bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasonographic markers for chromosomal abnormalities in women with negative nuchal translucency and second trimester maternal serum biochemistry
Authors: Verdin S. M. , Whitlow B. J. , Lazanakis M. , Kadir R. A. , Chatzipapas I. , Economides D. L. 
Published: March 2003

AbstractObjectiveTo analyze the value of second trimester ultrasound examination among those women whose fetuses were indicated to be at low risk of chromosomal anomalies on the basis of both first trimester nuchal translucency measurement and second trimester biochemical screening.MethodsA retrospective study of 5500 pregnancies carried out at the fetal medicine unit, Royal Free Hospital. During a period of over 3 years 5500 pregnancies underwent a first trimester scan and nuchal translucency measurement which enabled the detection of 62% (20 of 32) of all chromosomal anomalies. From the remaining pregnancies that underwent second trimester biochemical screening, 3548 were considered negative (risk < 1: 250; using maternal serum free beta human chorionic gonadotrophin and alpha fetoprotein). The ultrasound markers that were examined were: shortened femur length, echogenic bowel, pyelectasis, choroid plexus cysts and echogenic intracardiac foci. The likelihood ratios for chromosomal aneuploides for each of these markers were calculated.ResultsOf the 3548 screen negative pregnancies, 3541 (99.8%) had a normal karyotype. Seven (0.2%) fetuses had an abnormal karyotype including four (0.11%) with trisomy 21, one with trisomy 18 and two with 47XXY. Second trimester ultrasound markers were found in two of the five (40%) with severe chromosomal anomalies compared to 184 of 3541 (5.2%) with normal karyotypes. Detection of one or more ultrasound markers in a screen negative pregnancy increased the possibility of chromosomal aneuploidy and a negative ultrasound decreased the risk by a likelihood ratio of 0.6 (95% confidence interval, 0.3–1.3). The risk was considerably increased when two or more markers were detected and we would recommend karyotyping under these circumstances.ConclusionThis preliminary data indicates a possible role for abnormal ultrasound markers in assessing the risk of chromosomal abnormalities in patients considered to be at low risk by nuchal translucency and serum screening. However analysis of a much larger study group will have to be conducted to assess the significance of individual markers. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal therapy of non‐immunologic hydrops fetalis caused by severe aortic stenosis
Authors: Schmider A. , Henrich W. , Dähnert I. , Dudenhausen J. W. 
Published: March 2003

AbstractCongenital aortic stenosis is a rare cause of congestive heart failure and hydrops fetalis. This report describes a case of prenatally diagnosed critical aortic stenosis and endocardial fibroelastosis leading to a severe hydrops fetalis at 27 weeks of gestation. Successful transplacental digitalization was performed and all signs of hydrops resolved within 2 weeks. The pregnancy continued with normal development of the fetus and birth was induced at 39 weeks of gestation. After an uneventful vaginal birth, the child was transferred for cardiac catheterization, and balloon dilation of the aortic valve was performed successfully. Follow up at the age of 2 years showed only mild left ventricular cardiac hypertrophy, a moderate elevated pressure gradient of 50 mmHg at the aortic valve and mild aortic and mitral regurgitation. No further interventions were necessary at this point. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Fetal echogenic bowel: parameters to be considered in differential diagnosis
Authors: Strocker A.M. , Snijders R.J. , Carlson D.E. , Greene N. , Gregory K.D. , Walla C.A. , Platt L.D. 
Published: March 2003

AbstractObjectivesTo evaluate the extent that associated findings aid in the differential diagnosis and/or prognosis of fetal echogenic bowel.MethodsMedical history, obstetric records and outcome details were examined for 131 consecutive pregnancies with fetal hyperechogenic bowel.ResultsIn 62 (47%) cases, there were no visible anomalies other than hyperechogenic bowel and no evidence of growth restriction. This group included four (7%) pregnancies with Down syndrome, 15 (24%) with infection or a recent episode of influenza and eight (13%) with blood staining of amniotic fluid. In the remaining 69 (53%) cases, hyperechogenic bowel was accompanied by hydrops or nuchal edema (n = 16, 12.2%), growth restriction (n = 9, 6.9%), other markers for chromosome anomalies (n = 33, 25.2%) or multiple structural anomalies (n = 11, 8.4%). In this group, the prevalence of Down syndrome was 12%, infection or influenza was reported in 14 (20%) cases and there was blood staining of amniotic fluid in seven (10%). Cystic fibrosis screening was performed in 65 (50%) pregnancies; the results were negative in all cases and clinical assessment did not indicate cystic fibrosis in any of the 91 infants who were born alive. Maternal serum screening was performed in 41 (31%) pregnancies. High alpha‒fetoprotein levels were associated with multiple abnormalities or severe growth restriction.ConclusionsIn many pregnancies with fetal hyperechogenic bowel, there are multiple factors that may explain these findings. Thus identification of one potential underlying cause should not preclude further testing. Once chromosome defects, cystic fibrosis, structural abnormalities, infection and growth restriction have been excluded, parents can be counseled that the prognosis is good, irrespective of the presence or absence of blood stained amniotic fluid. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The effect of gestational age and placental location on the prediction of pre‐eclampsia by uterine artery Doppler velocimetry in low‐risk nulliparous women
Authors: Antsaklis A. , Daskalakis G. , Tzortzis E. , Michalas S. 
Published: March 2003

AbstractObjectiveTo assess how placental position and gestational age can influence the value of a diastolic notch of the uterine arteries as a screening test for pre‐eclampsia, in a low‐risk population of healthy nulliparous women.MethodsColor Doppler ultrasound was used to examine both uterine arteries in 654 healthy nulliparas at 4‐week intervals between 20 and 32 weeks. The only criterion for an abnormal result was the presence of an early diastolic notch. In each subject the placental position was also recorded. The major end points were pre‐eclampsia and pre‐eclampsia requiring delivery before the 34th week.ResultsNinety‐eight women (15%) had abnormal flow velocity waveforms at their first visit. Twenty‐one out of 654 women developed pre‐eclampsia (3.2%). The sensitivity of the test became lower as gestational age advanced and ranged from 81% at 20 weeks, to 71.4% at 32 weeks. In contrast, the specificity and positive predictive value increased significantly. Eleven out of 12 women who delivered before 34 weeks had abnormal waveforms at the 24th week. In women with a full lateral placenta, the predictive value of the test was extremely low, especially in cases with unilateral notches.ConclusionPre‐eclampsia can be more accurately predicted if, along with the presence of a notch, both gestational age and placental position are taken into account. At week 24 the test maintains a high sensitivity (76.1%), but also has an improved specificity (95.1%) and positive predictive value (34%), which allow the clinician to intervene with a potential preventive treatment. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Twin reversed arterial perfusion sequence in twin‐to‐twin transfusion syndrome after the death of the donor co‐twin in the second trimester
Authors: Gembruch U. , Viski S. , Bagamery K. , Berg C. , Germer U. 
Published: March 2003

AbstractA twin‐to‐twin transfusion syndrome was diagnosed in a monochorionic‐diamniotic pregnancy at 18 weeks' gestation without any malformation, especially heart defect. In spite of the aggressive treatment (serial amnioreduction, digoxin treatment) the donor twin died at 25 weeks and twin reversed arterial perfusion (TRAP) sequence developed and was documented by Doppler ultrasound. In the TRAP‐twin, the route of the reversed blood flow from the umbilical arteries was as follows: descending aorta, aortic arch, ascending aorta, aortic valve, left ventricle, mitral valve, left atrium, foramen ovale, right atrium, inferior vena cava, ductus venosus; and back to the placenta through the umbilical vein. After a 12‐h observation period the twin reversed arterial perfusion sequence disappeared. During this period ultrasound and fetal blood sampling revealed no sign of fetal anemia or disseminated intravascular coagulation in the surviving twin. Based on our observations, we propose, that the death of one of the twins in monochorionic pregnancy can result in twin reversed arterial perfusion sequence, which is an ultimately rare phenomenon in the second trimester. To our knowledge, this is the first reported case of twin reversed arterial perfusion sequence subsequent to the intrauterine demise of one twin in twin‐to‐twin transfusion syndrome in which the TRAP‐twin had no cardiac malformation. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Limitations of using first‐trimester nuchal translucency measurement in routine screening for major congenital heart defects
Authors: Mavrides E. , Cobian‐Sanchez F. , Tekay A. , Moscoso G. , Campbell S. , Thilaganathan B. , Carvalho J. S. 
Published: March 2003

AbstractObjectiveTo evaluate the effectiveness of nuchal translucency (NT) measurement in screening for major congenital heart disease (CHD) in chromosomally normal fetuses.DesignA population based cohort study of all women having fetal NT measurement at 10–14 weeks of gestation in an unselected population over a 3‐year period. The outcome measure was the identification of major CHD in chromosomally normal pregnancies either antenatally or postnatally.ResultsMajor defects of the heart and great arteries were identified in 26 out of 7339 pregnancies (prevalence 3.5 per 1000 pregnancies). Out of 26 cases, only four (sensitivity 15.4%, 95% CI 4–35) were in the group of 258 pregnancies (3.5%) with increased NT of ≥ 2.5 mm. The prevalence of major CHD increased from 3.1 per 1000 for NT < 2.5 mm to 50 per 1000 for NT ≥ 3.5 mm (likelihood ratio of 14.1, 95% CI 4.2–47.9). The positive and negative predictive values for NT ≥ 2.5 mm were 1.6% and 99.7%, respectively.ConclusionsThe prevalence of major CHD in this study was 3.5 per 1000, suggesting that ascertainment of CHD in our study population was thorough. Fetuses with NT measurements ≥ 3.5 mm have a significantly increased risk of major CHD, and this identifies a subgroup of high‐risk patients in whom early fetal echocardiography would be advocated. The low sensitivity of NT for major CHD in the general population, however, indicates that NT cannot be relied on as the sole or major screening tool for this condition as previously reported. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Significance of chromosome 22q11 analysis after detection of an increased first‐trimester nuchal translucency
Authors: Hollis B. , Mavrides E. , Carvalho J. S. , Hill L. , Dickinson V. , Thilaganathan B. 
Published: March 2003

AbstractObjectiveTo determine the value of performing routine fluorescent in situ hybridization (FISH) for microdeletions of chromosome 22q11 when karyotyping fetuses with increased nuchal translucency.DesignThis was a prospective observational study carried out over an 18‐month period. Fetal karyotyping by chorionic villus sampling was offered to 5429 women attending for a routine booking scan in the first trimester when their nuchal translucency adjusted risk for Down syndrome was ≥ 1 in 300. Cytogenetic samples were routinely tested for the 22q11 microdeletion when the nuchal translucency was ≥ 3 mm.ResultsThe prevalence of increased nuchal translucency ≥ 2.5 mm was 180 (3.3%) and ≥ 3.5 mm was 42 (0.8%). None of 75 fetuses with an increased nuchal translucency and normal karyotype demonstrated a 22q11 microdeletion on FISH analysis. In the same cohort, 3 of 20 (15%) cases of major congenital heart defects in which nuchal translucency was measured, had a nuchal translucency measurement ≥ 2.5 mm.ConclusionsRoutine FISH analysis for chromosome 22q11 microdeletions at the time of chorionic villus sampling for increased first‐trimester nuchal translucency is of limited value. As a significant proportion of fetuses with increased nuchal translucency will be found to have congenital heart defects later in the pregnancy, FISH analysis for chromosome 22q11 microdeletions can be targeted to fetuses with specific congenital heart defects. Tissue from the chorionic villus sampling should therefore be stored for subsequent analysis, until after detailed echocardiography is performed. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Fetus in fetu: a rare cause of a neonatal mass
Authors: Nastanski F. , Downey E. C. 
Published: March 2003

AbstractFetus in fetu is an unusual digression from the normal twinning process which often presents as a mass in neonates. Approximately 80 reports have been documented in the literature to date. The increasing use of routine obstetric ultrasound has identified more cases during the antenatal period. This allows more time for both the neonatology team and the parents to develop a coordinated treatment plan for the anticipated child. We report a case of a fetus in fetu which was first seen as a complex cystic mass during antenatal ultrasound at 21 weeks and was confirmed by subsequent imaging and surgical treatment shortly after birth. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Transient hydropic signs in the donor fetus after fetoscopic laser coagulation in severe twin–twin transfusion syndrome: incidence and clinical relevance
Authors: Gratacós E. , Van Schoubroeck D. , Carreras E. , Devlieger R. , Roma E. , Cabero L. , Deprest J. 
Published: March 2003

AbstractObjectiveTo evaluate the incidence, characteristics, and impact on perinatal outcome of the development of hydropic signs in the donor fetus after laser coagulation for severe twin–twin transfusion syndrome in the second trimester.MethodsForty cases of second‐trimester severe twin–twin transfusion underwent fetoscopic laser coagulation of placental anastomoses and were followed up with serial ultrasound up to 14 days after therapy. Ultrasound scans were performed just before, and on days 1, 3, 5 and 14 after therapy, and fetuses were monitored for the presence of hydropic signs (skin edema, pleural effusion, ascites and pericardial effusion). Response to therapy and perinatal outcome in terms of neonatal survival were recorded for all cases.ResultsFour recipients (10%) and three donors (7.5%) died over the first 72 h after therapy. During the study period, two recipients (5.5%) developed frank hydrops fetalis, and eventually died in utero. Ten donors (27.0%) developed one or more hydropic signs. In nine (90%), signs were mild or moderate and transient (mean, 3.2 days), while in one case hydrops worsened and the fetus eventually died. No donors with transient hydrops died in utero, and two died postnatally due to extreme prematurity. Gestational age at procedure and deepest amniotic fluid vertical pocket were similar between hydropic and non‐hydropic donors. Discrepancy in estimated fetal weight at procedure was significantly lower in donors developing hydrops (9.6 (SD, 6.4) vs. 17.8 (14.4)%,P = 0.018). In pregnancies with hydropic donors, gestational age at delivery (33.1 (3.4) vs. 29.7 (3.5) weeks,P = 0.015) and birth weight for recipient (2392 (423) vs. 1631 (576) g, P < 0.001) and donor (1908 (774) vs. 1281 (583) g, P = 0.021) were significantly higher. The development of transient hydrops had no influence on neonatal survival at 28 days nor on the rate of clinical resolution of intertwin transfusion.ConclusionsTransient hydropic signs may develop in a proportion of donor fetuses after laser coagulation for severe twin–twin transfusion syndrome. This phenomenon is normally not associated with a poor prognosis, and possibly indicates an hemodynamic adaptation response following interruption of the transfusion process. Copyright © 2002 ISUOG
Intrapartum fetal head position II: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the second stage of labor
Authors: Sherer D. M. , Miodovnik M. , Bradley K. S. , Langer O. 
Published: March 2003

AbstractObjectiveTo test the null hypothesis that no correlation exists between transvaginal digital examination compared with the gold standard technique of transabdominal suprapubic ultrasound assessment of fetal head position during the second stage of labor. A secondary objective was to compare the performance of attending physicians vs. senior residents in depicting fetal head position by transvaginal digital examination in comparison with ultrasound assessment.MethodsConsecutive patients in the second‐stage of labor at term with normal singleton cephalic‐presenting fetuses and ruptured membranes were included. Transvaginal digital examinations were performed by either attending physicians or senior residents and were followed immediately by transverse suprapubic transabdominal sonographic assessments performed by a single sonographer. Examiners were blinded to each other's findings. Power analysis dictated sample size. Exact binomial confidence intervals around observed rates were compared with χ2 and Cohen's κ‐tests. Logistic regression was applied. P < 0.05 was considered significant throughout.ResultsOne hundred and twelve patients were studied. The absolute error of transvaginal digital examinations was recorded in 65% of patients (95% confidence interval, 56–74%). Parity, pelvic station, combined spinal epidural anesthesia, length of first or second stages of labor, use of oxytocin augmentation, gestational age, mode of delivery, birth weight, and examiner experience did not significantly affect examination accuracy. Stratification, when the transvaginal digital examination was recorded as correct if occurring within ±45° of the ultrasound assessment, reduced the error of the transvaginal digital examinations to 39% (95% confidence interval, 30–49%). Independent variables again did not affect examination accuracy in this assessment modality. Rates of agreement between the two methods for attending physicians compared with residents were not significantly different. The overall degrees of agreement were 40% (95% confidence interval, 26–55%) and 68% (95% confidence interval, 53–80%) (κ = 0.25 and 0.30) for the absolute agreement and ±45° assessment modalities, respectively, for attending physicians, and 31% (95% confidence interval, 20–44%) and 55% (95% confidence interval, 42–68%) (κ = 0.14 and 0.12) for senior residents.ConclusionUsing ultrasound assessment as the gold standard, our data demonstrate a high rate of error (65%) in transvaginal digital determination of fetal head position during the second stage of labor. The performance of senior residents in transvaginal digital examinations did not differ significantly from that of attending physicians. Intrapartum ultrasound increases the accuracy of fetal head position assessment during the second stage of labor. Copyright © 2002 ISUOG
Teaching invasive perinatal procedures: assessment of a high fidelity simulator‐based curriculum
Authors: Pittini R. , Oepkes D. , Macrury K. , Reznick R. , Beyene J. , Windrim R. 
Published: March 2003

AbstractObjectiveLearning curves pose a difficult problem in the teaching of technical skills: how do you teach procedural skills without compromising patients' health? A simulator‐based curriculum has been designed to minimize the risks to patients undergoing amniocentesis by shifting the learning curve away from patients and into the laboratory. This study evaluated the effectiveness of a high‐fidelity simulator‐based curriculum in improving the performance of amniocentesis by obstetric trainees.DesignThirty trainees received a course on the practice of amniocentesis. The curriculum consisted of a lecture, a syllabus, and a hands‐on training session with the simulator. Pre‐ and post‐training performance were evaluated with two rating scales. Training and performance evaluation were completed using the same simulator. The effectiveness of the simulator‐based workshop and the effect of year of training were assessed using a two‐way analysis of variance.ResultsPerformance scores improved from a mean score of 55% to 94% using checklist scoring and from 57% to 88% using global ratings. The two‐way analysis of variance revealed a significant effect of training (F
1,60 = 43.57; P < 0.001) accounting for 45% of the variance in scores, and a significant effect of experience level (F
2,60 = 9.16; P < 0.001) accounting for 25% of the variance in scores.ConclusionsA comprehensive curriculum based on a high‐fidelity simulator was effective at improving skills demonstrated on the simulator. The challenge remains to establish that skills acquired on a simulator are transferable to the clinical setting. Copyright © 2002 ISUOG
Is there a relationship between fetal weight and amniotic fluid index?
Authors: Owen P. , Osman I. , Farrell T. 
Published: March 2003

AbstractObjectiveTo establish whether there is a relationship between the amniotic fluid index and estimated fetal weight in the third trimester. The presence of a relationship would require adjustment of amniotic fluid index to take account of estimated fetal weight with potential improvement in its prediction of adverse perinatal outcomes.MethodsPaired measurements of amniotic fluid index and estimated fetal weight from 274 low‐risk pregnancies enrolled in a longitudinal study of fetal growth. Measurements were made at fortnightly intervals from 30 weeks' gestation until delivery. A relationship between amniotic fluid index and estimated fetal weight was sought at gestational age week intervals of 30–32, 33–35, 36–38 and 39–41.ResultsOne thousand and three pairs of measurements of amniotic fluid index and estimated fetal weight were available for analysis. Mean amniotic fluid index decreased towards term as expected. There was no correlation between amniotic fluid index and estimated fetal weight. Furthermore, there was no correlation between amniotic fluid index and estimated fetal weight at any of the gestational age intervals.ConclusionsThere is no clinically relevant correlation between amniotic fluid index and estimated fetal weight. It should remain clinical practice to take account of gestational age when interpreting amniotic fluid index but it is not necessary to make adjustments for estimated fetal weight. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology