bluuebunny/crossref_metadata_2025 huggingface dataset:
Placenta previa percreta with bladder involvement: new considerations and review of the literature
Authors: Silver L. E. , Hobel C. J. , Lagasse L. , Luttrull J. W. , Platt L. D.
Published: March 2003

Placenta previa percreta is a life‐threatening condition. Antenatal diagnosis is important to establish and to optimize a plan of management. When bladder invasion occurs, other potential complications can result, including massive hemorrhage and the development of disseminated intravascular coagulation. Numerous modalities have been used successfully to treat these patients, but hysterectomy at delivery is the treatment most commonly used.

A case of placenta previa percreta with suspected bladder invasion was diagnosed in a 35‐year‐old woman by routine office ultrasound examination at 19 weeks 6 days' gestation. She was managed conservatively until 36 weeks 3 days' gestation, at which time she underwent a modified classical Cesarean section after amniocentesis to confirm fetal lung maturity. The placenta was left in situ immediately postpartum. The patient underwent a prophylactic embolization of her hypogastric arteries and received methotrexate chemotherapy. Eight weeks later, she developed a low‐grade coagulopathy and underwent a total abdominal hysterectomy.

Conservative management intrapartum is thought to be appropriate, to avoid the risk of severe hemorrhage at the time of delivery. However, elective hysterectomy ought to be considered earlier (2–4 weeks postpartum) than the time suggested in the literature, to avoid the development of further complications, including coagulopathy. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
In vitro demonstration of inhibition of retrograde flow in the human umbilical vein
Authors: Potter P. L.
Published: March 2003

This study was designed to investigate the apparent inhibition of retrograde flow in umbilical veins. While flushing fluid through cord veins for another study it appeared that there existed an impedance to retrograde flow. Simple hydraulic flow and Doppler ultrasound were used to evaluate this observation. First, in vitrostudies were carried out on 100 normal umbilical cords to measure the time it took fluid to flow forward through a 30‐cm segment of umbilical vein. These data were then compared to the time required for flow in the opposite direction. The average time was 8.84 s in the antegrade direction and 9.97 s in the retrograde direction. This difference was statistically significant with a p‐value of < 0.001. To evaluate this observation under more controlled conditions the second phase of the study was conducted. During phase two, umbilical cords were collected from term uncomplicated pregnancies. Doppler test fluid was pumped through the cord at a rate based on newborn weight. The volume and velocity were measured in both directions by Doppler ultrasound. Average flow volume was 369.1 ml/min in the antegrade direction and 174.8 ml/min in the retrograde direction. The velocities were 9.1 cm/s and 5.5 cm/s, respectively. The difference in mean flow volume was 194.3 ml/min. The difference of the mean velocity was 3.58 cm/s. Both are statistically significant with p‐values of < 0.01. These data suggest there is an intrinsic inhibition of retrograde flow in the umbilical vein. The etiology and significance of this finding are discussed. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Reversal of diastolic flow in the middle cerebral artery of the fetus during the second half of pregnancy
Authors: Respondek M. , Woch A. , Kaczmarek P. , Borowski D.
Published: March 2003

This study obtained data on 22 fetuses in whom reversal of diastolic flow in the middle cerebral artery (MCA) was seen. In 59% of cases there was normal heart function and in 28% there was isolated tricuspid valve regurgitation. The majority (73%) of cases presented with normal fetal anatomy and most (82%) had a normal amniotic fluid index and normal fetal growth. In all cases, Doppler results of the umbilical artery and vein were normal. Of the women, 6.5% were on no medication and 73% did not smoke during pregnancy.

The reversal of diastolic flow in the MCA was seen temporarily in the majority of cases (for 2–30 min); however, in one case with rhesus factor disease and a rim of ascites, it was observed for a longer period (about 2 h) and on the following day, intrauterine demise was recorded. In most of the cases without structural malformations, the neonatal outcome was normal.

We conclude that reversed diastolic flow in the MCA is a rare and usually transient event. In one of our cases prolonged reversed flow preceded intrauterine demise. Therefore, this may be an ominous sign and careful fetal surveillance should be undertaken when this observation is made. There are a few possible pathomechanisms of reversed diastolic flow in the MCA. In the majority of cases the cause of the observed phenomenon remains unknown, but an increased pressure in the right ventricle and possible tricuspid regurgitation should be considered. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Receiver operating characteristic curves of sonographic estimated fetal weight for prediction of macrosomia in prolonged pregnancies
Authors: O'Reilly‐Green C. P. , Divon M. Y.
Published: March 2003

We evaluated areas under receiver operating characteristic curves for sonographic estimated fetal weight (EFW) as a predictor of macrosomia in prolonged pregnancies. These areas were 0.85 for birth weights of ≥ 4000 g and 0.95 for birth weights of ≥ 4.500 g. Both were significantly greater than 0.5, the area under curves for useless tests. Areas under curves before and after adjustment for time elapsed between measurement and delivery did not differ significantly. At the inflexion point cut‐off level of 3711 g, sensitivity, specificity and positive and negative predictive values of EFW for birth weight of ≥ 4000 g were 85, 72, 49 and 94%, respectively. At the inflexion point cut‐off level of 4192 g for birth weight of ≥ 4500 g: these values were 83, 92, 30 and 99%. The relative risk for birth weight of ≥ 4000 g was 7.99, and for birth weight of ≥ 4500 g, 39.50, both significant. In conclusion, sonographic EFW is a useful test for predicting macrosomia. Adjustment for time elapsed did not significantly improve either test, probably because of slow rates of fetal growth at this gestational age. Cut‐off values derived from this analysis result in high sensitivity but low positive predictive value. A randomized controlled trial of mode and timing of delivery for predicted macrosomia is needed. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Correlation of fetal frontal lobe and transcerebellar diameter measurements: the utility of a new prenatal sonographic technique
Authors: Persutte W. H. , Coury A. , Hobbins J. C.
Published: March 2003

Several authors have reported the value of the sonographic assessment of both the fetal frontal lobe and the cerebellum. Both frontal lobe shortening and cerebellar hypoplasia have been associated with fetal aneuploidy. We anecdotally observed that the distance between the calvarium and the posterior cavum septum pellucidum (frontal lobe) closely approximated the transcerebellar diameter. This study was undertaken to investigate this relationship.

Between 1 July 1994 and 1 January 1996, the frontal Lobe (posterior cavum septum pellucidum to the inner calvarium) and transcerebellar diameter were measured in patients referred to two prenatal ultrasound laboratories in Denver, Colorado., USA. All pregnancies had certain dates and were uncomplicated. Statistical comparison was completed using interval polynomial regression analysis. During the study period, we performed 221 detailed ultrasound examinations in which the frontal lobe and the transcerebellar diameter were measured. We found a correlation coefficient of 0.950 when comparing the two variables (p < 0.0001).

Some conditions (Down's syndrome, lethal trisomies and pathological microcephaly) have differential effects on the frontal lobe and the transcerebellar diameter. Our preliminary judgement is that this new technique may prove to be a useful tool in assessing the relative effect of these conditions on structural neuroanatomy. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Effect of first‐trimester nuchal translucency on second‐trimester maternal serum biochemical screening for Down's syndrome
Authors: Thilaganathan B. , Slack A. , Wathen N. C.
Published: March 2003

We evaluated the effectiveness of 10–14 week nuchal translucency measurement in routine ultrasound screening for Down's syndrome, and its effect on the sensitivity of subsequent maternal serum biochemistry. This was an observational study, in which all women attending for antenatal care at a district general hospital were routinely offered a first‐trimester nuchal translucency scan and second‐trimester quadruple maternal serum biochemistry as screening tests for Down's syndrome, The main outcome measures were abnormal fetal karyotype and the performance of screening tests.

A total of 3604 women were scanned in the first trimester of pregnancy. Excluding the cases that did not fit the entry criteria (n = 344, 9.6%) and in which nuchal translucency measurements were not possible (n = 340, 9.4%), a total of 2920 women were screened. A nuchal translucency‐derived risk of 2 : 200 for an aneuploid pregnancy resulted in a 5% (n = 147) screen‐positive rate. Screening using this risk enabled the first‐trimester detection of five of seven (71%) fetuses with trisomy 21 and 14 of 18 (78%) aneuploid fetuses. Second‐trimester maternal serum biochemistry testing was performed in 1904 of the women who had nuchal translucency screening, with a screen‐positive rate of 7.5% (n = 143). Only one extra case of Down's syndrome would have been detected by maternal serum biochemistry testing if nuchal translucency screening had been implemented at a risk level of 1 : 300.

This study demonstrates that first‐trimester nuchal translucency measurement is effective in routine screening for fetal chromosomal abnormality. Furthermore, the implementation of a nuchal translucency screening program will significantly reduce the positive predictive value of second‐trimester maternal serum biochemistry testing. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of pseudothalidomide syndrome in consecutive pregnancies of a consanguineous couple
Authors: Petrikovsky B. M. , Gross B. , Bialer M. , Solamanzadeh K. , Simhaee E.
Published: March 2003

Pseudothalidomide syndrome is a rare autosomal recessive condition characterized by tetraphocomelia, craniofacial abnormalities and postnatal growth restriction.

We report the prenatal sonographic findings of pseudothalidomide syndrome in three consecutive pregnancies of a consanguineous couple. In the last pregnancy, the correct diagnosis was made sonographically at 11 weeks of pregnancy.

The combination of transabdominal and transvaginal ultrasound examinations revealed a large cystic hygroma extending over the lower back. The lower extremities were, markedly shortened with no identifiable bones below the level of the femora. The humeri on both sides were shortened; ulnae were small with no identifiable radii. The pregnancy was terminated by dilatation and curettage and diagnosis confirmed at 12 weeks of pregnancy.

In conclusion, fetuses with pseudothalidomide syndrome may exhibit characteristic findings in the first trimester of pregnancy which can be detected using ultrasound. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic diagnosis of fetal coarctation of the aorta at 14–16 weeks of gestation
Authors: Bronshtein M. , Zimmer E. Z.
Published: March 2003

The prenatal sonographic diagnosis of coarctation of the aorta is difficult. The objective of this study was to present a simple and reliable marker of this anomaly in early pregnancy. In fetuses with coarctation of aorta who were scanned at 14–16 weeks' gestation, a significant discrepancy was observed between a large ductus arteriosus and a smaller aorta at their point of connection. This difference between the sizes of the vessels probably reflects the reduced blood flow through the aorta and the compensatory increase in blood flow through the right outflow tract in cases of coarctation of the aorta. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonographic patterns of polycystic ovaries: color Doppler and hormonal correlations
Authors: Battaglia C. , Artini P. G. , Salvatori M. , Giulini S. , Petraglia F. , Maxia N. , Volpe A.
Published: March 2003

Ultrasound has been used in the identification of two different morphological patterns of polycystic ovaries, namely a peripheral cystic pattern and a general cystic pattern. The aim of this study was to evaluate whether patients with the peripheral form of polycystic ovaries showed different ovarian and uterine blood flow from those with the general form, and to investigate whether there was a correlation between the forms and different hormonal parameters.

Eighteen patients with the general form and 16 patients with the peripheral form of polycystic ovary underwent clinical, biochemical, gray‐scale and color Doppler ultra‐sonographic evaluation. The parameters analyzed confirmed polycystic ovarian syndrome (PCOS) in all patients. Individual levels of plasma luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, andro‐stenedione and estradiol did not differ between the groups. However, there was a significantly higher LH/FSH ratio and a greater stromal echodensity in the peripheral cystic group than in the general cystic group. Doppler ultrasonography demonstrated significantly lower pulsatility index values in the intraovarian arteries of the peripheral cystic group and a higher rate of visualization of these arteries than in the general cystic group.

These findings suggest that, apart from the LH/FSH ratio, the different morphological types of polycystic ovary do not reflect differences in endocrine profile. The differences in blood flow demonstrated by Doppler assessment in each case, however, showed that PCOS does not predetermine a single intraovarian blood flow pattern. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Doppler ultrasound evaluation of ductus venosus blood flow during acute hypoxemia in fetal lambs
Authors: Tchirikov M. , Eisermann K. , Rybakowski C. , Schröder H. J.
Published: March 2003

It has been demonstrated with invasive techniques in fetal lambs that the ratio of ductus venosus to umbilical vein blood flow rate (DV/UV ratio) increases during hypoxemia and infusion of catecholamines. Recently it was found in human fetuses using pulsed wave Doppler ultrasound equipment that the DV/UV ratio in fetuses with intra‐uterine growth restriction was significantly increased. The aim of the present study was to show in fetal lambs whether routine Doppler ultrasound devices were capable of determining the DV/UV ratio with sufficient reliability.

The experiments were performed on seven near‐term instrumented fetal lambs using pulsed wave Doppler ultra‐sound to measure flow rates (derived, in milliliters per min, from the intensity‐weighted mean velocity (Vmean) and the vessel's cross‐sectional area) in the ductus venosus and intra‐abdominal umbilical vein. Fetal hypoxemia was induced by administering a low‐oxygen gas to the ewe (5–7% oxygen, 2% carbon dioxide). Fetal arterial pO2 and heart rate decreased significantly during maternal hypoxia. The proportion of umbilical venous return passing through the ductus venosus in controls was 36 ± 5% (mean ± SD). This increased to 53 ± 6% (p < 0.001) because the umbilical venous blood flow fell during late hypoxemia when the heart rate had decreased by 20%. Severe hypoxemia tended to reduce the mean velocity (Vmean) and the minimum velocity (Vmin) (based on the maximum velocity envelope curve) in the ductus venosus, descending aorta and inferior vena cava. The pulsatility index of the umbilical artery significantly increased at the end of hypoxemia. We conclude that determination of the proportion of umbilical vein blood flow entering the ductus venosus by Doppler ultrasound in a clinical setting may contribute to the detection and evaluation of fetal distress. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic demonstration of nuchal cord and abnormal umbilical artery waveform heralding fetal distress
Authors: Pilu G. , Falco P. , Guazzarini M. , Sandri F. , Bovicelli L.
Published: March 2003

Ultrasound examination of a 30‐week fetus, appropriate for gestational age, revealed a nuchal cord and absence of end‐diastolic velocities in the Doppler waveforms of the umbilical artery. Cardiotocography suggested impending fetal distress, clinically confirmed following expedient abdominal delivery. We suggest that Doppler velocimetry of the umbilical vessels may be useful in the assessment of viable fetuses with a sonographic diagnosis of a nuchal cord. Conversely, a nuchal cord should be considered as part of the differential diagnosis of abnormal Doppler velocimetry of the umbilical vessels. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis and hemodynamic evaluation of Klippel‐Trenaunay‐Weber syndrome
Authors: Paladini D. , Lamberti A. , Teodoro A. , Liguori M. , D'Armiento M. , Capuano P. , Martinelli P.
Published: March 2003

Klippel‐Trenaunay‐Weber syndrome is a rare congenital soft‐tissue anomaly which is characterized by the presence of multiple hemangiomata, arteriovenous fistulas and limb hypertrophy. We report the ultrasound findings in two cases of early prenatal diagnosis at 17 and 18 weeks of gestation. The pathogenesis of the syndrome and involvement of the cardiovascular system are discussed. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasound examination of the fetal hands: normal and abnormal
Authors: Budorick N. E. , Pretorius D. H. , Johnson D. D. , Tartar M. K. , Lou K. V. , Nelson T. R.
Published: March 2003

Purpose

To assess particular features of fetal hand evaluation using three‐dimensional ultrasound, and to determine whether any advantage is offered by three‐dimensional over two‐dimensional ultrasound in fetal hand evaluation.

Methods

Three‐dimensional fetal data were collected prospectively from 44 hands in 40 fetuses from a predominantly high‐risk patient population. All had a concurrent two‐dimensional ultrasound examination of the hands. Diagnoses from two‐ and three‐dimensional ultrasound examinations were compared and additional information from the three‐dimensional volume assessment was noted. Three‐dimensional assessment of distal forearm bones, wrist position, finger configuration and number of metacarpals and digits was recorded.

Results

Hands were appropriately identified as normal (32/32) or abnormal (12/12) by both two‐ and three‐dimensional ultrasound. Three‐dimensional ultrasound provided additional information when compared to two‐dimensional ultrasound in both normal and abnormal hands, including the provision of three orthogonal planes with one volume acquisition, allowing rotation of the volume so that hands could be evaluated in planes not possible during two‐dimensional imaging, assessment of a hand with loosely curled fingers as normal, the ability to evaluate thumb and fingers simultaneously, and improved assessment of abnormal hands.

Conclusions

Three‐dimensional ultrasound offers the potential to provide greater information in fetal hand evaluation for both normal and abnormal hands. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The efficacy and fetal‐maternal cardiovascular effects of transdermal glyceryl trinitrate in the prophylaxis of pre‐eclampsia and its complications: a randomized double‐blind placebo‐controlled trial
Authors: Lees C. , Valensise H. , Black R. , Harrington K. , Byiers S. , Romanini C. , Campbell S.
Published: March 2003

Objectives

Pre‐eclampsia continues to be a major cause of maternal and perinatal mortality. A disorder of the nitric oxide system is implicated in the pathogenesis of this condition and preliminary studies have suggested a possible therapeutic role for nitric oxide donors in women with established pre‐eclampsia. The aim of this study was to determine whether pre‐eclampsia and its complications could be prevented by the long‐term use of nitric oxide donors in a group of women identified to be at risk on the basis of abnormal uterine artery Doppler measurements.

Study design We enrolled 40 healthy normotensive women at high risk of pre‐eclampsia selected on the basis of abnormal uterine artery Doppler waveforms at 24–26 weeks of gestation. Women were randomly allocated to receive transdermal glyceryl trinitrate 5 mg‐patches or equivalent placebo patches in a double‐blind randomized study. The primary outcome measures were pre‐eclampsia, fetal growth restriction, preterm delivery or small for gestational age/fetal growth restriction rates. Patches were worn daily from recruitment for 10 weeks or until delivery.

Results

The primary outcomes were not significantly different in the placebo compared to the glyceryl trinitrate group. However, survival analysis of adverse events with gestation in both groups showed a significantly reduced risk of an adverse event in the glyceryl trinitrate group (p = 0.004), equating to a 73% reduction in hazard. There was no difference in maternal systolic and diastolic blood pressure, mean uterine artery resistance index and fetal umbilical and middle cerebral artery pulsatility indices between the groups.

Conclusions

Low‐dose prophylactic transdermal glyceryl trinitrate commenced late in the second trimester did not reduce the incidence of pre‐eclampsia, preterm delivery or fetal growth restriction, but may increase the likelihood of a complication‐free pregnancy. Transdermal glyceryl trinitrate (5 mg/day) did not affect maternal cardiovascular, uterine artery or fetal arterial Doppler parameters. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Arteriovenous malformation of mesosalpinx associated with a ‘vanishing’ ectopic pregnancy: diagnosis with three‐dimensional color power angiography
Authors: Shih J.‐C. , Shyu M.‐K. , Cheng W.‐F. , Lee C.‐N. , Jou H.‐J. , Wang R.‐M. , Hsieh F.‐J.
Published: March 2003

We describe two cases of pelvic arteriovenous malformation diagnosed with the aid of three‐dimensional color power angiography. In both cases, ß‐human chorionic gonadotropin (ß‐hCG) increased to significant levels (8413 and 1560 mIU/ml, respectively); however, neither an intrauterine nor an adnexal gestational sac could be found. In each case, we observed an adnexal mass with several tortuous areas exhibiting abundant turbulent flow. The diagnosis of arteriovenous malformation was made and further assessment by three‐dimensional color power angiography and magnetic resonance imaging (MRI) was carried out. The complex vascular anatomy of arteriovenous malformation, including its feeding vessels and drainage, was clearly depicted by three‐dimensional color power angiography and correlated well with magnetic resonance angiography. Levels of ß‐hCG decreased in subsequent tests, and eventually became negative 2–3 months later without any intervention. We believe that an involutional ectopic pregnancy induced the rapid growth of the arteriovenous malformations within the mesosalpinx. Three‐dimensional color power angiography can be performed quickly and easily, using existing ultrasound equipment. It improves our understanding of complicated vasculature, and thus is a useful adjunct to two‐dimensional and color Doppler ultrasound in the diagnosis of arteriovenous malformation. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
The value of sonohysterography combined with cytological analysis of the fluid retrieved from the endometrial cavity in predicting histological diagnosis
Authors: Aviram R. , Michaeli G. , Lew S. , Fishman A. , Beyth Y. , Bernheim J. , Tepper R.
Published: March 2003

Objective

The purpose of the study was to assess the efficacy of sonohysterography combined with cytological analysis of the fluid retrieved from the endometrial cavity in predicting histological diagnosis.

Study design A prospective study was conducted comparing sonohysterography combined with endometrial washings for cytology with histological evaluation after surgical procedures. Of 152 patients referred for sonohysterography, 87 were premenopausal and 65 were postmenopausal. Some of the injected fluid was aspirated for cytological analysis. Sixty‐one patients (40%) underwent surgical hysteroscopy and eight (5%) had dilatation and curettage as a result of the sonohysterographic findings. Histological diagnoses were compared with the sonohysterographic and cytological findings.

Results

In 99 (65%) patients, sonohysterography demonstrated endometrial polypoid lesions. Only 54 endometrial cavitary lesions were confirmed pathologically. Epithelial cells with atypia were more often found in patients without (five of 53) than in those with (two of 99) an endometrial polyp (p < 0.05). Only one out of nine cases of histological diagnosis of hyperplasia was predicted cytologically.

Conclusions

The addition of cytological analysis of the fluid retrieved from the endometrial cavity during sonohysterography did not contribute to the prediction of benign histological diagnosis of endometrial hyperplasia. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Feasibility of the second‐trimester fetal ultrasound examination in an unselected population at 18, 20 or 22 weeks of pregnancy: a randomized trial
Authors: Schwärzler P. , Senat M.‐V. , Holden D. , Bernard J. P. , Masroor T. , Ville Y.
Published: March 2003

Objective

To date, there have been no studies on the optimal timing of second‐trimester ultrasound screening for fetal abnormalities. The purpose of this study was to investigate whether, of three gestational ages (18, 20 and 22 weeks), any one was associated with a significant advantage in terms of identification of abnormalities or need for further ultrasound assessment.

Design

Prospective, randomized study of second‐trimester unselected pregnant women, who had had an ultrasound examination with normal results at 10–14 weeks.

Subjects and methods

A total of 1206 women were randomized into three mutually exclusive groups relating to their second‐trimester appointment for a screening ultra‐sound examination for fetal abnormalities in the second trimester of pregnancy: Group 1 at 18−18 + 6 weeks, Group 2 at 20−20 + 6 weeks and Group 3 at 22−22 + 6 weeks. The anomaly scans were carried out according to a standardized protocol. The fetuses were examined for structural and developmental abnormalities. Uterine artery Doppler measurements, including waveform recordings, were performed in all cases. The main end‐points were the need for rescanning of all or part of the fetal anatomy, fetal outcome, placental localization, and incidence of notches in the uterine artery waveform.

Results

The baseline demographic characteristics and risk factors in the three groups were similar and gestational age‐related fetal measurements were comparable. There were significantly higher percentages of completed scans in Group 2 (90%) and Group 3 (88%) than in Group 1 (76%; p < 0.001), but no significant difference between those scanned at 20 and at 22 weeks. This was associated with a higher incidence of non‐cephalic presentation in Group 1 (46%) than in the other two groups (36%, p < 0.001). Significant differences in completing the assessment of the thorax, heart, spine and skeleton were also observed. There was no significant difference in maternal body habitus, fetal movements or the occurrence of uterine fibroids between the study groups. The incidences of low‐lying placenta and of abnormal uterine artery Doppler screening were also higher at 18 weeks than at 20 and 22 weeks (p < 0.001 for both variables), with no difference seen between Groups 2 and 3. The numbers of fetal anomalies detected in the three groups were three, two and two, respectively; these did not differ significantly between the groups.

Conclusions

This study suggests that, in an unselected pregnant population, second‐trimester ultrasound screening is easier to perform and less likely to require an additional scan at 20–22 weeks than at 18 weeks. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Analysis of normal breast tissue and of solid breast masses using three‐dimensional ultrasound mammography
Authors: Rotten D. , Levaillant J. M. , Zerat L.
Published: March 2003

Objectives

To describe the appearance of normal breast tissue and breast masses with three‐dimensional ultrasound mammography, and evaluate the contribution of this to the diagnosis of breast masses.

Materials and methods

A total of 186 solid hypoechoic breast masses were analyzed with two‐ and three‐dimensional ultrasonography. Three‐dimensional planar reformatted sections were reconstructed along planes either orthogonal or parallel to the skin surface.

Results

With parallel planar reformatted sections all the masses tended to be round. Margins were clearly demonstrated. In case of carcinomas, circumferential jagging was present in the equatorial planes. In case of fibroadenomas, complete wall continuity of the mass was readily apparent.

The hyperechoic bands of fibrous tissue peripheral to the masses appeared either as distinct from the central image (compressive pattern) or converged towards the hypo‐echoic central core of the mass, producing a stellar pattern (converging pattern). These two patterns were preferentially associated with benign lesions and carcinomas, respectively. Three‐dimensional ultrasound mammography had higher specificity, but lower sensitivity, than two‐dimensional ultrasound mammography.

Conclusions

Three‐dimensional reconstruction, in particular parallel planar reformatted sections, represents a valuable adjunct to the characterization of breast masses using ultrasonography. Further studies are necessary to assess the validity of the present findings, particularly with regard to the rarer, more unusual types of carcinoma. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Simultaneous multigate spectral Doppler imaging of the umbilical artery and placental vessels: novel ultrasound technology
Authors: Yagel S , Anteby E. Y. , Shen O. , Cohen S. M. , Friedman Z. , Achiron R.
Published: March 2003

Objective

To establish gestational age‐specific nomograms of pulsatility indices in the umbilical artery and chorionic and intraplacental vessels, using novel ultrasound technology.

Study design

A prospective, cross‐sectional study of 160 healthy singleton pregnancies between 18 and 33 weeks of gestation.

Measurements

Using simultaneous multigate spectral Doppler imaging specialized hardware and software, we measured the flow velocity waveforms of the umbilical artery, chorionic and intraplacental vessels. Computerized automatic mapping calculated the pulsatility indices in regions of interest.

Results

Data were adequately obtained for 160 fetuses. The pulsatility index values in the three sites measured decreased with advancing gestational age; the correlation coefficients r = −0.74, r = −0.67 and r = −0.68 for the umbilical artery, chorionic and intraplacental vessels, respectively, were found to be highly statistically significant (p < 0.0001).

Conclusion

Simultaneous multigate spectral Doppler imaging provides simultaneous measurements of the velocity waveforms in the umbilical artery, chorionic and intraplacental vessels, and is a feasible and reproducible method of obtaining these data. The normal data presented may facilitate early detection of flow disturbances in the fetoplacental circulation. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
First‐trimester fetal heart block: a marker for cardiac anomaly
Authors: Baschat A. A. , Gembruch U. , Knöpfle G. , Hansmann M.
Published: March 2003

Background

Fetal heart block in the second and third trimesters may be caused by transplacental passage of auto‐antibodies or cardiac defects. Little is known about the etiology of first‐trimester fetal heart block.

Materials and methods

Fetal heart block was diagnosed in four patients (negative antibody serology) referred for first‐trimester sonographic evaluation of increased fetal nuchal fold thickness with bradycardia. Two‐dimensional echocardiography was complemented by color Doppler flow imaging of the fetal heart. Fetal arrhythmia was verified by M‐mode, pulsed wave Doppler and/or color M‐mode echocardiography.

Results

All fetuses had congenital heart disease, atrio‐ventricular valve regurgitation, heart block and edema. Autopsy confirmed heterotaxy in three cases (left atrial isomerism with atrial septal defect; left isomerism with double‐outlet right ventricle, great artery malposition and ventricular septal defect. The third case had dextrocardia with atrioventricular canal defect and the fourth case dextrocardia with great artery transposition.

Conclusion

First‐trimester fetal bradycardia may result from heart block of the type associated with complex congenital heart disease. Accelerated edema formation in this setting may be the basis of nuchal edema formation. First‐trimester fetal echocardiography offers the potential for early diagnosis and intervention in these cases with poor prognosis. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of a bronchogenic cyst in an unusual site
Authors: Bagolan P. , Bilancioni E. , Nahom A. , Trucchi A. , Inserra A. , Neri M. , Spina V. , Giorlandino C.
Published: March 2003

We report a rare case of a subdiaphragmatic cyst, diagnosed prenatally during routine ultrasound screening at 25 weeks’ gestation. Serial ultrasonographic evaluation demonstrated a slight increase in the size of the cyst during pregnancy. On the basis of the anatomic site and the sonographic features of the lesion, four diagnosic hypotheses were postulated: cystic neuroblastoma, adrenal hemorrhage, duplication of the inferior third of the esophagus and retroperitoneal cystic lymphangioma.

A healthy baby, weighing 3300 g and with Apgar scores of 8 and 9, was delivered vaginally at term. He underwent successful surgery at the age of 3 months. The postoperative course was uneventful and the baby is currently doing well. Histology revealed a bronchogenic cyst.
Early prenatal sonographic diagnosis of congenital hypophosphatasia
Authors: Tongsong T. , Pongsatha S.
Published: March 2003

A pregnant woman of 14 weeks' gestation was sonographically examined due to large‐for‐dates uterine size. The ultrasound examination showed poor ossification of all bony structures. All limbs were shortened with no evidence of fractures. The echodensity approximated that of the surrounding organs. No acoustic shadowing was observed. Based on these sonographic findings, skeletal dysplasia and short‐limb dwarfism were diagnosed, the most likely condition being congenital hypophosphatasia. Early cordocentesis was successfully performed at 15 weeks' gestation to determine fetal alkaline phosphatase concentration. This was undetectable. The prenatal diagnosis of congenital hypophosphatasia was made. After counselling, the woman decided to opt for termination of pregnancy which was performed vaginally. Post‐abortion findings confirmed the prenatal diagnosis. To our knowledge, this is the earliest sonographic diagnosis of this condition reported.
Circulatory effects of acute bradycardia in the human fetus as studied by Doppler ultrasound
Authors: Gembruch U. , Baschat A. A.
Published: March 2003

Objective

To report on flow changes in fetal arterial, venous and coronary vessels during bradycardia following cordocentesis. Changes in the fetal circulation in response to acute challenges are incompletely understood.

Methods

Fetal blood sampling was performed at 29 + 4 weeks for chromosome analysis in a fetus with multiple malformations including a complete atrioventricular septal defect with competent atrioventricular valve. The procedure was complicated by a 12‐min bradycardia of 57 beats/min. ‘Heart sparing’ (sudden visualization of coronary blood flow) and ‘brain sparing’ (increased diastolic velocities in the middle cerebral artery) were demonstrated by Doppler examination despite marked circulatory compromise (regurgitation of atrioventricular valve, increased reverse flow in precordial veins and pulsatile umbilical vein flow pattern) which persisted after normalization of the fetal heart rate. The findings had resolved completely at a full cardiovascular examination 6 h after the bradycardia. Pregnancy termination was subsequently performed for partial monosomy 13q.

Conclusion

Protective fetal changes producing ‘heart sparing’ and ‘brain sparing’ and may be operational during episodes of acute fetal bradycardia. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Uterine artery impedance to blood flow on the day of embryo transfer does not predict obstetric outcome
Authors: Isaksson R. , Tiitinen A. , Cacciatore B.
Published: March 2003

Objective

To evaluate the influence of uterine artery impedance to blood flow on the day of embryo transfer for prediction of early pregnancy loss and obstetric outcome.

Methods

The uterine artery pulsatility index (PI) and resistance index (RI) were evaluated prospectively by transvaginal Doppler in 102 infertile women, who conceived as the result of fresh or frozen embryo transfer. Uterine artery impedance to blood flow was compared to the obstetric outcome.

Results

The 111 treatment cycles studied resulted in 31 spontaneous abortions, four ectopic pregnancies, and 76 deliveries. There were no differences in uterine artery PI and RI (mean ± SD) between cycles resulting in normal delivery (2.69 ± 0.71 and 0.88 ± 0.06) and those resulting in spontaneous abortion (2.71 ± 0.67 and 0.88 ± 0.05) or ectopic pregnancy (2.36 ± 0.54 and 0.85 ± 0.06). There were no differences in PI and RI between uncomplicated singleton pregnancies (2.74 ± 0.78 and 0.88 ± 0.06) and those developing intra‐uterine growth restriction (IUGR), pregnancy‐induced hypertension (PIH), or preterm birth (2.54 ± 0.47 and 0.87 ± 0.04, pooled data).

Conclusions

Uterine artery PI and RI on the day of embryo transfer were unrelated to the risk of the pregnancy ending in spontaneous abortion or ectopic pregnancy. These values were of no value in the prediction of IUGR, PIH or preterm birth. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Development of gastric emptying in the human fetus
Authors: Sase M. , Nakata M. , Tashima R. , Kato H.
Published: March 2003

Objective

To evaluate stomach size and the development of gastric emptying in human fetuses using ultrasound.

Design

Clinical observational study.

Methods

The motility and peristalsis of the fetal stomach were studied in 80 normal fetuses between 12 and 39 weeks of gestation. Fetal gastric motility was assessed by analysis of videotaped recordings of ultrasound images of the stomach taken in real time.

Results

Fetal maximum gastric area gradually increased and minimum gastric areas gradually decreased after 20 weeks of gestation. At term, the maximum and minimum gastric area ratios were approximately 13 and 5%, respectively. The change in fetal gastric area, defined as the difference of maximum and minimum gastric area ratios, was relatively constant at 3% from 12 to 15 weeks of gestation to 20–23 weeks of gestation. It increased significantly (to 8%) after 24–27 weeks of gestation until term.

Conclusions

Fetal gastric emptying was quantified and its development assessed during pregnancy. A critical point of gastric development, associated with an increase in the change of gastric volume, was identified at 24–25 weeks of gestation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Correlation of prenatal ultrasound diagnosis and pathologic findings in fetal brain abnormalities
Authors: Carroll S. G. M. , Porter H. , Abdel‐Fattah S. , Kyle P. M. , Soothill P. W.
Published: March 2003

Objective

To determine the degree of agreement between prenatal ultrasound diagnosis of brain abnormalities and subsequent pathologic findings.

Methods

Between August 1993 and August 1999 there were 62 cases where a fetus with a prenatal ultrasound diagnosis of a brain abnormality other than neural tube defects underwent autopsy at the Regional Department of Pediatric Pathology. The cerebral diagnosis at ultrasound was compared with the findings at autopsy in all cases.

Results

In 47 of 61 (77%) cases the same defects were seen on ultrasound and at autopsy. The most common disparity was with the Dandy–Walker malformation or variant, where only six of the 14 (43%) cases prenatally diagnosed with this condition showed the same abnormality at autopsy. When fetuses with the Dandy–Walker malformation or variant were excluded, the scan findings correlated with autopsy in 41 of 47 (87%). In the main group with discordant findings, five of the seven cases where termination of pregnancy was undertaken had other fetal anomalies on ultrasound examination which were confirmed at autopsy. In the sixth case there was autolysis of brain tissue which affected detailed autopsy.

Conclusions

A very high level of agreement between prenatal ultrasound and autopsy findings was found for all abnormalities of the fetal brain, except for the Dandy–Walker malformation or variant. Potential discrepancy in findings between ultrasound and autopsy should be explained to patients who are considering termination of pregnancy for the Dandy–Walker type of abnormality. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Echocardiographic evaluation of the fetus with congenital cystic adenomatoid malformation
Authors: Mahle W. T. , Rychik J. , Tian Z.‐Y. , Cohen M. S. , Howell L. J. , Crombleholme T. M. , Flake A. W. , Adzick N. S.
Published: March 2003

Objective

The development of nonimmune hydrops is a known complication of congenital cystic adenomatoid malformation (CCAM) in the fetus. The aim of this study was to investigate the impact of CCAM on hemodynamics in the fetus and to determine whether cardiac dysfunction contributes to the development of hydrops in this patient population.

Methods

The echocardiographic data from 41 consecutive fetuses diagnosed prenatally with CCAM were reviewed. The presence or absence of hydrops was noted in each patient. Two‐dimensional ultrasonographic and Doppler data were compared between the two groups (with or without hydrops).

Results

The mean gestational age for the study group at the time of imaging was 23.2 ± 3.0 weeks. Hydrops was noted in 15 of 41 fetuses (36.5%). The fetuses that developed hydrops had a lower cardiac/thoracic ratio than those which did not develop hydrops (0.18 vs. 0.23, P = 0.001). The fetuses with hydrops also demonstrated an increase in early ventricular filling. The ratio of early ventricular filling to atrial contraction (E/A ratio) at both the tricuspid and mitral valves was significantly higher in the fetuses with hydrops (P = 0.005 and P = 0.03, respectively). Doppler interrogation of the inferior vena cava demonstrated a greater degree of reversal with atrial contraction in the hydrops group (29.7% vs. 15.1%, P = 0.003). The development of significant atrioventricular valve insufficiency was rare in the fetuses with hydrops (one of 15 cases).

Conclusions

Cystic adenomatoid malformation can result in significant cardiac compression in the fetus. This alters hemodynamics and may result in hydrops on the basis of elevated central venous pressure. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Segmentary fetal branch pulmonary artery blood flow velocimetry: in utero Doppler study
Authors: Sivan E. , Rotstein Z. , Lipitz S. , Sevillia J. , Achiron R.
Published: March 2003

Objective

To evaluate changes in human, fetal segmentary, pulmonary artery blood flow velocimetry throughout pregnancy.

Design

Ninety‐nine women with a singleton, low‐risk gestation between 14 and 37 weeks of pregnancy were selected to participate in a prospective, cross‐sectional study. All fetuses were evaluated using power and color Doppler ultrasound. Flow velocity waveforms at three sites of the right pulmonary artery were obtained. The pulsatility index (PI) was calculated in the proximal, mid and distal segment of the pulmonary artery. Mean values and 95% confidence interval (CI) for each segment were determined in correlation with gestational age.

Results

A full study that included Doppler measurements of all three segments of the pulmonary artery was completed on 99 fetuses. The highest mean PI of 2.36 was obtained in the proximal segment of the right pulmonary artery (CI = 2.29–2.42), whereas in the mid and distal segments the mean PI decreased significantly to 1.57 (CI = 1.53–1.61) and 1.02 (CI = 1.0–1.0) (P < 0.001), respectively. Throughout gestation, the mean PI measurements in the proximal, middle and distal segments of the branch pulmonary artery increased slightly, but without statistical significance (r = 0.274, 0.248, 0.047), respectively; (P > 0.5).

Conclusions

The data obtained suggests that pulmonary circulation maintains stable vascular resistance during gestation in the human fetus. However, the PI obtained from the separate segments of the branch pulmonary artery is unique and each differs from the other, reflecting the proximity to the heart and the peripheral impedance at each location. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of fetal urinary ascites
Authors: Bettelheim D. , Pumberger W. , Deutinger J. , Bernaschek G.
Published: March 2003

We report on a rare in utero appearance of the rupture of the fetal bladder caused by low urinary tract obstruction with subsequent urinary ascites. The findings on prenatal sonography, postnatal X‐ray examinations and postnatal surgical treatment are described and the literature is reviewed. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The subjective assessment of echogenic fetal bowel
Authors: Harrison K.L. , Martinez D. , Mason G.
Published: March 2003

Objectives

To assess the subjective interpretation of the echogenicity of fetal bowel compared to bone from antenatal ultrasound images taken during examinations conducted between 17 and 22 weeks of gestation.

Methods

Eighty‐seven women attending for their antenatal scan were selected in a random prospective manner over a 9‐month period. Images of the fetal bowel were taken and evaluated by 10 sonographers, one consultant obstetrician and one consultant radiologist. Images from a further 13 fetuses, in which the subjective assessment of echogenic bowel was made, were also included. All ultrasound images were acquired on a dedicated ultrasound scanner, with a standard transducer, thermal paper printer and single operator using standardized equipment settings and reproducible image sections. Questionnaires with 100 sets of images of fetal bowel were distributed to the participants. Performance was assessed by means of percentage agreement and levels of chance corrected agreement (Kappa).

Results

The subjective assessment of fetal bowel echogenicity is very variable. Intra‐ and inter‒observer variation discrepancies in the assessment of bowel echogenicity compared to bone were demonstrated between the sonographers. Good agreement was identified between the consultants with good to almost perfect intra‒observer agreement. Overall, only moderate agreement was observed between the sonographers and the consultants.

Conclusions

The lack of agreement demonstrated between sonographers when evaluating the echogenicity of fetal bowel should be addressed if this ultrasound marker is to be incorporated into routine fetal screening programs. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology