bluuebunny/crossref_metadata_2025 huggingface dataset:
Three‐dimensional imaging of the brain cavities in human embryos
Authors: Blaas H.‐G. , Eik‐Nes S. H. , Kiserud T. , Berg S. , Angelsen B. , Olstad B.
Published: March 2003

A system for high‐resolution three‐dimensional imaging of small structures has been developed, based on the Vingmed CFM‐800 annular array sector scanner with a 7.5‐MHz transducer attached to a PC‐based TomTec Echo‐Scan unit. A stepper motor rotates the transducer 180° and the complete three‐dimensional scan consists of 132 two‐dimensional images, video‐grabbed and scan‐converted in to a regular volumetric data set by the TomTec unit. Three normal pregnancies with embryos of gestational age 7, 9 and 10 weeks received a transvaginal examination with special attention to the embryonic/fetal brain. In all three cases, it was possible to obtain high‐resolution images of the brain cavities. At 7 weeks, both hemispheres and their connection to the third ventricle were delineated. The isthmus rhombencephali could be visualized. At 9 weeks, the continuous development of the brain cavities could be followed and at 11 weeks the dominating size of the hemispheres could be depicted. It is concluded that present ultrasound technology has reached a stage where structures of only a few millimeters can be imaged in vivo in three‐dimensions with a quality that resembles the plaster figures used in embryonic laboratories. The method can become an important tool in future embryological research and also in the detection of early developmental disorders of the embryo. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Resolution of unilateral fetal hydrothorax with associated non‐immune hydrops after intrauterine thoracentesis
Authors: Aguirre O. A. , Finley B. E. , Ridgway L. E. , Bennett T. L. , Cowles T. A.
Published: March 2003

Congenital hydrothorax has been successfully managed in utero by two different treatment modalities: thoracentesis and pleuroamniotic shunting. Unfortunately, there is a paucity of data as to which method is better for the management of this problem. This case report supports the use of thoracentesis as the initial procedure for primary fetal hydrothorax. We report a pregnancy complicated by primary fetal hydrothorax with non‐immune hydrops that completely resolved after two thoracenteses in the early third trimester. Complete resolution was maintained throughout pregnancy without the need for further antenatal or neonatal intervention, i. e. further thoracentesis, pleuroamniotic shunt placement, intubation, or chest and/or abdominal tube placement. The child was delivered at 42 weeks and is doing well without problems at 1 year of age. We believe that intrauterine thoracentesis should be the initial procedure of choice for the treatment of primary fetal hydrothorax with mediastinal shaft, and pleuroamniotic shunting should be reserved for cases that require repetitive thoracenteses. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Natural history of trisomy 21 fetuses with increased nuchal translucency thickness
Authors: Pandya P. P. , Snijders R. J. M. , Johnson S. , Nicolaides K. H.
Published: March 2003

Increased fetal nuchal translucency thickness at 10–14 weeks of gestation can identify 80% of trisomy 21 pregnancies. However, a potential disadvantage of screening in the first trimester of pregnancy is that earlier screening preferentially identifies those chromosomally abnormal pregnancies that are destined to miscarry. In this study, we report on the outcome of six fetuses with increased nuchal translucency thickness and trisomy 21 whose parents chose to continue with the pregnancy. During the second trimester, the nuchal translucency resolved in five of the cases and in one it evolved into nuchal edema. Therefore, resolution of translucency with advancing gestation is not indicative of a normal karyotype. All pregnancies resulted in live births, suggesting that increased nuchal translucency does not necessarily identify those trisomic fetuses that are destined to die in utero. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Diagnosis of fetal anemia with Doppler ultrasound in the pregnancy complicated by maternal blood group immunization
Authors: Mari G. , Adrignolo A. , Abuhamad A. Z. , Pirhonen J. , Jones D. C. , Ludomirsky A. , Copel J. A.
Published: March 2003

We investigated whether Doppler measurement of the fetal middle cerebral artery peak systolic velocity can be used to detect fetal anemia in pregnancies complicated by maternal blood group immunization. We first studied normal values for the middle cerebral artery peak systolic velocity in 135 fetuses (Group A), and also in 23 fetuses at risk for anemia who underwent 56 cordocenteses to assess the fetal hematocrit (Group B). A test to detect fetal anemia, based on the middle cerebral artery peak systolic velocity, was developed by using the data of the fetuses of Group A and Group B. Successively, the middle cerebral artery peak systolic velocity was prospectively determined in 16 fetuses at risk for anemia who underwent 42 cordocenteses (Group C) to assess the test developed, in a multicenter prospective fashion, by using the data of Group A and Group B.

In the normal fetuses an exponential model expressed the increase of the middle cerebral artery peak systolic velocity values with advancing gestation. By using the data of the fetuses of Group A and Group B, four zones of anemia risk were identified. In Group C, none of the anemic fetuses had the middle cerebral artery peak velocity below the normal mean value, whereas all of the anemic fetuses had the peak velocity above the normal mean.

The middle cerebral artery blood velocity increases with advancing gestation and is a non‐invasive method of detecting anemia in pregnancies complicated by maternal blood group immunization. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
An adjustable fetal weight standard
Authors: Gardosi J. , Mongelli M. , Wilcox M. , Chang A.
Published: March 2003

The monitoring of fetal weight is an important aspect of antenatal care. To construct an individually adjustable standard, we developed a model to link the predicted birth weight to a fetal weight curve which outlines how this weight is to be reached in an uncomplicated pregnancy. A formula was derived which describes the median fetal weight at each gestation as a proportion of the optimal term weight, and also defines the 90th and 10th centile curves as normal limits.

We analyzed a birth weight database of 38 114 singleton, routine ultrasound‐dated pregnancies resulting in term deliveries. By stepwise multiple regression analysis, we derived coefficients for the factors that act as variables on term birth weight in our population. Apart from gestational age and sex, the maternal height, weight at first visit, ethnic group, parity and smoking all have significant and independent effects on birth weight. The variation due to ethnic group appears to be physiological in this population. Smoking is associated with a reduction in birth weight, which is independent of maternal physique and related to the number of cigarettes per day as reported at the first visit.

We have developed a software program which calculates, on the basis of pregnancy variables entered at the first visit, an adjusted normal range for fetal size. This can be printed out as a chart and used for antenatal surveillance of growth. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal sonographic diagnosis of a vein of Galen aneurysm: relevance of associated malformations for timing and mode of delivery
Authors: Dören M. , Tercanli S. , Holzgreve W.
Published: March 2003

The term ‘aneurysm of the vein of Galen’ encompasses a range of different midline arteriovenous fistula malformations. Prenatal real‐time and Doppler sonography can contribute to the differential diagnosis of fetal cerebral cystic lesions of various origins, pineal and choroid tumors, and in tracerebral hematoma. Regardless of the type of treatment, perinatal morbidity and mortality are high, often due to cardiac failure. A case of spontaneous delivery at 36 weeks of gestation by a 30‐year‐old woman presenting with a fetal aneurysm of the vein of Galen is described. As the extrauterine cardiac function was normal and a steal phenomenon was not present, expectant management was justified. Five arterial embolizations within the following 4 years were performed as a means of treating the primary lesion. Our case illustrates the fact that elective spontaneous vaginal delivery followed by serial embolization is possible in cases of arteriovenous fistula malformation without signs of cardiac insufficiency. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Fetal lateral neck cysts: early second‐trimester transvaginal diagnosis, natural history and clinical significance
Authors: Achiron R. , Yagel S. , Weissmann A. , Lipitz S. , Mashiach S. , Goldman B.
Published: March 2003

The objective of the study was to explore the natural history and clinical significance of lateral neck cysts during the early second trimester of pregnancy. A survey was conducted of pregnant women at 12–15 weeks' gestation who presented at the ultrasonographic unit between January 1991 and December 1994. During the 4‐year period, of the 1500 fetuses scanned, 42 fetuses with lateral neck cysts were detected by high‐resolution transvaginal ultrasonography. Twenty‐six of the 42 fetuses were seen to have isolated lateral neck cysts, and 16 demonstrated a combination of nuchal thickness of ≥ 4 mm and lateral neck cysts. Natural history, fetal karyotype and pregnancy outcome were compared between these two groups. None of the fetuses with isolated neck cysts had an abnormal karyotype, and all cysts resolved spontaneously at 16–20 weeks. No congenital abnormalities were found among the 26 cases. Four chromosomal abnormalities (three trisomy 21 and one monosomy XO) were detected among the 16 fetuses with combined lesions, resulting in termination of pregnancy in all. Among the remaining 12 fetuses, spontaneous resolution of the neck findings occurred between 16 and 20 weeks' gestation. The finding of isolated lateral neck cysts in the early second trimester is not associated with increased risk of aneuploidy. However, the combination with nuchal thickness of ≥ 4 mm should prompt genetic counselling and consideration of karyotyping, since this delay in maturation of the cervical jugular lymphatic communication may be associated with chromosomal aberrations. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic size of uterus and ovaries in pre‐ and postmenopausal women
Authors: Merz E. , Miric‐Tesanic D. , Bahlmann F. , Weber G. , Wellek S.
Published: March 2003

Uterine and ovarian size were measured in 765 pre‐ and postmenopausal women by transvaginal ultrasound. Of these, 263 (premenopausal, n = 155; postmenopausal, n = 108) were found to have neither uterine nor ovarian pathological findings. According to parity, premenopausal women were separated into three groups: nullipara, primipara and multipara. Postmenopausal women were separated into two groups according to years since menopause: ≤ 5 years and > 5 years since menopause.

In the premenopausal group, a parity‐related enlargement in uterine size was observed between nulliparous and parous women. After the menopause, a significant reduction in uterine size and in the corpus‐cervix ratio was observed. The reduction in uterine size was related to years since menopause. The endometrial thickness measured in the group of premenopausal women did not exceed 4 mm on day 4 and 8 mm on day 8 of the menstrual cycle; in the postmenopausal group, endometrial thickness did not exceed 5 mm (mean 3.6 mm).

In the group of premenopausal women, no parity‐related change in ovarian volume was observed. After menopause, there was an obvious reduction in ovarian volume. Between the two postmenopausal groups, there was a small but significant difference in ovarian volume. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonographic tubal patency testing using air and saline solution as contrast media in a routine infertility clinic setting
Authors: Volpi E. , Zuccaro G. , Patriarca A. , Rustichelli S. , Sismondi P.
Published: March 2003

Tubal patency testing by transvaginal sonography has been implemented in our infertility clinic since 1991. We report our experience with this technique during the last year of routine outpatient activity. A total of 154 infertile patients, including three patients on two occasions, underwent tubal patency testing by transvaginal sonography; 36 also underwent laparoscopy or hysterosalpingography, with a further three undergoing both. A detailed account of the method used to visualize the passage of air and saline through the salpinx is described. The ‘gold standard’ for tubal patency was laparoscopy. In any cases that were doubtful or if there was tubal occlusion, laparoscopy was advised.

The diagnoses by transvaginal sonography in the 154 patients consisted of: 106 with bilateral tubal patency (68.8%), 34 with unilateral tubal occlusions (22.1%), and 13 with bilateral occlusion (8.4%); one case was undiagnosed. Tubal disease was present in 2.5 out of the 36 (69.4%) patients undergoing laparoscopy or hysterosalpingography (69.4 %). The sensitivity, specificity, accuracy, positive and negative predictive values were respectively 80, 85, 82.7, 85 and 80% for the 29 patients undergoing transvaginal sonography and laparoscopy. When the number of tubes examined was considered, these values were respectively 85, 91.6, 89.3, 85 and 91.6%. No discordance was observed in the ten patients undergoing hysterosalpingography.

Demonstration of the tubal course relies on a positive contrast medium filling the tubal lumen. Air and saline were successful for this purpose. In our study, the results of tubal patency testing by transvaginal sonography were very similar to those of hysterosalpingography, but differed in about 10% of the cases from those of laparoscopy. The most difficult problem to rule out was distal tubal occlusion without hydrosalpinx. Tubal patency testing by transvaginal sonography can be used safely as a first‐step examination of tubal patency. Easy tubal passage can allow medical treatment, while a doubtful or frankly occluded salpinx should be investigated by laparoscopy. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
The lambda sign at 10–14 weeks of gestation as a predictor of chorionicity in twin pregnancies
Authors: Sepulveda W. , Sebire N. J. , Hughes K. , Odibo A. , Nicolaides K. H.
Published: March 2003

Chorionicity was prospectively determined in 369 twin pregnancies by ultrasound at 10–14 weeks of gestation. Pregnancies were classified as monochorionic if there was a single placental mass in the absence of the lambda sign at the inter‐twin membrane‐placental junction, and dichorionic if there was a single placental mass but the lambda sign was present, or the placentas were not adjacent to each other. In 81 (22%) cases, the pregnancies were classified as monochorionic and in 288 (78%) as dichorionic. Pregnancy outcome was available in 279 cases and all 63 of these pregnancies classified as monochorionic resulted in the delivery of same‐sex twins. Similarly, all 100 different‐sex pairs were correctly classified as dichorionic. These findings demonstrate the high reliability of ultrasound examination at 10–14 weeks of gestation in determining chorionicity in twin pregnancies. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
In utero diagnosis of infra‐diaphragmatic total anomalous pulmonary venous return
Authors: Wessels M. W. , Frohn‐Mulder I. M. E. , Cromme‐Dijkhuis A. H. , Wladimiroff J. W.
Published: March 2003

This report describes the diagnosis of infra‐diaphragmatic total anomalous pulmonary venous return in a fetus at 25 weeks of gestation. Abnormal venous pathways were visualized with real‐time, pulsed and color Doppler ultrasound. The growth of cardiac structures, especially the left ventricle, was evaluated during subsequent ultrasound examinations. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Conotruncal anomalies in prenatal life
Authors: Paladini D. , Rustico M. , Todros T. , Palmieri S. , Gaglioti P. , Benettoni A. , Russo M. G. , Chiappa E. , D'Ottavio G.
Published: March 2003

This retrospective multicenter study represents an analysis of the intrauterine determinants of the prognosis for conotruncal anomalies. Data regarding reason for referral, presence of chromosomal or extracardiac anomalies, pregnancy and surgical outcome were recorded in 67 cases of conotruncal anomalies from three Italian referral units.

Chromosomal aberrations affected 11 of the 60 (18.3%) fetuses in which a karyotype was available. Extracardiac malformations were present in 25/67 cases (37.3%). No chromosomal anomalies were present in fetuses with complete or corrected transposition of the great arteries. However, tetralogy of Fallot and double‐outlet right ventricle were associated with chromosomal anomalies in 22% and 38% of cases, respectively, and with extracardiac anomalies in 45% and 46% of cases, respectively. Only 20 of the 67 (31%) cardiac malformations were associated with an abnormal four‐chamber view. There were 28 (41.7%) terminations of pregnancy, six (8.9%) intrauterine deaths and 16 (23.8%) neonatal deaths. Seventeen neonates (25.3 %) are currently alive, and 15 of these have undergone reparative surgery.

The prognosis of conotruncal anomalies is poorer when the condition is diagnosed in utero. This is mainly due to the frequent association with chromosomal and/or extracardiac anomalies, often leading to intrauterine or early neonatal death. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Atresia or absence of the left‐sided atrioventricular connection in the fetus: echocardiographic diagnosis and outcome
Authors: Allan L. D. , Anderson R. H. , Cook A. C.
Published: March 2003

Our objective was to describe the appearance of atresia of the left‐sided atrioventricular valve on the four‐chamber view of the fetal heart. Twenty‐four cases of atresia of the left‐sided atrioventricular connection were detected over a 2 year period. Cases were analyzed according to the appearance of the four‐chamber view and the connections of the great arteries.

All cases were referred because the left‐sided ventricle was smaller than the right. There were five different groups of cardiac anomaly detected. Associated findings varied according to the diagnostic group.

It was concluded that it is possible to identify atresia of the left‐sided atrioventricular connection accurately during obstetric ultrasound examination by evaluation of the four‐chamber view. However, the appearance of this view varies with the diagnosis. Each diagnostic group has different implications in terms of associated extracardiac malformations and postnatal management. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Doppler ultrasonography in suspected intrauterine growth retardation: a randomized clinical trial
Authors: Nienhuis S. J. , Vles J. S. H. , Gerver W. J. M. , Hoogland H. J.
Published: March 2003

A randomized clinical trial was performed to test the hypothesis that if suspected intrauterine growth retardation (IUGR) is associated with normal umbilical artery Doppler ultrasound findings, hospitalization can safely be avoided.

One hundred and fifty women with singleton pregnancies and suspected IUGR were randomized between an intervention (n = 74) and a control group (n = 76). In the intervention group, clinicians were strongly requested not to hospitalize for suspected IUGR if the Doppler findings were normal. ln the control group, the Doppler results were not revealed and the participants received the standard management for suspected IUGR. Endpoints of the trial were: costs in terms of hospitalization, perinatal outcome, neurological development, and postnatal growth.

Duration of hospitalization was significantly shorter in the intervention group than in the control group. Contrary to expectations, the hospitalization rate during pregnancy in the intervention group was not below that of the control group. This negative finding was partly due to the admission of patient in the intervention group despite their normal Doppler results. Moreover, the trial might have induced a more critical attitude towards hospitalization in suspected IUGR, decreasing admission in the control group. No clear differences were found in perinatal outcome, neurological development, or postnatal growth.

The results suggest that normal umbilical artery Doppler findings in suspected cases of IUGR justify outpatient management. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Ductus arteriosus‐dependent pulmonary circulation secondary to cardiac malformations in fetal life
Authors: Mielke G. , Steil E. , Kendziorra H. , Goelz R.
Published: March 2003

The objective of this study was to describe the characteristic prenatal findings of a ductus arteriosus‐dependent pulmonary circulation secondary to cardiac malformations. B‐mode, color and pulsed wave Doppler echocardiography were performed in seven fetuses with severe pulmonary stenosis or atresia. All findings were confirmed postnatally by echocardiography and cardiac catheterization or autopsy.

Severe fetal pulmonary stenosis or atresia was characterized by decreased pulmonary valve diameters, frequently with reduced pulmonary artery diameters, increased flow velocities or absent flow across the stenotic pulmonary valve, increased ascending aorta diameters, slightly increased aortic velocities and normal umbilical and middle cerebral artery Doppler wave forms. 112 all cases, prenatal assessment of neonatal ductus dependence was possible by demonstrating reverse flow across the fetal ductus with peak systolic velocities ranging from 0.9–2.0 m/s and absent diastolic flow. Ductal diameters were slightly decreased, ranging from 2–4 mm.

Prenatal detection of a ductus‐dependent pulmonary circulation is a strong indication of the presence of severe pulmonary stenosis or atresia. Its diagnosis allows avoidance of maternal administration of drugs with constrictive effects upon the ductus, interdisciplinary planning of perinatal management, early postnatal confirmation of the diagnosis, and early postnatal intervention, in particular administration of prostaglandins to prevent life‐threatening ductal closure. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Comparison of long‐term psychological responses of women after pregnancy termination due to fetal anomalies and after perinatal loss
Authors: Salvesen K. Å. , Øyen L. , Schmidt N. , Malt U. F. , Eik‐Nes S. H.
Published: March 2003

The objective of the study was to compare psychological responses of women following a pregnancy termination due to ultrasound‐detected fetal anomalies (ultrasound group) with the psychological responses of women following a late spontaneous abortion or a perinatal death (perinatal loss group). The assessments, which were performed on four occasions in the year after the life event, included Montgomery and Asberg Depression Rating Scale, Goldberg General Health Questionnaire, Impact of Event Scale, State‐Trait Anxiety Inventory and Schedule for Recent Life Events. In the acute phase, a few days after the life event, the women in the ultrasound group reported statistically significantly less depressive symptoms and less intrusion and avoidance symptoms than the perinatal loss group. No differences in psychological responses in the two groups were found at the examinations at approximately 7 weeks, 5 months or 1 year. A statistically significantly higher proportion of women in the ultrasound group reported that they had tried to become pregnant in the following year. A few subjects in each group reported persisting high psychological distress throughout the year, but only one woman fulfilled the criteria of a post‐traumatic stress disorder. It is concluded that the long‐term psychological stress response in women to pregnancy termination following ultrasonographic detection of fetal anomalies does not differ from the stress responses seen in women experiencing a perinatal loss. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Application of transvaginal and abdominal three‐dimensional ultrasound for the detection or exclusion of malformations of the fetal face
Authors: Merz E. , Weber G. , Bahlmann F. , Miric‐Tesanic D.
Published: March 2003

In a total of 618 pregnant women between 9 and 37 weeks' gestation, the fetal face was evaluated by two‐dimensional and three‐dimensional ultrasound imaging as part of a level III screening evaluation for fetal anomalies. A three‐dimensional endovaginal probe (5 MHz) was used for examinations at between 9 and 15 weeks, and an abdominal three‐dimensional probe (3.5 MHz) was used after 15 weeks. Three different three‐dimensional image display modes were employed: (1) the orthogonal display; (2) the surface display; and (3) the transparent display.

When we studied the three‐dimensional orthogonal displays in 125 cases evaluated by abdominal ultrasound, we found that the facial profile shown in the two‐dimensional image represented the true mid‐sagittal profile in only 69.6% of cases. In the remaining 30.4%, the profile view deviated from a true mid‐sagittal section by up to 20° in one or two planes.

In a total of 25 facial anomalies detected by abdominal ultrasound, 20 were clearly demonstrated by both two‐dimensional and three‐dimensional technology. In the remaining five cases, three‐dimensional ultrasound revealed or confirmed an additional defect or abnormality: a narrow cleft lip in an unfavorable position of the fetal face (n = 2), a unilateral orbital hypoplasia (n = 1), a cranial ossification defect (n = 1) and a flat profile in the presence of marked oligohydramnios (n = 1).

When transvaginal scanning was used, there were cases in which a detailed surface image of the fetal face could be obtained as early as 9 weeks' gestation. Abdominal scanning routinely yielded high‐quality surface images by 20 weeks. Three‐dimensional ultrasound consistently displayed facial abnormalities with greater accuracy and clarity than conventional two‐dimensional imaging. This particularly applied to chromosomal aberrations and syndromes associated with subtle facial abnormalities requiring a detailed evaluation.

Not only does three‐dimensional ultrasound help in appreciating the severity of a fetal defect, but it can also provide more convincing evidence of a normal fetus than conventional two‐dimensional sonograms. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Doppler findings in chronic ectopic pregnancy: case report
Authors: Abramov Y. , Nadjari M. , Shushan A. , Prus D. , Anteby S. O.
Published: March 2003

Chronic ectopic pregnancy is an uncommon form of tubal pregnancy manifested as a pelvic mass with minimal symptoms and a low or absent titer of human chorionic gonadotropin. For this reason, most of the reported cases have been diagnosed only after explorative laparotomy. The value of Doppler ultrasonography for preoperative diagnosis of this entity has not yet been established. We report on a 36‐year‐old patient who was admitted for intermittent right lower quadrant abdominal pain of 3 months' duration, and a right adnexal mass found on pelvic examination. On Doppler ultrasonography, a right complex adnexal mass was demonstrated, characterized by extensive external vascularization, aberrant vessels and arteriovenous shunting, but with no internal blood flow. Explorative laparotomy revealed a right tubal mass adherent to the omentum, and covered by numerous enlarged and tortuous blood vessels originating in the omentum. Pathological examination of the mass revealed a chronic ectopic pregnancy. The possible contribution of Doppler‐specific characteristics for the diagnosis of chronic ectopic pregnancy is described and discussed. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Dilated coronary sinus in the fetus: misinterpretation as an atrioventricular canal defect
Authors: Park J. K. , Taylor D. K. , Skeels M. , Towner D. R.
Published: March 2003

The ostium of the coronary sinus opens directly into the right atrium in close proximity to the insertion of the atrioventricular valves. If the coronary sinus is dilated, it can create the appearance of an atrioventricular canal defect in the fetal echocardiographic four‐chamber view. The diagnosis of a serious heart lesion, such as a canal defect, necessitates decisions regarding pregnancy termination or optimal timing/location of delivery. We present three women who were referred at 23, 36 and 38 weeks' gestation with a preliminary diagnosis by level II ultrasound of a fetal atrioventricular canal defect. In each patient, the targeted fetal echocardiogram demonstrated a dilated coronary sinus and no evidence of an atrioventricular canal defect. The fetal echocardiographic presentation of a dilated coronary sinus can be mistaken for an atrioventricular canal defect. Misdiagnosis can be avoided by utilizing both variable angulation in the four‐chamber projection and additional transducer views to confirm an intact atrioventricular septum and two normal atrioventricular valves. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal ultrasonographic detection of the tracheal atresia sequence
Authors: Kassanos D. , Christodoulou C. N. , Agapitos E. , Pavlopoulos P. M. , Pagalos N.
Published: March 2003

We report on a rare case of tracheal atresia, without fistula, in a 29 weeks' female fetus. The abnormality was detected by prenatal ultrasonography, which demonstrated a bilateral and uniform hyperechogenicity and enlargement of the lungs, associated with ascites and moderate oligohydramnios. We suggest that oligohydramnios may be helpful in distinguishing the upper respiratory tract obstruction from congenital cystic adenomatoid malformation of the lungs, type III. A morphometric study revealed a three‐fold more dense pulmonary vasculature in comparison with two control cases of the same gestational age. The pathological finding of pulmonary and vascular hyperplasia as well as the pathophysiology of the syndrome are discussed. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Human fetal right ventricular ejection force under abnormal loading conditions during the second half of pregnancy
Authors: Rasanen J. , Debbs R. H. , Wood D. C. , Weiner S. , Weil S. R. , Huhta J. C.
Published: March 2003

Our objective was to determine whether abnormal loading conditions can modify human fetal right ventricular ejection force during the second half of pregnancy. By Doppler echocardiography, we studied 73 normal fetuses between 19 and 41 weeks of gestation, 27 fetuses with hypoplastic left heart syndrome (chronic volume overload) between 18 and 38 weeks of gestation, 14 fetuses with mild to moderate constriction of the ductus arteriosus (pulsatility index (PI) between 1.0 and 1.9) and seven fetuses with severe constriction (PI < 1.0) or occlusion of the ductus arteriosus (relatively acute pressure overload) between 28 and 34 weeks of gestation. In the normal and ductal constriction/occlusion groups, blood velocity waveforms were recorded at the level of the aortic and pulmonary valves, and in the group with hypoplastic left heart syndrome at the level of the pulmonary valve. The ventricular ejection forces were calculated.

In the normal group, right (RVEF; r = 0.91, p < 0.0001) and left (LVEF; r =: 0.86, p < 0.0001) ventricular ejection forces increased and were equal during the second half of gestation. In the group with hypoplastic left heart syndrome the RVEF increased (r = 0.76, p < 0.0001) with advancing gestation. The RVEF (p < 0.0005) and its average weekly increase (p < 0.0001) were greater in the hypo plastic left heart syndrome group than in the normal group. In the group with mild to moderate ductal constriction, both ventricular ejection forces were similar to those of the normal group. The RVEF (p < 0.003) and its average weekly increase (p < 0.03) were lower in the group with severe ductal constriction or occlusion than in the normal group. The LVEF did not differ from that of the normal group.

We conclude that chronic volume overload increases and relatively acute pressure overload decreases human fetal RVEF. The right ventricular performance is modified by abnormal loading conditions. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Fetal inguinoscrotal hernia: sonographic diagnosis and obstetric management
Authors: Kesby G. , BeiLby R. , Petroni M.
Published: March 2003

Fetal inguinal hernia is a rare antenatal diagnosis. We present the sonographic features and outcome of a fetus diagnosed at 36 weeks' gestation as having an (indirect) inguinoscrotal hernia. Sonographic criteria for antenatal diagnosis are discussed within the context of differential diagnoses raised by the presence of a perineal mass. Guidelines for obstetric management and counselling are suggested. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic evaluation of intervillous flow in early pregnancy: use of echo‐enhancement agents
Authors: Simpson N. A. B. , Nimrod C. , De Vermette R. , Leblanc C. , Fournier J.
Published: March 2003

The uteroplacental circulation of the cynomolgus monkey was examined in early pregnancy using a high‐resolution ultrasound scanner. Intravenous injection of an echo‐contrast agent, Albunex (sonicated albumin), was used to enhance the color Doppler images obtained. The flow of blood into and out of the intervillous compartment was readily assessed and quantified using pulsed and color Doppler. Flow within the intracotyledonary space was pulsatile and indicative of a low‐resistance system. Flow within the decidual veins was non‐pulsatile. The use of echo‐contrast agents may assist in the determination of intervillous flow in human pregnancy at a correspondingly early stage. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The effect of nuchal cord on nuchal translucency measurement at 10–14 weeks
Authors: Schaefer M. , Laurichesse‐Delmas H. , Ville Y.
Published: March 2003

The aim of this study was to determine the incidence of nuchal cord and its possible effect on nuchal translucency thickness at 10–14 weeks' gestation. Out of 316 consecutive pregnancies in which nuchal translucency thickness was measured transabdominally, 26 (8.23%) fetuses were shown to have the umbilical cord around the neck. The umbilical cord can be measured together with the nuchal translucency thickness when it passes around the fetal neck and this adds a mean of 0.8 mm to the actual translucency measurement. After the thickness of the cord was subtracted, the measurements of nuchal translucency thickness did not differ from those in the overall population studied. Of the 22 fetuses available for follow‐up, a nuchal cord was found in only one at 20 weeks and in none at delivery. Our findings indicate that the presence of a nuchal cord may bias the results of fetal nuchal translucency measurement and that the use of color Doppler might decrease the false‐positive rate in screening for fetal aneuploidy by nuchal translucency measurement at 10–14 weeks' gestation. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The second‐trimester fetal iliac angle as a sign of Down's syndrome
Authors: Shipp T. D. , Bromley B. , Lieberman E. , Benacerraf B. R.
Published: March 2003

Objective

To determine whether the iliac angle of second‐trimester fetuses is a useful sonographic marker for the detection of fetuses with Down's syndrome.

Methods

We prospectively measured the iliac angle for all fetuses karyotyped over a 17‐month period. A transverse view of the upper fetal pelvis was obtained at the time of amniocentesis and, by means of a protractor, the angle between the two iliac bones was measured. The angles of all those fetuses with Down's syndrome and the first 500 fetuses with normal karyotypes were compared, as was gestational age and maternal age.

Results

Nineteen fetuses with Down's syndrome and 1167 fetuses with normal karyotypes underwent genetic amniocentesis over the study period. The mean gestational age of the fetuses with Down's syndrome was 16.6 weeks (± 1.9 weeks), and for the controls, 16.1 weeks (± 1.4 weeks) (p = 0.3). The mean maternal ages were 34.7 years (± 4.8 years) and 35.4 years (± 4.1 years) for those pregnancies with Down's syndrome and with normal karyotypes, respectively (p = 0.5). The mean iliac angle was 80.1° (± 19.7°) for those fetuses with Down's syndrome, and 63.1°(± 20.3°) for those fetuses with normal karyotypes (p = 0.0004). The iliac angle was at least 90° in 36.8% (seven of 19 fetuses) with Down's syndrome and in 12.8% (64 of 500 fetuses) with normal karyotypes (p = 0.003).

Conclusion

Fetuses with Down's syndrome have a significantly larger iliac angle than fetuses with normal karyotypes. Use of an iliac angle cut‐off point of 90° would identify over one‐third of second‐trimester fetuses with Down's syndrome. However, because of the high false‐positive rate (12.8%), the iliac angle is not useful in a high‐risk population as a screening test when used in isolation. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Cost issues surrounding the use of computerized telemedicine for obstetric ultrasonography
Authors: Malone F. D. , Athanassiou A. , Craigo S. D. , Simpson L. L. , D'Alton M. E.
Published: March 2003

Objective

The purpose of this study was to describe the cost implications of converting an established videotape review network for obstetric ultrasonography to one based on telemedicine technology.

Design

Retrospective review of fixed and non‐fixed costs associated with interpreting obstetric ultrasound examinations using both videotape and telemedicine transmission.

Subjects

A network of three community offices transmitting 600 obstetric ultrasound examinations per month to a central tertiary level facility.

Methods

Sonographers at the community offices record ultrasound examinations onto videotape, which are then sent by courier to a central facility for interpretation. At the completion of this videotaped examination, sonographers repeat the ultrasound scan while transmitting real‐time images over a telemedicine link to the central facility. Costs associated with the videotape review technique that can be avoided by converting to telemedicine interpretation were derived and compared with the fixed and non‐fixed costs associated with establishing the telemedicine network.

Results

For this network, the fixed costs for establishing telemedicine are $101 750. Monthly non‐fixed cost savings by eliminating videotape review include $1620 to $2700 for printing still images, $1200 for courier charges and $7000 for fewer repeat ultrasound examinations. Monthly non‐fixed costs for the telemedicine network are $2415. Net monthly savings in non‐fixed costs for a telemedicine network are therefore $7405 to $8585, which may pay for the initial fixed costs in 12 to 14 months.

Conclusions

The high cost of a telemedicine network may be offset by possible savings in non‐fixed costs compared with alternative systems for interpreting obstetric ultrasonography. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Screening for Down's syndrome by fetal nuchal translucency measurement in a high‐risk population
Authors: Pajkrt E. , Mol B. W. J. , van Lith J. M. M. , Bleker O. P. , Bilardo C. M.
Published: March 2003

Objective

To examine the discriminative capacity of nuchal translucency measurement in the detection of trisomy 21 and other chromosomal anomalies.

Design

Prospective cohort study.

Subjects

A total of 2247 women with viable singleton pregnancies between 10 and 14 weeks' gestation attending a prenatal diagnosis center for fetal karyotyping.

Methods

The fetal nuchal translucency was measured transabdominally in all women before invasive prenatal testing.

Results

Chromosomal abnormalities were found in 63 fetuses, including 36 with Down's syndrome. The likelihood of the presence of chromosomal abnormalities increased with larger nuchal translucency thickness. A nuchal translucency of 3 mm or more identified 25 out of 36 fetuses (69%) with trisomy 21 at the expense of a 4.0% false‐positive rate. Correction of nuchal translucency measurements for differences due to variation of the measurement with gestational age, either by using the ‘delta‐value’ or multiples of the median (MoM), did not improve the detection rate in our patient data set.

Conclusions

The discriminative capacity of nuchal translucency measurement makes it a useful tool in screening for trisomy 21 and other chromosomal anomalies. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal diagnosis of velamentous umbilical cord insertion and vasa previa with color Doppler imaging
Authors: Nomiyama M. , Toyota Y. , Kawano H.
Published: March 2003

Objective

To determine whether cord insertion can be consistently visualized and whether velamentous cord insertion and vasa previa can be consistently identified with color Doppler imaging during routine sonography in the mid‐trimester.

Design

A prospective study.

Subjects

A total of 587 fetuses at 18–20 weeks' gestation.

Methods

During routine ultrasound examinations, the sonographer was instructed to take additional time and to image the placental cord insertion with color Doppler imaging and classify this as normal, velamentous or ‘not seen’. When the insertion was velamentous, the sonographer was instructed to indicate whether or not it was vasa previa. The sonogram obtained at 18–20 weeks' gestation was used for comparison with outcome data.

Results

Cord insertion was visualized by color Doppler imaging in 99.8% (586/587) of the fetuses in our study. The mean time required for examination was 20 s and, in 95% of the cases, cord insertion was visualized within 1 min. The sonographic identification of velamentous cord insertion had a sensitivity of 100% (5/5), a specificity of 99.8% (580/581), a positive predictive value of 83% (5/6) and a negative predictive value of 100% (580/580). In our study, vasa previa was diagnosed at 18 gestational weeks in two cases and, in one of the cases, vasa previa was confirmed at delivery.

Conclusions

We could consistently identify cord insertion and velamentous cord insertion with color Doppler imaging during routine sonography in the mid‐trimester. Transvaginal color Doppler imaging and serial scans were needed to identify vasa previa. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Definitive diagnosis of intestinal volvulus in utero
Authors: Yoo S.‐J. , Park K. W. , Cho S. Y. , Sim J. S. , Hhan K. S.
Published: March 2003

Midgut volvulus with or without intestinal malrotation can occur in fetal life. Several reports have described congenital midgut volvulus showing non‐specific sonographic findings of intestinal obstruction and perforation in utero. None of the previously reported cases, however, were definitively diagnosed as midgut volvulus by fetal sonography. We report two cases both exhibiting the sonographic ‘whirlpool’ sign, in utero. Color Doppler interrogation provided a clue to the viability of the involved intestinal segment. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Gastroschisis associated with bladder evisceration complicated by hydronephrosis presenting antenatally
Authors: Ikhena S. E. , de Chazal R. C. , Konje J. C.
Published: March 2003

We report here a case of gastroschisis associated with bladder evisceration and complicated by rapidly developing hydronephrosis diagnosed antenatally. The timing of delivery was determined by the hydronephrosis, associated bowel dilatation and polyhydramnios. The case highlights the need for continuing ultrasonographic surveillance of fetuses with gastroschisis to identify further associated complications which were hitherto absent but whose presence may influence the timing of delivery and neonatal care. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Hormonal replacement therapy and urinary problems as evaluated by ultrasound and color Doppler
Authors: Battaglia C. , Salvatori M. , Giulini S. , Primavera M. R. , Gallinelli A. , Volpe A.
Published: March 2003

Objective

To determine how hormone replacement therapy modifies bladder vascularization and urinary symptoms.

Study design

Twenty‐eight postmenopausal women with urinary symptoms (day‐time frequency > 8; nocturia > 1; urgency and/or dysuria) were analyzed before and after 1, 3 and 6 months of hormone replacement therapy. The patients underwent transvaginal ultrasound evaluation of the pelvic organs and endometrial and bladder wall thickness. Transvaginal color Doppler analysis of blood flow impedance of the uterine and intramural bladder wall arteries was performed in all cases.

Results

Hormone replacement therapy significantly increased bladder wall and endometrial thickness. This result was associated with significant improvements in uterine and bladder wall vascularization. Urinary symptoms also improved during therapy.

Conclusion

The study of bladder wall thickness and vascularization provides additional information regarding the beneficial effect of hormone replacement therapy on lower urinary tract symptoms in postmenopausal women. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Double‐outlet right ventricle: an antenatal diagnostic dilemma
Authors: Smith R. S. , Comstock C. H. , Kirk J. S. , Lee W. , Riggs T. , Weinhouse E.
Published: March 2003

Objective

The purpose of this study was to describe the antenatal ultrasonographic findings of fetuses with double‐outlet right ventricle (DORV).

Design

The records were reviewed of all fetuses scanned in our ultrasound unit which were suspected of having DORV during a 6‐year period ending in April 1996. A medical record search for all infants with a postnatal diagnosis of DORV was also undertaken to identify cases that were not detected antenatally. Records were examined to determine the accuracy of antenatal diagnosis and the reasons for diagnostic errors. Fetuses without follow‐up were excluded.

Results

There were 20 fetuses with antenatally detected conotruncal defects that had DORV included in the differential diagnosis. Three fetuses were excluded, seven did not have DORV and ten were confirmed postnatally as having DORV. Two additional infants were found to have DORV from the medical record search, producing a total of 12 cases. Antenatal sonographic cardiac findings included malpositioned (overriding or transposed) great arteries (n = 11), ventricular septal defect (n = 11) and small pulmonary artery suggesting stenosis (n = 4). Confirmed post‐natal cardiac findings that were missed antenatally included aortic coarctation (n = 2), right‐sided aortic arch (n = 2) and pulmonary stenosis (n = 1). Seven of the 12 fetuses had extracardiac findings. Nine of the 12 fetuses tested had a normal karyotype. Eleven of the 12 infants were liveborn. Nine of these 11 survived the neonatal period and underwent surgical repair within the first year of life; two subsequently died. In total, seven fetuses survived and five did not.

Conclusion

Most fetuses with DORV can be identified antenatally as having an abnormal heart. However, it is very difficult to distinguish this particular defect from other conotruncal abnormalities. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology