bluuebunny/crossref_metadata_2025_split huggingface dataset:
An audit of invasive prenatal diagnosis for Bart's hydrops
Authors: Tan T. Y. T. , Yeo G. S. H. 
Published: March 2003

Objective:  To audit invasive prenatal diagnosis performed for pregnancies at risk of Bart's hydrops fetalis in KK hospital.Methodology:  This is a retrospective study in a single tertiary center in Singapore. All cases of invasive prenatal diagnosis performed for parents whose pregnancies are at risk of Bart's hydrops fetalis between 16 September 1993–28 November 2000 were traced from the KK invasive procedures register.Results:  A total of 63 invasive prenatal procedures were done (59 chorionic villus sampling and four cordocentesis) for a total of 44 couples. The majority of the carriers had SEA deletions (84 or 95.5%); Thai deletions (2), compound beta and SEA alpha thalassaemia‐1 traits (1), and HbH disease (1) accounted for the rest. The number of invasive prenatal procedures has increased steadily through the years from 3 in 1994 to 13 in 2000. The major indications for the invasive procedures were past history of Bart's hydrops (30) and both parents being known alpha thalassaemia carriers (27). Both parents were identified as carriers at ≤12 weeks in the 1st pregnancy in 12 couples (27.3%), beyond that time but before the development of hydrops in any pregnancies in 13 couples (29.5%), and after the development of hydrops in 19 couples (43.2%). Eighteen Bart's hydrops were diagnosed and most of them were terminated, either by vacuum aspiration within the first 14 weeks (8) or by prostaglandins beyond the first trimester (8). The iatrogenic fetal loss rate for the invasive procedures was 0% in this audit.Conclusion:  Further measures are necessary to increase the proportion of at‐risk couples who are identified as carriers before the first trimester in the first pregnancy to allow early and safe prenatal diagnosis and early terminations of affected pregnancies.
The outcome of antenatally diagnosed talipes equinovarus
Authors: Bakalis S. P. , Sairam S. , Patton M. , Harrington K. , Nicolaides K. , Thilaganathan B. 
Published: March 2003

Aim:  Congenital talipes equinovarus is a relatively poorly studied congenital anomaly with very little information available for parents. The aim of this study is to investigate the natural history and postnatal outcome of fetal talipes detected at 18–23 weeks in a large, unselected obstetric population.Patients and methods:  This is a prospective study of routine antenatal ultrasound screening in an unselected obstetric population, carried out on patients booking at three major London hospitals. Congenital talipes was classified as postural, tetralogic (associated with other congenital abnormalities) and idiopathic. Outcomes measured included termination of pregnancy, stillbirth, aneuploidy, fetal structural abnormality and neonatal death.Results:  The incidence of congenital talipes was 0.11% (111/103,228) in our study population. Of these, 64.9% were live born, 31.5% were terminated, and 3.6% were intrauterine deaths. Talipes was bilateral in 60% of the cases, with an overall male to female ratio of 1.5:1. There were significant differences in the prevalence of tetralogic, idiopathic and postural talipes in the unilateral vs. bilateral talipes groups. The outcome of pregnancy was good in 97% of fetuses with a diagnosis of idiopathic and in 36% of those with tetralogic talipes. Fetuses with a diagnosis of postural talipes were postnatally found to have other abnormalities in 7% of cases.Conclusion:  The outcome of antenatally detected congenital talipes is significantly worse than previously reported. The outcome of pregnancy depends on the laterality of the talipes and the presence of associated features.
The postnatal significance of mild fetal pyelectasis
Authors: Chudleigh T. M. , Chitty L. S. 
Published: March 2003

Purpose:  To determine the incidence of significant renal pathology in fetuses with mild pyelectasis in the second trimester, and to define prognostic criteria with which to identify those fetuses requiring detailed postnatal follow up.Methods:  A prospective, observational, multicenter study of unselected fetuses identified during routine second trimester anomaly screening. Mild pyelectasis was defined as an antero‐posterior diameter of 5–10 mm. All fetuses with unilateral or bilateral pyelectasis identified between 16 and 25 completed weeks of gestation were recruited.Results:  Four hundred and twenty‐five fetuses with mild pyelectasis were recruited from a population of 101600 pregnancies. Dilatation was bilateral in 270 and unilateral in 155 cases. Multicystic or horseshoe kidney was subsequently diagnosed in four cases. Prenatal pyelectasis improved in 90 cases, remained unchanged in 124 cases and deteriorated in 177 cases. One prenatal scan only was performed in 30 cases. Neonatal renal findings were abnormal in 185 cases. Pathological findings were present in 48 cases of which 16 resulted in surgery. The primary diagnosis was obstruction in 15 cases, duplex kidney in 11 and upper tract dilatation in 22 cases leading to surgery in eight, five and three cases, respectively. Significantly, more cases of pathology were present in fetuses where the dilatation increased to 10 mm or greater in the third trimester than in those where it remained unchanged.Conclusions:  Postnatal upper urinary tract dilatation is demonstrated in 43.9% of fetuses with mild second trimester pyelectasis. Urinary tract pathology is present in 11.4% of such fetuses and 3.8% require surgery. All cases with persistent pyelectasis, particularly those with progressive dilatation, should be investigated postnatally.
Accuracy in estimating fetal urinary bladder volume using a modified ultrasound technique
Authors: Fägerquist M. A. , Fägerquist U. O. , Steyskal H. , Odén A. , Blomberg S. G. 
Published: March 2003

Purpose:  The fetal urine production rate can be used as non‐invasive test of fetal well‐being. However, the accuracy of measuring urine production rate by ultrasound depends on the accuracy of volume estimation of the certain bladder image. The aim of this study was to assess the accuracy of measurement of volumes of the bladder using a modified ultrasound technique and digitising the bladder images. Also, it was possible to compare these results with the corresponding findings assessed by conventional ultrasound technique.Methods:  A swaying movement of the ultrasound transducer causes characteristic changes on the screen, which can be utilized for identifying whether or not the ellipsoid configuration of fetal bladder is correctly sectioned along its midline. In this study, 34 unselected pregnant women participated and the gestational ages of the fetuses were between 24 and 40 weeks. The assumption was made of a circular appearance of the bladder in the transversal plane and then the calculation of volume was simplified. We distinguished between different kinds of errors, i.e. technical limitations due to the particular ultrasound machine, errors due to the operators measurement in the selected image of the bladder and errors due to the selection procedure of appropriate image.Results:  The technical limitations and intraoperators errors measuring the volume of the selected bladder image (the ‘frozen’ error) occupied only a minor part of the total variability, whereas the major part consisted of errors was owing to the selection of scan, the ‘freezing’ procedure. Concerning this dominating part the standard deviation of the measurement errors of volume estimation using the modified technique was SD = 0.37892 + 0.04119 × volume, e.g. for 5–40 mL was 11.7–5.1%, respectively. Corresponding standard deviation without this modified technique was SD = 0.36516 + 0.09978 × volume, e.g. SD for 5–40 mL was 17.3–10.9%, respectively.Conclusion:  When estimating the volume of fetal urinary bladder the major part of measurement errors due to the selection of appropriate bladder image. Using a modified technique this error can be reduced.
Endometrial sampling during sonohysterography (SHGes)
Authors: Leone F.P.G. , Lanzani C. , Ciminera N. , Conserva V. , Ferrazzi E. 
Published: March 2003

Purpose:  To assess the diagnostic accuracy of sonohysterography (SHG) and endometrial sampling during SHG (SHGes) compared to traditional hysteroscopy and biopsy.Methods:  Seventy‐two consecutive patients with irregular bleeding and/or intracavitary abnormalities underwent transvaginal sonography (TVS) and SHG. SHG was performed with a 4.7‐mm intrauterine catheter. In all patients, an endometrial biopsy was performed by a syringe vacuum aspiration at the end of SHG. Procedure‐related pain was assessed. Sonographic findings at SHG were defined as normal, focal lesions or diffuse endometrial abnormality. In patients with diffuse endometrial abnormality, hysteroscopy and hysteroscopic guided biopsy were performed. In patients with focal lesions, an operative hysteroscopy was performed. Pathologic report was the gold standard.Results:  Mean age was 48 years (interquartile range 38–54). At SHG, no pain, mild, and severe discomfort was reported by 75, 18 and 7% of patients, respectively. Fifty patients underwent hysteroscopic guided biopsy, 22 operative hysteroscopy. Hysteroscopic findings were compared to SHG–SHGes finding. (A) Benign lesions: in 56 cases SHG and SHG sampling was concordant with pathologic report, in five cases SHG and SHG sampling over diagnosed the endometrial lesion. In five cases, simple hyperplasia was missed by SHG endoemetrial sampling. (B) (pre)Malignant lesions (six cases): in five cases SHG–SHGes was correct. One case of adenocarcinoma was intepreted as atypical hyperplasia at SHG–SHGes. Sensitivity, specificity, positive and negative values of SHG and SHGes for intracavitary abnormalities were 100, 64, 94 and 100%, respectively.Conclusions:  SHG and SHGes should be considered a reliable office triage in the management of patients with intracavitary uterine abnormalities, as adequate as hysteroscopic endometrial biopsies.
Asymptomatic endometrial polyps in postmenopausal women: are they an indication for surgical removal?
Authors: Leone F.P.G. , Lanzani C. , Ferrazzi E. , Conserva V. , Padoan A. 
Published: March 2003

Purpose:  To compare demographic, sonographic, and outcome data of postmenopausal patients with asymptomatic endometrial polyp, surgically treated or not treated.Methods:  Ninety postmenopausal women with sonographic/sonohysterographic diagnosis of asymptomatic endometrial polyp were prospectively enrolled in this study. All patients underwent transvaginal sonography with color Doppler evaluation (Voluson 5300, KRETZ), and sonohysterography in selected cases. Patients were counseled on the risk of malignancy (estimated risk < 1/200). Sonographic follow up at 3, 6 and 12 months was proposed as an option to standard hysteroscopic polipectomy. Surgery was considered in case of bleeding, polyp enlargement, or Doppler PI < 0.6. Demographic and sonographic data of both groups were recorded. Surgical complications in group B patients were considered as abnormal outcome.Results:  Sonographic follow up was chosen by 42 women (group A) and surgical removal by 47 patients (group B). Forty‐three patients underwent operative hysteroscopy, and four patients hysterectomy (group B). One major (uterine perforation not requiring surgery) and three minor complications (two cervical lacerations requiring hemostatic suturing, one false entry) (9%). Demographic (age, years of menopause, blood hypertension/diabetes, BMI, nulligravidity, hormonal replacement therapy assumption, tamoxifen assumption) and sonographic data) Endometrial thickness mean (interquartile range) = 8 (5–10) vs. 11 mm (7–13); volume (cc): 3 (1–4) vs. 4 (1–5); PI: 0.48 (0.44–0.51) vs. 0.49 (0.45–0.53) were not significantly different between group A and B. Pathologic findings were glandulocystic and hyperplastic polyp in 45 and in two patients, respectively. All group A patients remained asymptomatic in the follow up period (mean 10 months, interquartile range 5–16).Conclusions:  Demographic and sonographic data were not significantly different in the two groups. No untreated patient became symptomatic during follow up period. Benign lesions only were found in treated patients, at the cost of one uterine perforation. A large multicentre study is needed to understand the exact prevalence of endometrial cancer in asymptomatic endometrial polyp, and verify the safety of conservative management.
Transit‐time study of an ultrasound contrast agent in benign and malignant adnexal tumors
Authors: Ordén M.‐R. , Jurvelin J. S. , Kirkinen P. P. 
Published: March 2003

Purpose:  To evaluate objectively the effects of a microbubble contrast agent on the power Doppler ultrasonographic examination of adnexal tumors specially focusing in timing of the transit of the microbubble bolus.Methods:  Seventy patients with suspected ovarian tumors were examined pre‐operatively using contrast‐enhanced ultrasonography. A 5 min examination was stored digitally and the behavior of the contrast agent was evaluated objectively by measuring the time‐dependent image intensity at the region of interest with a computer program. A time–intensity curve of each case was derived and analyzed.Results:  Both the baseline and maximum power Doppler intensities as well as the absolute and relative (%) rise in intensity were significantly higher (P < 0.001) in malignant as compared to benign tumors. The arrival time was shorter (17.5 s vs. 22.5 s; P = 0.005) and the wash‐out time longer (219 s vs. 128 s; P = 0.000) in malignant than in benign tumors. A wash‐out time >170 s showed a 91% sensitivity and 75% specificity for the diagnosis of ovarian malignancy, and the accuracy was 78%.Conclusions:  After microbubble contrast agent injection, malignant and benign adnexal lesions behave differently in degree, onset, and duration of Doppler ultrasound enhancement.
Evaluation of placental Doppler velocimetry in pregnancies complicated with oligohydramnios
Authors: Wojcieszyn Michal , Blaszczyk K. , Lukasik A. , Swadzba K. , Stokowacka M. , Poreba R. 
Published: March 2003

Objective:  The objective of the study was to evaluate intraplacental Doppler indices in pregnancies complicated with oligohydramnios.Methods:  Thirty‐six singleton pregnancies between 32 and 39 weeks complicated with oligohydramnios (cases of premature rupture of the membranes and fetal malformations were excluded from the study) and 40 normal pregnancies were examined by real time ultrasonography, color and pulse Doppler. Placental Doppler velocity waveforms were estimated in the placental cord insertion (umbilical artery velocimetry) and in three different pulsatile intraplacental vessels (the mean value). Placental Doppler velocity waveforms analysis was performed on the base of Haberman and Friedman method. The ratios between intraplacental and umbilical artery pulsatility index values were calculated. Fetal well‐being was evaluated by means of non‐stress test analyzed according to Fischer method.Results:  In normal pregnancies group all Doppler velocity waveforms values were between 10 and 90th percentile of the normal for gestational age values based on Doppler indices nomograms, as well as all patients had the normal (<1) intraplacental to umbilical artery pulsatility index ratio. In the group complicated with oligohydramnios in 15 patients abnormal (>1) intraplacental to umbilical pulsatility index ratio were observed (P < 0.05, sensitivity 42%, specificity 100%, positive predictive value 100%, negative predictive value 65%). In that group the results of non‐stress test analysis according to Fisher method were pathological (Fisher <5) significantly more often (P < 0.05).Conclusion:  The results of the study demonstrate, that in pregnancies complicated with oligohydramnios the evaluation of intraplacental to umbilical pulsatility index ratio is a valuable method for estimation the fetoplacental circulation and is an important complement of fetal well‐being assessment.
Intrapartum umbilical artery, fetal aorta and middle cerebral artery Doppler velocimetry as a predictor of poor perinatal outcome in growth retarded fetuses
Authors: Klep N. , Concin H. , Kurjak A. 
Published: March 2003

Background:  The aim of the study was to evaluate the diagnostic prediction of the Doppler waveform analysis during active labor for adverse perinatal outcome in a group at significant risk of intrapartum hypoxia.Materials and methods:  The study population consisted of 33 pregnant women at high‐risk and ultrasonographic diagnosis of IUGR between 28 and 35 weeks of gestation. On the basis of the flow velocity changes in the fetal vessels during pregnancy, patients were divided into two study groups A, with physiological Doppler waveforms (12 women) and B, with pathological Doppler waveforms (21 women). The percentage of the changes of the index values during active labor were correlated with pH values of the blood from the umbilical artery.Results:  In group A, no statistically significant correlation was found. In group B, following was established: high negative correlation between the changes of the index values and pH values of the blood from the umbilical artery: dPAU 24%, r = − 0.531, t = 2.179, P < 0.05. dPIAFD 26%, r = − 0.655, t = 3.0, P < 0.05; dPIACM 10%, r = − 0. 699, t = 3.1, P < 0.01.Conclusions:  The study revealed a significant correlation between the changes of index values of the Doppler waveform analysis during active labor and pH values of the blood from the umbilical artery in the process of intrapartum aggravation of already antepartum from chronic hypoxemia suffering fetuses.
A nomogram for the umbilical cord cross‐sectional area in normal pregnancies
Authors: Vasques F. A. P. , Moron A. F. , Murta C. G. V. , Carvalho F. H. C. , Gonçalves T. R. , Cattini H. , Hisaba W. J. , Barbosa M. M. 
Published: March 2003

A prospective cross‐sectional study was developed in order to determine reference ranges for the umbilical cord cross‐sectional area (UCCSA) during normal pregnancies (patients with known dates of LMP and an ultrasound examination before the 20th week, without any pathologic condition). The measurements of the UCCSA were obtained in a plane adjacent to the insertion of the cord abdomen, as proposed by Raio et al, 1999. The inclusion criteria were: (1) singleton pregnancy, (2) gestation age >20 weeks, (3) intact membranes, (4) normal umbilical Doppler flow velocimetry. The exclusion criteria, in the presence of any of those, were: (1) congenital and/or chromosomal abnormalities; (2) pregnancy complications (any type); (3) inadequate size for gestational age when the examination was performed, i.e. the weight below the 10th percentile or above the 90th; (4) abnormal AFI for the gestational age. The patients were examined and included only once. During the period of the study (February 2000–May 2001), 545 patients were examined, after meeting the inclusion criteria determined for the present study. The age of the patients ranged from 15 to 42 years (mean = 26.7 ± 4.8), 242 patients (44.4%) had two gestations, 135 patients (28.1%) were at their first gestation, 129 patients (23.7%) were at their third gestation and 39 patients had four or more gestations (3.8%). The ultrasound machine used was the Synergy Multi Sync M 500 and the statistical analysis was performed by the program called Statistical Package for Social Sciences (SPSS). Our data were considered normally by the Kolmogorov–Smirnov test and then we figured the nomogram by linear regression analysis. The analysis of variance obtained through the F‐test (value = 356.27) showed that our regression model was significant at the level of P < 0.001, showing that the curve represented well the studied population and that the confidence interval (95%) contained the real value of the UCCSA. The regression equation was: y = − 532.27 + 44.358x − 0.6555x2. We conclude that, there is a progressive increase in the UCCSA up to the 32nd week of gestation, followed by a stabilization until the 34th week and a fall of the values from the 35th week of gestation.
Fetal breathing: a clinically useful paradox
Authors: Hepper P. G. , Shannon A. , Dornan J. C. 
Published: March 2003

Purpose:  To examine fetal breathing movements in fetuses with congenital diaphragmatic hernia and compare this to unaffected fetuses and with their outcome after birth.Methods:  Twenty women with normal singleton pregnancies and four cases of congenital diaphragmatic hernia were studied. All fetuses were observed for 60 min at 36 weeks of gestation. Fetal breathing movements were observed by scan taking a cross‐sectional view across the abdomen. The scan was recorded and breathing movements analyzed off‐line. All sessions occurred at the same time of the day and two hours after a light meal. No patients were cigarette smokers. Bouts of fetal breathing activity were defined as the length in seconds of each series of successive individual breathing movements bracketed by periods of apnea. The absence of fetal breathing movements for more than 3 s was called the apnea period. Total duration of breathing was the sum of all bouts.Results:  The normal fetuses exhibited a breath to breath interval of 1.3 s and displayed breathing movements for around 30–35% of the observation period. Of the four fetuses with congenital diaphragmatic hernia, three died during the neonatal period due to lung hypoplasia, one survived following surgical repair. All four fetuses exhibited a similar breath to breath interval as unaffected fetuses but the three fetuses who died spent 80% (range 70–90%) of the time breathing whereas the fetus that survived spent 32% of its time breathing. Increased yawning was also observed in the fetuses who died.Conclusions:  It has been speculated that the inhibition of fetal breathing movements may result in pulmonary hypoplasia, yet fetuses with lung hypoplasia spend more time breathing than those without lung hypoplasia. The relationship between breathing movements and lung development requires further study. Breathing movements may provide important information on fetal health and outcome.