery 23 ± 0 vs. 38 ± 2 weeks (P = 0.002), suture insertion to delivery interval 17 vs. 122 days (P < 0.0001), fetal survival rates 50 vs. 93% (P = 0.0005)). This finding was regardless of preoperative cervical length (of all women with preoperative cervical length <15 mm (n = 31) gestation at delivery 25 ± 1 vs. 35 ± 5 (P = 0.008), suture insertion to delivery interval 17 vs. 119 days (P = 0.0005), fetal survival rate 50 vs. 90%).

Conclusions:  In a high risk population undergoing serial transvaginal ultrasound surveillance of cervical length, regardless of preoperative cervical length, the presence of visible membranes at the time of suture insertion is associated with a poor outcome. Fetal membranes were not visible in any case with a preoperative cervical length >15 mm. These findings support a concept of cervical cerclage at a cervical length of 15 mm.
Regional variation in power Doppler perfusion measurements within normal placenta
Authors: Welsh A. W. , Fisk N. M.
Published: March 2003

Background:  Power Doppler ultrasound is well suited to the evaluation of placental perfusion, with its sensitivity to low flow, lack of aliasing and relative angle independence. Previously published work from our group has proposed the use of power Doppler evaluation of abnormal placentation to monitor progress after significant placental abruption. Commercially available software (CQ Analysis, Kinetic Imaging Ltd., UK) is able to segment color flow information from compound color/greyscale images and express flow information in relation to vessels (mean color velocity or energy) or tissue (percentage integrated velocity or energy). Care must be taken to either standardize power Doppler values to local regions of 100% blood flow or alternatively to compare regions at the same depth and machine settings sat the same examination.

Methods:  Ten patients with uncomplicated pregnancies were recruited for additional power Doppler ultrasound examination. All were in the third trimester with anterior placentas. The placental location was initially mapped, and then separate regions were chosen, approximating to different placental quadrants. With constant machine settings for each case, and depth being constant, multiple clips were stored from each region. After image segmentation, all frames were examined individually to exclude any with movement or flash artefact. The percentage of ICE was measured in each frame: firstly, carefully tracing the fetal placental vessels away from the surface and secondly, using an oval shaped region of interest as defined by CQ Analysis. From these two regions, two different examinations were performed, averaging over the whole clip to remove cardiac cycle effects, and looking manually at systolic frames only.

Results:  A total of 8156 frames were analyzed, of these 872 selected as systolic. The variation in regional perfusion assessed with power Doppler from normal placenta ranged from 19 to 132%. There were no statistically significant differences in reproducibility for the techniques for region selection and for region selection.

Conclusions:  In this study, an attempt was made to show the high degree of variation in normal perfusion within the human placenta as a function of space. Unlike other organs where power Doppler perfusion evaluation may be linked to specific planes or landmarks, this is not technically possible with the placenta. An exception to this may be within areas of pathological placentation that are followed prospectively. However, caution should be exercised in the use of power Doppler for evaluation of normal human placenta perfusion.

Acknowledgements:  Alec Welsh was supported by a Research Training Fellowship from RCOG/WellBeing, the BUPA Research Foundation Clinical Scientist Award 2000 and the 2001 Bernhard Baron/RCOG Travelling Scholarship.
The importance of funneling to the level of a cervical cerclage
Authors: O'Brien J. M. , Hill A. L. , Barton J. R.
Published: March 2003

Purpose:  Our purpose was to evaluate the utility of ultrasound surveillance after cerclage placement and to propose a rationale for cervical sonography in this setting.

Methods:  A retrospective case series was evaluated. Women undergoing cervical cerclage by a maternal–fetal medicine specialist regardless of indication and delivering between January 1999 and April 2001 were included. Transvaginal assessment of cervical length and the degree of cervical funneling after cerclage were compared to preoperative values and to outcomes. Funneling to the cerclage was defined as membranes prolapsing down the endocervical canal until they reached the plane of the cerclage.

Results:  A total of 53 cases were available for analysis. Cervical cerclage resulted in a significant increase in cervical length as the mean length increased from 2.1 ± 1.2 cm to 2.9 ± 0.8 cm after the procedure, P < 0.001, but this measure was not correlated with gestational age at delivery. Funneling to the level of the cerclage, however, was associated with an earlier gestational age at delivery 31.3 ± 5.6 weeks vs. 36.8 ± 2.8 weeks for those cases without this finding, P < 0.001. This observation was statistically significant irrespective of the indication for the procedure and was noted by 28 weeks' gestation in all patients followed. The incidence of premature rupture of the membranes was also significantly greater postcerclage in women with descent of the membranes to the cerclage (52%) vs. those without this finding (3%, P = 0.002).

Conclusions:  Funneling to the cerclage has predictive value for earlier preterm delivery in patients who have undergone cervical cerclage. Serial sonography up to 28 weeks' gestation may be useful in identifying patients at higher risk for premature rupture of the membranes.
Abnormal ductus venosus blood flow in fetuses with normal nuchal translucency (NT)
Authors: Char Sang Choon , Yamasaki A. A. , Pares D.
Published: March 2003

Objective:  To assess the incidence of reverse flow during atrial contraction at ductus venosus in fetuses with normal nuchal translucency and correlation with cardiac abnormalities.

Methods:  Ductus venosus Doppler ultrasound blood flow velocity waveform were obtained in 932 fetuses with 11–14 weeks' gestation during measurement of nuchal translucency.

Results:  Among 932 fetuses, NT was increased in 43 (4.6%). The incidence of reverse flow was observed in 5.4% of fetuses with normal NT (2.5 mm) and 13.9% of fetuses with increased NT (>2.5 mm). Among fetuses with normal NT, there was no cardiac abnormalities observed.

Conclusion:  Reversed flow in fetuses with normal NT is not associated with cardiac abnormalities.