bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of the hemodynamics of the renal artery of normal fetuses by the color Doppler method
Authors: Iura T. , Higashiyama N. , Miyazaki S. , Ooshima K. , Makinoda S. 
Published: March 2003

Objectives:  Urination interval or the pulsatility index (PI) and resistance index (RI) of the renal artery have often been measured to assess renal function of fetuses in cases such as oligoamnion. However, PI and RI do not reflect dynamic changes of the renal artery not only in fetuses with oligoamnion, etc. but also in normal fetuses. For this reason, we have analyzed the blood flow of the renal artery in normal fetuses using new indexes to clarify its hemodynamics.Study methods:  The healthy fetuses of 33 pregnant women participated in this study with informed consent of mothers in their 20–40th week of pregnancy. The blood flow of the renal arteries was examined at the renal hilum using a color Doppler apparatus using the indexes of PI, RI, maximum velocity (Vmax), mean velocity time (VMT), sectional area of the renal artery (AREA) and renal blood flow (RBF). The gestational age of the fetuses were divided into five groups of 20–24, 25–28, 29–32, 33–36, and 37–40 weeks through longitudinal study. Statistical analysis was performed using Fisher's protected least significant difference.Results:  RI did not show marked changes throughout all gestational age. In contrast, the Vmax and RBF of the renal artery for the 20–24 weeks group were 21.98 cm/s and 0.049 L/min, respectively (mean), and those for the 25–28 weeks group were significantly higher at 27.68 cm/s and 0.003 L/min, respectively (P < 0.05 and 0.05, respectively). The same applied for VMT and AREA. The 95% confidence interval of the Vmax of the right renal artery was 23.2–20.8, 28.7–26.6, 33.7–31.4, 34.6–32.8 and 40.7–37.8 for the 20–24, 25–28, 29–32, 33–36 and 37–40 weeks group, respectively. Thus, we have determined the 95% confidence interval for the Vmax, VMT, AREA and RBF of the renal artery of fetuses in different stages of development.Conclusions:  The present study demonstrated that Vmax, VMT, AREA and RBF were more useful than either PI or RI in assessing the hemodynamics of the renal artery of fetuses in different stages of development. Moreover, we have clarified the normal range of the Vmax, VMT, AREA and RBF for the renal artery of fetuses after the 20th week of gestation. These results are very useful to assess the renal function of fetuses.
Ultrasound time domain and color M‐mode analysis of uterine blood flow in twin pregnancy: prediction of uteroplacental complications, placental insufficiency and intrauterine growth restriction
Authors: Thompson M. O. , Vines K. S. , Harrington K. 
Published: March 2003

Objectives:  A preliminary assessment of the usefulness of a non‐Doppler technique of uterine artery blood flow measurement in twin pregnancy, for the prediction of preeclampsia, utero‐placental insufficiency and intrauterine growth restriction. To compare the results obtained with the contemporary Doppler method.Methods:  A prospective study of 32 twin pregnancies presenting consecutively for a routine second trimester ultrasound scan. Maternal demographic and physical characteristics were recorded in all cases. Using previously described methods, blood flow studies were then conducted using the two different techniques; pulsed color Doppler was used to measure blood flow velocity waveform resistance indices, while a time domain correlation technique with color M‐mode imaging was used to measure blood volume flow in both uterine arteries. The placental site and morphology, uterine artery waveform characteristics, and presence or absence of diastolic notches were recorded. The ultrasound fetal growth measurements were plotted on reference charts to assess individual fetal growth patterns, and the obstetric outcomes were recorded for all the pregnancies. Statistical analysis was performed to assess the predictive value of each method of blood flow measurement for the relevant obstetric complications.Exclusions:  One mother with sickle cell trait (Hb A + S).Results:  An abnormal uterine artery waveform (high resistance with persistence of uterine artery notching) was of limited value in the prediction of pre‐eclampsia and IUGR in twin pregnancies. There was close correlation between a significant reduction in uterine artery blood volume flow and early onset intrauterine growth restriction requiring delivery before 34 weeks gestation. Uterine artery blood volume flow may be less influenced by the placental site compared with traditionally used resistance and pulsatility indices.Conclusions:  Uterine artery notching appears to be of limited value in the direct prediction of growth complications in twins. The volume flow method correctly identified all the pregnancies complicated by early onset intrauterine growth restriction. Both methods may well prove to be complementary in the antenatal management of twin pregnancy although further studies will be required.
Congenital diaphragmatic hernia: prenatal evaluation and outcome
Authors: Masini L. , De Santis M. , Noia G. , Milej B. , Cavaliere A. F. , Romagnoli C. , Perrelli L. , Caruso A. 
Published: March 2003

Objectives:

• To describe the incidence of congenital diaphragmatic hernia (CDH).

• To describe the hernia type (right, left, eventration), the gestational age at diagnosis, the associated anomalies and chromosomal disorders.

• To describe the perinatal outcome and the pre‐ and postoperative mortality rate.

Material and methods:  A total of 51 fetuses and babies with congenital diaphragmatic hernia or eventration (referred to collectively as CDH) were studied at Dept. Obstetrics and Gynecology, Università Cattolica di Roma, in the 20‐year period from 1981 to 2001.Results:  Prenatal diagnosis was made in 48 cases (17 were diagnosed before 26 weeks, 31 between 27 and 40 weeks), two cases were diagnosed in the neonatal period and one case at the postmortem analysis. The most common hernia was left‐sided (38 cases); six cases were right‐sided; four cases had eventration; four cases had complex anomaly with exomphalos and ectopia cordis (suspicious Cantrell's pentalogy). Twenty‐three fetuses had associated anomalies, including four chromosomal disorders (trisomy 18 in two cases, trisomy 13 in one and unbalanced translocation in one). Polyhydramnios was present in 20 fetuses.Perinatal outcome:  Two patients had termination of pregnancy in other institutions; 44 patients delivered (36 cesarean section and 8 vaginal delivery); 2 pregnancies are still ongoing and 3 patients (early diagnosis) have no follow up. Out of the 44 live births, 16 died before surgery and 28 underwent surgical repair. Fifteen early postoperative deaths occurred.Conclusions:  The overall survival in babies with CDH is very poor, despite multidisciplinary management, mainly for associated anomalies. A careful ultrasound survey may suggest which fetuses have an isolated diaphragmatic defect and a better prognosis.
Neonatal renal ultrasound – a 5‐year review in an obstetric hospital
Authors: Acton C. M. , Pahuja M. 
Published: March 2003

Aim:  To review a consecutive series of neonatal renal scans presenting to the imaging department in an obstetric hospital, record the abnormalities seen and assess the accuracy of the antenatal diagnosis with subsequent outcome.Material and methods:  In the 5 years (1996–2000), there were 788 neonates referred for renal ultrasound scans. Many of the infants had a micturating cystourethrogram (MCU) at the time of presentation. The commonest indication in 92% of neonates was fetal pyelectasis reported on the antenatal scan. The hospital records of these infants were reviewed with further details obtained from clinicians and surgeons and subsequent investigations.Results:  The results were classified according to the findings. There were a total of 788 neonates who had a renal scan. There were 592 (75%) in whom the scan was considered normal and of these 49 had an MCU and 17 had associated vesico‐ureteric reflux (VUR) grades 1–4. There were 125 (16%) infants with persisting mild‐moderate pyelectasis/hydronephrosis and of these 61 resolved or were lost to follow up and 64 persisted at follow up scans variably timed 3–15 months later. Most of these had an MCU and 26 had associated VUR grade 1–5, not always on the side of the pyelectasis. Miscellaneous abnormalities were seen in 71 (9%) neonates, multicysticdysplastic kidney 25, pelviureteric junction obstruction (PUJ) 7, solitary kidney 6, crossed renal ectopia 5, uncomplicated duplex kidney 5, ureterocoele 5, two with posterior urethral valves and one with vesico‐ureteric junction obstruction (VUJ). There were four infants with significant VUR, three with thinned renal parenchyma and one with a small kidney. There were three with autosomal recessive polycystic kidney disease (Potter's type II), one with small dysplastic kidneys.Conclusion:  In this review, there were 113 neonates (14%) found to have significant renal anomaly or VUR. Many of the miscellaneous fetal renal abnormalities have a characteristic and identifying appearance on the antenatal ultrasound. The majority of neonatal renal scans are referred because of mild/moderate fetal pyelectasis and many of these resolve over a variable time. Persisting moderate pyelocaliectasis is not a sensitive sign of VUR, nor in differentiating early PUJ obstruction from the normal variant that subsequently resolves. Follow up ultrasound may confirm resolution or increasing hydronephrosis. Nuclear medicine studies will compare function and drainage of the systems in patients with PUJ obstruction.
Long‐term neurological outcome of survivors of twin twin transfusion syndrome (TTTS)
Authors: Cincotta R. B. , Gray P. H. , Rogers Y. M. , Chan F. Y. 
Published: March 2003

Aim:  The aim of this study was to examine the long‐term neurological outcome of survivors of TTTS.Methods:  Survivors of TTTS were followed up in the multidisciplinary Growth and Development Unit in the Mater Children's Hospital. A detailed neurological examination and a neurosensory motor developmental assessment was performed. Cerebral palsy (CP) was diagnosed on the basis of this examination according to standard criteria. A Griffith's developmental assessment was performed by a psychologist. A general quotient (GQ) more than two standard deviations below the mean (GQ < 76) represented global developmental delay (GDD).Results:  There were 39 cases of TTTS delivered at the Mater Mother's Hospital, from January 1994 until June 2000. There were 48 surviving infants (62%), 17 stillbirths (22%), and 13 NND (17%). The mean gestation of delivery was 28.5 weeks (range 19–36). Fifty‐nine percent of cases were treated with amnioreduction whilst the others were delivered prior to treatment. Of the 48 survivors, detailed neurological assessment from 1 to 4 years was available for 35 (73%). An additional four twins were known to have normal long‐term outcomes but formal neuro‐developmental assessment had not been performed and the others had been lost to follow up. Of those with complete assessment, 29 (83%) were normal. There were three (8.6%) cases with CP and three (8.6%) with GDD. Of the three cases with CP, one had a co‐twin that had a FDIU, one had a co‐twin with GDD and the other had a normal co‐twin. The other two cases of GDD had normal co‐twins.Conclusion:  Survivors of TTTS have a significant risk of major neuro‐developmental impairment such as cerebral palsy and global developmental delay. Further research is required to determine what factors contribute to this risk and to develop treatments to minimise the incidence and severity of these handicaps.
Ductus venosus blood flow assessment at 10–16 weeks' gestation and chromosomal abnormalities
Authors: Antolín E. , Comas C. , Echevarría M. , Torrents M. , Muñoz A. , Figueras F. , Cararach M. , Carrera J. M. 
Published: March 2003

Background:  Enlarged fetal nuchal translucency (NT) is a well established ultrasonographic marker for aneuploidy screening, especially during the first trimester of gestation. Nuchal translucency screening combined with maternal age at early mid‐trimester can identify about 75–80% of chromosomal abnormalities with a false–positive rate of 5%. Recently, Doppler parameters have been included in fetal aneuploidy screening, in order to improve the test performance. Changes in the ductus venosus (DV) blood flow velocity waveforms have been reported in a significant proportion of chromosomally abnormal fetuses at first and early mid‐trimester of pregnancy.Objective:  The aim of our study was to evaluate the role of the DV blood flow assessment at 10–16 weeks' gestation in the screening for chromosomal abnormalities.Methods:  From December 1998 to June 2001, DV blood flow was prospectively evaluated in 5067 consecutive pregnancies between 10 and 16 weeks of gestation. Pulsatility index for the DV (DVPI) was calculated. All cases were screened for chromosomal defects combining maternal age and fetal NT thickness.Results:  The average maternal age was 32 years (range 22–47). Seventy‐four percent of the women were younger than 35. The incidence of chromosomal abnormalities was 1.06% (n = 54), including trisomy 21 (n = 25), trisomy 18 (n = 6), trisomy 13 (n = 2) and others (n = 21). The incidence of chromosomal abnormalities was 13.8% in those cases where DVPI was greater than the 95th centile, compared with an incidence of 0.3% in the remaining cases with a DVPI below this cut‐off. This fact gives and odds ratio (OR) of 48 (95% IC: 26–87). The overall detection rate (DR), specificity (S), positive predictive value (PPV) and negative predictive value (NPV) for chromosomal abnormalities were 70.4, 95.3, 13.8, and 99.7%, respectively, when using the 95th centile DVPI as a cut‐off. According to gestational age, all the statistical parameters were increased in early gestational age (10–13 weeks) when comparing with late gestational age (14–16 weeks), the corresponding DR and OR being 76.3% and 64 (95% CI: 30–138) compared with 56.3% and 26 (95% CI: 9–72), respectively. Moreover, when only autosomal trisomies were considered, a DR of 87.9% was reached with an S, PPV, NPV and OR of 95.3, 10.9, and 99.9% and 146 (95% CI: 51–418).Conclusions:  Our results suggest that the evaluation of DVPI at 10–16 weeks' gestation is a useful tool in the screening for chromosomal defects, especially in detecting autosomal trisomies and when it is assessed in early gestational age.
First trimester determination of fetal gender by ultrasound
Authors: Podobnik M. , Podgajski M. 
Published: March 2003

Objective:  To determine the feasibility of correctly identifying fetal gender from 11 to 13 weeks of gestation.Methods:  Fetal gender assessment by ultrasound was prospectively carried out in 425 singleton pregnancies at 11–13 weeks of gestation (confirmed by crown‐rump length or biparietal diameter) immediately before chorionic villus sampling for karyo‐typing. A total of 425 women underwent a detailed assessment of fetal anatomy at 11–13 weeks of gestation by means of transabdominal and transvaginal sonography. Fetal gender was identified in transverse and sagital planes, and was confirmed by chorionic villus sampling.Results:  The accuracy of sex determination increased with gestation from 91.7% at 11 weeks, to 97.2% at 12 weeks and 100% at 13 weeks. Male fetus were wrongly assigned as female in 5.5% of cases in 11 weeks, 2.4% at 12 weeks and 0% at 13 weeks. The accuracy of correctly identifying fetal gender increased with gestational age.Conclusion:  Whilst the accuracy of sonographic determination of fetal gender at 11–13 weeks is good, our decision on invasive testing for sex‐linked conditions should be undertaken only after 12 weeks of gestation.
Sonohysterographic staging of submucous myomas
Authors: Leone F.P.G. , Lanzani C. , Digrandi M. , Padoan A. , Ferrazzi E. , Mastromatteo C. 
Published: March 2003

Purpose:  To assess the diagnostic accuracy of sonohysterography in preoperative assessment of submucous myomas.Methods:  Twenty premenopausal patients with submucous myomas and irregular uterine bleeding and/or infertility were consecutively collected in 12 months. Before surgery, all patients underwent transvaginal sonography (TVS) (Voluson, KRETZ, 5300), with color Doppler evaluation, and sonohysterography (SHG). Number and site of myomas and the myoma–perimetrium distance were considered at TVS. SHG was performed with a 4.7‐mm (14F) intrauterine catheter. Patient compliance to SHG was evaluated by a subjective pain scale. Duration from TVS to completion of the procedure, and volume of saline solution instilled for SHG, were evaluated. Sonographic findings at TVS and SHG were classified as submucous myoma G0, G1 and G2 and compared to hysteroscopic finding. Depending on myoma grading and volume, selected patients underwent preoperative medical treatment with triptorelin (decapeptyl‐ipsen). Hysteroscopic myomectomy was the standard surgical approach. Diagnostic accuracy of TVS and SHG was evaluated.Results:  Mean age was 41 years (interquartile range 34–47). Mean BMI was 24 kg/m2 (interquartile range 21–28). Twelve patients reported irregular bleeding, eight infertility. Eleven patients had additional intramural and or subserous myomas. Mean duration time of SHG was 12 min (interquartile range 9–16). Mean volume of sterile solution instilled for SHG was 16 mL (interquartile range 8–24). In all cases, a successful SHG was performed, with no and mild discomfort in 16 (80%) and 3 (11%) patients, respectively. Hysteroscopic findings were compared to TVS and SHG considering the submucous myoma grading. SHG correctly classified all miomas (five cases of G0, 11 cases of G1, five cases of G2). TVS correctly classified all G0 cases, over classified two G1 cases as G2, correctly classified five cases of G2.Conclusions:  Sonohysterography was a simple and well tolerated imaging technique, with a diagnostic accuracy comparable to hysteroscopy. We speculate that endometrial sampling performed during SHG could help to exclude coexisting endometrial abnormalities which are likely to occur in larger series.
Uterine Doppler evaluation in 12 women with pregnancy‐induced hypertension: correlation with fetal Doppler study and perinatal outcome
Authors: Gómez O. , Del Río M. , Martínez J. M. , Palacio M. , Puerto B. , Cararach V. 
Published: March 2003

Introduction:  Classification of hypertensive disorders of pregnancy is problematic due to variable clinical presentation and confusing terminology. Management is based on severity of clinical and laboratory criteria, which, unfortunately, do not select pregnancies that will be delivered because of maternal or fetal indication.Objective:  To evaluate whether maternal uterine Doppler evaluation correlates with fetal Doppler study and maternal and perinatal results.Design:  Twelve women with pregnancy‐induced hypertension (ISSHP criteria) between 26 and 38 weeks of gestation were divided into two groups based on uterine Doppler examination (presence – group A, or absence – group B, of a bilateral protodiastolic uterine notch) at diagnosis.Results:  There were seven patients in group A (four severe and three mild pre‐eclampsia) and five patients in group B (one severe and one mild pre‐eclampsia, two severe gestational hypertension, one Hellp syndrome). The mean gestational age at delivery (weeks gestation), the mean birth weight (grams) and the mean umbilical artery pH in groups A and B were, respectively, 31.1 vs. 36.1, 1256 vs. 2428, and 7.20 vs. 7.25. Doppler evaluation showed statistically significant higher pulsatility index of the right and left uterine artery, as well as in the umbilical artery, in group A vs. group B. Fetal vascular redistribution or a ductus venosus PI >1 were detected only in group A (5/7 and 3/7, respectively), whereas in none of the group B. Indication for delivery was always for fetal risk (four cases) or maternal risk (three cases) among group A, whereas for maternal indication was only in one case of the group B.Comments:  We suggest that uterine Doppler examination at the time of diagnosis in patients with hypertensive disorders of pregnancy may help to identify pregnancies at serious maternal and fetal risks better than classical clinical and laboratory criteria.
Computerized cardiotocography: correlation between STV > 4 ms and response of fetal cardiac frequency to vibroacoustic stimulation test
Authors: Char Sang Choon , Yamasaki A. A. , Braia G. , Toma O. 
Published: March 2003

Introduction:  In classic cardiotocography, a fetus is considered active when there are two transitory accelerations (TA) or elevation of 20 bpm in cardiac frequency after vibroacoustic stimulation test. In computerized cardiotocography there must an instant variability, also named short‐term variation (STV), higher than 4 ms.Objective:  Comparison between STV > 4 ms and fetal response to acoustic stimulus.Patients and methods:  Twenty‐four normal pregnant were analyzed between 30 and 36 weeks by computerized cardiotocography (SYS 8002). If STV > 4 ms, but TA is absent after 10 min, a vibroacoustic stimulation test was done for 3 s. The fetus was considered reactive when heart rate increased by 20 bpm for 3 min. The fetus was considered hyper‐reactive when heart rate increased less than 20 bpm or duration of response less than 3 min.Results:  Among 24 fetuses, 20 (87%) were considered reactive after vibroacoustic stimulation test (elevation of 20 bpm for 3 min or more). Only four fetuses (13%) were hyperactive.Conclusion:  When STV > 4 ms fetuses are reactive in 87% cases and hyperactive in 13%. The STV can be used as isolated parameter for assessment of fetal well‐being.
Cardiac function in fetuses of poorly controlled pregestational (pre‐existing) diabetic pregnancies
Authors: Wong S.‐F. , Chan F.‐Y. , Cincotta R. , Ward C. 
Published: March 2003

Background:  Cardiac impairment is frequently found in fetuses of diabetic mothers. Poor diabetic control has been implicated as one of the cause for cardiac dysfunction, but it is still controversial.Aim:  To assess the cardiac function in fetuses of well‐controlled and poorly controlled pregestational (pre‐existing) diabetic pregnancy in the third trimester.Methods:  Women with pregestational diabetes (Type 1 and 2) were enrolled at 30–36 weeks. Right‐, left‐ventricular septal wall and interventricular septal wall thickness were measured by M‐mode at end‐diastolic phase. At the mitral and tricuspid valves inflow, the ratio between early ventricular filling and active atrial filling (E/A) at both atrioventricular valves were measured by Doppler echocardiography. Peak velocities of ascending aorta and pulmonary artery were assessed. Angle of isolation was kept at less than 20°. Results from women with poorly controlled diabetes (HbA1c > 6.5%) were compared with those whose diabetes were satisfactorily controlled (HbA1c ≤ 6.5%).Results:  A total of 15 women were included in this study. Six had well‐controlled diabetes and the other seven had poorly controlled diabetes. HbA1c in the poorly controlled group was 7.3% and in the well‐controlled group was 5.4% (P < 0.001). There was no difference between the groups in cardiac size, interventricular septal wall thickness, ejection fraction, aorta and pulmonary artery peak flow velocities. The right atrioventricular E/A ratio was significantly lower among the poorly controlled DM pregnancies (0.71 vs. 0.54; P < 0.05). This reflected an impaired right ventricular compliance in fetuses of poorly controlled diabetic mothers.Conclusion:  Fetuses of poorly controlled diabetic mothers had lower atrioventricular E/A ratio. This may be due to impaired right ventricular compliance.