bluuebunny/crossref_metadata_2025 huggingface dataset:
F32Comparison of conventional two‐dimensional and three‐dimensional multiplanar analysis for evaluation of fetal nuchal translucency
Authors: Koudelka M. , Malý Z. , Novotná
Published: March 2003

Backround

One of the most useful US markers for fetal aneuploidy and other structural anomalies is measurement of nuchal translucency (NT). Using conventional 2D ultrasound, irrespective of high quality of current devices, brings problems connected with fetal intauterine possition. Unfavourable position increases intra‐and interobserver variability of measurement or can even disables the evaluation.

Method

In this study the fetal textbook ‘standard’ position for measurement of NT using konventional 2D and 3D was performed in 105 cases in 11th − 14th week of pregnancy, 3x in each case. Two aspects were evaluated: succes of achieving standard position and variability of individual measurement.

Results

The nuchal translucency with 2D scanner was measurable in 63% of cases. With 3D vaginal scanner, using computed 2D multiplanar analysis the correct and standart plane was achieved in 97% the cases. The exactness of 3D measurement is significantly higher.

Conclusions

The problems with fetal position seems to be solved using 3D computer sonography with its electronic tools as multiplanar 2D and possibility of electronic rotational display of embryo. 3D decreased the interobserver and intraobserver error to minimum. The 3D multiplanar analysis was found to be superior.
F40Response of the fetal pupil in the chromosomal anomalies
Authors: López Ramón y Cajal C.
Published: March 2003

Background

We studied sonographically the response of the fetal pupil to the stimulus of color Doppler (CD) in fetuses with chromosomal anomalies below 22nd weeks.

Method

The pupils of 28 fetuses were studied sonographically between 15 h‐21 weeks' gestation, diagnosed of a chromosomal alteration through of genetic amniocentesis. The areas of the pupil and iris were compared before and after CD imaging.

Results

The great majority of the fetuses have some data out of range in the relationship pupil/iris in basal conditions or after CD. Usually, we observed an atypical response (mydriasis before the 19 weeks or miosis after this) and/or an exaggerated response (hyperreflexia).

Conclusion

These results affirm that this type of test increases the possibilities in a fetal study of high resolution performed before the 22nd weeks of gestation and it can be a useful indicator like an aneuploidy marker.
F49Subclassification of small‐for‐gestational‐age fetus using fetal Doppler velocimetry
Authors: Kanenishi K. , Yamashiro C. , Tanaka H. , Kuno A. , Yanagihara T. , Hata T.
Published: March 2003

Background

Our purpose was to determine whether small‐for‐gestational‐age (SGA) fetus can be divided to subclassified groups using fetal Doppler velocimetry.

Method

Fifty‐four pregnant women with SGA infant delivered after 37 weeks of gestation were studied. After 24 weeks of gestation, fetal middle cerebral artery pulsatility index (MCAPI) and umbilical artery pulsatility index (UAPI) were measured at 2‐to 3‐week intervals using Doppler ultrasound. Perinatal outcomes were compared in subclassifid SGA groups using fetal Doppler velocimetry.

Results

The number of SGA fetuses with normal MCAPI and UAPI (normal SGA group) was 39, and those with significantly low MCAPI but normal UAPI (eventful SGA group) 15, respectively. Birth age and birth weights in eventful SGA group were significantly earlier and lower than those in normal SGA group, respectively (P < 0.05, and P < 0.005). There were significant increases in operative deliveries, abnormal FHR patterns and decreased amniotic fluid in eventful SGA group. However, there were no significant differences in meconium staining of amniotic fluid, low Apgar score, neonatal acidosis, and NICU admission between the two groups.

Conclusion

These results suggest that SGA fetus with abnormally low MCAPI but normal UAPI has more poor perinatal outcomes, compared with that with normal MCAPI and UAPI.
F55Venous velocimetry in the surveillance of severely compromised fetuses. Where is the point of no return?
Authors: Hofstaetter C. , Hansmann M.
Published: March 2003

Objective

To investigate special changes in venous velocimetry of severely compromised fetuses and to determine signs of cardiac decompensation prior fetal demise.

Methods

A prospective study in 154 growth‐restricted fetuses. 37 were severely compromised with reverse flow in the umbilical artery. The velocimetry of right hepatic vein and ductus venosus were investigated and the presence of umbilical venous pulsations were registered. The final examination prior to birth or fetal demise were taken for analysis and related to obstetrical outcome defined as gestational age at birth, birthweight and rate of perinatal mortality. Secondly the velocimetry of 15 nonsurvivors was pared with 22 survivors.

Results

There were a significant (P < 0.05) decrease of the S‐ and ES‐, increase of the A‐velocity and pulsatility in the RHV and a significant (P < 0.05) decrease of all velocities and increase of pulsatility in DV. 24% had a reversed flow in DV and 75% had pulsations. The newborn were significantly premature and small for gestational age. 15 fetuses died perinatally. Special predictors of fetal demise were a further increase or decrease of A‐velocity in RHV and DV. 8/15 fetuses had a reversed flow in DV and 11/1 5 had mainly double pulsations as signs of cardiac decompensation.

Conclusions

Venous velocimetry changes significantly in compromised fetuses. Prior to fetal demise the A‐velocity decreases specifically in DV. Especially a reversed flow in DV and double umbilical venous pulsations are omnious signs of left heart decompensation.
F64Intrauterine therapy of fetal obstructive uropathy
Authors: Szaflik K. , Borowski D. , Kozarzewski M. , Kunert A.
Published: March 2003

Background

The aim of our study was the evaluation of the usefulness of fetal bladder drainage in cases of obstructive uropathy before the 24th week of gestation.

Methods

Since January 1997 we have diagnosed 9 cases of fetal obstructive uropathy before the 24th week of gestation. In all cases, oligohydramnios or ahydramnios was also diagnosed. After evaluation of kidneys function on the basis of fetal urine samples, obtained from punctures of fetal bladder (three times in each fetus) we selected 7 fetuses for in‐utero shunting. 2 fetuses presented features of renal cystic dysplasia and its renal function prognostic factors were poor. Those fetuses were not offered intrauterine decompression.

Results

All the newborns in which intrauterine decompression of the obstructive uropathy was made have had a good perinatal outcome. The mean apgar score was 8 (7–10 points). The weight at delivery was between 1700 and 3300 g. No pulmonary hypoplasia was observed. All the deliveries took place after the 33rd week of gestation (33–38 hbd). The minimum time of drainage was 11 weeks, the maximum 18 weeks.

Conclusions

Early bladder drainage enables delivery of newborns without pulmonary hypoplasia. Drains with a good ‘shape memory’ enable good results, because they are not prone to migration. Shunting should be performed only in selected cases which would not be better managed by early delivery, but who have not yet developed renal dysplasia.
Three‐dimensional power Doppler in obstetrics and gynecology F67Three dimensional follicular and endometrial volume assessment and pregnancy rate in in vitro fertilization patients
Authors: Bjelos D. , Kupesic S. , Kurjak A.
Published: March 2003

The aim of this study was to assess the role of three‐dimensional (3D) follicular and endometrial volume measurements in predicting the pregnancy outcome of the in vitro fertilization (IVF) programme. For the purpose of this study we evaluated 52 patients on the day of oocyte retrieval and embryo transfer. Follicular volume and endometrial volume were main outcome measures related to the occurrence of a successful implantation. The overall pregnancy rate was 30.8% (16/52). Sixteen pregnant patients demonstrated mean follicular and endometrial volume measurements 4.81 ± 1.92 mL and 5.2 ± 1.9 mL, respectively. In the same time, 36 nonpregnant patients had corresponding measurement of 3.82 ± 1.7 mL and 5.6 ± 2.1 mL, respectively.

Presented data demonstrate that 3D volume measurements of the follicles and endometrium on the days of oocyte retrieval and embryo transfer are not predictive of IVF outcome. However, follicular volume measurements are clearly related with the number and quality of the oocytes collected on the day of pick‐up.
F69Three‐dimensional ultrasound in the diagnosis of uterine malformations
Authors: Montenegro C. A. B. , Leite S. P. , Mathias M. L. , Rezende‐Filho J.
Published: March 2003

Uterine evaluation by means of 3D US is useful in classifying the main malformations, as it allows the visualisation of the frontal plane, impossible to obtain with conventional sonography. In the frontal plane it is possible to classify the uterine abnormalities, according to the fundal surface, the endometrial cavity and the uterine cervix.

Arcuate uterus presents with a normal fundal surface, but the endometrial cavity is concave, different from the normal uterus, where it is convex or rectilinear. Septate uterus also shows a normal fundus, but 2 endometrial cavities, due to the septum. Bicornuate uterus is characterised by a fundal indentation (≥ 1 cm) and 2 endometrial cavities. Didelphic uterus is identical to complete bicornuate uterus, but the duplication extends to the cervix, which is doubled. Unicornuate uterus exhibits only one half of the uterus and does not seem to present any diagnostic pitfall, although it may present with a rudimentary cornus, that may or not communicate with the main cavity.

Septal vascularization may be identified in slightly over 70% of the cases with this abnormality. Power Doppler is helpful in identifying those cases, and differentiate them from bicornuate uterus.

17 patients with suspected uterine malformation were examined. 4 bicornuate, 6 septate, 6 arcuate, and 1 didelphic uterus were found. 3D US was concordant in 11 cases.
F72Visualization of anal sphincter disruptions with transperineal three‐dimensional ultrasound following vaginal delivery in primiparous women
Authors: Bader G. , Rozenberg P. , Ville Y.
Published: March 2003

Objective

To visualize the anal sphincter disruptions following vaginal delivery in primiparous women using 3D ultrasound to correlate damage to obstetrical factors.

Methods

We have studied prospectively 150 consecutive primiparous women. Axial and sagittal images of the anal sphincter were performed 48 h after vaginal delivery using a 7.5‐MHz convex transducer placed on the perineum (Voluson 530 D Kretz) and repeated in the 30 women with anal sphincter disruption at a median of six months post natally. Obstetrical characteristics were analysed in all cases.

Results

Anal sphincter defect and its location were detected in 30 women (20%). None of the 24 women (16%) who underwent cesarean section had a sphincter disruption even in the 10 women delivered by cesarean section in labor. Head circumference, birth weight, maternal age, the duration of each stage of labor and the duration of active pushing were not significantly related to anal sphincter disruptions after vaginal delivery. Instrumental delivery, epidural analgesia and posterolateral episiotomy were associated with a sphincter defect but the only single independent factor related to the development of sphincter defects was instrumental delivery. The 3D sonography revealed sphincter injuries in 70% of the cases in the forceps delivery group (7 of 10), 13.3% of the cases in the vacuum delivery group (2 of 15) and 9.9% of the cases in the normal vaginal delivery group (10 of 101). 12 women (8%) had anal incontinence of faecal urgency when studied two months after vaginal delivery. The anal function was not altered after cesarean section.

Conclusions

Transperineal 3D ultrasound of the anal sphincter is a reliable method for evaluating the anal sphincter. It is quickly performed and well tolerated by patients. Besides forceps delivery, commonly measured delivery variables are not useful predictors of latent anal sphincter injury.
F77Application of ‘Live 3D’ ultrasound in the detection of fetal malformation of extremities
Authors: Lee A. , Pöhl M. , Bernaschek G.
Published: March 2003

Background

3D ultrasound can produce images comparable to photographs. However, they only represent about a second of the hole examination. Artifacts due to fetal movements can make interpretation difficult. Sequential rescanning, a technique which is also called ‘Live 3D’ may overcome these limitations.

Method

Patients who underwent 3D ultrasound examination because of suspicious of fetal skeleton malformation were included into this study. Live 3D ultrasound was performed with a commercially available machine (Combison C530, Kretztechnik, Zipf, Austria)

Results

In 32 out of a total from 70 patients malformation of the fetal extremities have been postulated in 2D ultrasound. Sufficient surface rendering of the region of interest could be achieved within 85% of all patients. Malformations of the fetal extremities could be visualized in 93%. Discrepancy between 2D and 3D findings could be found in only 2 cases.

Conclusion

Live 3D ultrasound can give confirmation and new diagnosis in cases of fetal malformation of extremities compared to 2D ultrasound examination.
F08Real‐time intraoperative ultrasound guidance; the transrectal approach
Authors: Bar‐Hava I. , Meizner I. , Rabinerson D. , Shalev I. , Mashiach R. , Orvieto R. , Ben‐Rafael Z. , Dekel A.
Published: March 2003

Background

The aim of this study was to assess the role of real‐time transrectal ultrasound (RT‐TRUS) guidance in complicated gynecological procedures.

Method

During the study period RT‐TRUS was utilized to direct and assist the gynecological surgeon in two complicated gynecological procedures: Completing the evacuation of the uterine cavity after identification of uterine wall perforation during termination of pregnancy and drainage of posthysterectomy infected vault hematomas.

Results

In all, 11 patients were treated by this fashion (6 abortions and 5 infected vault hematomas). All procedures were completed without any further complications and the patients were discharged the following day with uneventful follow‐up.

Conclusion

RT‐TRUS is an effective tool that can provide on‐line assistance to the gynecological surgeon in various pelvic procedures.
F80Three dimensional ultrasound reconstruction of monochorionic placental anastomoses
Authors: Welsh A. W. , Taylor M. J. , Fisk N. M.
Published: March 2003

Background

Feto‐fetal transfusion syndrome is characterized by a paucity of bi‐directional superficial vascular anastomoses which protect against haemodynamic imbalance built up by deep unidirectional arterio‐venous (AVA) anastomoses. Vascular identification and ‘mapping’ is a necessary prerequisite to selective therapy for FFTS.

Method

The sites of arterio‐arterial (AAA) and an arterio‐venous anastomoses were identified by colour flow mapping and characteristic doppler waveforms (Acuson SequoiaTM5C2 MHz curvilinear probe). Having identified these sites, freehand 2D image storage to disk was performed, and images transferred to a personal computer. Purpose‐designed software (CQ Analysis, Kinetic Imaging Ltd, Liverpool, UK) was used to segment the colour information from these images and the resulting greyscale images were saved as TIFF image format files. These files were fed as a parallel data set into VoxBlast software (Vaytek Inc, Iowa, USA) for 3D rendering and rotational movie generation.

Results

This technique allowed perfect reconstruction of 3D vascular and placental anatomy for both AAA and AVA. Dual rendering with original greyscale images allowed accurate visualisation of anastomotic location within the placenta.

Conclusions

It is now technically feasible to gain an understanding of monochorionic placental microvasculature in 3D. Prospective evaluation is underway to compare the predictive ability of 3D vs. 2D ultrasound placental mapping.

Acknowledgements

Alec Welsh is supported by a Research Training Fellowship from RCOG/WellBeing.
Complications in pregnancy F86Mullerian anomalies: prospective follow‐up with transvaginal ultrasound of the cervix
Authors: Berghella V. , Talucci M. , Odibo A. , Chen J.
Published: March 2003

Introduction

Patients with mullerian anomalies have higher rates of preterm delivery (PTD), but the true reason for PTD has not been elucidated. Transvaginal ultrasound (TVU) has proven an accurate test for the prediction of PTD, but has not been studied in this patient population.

Methods

Patients with known mullerian anomalies were followed prospectively in pregnancy with TVU of the cervix between 14 and 24 weeks. The predictive value of TVU was evaluated using < 25 mm cervical length and/or > 25% funneling as definition for a short cervix. The primary outcome was PTD < 35 weeks.

Results

45 patients with mullerian anomalies were identified. 16 were excluded from analysis because of: prophylactic cerclage (6), twins (3), induced PTD (4), no follow‐up (1), still pregnant (2). Of the 29 pregnancies available for analysis, there were 8 with septate uterus (5 corrected), 7 with bicornuate uterus, 6 with didelphus uterus, and 5 with unicornuate uterus (3 were unknown type). 6 (21%) had a short cervix (3 of these received a therapeutic cerclage because of TVU short cervix), with 2 (33%) having PTD despite both receiving therapeutic cerclage. 23 (79%) did not have a short cervix, with 2 (9%) having PTD. Both of these patients had a didelphus uterus. The sensitivity, specificity, positive and negative predictive values for PTD were 50, 88, 40, 92%, respectively (RR 4.8, CI 0.9–26.5).

Discussion

TVU seems to be predictive of PTD in patients with mullerian anomalies, with the possible exception of didelphus uterus. Therapeutic cerclage in patients with a mullerian anomalies with a short cervix on TVU may not prevent PTD.
F94Early ultrasonographic screening for malformation – how early is too early?
Authors: Gull I. , Wolman I. , Har‐Toov J. , Fait G. , Amster R. , Lessing J. B. , Jaffa A. J.
Published: March 2003

Background

Early ultrasonographic screening for malformation is performed between 14 and 17 weeks of gestation.

Aims

To analyze the effect of the gestational age on the screening efficacy of specific organs and to assess the optimal date for screening.

Methods

We analyzed 427 ultrasound screening performed between 14 and 18 weeks of gestation. The efficacy of screening for each structure at certain week was calculated. Then, we analyzed the data to obtain the best date in which the need for repeated screening was minimal.

Results

The lips, posterior fossa, heart and gall bladder were the main structures that could not be optimally visualized during the 14th week of gestation. The lips, Gall bladder and the VA valves and the great vessels were the structures that were not visualized optimally during 15–16 weeks of gestation. The ears and the fingers were the main structures that could not be optimally visualized during 17–18 week of gestation. The need for repeated screening at the 14th week of gestation was ∼65%, and at the first half of the 15th week ∼20%. The need for repeated screening from the end of the 15th week of gestation to the 17th week was ∼8% and rose to 11% at the 18th week.

Conclusion

The optimal date for early screening for malformation is the end of the 15th week of gestation to the 17th week.
F96A discrepancy between gestational age estimated by last menstrual period and biparietal diameter may indicate an increased risk of fetal death and adverse outcomes of pregnancy
Authors: Nguyen T. , Larsen T. , Engholm G. , Møller H.
Published: March 2003

Objective

To analyse the association between the discrepancy between gestational age estimated by last menstrual period and by biparietal diameter (GALMP– GABPD) and adverse outcomes of pregnancy.

Design

Population based follow‐up study based on registry data.

Material

Singleton pregnancies with a reliable date of last menstrual period and biparietal diameter measured between 12 and 22 weeks of gestation were studied (n = 16 469).

Method

Logistic regression analysis and Kaplan‐Meier survival analysis was used to analyse the association between (GALMP–GABPD) and adverse outcomes of pregnancy.

Main outcome measure

Adverse outcomes were defined as: abortion after 12 weeks of gestation, stillbirth and postnatal death within 1 years of birth, prematurity, birth weight lower than 2500 g and birth weight lower than 22% below the sex‐specific expected.

Result

The risk of death was more than doubled if (GALMP– GABPD) was eight days or more compared to (GALMP– GABPD) of less than eight days (odds ratio, 2.2; 95% ci 1.6–3.1). The corresponding risks for other adverse outcomes were approximately 1.5 times higher. The risk of death was further factor of 6.1 higher if (GALMP– GABPD) of ≥ 8 days was associated with multiple of median of maternal alpha‐fetoprotein (AFP‐MOM) measured in the 2nd trimester over two.

Conclusion

A discrepancy between GALMP and GABPD generally reflects the precision of the two methods used to predict term. However, a positive discrepancy of more than seven days, particularly with high AFP‐MOM, might indicate that a foetus is intrauterine growth‐retarded and at increased risk of adverse outcomes.
Prenatal diagnosis of abnormalities of the fetal venous system
Authors: Hofstaetter C. , Plath H. , Hansmann M.
Published: March 2003

Objective To present our experience in the prenatal diagnosis of anomalies of fetal veins using high‐resolution color Doppler ultrasound.

Design An observational study of 16 fetuses with abnormalities of the umbilical, portal, hepatic and caval venous system being diagnosed at the Division of Prenatal Diagnosis and Therapy (Bonn, Germany) over the past 5 years. The abnormality of the venous system, the underlying embryologic disorder and the outcome of the pregnancy are presented and compared with the literature.

Results In group A, eight fetuses had an abnormal course of the umbilical vein with a patent (n = 3) or absent (n = 5) ductus venosus. No portal veins and absent or abnormal hepatic veins were visualized by color Doppler sonography. Six fetuses (75%) did not have an associated malformation and have survived. Two pregnancies with fetal hydrops due to a small heart and to Turner's syndrome were terminated or ended in fetal demise. In group B, seven of eight fetuses with an abnormal caval system had a situs ambiguus or an atrial isomerism. A cardiac defect was detected in six cases (86%). These six pregnancies ended in four terminations of pregnancy and two infant deaths due to the severity of the congenital cardiac defect. One child with a normal heart and a child with an isolated abnormal course of the lower inferior vena cava are developing well.

Conclusions In a targeted fetal scan the course of the umbilical vein, ductus venosus, the portal and hepatic veins and inferior vena cava should be carefully examined using color Doppler. Any suspicious finding should be followed by a detailed assessment of the specificity of this abnormality taking into consideration the embryologic development of the fetal venous system together with the associated malformations.
Outcome of first‐trimester chorionic villus sampling for genetic investigation in multiple pregnancy
Authors: Brambati B. , Tului L. , Guercilena S. , Alberti E.
Published: March 2003

Objectives

To evaluate the efficacy of and risk associated with chorionic villus sampling for genetic investigations in multiple pregnancies, and to evaluate the accuracy of the ultrasonographic detection of chorionicity during the first trimester.

Patients and Methods

A total of 198 sets of twins and nine sets of triplets from 10 087 consecutive first‐trimester pregnancies undergoing chorionic villus sampling were considered. Gestational age ranged from 7 to 12.6 weeks. Assessment and confirmation of chorionicity was based on a multiplicity of features. Dichorionicity was established in 169 sets of twins (85.3%) and trichorionicity in all triplet cases, while 29 twins were considered monochorionic. Chorionic villus sampling was performed transabdominally in all but one case, and identification of the placental insertion of the umbilical cord was the main benchmark for sampling. Sampling risks were evaluated by comparing clinical outcome with that of a control population of 63 dichorionic twin pregnancies which underwent no invasive procedure.

Results

Determination of the presence or absence of the lambda sign led to a correct assignment of chorionicity in all cases, while the presence of a membrane thickness of 2 mm or more reflected a 100% specificity with a 22% false negative rate. Sampling was successfully performed in all cases and in only four cases (1.0%) were two needle insertions needed. At follow‐up no evidence of incorrect sampling was reported. Karyotyping was provided to all patients, and in 94.1% of cases both short and long‐term culture methods were carried out. No difference in fetal and perinatal losses between the study and control populations was found, but a higher rate of deliveries before 37 weeks and of low birth weight babies was noted amongst controls.

Conclusions

Chorionicity in twin pregnancy can be determined with certainty between 7 and 12 weeks of gestation; in cases of confluent placentas reliability is provided by determining the presence or absence of the lambda sign. This study indicates that first‐trimester transabdominal chorionic villus sampling is a highly efficient, reliable, and relatively safe approach for genetic diagnosis in twin pregnancies. Although a precise evaluation of the relative risks of chorionic villus sampling and mid‐trimester amniocentesis in twins must await randomized control studies, the advantages of a first‐trimester diagnosis to enable early decision‐making about selective fetal reduction are obvious. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Intraobserver reproducibility of Doppler measurements of uterine artery blood flow velocity in premenopausal women
Authors: Valentin L. , Sladkevicius P. , Bland M.
Published: March 2003

Objective

To determine the intraobserver repeatability of Doppler measurements of uterine artery blood flow velocity and the contribution of various factors to within‐subject variance.

Design

Seventeen healthy premenopausal women underwent vaginal Doppler ultrasound examination of the uterine artery by the same observer. Three measurements were taken at each of three sites: 1) the currently recommended sampling site; 2) the ascending branch of the uterine artery at a level between the lower and middle third of the corpus uteri; 3) 1.5 cm lateral to the recommended sampling site. Three measurements were taken at each site. For each measurement, three uniform consecutive cardiac cycles were analyzed. Peak systolic velocity, time‐averaged maximum velocity, and pulsatility index were calculated. Each Doppler shift spectrum was analyzed twice. Thus, for each woman, 18 measurement results per sampling site were obtained. Analysis of variance was used.

Results

The effect of sampling site on measurements of peak systolic velocity and time‐averaged maximum velocity was non‐significant, but pulsatility index values obtained at the distal sampling site were slightly higher than those obtained at the other sites (P = 0.01). Repetition accounted for most of the within‐subject variance. Averaging the results of the three repeat measurements yielded increased intraclass correlation coefficients: 0.79–0.89 for peak systolic velocity, 0.80–0.92 for time‐averaged maximum velocity and 0.86–0.93 for pulsatility index.

Conclusion

As the effect of repetition on the results of Doppler measurements of uterine artery blood flow velocity is large, the average of several repeat measurements should be used to enhance measurement reproducibility. However, it is not worth doing more than one analysis of a Doppler shift spectrum, and it is not worth analyzing more than one cardiac cycle per spectrum. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Combined prenatal ultrasound and magnetic resonance imaging in two fetuses with suspected arachnoid cysts
Authors: Blaicher W. , Prayer D. , Kuhle S. , Deutinger J. , Bernaschek G.
Published: March 2003

Sonography and ultrafast magnetic resonance imaging were used in the prenatal assessment of two fetuses with sonographically suspected arachnoid cysts. In one case magnetic resonance imaging confirmed the ultrasound diagnosis, in the other case magnetic resonance imaging revealed the presence of a midline cyst associated with dysgenesis of the corpus callosum. Ultrafast magnetic resonance imaging is a useful supplementary imaging method in the evaluation of pregnancies complicated by fetal cerebral anomalies. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of congenital heart disease in a low risk obstetrics population in Singapore
Authors: Yeo G. S. H. , Woo B. H. , Yan Y. L.
Published: March 2003

Objective:  To compile information of the type of Congenital Heart Disease (CHD), the concomitant presence of extra‐cardiac structural defect and chromosomal abnormality in our center to assist patient counseling. The true positive rate (TPR) and positive predictive value (PPV) of the prenatal screening of various CHD is calculated.

Methods:  A single center, prospective, cross‐sectional observational study of screening scans on low risk patients. A search of all the cases with CHDs from June 1996 to May 1999 yield a total of 226 cases of confirmed CHDs identified by postmortem examinations, surgery or neonatal 2D echocardiography.

Results:  The commonest defect is ventricular septal defect (VSD) and/or atrial septal defect (ASD) (75 cases), followed by Fallot's tetralogy/double outlet right ventricle (DORV) (31), pulmonary stenosis/atresia (14), hypoplastic left heart (12), tubular hypoplasia (9), atrio–ventricular septal defect (AVSD) (8) and Ebstein anomaly (8).

The TPR differ for individual defect, ranging from 100% for hypoplastic left heart, hypoplastic right heart and Ebstein anomaly to 0% for truncus arteriosus and tubular hypoplasia. The PPV vary for the individual defects, ranging from 100% for Ebstein anomaly, coarctation of aorta, pulmonary stenosis, atrial septal defect and single ventricle to 0% for truncus arteriosus.

The presence of a prenatally diagnosed CHD is associated with an increased risk of chromosomal abnormalities from 85.7% for AVSD and 57.1% for coarctation of aorta to 14.3% for Ebstein anomaly. Extra‐cardiac defects are common in fetuses with chromosomal disorder.

Conclusion:  CHD is the commonest defect in the fetus and should be routinely screened for. Availability of de facto information in a diagnostic center is essential to help the mothers to come to an informed decision. Karyotyping should be routinely offered. Extra‐cardiac lesions are common associations and should be carefully looked for. An acceptable positive predictive value is particularly important in post‐screening counseling.
Behavioral organization of the fetus in early pregnancy
Authors: McCartney G. R. , Hepper P. G.
Published: March 2003

Purpose:  The behavior of the human fetus consists of complex dynamic relationships. To date, previous methods of measuring fetal behavior have failed to capture the complexity of behavior. However, as behavior is a reflection of neural functioning it is only when quantitative assessment of this complexity has been undertaken that underlying neural organization can be elucidated. In order to reveal fundamental features of neurobehavioral organization and development, the present study provided a quantitative description of the complex spatial (sequential) and temporal (synchronous and asynchronous) patterning of behavior in the human fetus in early pregnancy.

Methods:  Twenty fetuses from normal singleton pregnancies were scanned at two weekly intervals for a period of 1 h from 9 to 17 weeks' gestation. An ethogram of the timing and sequencing of right and left arm and leg movements was constructed from each videotaped session. A description of sequential and synchronous relationships between limb movements was determined using stochastic modeling. The temporal patterning of activity in arm, leg and all limb movements was examined by quantitatively determining bout criterion using survivor analysis.

Results:  Fetuses exhibited within and between limb synchronous, sequential and temporal patterning from the appearance of single limb movements indicating that initial patterning may be genetically hard‐wired. Self‐organization of behavior was apparent in increasing synchronous, sequential and temporal patterning with advancing gestation. These changes coincided with rapid increases in neurulation, synaptogenesis and myelinization in early pregnancy. Different sequential, synchronous and temporal organization was found in arm and leg movements indicating differential neural control of co‐ordination in these limbs. Furthermore, lateralization and gender differences were found to be important features of behavioral organization.

Conclusions:  The present study has revealed that quantitative assessment can define and measure behavioral complexity and this can elucidate fundamental neurobehavioral organization in early pregnancy.
Three‐dimensional quantitative echocardiographic assessment of ventricular volume in healthy human fetuses with and in fetuses with congenital heart disease
Authors: Meyer‐Wittkopf M. , Schmidt S. , Cooper S. G. , Sholler G. F.
Published: March 2003

We examined the feasibility and appearance of 3D fetal echo assessment of ventricular volumes in 29 normal fetuses and 22 fetuses with congenital heart disease (gestation 18–35 weeks). Gated 3D volume sets could be obtained in 51 of 57 cases. Normal right and left ventricular volume, stroke volume data, and RV/LV ratios were obtained, together with normal changes with gestation. In patients with congenital heart disease, those with a biventricular heart (index lesion teratology of Fallot) demonstrated normal combined ventricular volumes and right/left volume ratios for gestation age. Fetuses with single ventricular heart with intact septum (hypoplastic left or right heart) demonstrated a small but significant reduction in combined ventricular size and stroke volume for gestation age.
Freehand three‐dimensional ultrasound in the diagnosis of fetal anomalies
Authors: Guerra F. A. , Caro J. , Mansilla J. , Gutierrez R. , Aguilar R. , Isla A.
Published: March 2003

Purpose:  To determine the clinical impact and additional information of freehand three‐dimensional ultrasound (3DUS) in the diagnosis of fetal anomalies compared to two‐dimensional ultrasound (2DUS).

Methods:  We studied a total of 146 anomalies found in 95 fetuses. In all of them the fetal anomaly was first assessed by 2DUS, and then by freehand 3DUS. According to the fetal anomaly, fetal or maternal conditions, one or more of the following modes of data capture were employed: volume capture (n = 42 anomalies), static capture (n = 21 anomalies), and free style capture (n = 83 anomalies), then the most suitable screen presentation was used. Clinical impact, fetal outcome and additional information were determined in all cases.

Results:  Freehand 3DUS images provided additional information only in three anomalies (2%) compared with 2DUS, were equivalent in 132 anomalies (90%), and were disadvantageous in 11 anomalies (8%) In most cases, when the anomalies were well visualized by 2DUS, the 3DUS images added no further information. In none of the cases the 3DUS changed the clinical management. Furthermore, all files obtained by 3DUS were more advantageous in term of post‐processing capabilities, manipulation of images by multiples physician and teaching activities compared with 2DUS.

Conclusions:  The different freehand 3DUS modalities were diagnostic equivalent to 2DUS in the majorities of the clinical cases and has no additional clinical impact on patient management. The most important advantages were related to the post‐processing capabilities.
Can sonography represent a marker of dystocia in epidural analgesia? A prospective randomized study
Authors: Malvasi A. , Brizzi A. , Cecinati A. , Liaci L. , Totaro P. , Traina V.
Published: March 2003

Purpose:  An association between epidural analgesia and dystocia in the second stage of labor remains controversial. To compare severe labor pain and dystocia at the time of epidural placement for predicting cesarean section (c.s.) risk. We hypothesized, the dystocia causes severe labor pain, such that more epidural medication is required to maintain comfort.

Methods:  We examined the relationship between labor outcome and severe labor pain defined by the number of supplemental anesthetic boluses, by cervical dilatation, clinical evaluation of pelvic dimension, sonographic fetal weight and ultrasonographic examination of fetal axis in cephalic presenting deliveries. This prospective study included 375 women in labor with have singleton fetuses at term in vertex presentations. We excluded women with pre‐eclampsia, placenta previa, repeat c.s.

Results:  Seventy‐nine of the 375 patients receiving early epidural analgesia were delivered by c.s. (68 due to dystocia, 11 due to fetal distress). A multiple logistic regression model evaluated demographic and labor‐related variables associations with cesarean risk. By using multivariate analysis, the odds ratio of c.s. among patients who required at least three boluses was 2.4 compared with those who required two boluses or less (P < 0.001). Variables that proved to be statistically significant in increasing the likelihood of c.s. were station at time epidural placement (P < 0.01) and severe labor pain associated with dystocia (P < 0.01). The relationship between severe labor pain‐dystocia and labor arrest (persistent occipito‐posterior or occipito‐transverse position in labor progress) we confirmed with sonography examination during the first and second stage of labor (82% of cases) (P < 0.01).

Conclusions:  This is a prospective study demonstrating an association between severe labor pain and c.s. The abnormality of fetal axis exists and it can affect the progress of epidural analgesia labors. The sonographic examination in labor reducing the time of labor failure, the possibility of fetal and maternal complications. Furthermore it reduces forensis implications because of the possibility to give evidence of the intrapartum head fetal axis.
Prognostic factors of non‐immune hydrops fetalis in Korean population
Authors: Lee J. Y. , Shim S. S. , Park J. S. , Jun J. K. , Yoon B. H. , Syn H. C. , Lee H. P.
Published: March 2003

Objective:  Non‐immune hydrops fetalis (NIHF) is rare and carries a grave prognosis. We undertook this study to find out prognostic factors of NIHF in Korean population.

Material and methods:  From October 1988 to February 2001, 71 pregnancies of NIHF were evaluated with antenatal testes, including fetal karyotyping, fetal echocardiography, detailed ultrasonography, and infection work‐up. In some cases, we performed them after delivery and included autopsy results. Twenty cases were sacrificed due to parents' decision before viable stage. Four cases were lost in follow up. Sixteen cases of cystic hydroma were excluded because they were regarded as a different entity. Thirty‐one cases were retrospectively evaluated to find out prognostic factors in NIHF. We analyzed, the presumed prognostic factors, such as gestational age at detection, gestational age at delivery, birth weight over 90th percentile, the presence of associated conditions, 5 min Apgar score less than 4, number of body cavities filled with fluid, and the presence of polyhydramnios.

Results:  Of 31 cases, 21 cases were expired in utero or neonatal period (67%) and 10 cases were survived till at least 28 days after birth. Only 5 min Apgar score less than 4 was significantly associated with perinatal death (Odds ratio 6.000, CI 1.693–21.262). Other factors were not risk factors of increased perinatal mortality.

Conclusion:  On the basis of our data, we concluded that 5 min Apgar score less than 4 was a significant risk factor for predicting increased perinatal death in NIHF.
Preliminary experience with invasive procedure in utero using ‘live‐3D’ ultrasonography
Authors: Kim S.‐R. , Won H.‐S. , Chung J.‐Y. , Lee P. R. , Lee I.‐S. , Kim A. , Nam J.‐H. , Kim A.
Published: March 2003

Objective:  Technological advances in ultrasound have revolutionized the prenatal diagnosis and treatment. We recently began to evaluate the clinical applications of three‐dimensional (3D) ultrasonography (USG) to invasive procedures in utero. The purpose of this report is to describe the effectiveness of live‐3D USG on the operative in utero procedures.

Study design:  The operative in utero procedures through live‐3D USG were recorded prospectively in 21 cases: one amnioinfusion, 10 amniocenteses, 10 chorionic villi samplings (CVS), and 10 cordocenteses. All cases were examined with a 3D ultrasound volume scanner (Voluson 730D, Medison). To sum up, we searched the needling site with 2D mode, and then confirmed by 3D mode prior to the procedures. After localization of the needle, we checked up the true position of the needle in all three planes (3D targeting). The time for each phase, efficient actions (e.g. identifying targeting site, inserting needle, or taking a sample) and limiting factors (e.g. technical problems, time spent in waiting) were determined.

Results:  The ‘live‐3D’ USG‐guided procedures showed a great achievement. Most procedures were performed within 5 min with 100% success rate, even in cases, such as severe oligohydramnios (in case of amniocentesis), thin placenta (in case of CVS), or weak umbilical vein (in case of cordocentesis). Moreover, there were no serious complications or inconveniences during the procedure.

Conclusions:  In our initial limited experience, live‐3D USG was effectively performed in various operative in utero procedures. Compared to conventional 2D USG, live‐3D USG guidance offers clear information of all three planes. These preliminary data support the great usefulness of live‐3D USG for invasive procedures in utero.
The affect of image size on nuchal translucency measurement: a report from the FaST study
Authors: Edwards A. G. , Mulvey S. F. , Wallace E. M.
Published: March 2003

Purpose:  To establish whether image size affects nuchal translucency measurement.

Methods:  A random sample of participants in the FaST study were selected to have additional measurements performed to determine whether image size affects the nuchal translucency measurement. The FaST study is a collaborative research project funded by the Department of Human Services, Victoria Government, and Monash University. This study was established to assess the relative merits of first and second trimester screening for Down syndrome and to thereby determine the optimum screening strategy. Nuchal translucency measurements were performed using an ATL HDI3000 with C5‐2 probe with the fetus in a sagittal section and the amnion excluded. Using HD zoom, the image size was adjusted so that the fetus occupied 60, 100 or 200% (head and neck view) of the monitor. Three measurements were taken at each image size, in random order, according to the methods described by the fetal medicine foundation. The ultrasound machine operator was blinded from the measurement values during the examination. Statistical analysis utilizing STATA 6.0 was performed using analysis of variance after log transformation of the nuchal translucency data to produce a normal distribution.

Results:  Forty‐eight women were scanned with nine nuchal translucency measurements performed in each case. All scans were transabdominal. The CRL ranged from 44 to 80 mm and BPD from 15 to 28 mm. The mean NT was 1.5, 1.3, and 1.1 mm at 60, 100 and 200% image sizes, respectively. Analysis of variance with Bonferroni multiple‐comparison test revealed statistically significant differences between 60 and 200% (P < 0.0001) and 100 and 200% (P = 0.025) images, but not between the 60 and 100% images (P = 0.057).

Conclusion:  Image size appears to make a significant difference to the nuchal translucency measurement with an inverse relationship between the fetal image size and the nuchal translucency recorded.
Fetal cardiac function in fetuses with intracardiac echogenic foci
Authors: Degani S. , Leibovitz Z. , Shapiro I. , Ohel G.
Published: March 2003

Objective:  To evaluate cardiac dimensions and function in euploid fetuses with intracardiac echogenic foci.

Study design:  Forty‐eight fetuses with a single cardiac echogenic focus situated in the left ventricle, had echocardiography performed at 22–24 weeks of gestation. Fifty normal fetuses at 22–24 weeks gestation served as controls. The 2‐D and M‐mode directed fetal echocardiography were used to exclude cardiac anomalies and measure right and left ventricular free walls and interventricular septal thickness and ventricular systolic and diastolic dimensions. Cardiac size was expressed as a ratio of ventricular wall thickness/biparietal diameter, and function was expressed as ventricular shortening fraction. Doppler fetal echocardiography measurements included pulmonary and aortic maximum systolic velocities and time to peak velocities as indices of ventricular systolic function and the ratio between E‐wave and A‐wave at the level of atrioventricular valves as indices of ventricular diastolic function.

Results:  Early ventricular filling/active atrial filling ratios (E/A ratios) were significantly lower in fetuses with intracardiac echogenic foci than in control fetuses. No significant differences were found in cardiac dimensions, ventricular shortening fraction and Doppler systolic indices.

Conclusion:  Euploid fetuses with intracardiac echogenic foci show low E/A ratio values in mid‐trimester echocardiography. This finding might indicate cardiac diastolic dysfunction.