bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

ObjectiveTo 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.DesignPopulation based follow‐up study based on registry data.MaterialSingleton 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).MethodLogistic regression analysis and Kaplan‐Meier survival analysis was used to analyse the association between (GALMP–GABPD) and adverse outcomes of pregnancy.Main outcome measureAdverse 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.ResultThe 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.ConclusionA 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

AbstractObjectivesTo 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 MethodsA 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.ResultsDetermination 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.ConclusionsChorionicity 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

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

AbstractSonography 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.
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.