bluuebunny/crossref_metadata_2025 huggingface dataset:
The dilemma of prenatal diagnosis of bladder exstrophy: a case report and a review of the literature
Authors: Goldstein I. , Shalev E. , Nisman D.
Published: March 2003

Bladder exstrophy is a very rare congenital anomaly characterized by the exteriorization of the viscera on the abdominal surface, low insertion of the umbilical cord, divergent pubic rami and abnormal exterior genitalia. We report a case of prenatal diagnosis of fetal bladder exstrophy in which the urachus resembled the normal bladder. Considering that non‐visualization of the bladder is one of the main findings in cases of bladder exstrophy, special attention should be given to fetal lower abdominal cystic images in order to differentiate them from a normally positioned fetal bladder. A review of the literature together with a sonographic study of the urachus is provided. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound imaging of the lower urinary system in women after Burch colposuspension
Authors: Martan A. , Mašata J. , Halaška M. , Voigt R.
Published: March 2003

Objective

Most of the relevant surgical procedures employed in the management of genuine stress urinary incontinence (GSI) involve the technique of bladder neck elevation. The appropriate level of suspension is an important (but frequently overlooked) consideration as the clinical consequences of over‐correction of the posterior angle are voiding dysfunction and urgency symptoms. The aim of our study was to compare ultrasound characteristics in women with GSI with those of women before and after Burch colposuspension. The findings of our study should have implications for GSI management.

Design

Prospective randomized clinical study at the Department of Obstetrics and Eynecology, Charles University, Prague, Czech Republic.

Setting

Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic.

Methods

Seventy women with previously untreated GSI (properative group) and 52 women (42 of whom had been in the preoperative group) who were studied 3–12 months after receiving Burch colposuspension (postoperative group) took part in the study. The standard transperineal and introital ultrasound scans were performed. The mobility of the bladder neck was assessed transperineally with a curved array probe after instillation of 300 mL of saline. The bladder was then evacuated and the thickness of the urinary bladder wall in the sagittal plane in defined regions (base, vertex and anterior wall) was measured.

Results

We found significant differences in bladder neck position, mobility, and in bladder wall thickness. Where symptoms of urgency occurred, the average bladder wall thickness was > 5 mm, the gamma angle < 40°, and lower bladder neck mobility was evident.

Conclusion

These findings supported our hypothesis that signs of urgency follow over‐elevation of the bladder neck. These results helped us significantly to refine our GSI management. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Reconstructed measurements produced from ultrasound images using a computerized system
Authors: Herman A. , Abargel A. , Maymon R. , Dreazen E. , Tovbin Y. , Weinraub Z.
Published: March 2003

Objective

The aim of this study was to evaluate the feasibility and accuracy of reconstructed measurements produced from video‐printed ultrasound images.

Design

Reproduction of reconstructed measurements using designated software and comparison of the results with regular measurements derived from the same images.

Subjects

Seventy regular sonographic examinations of biparietal diameter (BPD) and nuchal translucency (NT) thickness.

Methods

The study included 35 conventional‐size (BPD) and 35 small‐size (NT) measurements. Each image was measured twice during a dynamic ultrasound examination (regular measurements) and twice using a computerized system (reconstructed measurements). The latter comprised three steps: (i) computerization (computer‐generated images by scanning); (ii) calibration (using the scale located alongside the image); (iii) measurement (placing the calipers at the desired points).

Results

All images were successfully scanned, and the computer‐generated images were of sufficient quality for proper measurement. There was no difference between mean values of regular and reconstructed BPD measurements, 63.9 mm (3.7 mm, SE) and 63.6 mm (3.8 mm, SE), respectively. Similarly, mean values of regular NT measurements were similar to the reconstructed ones, 1.48 mm (0.09 mm, SE) and 1.49 mm (0.09 mm, SE), respectively. Repeated regular BPD and NT measurements exhibited repeatability coefficients of 1.6 mm and 0.4 mm, respectively. These values were smaller than those obtained by repeated reconstructed measurements of 2.1 mm and 0.52 mm, respectively.

Conclusions

Reconstructed measurements of ultrasound video‐printed images are feasible, require modest facilities and exhibit more than reasonable accuracy. This option may contribute to medical research, audit, quality control and training, as well as to medico‐legal issues. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
First‐trimester increased nuchal translucency and fetal hypokinesia associated with Zellweger syndrome
Authors: Johnson J.M. , Babul‐Hirji R. , Chitayat D.
Published: March 2003

We report the prenatal detection of increased nuchal translucency and decreased fetal movements, at 11 weeks of gestation, in a fetus at risk for Zellweger syndrome. The diagnosis of Zellweger syndrome was confirmed by metabolic studies on cultured chorionic villus sampling (CVS) cells and the pregnancy was terminated. The couple's subsequent pregnancy was monitored using the same method. In this pregnancy the nuchal translucency measured at 12 weeks' gestation was normal, the fetus was active, and biochemical studies using CVS and amniocentesis confirmed normal results. We believe this to be the first reported case of Zellweger syndrome followed prenatally in which an increased nuchal translucency and fetal hypokinesia were detected in the first trimester. During the pregnancy with the affected child the maternal serum screen (MSS) showed low estriol level. We believe this to be the second report of a low estriol level on MSS in a pregnancy affected with Zellweger syndrome. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Saline contrast sonohysterography in the preoperative assessment of benign intrauterine disorders
Authors: Bernard J. P. , Rizk E. , Camatte S. , Robin F. , Taurelle R. , Lecuru F.
Published: March 2003

Objectives

To assess the value of saline contrast sonohysterography (SCSH) in the preoperative evaluation of benign intrauterine lesions.

Design

Patients presenting with abnormal bleeding related to benign uterine pathologies and scheduled for surgical treatment were prospectively enrolled in a study conducted between 1 January 1996 and 31 December 1997. SCSH was first carried out with the intention of establishing further surgical management (hysterectomy or hysteroscopy). The end point of the study was to compare the surgical option ultimately carried out with the one decided after SCSH. In addition, size and location of intrauterine lesions determined by SCSH were compared with those issued from surgical records. Similarly, pathologic results were juxtaposed to SCSH diagnosis. Statistical analysis used non‐parametric and correlation tests.

Results

Two hundred and thirty‐three patients were included in the study, 39.5% of whom were postmenopausal. SCSH was consistently effective in the choice of the best surgical method, because no hysterectomy was required when an operative hysteroscopy was indicated on SCSH data. Similarly, only one patient treated by hysterectomy (5.8%) could have undergone a more conservative approach. But this patient had a genital prolapse, and thus hysterectomy was a part of the treatment. SCSH correlated well with surgery for the location and size of intrauterine lesions (P < 0.001). SCSH was accurate in the diagnosis of polyps and submucous myomas (sensitivity 85.7%, specificity 95.4%).

Conclusions

SCSH appears an important tool for preoperative assessment of benign intrauterine pathologies. It should be used in the selection of patients that should be scheduled for an operative hysteroscopy. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal detection of Fraser syndrome without cryptophthalmos: case report and review of the literature
Authors: Berg C. , Geipel A. , Germer U. , Pertersen‐Hansen A. , Koch‐DÖrfler M. , Gembruch U.
Published: March 2003

Fraser syndrome (cryptophthalmos–syndactyly syndrome) is an autosomal recessive multiple malformation syndrome whose major manifestations are cryptophthalmos, syndactyly, laryngeal atresia and urogenital defects. Enlarged hyperechogenic lungs contrasted by oligohydramnios, non‐visualization of the kidneys and microphthalmia were sonographic markers leading to the prenatal detection of this rare autosomal recessive disorder in earlier reports. We report a case of Fraser syndrome diagnosed at 16 weeks' gestational age in a woman whose previous pregnancy was terminated because of multiple fetal malformations. Abnormal sonographic findings included bilateral agenesis of the kidneys, dilated trachea and main bronchi (suggestive of high airway obstruction), hyperechogenic lungs, syndactyly of the fingers, hepatomegaly, oligohydramnios and hydrops placentae. Face and cerebral structures appeared normal. These findings together with those of the previously affected child led to the diagnosis of Fraser syndrome. The parents elected to terminate the pregnancy. Autopsy results were confirmatory. In conclusion, prenatal diagnosis of Fraser syndrome is possible in the hands of an expert, but due to the great variety of possible malformations the diagnosis will remain doubtful in most cases in which no previous child is affected. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Intraobserver and interobserver variability of transabdominal Doppler velocimetry measurements of the fetal ductus venosus between 10 and 14 weeks of gestation
Authors: Mavrides E. , Holden D. , Bland J. M. , Tekay A. , Thilaganathan B.
Published: March 2003

Objective

To assess the intraobserver repeatability and interobserver reproducibility of transabdominal Doppler ultrasound measurements of ductus venosus blood flow in fetuses between 10 and 14 weeks of gestation.

Design

A prospective study with the following end‐points: coefficient of variation, intraclass correlation coefficients within and between observers, repeatability coefficient and Cohen's kappa coefficient.

Subjects and Methods

Doppler velocimetry indices (maximum peak systolic velocity during ventricular systole, end‐diastolic velocity during atrial contraction, peak systolic velocity/end‐diastolic velocity ratio and pulsatility index for veins) were successfully measured three times by the same trained observer in 67 fetuses. Of these, in 24 fetuses, the measurements were then repeated by a second trained observer. In addition, both observers classified qualitatively the blood flow as being normal or abnormal with regard to the presence or absence/reversal of flow during atrial contraction.

Results

The intraobserver repeatability of the pulsatility index for veins measurements was considered good with a coefficient of variation of 8.9% and an intraclass correlation coefficient value of 0.62. However, inconsistencies occurred in maximum peak systolic velocity, end‐diastolic velocity and systolic/diastolic ratio measurements, which had coefficients of variation of 19%, 28.5%, and 25.4%, respectively. The corresponding intraclass correlation coefficient values were 0.70, 0.69 and 0.60. Interobserver reproducibility of these indices was unsatisfactory, the coefficient of variation varying between 11.5% and 47.2% and the intraclass correlation coefficient between 0.18 and 0.44. Agreement between the repeated observations with regard to interpretation of normal or abnormal blood flow varied from moderate (interobserver) to very good (intraobserver).

Conclusions

There was considerable variability in all Doppler indices except for the intraobserver repeatability of the pulsatility index for veins measurement. This makes the implementation of the semiquantitative Doppler indices in a screening setting difficult. On the contrary, qualitative classification of the flow velocity waveforms seemed to be a reproducible method. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
The role of ductus venosus blood flow assessment in screening for chromosomal abnormalities at 10–16 weeks of gestation
Authors: Antolín E. , Comas C. , Torrents M. , Muñoz A. , Figueras F. , Echevarría M. , Cararach M. , Carrera J. M.
Published: March 2003

Objective

To evaluate the role of ductus venosus blood flow assessment at 10–16 weeks' gestation in screening for chromosomal abnormalities.

Methods

Ductus venosus blood flow was prospectively evaluated in 1371 consecutive pregnancies between 10 and 16 weeks of gestation. The pulsatility index for veins was calculated. All cases were screened for chromosomal defects combining maternal age and fetal nuchal translucency thickness.

Results

A chromosomal abnormality was found in 20 cases. The overall detection rate, specificity, positive predictive value, negative predictive value and odds ratio for chromosomal abnormalities were 65%, 95.7%, 18.3%, 99.5% and 41 (95% CI 16–108), respectively, when using the 95th centile pulsatility index as a cut‐off.

Conclusions

These preliminary results suggest that evaluation of the ductus venosus pulsatility index at 10–16 weeks' gestation is a useful second‐line screening test for chromosomal defects. A combination of nuchal translucency measurement and ductus venosus assessment might increase specificity while maintaining an optimal detection rate for chromosomal abnormalities. Such a policy could identify 55% of all chromosomal abnormalities and about 69% of autosomal trisomies, reducing the need for invasive testing to less than 1%. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis and follow up of congenital splenic cyst: a case report
Authors: Lopes M. A. B. , Ruano R. , Bunduki V. , Miyadahira S. , Zugaib M.
Published: March 2003

We report a case of congenital splenic cyst that was identified by prenatal sonography at 25 gestational weeks. Serial scans demonstrated an increase in size during the prenatal period but after birth the cyst progressively decreased in size until its complete regression at 6 months of age. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Diagnostic and therapeutic problems in a case of prenatally detected fetal hydrocolpos
Authors: Geipel A. , Berg C. , Germer U. , Ahrens P. , Gloeckner‐Hofmann K. , MÖller J. , Gembruch U.
Published: March 2003

We report on a female fetus with prenatally suspected hydrometrocolpos. Postnatal evaluation additionally revealed ambiguous genitalia, anorectal atresia, vertebral segmentation anomalies and congenital intestinal aganglionosis. Colostomy was performed, but postoperative recovery was complicated by pulmonary hypertension and renal failure, resulting in death at day 18. Postmortem examination furthermore revealed a small ventricular septal defect, as well as rectovaginal and urethrovaginal fistulae, causing massive dilatation of the septated vagina (hydrocolpos). The possibility of an overlapping VACTERL and MURCS association is discussed. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
The relevance of placental location at 20–23 gestational weeks for prediction of placenta previa at delivery: evaluation of 8650 cases
Authors: Becker R. H. , Vonk R. , Mende B. C. , Ragosch V. , Entezami M.
Published: March 2003

Objective

To determine the correlation between placental position at 20–23 weeks and incidence of birth complications caused by placental position.

Subjects and methods

In an ongoing prospective study, placental position was determined by transabdominal sonography as part of anomaly scanning at 20–23 gestational weeks, followed by transvaginal sonography in uncertain or suspicious situations. Examination was performed in 9532 cases; feedback was obtained from 8650 patients (90.7%).

Results

Transabdominal sonography was followed by transvaginal scan in 363 of 8650 cases (4.2%). In 8551 cases (98.9%), we found normal placental position, with the placenta not reaching the internal os and a Cesarean section rate of 17.1% (1458/8551). The incidence of ‘low placental position’, with the placenta reaching the internal os was 0.66% (57/8650), with a Cesarean section rate of 21% (12/57). In 0.49% (42/8650) of cases, the placenta overlapped the internal os at 20–23 weeks; Cesarean section because of placenta previa or bleeding was performed in 28 of 8650 cases (0.32%). Vaginal delivery was possible in 43% of cases (13/30), when the overlap did not exceed 25 mm. If the overlap exceeded 25 mm (12 cases), no vaginal delivery was reported. There was no reported case of placenta previa missed at the 20–23‐week scan.

Conclusion

At 20–23 weeks, a combination of routine transabdominal and indication‐based transvaginal location of placental position is a powerful tool in predicting placenta previa at delivery. The advantage of determining placental position at this stage of pregnancy is a low false‐positive rate compared to at earlier stages of pregnancy. We conclude that an overlapping placenta at 20–23 weeks has the consequence of a high probability of placenta previa at delivery. An overlap of 25 mm or more at 20–23 weeks seems to be incompatible with later vaginal delivery. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
The feasibility of a ‘one stop’ ultrasound‐based clinic for the diagnosis and management of abnormal uterine bleeding
Authors: Jones K. , Bourne T.
Published: March 2003

Objectives

We have established a ‘one stop’ clinic for the management of women with abnormal uterine bleeding based on transvaginal sonography and saline contrast sonohysterography. This report reviews our experience with the first 93 patients attending the clinic.

Design and methods

Patients were seen with the intention of performing a transvaginal scan, saline contrast sonohysterography, endometrial biopsy, full blood count and thyroid function tests. The findings were prospectively recorded on a computer database and a management plan formulated.

Results

A transvaginal scan was performed on 89 (95.7%) women, 70 (75.3%) also undergoing saline contrast sonohysterography. An endometrial biopsy was carried out in 67 (72%) women aged 40 years and above, and 79 (84.9%) had blood tests. The median age of patients was 44 (range, 21–78) years. The majority of women presented with menstrual disorders. Uterine pathology was detected on transvaginal scan in 42 (47.2%) cases. Adnexal pathology was detected in 12 (13.5%) of the patients. Endometrial biopsy detected three (4.5%) cases of endometrial atypia, and three (4.5%) cases of adenocarcinoma. A hemoglobin level of < 10 g/dL was detected in 3 (3.4%) patients. A single clinic visit was thought sufficient for 83 (89.2%) women. Medical therapy was started in 47 (50.5%) patients, 15 (16.3%) were brought back for inpatient diagnostic hysteroscopy, and nine (9.7%) were booked for operative endoscopy, while six (6.5%) had conventional surgery; the remainder were reassured.

Conclusions

This study demonstrates that a ‘one stop’ management philosophy based on pelvic ultrasound is feasible. Our data suggest that diagnostic hysteroscopy can be decreased using this approach, and challenge the use of hysteroscopy as the first stage test. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional sonographic volumetry of the placenta and the fetus between weeks 15 and 17 of gestation
Authors: Hafner E. , Schuchter K. , Van Leeuwen M. , Metzenbauer M. , Dillinger‐Paller B. , Philipp K.
Published: March 2003

Objectives

Three‐dimensional sonographic volume measurement enables for the first time direct comparison of the increase in size of different but closely interacting structures like the placenta and fetus. Our aim was to calculate the fetal and placental volumes between weeks 15 and 17 of gestation, to monitor the difference in the increase of the fetal and placental sizes and to determine their mutual relationship.

Methods

Fetal and placental sonographic volume measurements were made in 356 singleton pregnancies. To measure the relationship between fetal and placental volumes, a quotient was calculated. Regression analyses were performed to analyze the dependence of the fetal and placental volumes and placental quotient on the week of gestation and other influencing variables.

Results

The mean of the fetal volume increased markedly from 67.8 to 76.6 mL (by 13%) within the 3 weeks of observation, whereas placental volume increased only slightly (111.1 to 114 mL (by 2.6%)). The random variation of placental volumes around the mean in all three gestational weeks was considerably higher than that of fetal volumes, indicating that in this early period of gestation there is little correlation between fetal and placental sizes. Fetal volume correlated better to gestational week than did placental volume.

Conclusion

The quotient of fetal and placental volume might assist in the diagnosis of high‐risk pregnancies and the assessment of a normal or large fetus with a small placenta. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Preoperative ultrasound preparation in endometrial cancer
Authors: Szabó I.
Published: March 2003

Purpose:  The aim of this study was to determine the efficiency of transvaginal sonographic (TVS) in the assessment of myometrial invasion and cervical involvement (preoperative staging) of endometrial cancer as well as to evaluate the influence of myometrial invasion and cancer grading on uterine blood flow characteristics in endometrial cancer.

Methods:  Transvaginal 2D, color Doppler and pulsed Doppler ultrasound were performed on 97 women to classify endometrial cancer with respect to myometrial invasion and cervical involvement. According to the FIGO recommendation for surgical staging of endometrial cancer 11 stage IA, 33 stage IB, 37 stage IC, 7 stage II, 8 stage III, and 1 stage IV were identified. Endometrial cancer was diagnosed on the basis of dilatation and curettage. The degree of invasion and the uterine blood flow characteristics were evaluated preoperatively. Ultrasonographic findings were compared to the surgical staging and histopathology of the surgical specimen.

Results:  Myometrial invasion (more or less than 50%) evaluated by TVS was accurate in 87 of 97 cases (accuracy 90%, sensitivity 87%, specificity 93%, positive predictive value 92%, negative predictive value 85%). Tumor extension to the cervix was properly assessed in 9 of 14 women in which it was present (sensitivity 64%, specificity 97%, positive predictive value 82%, negative predictive value 94%). In 90 of the 97 patients with endometrial cancer, abnormal blood flow with low impedance levels (RI, 0.39 ± 0.08; PI, 0.51 ± 0.15) was found within the endometrial echo or very close to it. Uterine blood flow was not modified by the cancer grading. Moreover, there was no difference in impedance indices of the uterine arteries between myometrial invasion of <50 and >50%.

Conclusion:  These results suggest that 2D TVS evaluation of endometrial cancer is a reliable method for assessing myometrial invasion and cervical involvement. Uterine blood flow analysis could not predict the tumor staging and grading, however, it did provide additional discriminatory information on tumor vascularization which can be used with morphology for more accurate diagnosis. Preoperative ultrasound examination should be seen as an important tool in the establishment of individualized treatment programs for women with endometrial cancer.
Relationship between fetal pulmonary artery blood flow velocity waveform and fetal lung length in pregnancies complicated by oligohydramnios
Authors: Blaszczyk Krysztof , Wojcieszyn M. , Lukasik A. , Swadzba K. , Stokowacka M. , Poreba R.
Published: March 2003

Objectives:  The objective of this study is to evaluate weather there is a correlation between Doppler velocity waveform parameters obtained from fetal pulmonary artery and fetal lung length considered as one of the lung hypoplasia risk parameters in pregnancies complicated by oligohydramnios.

Methods:  A total of 35 singleton pregnancies between 26 and 39 weeks complicated by oligohydramnios due to premature rupture of the membranes, placental insufficiency or idiopathic etiology and 69 normal pregnancies were examined by real time ultrasonography, color and pulse Doppler. Pulse Doppler signal was obtained from the distal part of right or left pulmonary artery after visualization with color Doppler at the level of four chamber view. The systolic to diastolic ratio, resistance index and pulsatility index were used to quantify velocity waveforms. The right lung of the fetus was measured longitudinally from the apex next to clavicle to the base at the top of diaphragm. The results of fetal lung length measurements were compared with namogram given by Roberts.

Results:  Statistically significant difference in distal pulmonary artery pulsatility index between normal pregnancies (1.74 ± 0.23) and pregnancies complicated by oligohydramnios (2.72 ± 0.56) with decreased value of fetal lung length (below fifth percentile) was observed. The sensitivity, specificity, positive and negative predictive value of 95, 91, 93, 91%, respectively, were obtained. In the group with oligohydramnios and normal values of fetal lung length, the difference in pulsatility index in comparison with normal pregnancies was not significant. No differences in systolic to diastolic ratio and resistance index between examined groups were found.

Conclusions:  Strong relationship between increased pulsatility index value obtained from distal part of pulmonary artery and decreased value of fetal lung length measurement in pregnancies complicated by oligohydramnios was observed. The measurement of pulmonary artery pulsatility index enriched with fetal lung length may give additional information useful in predicting pulmonary hypoplasia risk.
Early diagnosis in ovarian cancer: role of transvaginal ultrasound
Authors: Pascual M. A. , Tresserra F. , Grases P. J. , Dexeus S.
Published: March 2003

Purpose:  To evaluate the efficiency of transvaginal ultrasound in the early diagnosis of ovarian cancer.

Methods:  Screening transvaginal ultrasound has been annually performed during the last 2 years in asymptomatic women without familial history of ovarian cancer. When abnormalities were detected, the procedure was repeated after 4–6 weeks. If the findings disappeared, the study was repeated after 1 year. If the abnormality persisted, study was complemented with tumor markers, computed tomography and laparoscopic surgery. The findings were compared with a control group of women in whom ovarian transvaginal ultrasonography was formally indicated.

Results:  A total of 26007 transvaginal ultrasound were performed: 8813 (33.8%) belonged to the screening group and 17194 (66.2%) to the control group. In 14 patients of the screening group, a malignant tumor was diagnosed and histologically confirmed. The mean age of these patients was 45 years old (SD 12). Eleven of these tumors were stage I (seven Ia, and four Ic), two stage IIIc and one was a metastatic melanoma in both ovaries. Six lesions were borderline tumors (five serous and one mucinous). In the control group, 27 ovarian cancers were diagnosed in patients with a mean age of 48 years (SD 17). In this group, 11 tumors were in stage I, and six were borderline.

Conclusions:  Although consensus about the benefits of using transvaginal ultrasound as a screening procedure is not conclusive, our data reveals that tumors detected in patients screened with transvaginal ultrasound are in earlier stages when compared with those diagnosed in the control group. No differences were found in age and number of borderline tumors between both groups. Additional studies are needed to support this preliminary findings.
Three‐dimensional ultrasound and treatment of choice in cervical cancer
Authors: Babinszki A. , Artner A. , Szalay J. , Palfalvi L. , Ungar L.
Published: March 2003

Purpose:  Tumor volume, parametrial involvement, lymph nodal status, urinary bladder and rectum involvement are essential parameters in the treatment planning of early stage cervical cancer. Fertility sparing trachelectomy criteria has become a new diagnostic challenge within the last years. We assumed that three‐dimensional (3D) ultrasound may add useful information for the oncologists in planning the treatment of cervical cancer patients.

Methods:  Three‐dimentional transvaginal sonography was performed in all cases to assess tumor volume, parametrial involvement, local and distant spread of the tumor. Tumor vascularization was also examined by 3D power Doppler.

Results:  In the last 5 months, 15 patients with early stage cervical cancer, considered for primary surgical treatment, have been examined with 3D sonography prior to surgery. Two out of 15 patients have undergone abdominal radical trachelectomy, 13 were surgically explored with the intention of Wertheim hysterectomy. In one patient, paraaortal tumor spread was suspected on our 3D examination, surgical finding at exploration has proven lymphatic spread extending above the renal blood vessels, that has made the surgeon to abandon first line surgery as a curative intent treatment.

Conclusions:  Tumor volume was difficult to measure since most of the early stage patients underwent cone biopsy prior to referral for radical surgery. Macroscopic pelvic lymph node involvement was assessed accurately in all of our patients. Our impression was, that parametrium involvement, especially the caudal third of the parametrium, and the urinary bladder wall could be visualized and assessed more accurately than it was possible with 2D method. Involvement of the upper part of the cervical canal could be examined accurately in candidates for radical trachelectomy. Early experience suggest, that 3D examination of the macroscopic lymph node involvement, parametrial, urinary bladder and rectal wall tumor spread can be helpful for treatment planning of early stage cervical cancer patients.
First trimester Down syndrome screening by nuchal translucency in Thai population
Authors: Panburana Panyu , Ajjimakorn S. , Tungkajiwangoon P. , Jaowisidha A.
Published: March 2003

Purpose:  To examine the significance of the fetal nuchal translucency (NT) at 10–13 + 6 weeks' gestation in the prediction of DS in a Thai population.

Methods:  Total 2353 pregnant women were recruited from January 1996 to June 1999. Almost all women underwent transabdominal scanning (TAS) (Toshiba 140, TAS probe 5.0 MHz Toshiba PVF‐5.00 MT). When the result showed an increased risk for DS (>2.5 mm NT), the pregnant woman was counseled and the invasive test was optional. All the newborns were physically examined thoroughly by pediatricians to detect the markers for major chromosomal anomalies such as DS, trisomy 18 and 13. For the suspected DS or other chromosomal abnormalities, the newborn's blood was sent for the chromosome study.

Results:  The mean maternal age was 28.71 + 0.13 years and 2037 pregnant women (86.57%) were <35 years old. The mean gestational age was 11.94 + 1.07 weeks. Sixty‐five pregnant women who had NT > 2.5 mm decided to have the invasive tests. Sixty had normal karyo‐types while five had abnormal chromosome abnormalities (one trisomy 13, two trisomy 18 and two trisomy 21). All of them were >35 years old. Sixty pregnant women with normal chromosome fetuses had detailed ultrasound scanning at 18–20 weeks' gestation and screening for maternal toxoplasmosis, cytomegalovirus, rubella virus, and herpes virus. The infection screen was negative in all cases. There were 20 congenital heart diseases, four fetal deaths in utero at 28–30 weeks, one Bart's hydrops fetalis and 10 abortion. The rest had normal pregnancy outcomes and NT resolved by 20 weeks. There were 316 (13.43%) cases with maternal age >35 years. Twenty‐three had >2.5 mm. NT and all of them had the invasive tests which revealed five abnormal chromosomes (as mentioned above). However, no DS fetuses were detected in <35 years pregnant women. Two hundred pregnant women with normal NT decided to have the invasive tests due to advanced maternal age and all of them had normal karyo‐types. The sensitivity, specificity, positive predictive values and negative predictive values for trisomy 21, 18 or 13 with different cut‐off values for fetal NT were studied. This is the first report of the first trimester NT screening for DS in Thai people. The cut‐off of >2.5 mm NT was used to increase sensitivity. We can detect all the cases of DS with this cut‐off value but one case of DS will be missed if we use the cut‐off of >3.0 mm.

Conclusions:  This study revealed the feasibility in NT measurement for DS screening in the first trimester of pregnancy in Thai population. This test can increase detection rate of DS in the high‐risk pregnant women, who did not accept the invasive prenatal diagnosis procedures, as well as in the low risk pregnancy.
Influence of maternal cigarette smoking on maternal weight gain, uterine and umbilical flow velocities and fetal growth
Authors: Albuquerque C. A. , Smith K. , Johnson C. , Harding R.
Published: March 2003

Objective:  To investigate the effects of cigarette smoking during pregnancy on maternal body mass index, maternal weight gain, uterine and umbilical artery flow velocities and fetal growth.

Methods:  We studied 37 pregnant women (17 cigarette smokers [>10/day] and 20 non‐smokers) using an ATL HDI 5000 scanner for fetal anatomic survey and measurement of uterine and umbilical artery flow velocities. Maternal BMI change and weight gain during pregnancy, uterine and umbilical cord flow velocities, and fetal weight at delivery were measured in all patients.

Results:  There were no differences between the smoking and non‐smoking groups in gestational age at scanning (23.7 ± 1.5 vs. 26.5 ± 1.3 week), gravid (2.3 ± 0.3 vs. 2.1 ± 0.3) and parity (0.9 ± 0.2 vs. 0.6 ± 0.2). The median maternal BMI was less in smokers than non‐smokers both pre‐pregnancy (19 vs. 24) and at delivery (27.5 ± 1.3 vs. 32.3 ± 1.3). Maternal weight gain was less in smokers than non‐smokers (10.2 ± 1.6 vs. 14.7 ± 1.5 kg, P < 0.05). In the uterine artery, there was no significant difference in the systolic/diastolic ratio between smokers and non‐smokers (1.9 ± 0.1 vs. 1.8 ± 0.1). The umbilical artery systolic/diastolic ratio was greater in smokers than non‐smokers (3.25 ± 0.2 vs. 2.31 ± 0.07, P < 0.05) and fetal weight at delivery was lower in smokers (2.7 ± 0.2 vs. 3.3 ± 0.2 kg, P < 0.05).

Conclusions:  Decreased BMI and lower weight gain of women who smoke suggest that their nutritional intake may be lower than in non‐smokers. Decreased maternal weight gain in smokers and increased umbilico–placental resistance may both contribute to fetal growth restriction. Smoking appears not to affect utero‐placental resistance.
Incidental discovery of small adnexal tumors: how well do the conventional diagnostic models work?
Authors: Lawrence A. C. , Aslam N. , Elson J. , Salim R. , Jurkovic D.
Published: March 2003

Background:  The increasing use of diagnostic ultrasound in gynecology has led to a growing number of small adnexal tumors being diagnosed incidentally in asymptotic women. Although numerous diagnostic models have been designed to estimate the preoperative risk of malignancy in symptomatic adnexal masses, it is not known whether these methods are also applicable to small tumors. The aim of this study was to investigate the accuracy of a number of diagnostic models in the preoperative diagnosis of clinically undetectable adnexal masses.

Methods:  All patients undergoing surgery for known adnexal masses were assessed preoperatively using clinical examination, transvaginal ultrasound, color Doppler imaging and serum CA125 measurements. The presenting complaint and demographic details were also recorded. The risk of malignancy was then estimated using a variety of previously published morphological scoring systems, Doppler indices of impedance to flow, tumor markers and logistic regression models. The receiver operating characteristic curves were calculated for each diagnostic approach to examine significant differences in their performance for the detection of ovarian cancer.

Results:  A total of 115 patients had surgery for adnexal tumors between August 1997 and June 2000. Of these, 90 had benign masses, 6 borderline and 19 malignant. Of the 115 patients, 69 had a clinically detectable cyst and 46 small tumors were found incidentally. In these 46 cases, the best characterization of ovarian tumors was achieved by the use of a logistic regression model, which combined menopausal status, presence of tumor papillarities, blood supply and serum CA125 levels. This model achieved 100% sensitivity with a specificity of 78% in the diagnosis of ovarian malignancy.

Conclusion:  A combination of various diagnostic parameters in the form of a logistic regression model is superior to other methods for non‐invasive diagnosis of ovarian cancer diagnosed incidentally on ultrasound scan.
Is nuchal translucency measurement useful as a screening test for major cardiac abnormalities?
Authors: Lee‐Tannock A. , Cincotta R. B. , Chan F. Y. , Hawthorne F.
Published: March 2003

Aim:  To determine if measurement of nuchal translucency is a useful predictor of major cardiac abnormality in a low risk population.

Methods:  A total of 1888 fetuses (1849 patients) were scanned in our department as part of a nuchal translucency screening programme between 1 January 1999 and 31 December 2000. Those pregnancies with abnormal karyotypes were excluded from this study. Follow up was obtained and cases of major isolated cardiac anomalies were identified.

Results:  There were 35 fetuses that had normal chromosomes and a nuchal translucency measurement greater than the 95th centile. Nine of these had a nuchal translucency measurement greater than 3.5 mm, and 12 of these had a nuchal translucency measurement greater than 4.5 mm. In our study population, there were six fetuses diagnosed with an isolated major cardiac defect (3.2/1000 births). All of these fetuses had normal nuchal translucency measurements less than the 95th centile and none came from the group with increased nuchal translucency. In one case, the diagnosis was made at 12 weeks, three were diagnosed at the 18–20 weeks morphology scan and two were diagnosed after birth.

Discussion:  Several studies have demonstrated a link between an increased nuchal translucency measurement and cardiac defects in fetuses with normal chromosomes. Hyett suggests that increased nuchal translucency at 10–14 weeks will detect 55% of major cardiac abnormalities. According to the risk estimates from this paper, we estimate that there should have been 1.5 cases of cardiac anomalies in the low risk group whilst there should have been two cardiac anomalies in the fetuses above the 95th centile. We found six major cardiac anomalies in the low risk group and none in the higher risk group. However, the difference between the estimated and observed number of cases was not statistically significant due to the small size of our screening study. We would recommend larger studies to determine the efficacy of nuchal translucency as a screening tool for detection of cardiac anomalies. Detailed cardiac imaging at the 18–20 weeks morphology scan should continue to be performed on all patients regardless of the nuchal translucency measurement in the first trimester.
Functional evaluation of normal kidney by three‐dimensional (3D) ultrasonography – the hourly fetal urine production rate
Authors: Jun J. K. , Jin S. M. , Ko E. M. , Park J. S. , Yoon B. H. , Moon S. Y. , Syn H. C. , Lee H. P.
Published: March 2003

Background and objective:  Fetal urine is the main source of amniotic fluid, which is very important marker of fetal wellbeing. Single deepest pocket measurement or amniotic fluid index method are widely used to evaluate amniotic fluid volume. They are well correlated with real amniotic fluid volume in cases of normal amniotic fluid volume. However, they are not in extreme cases, which are clinically more important. Direct measurement of fetal urine production may be another option to evaluate amniotic fluid volume and fetal kidney function. Moreover, it is well known that 3D USG is superior to 2D USG especially in volume measurement of irregular shape object. We undertook this study to measure the hourly fetal urine production rate (HFUPR) with 3D US in normal pregnancies and evaluate its clinical implication and feasibility.

Material and methods:  From 20 weeks of gestation to term, 157 pregnant women were enrolled. We used Voluson 730 to measure 3D bladder volume. Vocal (virtual organ computer aided analysis) software was used to measure the volume. Initially, we measured the volume of fetal urinary bladder and observed whether the bladder was emptying or not in 5 and 10 min after initial measurement. We excluded 35 cases whose bladder was found empty within 5 min. If distended bladder was still found, we calculate the HFUPR. We constructed a best‐fit graph of the HFUPR according to gestational age (GA) in weeks.

Results:  We constructed the following quadratic equation and plotted a graph on the basis of our data.

We also showed 10 and 90% values of each gestational week.

Conclusion:  We demonstrated that serial 3D USG assessment of fetal bladder volume could be used as an alternative method to evaluate amniotic fluid volume.
Abnormal umbilical vein blood flow in trisomy 9 fetus during early pregnancy
Authors: Murta C. C. V. , Moron A. F. , Ávila M. A. P. , Vasques F. A. P.
Published: March 2003

We describe a case of reversed flow in the umbilical vein and in the ductus venosus during atrial contraction of one fetus at 12 weeks' gestation with increased nuchal translucency (9.1 mm). In addition, Doppler velocimetry detected high retrograde flow in the inferior vena cava. Cytogenetic analysis of chorionic villi revealed trisomy 9. We suggest that these findings can be an early sign of chromosomal abnormalities and cardiac defects in the first trimester. To the best of our knowledge, this is the second report of reverse umbilical venous blood flow described in the literature and the earliest case reported in pregnancy.
Twin cervical ectopic pregnancy
Authors: Bethune M. P. , Sampson A.
Published: March 2003

A 40‐year‐old woman presented for IVF treatment due to 8 years of secondary infertility. Two embryos were transferred without ultrasound guidance. The patient presented at 6.5 weeks gestation with heavy vaginal bleeding. A transvaginal ultrasound revealed twin cervical ectopic pregnancies, lying side by side in the cervical canal and within 6 mm of the external os. One contained a 9‐mm embryo with a normal fetal heart rate. The other sac was anembryonic. The bHCG level was 129 000 IU/L. The patient was treated with the same regimen of methotrexate as used for persistent trophoblast disease: second daily methotrexate with folinic acid rescue after each dose. Complete resolution of the twin pregnancy occurred, bleeding was however, recurrently heavy over the next 6 weeks.

Discussion:  Cervical ectopic pregnancy is a rare event, accounting for less than 1% of ectopic pregnancies. The incidence is increasing due to the increased use of in vitro fertilization. Prior to the advent of conservative treatments most patients required hysterectomy due to severe, uncontrollable bleeding. Conservative measures include dilatation and curettage (usually combined with uterine artery embolization, ligation or cervical balloon tamponade); local injection of methotrexate or potassium chloride (ultrasound guided); or systemic methotrexate. Twin cervical pregnancy is an extremely rare event with only two previous case reports in the literature [1]. Due to the large size of this twin pregnancy mass, the high bHCG level and the large volume of vascular trophoblast; we decided to treat this patient in a similar manner to a patient with gestational trophoblast disease. This mode of treatment should be considered with cervical ectopic pregnancies where the bHCG level is abnormally elevated.
The association between the Doppler hypoxia index and arterial umbilical cord pH in multiple gestation pregnancies complicated by intrauterine growth restriction
Authors: Musser U. , Gaziano E. P. , Arbeille P. H.
Published: March 2003

Purpose:  To study the relationship between the Doppler hypoxia index and umbilical cord pH in multiple gestation pregnancies complicated by fetal growth restriction.

Methods:  Seventeen fetuses were studied from 12 multiple gestation pregnancies (11 twins and 1 triplet). Each pregnancy had at least one growth‐restricted fetus from which middle cerebral artery and umbilical artery Doppler values were collected, the last value of which was within 3 weeks of delivery. For each fetus, we calculated the cerebral umbilical ratio and the hypoxia index, which reflects the duration and degree of Doppler determined fetal blood flow redistribution. Umbilical arterial cord blood was obtained for blood gas analysis immediately after the births. Excluded were fetuses with major congenital anomalies and those with reverse end diastolic flow in the umbilical artery.

Results:  There is a significant correlation at the 0.05 level, one‐tailed, between the hypoxia index and arterial umbilical cord pH. A linear regression model suggests that gestational age and birth weights are not cofounders in the relationship between the hypoxia index and arterial pH. While the hypoxia index has the same sensitivity (75%) as the cerebral umbilical ratio for identifying fetuses who will have an arterial cord pH of less than 7.20, the hypoxia index has a better specificity (85 vs. 69%), positive predictive value (50 vs. 38%) and negative predictive value (92 vs. 90%).

Conclusions:  There is a significant correlation between the non‐invasive hypoxia index and arterial umbilical cord pH in the growth‐restricted fetus from multiple gestation pregnancies.