bluuebunny/crossref_metadata_2025 huggingface dataset:
Sonographic prediction of malignancy in adnexal masses using multivariate logistic regression analysis
Authors: Tailor A. , Jurkovic D. , Bourne T. H. , Collins W. P. , Campbell S.
Published: March 2003

The aim of the study was to assign a probability of malignancy for any patient with an adnexal tumor by the application of multivariate logistic regression analysis to variables recorded at the time of pelvic sonography. Sixty‐seven women with known adnexal masses were examined using transvaginal B‐mode and color Doppler imaging. For each patient the variables included: (1) age, (2) maximum tumor diameter, (3) tumor volume, (4) unilocularity (presence (0) or absence(1)), (5) papillary projections (presence (1) or absence (0)), (6) random echogenicity (presence (1) or absence (0)), (7) highest peak systolic velocity (PSV), (8) time‐averaged maximum velocity (TAMXV), (9) pulsatility index (PI) and (10) resistance index (RI). The TAMXV, PI and RI were those associated with the highest PSV. These ten independent variables and the final histological diagnosis for each patient (the dependent variable) were used for the regression analysis. Approximately 75% of the entire dataset was randomly selected for generating the regression model. The remaining 25% was used as the testing set for cross‐validation of the model. In the entire dataset there were 52 women with benign, three with borderline and 12 with invasive ovarian tumors. Regression analysis on the ten variables resulted in the retention of only ‘age’, ‘papillary projection score’ and ‘TAMXV’ as significantly contributing to predicting the presence or absence of malignancy. The probability of malignancy for any patient was given by solving the equation: Probability = 1/(1 + e−Z) where e is the base value for natural logarithms and z = (0.1273 × Age) + (0.2794 × TAMXV) + (4.4136 × Papillary projections score) − 14.2044. Cross‐validation of the model on the test set of data gave a 100% sensitivity and specificity. However, for the entire dataset the best sensitivity and specificity were 93.3 and 90.4%, respectively, at a cut‐off value of 25% probability of malignancy. In conclusion, multivariate logistic regression analysis enables the calculation of probability of malignancy for any patient with a known adnexal mass. The accuracy of this prediction appears to be better than that of morphological or Doppler criteria when the latter are used independently. The value of this model needs to be tested prospectively. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Psychological outcomes following missed abortions and provision of follow‐up care
Authors: Nikcevic A. V. , Tunkel S. A. , Nicolaides K. H.
Published: March 2003

This cross‐sectional study of 204 women who had experienced a missed abortion, diagnosed at 10–14 weeks of pregnancy, examined the availability and desirability of routine follow‐up care, and whether such care is associated with reduced psychological morbidity in the aftermath of miscarriage. Clinically elevated anxiety and depression were observed in 45% and 15% of women, respectively, and the mean score of grief was 2.52 which is similar to that observed in people who suffer death of a close relative. A follow‐up appointment after the miscarriage was thought to have been desirable by 92% of women but was offered to only 30%. No significant association between such care and reduced psychological morbidity was identified. However, there were significantly more women with clinically elevated levels of anxiety among those who felt that they were not provided with an opportunity to discuss their feelings during the follow‐up, suggesting that such a follow‐up either had a deleterious effect on women's psychological state or the distress itself led to such a perception of care. One‐third of women in our sample would have liked psychological counselling to help them deal with the emotional aspects of their loss. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Diagnosis of adnexal malignancies by using color Doppler energy imaging as a secondary test in persistent masses
Authors: Guerriero S. , Ajossa S. , Risalvato A. , Lai M. P. , Mais V. , Angiolucci M. , Melis G. B.
Published: March 2003

The purpose of this prospective study was to compare the accuracy of B‐mode transvaginal ultrasonography alone and in combination with color Doppler energy (or power Doppler) imaging in differentiating benign from malignant adnexal masses. A total of 192 consecutive persistent adnexal masses (159 benign, 33 malignant) were studied before surgery by B‐mode transvaginal ultrasonography with and without color Doppler energy. In addition, CA‐125 plasma levels were determined and spectral Doppler analysis was performed. By color Doppler energy imaging, a mass was considered malignant when arterial flow was visualized in an echogenic portion of a mass defined as malignant by B‐mode. Intratumoral arterial blood flow could be readily detected by color Doppler energy imaging in all malignant tumors and in 94% of the benign tumors. The combined use of transvaginal B‐mode ultrasonography and color Doppler energy imaging has greater accuracy in the diagnosis of ovarian malignancies than transvaginal ultrasonography alone (value of kappa: 0.81 and 0.63, respectively), reducing the number of false‐positive results. The use of spectral Doppler analysis was of limited diagnostic value, with a kappa value of 0.17 for the pulsatility index (< 1) and of 0.41 for the resistance index (< 0.4). Also, the association with CA‐125 increased the number of false‐negative results. In conclusion, the use of color Doppler energy imaging seems to be a useful secondary test when a mass is suspected to be malignant by B‐mode ultrasonography. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Unfused amnion and chorion after 14 weeks of gestation: associated fetal structural and chromosomal abnormalities
Authors: Ulm B. , Ulm M. R. , Bernaschek G.
Published: March 2003

Objective

To assess possible associations between delayed chorioamniotic fusion after the end of the first trimester and fetal structural and/or chromosomal abnormalities.

Design

We prospectively studied 492 fetuses from high‐risk pregnancies between 14 and 18 weeks of gestation by transabdominal ultrasonography. Of these, 60 (12%) had unfused amnion and chorion.

Results

No additional abnormalities were detected in 28/60 fetuses (47%). Karyotyping was performed in 27/28 cases, and one fetus had trisomy 13 (4%). Ten of 24 fetuses (42%) of this group attending a second mid‐trimester scan after 18 weeks of gestation had abnormal sonographic findings not noted at the initial scan. Thirty‐two of 60 (53%) fetuses had additional abnormalities at the initial scan: cystic hygroma (n = 12), increased nuchal translucency (n = 10) and other abnormalities (n = 10). Karyo‐typing revealed aneuploidy in 13 of 28 fetuses (46%) tested: trisomy 21 (n = 5), Turner's syndrome (n = 3), trisomy 18 (n = 3) and trisomy 13 (n = 2). Additional fetal abnormalities were detected only at the second scan after 18 weeks of gestation in three of eight fetuses (38%).

Conclusions

These preliminary data suggest that the sonographic finding of unfused amnion and chorion after 14 weeks of gestation may be associated with fetal structural and/or chromosomal abnormalities. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
P103Effect of uterine contraction on preload index1 in recipient fetus of feto–fetal transfusion syndrome: case report
Authors: Takahashi Y. , Kawabata I.
Published: March 2003

A case of monochorionic‐diamnionic twin was diagnosed as feto‐fetal transfusion at 19 weeks gestation. We performed amniocentesis to reduce the fluid and amnioseptostomy. The discodancy of amniotic fluid was remarkably dissolved for long period. At 25 weeks gestation, we started tocolysis by ritodrine and magnesium sulfate drip infusion. During the uterine contraction, we detected increased preload index on recipient fetus by evaluation of the flow of inferior caval vein and reverse end‐diastolic flow of umbilical artery on donor fetus and these unfavorable findings disappeared a few minutes after the uterine contraction improved. These findings suggest that uterine contraction is absolute risk factor for feto–fetal transfusion syndrome because they worsen blood flow on both fetuses.

(1) Kanzaki T, Chiba Y. Evaluation of the preload condition of the fetus by inferior vena caval blood flow pattern. Fetal Diagn Ther 1990; 5(3–4):168–74.
P104 Ultrasonic fetal and placental tissue characterization and the role of Doppler ultrasound in lung maturity
Authors: Podobnik M. , Podgajski M. , Breyer B. , Gebauer B.
Published: March 2003

Objectives

The aim of this study is to known the relationship between the gestational age and quantitative assessment of ultrasonic signs of placental tissue, fetal lungs and liver tissue and to correlate Doppler parameters from main stems of the pulmonary arteries for determining fetal lung maturity in normal pregnancy and pregnancy with preeclampsia and diabetes.

Method

The placenta, fetal lungs and fetal liver in 300 normal pregnancies, 100 preeclamptic pregnancies and 100 diabetic pregnancy were examined by ultrasound at 30–41 weeks of gestation. The coefficients of variation (the standard deviation divided by the mean value) were used to characterise the tissue in different groups during pregnancy. Doppler velocimetry was performed in the main stems of pulmonary arteries in normal pregnancies and pregnancies with preeclampsia and diabetes.

Results

The coefficients of variation in mature foetuses were greater than 29% for placentas in‐vivo, greater than 34% for placentas in‐vitro, greater than 28% for liver tissue and greater than 30% for lung tissue. Placental, lung and liver tissue of diabetic pregnancy tended to have lower coefficients of variation throughout their pregnancies. We found in mature foetuses mean peak systolic velocity higher than 40 cm/sec. and PI lower than 3,00. In mature foetuses with preeclampsia we found higher mean peak systolic velocity in comparing with normotensive patients.

Conclusion

The coefficient of variation values for placentas in‐vivo and in‐vitro, and fetal lungs and liver increase during pregnancy in normal and preeclamptic patients with increasing gestational age and decrease in diabetic patients.
P105Umbilical vein blood flow changes in normal and growth retarded fetuses
Authors: Di Naro E. , Ghezzi F. , Raio L. , Franchi M. , Romano F. , Clericò L. , Lanzilotti G. , Bolla D. , Balestreri D.
Published: March 2003

Background

The aim of this study was to assess whether changes of UV flow volume over time in late (third trimester) growth retarded fetuses (IUGR) are different than those in normal fetuses.

Method

Umbilical morphometric characteristics and UV blood flow parameters of 15 women whose fetus was diagnosed to be IUGR without umbilical artery Doppler abnormality were compared to those of 30 women whose fetus was healthy. Gestational age and parity were used as matching criteria. Digital color Doppler velocity profile integration was used. For each patient, two scans were performed in a period of 3 weeks.

Results

The umbilical cord area was significantly smaller in IUGR than in healthy fetuses at each examination (P < 0.05). The umbilical artery areas were not different between groups. The UV blood flow normalized for estimated fetal weight was lower in IUGR than in healthy fetuses 115 ± 41 vs. 145 ± 39, P < 0.05). The UV flow increase between two consecutive exams was significantly lower in IUGR than in healthy fetuses (P < 0.05).

Conclusion

The umbilical cord area and the uv blood flow of IUGR were reduced in comparison to healthy fetuses. The normalized UV blood flow difference between IUGR and healthy fetuses increases with advancing gestation.
109Transcranial‐duplex‐Doppler US findings and neurodevelopmental outcome of infants with perinatal cerebral infarction
Authors: Ðuranović V. , Mejaški‐Bošnjak V. , Marušić‐Della Marina B. , Duplanćić R. , Lujić L. , Babic‐Polak J. , Huzjan R.
Published: March 2003

Objectives

We recorded cerebral flow velocities by TCDD in 10 infants diagnosed with cerebral infarction (CI) of the irrigational area of the middle cerebral artery (MCA), with special reference to the etiology and pathogenesis of CI. We correlated the hemispheral localization and the distribution of the lesion with neurodevelopmental outcome of the children affected.

Patients and methods

Two children were preterms and other eight were full terms. The diagnosis was obtained in all children by using cranial US, CT and MRI. Because of vascular etiology of lesion cerebral circulation was investigated by TCDD. Perinatal risk factors were assessed and patients underwent neurodevelopmental follow‐up for 1–14 years.

Results

Cerebral infarction involved the irrigational area of MCA. Asymmetric flow between the left and right MCA was the main finding on the TCDD. Lower velocities were found in the MCA on the affected side. These side‐to‐side differences were present at subsequent Doppler measurements. The lesion was more often found on left size. The distribution of the infarction was classified as the area of the lesion determines the neurological sequels. All infants had delayed psychomotoric development: contralateral hemiparesis, persistent seizures and language delay. The level of cognitive functioning was variable.

Conclusions

Based on clinical and diagnostical follow‐up the results showed no simple and clear connection between lesion parameters and neurodevelopmental outcome. We suppose that the time when lesion occurred is crucial for the possible neurodevelopmental outcome. The data indicates that beside brain US, CT and MR, TCDD can be useful method for identifying and following infants with suspected cerebral infarction.
P110Neurodevelopmental outcome of children with intrauterine growth retardation and pathological antenatal color Doppler: a 1‐year follow‐up
Authors: Huzjan R. , Mejaški‐Bošnjak V. , Gojmerac T. , Jugović D. , Grguric‐Koprčina B. , Tumbri J. , Polak‐Babić J. , Kalafatić D.
Published: March 2003

Objective

The aim of the study is to determine the neuro‐developmental outcome of children with IUGR due to placental insufficiency diagnosed by Color Doppler during pregnancy.

Patients and methods

25 children who were diagnosed with IUGR were included. The intrauterine growth was evaluated by repeated US and Doppler examinations and the resistance indexes in umbilical and cerebral fetal blood vessels were registered. The C/U ratio lower than one was considered pathological, implying the phenomena of fetal circulation centralization and brain sparing effect. All children underwent protocol that included the evaluation of other perinatal risk factors and extensive neurological follow‐up with repeated brain US, electrophysiological tests, visual and hearing acuity testing, as well as developmental assessment.

Results

The gestational age ranged from 30 + 6 to 41 gestational weeks. The follow‐up period ranged from 2 to 16 months. None of the children has severe disorder. Some children have signs of dystonic syndrome (6 cases) or global neuroedevelopmental delay (2 cases). The nonoptimal outcome was always connected to neonatal complications and pathological brain US finding (PV‐IVH or cortical brain atrophy). Further neurodevelopmental evaluation for assessment of higher cognitive functioning at later (even school age) age will be necessary.
Prenatal diagnosis P11Fetal scanning between 18 and 22 weeks is passé
Authors: Bronshtein M.
Published: March 2003

Our study summarizes about 40000 early transvaginal examinations (14–16 weeks gestation). There were more than 1200 anomalous fetuses which demonstrated more than 1700 anomalies. We analysed the anomalies according to (1) early onset anomalies, (2) transient anomalies which disappeared toward the second trimester (nuchal findings, echogenic bowel, hypospadias., etc.), (3) anomalies which are much more easily detected in early pregnancy (vascular ring, rt. aortic arch, coarction, finger anomalies, kidney anomalies and others), (4) abnormalities which appear or manifest only in late pregnancy (lissencephalos, achondroplasia, etc.).

Conclusions

The percentage of late onset abnormalities is lower than for transient abnormalities. Therefore, performing only one examination by an expert will detect 97% of the detectable abnormalities in early pregnancy. Performing only one examination between 18 and 22 weeks will reveal a lower rate of the detectable anomalies. Most of the late onset anomalies appear later than the 22rd week of gestation. Therefore, the 18–22 week scan is passé and should give way to the 14–16 week TVS scanning in the search for fetal anomalies.
Fetal echocardiography P111Bradyarrythmia in the first trimester, a predictor of pregnancy loss
Authors: Vincze T.
Published: March 2003

Background

To determine the prognostic of cardiac bradyarrythmia detected in the first trimester.

Method

Cases in which bradyarrythmia was detected by ultrasound between 8–11 weeks were retrospectively reviewed.

Results

Bradyarrythmia was founded in five cases of 1292 examinations. One week later was not detected cardiac activity in three, and 2 weeks later in two cases.

Conclusion

The report suggest that bradyarrythmia is a poor prognosis in early pregnancy and associated with pregnancy loss
P122Fetus with partial hyperechoic cardiac walls
Authors: Duyos J. A.
Published: March 2003

Objective

To present a rare case of a fetus with very echogenic cardiac atrial walls, but with normal density in the rest of the heart, perhaps due to a viral infection.

Case report

The first ultrasound examination at 17 weeks was normal, but in the next exam at 24 weeks we detected that the fetal cardiac atrial walls were very echogenic. However, the density of the atrioventricular valves and the ventricular cardiac walls were normal. The morphology of the heart was also normal. There was also an important amount of ascites. Doppler study of the atrioventricular valves was normal. Later examinations were similar but the quantity of ascites gradually decreased. At 34 weeks, the patient had a premature rupture of the membranes and a healthy infant was born. The ascites had disappeared and the baby's outcome was normal.

Discussion

To prevent misdiagnosis of the density of the cardiac walls, we made exams of different fetal positions, but hyperechoic atrial walls were always seen. After consulting a neonatal cardiologist, we concluded that the cause of this alteration may have been a viral infection, which could have produced partial density alteration of the cardiac walls. The hyperechoic atrium may cause poor contractability and produce ascites.

Conclusions

Despite the impressive aspect of the hyperechoic atrial cardiac walls and an important ascites, the infant's outcome was normal.
P138A case of bilateral mature cystic teratoma with calcified elements in an old age postmenopausal woman
Authors: Kavak Z. N. , Başgül A.
Published: March 2003

Background

Dermoid cysts are interesting tumours in which all body tissues may be represented. Neither presence of calcified elements, nor postmenopausal age, nor bilaterality are usual for them. We present here, a case of postmenopausal woman in whom bilateral dermoid cysts were found with calcified elements. Ultrasonographic features, clinical presentation, differential diagnosis and treatment modalities of this rare case are presented and discussed.

Case

70‐year‐old woman gravida 0 para 0 was referred to our Department complaining of postmenopausal bleeding for the last two months. She was postmenopausal for the last 27 years during which she had never been treated with estrogen replacement therapy. On a gynaecologic examination, bilateral adnexal mass found. Ultrasonographic scanning demonstrated a normal sized anteverted uterus with an endometrial thickness of 4 mm with an hypoechoic ring around it. Transverse ultrasonogram showed bilateral adnexal highly reflective echogenic well circumscribed mass with solid and cystic components. Endometrial biopsy showed granulomatous endometritis. At surgery, a bilateral ovarian tumour measuring 4 × 5 cm in diameter was seen. A pathologic examination confirmed bilateral dermoid cysts with no malignant component. Peritoneal washing was also negative. Total abdominal histerectomy with bilateral salphingooopherectomy was performed. On discharging from Hospital, estrogen replacement therapy was given.
P146Early detection of ectopic pregnancy with ultrasound
Authors: Simic M. , Kopjar M. , Viskovic T. , Zadro M.
Published: March 2003

Objective

To determine if the typical appearance of endometrium for late proliferative phase and early secretary phase could be used as a patognomonic sign for early detection of ectopic pregnancy in combination with other patognomonic signs for ectopic pregnancy.

Methods

Over a period of four 76 patients were admitted at our department as a result of suspicion of ectopic pregnancy.

Results

In three patients out of those 76 at the time of admission ectopic pregnancy was not visible neither on ultrasound nor on laparoscopy. One of them was a cervical pregnancy, and two others were cornual pregnancies. Sixty‐six patients have had tubar abortions, including two pregnancies with live embryo in the tube.

Conclusion

Typical late endometrial look for late proliferative phase and early secretary phase can be used as a patognomonic ultrasound finding for ectopic pregnancy especially in combination with other patognomonic ultrasound findings and in combination with serum progesterone measurement.
Miscellaneous P150Illustration of a cervical pregnancy medically treated
Authors: Guizani M. , Vernaeve V. , Van Pachterbeke C.
Published: March 2003

A 26 year old woman, without any previous medical history and who has done two pregnancies interruptions, came at the visit for inquieries for a third pregnancy termination. She was in amenorrhea, the time elapsed from the last period was unknown. The patient had abdominal pain progressing since a few weeks. The clinical examination showed a painful cervix mobilisation. An ultrasound scan was performed showing a seven weeks nonevolutive cervical pregnancy. The uterine cavity was enlarged and filled with blood clots. To avoid hemorragic complications that could be life‐threatening, the patient received a single intramuscular injection of 60 milligrams of methotrexate. We followed the evolution with ultrasounds scans and measurements of plasmatic βHCG and progesteron. The course of the diesease ended succesfully. The poster will summerise the clinical, biological and sonographic evolution during the four weeks following the medical treatment.
P153Cerebral venous thrombosis and pregnancy: image diagnosis
Authors: Lagos N. , García C. , Castillo G. , Luengo N. , Hoffmann I. , Ortega P. , Astorga  , Ferres I.
Published: March 2003

Background

Thrombotic conditions are common complications during pregnancy.

Cerebral venous thrombosis is also more frecuent in pregnant patients, with a prevalence of 4.5 per 1000 obstetric admissions. We present 3 cases that were managed in our unit.

Patient 1

38‐year‐old, epileptic, 10 week pregnant. She had occipital, pulsatil headache plus blurred vision. A Magnetic Nuclear Resonance (MNR) showed lack of flow, in the right transverse sinus, and yugular gulf.

Patient 2

32‐year‐old, with an haemolytic anemia and an occipital meningioma. She had a 34‐weeks pregnancy and was admitted because of edema of the lower extremities.

She has paresthesies and hypoesthesia of the right leg, which progresed to anesthesia. MNR showed her occipital tumor, measuring 10 × 12 mm, and thrombosis of the right transverse and lower sagital sinus.

Patient 3

30‐year‐old, 10 weeks pregnant, admitted because of a headache that did not respond to common analgesics. MNR informed thrombosis of the left transverse sinus, and the yugular gulf.

All 3 patients were treated with low molecular weight heparin.

Conclusions

The majority of cases of cerebral venous thrombosis involve the high sagital sinus. In the pregnant patient study by images is recommendable and the test of choise is MNR, which has a sensibility of 90%. Recommended treatment is anticoagulant therapy.
P159Three‐dimensional ultrasound reconstruction and telemedicine. Image analysis
Authors: Ferrer‐Roca O. , Troyano J. M. , Vilarchao‐Cavia J. , Clavijo M. T. , Marco O. Y. , Feo C. M.
Published: March 2003

Background

In the present study the 3D US images reconstruction is combined with the distant consultation through internet or through an ISDN line.

Method

Trial consists of explorations done during 1999/2000 in our US unit at the Obstetrics and Gynaecology Department. The equipment is integrated by: a standard Aloka‐SSD 680 ultrasound device, a Dual Pentium II workstation with 256 Mb RAM memory and Windows NT operative system, a falcon framegrabber board, and the TeleInvivo 3D reconstruction and teleconsultation software by MEDCOM.

Echograph images are acquired by the workstation through a falcon digitising board, and the TeleInVivo software generates a 3D volume. These volumes can be sent to a remote host via internet or via an ISDN line, allowing an on‐line teleconsultation and telediagnosis.

Results

During the trial we made 149 teleconsultations of different pathologies. 3d reconstruction was time consuming (20 min to 4 h) and of a limited diagnostic value, but of future relevance to reduce patient multiple explorations due image constraints such as sub optimal foetal position among others. The final volumes are sent wavelet lossless compressed through internet or an ISDN line, and for a normal size of 1.5 MB the time consuming is from 4 to 8 min to be transmitted.

Conclusion

The use of internet or an ISDN line is a fast method for sending and consulting 3D ultrasound images, and it is possible due to the selected volume rendering techniques that provide an effective compression of the original data.
P17At what gestational age can the corpus callosum and cavum septi pellucidi be regularly seen at routine obstetrical ultrasound examination?
Authors: Toi A.
Published: March 2003

Background

Agenesis of the corpus callosum (ACC) is reported to be difficult to detect before 22 weeks gestation. However, the cavum septi pellucidi (CSP) develops with the CC and is seen by 15–16 weeks. Thus, ACC should be detectable by 16 weeks.

Purpose

To determine at what gestational age the cavum septi pellucidi and corpus callosum become regularly visible and hence ACC can be suspected if they are not visible.

Methods

Fifty consecutive women referred for US for all indications between 25 June and 9 July 1999 were scanned trans‐abdominally with specific attempt to see the cavum septi pellucidi (CSP) and the corpus callosum.

Results

BPD ranged from 32 (15.6 week) to 81 mm (33.1 week). The CSP was visible in every fetus starting at BPD 34 mm (16.2 week). On mid sagittal views the CC was also visible starting at BPD 34 mm (16.2 week) in all but 3 fetuses due to fetal position. The CC was seen well enough to confidently measure its length in 27/49 (55%).

Conclusions

At routine examination, the CSP was detectable by 16.2 week (BPD 34 mm) gestation and in every pregnancy after this age. Using only trans‐abdominal scans, the CC was visible on sagittal views by exploiting access provided by sutures and fontanelles. Detection of complete agenesis of the corpus callosum should be possible by 16 weeks gestation.
P31Structural reorganization of the brain after perinatal damage – US/MRI review
Authors: Gojmerac T. , Mejaški‐Bošnjak V. , Polak‐Babić J. , Radoš M.
Published: March 2003

Background

The aim of this study was to estimate structural reorganization of the brain after perinatal brain damage, diagnosed by ultrasonography (US) in the neonatal period, using magnetic resonance imaging (MRI).

Methods

A follow up study was carried out on a cohort of 28 perinatal risk children who were ultrasonographicaly followed during the first 2 years of life. 22 children, who had intraventricular haemorrhage (IVH I and II), were in the investigation group and the other 6, who had continuous normal us findings, were in the control group. Follow up included high resolution 2T magnetic resonance imaging of the brain at 13–16 years.

Results 

MRI

normal
PV1
CA2
ML3

cases (n = 22)
US
IVH I (n = 12)
9
0
2
1

IVH II (n = 10)
4
3
1
2

controls (n = 6)

4
2
0
0

PV = periventricular tracks of haemorrhage;

CA = cortical atrophy;

ML = multiple lesions

Conclusion

Abnormal MRI scans are more frequently in the cases with IVH II, than in the cases with IVH I. We can conclude that structural reorganization of the brain can repair majority of mild perinatal intraventricular haemorrhage.
P04Pre‐abortion ultrasonography
Authors: Balić A. , Balić D. , Balić B. , Berbić S. , Zukić I.
Published: March 2003

Background

The aim of this study was to audit prospectively the value of pre‐abortion ultrasonography.

Methods

All women who came in our Centre because of doubt unplanned pregancy in first trimester from March 1994 to March 1996 were underwent an exam by vaginal ultrasound before abortion. We analysed these data and compared them with complications after legal induced abortion.

Results

During two years a total of 334 women were surveyed. Twenty‐seven women (8.08%) were not being pregnant. In thirty‐three cases (10.75%) the pregnancy was greater for two weeks than we expected on the basis of last menstrual period. Also we founded: 21 (6.84%) myoma uteri, 5 (1.62%) ovarian cysts, 5 (1.62%) multiple pregnancy, 4 (1.3%) anomaly of the uterus, 1 (0.32%) blighted ovum and 1 (0.32%) nuchal translucency greater than 5 mm.

Conclusion

Pre‐abortion ultrasonography increases security of this intervention by elimination some problems about induced abortion. Since the elimination is simple, fast and cheap we recommended it for routine use. We hope that is one of the way for decreasing of late complications after abortion like as infertility.
P54A case of Gollop Wolfgang complex: prenatal diagnosis and pregnancy termination
Authors: Tekin B. , Hassa H. , Şener T. , Şenses T.
Published: March 2003

Objective

To report a prenatal diagnosis of Gollop Wolfgang complex.

Case history

This is a pregnant women of 29 years of age, G:2 P:1 Ab:0 with 23 weeks of gestation, has not any history of drug use nor infection during pregnancy. Her husband 29 years of age, has not any family history of anomaly nor medical illness of skeletal deformity as his wife. Ultrasound examination of this pregnancy at 16 weeks gestation showed pes equinovarus deformity and an absence of distal bone of right extremity. The family was informed about the problem. At the meantime ethical permission was obtained for termination of this pregnancy. At 23th weeks, after having family's consent for termination of pregnancy, careful ultrasound examination of the fetus was carried out; double distal femoral epiphysis with ipsilateral deficiency of distal bone (tibia or fibula) and pes equinovarus of the right lower extremity were diagnosed. After cervical priming and induction of labor, female fetus with 1‐1‐1 Apgar scoring at 1st, 5th and 10th minute was born. There was also hypoplastic right knee joint with bony prominence and flexion contracture at the right leg. X‐rays of whole body were taken. There was also some other deformities and absence of some small bones.

Conclusion

This is the first case of prenatal diagnosis of Wolfgang Complex. We showed the importance of a careful ultrasound examination of fetus in the first and second trimesters for the diagnosis of fetal malformation.
P06Isolated hyperechogenic foci in the fetal thalamus in early pregnancy
Authors: Bronshtein M. , Zimmer E. Z. , Auslander R. O. N. , Blazer S.
Published: March 2003

Background

The purpose of this study is to describe the monographic features and outcome of fetuses with isolated hyperechogenic foci in the thalamic region.

Method

A detailed monographic survey was performed in 46244 consecutive pregnancies. Both low and high‐risk pregnancies were included. Transvaginal examinations were performed at 14–16 weeks' gestation, while transabdominal examinations were performed after 18 weeks' gestation.

Results

Isolated hyperechogenic foci in the thalamic region were observed in 7 fetuses. All cases were diagnosed at 14–16 weeks' gestation. Six fetuses had one hyperechogenic focus, and one fetus had two foci. The size of these foci ranged from 2 to 4 mm. A serologic work‐up was negative in all these fetuses and their karyotype was normal. The hyperechogenic foci disappeared in mid‐pregnancy in all cases, and fetuses were normal at delivery and on follow‐up up to the age of 9 years.

Conclusion

Isolated hyperechogenic foci in the thalamic region in the early pregnancy have probably a benign nature.
P61The possible impact of storing fetal samples collected during prenatal invasive procedures: case report
Authors: Pedreira D. A. L. , Yamasaki A. , Chauffaille M. L. , Muller R. , Cha S. C.
Published: March 2003

MGB, 34 years‐old, primigravida, conceived after IVF (still has 08 frozen embryos). At 21 weeks + 2 days the anomaly scan showed mild dilatation of fetal cerebral ventricles and a multicystic right kidney with mild nasal bone hypoplasia. Fetal growth was considered normal (20 weeks + 3 days based on biometry). Karyotipe obtained at 23 weeks showed a normal male (46, XY). By that time ventricular dilatation had increased but head circumference was normal for gestational age. Delivery occurred at 24 weeks. Postnatal examination showed smooth brain, ventricular dilatation, agenesis of corpus calosus and cystic dysplasia of right kidney. Lisencephaly was suspected and fish test targeting microdeletion of chromosome 17 was performed in the frozen cells obtained at amniocentesis, which showed negative results. Parents were counselled with the maximum risk of recurrence of an autosomal recessive disease for the next pregnancy.

Discussion

The recent advances in the genetics field will soon offer us the possibility of diagnosing an increasing number of diseases that can have an impact in counselling. If we could diagnose de Mieller–Dieker syndrome in this fetus we could have changed the empirical risk of 25% recurrence in counselling for a future pregnancy. This is because, if none of the parents was found to be a carrier of the microdeletion, we could postulate that this was a ‘de novo’ mutation (happens in 80% of the cases) and the risk for the next pregnancy should be negligible.
P79Maternal ophthalmic artery Doppler velocimetry in type 1 diabetes during pregnancy
Authors: Kanenishi K. , Yamashiro C. , Tanaka H. , Kuno A. , Yanagihara T. , Hata T.
Published: March 2003

Background

Our purpose was to evaluate whether maternal ophthalmic artery pulsatility index (PI) in normotensive pregnancies with type 1 diabetes is different from that in normal normotensive pregnancies.

Method

The ophthalmic artery in 15 normal normotensive pregnant women, and 13 normotensive pregnant women with type 1 diabetes was studied once with colour Doppler flow imaging and pulsed Doppler ultrasonography after 16 weeks gestation. The heart rate, mean arterial blood pressure, and ophthalmic artery PI were calculated in each group.

Results

The PI (1.94 ± 0.45) in normotensive pregnant women with type 1 diabetes was significantly lower than that (2.73 ± 0.32) in normal normotensive pregnant women (P < 0.0001). There was no significant difference in maternal heart rate or mean arterial blood pressure between the two groups.

Conclusion

These results suggest that vascular resistance in the maternal orbital circulation is reduced in pregnancies with type 1 diabetes that are normotensive. The lower PI in pregnant women with type 1 diabetes should be interpreted as orbital vascular vasodilatation, indicating orbital hyperperfusion or hyperaemia.
P80Combined assessment of the fetal distress in diabetic pregnancy class R/F using uterine, middle cerebral, umbilical artery blood flow and fetal heart rate monitoring
Authors: Pietryga M. , Wender‐Ozegowska E. , Biegańska E. , Brzert J. , Biczysko R.
Published: March 2003

Background

Pregnacies complicated by diabetes mellitus cl.R/F are in higher risk of placentae insufficiency and poor perinatal outcome.

Methods

We have investigated 15 diabetic pregnant women of class R/F after 26 weeks of pregnancy. We observed waveform ‘notch’ in ascending uterine artery. Fetal distress was diagnosed when, in the nst silent oscilation or late decelarations appeared. Pathological blood flow in term pregnancy was diagnosed when RI and PI was abnormal and cerebro‐placental ratio was above 1. AEDF and REDF were assessed as fetal distress. Newborns were estimated by Apgar score and pH value of umbilical artery. The mean diurnal glycemia ranged 110 mg/dl, and the HbA1c 6.2%, 8.0%.

Results

Pathological condition acc. to the AS and pH A.umb. manifested 75% newborns, but acc. only to pH A.umb.values 15% of them. Positive predictive value of NST in fetal distress detection was 66%, of the DV 53%, uterine artery ‘notch’ 66% when neonates condition was analysed by using AS and pH. The highest (80%) PPV was achieved all methods. False positive results in NST analysis were found in 19.8% of cases. False negative results was for methods together in 6.6%. When the neonates condition was analysed only by using pH A.umb.value, the PPV for NST was 66%, for DV 73%, for ‘notch’ 73% and for all methods together 86%. False positive results for all methods NST, DV, ‘notch’: and for all methods tohether, achieved the following values: 26%, 19.8%, 19.8% and 26%. False negative result in all methods was 6.6%.

Conclusins

Blood flow measurements in fetal and maternal circulatory circles combined with FHR monitoring reaches very high prognostic values in detection of the fetal distress.
WS15‐09Three‐dimensional ultrasound examination of fetal and placental vessels
Authors: Wisser J.
Published: March 2003

Objective

Since August 1998 we used the integrated 3‐D software with the Siemens Elegra in order to evaluate fetoplacental vessels in the 3‐D mode. Aim of the evaluation was to examine the feasibility of the application and to demonstrated potential clinical advantages.

Methods

In our antenatal clinic we recruited pregnant women between 12 and 38 weeks of gestation to take part in a feasibility study in order to evaluate the free‐hand 3‐D application using the 5.0 MHz transducer for routine antenatal scanning. We examined vasculatore within the placenta, intrathoracoabdominal and intracranial fetal vessels with the integrated powermode. Acquisition time for a volume date set is between 3 and 20 s depending on the resolution selected.

Results

Three‐dimensional examination of the fetoplacental vessels is easily available using the Siemens Elegra, because no change in transducer is necessary. Our preliminary data show that we are able to demonstrate the complexity of intraplacental vasculature, which may be clinically helpful in the evaluation of twin placentas. Within the fetus the spatial arrangement of the vessels and their relation to each other can be depicted. This allows to study the fetal vascular tree and clearly discloses vascular anomalies.

Conclusions

Application of the integrated 3‐D software within the Siemens Elegra for the first time allows the examination of the complex fetoplacental vascular tree in vivo. This may be clinically helpful in the differential diagnosis of fetal anomalies.
WS16‐06Three‐dimensional ultrasound assessment of the first trimester fetus – a ‘one step’ approach
Authors: Hull A. D. , James G. , Nelson T. R. , Pretorius D. H.
Published: March 2003

Background

The optimal time at which to perform obstetric ultrasound remains controversial. Late first trimester imaging offers the possibility for early diagnosis of structural and genetic abnormalities. Three‐dimensional ultrasound (3DUS) allows the entire first trimester conceptus to be contained within one or two volumes of data. Subsequent processing of this data allows optimized views of the fetus, placenta and cord to be obtained.

Method

Late first trimester (∼12 week) pregnancies were imaged with transvaginal 3DUS. A fetal structural survey was performed, standard biometry obtained and nuchal translucency thickness (NTT) measured. The time taken to perform and assess the scans was recorded.

Results

A comprehensive fetal survey was obtained, fetal measurements made and NTT measured in most fetuses with average scan times of less than one minute and average volume assessment times of less than 10 min in all cases. There were no abnormal findings in this series.

Conclusion

3DUS appears to be a useful tool in the ultrasound evaluation of the 12 week fetus. A detailed examination of the fetus may be performed with minimal scan time offering exciting possibilities for the use of transvaginal 3DUS as a ‘one step’ screening examination.
WS17‐02Utero‐ovarian arterial blood flow and hormonal profile in patients with polycystic ovaries
Authors: Vrtačnik‐Bokal E.
Published: March 2003

Background

To review the literature of utero‐ovarian arterial blood flow and serum hormonal profile in the patients with polycystic ovaries (PCO) compared to the patients with normal menstrual cycles undergoing in‐vitro fertilization treatment.

Method

Pertinent studies were identified through a computer MEDLINE search. References of selected articles were hand‐searched for additional citations.

Results

The vascular impedance to uterine artery blood flow is higher during the luteal phase of PCO patients compared to the normally cycling patients and it does not show any dynamics throughout the menstrual cycle. In the normally cycling patients the active ovary shows dramatic hemodynamic changes during the cycle, therefore the vascular impedance to ovarian artery blood flow is almost constant throughout the menstrual cycle in the inactive ovary. In PCO patients the ovarian arterial blood flow in both ovaries is about the same as in inactive ovaries in the normally cycling patients. High vascular impedance to utero‐ovarian arterial blood flow is associated with typical low vascular impedance of stromal ovary vascularization in PCO patients. In stimulated cycles a strong negative correlation between the vascular impedance to the uterine artery blood flow and the serum E2 concentration is found on the day of HCG administration. Taking only anovulatory PCO cycles into consideration, the above correlation is not confirmed.

Conclusion

Doppler analysis can be a valuable method for the assessment of utero‐ovarian arterial blood flow in spontaneous and in stimulated cycles.
WS17‐03Relationship between ultrasound‐determined follicular size and DNA ploidy of human granulosa cells
Authors: Gersak K. , Lavrencak J. , Us‐Krasovec M. , Tomazevic T.
Published: March 2003

Background

The possibility that the hyperstimulatory effect of gonadotropins may be important etiologically in the genesis of some cases of ovarian cancer is still under discussion. Few flow and image cytometric studies report on DNA aneuploid granulosa cells in follicular fluid from women undergoing in vitro fertilization (IVF). The reports are very controversial. The aim of the study was to analyse relationship between ultrasound‐determined follicular size and DNA ploidy of granulosa cells from gonadotropin‐stimulated follicles.

Method

The granulosa‐luteal cells were obtained from women undergoing an IVF‐ET program at the University Department of obstetrics and Gynecology Ljubljana. Seventy aspirates of individual follicles (transvaginal determined size, range 15 mm – 30 mm in diameter) from gonadotropin‐stimulated cycles were analysed. Cytospins were prepared and fixed in delaunay fixative. All the slides were stained by the feulgen thionin method. Image DNA analyses was performed on automated high‐resolution image cytometer. The DNA index was calculated to define DNA ploidy.

Results

All granulosa cell samples were found to be diploid.

Conclusion

Regardless of different ultrasound‐determined size of follicles, all analysed granulosa cells have diploid DNA content.

Acknowledgements

Supported by grants from ministry of Research and technology republic of Slovenia (No. j3‐0428–032–98).
WS17‐09Doppler flow measurements and neuromotoric morbidity
Authors: Ertan A. K. , Schmidt W.
Published: March 2003

Background

Absent enddiastolic flow (AEDF) velocities are associated with fetal distress and adverse fetal outcome. The aim of this study was to evaluate perinatal findings of fetuses with an AEDF in fetal vessels and to investigate the neurological long‐term‐outcome.

Method

The analytical program ‘Munich functional developmental diagnostics’ (MFDD) was applied to the 90 children at different time intervals. The results of 40 children with an AEDF (Gr. I) and 20 children with pathological S/D‐Ratio (Gr. II) were compared to the group of 30 children with normal Doppler‐flow‐findings (Gr. III) with the same pregnancy weeks at birth.

Results

The rate of C‐section (92% vs. 71% vs. 36%), birthweight (1140g vs. 1725g vs. 2570g), 5′min. APGAR‐Score (31% vs. 5% both) were significantly different in three groups. Brain sparing effect in the middle cerebral arteries was found in 81% in Gr. I, in 21% Gr. II and only 8% in Gr. III. At the time of neurological assessment the age of children was between 12 and 36 months. The developmental age for each functional category was evaluated and the difference between corrected age and developmental age was calculated. In 33% of all infants with a AEDF had a pathological neuromotoric development vs. 22% in Gr. II and only 15.3% in Gr. III.

Conclusions

The children with pathological Doppler‐flow‐measurements during pregnancy have not only very high risk of perinatal abnormality but also show a distinctly increased risk of impaired growth and neurodevelopmental disability comparing to the cases with a normal Doppler‐flow‐finding. Most of these fetuses showed brain‐sparing effect. These aspects are very important to be discussed with the parents before the definitive perinatal decision is made.
WS02‐03What can fetopathology add to the prenatal ultrasound diagnosis?
Authors: Papp Z.
Published: March 2003

Background

Multiple malformation syndromes are generally heterogeneous diseases with inappropriate clinical delineation most cases. Geneticists are facing problems with lack of proper knowledge inspite of the overwhelming information available regarding a certain syndrome. Emphasis should be placed on the characteristic features of the suspected syndrome, or any major or detectable minor anomaly with significant effect on the course of the pregnancy.

Conclusion

Detailed ultrasonography by experienced personnel provides a valuable tool in diagnosing morphological alterations of the fetus in mid‐gestation. After termination of the pregnancy, the effected fetus must be examined thoroughly by an experienced fetopathologist. Careful and comprehensive examinations reveals all major and minor morphological alterations that might outline a certain syndrome or other multiple abnormality entity. Computer based syndromological programs are important in this process, for they help geneticists and fetopathologists by matching the most suitable syndrome to the given case. Genetic counseling can be completed only with the establishment of the most probable diagnosis. Declaration of recurrence rate and possible application of other prenatal diagnostic methods must be included in the counseling. Different types of multiple malformation syndromes of the fetus will be presented in the lecture.