bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of thymidine phosphorylase in uterine sarcoma and uterine leiomyoma: association with microvessel density and Doppler blood flow analysis
Authors: Hata K. , Hata T. , Iida K. , Miyazaki K.
Published: March 2003

The aim of this study was to determine whether the expression of thymidine phosphorylase (TP) by uterine sarcoma and leiomyoma cells is associated with the density of microvessels within the tumor, and with Doppler ultrasound‐derived peak systolic velocity (PSV) of blood flow.

Sections of tissue from four uterine sarcomas and 41 uterine leiomyomas which had been used in a previous study to determine intratumoral peak systolic velocity were analyzed for the cellular expression of TP and the intratumoral density of microvessels by immunohistochemistry, using monoclonai antibody to TP and factor VIII‐related antigen, respectively. The main outcome measures were whether or not the tumor cells were TP‐positive or TP‐negative, and the microvessel count within each tumor type

Uterine sarcomata were classified as TP‐positive and uterine leiomyomata as TP‐negative. The microvessel count in uterine sarcomas was significantly higher than that in uterine leiomyomas (p = 0.002, Mann‐Whitney U test).

We concluded that the expression of TP by uterine sarcoma cells is associated with an increase in microvessel density and with a higher peak systolic velocity. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Effect of the levonorgestrel‐releasing intrauterine system on the uterine artery pulsatility index in postmenopausal hormone replacement therapy
Authors: Järvelä I. , Raudaskoski T. , Tekay A. , Jouppila P.
Published: March 2003

The aim of this study was to determine the effect of continuous intrauterine release of progestin on the uterine artery pulsatility index (PI) in women on postmenopausal hormone replacement therapy (HRT). The voluntary participants, 13 symptomatic postmenopausal women, received transdermal estradiol (50 µg/day) for 1 month before combining the levonorgestrel‐releasing (20 µg/day) intrauterine system (LNG‐IUS) with estrogen replacement therapy. The PI of uterine artery Mood flow was measured by transvaginal color Doppler ultrasonography before the onset of HRT, 1 month after the treatment with estradiol (estradiol‐only phase) and 1, 3 and 6 months after insertion of the LNG‐IUS. The mean uterine artery PI decreased significantly from its pretreatment level after 1 month of transdermal estradiol treatment (p < 0.05), but the LNG‐IUS induced an increase in PI, and 6 months after its insertion the PI did not differ significantly from the pretreatment level (p > 0.05). Compared with the estradiol‐only phase, the last measurement of the PI was significantly increased (p < 0.05). The results suggest that continuous intrauterine release of levonorgestrel abolishes the vasodilatory effect on the uterine arteries accomplished by post‐menopausal estradiol treatment. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
In vitro volume measurement by three‐dimensional ultrasound: comparison of two different systems
Authors: Hösli I.M. , Tercanli S. , Herman A. , Kretschmann M. , Holzgreve W.
Published: March 2003

The aim of this study was to compare volumetric capabilities in vitro between two different three‐dimensional technical modalities with a transvaginal transducer. We intended to evaluate the effect of different sizes and shapes on the accuracy of the measurements, and to establish criteria for choosing the appropriate system for three‐dimensional volume measurement. We did not find significant differences between the two systems, either in the results or in their operation. We confirmed the high accuracy of three‐dimensional volume measurements in vitro. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Conditional centiles for the quantification of fetal growth
Authors: Owen P. , Ogston S.
Published: March 2003

A total of 274 low‐risk pregnancies underwent predetermined, scheduled, serial ultrasound examinations and measurement of the biparietal diameter, fetal abdominal area, femur length and estimated fetal weight. The longitudinal nature of this dataset permits the construction of conditional centiles for these measurements, whereby the dimensions of an individual fetus at a given gestational age can be extrapolated to give a range of expected values (expressed as centiles) at a later gestational age. Examples of conditional centiles based upon 4‐week measurement separations are presented. These conditional centiles permit the appropriate quantification and subsequent evaluation of time‐dependent changes in fetal dimensions to be made. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Trisomy 22: a cause of isolated fetal growth restriction
Authors: Morrison J. J. , Hastings R. , Jauniaux E.
Published: March 2003

The management of severe isolated fetal growth restriction at term involves consideration of the risk of associated aneuploidy. A case is described in which intrauterine growth restriction was detected at 37 weeks' gestation in a structurally normal fetus. The diagnosis of trisomy 22 was made after fetal blood sampling. This diagnosis has not been previously reported in a structurally normal fetus. This case highlights the dilemma that arises in the management of the small, structurally normal fetus in the late third trimester. The reasons for survival to term of some trisomy 22 fetuses are as yet unclear and are discussed. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Doppler parameters of uterine and ovarian stromal blood flow in women with polycystic ovary syndrome and normally ovulating women undergoing controlled ovarian stimulation
Authors: Pinkas H. , Mashiach R. , Rabinerson D. , Avrech O. M. , Royburt M. , Rufas O. , Meizner I. , Ben‐Rafael Z. , Fisch B.
Published: March 2003

Objective

To test the hypothesis that the increased ovarian sensitivity to gonadotropins observed in women with polycystic ovary syndrome (PCOS) may be due to changes in ovarian stromal blood flow in these patients.

Design

Uterine and ovarian stromal arterial blood flow (with transvaginal color Doppler ultrasound) were measured in ten women with PCOS and 12 normo‐ovulatory women (control group), undergoing gonadotropin stimulation before in vitro fertilization.

Methods

A careful ovarian stimulation strategy was adopted for the study group in order to avoid ovarian hyperstimulation syndrome and achieve an ovarian response which was comparable to that of the control group. Resistance and pulsatility indices (RI and PI) of the uterine and ovarian stromal arteries were calculated before the onset of gonadotropin treatment, on cycle day 5 (after commencing treatment), day of human chorionic gonadotropin injection, day of ovum pick‐up, as well as on the day of embryo transfer, and 7 and 12 days later.

Results

No significant differences were found in RI and PI between the study and control groups throughout the treatment cycle.

Conclusions

It seems that polycystic ovaries do not bear an inherent disturbance in blood flow dynamics of the uterine and ovarian arteries, as measured by color Doppler, which would explain the increased sensitivity of polycystic ovaries to stimulation with gonadotropins. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Expression of thymidine phosphorylase in malignant ovarian tumors: correlation with microvessel density and an ultrasound‐derived index of angiogenesis
Authors: Hata K. , Nagami H. , Iida K. , Miyazaki K. , Collins W. P.
Published: March 2003

Objective

The aim of this study was to determine whether the expression of thymidine phosphorylase by ovarian cancer cells correlates with the density of microvessels within the tumor, and with ultrasound‐derived indices of blood flow.

Methods

Transvaginal ultrasonography with color Doppler imaging and pulsed Doppler spectral analysis was used to scan patients with an overt ovarian mass immediately before laparotomy. Sections of malignant tumors were analyzed for the cellular expression of thymidine phosphorylase and the intratumoral density of microvessels by immunohistochemistry using monoclonal antibodies to thymidine phosphorylase and factor VIII‐related antigen, respectively. The main outcome measures were the histological classification of the tumor, the stage of the disease, whether or not the tumor cells were positive or negative for thymidine phosphorylase, the microvessel count and the peak systolic velocity (PSV).

Results

Forty‐two tumors were studied (three of low malignant potential, 29 epithelial, four granulosa cell, two germ cell and four metastatic); 18 were stage I, six stage II, 11 stage III and three stage IV. Twenty‐seven tumors (64%) were classified as thymidine phosphorylase‐positive. The proportion of stage I tumors that was thymidine phosphorylase‐positive (44%) was significantly lower (p = 0.022) than the corresponding value for stages II‐IV (85%), but the values for microvessel count and PSV were similar. The microvessel count in thymidine phosphorylase‐positive tumors was significantly higher than in thymidine phosphorylase‐negative tumors (p = 0.005). Similarly, the PSV was significantly higher in thymidine phosphorylase‐positive tumors (p = 0.009). There was a significant correlation between the microvessel count and the PSV (r = 0.354, p = 0.022).

Conclusions

The expression of thymidine phosphorylase by malignant tumor cells is associated with an increase in microvessel density and PSV in patients with ovarian cancer. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Validation of diameter measurements by ultrasound: intraobserver and interobserver variations assessed in vitro and in fetal sheep
Authors: Kiserud T. , Saito T. , Ozaki T. , Rasmussen S. , Hanson M. A.
Published: March 2003

Objectives

Blood flow evaluation in the fetus is hampered by inaccuracy in the measurement of vessel diameter. The impact of biological variation on reproducibility studies is unknown. The present study evaluated diameter measurements carried out with modern ultrasound equipment by assessing inter‐ and intraobserver variations.

Design

Repeated measurements analyzed by a general factorial model of analysis of variance.

Methods

Three observers measured repeatedly (six or more times for each tube and session) silicone tube implants (0.6, 2.2 and 6 mm), applying ultrasound imaging in eight fetal sheep, and the same silicone tubes. Analysis of variance was carried out on 199 observations made and 537 in vivo.

Results

The upper 95% confidence limit for the intra‐ and interobserver variations was higher for measurements made than. It was highest for the largest diameter and varied between 0.10 and 0.38 mm. When the diameter was determined as an average of repeated measurements, the error was reduced: six measurements in vivo had upper 95% confidence limits for intraobserver variation of 0.04 and 0.09 mm for diameters of 0.6 and 6 mm, respectively.

Conclusions

The results show that ultrasound diameter measurements have a high reproducibility even for vessels of small dimensions when repeated measurements are taken with high‐frequency ultrasound under favorable conditions. The low variation described in the present investigation of silicone tubes, compared to previous studies, suggests that diameter changes of living vessels represent a separate source of measurement variation. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
The effects of maternal indomethacin therapy on human fetal branch pulmonary arterial vascular impedance
Authors: Rasanen J. , Debbs R. H. , Wood D. C. , Weiner S. , Huhta J. C.
Published: March 2003

Objective

To examine whether maternal indomethacin therapy affects human fetal pulmonary arterial vascular impedance without constriction of the ductus arteriosus and to determine the changes in the pulmonary arterial vascular impedance in the presence of ductal constriction.

Study design In this cross‐sectional study, 52 normal fetuses without maternal medication (control group), 33 fetuses without ductal constriction (Study group I) and 11 fetuses with ductal constriction (Study group II) during maternal indomethacin therapy between 24 and 34 weeks of gestation were examined by Doppler echocardiography. Blood velocity waveforms across the proximal right or left pulmonary artery were obtained and the pulsatility index (PI) of the proximal pulmonary arteries was calculated.

Results

In the control group, the proximal pulmonary artery PI was higher (p < 0.0001) at 24–25 weeks (n = 7) (3.73 ± 0.33; mean ± SD) than at 33–34 weeks of gestation (n = 11) (2.98 ± 0.27). The PI was constantly greater (p < 0.005) in Study group I than in the control group. However, in this group the mean average weekly decrease in the PI of the proximal pulmonary arteries was similar to that in the control group. After 26 weeks of gestation, the PI values in Study group II were significantly higher than in the control group (27 weeks: 4.12 vs. 3.34 (p < 0.005); 30 weeks: 4.48 vs. 3.14 (p < 0.0001); 34 weeks: 4.96 vs. 3.00 (p < 0.0001), respectively).

Conclusions

Human fetal pulmonary arterial vascular impedance is increased by maternal indomethacin therapy even without ductal constriction. In the presence of ductal constriction, the magnitude of the increase in the vascular impedance is related to the gestational age. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
First‐trimester cord entanglement in monoamniotic twins
Authors: Overton T. G. , Denbow M. L. , Duncan K. R. , Fisk N. M.
Published: March 2003

Objective

Monoamniotic twinning occurs in only 1% of twin pregnancies, but carries a high perinatal mortality rate. Early and reliable diagnosis is essential if attempts are to be made to reduce the complication rate. We report color Doppler demonstration of cord entanglement in the first trimester, which is diagnostic of monoamnionicity.

Methods

Two patients with twin pregnancies were examined in the first trimester with pulsed and color Doppler insonation of their umbilical arteries.

Results

Cord entanglement was suspected and proved by demonstrating differing fetal heart rate patterns in the same direction on umbilical artery Doppler analysis of a common mass of cord vessels. Following appropriate counselling, medical amnioreduction was induced at 20 weeks of gestation to reduce fetal movements and worsening cord entanglement. Delivery was by elective Cesarean section at 32 weeks' gestation and monoamnionicity was confirmed.

Conclusion

We report a new sign for the demonstration of monoamnionicity in twin pregnancies in the first trimester. This should improve the reliability of early diagnosis, but further studies are required to confirm that, if cord entanglement occurs, it is usually present by the end of the first trimester. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal sonographic features of spondylocostal dysostosis and diaphragmatic hernia in the first trimester
Authors: Lam Y. H. , Eik‐Nes S. H. , Tang M. H. Y. , Lee C. P. , Nicholls J. M.
Published: March 2003

Spondylocostal dysostosis is a congenital disorder characterized by multiple malformations of the vertebrae and ribs. We describe the sonographic features of an affected fetus at 12 and 14 weeks of gestation. The fetus had thoracic scoliosis, multiple vertebral and rib malformations and a grossly dilated stomach that had herniated into the chest through a left‐sided diaphragmatic hernia. The stomach spanned the whole length of the fetal trunk. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
A screening program for trisomy 21 at 10–14 weeks using fetal nuchal translucency, maternal serum free β‐human chorionic gonadotropin and pregnancy‐associated plasma protein‐A
Authors: Spencer K. , Souter V. , Tul N. , Snijders R. , Nicolaides K. H.
Published: March 2003

Objective

To examine the potential impact of combining maternal age with fetal nuchal translucency thickness and maternal serum free β‐human chorionic gonadotropin (β‐hCG) and pregnancy‐associated plasma protein‐A (PAPP‐A) in screening for trisomy 21 at 10–14 weeks of gestation.

Methods

Maternal serum free β‐hCG and PAPP‐A were measured by Kryptor, a random access immunoassay analyzer using time‐resolved amplified cryptate emission, in 210 singleton pregnancies with trisomy 21 and 946 chromosomally normal controls, matched for maternal age, gestation and sample storage time. In all cases the fetal crown–rump length and nuchal translucency thickness had been measured by ultrasonography at 10–14 weeks of gestation and maternal blood had been obtained at the time of the scan. The distributions (in multiples of the median; MoM) of free β‐hCG and PAPP‐A (corrected for maternal weight) and fetal nuchal translucency (NT) were determined in the trisomy 21 group and the controls. Likelihood ratios for the various marker combinations were calculated and these were used together with the age‐related risk for trisomy 21 in the first trimester to calculate the expected detection rate of affected pregnancies, at a fixed false‐positive rate, in a population with the maternal age distribution of pregnancies in England and Wales.

Results

In a population with the maternal age distribution of pregnancies in England and Wales, it was estimated that, using the combination of maternal age, fetal nuchal translucency thickness and maternal serum free ß‐hCG and PAPP‐A, the detection of trisomy 21 pregnancies would be 89% at a fixed false‐positive rate of 5%. Alternatively, at a fixed detection rate of 70%, the false‐positive rate would be 1%. The inclusion of biochemical parameters added an additional 16% to the detection rate obtained using NT and maternal age alone.

Conclusions

Rapid diagnostic technology like Kryptor, which can provide automated reproducible biochemical measurements within 30 min of obtaining a blood sample, will allow the development of interdisciplinary one‐stop clinics for early fetal assessment. Such clinics will be able to deliver improved screening sensitivity, rapidly and more efficiently, leading to reduced patient anxiety and stress. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Non‐invasive detection of alterations of the carotid artery in pregnant women with high‐frequency ultrasound
Authors: Sator M. O. , Joura E. A. , Gruber D. M. , Obruca A. , Zeisler H. , Egarter C. , Huber J. C.
Published: March 2003

Objective

To compare the thickness of the layers of the carotid artery wall in pregnant and fertile non‐pregnant women.

Design

Prospective cross‐sectional study.

Subjects

Fifty‐one pregnant women at a mean gestational age of 38.9 weeks and 64 fertile non‐pregnant women were examined at a University hospital.

Methods

The three layers (adventitia, media, intima) of the superficial wall of the left common carotid artery were identified and measured with high‐resolution ultrasound (22.5 MHz).

Results

Pregnant women had a thinner intima layer (0.25 ± 0.07/0.29 ± 0.08 mm) and a thicker media layer (0.31 ± 0.08/0.27 ± 0.09 mm) compared with controls. A statistically significantly higher intima/media ratio was calculated for the pregnant women (1.14 ± 0.03), compared with the non‐pregnant women (0.88 ± 0.04).

Conclusion

There are differences in the thickness of the histological layers of the carotid artery wall in pregnant compared with non‐pregnant women. This is likely to be due to the effect of different estradiol levels in these two groups. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Congenital diaphragmatic hernia: ultrasonic measurement of fetal lungs to predict pulmonary hypoplasia
Authors: Bahlmann F. , Merz E. , Hallermann C. , Stopfkuchen H. , Krämer W. , Hofmann M.
Published: March 2003

Objective

The purpose of this study was to assess the value of biometric lung measurements for the prediction of severe fetal pulmonary hypoplasia in congenital diaphragmatic hernia and to determine whether a correlation between lung measurements and autopsy findings or neonatal outcome could be established.

Design

Prospective study, between 1991 and 1997.

Subjects

Nineteen fetuses with congenital diaphragmatic hernia.

Methods

In addition to standard biometry, sonographic measurement of the transverse thoracic diameter, sagittal thoracic diameter, fetal lung diameters at the level of the four‐chamber view and lung/thoracic circumference ratio were performed. These were compared with the standard curves defined by Merz and colleagues. Autopsy examinations were performed to determine lung weight, lung weight/body weight ratio and radial alveolar count.

Results

Five fetuses (26%) were terminated before 24 weeks of gestation. All of these fetuses had lung measurement values below the 5th centile. Eleven of 14 fetuses (78.6%) with pulmonary hypoplasia diagnosed after 24 weeks of gestation died postnatally. The mortality rate was 70% (7/10) in the fetuses without associated anomalies. The sonographic diagnosis of fetal pulmonary hypoplasia was made in all fetuses who died postnatally. All fetuses with a lung diameter/thoracic circumference ratio below 0.09 died. Three fetuses, which had values within the normal range, survived. In contrast, measurements of the bony thorax (transverse and sagittal thoracic diameters, thoracic circumference) did not provide an indication of the presence of fetal pulmonary hypoplasia. Pulmonary hypoplasia was confirmed at autopsy in all fetuses on the basis of lung weight, lung/body weight ratio or radial alveolar count. Concomitant with pulmonary hypoplasia was polyhydramnios in ten fetuses (71.4%), mediastinal shift in 11 fetuses (78.6%), intrathoracic herniated stomach in six fetuses (42.9%) and associated malformations in four fetuses (28.6%). Postnatal mortality for these conditions was 80%, 78.6%, 100% and 100%, respectively. Postnatal mortality was 75%, 70% and 100% in the fetuses with an isolated diaphragmatic hernia.

Conclusion

The results of this investigation suggest that the assessment of fetal lung diameter and the use of the lung diameter/thoracic circumference ratio are further useful prognostic parameters in the management of congenital diaphragmatic hernia. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Histological analysis of the uterine junctional zone as seen by transvaginal ultrasound
Authors: Tetlow R. L. , Richmond I. , Manton D. J. , Greenman J. , Turnbull L. W. , Killick S. R.
Published: March 2003

Objective

This study aimed to investigate the histology of the subendometrial halo, the junctional zone between the endometrium and myometrium.

Methods

Thirteen ex vivo uteri removed for treatment of menorrhagia were studied. In each case, the subendometrial halo, as seen by transvaginal ultrasound, was marked using a Nottingham breast location biopsy needle. A standard histological examination was performed. Full thickness blocks of the anterior uterine wall were taken and standard serial 5‐µm tissue sections were prepared from each block. Subsequent morphometric analysis followed staining with Feulgen reagent, using a CAS 200D quantitative image analysis system. Additionally, anti‐CD31, an antibody stain for vascular endothelium, was used.

Results

The histological examination showed the subendometrial halo to consist of apparently normal myometrium. Morphometric analysis demonstrated a greater total nuclear area in the subendometrial halo than the outer myometrium, but no difference in individual nuclear size between the two zones. CD31 stained a greater total area in the inner myometrium.

Conclusions

These results suggest that the subendometrial halo is a distinct compartment of the myometrium comprising tightly packed muscle cells with an increased vascularity. Such architecture would increase the density of this tissue layer, altering its acoustic impedance, and account for its echopenic appearance on ultrasound. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Central arterial hemodynamics in small‐for‐gestational‐age fetuses before and during maternal hyperoxygenation: a Doppler velocimetric study with particular attention to the aortic isthmus
Authors: Brantberg A. , Sonesson S.‐E.
Published: March 2003

Objective

Hemodynamic changes indicating a normalization of fetal blood flow redistribution during maternal oxygen administration have been suggested to be of positive prognostic value in growth‐restricted fetuses. The aortic isthmus has been suggested as a site for early detection of blood flow redistribution as well as for verification of a response to maternal hyperoxygenation. The present study was performed to investigate whether this concept could be confirmed in a study involving fetuses assumed to have only a moderate disturbance in fetoplacental hemodynamics.

Design and Subjects

Twenty‐five singleton fetuses with an estimated weight less than −2 SD below the gestational age‐related mean and without any malformation or chromosomal aberration were studied between 27 and 38 (median 34) weeks of gestation.

Methods

Velocity waveforms from the mitral valve, aortic valve, middle cerebral artery, aortic isthmus and umbilical artery were recorded before and during maternal breathing of 100% oxygen.

Results

Nine fetuses demonstrated absent or reversed end‐diastolic velocity (ARED) in the aortic isthmus while forward flow was present in the umbilical artery. The cerebral artery pulsatility index (PI) increased with oxygen administration and there was a decrease in the aortic isthmus PI. Variables obtained from the other recording sites did not change with maternal hyperoxygenation.

Conclusions

ARED in the aortic isthmus appears to be an early sign of blood flow redistribution in this group of fetuses. Maternal oxygenation results in velocity waveform changes that suggest an increase of cerebral vascular resistance and a redistribution of blood from the brain to the vascular beds supplied by the descending aorta. The aortic isthmus is a suitable site to verify this response. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
P50Ultrasonographic research of gonadas at a true hermaphroditismis
Authors: Latypov A. S. , Teregoulova L. E. , Bubis I. G.
Published: March 2003

Background

The differential diagnosis between the various forms of violation of a structure of gonadas at the patients with a female phenotype represents a problem, especially at a primary inspection.

Method

We represent a case of ultrasonographic diagnostics an ovotestis at a true hermaphroditismis in our practice. There was used linear transabdominal and convex transrectal transducers on ultramark‐9 device.

Results

The young woman (17yo) who has addressed to the gynecologist concerning a primary amenorrhoea, was examined by ultrasound in the Hospital. There were detected a male's structure internal sexual ductuses and presence of gonadas located below usual position of ovaries with structure, estimated as a testicula. The Morris syndrome was diagnosed. At the consequent inspection in center, specializing in genetic ultrasound, specific echostructure of the gonadas was detected, appropriated to their mixed structure (ovotestis), thus a true hermaphroditismis with a female phenotype was diagnosed. The consequent karyotyping (46XX/46XY (16:4)) has confirmed the preliminary ultrasonographic diagnosis.

Conclusion

The sufficient qualification of the sonographist conducting a ultrasonic research, knowledge of a ultrasonographic picture of the this pathology, allows correct diagnostics already before lab stage of an inspection, using even the routine equipment and review.
WS13‐07The dilemma of selective termination of a malformed fetus in multifetal pregnancy
Authors: Lipitz S.
Published: March 2003

The incidence of fetal malformation is higher in multifetal pregnancies than in singletons. In a dizygotic twin gestation there is slightly more than twice the risk per pregnancy of a fetal malformation. In a monozygotic twin gestation the rates of chromosomal and mendelian abnormalities are identical to those of a singleton pregnancy. However, there is an increased risk of structural malformations. Selective termination in a bichorionic biamniotic twin pregnancy is done with intracardiac injection of potassium chloride. The international experience show that it can be performed in all 3 trimesters with good outcomes in > 90% of cases and the loss rate is approximately 7%. In monochorionic twin gestation the aim is to arrest the umbilical cord flow completely and permanently. Several methods to achieve this goal are embolization, ligation (fetoscope of U/S guidance), laser coagulation, monopolar and bipolar thermocoagulation. The latter technique became more popular, with estimated loss rate of 20%. The techniques and results will be presented (including video), and the ethical issue will be discussed.
WS14‐05Technique of ‘three‐dimensional’ volume mode sectional planar imaging
Authors: Jackson D. N. , Aptekar L. , Thompson K. K.
Published: March 2003

Background

Three‐dimensional imaging of superficial fetal abnormalities is well established. We prospectively evaluated if a technique of sectional planar imaging could interrogate nonsurface fetal abnormalities without changing transducers or requiring postrendering software.

Method

Patients referred for perinatal consultation received traditional 2‐D scanning and simultaneous volume mode imaging. Fetal abnormalities were visualized with a sectional technique similar to ‘tomogram’ slices. No post image rendering manipulation was required. Twelve patients had correlative MRI scanning. Neonatal images were obtained when possible.

Results

Structural fetal abnormalities amenable to volume rendering were found in 192 of 600 referral patients. Of these, 49% (94/192) benefited from 3‐D planar imaging. Consistently improved counseling occurred with abdominal wall defect (11/11), cystic hygroma (8/8), neural tube defect (8/8), skeletal dysplasia (5/5), hydrops (5/5), ovarian mass (4/4), myoma (9/11), and fetal chest mass (2/3). Moderate image concordance was seen for nuchal thickness (4/8), renal dysgenesis (27/50), and placental mass or separation (7/12). Lowest concordance was seen for echogenic bowel (0/17), isolated SUA (0/9), and CPC (4/41).

Conclusion

Complex syndromes with superficial and deep architecture are accessible with a simple volume mode planar scanning technique. The additional information is immediately available and useful in counseling of these syndromes.
Mid‐trimester uterine artery Doppler screening as a predictor of adverse pregnancy outcome in high‐risk women
Authors: Coleman M.A.G. , McCowan L.M.E. , North R.A.
Published: March 2003

Objective To assess the value of uterine artery Doppler ultrasound screening, when performed in a clinical setting, to predict complications of impaired uteroplacental blood flow in high‐risk women.

Design A prospective audit.

Subjects A total of 116 pregnancies in 114 women at high risk of pre‐eclampsia and/or small‐for‐gestational‐age (SGA) babies attending a maternal–fetal medicine clinic at National Women’s Hospital, a tertiary referral hospital, Auckland, New Zealand.

Methods Uterine artery Doppler screening was performed as part of clinical practice between 22 and 24 weeks’ gestation. A resistance index (RI) was calculated from each uterine artery and the presence or absence of a notch was determined. An RI of > 0.58 was defined as abnormal and an RI of ≥ 0.7 was defined as very abnormal. The main outcome measures were: pre‐eclampsia, SGA baby (birth weight < 10th centile), placental abruption, intrauterine death, ‘all’ and ‘severe’ outcomes.

Results Thirty‐two (27.5%) women developed pre‐eclampsia, 31 (26.7%) had SGA babies, 23 (20%) were delivered at < 34 weeks because of pregnancy complications, and there were three (2.6%) placental abruptions and three (2.6%) perinatal deaths. The sensitivity of any RI of > 0.58 for pre‐eclampsia, SGA, ‘all’ outcomes and ‘severe’ outcome was 91%, 84%, 83% and 90%, respectively. The specificity of any RI of > 0.58 for these outcomes was 42%, 39%, 47% and 38%, respectively. The positive predictive value of any RI of > 0.58 for the same outcomes was 37%, 33%, 58% and 24%, respectively. Among women with both RI values of ≥ 0.7, 58%, 67%, 85% and 58% developed pre‐eclampsia, SGA, ‘all’ and ‘severe’ outcomes, respectively. In women with bilateral notches, 47%, 53%, 76% and 65% developed the respective outcomes. Women with both RI values of ≥ 0.7 and women with bilateral notches had relative risks of 11.1 (95% CI 2.6–46.4) and 12.7 (95% CI 4.0–40.4) for developing severe outcome, respectively. Only 5% of women with both RI values of < 0.58 developed a severe outcome.

Conclusion In high‐risk women, uterine artery Doppler waveform analysis performed best in the prediction of severe adverse outcome and was better than clinical risk assessment in the prediction of pre‐eclampsia and SGA babies. Further studies are necessary to determine how information from uterine artery Doppler studies should modify current practice in high‐risk women.
F111Evaluation of routine prenatal ultrasound detection of fetal gastrointestinal malformations: European multicentric study
Authors: Barisic I. , Clementi M. , Haeusler M. , Gjergja Matejic R. , Stoll C. ,   EUROSCAN STUDY GROUP
Published: March 2003

We have evaluated the effectiveness of routine prenatal ultrasound screening in detection of selected groups of major gastrointestinal malformations occurring among 690 123 pregnancies monitored from July 1st 1996 to December 31st 1998 in 19 European Congenital Malformation Registries. There were 243 cases of abdominal wall defects, 177 cases of diaphragmatic hernia and 386 cases of gastrointestinal atresia/stenosis. Only 57% of cases with diaphragmatic hernia and two thirds of cases of omphalocele compared to 95% of the fetuses with gastroschisis are currently being identified in an unselected population offered routine mid trimester ultrasound screening in europe. Among various cases of atresia/stenosis, the highest detection rate was recorded for duodenal (59%) and anorectal (32%) anomalies. Sensitivity of prenatal ultrasound clearly depends on the type of malformation and the presence of other structural anomalies or chromosomal aberrations. There is also significant variation in detection rates between different european regions reflecting policies, equipment and operators experience. The highest rates of elective top after prenatal ultrasound diagnosis were observed for omphalocele (50 or 36%), and gastroschisis (32 or 30%), and lowest for esophageal atresia (8%).
F28Correlation of saline hysterosonographic and hysteroscopic diagnosis
Authors:   B. Tekin, Hassa H. , Yildrim A. , Şenses T.
Published: March 2003

Objective

To investigate correlation of an office procedure saline sonohysteroscopic analysis with an invasive procedure diagnostic hysteroscopy.

Intervention

Diagnostic analysis of infertile patient in Osmangazi University Reproductive Health Center.

Materials and methods

In Osmangazi University, Reproductive Health Center, saline hysterosonographic analysis of the uterus, as an office procedure is done to all seconder infertile patient and primer infertile patients who have any suspicion to have an uterine anomaly or adhesion. Also if ultrasound examination of the uterus show endometrial thickness more than 5 mm after the end of menstruation saline hysterosonographic analysis (SHG) was performed.

Results

SHG is an easy and speedy method to use in office procedure. There were 38 cases of SHG showing disturbance of uterine cavity; 28 had polyp like lesions, 7 cases of suspected synechia. There were 11 patients who had normal SHG but recurrent pregnancy loss; these patients had normal findings in hysteroscopic analysis. After endoscopic procedures, 7 cases of synechia were verified, 5 cases out of 28 had submucous myomas, the others polyps. Effectiveness of the shg according to the hysteroscopic analysis is thus excellent. Correlation between the two methods, shows us that SHG can replace diagnostic hysterocopic analysis.

Conclusion

In case of doubt, diagnostic analysis of the uterine cavity, can be done by SHG; hysteroscopy is superior to the SHG by its capability of treatment (surgery).
F51Development of power Doppler as a quantifiable tool for assessing fetal perfusion: fractional renal vascular volume
Authors: Welsh A.W. , Eckersley R. , Blomley M. , Cosgrove D. , Fisk N.M.
Published: March 2003

Background

Power Doppler allows the display dynamic range to be increased by up to 10–25dB by coding the amplitude rather than the velocity component of the Doppler frequency shift. Though this means an improvement in image quality, the real advantage of the additional information coded within this signal lies in the potential for quantification of flow (as vascular volume).

Method

Isolated measurements of amplitude do not have meaning unless they can be standardised to remove the effects of machine settings and attenuation. Two important functions are necessary for this: 1. Correction of the nonlinearities of the energy scale bar (purpose‐designed software ‐CQ Analysis, Kinetic Imaging Ltd, Liverpool). 2. Standardisation to a local area of 100% blood flow (the fetal aorta) to define a fractional regional vascular volume. Multiple clips of fetal renal perfusion were stored to mo disk using the Acuson SequoiaTM for offline computer analysis.

Results

150 fetuses were examined (24–40 weeks). Fetal vascular branching could be seen throughout the renal parenchyma in > 80% of fetuses, with clear fluctuations in the fetal cardiac cycle and statistically significant energy values to the aorta and renal parenchyma. Standardising the peripheral volume flow to the aorta gives a fractional vascular volume of approximately 10–20%.

Conclusions

Further work is underway to improve reproducibility of this technique, to develop an accurate index of fetal renal perfusion.

Acknowledgements

Alec Welsh is supported by a Research Training Fellowship from RCOG/WellBeing.
F89Retrospective case control study evaluating the outcome of pregnancy and delivery in patients with myomas
Authors: Sandberg J. , Herbst A. , Andolf E.
Published: March 2003

Background

The aim of the present study was to compare the outcome of pregnancy and delivery of patients with myomas to normal controls.

Method

The cases were found by searching for the diagnosis ‘myoma in pregnancy’ on the ultrasonography data base from the period of August 1992 to November 1999. Cases were followed up in the delivery data base. The control group was matched for age, parity and pregnancy complications.

Results

Seventy cases with the diagnosis were found among 21 925 deliveries giving an incidence of 3.2 per 1000. Seventeen (26.6% of the cases) were delivered by Caesarian section, compared to 22 out of 128 (17.2%) in the matched control group. The difference was not statistically significant. The rate of Caesarian section and maternal age was higher than in the general population. There was no difference in Apgar score between babies delivered from cases and controls. Neither was there any notable difference in the amount of bleeding between the two groups. No mentionable difference could be seen in the length of gestations.

Conclusion

In this study no difference could be seen in the outcome of pregnancy and delivery in cases with myomas. Cases were older and had a higher rate of Caesarian section than the general population.
A correlative study of prenatal ultrasound and post‐mortem findings in fetuses and infants with an abnormal karyotype
Authors: Isaksen C. V. , Eik‐Nes S. H. , Blaas H.‐G. , Torp S. H. , Van Der Hagen C. B. , Ormerod E.
Published: March 2003

Objective

To compare ultrasound and post‐mortem findings in 98 fetuses and infants with an abnormal karyotype.

Design

Criteria for inclusion were an ultrasound examination at the National Center for Fetal Medicine (NCFM), an abnormal karyotype, and an autopsy performed during the period 1985–94.

Results

Trisomy 18 and 21 were the two most common abnormal karyotypes. The highest number of congenital anomalies was observed in cases with trisomy 13 and 18; congenital heart defects (CHD) were most prevalent among fetuses with trisomy 18. In 80% of cases there was full agreement between the ultrasound and autopsy findings; in another 8% of cases there was nearly complete concordance. Thus, in 88% of cases, the main prenatal sonographic diagnosis was correct. In 6% major autopsy findings were not detected by ultrasound examination, in 1% none of the autopsy findings were detected by routine ultrasound and in 5% ultrasound findings were not verified at autopsy. Where the correlation was related to individual autosomal trisomies, structural anomalies were most often correctly diagnosed in fetuses with trisomy 13, with the main diagnosis correct in all cases; second in accuracy were the ultrasound diagnoses in fetuses with trisomy 21 with the main diagnosis correct in 96%; for trisomy 18 the concordance was less good, with the main diagnosis correct in 71%.

Conclusion

The present comparison of sonographic diagnoses with post‐mortem findings demonstrates good accordance between the two methods. It also demonstrates the importance of awareness of the anomalies known to occur with different aneuploidies. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional multiplanar ultrasound for fetal gender assignment: value of the mid‐sagittal plane
Authors: Lev‐Toaff A. S. , Ozhan S. , Pretorius D. , Bega G. , Kurtz A. B. , Kuhlman K.
Published: March 2003

Objective

To evaluate the feasibility and accuracy of fetal gender assignment from three‐dimensional ultrasound (3D US) data at 10–24 weeks' gestation.

Methods

Three‐dimensional ultrasound volume data on 47 fetuses were reviewed and divided into groups: 10–14, 15–18, and 19–24 weeks. Fetal genitalia were studied in axial and sagittal planes for gender assignment, using published criteria. The most valuable plane for assignment was noted. Gender assignment was compared with gender at birth.

Results

Gender assignment was possible in 44 of 47 fetuses; 25 assigned male and 19 female. Between 10 and 14 weeks the mid‐sagittal plane alone was diagnostic for all fetuses. Accuracy of assignment between 11 and 14 weeks was 100%. Between 15 and 18 and 19 to 24 weeks, male assignment was 100% accurate. Female assignment was 100% accurate between 15 and 18 weeks. Accuracy decreased to 60% in the 19 to 24 week group, however, in two of the five cases in which gender was wrongly assigned to be male, the assignment was prospectively considered doubtful due to poor resolution of volume data. Excluding these two cases, accuracy for female assignment in the 19–24 week group was 100%.

Conclusion

Using 3D US, gender assignment was possible in 44 of 47 of fetuses, as early as 11 weeks' gestation. In early gestation, 11–14 weeks, accuracy of male and female gender assignment was 100%. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Use of free‐hand three‐dimensional ultrasound software in the study of the fetal heart
Authors: Guerra F. A. , Isla A. I. , Aguilar R. C. , Fritz E. G.
Published: March 2003

Objective

To propose a new approach to the study of the fetal heart using free‐hand three‐dimensional (3D) ultrasound software.

Methods

We studied a total of 28 fetuses, of which 26 were normal and two were known to have heart pathology. In all of them a B‐mode scan was performed. After obtaining a four‐chamber view, and keeping the transducer in the same position, the free‐hand 3D‐View software was activated. A sequence of frames was stored. Additional information was recorded looking from the four‐chamber view towards the outflow tract, and also adding color Doppler.

Results

We obtained a multiplanar display of one B‐mode and two perpendicular M‐modes in all cases studied. In this multiplanar mode, Y and X axes represent distance and Z axis represents time. We were able to obtain M‐modes and a variation of color‐M‐mode in any desired position. Moving the information along the Z axis, a frame sequence of the B‐mode was obtained. Using this approach we observed one case of fetal supraventricular extrasystoles and other having an interventricular septum defect.

Conclusions

This modality gives a new perspective of fetal heart scanning using the free‐hand 3D‐View software, in which there is benefit from many of the advantages of the 3D software, although the power of this procedure must be improved. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Severe polyhydramnios in twin reversed arterial perfusion sequence: successful management with intrafetal alcohol ablation of acardiac twin and amniodrainage
Authors: Sepulveda W. , Sfeir D. , Reyes M. , Martinez J.
Published: March 2003

We present two cases of twin reversed arterial perfusion (TRAP) sequence complicated by severe polyhydramnios during the second trimester. Both cases were successfully managed at 27 and 26 weeks with ultrasound‐guided intrafetal alcohol ablation of the acardiac twin and amniodrainage. The pump twins were delivered at 35 and 37 weeks, respectively, and both had uneventful postnatal courses. These cases suggest that, in the setting of severe polyhydramnios, prenatal intervention in TRAP sequence could certainly improve the otherwise poor prognosis of the pump twin. Targeting the main intra‐abdominal vessel of the acardiac twin rather than its umbilical cord seems to be a good alternative in the prenatal treatment of these cases. The option of percutaneous intrafetal alcohol injection is widely available and less invasive, simpler and easier to perform than recently advocated endoscopic techniques. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic diagnosis of congenital megalourethra at 13 weeks of gestation
Authors: Lam Y.H. , Tang M.H.Y.
Published: March 2003

Congenital megalourethra is a rare disorder characterized by the congenital absence of the corpus spongiosum and/or corpus cavernosum, leading to dilatation of the urethra. We present a case of congenital megalourethra diagnosed by ultrasound examination at 13 weeks of gestation. Transabdominal and transvaginal sonography showed gross megacystis, bilateral hydronephrosis and a cystic dilatation of the penis. Transabdominal needle embryoscopy confirmed a balloon dilatation of the fetal penis. The pregnancy was terminated by suction curettage. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology