bluuebunny/crossref_metadata_2025 huggingface dataset:
WS02‐04Fetal tumours
Authors: González A. G. , Herrero F. L. , Alvarez E. CH. , Rodriguez R. R.
Published: March 2003

Fetal oncology is a chapter of the Obstetrics non well known yet. Fortunately, the improvements in the ultrasonography has let us to obtain an intrauterine diagnosis and to follow its evolution in order to choose the most appropriated obstetrical way.

A total of 1326 fetal abnormalities has been diagnosed in the last 10 years in the Hospital ‘La Paz’, Madrid, and we have found 54 cases of fetal tumours detected by ultrasonography (cyst and solid tumours included). This number of fetal tumours is estimated to be the 4.07% of all fetal abnormalities. Most frequent tumours include the fetal central nervous system, fetal lung, fetal heart, fetal genitourinary system, fetal gastrointestinal system.

We have reviewed these fetal tumours histology, location and behaviour, trying to study the best obstetrical conduct and its chirurgical treatment. Ultrasonographic characteristic of each fetal tumour has been specified. Besides, we describe the possible differential diagnosis, maternal complications (preeclamptic status, mirror syndrome), obstetrical complications (polyhydramnios, preterm labour and delivery or placentomegaly) and fetal complications (cardiovascular failures, hydrops or death).

Finally, we perform the indications for the spontaneous delivery or the preterm delivery induction depending on each case. Although we have not experience in intrauterine surgery, we believe that the best results are obtained in the neonatal surgery, always after an individual study and in agreement with the whole perinatal equipment.
WS03‐06Tubal patency as assessed by three‐dimensional power Doppler imaging (3D‐PDI) and hystero‐salpingo‐contrast sonography (HyCoSy)
Authors: Sladkevicius P.
Published: March 2003

Background

The purpose of the study was to evaluate the feasibility of three‐dimensional power Doppler imaging (3D‐PDI) in the assessment of the patency of the fallopian tubes during hystero‐salpingo‐contrast sonography (HyCoSy).

Methods

HyCoSy using contrast medium echovist was done on 67 subfertile women. 3D‐PDI and two‐dimensional (2D) gray‐scale imaging were used to visualize the contrast medium in the tubes.

Results

Contrast medium echovist produced prominent signals on the 3D‐PDI image. Free spill of the fallopian tubes which had had the proximal part visualized was demonstrated in 114 (91%) tubes using 3D‐PDI technique and in 58 (46%) tubes using conventional HyCoSy. The mean duration of imaging procedure was less than 3D‐PDI. A significantly lower volume of contrast medium (5.9 + 0.6 ml) was used for 3D‐PDI in comparison with volume (11.2 + 1.9 ml) used for conventional HyCoSy.

Conclusions

The 3D‐PDI method appeared to have advantages over the conventional HyCoSy technique, especially in terms of visualization of spill from the distal end of the tube which was achieved twice as often with the 3D technique. The shorter duration of the imaging and lower volume of the contrast medium used suggested that the 3D‐PDI technique may have a better side‐effect profile. The 3D‐PDI technique allowed better storage of the information for re‐analysis and archiving than 2D scanning.
WS04‐04Vascular impedance of uterine, inferior vesicle and ophthalmic arteries in postmenopausal women receiving hormonal replacement therapy: comparative Doppler study
Authors: Bekavac I. , Kupesic S. , Mihaljevic D. , Kurjak A.
Published: March 2003

Background

To investigate the effects of combined hormone replacement therapy (HRT) on the vascular impedance of the uterine, inferior vesicle and ophtalmic artery.

Method

Thirty‐five postmenopausal patients were analysed in basal condition and during a HRT phase at 1, 3 and 6 months. Patients were divided in two groups: 21 patients whose last menstrual bleeding was 1–5 years ago, and 14 patients with the duration of menopause > 6 years. Color Doppler analysis of the blood flow impedance was performed at the level of the uterine, inferior vesicle and ophtalmic artery. Estradiol plasma concentrations were assayed on the day of Doppler examinations.

Results

The analysis of the uterine and inferior vesicle artery flow velocities demonstrated significant positive correlations between resistance index (RI) and years of menopause; higher impedance values were obtained in patients with longer interval from last menstrual bleeding (P < 0.05). The impedance in patients with > 6 years duration of menopause was 0.94 ± 0.03 vs., 0.89 ± 0.04, in the group of patients with 1–5 years duration of menopause for uterine artery, and for inferior vesicle artery (0.91 ± 0.04 vs. 0.98 ± 0.02). No significant correlation between baseline RI and time since menopause was noticed (0.72 vs. 0.73, respectively, P > 0.05) at the level of ophtalmic artery. After six months of HRT plasma estradiol levels inversely correlated with RI uterine (r = −0.2556; P = 0.021), inferior vesicle (R = −0.2653; P = 0.023) and opthalmic (r = −0.2211; P = 0.017) arteries.

Conclusion

Doppler studies of uterine, inferior vesicle, and ophtalmic artery can provide specific and precise pathophysiological information to assess blood flow variations in correlation with combined HRT administration.
WS05: Endometrial pathology WS05‐01Ultrasound in endometrial pathology
Authors: Haller H.
Published: March 2003

Background

This study was undertaken to evaluate the accuracy of transvaginal ultrasound combined with vaginal and endometrial cytology in detecting endometrial pathology in postmenopausal women.

Method

In all patients who underwent dilatation and curettage (D & C) for postmenopausal bleeding during four years endometrial thickness, vaginal and endometrial cytology were evaluated.

Results

Accuracy of endometrial thickness in detecting pathologic condition, like as polyp, hyperplasia and carcinoma was high sensitive but with low specificity. Combined use transvaginal ultrasound, vaginal and endometrial cytology show very high sensitivity and specificity for endometrial cancer. The combined use of three diagnostic methods show no benefit for other pathologic conditions.

Conclusion

Combination of transvaginal ultrasound, vaginal and endometrial cytology can not absolutely replace histologic findings obtained by D & C. However, in the cases with thin endometrium and negative cytology D & C could be avoided. Usefulness of these three methods has to be found in providing more information resulting in better understanding of endometrial condition.
WS06‐08Real‐time three‐dimensional fetal echocardiography: imaging and volume measurement
Authors: Nelson T. R. , Pretorius D. H.
Published: March 2003

The objective of this work was to assess the feasibility of real‐time three‐dimensional echocardiography (which acquires data as a volume, instead of a series of planes, eliminating gating) to evaluate fetal cardiac anatomy and function. We evaluated 10 human fetuses including several with congenital heart disease. Transabdominal scanning was performed using a real‐time three‐dimensional echocardiography system. Four 1.5 second volume clips at 20 volumes/second were obtained for each fetal heart and stored for off‐line analysis. Data were reviewed on a graphics workstation. Our results showed that fetal heart data could be acquired rapidly. Fetal heart data were displayed as 3 simultaneous planes. The reviewer could manipulate plane orientation and position in the volume to optimize views. Cardiac motion could be accelerated, slowed, stopped or viewed at its original speed. Although image quality did not equal high‐end equipment, cardiac structures, views and function could be consistently visualized. Abnormal structures were readily detected. In conclusion, real‐time three‐dimensional fetal echocardiography is a feasible and potentially important new technique that will gain importance as equipment performance improves.
WS07‐03Stage‐based treatment of twin–twin transfusion syndrome: preliminary study
Authors: Quintero R. A. , Bornick P. W. , Morales W. J. , Allen M. H. , Johnson P. K.
Published: March 2003

Background

The purpose of this study was to test the value of sonographic staging of twin–twin transfusion syndrome (TTTS) in predicting the outcome of patients treated with amniocentesis or selective laser photocoagulation of communicating vessels (SLPCV).

Methods

TTTS was defined as a deep vertical pocket (DVP) in the recipient twin of > 8 cm and in the donor twin < 2 cm. TTTS was staged as follows: Stage I: bladder of donor visible; Stage II: bladder of donor not visible; Stage III: critically abnormal Dopplers; Stage IV: hydrops; Stage V: demise. Patients were treated with amniocentesis or SLPCV.

Results

There were a statistically significant difference by stage for at least one survivor between the two techniques (Chi‐square = 2.63, p = 0.05), but analysis was limited by sample size (amniocentesis n = 9, SLPCV n = 70). In the amniocentesis group there was an 83% (n = 5) survival rate for two survivors in Stage I and no survivors (n = 3) in stages II or III. In the SLPCV group, at least one fetus survived 83% of the time, regardless of stage.

Conclusion

Our preliminary data suggests that analysis of survival data by in TTTS needs stratification by stage. Early stages may be amenable to treatment with amniocentesis, while later stages may not benefit. SLPCV is uniformly effective, regardless of stage, but may not be warranted in early stages of TTTS.
WS10‐02Nuchal translucency in multiple pregnancies
Authors: Monni G.
Published: March 2003

Background

The significance of an increased nuchal translucency measurement (NT) in relation to the fetal karyotype and pregnancy outcome has been evaluated in multiple pregnancies.

Methods

115 multiple pregnancies with 252 fetuses, including 100 pairs of twins (70 pairs with dichorionic placentas and 30 pairs with nonochorionic placenta), 9 sets of triplets, 5 sets of quadruplets, and one set of quintuplets, were considered.

Results

NT was greater than 95th centile in one fetus in 10 out of 70 cases of dichorionic twin pregnancies (14%), in two sets of quadruplets, in 7 out of 30 monochorionic twin pregnancies (23.3%). NT greater than 95th centile in both fetuses was found in one dichorionic twin pregnancy. Two cases of trisomy 21 and one 47, XXY were found. NT greater than 95th centile in 2/2 fetuses with trisomy 21 (one dichorionic twin pregnancy and one tetrachorionic pregnancy), and not enlarged in the 47, XXY (trichorionic triplet pregnancy). A case of skeletal dysplasia and one goldenhar syndrome were found among the 10 cases of increased NT in dichorionic pregnancies. Three intrauterine deaths of both fetuses, one congenital heart disease and a case of twin‐to‐twin transfusion occurred in 7 cases of increased NT in monochorionic pregnancies.

Conclusions

An enlarged NT in multiple pregnancies indicates fetuses at risk for chromosomal abnormalities and fetal malformation, as well as monochorionic twin pregnancies at higher risk for an adverse outcome.
F104Prenatal diagnosis and follow‐up of 38 cases of cleft lip – 5‐year experience of a Brazilian specialized center
Authors: Ruano R. , Hanaoka B. , Iglesias M. L. M. , Bunduki V. , Yamamoto R. M. , Miyadahira S. , Zugaib M.
Published: March 2003

Background

Sonographic aspects of prenatally diagnosed cleft‐lip were reviewed and compared with postnatal findings.

Method

38 cases of prenatally diagnosed fetal cleft lip were reviewed and the following was recorded: gestational age at diagnosis, maternal age, malformation history, associated palate clift, associated aneuploidies and malformations and postnatal follow‐up. Kariotyping was performed in all cases.

Results

Maternal age was 28.37 years and only one case had history of cleft lip. Gestational age at diagnosis was 28 weeks. Isolated cleft lip were observed in 7 cases (18.42%): 5 fetuses (71.43%) with left lesion and 2 (28.57%) with right lesion. One case (2.63%) was associated with cleft palate. Aneuploidy associated with structural malformations was identified in 9 cases (23.68%): trissomy 13 (n = 6); trissomy 18 (n = 2) and 47XXY (n = 1) In 66% of those cases associated cleft palate was found. Associated malformations with normal karyotype were found in 22 cases with associated cleft palate in 50% of those cases.

Conclusion

In this series, fetal cleft lips were frequently associated with structural malformations and cromossomal, especially when cleft palate was associated. Cleft lip is an indication for fetal karyotyping and associated malformations must be discarded by level three ultra‐sound scan.
F106Prenatal diagnosis of syndromic and nonsyndromic craniosynotosis by ultrasound
Authors: Bernard J.P. , Delahaye S. , Senat M.V. , De Keersmaecker B. , Renier D. , Ville Y.
Published: March 2003

Background

Prenatal diagnosis of cranyosynostosis are rare. Most of them are syndromic synsostosis (Apert, Crouzon.) and ultrasound diagnosis is done on associated lesions. Very few publications described nonsyndromic craniosynostosis and the diagnosis is made on skull deformation. Some animal experimentations have proven that synostosis have different sonographic features than normal sutures.

Material

For 5 years we examined 32 fetuses, referred in our institution with a high risk of craniosynostosis. Some because of a family history of previous craniosynostosis, others because of an abnormality of the cephalic index or skull deformations.

The diagnosis of craniosynostosis was only made when the sutures seemed abnormal.

Results

Nine fetuses had a very high risk of craniosynostosis secondary to a previous autosomic craniosynostosis. In 5 of them, the sonographic appearance of the suture was abnormal and the newborn presented a recurrent craniosynostosis. In 4 of them, the sonographic appearance of the sutures was normal and the newborn were healthy.

Twenty‐three fetuses had an increased risk of craniosynostotsis secondary to the appearance or biometry of the skull on the routine second trimester scan. In 20 of them, sutures were normal and newborns were healthy. Three fetuses presented abnormal sonographic features, two of them presented a craniosynostosis, however, one was a healthy newborn.

Conclusion

Ultrasound seems to be a very good tool for the diagnosis of craniosynostosis even isolated in a very high risk population (risk of 1/2). In lower risk the negative predictive value can be used to rassure parents when the biometry or the appearance of the skull seems abnormal.
F108Correlation between prenatal ultrasound findings and postnatal outcome in 37 cases of isolated spina bifida aperta
Authors: Peralta C. F. A. , Bunduki V. , Plese J. P. , Yamamoto R. M. , Miyadahira S. , Zugaib M.
Published: March 2003

Background

The aim of this study was to find prenatal prognosis predictors in spina bifida aperta.

Method

Thirty‐seven cases of isolated Spina Bifida Aperta were prospectively evaluated from 1995 to 2000. Prenatal ultrasound findings such as hydrocephaly, talipes, site of the lesion and prenatal evolution were correlated with postnatal neurological outcome. Minimum postnatal follow up was one year.

Results

Mortality rate was 24% (9/37). Among 28 survivors, 21 (71%) had normal intellectual development. Six (6/28–21%) had normal intellectual and motor development Fourteen (14/28–50%) had normal intellectual development but severe motor impairment. Severe motor and intellectual impairment were present in 8/28 survivors (29%). All of them had hydrocephaly (mean ventriculo‐hemisphere ratio = 0.75), and 5(5/8–63%) had talipes. Site of spina was higher in this group with no case of sacral meningomielocele. All 28 patients had problems in controlling sphincters which was analysed separately from inferior limbs motor development.

Conclusions

The group with small sacral lesions without hydrocephaly nor talipes had good prognosis, with normal intellectual and inferior limb motor development but no sphincter control. In any other situation a poor prognosis was observed with a high mortality rate. Longer follow up is needed to better ascertain and confirm these prognostic factors.
F109The management and outcome of fetal hydrothorax in Taiwan
Authors: Chao An‐Shine , Chung Chao‐Lung , Lien Reyin , Lin Jer‐Nan
Published: March 2003

Background

To evaluate the outcome and management of the complications encountered in the cases of fetal hydrothorax.

Method

14 cases of fetal hydrothorax were enrolled. Complete prenatal work‐up were done. Thoracocentesis were performed 24–48 h prior to the thoracoamniotic shunting (T‐A shunt). Thoracoamniotic shunting was performed when (i) the age of diagnosis was less than 34 weeks (ii) presence of hydrops fetalis (iii) progression of pleural effusion even after thoracocentesis.

Results

Among the 14 cases, 10 cases received T‐A shunts with 1 case technically failed to insert who subsequently had distress and demised. The remaining 9 cases (except a case of trisomy 21 & a case of persistent hydrops) had resolved hydrops and pleural effusion after the shunting and survive with good neonatal outcome although 5/8 had preterm delivery. For the 4 cases who did not receive T‐A shunt, only one had pulmonary and gastroenterology sequales. The major underlying cause of effusion was chylothorax. There were 2 dislodged shunts into fetal pleural cavity which had to be removed postnatally.

Conclusion

The thoracoamniotic shunting is an potentially corrective and effective method for the chronic drainage of massive fetal pleural effusion by reversal of hydrops and prevention of pulmonary hypoplasia. Conservative managements are preserved for the slow‐accumulating pleural effusion, nonhydropic circumstances.
F112Prenatal sonographic diagnosis and outcome of anterior abdominal wall defects
Authors: See T. C. , Set P. A. K. , Brain J. , Coleman N.
Published: March 2003

Objectives

(1) To evaluate the accuracy of routine second trimester ultrasound screening in the detection of anterior abdominal wall defects (AAWD); (2) To assess the outcome of these pregnancies.

Methods

A retrospective study of low risk population between January 1993 to December 1999. Cases with AAWD were obtained from antenatal, neonatal surgical and pathology Departments. Correlation was made with the second trimester ultrasound examinations to assess the accuracy of detection. Pregnancy outcome was reviewed.

Results

There were 25 fetuses with AAWD. 15 with omphalocoele, 9 with gastroschisis and 1 with bladder exstrophy. All except the bladder extrophy case were detected antenatally. Pathology report on a case of omphalocoele was inconclusive. A case of gastroschisis did not have histological confirmation following termination of pregnancy. However, sonogram review of these 2 cases confirmed the original diagnosis and hence are included as true positives. 7 of the 9 cases of gastroschisis were live births and all did well following surgery. 7 of the 15 cases of omphalocoele were livebirths. One died at 9 months but others did well post surgery.

Conclusion

We demonstrate a sensitivity of 96% (24/25) and a specificity of 100% for the detection of AAWD. 13 of the 14 live births (93%) did well following surgery. With the increasing awareness of evidence based medicine, this study hopes to set a standard for clinical practice.
F114Ultrasonographic detection of undescended testes in the third trimester of pregnancy
Authors: Wolman I. , Gull I. , Hartoov J. , Fait G. , Amaster R. , Lessing J. B. , Jaffa A. J.
Published: March 2003

Objective

The aim of the present study was to assess, the sonographic rate of detection of undescended testes among a low‐risk population during the third trimester.

Study methods

332 women between 34 and 40 weeks of pregnancy underwent prospectively an ultrasonographic evaluation including biometrical studies and detailed study of the fetal genitals. The presence of the testes within the scrotum was examined by a qualified neonatologist within 3 days after birth.

Results

Of the 332 fetuses that were examined, the scrotum was visible in 294 of them (89%). Nine cases of undescended testes were detected (3%). Of these, the diagnosis of one case, examined at 34 weeks of gestation, was a false positive one as revealed after birth. There was no false negative result. The present series has delineated the best timing for the detection during the late 3rd trimester as being between 34 and 36 weeks of pregnancy. When undescended testes is diagnosed, a second evaluation is recommended at around 37 weeks of pregnancy.

Discussion

Ultrasound examination during the late third trimester of pregnancy appears to allow an accurate diagnosis of undescended testes prenatally. This early identification will alert the neonatologist of the possibility of cryptorchidism and permit early postnatal identification and treatment.
F115Prenatal diagnosis and clinical management of fetal hydro(metro)colpos: report of 3 cases
Authors: Geipel A. , Berg C. , Germer U. , Gloeckner‐Hofmann K. , Möller J. , Gembruch U.
Published: March 2003

Background

Hydrometrocolpos represents the dilatation of the vagina and uterus due to obstruction of the genital tract, leading to accumulation of secretions.

We report on 3 female fetuses with prenatally diagnosed hydro(metro)colpos. Gestational age ranged from 28 to 35 week's. In the first case, hydrometrocolpos was associated with postaxial hexadactyly of both upper extremities, strongly indicating McKusick Kaufman syndrome. In the second case, malformation of the urogenital sinus included anorectal and vaginal atresia with rectovaginal and urethrovaginal fistula. Furthermore, vertebral segmentation anomalies, horseshoe kidney and ventricular septal defect were detected, creating an overlap between VACTERL and MURCS association. In the third case, hydrometrocoplos secondary to cloacal anomaly with anal atresia and bilateral hydronephrosis were observed. All 3 newborns underwent surgical correction, 2 of them survived.

Conclusion

The presence of hydro(metro)colpos warrants a systematically evaluation of fetal and neonatal anatomy to rule out a large variety of possibly associated malformations or syndromes.
F117Hystero‐embryoscopic findings in early nonviable pregnancies
Authors: Ferro J. , Lara C. , Martínez M. C. , Crespo J. , Vidal C. , Remohí J. , Pellicer A. , Serra‐Serra V.
Published: March 2003

Background

A high proportion of early pregnancy losses are associated to abnormal embryo development. However, chromosomal analysis of routine curettage samples are of limited value; and histopathological examinations of the embryos are rarely performed in clinical practice.

Method

A transcervical hystero‐embryoscopy was performed prior to the curettage in 31 nonviable first‐trimester pregnancies and a control group of 5 early terminations of pregnancy. In the study group, the estimated gestational age according to the ultrasound findings was 6.7 (4–9) menstrual weeks. Direct biopsies of different gestational structures were taken during the endoscopic procedure.

Results

In nonviable pregnancies, focal haemorrhagic/necrotic changes were present in the decidua capsularis. The collapse of the gestational sac was variable. Most chorionic villi had an oedematous appearance. Degenerative changes of the embryo and yolk sac were not uniform. The following gestational anomalies were identified: partial moles (n = 2), structural abnormal embryos (n = 4), umbilical cord cysts (n = 3) and abnormal yolk sacs (n = 2). Chromosomal analysis of selective chorionic and embryo biopsies identified a misdiagnosis of the curettage sample result in 8 cases.

Conclusion

Hystero‐embryoscopy offers great potential for evaluating early nonviable pregnancies. Accurate karyotypes can be obtained from direct chorionic and embryo biopsies.
F118Placental size and growth in early pregnancy: does it affect birthweight?
Authors: Michailidis G. D. , Papageorgiou P. , Economides D. L.
Published: March 2003

Objectives

To study the influence of placental size and growth from first to mid‐second trimesters on birthweight.

Subjects/methods

Eighty one pregnant women with a singleton pregnancy were recruited at 11–14 weeks' gestation. For each case we performed three scans of the placenta the first at recruitment and the following two in three weeks intervals. The volume of the placenta was measured at each visit using a three dimensional ultrasound scanner. The information for the birth weight was obtained from the hospital notes. Customised centiles were used to correct birth weight for gestational age at delivery, parity, BMI and ethnic origin.

Results

The placental growth rate from the first to the early second trimester was associated with birthweight (r = 0.33, P < 0.01) while the growth later in the second trimester was not. The placental volume, corrected for gestational age, at the first trimester (11–14 weeks: r = 0.3, P < 0.01), early second (14 to 17 weeks: r = 0.42, P < 0.01) trimester but not at the mid‐second (17–20 weeks) trimester was correlated with birthweight. The placental growth rate was not related to maternal BMI, or parity.

Discussion

This study demonstrates the influence of early placental development on pregnancy outcome and supports the hypothesis that early pregnancy events can affect the final pregnancy outcome. Our data suggests that placental growth in early pregnancy could be a useful independent predictor of birthweight.
Fetal echocardiography F119Fetal cardiac flow velocity waveforms between 14 and 16 weeks' gestation in normal pregnancies
Authors: Ben‐Ami M. , Perlitz Y. , Peleg D.
Published: March 2003

Background

The purpose of this study was to establish normal values for flow velocity waveforms in fetuses at 14–16 weeks' gestation.

Method

Doppler waveforms were recorded in 89 normal fetuses at 14–16 weeks' gestation. All scans were performed transvaginally. Peak velocities at E (passive atrial filling) and A (atrial contraction) waves were obtained from tricuspid and mitral flow velocity waveforms. Peak systolic velocities for the ascending aorta and pulmonary artery were also calculated. Linear regression analysis was performed.

Results

There was no significant correlation between any of the velocities and gestational age.

Velocity(cm/sec)
 r
P

Tricuspid valve peak E‐wave velocity
25.3 ± 4.3
0.04
0.74

Tricuspid valve peak A‐wave velocity
42.7 ± 5.7
0.08
0.48

Mitral valve peak E‐wave velocity
23.0 ± 4.1
−0.02
0.84

Mitral valve peak A‐wave velocity
39.9 ± 5.1
0.01
0.94

Aortic peak systolic velocity
38.5 ± 4.8
0.01
0.96

Pulmonary peak systolic velocity
38.6 ± 4.9
−0.14
0.21

Conclusion

Fetal cardiac function by Doppler waveform analysis remains unchanged between 14 and 16 weeks' gestation in normal pregnancies.
F126Congenital complete atrio‐ventricular (AV) block. Prenatal diagnosis and perinatal outcome
Authors: Muñoz H. , Guerra F. , Hernández I. , Díaz C. , Palominos G. , Nazaretian M. , Puga M. , Villa S.
Published: March 2003

Background

There are two types of complete heart AV block; associated and non associated with congenital heart malformations. The purpose of this work is to describe the ultrasound features and perinatal outcome of cases with prenatal diagnosis of complete AV block.

Methods

A descriptive retrospective trial was performed. The AV block criteria were the presence of ventricular cardiac frequencies less than 80 bpm, and atria ventricular dissociation. In normal fetal heart group presence of Ro, Ssa and/or Ssb maternal antibodies were tested.

Results

Thirteen cases of complete AV block were identified, 8 with structural malformations and five with normal cardiac structure but with presence of maternal antibodies. The patients average age was 23 years (range: 18–37), the gestational age at diagnosis was 25 weeks (range: 20–30). The ventricular frequency was 52 bpm (range: 42–73) and the atrial frequency was 112 bpm (range: 70–152). The cardiac malformations were present in 8 fetuses and the most frequent were the AV channel and single atria. Mortality in malformations cases was 100% and in those with immunological origin was about 40% (2/5). There were three survivors; two of them needed definitive heart peacemaker.

Conclusion

The prognosis in the cases associated to structural malformations was always lethal, nevertheless in immunological origin cases prenatal diagnosis and perinatal management allowed the survival of them.
F129Prenatal diagnosis of conotruncal anomalies: associated defects and chromosomal abnormalities
Authors: Galindo A. , Grañeras A. , Gutiérrez‐Larraya F. , Regojo F. , Carrera M. , De La Fuente P.
Published: March 2003

Aim

To evaluate the incidence, type, associated defects and chromosomal abnormalities of fetuses with conotruncal anomalies (CTA).

Methods

Retrospective study of CTA prenatally diagnosed between Jan.1998–May 2000.

Results

46 CTA was diagnosed and the number of congenital heart defects (CHD) diagnosed in the period reviewed was 154; therefore, CTA accounts for 30% of CHD. In this period there were 13 236 deliveries; thus, incidence of CTA was 3.5% and of CHD was 1.2%. The chromosomal defects (CRD) rate in CTA was 28% (13 cases): 5 CATCH 22, 3 Tr.13 (23%), 2 Tr. 18 (15%), 1 Tr.7 (8%), 1 45XO (8%), 1 triploidy (8%). Associated defects were diagnosed in 17 cases (37%), and 10 of these had a CRD (59%). CTA pernatally diagnosed distribution was as follows: 12 tetraology of fallot (26%), with 4 CRD (33%): 1 Catch 22, 1 Tr.13, 1 Tr.7 and 1 triploidía; 9 double‐outlet right ventricle (20%), with 2 CRD (22%): 2 Tr.18; 8 transposition of great arteries (17%) without CRD; 6 coarctation of aorta (13%), with 1 CRD (17%): 45XO; 6 truncus arteriosus (13%) with 5 CRD (83%): 4 Catch 22 and 1 Tr.13; 4 pulmonary atresia (9%), with 1 Cr (25%): Tr.13 and finally 1 interrupted aortic arch (2%), without CRD. In 4 out of the 5 cases of catch‐22 additional anatomic defects were prenatally observed (80%).

Conclusions

CTA accounts for a high number of CHD prenatally diagnosed. Therefore, extended fetal echocardiographic examination is of paramount importance to detect prenatally CTA. Associated defects and chromosomal abnormalities are common. Thus, analysis of fetal karyotype must be performed mainly in cases of tetralogy of Fallot, truncus, arteriousus, double‐outlet right ventricle and pulmonary atresia.
F18Hysterosalpingo contrast sonography in the assessment of tubal patency after ectopic pregnancy treated by methotrexat
Authors: Odeh M. , Priborkin A. , Lebovitz Z. , Degani S. , Oettinger M.
Published: March 2003

Background

The aim of this study was to assess tubal patency in patients treated by methotrexat for ectopic pregnancy using hysterosalpingo contrast sonography (HyCoSy).

Method

Patients that had ectopic pregnancy treated by methotrexat and in whom the pregnancy site was confirmed by ultrasound were included in this study. Echovist contrast medium was used to assess tubal patency. Fallopian tube patency was defined as being the visualization of a steady flow of contrast agent within the fallopian tube and/or the visible contrast spill from the fimbirial end over the ovary. In patients who previously underwent HSG the results were compared.

Results

135 patients were contacted out of 157 but 28 only reported for the examination. The ectopic pregnancy was localized in the left tube in 14 patients and in the right tube in 14. Twenty‐four patients stated that they are still planing future pregnancies and 4 of them delivered before the examination. Both tubes were patent in 22 (78.6%) patients (5 normal HSG) while 3 (10.7%) had one patent tube in the contralateral side (1 normal HSG) and 1 (3.6%) in the ipsilateral side (1 normal HSG) and 2 (7.1%) had both tubes occluded (no HSG). The examination was completed in all patients and 6 reported on severe pain and 14 on mild discomfort.

Conclusion

Our results match the tubal patency rate reported in this group of patients using HSG and we think HyCoSy may replace HSG in the majority of these cases.
F19The use of color Doppler ultrasound in conservative menagement of ectopic pregnancy
Authors: Bauman R. , Kupesc S. , Hafner T. , Stilinovic K. , Ilijas M.
Published: March 2003

Background

Up to 20% of all patients with ectopic pregnancies located in the ampullary part of the tube could be treated by expectant menagement. Conservative treatment with MTX is a method of choice in cases of cervical or cornual pregnancy. Serum values of ßhCG are commonly used as an indirect indicator of trophoblastic proliferative activity. The aim of this study is to establish the value of color Doppler ultrasound in conservative menagement of ectopic pregnancies.

Method

All patients with ectopic pregnancies that have been treated conservatively in our Department had serial ßhCG measurements and color Doppler examinations.

Results

From January 1998. to December 1999. total of 21 patient with ectopic pregnancy had expectant menagement. Spontaneous resolution occurred in 15 patients and in 6 patients we had to perform laparoscopy. One patient with cornual pregnancy and one patient with cervical pregnancy were successfully treated with MTX. In all patients color Doppler findings could be correlated with serum ßhCG values.

Conclusion

Color Doppler ultrasound can be used in addiction to hormone asseys in order to follow the resolution of ectopic pregnancies treated expectantly or with MTX.
Miscellaneous F20Sonographic tissue characterization based on the parameters derived from computerized processing of gray level data
Authors: Leibovitz Z. , Degani S. , Shapiro I. , Ohel G.
Published: March 2003

Background

Sonographic tissue characterization is a relatively weak arm of ultrasound diagnosis. There is a great influence of the sonographic machine setup on the B‐mode gray level appearance of the ultrasound image. Various ultrasound artefacts can produce significant changes in brightness setting of the details in sonographic pictures. Nevertheless, in certain situations, the ability to specify the sonographic texture of the tissues may reveal interesting information.

Method

We present measurable parameters for the specification of the ‘homogenicity’ of the sonographic texture of the scanned tissue. These parameters are derived from the computerized image processing. The processing includes selection of the region of interest, which is related to the specific tissue in the image plane and distribution analysis of the gray level of pixels within the selected region.

Results

An implication of this algorithm is demonstrated by texture analysis of the different fetal choroid plexus images as they appear in early anatomical scans (15–17 weeks).

Of the effects of B‐mode presets – the dynamic range and rejection level had most significant impact on the texture appearance in view of the studied parameters.

There was good correlation between the subjective perception of the tissue homogenicity and the computer analysis results.

Conclusion

The proposed texture parameters may lead to the new approach for the sonographic tissue characterization. These parameters may be used for the standardization of ultrasound machine setups as well.
F26Reproductive outcomes in women with arcuate and subseptate uteri
Authors: Wölfer B. , Lawrence A. C. , Elson J. , Jurkovic D.
Published: March 2003

Background

The effect of congenital uterine anomalies on reproductive performance is uncertain. The aim of this study to correlate uterine morphology with past reproductive outcomes in a large group of women with no history of infertility or recurrent pregnancy loss.

Method

In a period of three years 1028 women were recruited into the study. A detailed history of past pregnancies was obtained first, followed by transvaginal three‐dimensional ultrasound examination. The uterus was classified as being normal, arcuate or subseptate after the examination of uterine morphology in the coronal reformatted section. Uterine anomalies were classified according to the American Fertility Society classification and the degree of uterine cavity distortion was measured.

Results

884 women had a normal uterus, 72 arcuate and 29 subseptate uteri. In the past they had total of 1944 pregnancies. The risk of miscarriage was significantly increased in both women with arcuate (OR = 1.9; 95% CI 1.1–3.5) and subseptate uteri (OR = 5.8; 95% CI 3.4–10.1) compared to those with normal uterine morphology. There was no correlation between the depth of uterine septum and the risk of miscarriage.

Conclusion

Miscarriage is significantly more frequent in women with arcuate and subseptate uterus. Further research is needed to assess potential benefits of surgical treatment in these cases.
F31Implementation of nuchal translucency screening in the Dutch prenatal care system: evaluation of screening performance and acceptance
Authors: Müller M. A. , Bonsel G. J. , Bleker O. P. , Bilardo C. M.
Published: March 2003

Background

The aim of this study was to determine the performance of nuchal translucency screening and its uptake in a low‐risk population

Method

For a period of 18 months all women attending midwife practices of two health regions were informed on the possibility of having nuchal translucency screening for Down's syndrome. Reasons for opting in or out were recorded and nuchal translucency measurement was performed on request. A risk of more than 1:200, based on gestational age, maternal age and NT, was used as cut‐off for increased risk.

Preliminary results

screening was offered to 6000 pregnant women, of which 83% accepted (n = 4980). The main reason for declining the screening was not considering termination in case of an affected pregnancy. NT measurement failed in 179 cases (3.6%), mainly because of a gestational age of more than 14 weeks or because of a non viable pregnancy at ultrasound. Of the 4801 women in whom NT measurement was performed, 1.4% had an increased risk. Of these 40% were found to have a chromosomal anomaly and in 4% a structural defect was diagnosed at subsequent scans. In total an unfavourable outcome was recorded in 48% of cases with increased risk.

Conclusion

Women of all ages accept nuchal translucency screening. This is an effective screening method for chromosomal abnormalities with a low false positive‐rate.
F04Prognostic value of Dopplerometry during antirecurrent hormonal therapy in patients with hyperplastic process of the endometrium
Authors: Fedorova E. V. , Lipman A. D. , Khokhlova I. D. , Pobedinski N. M.
Published: March 2003

Background

The purpose of study was to find out changes of Doppler parameters in all uterine arteries during antirecurrent hormonal courses and to define their role in prediction of outcomes.

Method

53 patients receiving hormonal therapy (Norcolut, Provera, Danazol) after D & C were undergone 6 months monitoring by transvaginal ultrasound with Color Flow Mapping and Doppler assessment of the main uterine, arcuate, radial and basal arteries. The mean values of resistance indices (RI) were calculated after retrospective division into groups with effective (n = 41) and effectless (n = 12) treatment. Investigated RI data were used for statistical creation of prognostic upper and lower cut‐off levels (for P < 0.05).

Results

The resistance indices were:

Healthy
Effective  treatment
Effectless  treatment
Cut‐off intervals  for P < 0.05

Uterine arteries
0.88
0.86
0.83
0.83–0.87

Arcuate arteries
0.78
0.74
0.72
0.65–0.80

Radial arteries
0.71
0.73*
0.65*
0.60–0.75

Basal arteries
0.57
0.62
0.57
0.48–0.68

– p < 0.10

Conclusion

For predicting effectiveness of hormonal treatment after two months from its beginning Doppler measurements should be carried out in Radial Arteries and RI must exceed 0.75.
Multiple pregnancy F41Early versus late multifetal pregnancy reduction, comparison of pregnancy outcome
Authors: Jaffa A. J. , Hat‐Toov J. , Fait G. , Wolman I. , Gull I. , Achiron R. , Lipitz S.
Published: March 2003

Background

To evaluate the pregnancy outcome of selective second‐trimester multifetal pregnancy reduction (MFPR) compared to late first‐trimester and early first‐trimester MFPR in triplets and quadruplets.

Method

The study groups comprised of 46, 47, and 48 patients who underwent MFPR at mean gestational of 11.2 (group A), 13.6 (group B), and 18.5 (group C) weeks, respectively. Patients of groups B and C underwent ultrasonographic fetal malformation screening. Some patients of group C had amniocentesis for chromosomal evaluation.

Results

No statistically significant difference was found between Group A, B, C regarding Pregnancy loss (4%, 4.3%, 2.5%, respectively), mean gestational age at delivery (35.8, 35.7, 35.8, respectively), and mean birth weight (2190, 2140, 2190, respectively). In group C fetal structural anomalies and chromosomal abnormalities were found in 4.2%, and 4.2% of pregnancies, respectively.

Conclusion

Pregnancy outcome was similar after MFPR at different stages of pregnancy. Selective second‐trimester MFPR is associated with favorable perinatal outcome and may facilitate detection of structural and chromosomal anomalies before the procedure and selective reduction of the affected fetus.
F43Feto‐placental Doppler measurements pre and post laser coagulation in severe twin–twin transfusion syndrome
Authors: Carreras E. , Deprest J. , Van Schoubroeck D. , Roma L. , Van Assche A. , Cabero L. , Gratacos E.
Published: March 2003

Objective

The aim of the study was to know what fetal hemodynamic response to therapeutical fetoscopic laser was, specially in the donor.

Material and methods

Patients with severe TTS undergoing laser coagulation of placental anastomoses (n = 25) were included. Doppler measurements (Accuson Aspen) were performed in the Umbilical artery, Middle cerebral artery, ductus venosus and Umbilical vein of both fetuses preoperatively and on days 1, 3 and 5 postlaser.

Results

Venous pulsatility indices tend to decrease in the recipient while they increase in the donor. Increased PI and/or appearance of pulsations in the UV was observed in 75% of donors, which was accompanied but one or more signs of hydrops in 20% of cases. These did not constitute signs of poor prognosis.

Conclusions

We hypothesize that venous return in the donor fetus increases after laser coagulation, which could explain a transient overload phase, which in any case does not imply a poorer prognosis.
F44Serial amniocentesis in twin Transfusion syndrome
Authors: Szaflik K. , Borowski D. , Wilczyñski J. , Wyrwas D. , Kunert A. , Hincz P. , Ciesielski A.
Published: March 2003

Background

The aim of our study was to estimate the efficiacy of serial amniocentesis in cases of acute polyhydramnion in TTS.

Method

The study group consisted of 13 pairs of twins with sonographically confirmed hydramnios. After the examination patients were prepared for amnioreduction. During the procedure the excess of amniotic fluid was removed through the punction needle.

Results

The mean gestational age was 24.3 ± 2.9 weeks in the range 22–29 weeks. In 6 cases polyhydramnion/oligohydramnion was found. The therapy of TTS was based mainly on serial amniocentesis.The mean gestational age during delivery was 27.6 ± 3 weeks. The mean interval between the diagnosis and delivery was 3.3 weeks. In all cases the deliveries were preterm. The mean donor weight was 730 ± 290 g and the mean recipient weight was 1145 ± 435 g. The difference between the recipients and donors was approximately 37%. In 7 cases we observed an intrauterine demise of one fetus. The 5th min Apgar score was 1 pt (median). When the analysis was performed after exclusion of stillborns, the median Apgar score for donors and recipients was 4 and 2 pt, respectively.

Conclusion

Serial amniocentesis are effective in significant prolongation of gestation (the mean interval between diagnosis and delivery 24 days). The improvement of perinatal outcomes in twin gestations complicated by TTS can be achieved by the combination of serial amniocentesis and the laser ablation.
Second and third trimester Doppler F46Fetal cerebral and adrenal blood velocimetry in predicting hypoxia of the fetus
Authors: Breborowicz G. H. , Dubiel M. , Marsal K. , Gudmundsson S.
Published: March 2003

Background

Animal studies have shown that hypoxic fetuses redistribute their blood flow, giving preferential supply to the brain, heart and adrenal glands. The aim of this study was to evaluate blood velocity waveforms in the fetal middle adrenal artery and cerebral arteries in relation to the outcome of high‐risk pregnancy.

Methods

Middle adrenal artery and anterior, middle and posterior cerebral arteries were recorded in 102 pregnancies complicated by pregnancy induced hypertension between 27 and 41 weeks of gestation. Signs of the fetal ‘adrenal‐sparing’ were considered present when pulsatility index (PI) was below the 95% confidence interval. Signs of fetal brain‐sparing were considered present when the cerebral arterial PI were < mean −2 SD of the normals and cerebroplacental PI ratio < 1.08. The blood velocimetry results were related to perinatal outcome.

Results

Adrenal velocimetry was strongly associated with aDVerse perinatal outcome, being significant for all studied parameters. All perinatal mortality showed signs of adrenal sparing. Adrenal sparing, but not brain sparing, was correlated with fetal acidosis. Combining adrenal velocimetry with brain velocimetry shown worser predictive results than adrenal velocimetry itself.

Conclusion

Fetal adrenal sparing is more predictive of perinatal outcome in high‐risk pregnancies and might be maintained longer than the brain‐sparing sign.
F05Is TV‐USG detection of myometrial invasion of endometrial cancer predictible?
Authors: Tekin B. , Özalp S. , Hassa H. , Şener T. , Yalçin Ö. T. , Etiz E.
Published: March 2003

Background

The aim of the study is to determine effectiveness of transvaginal ultrasound (TV‐USG) examination in predicting myometrial invasion of the endometrial cancer.

Method

Some patients of endometrial cancer, were examined under TV‐USG examination. All TV‐USG procedures were done by the same person and by the same ultrasound equipment between 1.9.1998 and 31.12.1999. After then, patients were operated, and pathological examination of the specimens were done as routine procedure.

Results

Twenty‐six cases who were in this research, were in stage 1 except 4 who were in stage 4. Histopathologic type of 22 cases was endometrioid cell cancer and grade‐1 in 58.3% cases. Ultrasound examination revealed 76.9% similarity with pathological results. Positive predictivity was 94.4% and the negative predictivity was 37.5%.

Conclusion

TV‐USG diagnosis of endometrial invasion of cancer, may be a useful technique in predetermining the way of treatment while the depth of invasion is an important key as well as histopathology and grade of the tumor.
F60Umbilical vein blood flow in growth restricted fetuses
Authors: Rigano S. , Ferrazzi E. , Bozzo  , Giovannini N. , Bellotti M. , Galan H. , Battaglia F.C.
Published: March 2003

Objective

The present study was designed to determine whether specific umbilical blood flow is reduced in IUGR fetuses.

Subjects

Thirty‐seven IUGR fetuses of different clinical severity were examined by Doppler ultrasound within four hours of the last nonstress test prior to delivery.

Method

Absolute and weight specific umbilical vein (UV) flow were calculated from measurements of UV diameter and UV mean velocity. UV diameter, velocity and UV flow were calculated also per unit head (HC) or abdominal circumference (AC) and correlated with gestational age.

Results

UV flow per kilogram was significantly lower in the more severe IUGR fetuses (abnormal umbilical arterial p.i.) than in normal comparable fetuses (P < 0.001). UV flow per unit head circumference was significantly lower in the three groups (P < 0.001) than in the control population. The UV diameter/HC was normal whereas UV velocity/HC was significantly lower in IUGR fetuses than in comparable controls.

Conclusions

The present study clearly establishes that umbilical venous blood flow is reduced in IUGR fetuses on a weight specific basis. The sonographic growth parameter which best distinguishes umbilical flow differences of IUGR fetuses from normal fetuses is the head circumference.