bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intrauterine lethality of trisomy 21 fetuses with increased nuchal translucency thickness
Authors: Hyett J. A. , Sebire N. J. , Snijders R. J. M. , Nicolaides K. H. 
Published: March 2003

AbstractThis study investigates whether first‐trimester screening for trisomy 21 by fetal nuchal translucency thickness preferentially identifies those fetuses destined to die in utero and examines the potential impact of such a method of screening on the live birth incidence of trisomy 21. In 70 pregnancies, trisomy 21 was diagnosed at 12 (range 1l–l4) weeks of gestation and the parents opted for elective termination which was carried out at 14 (12–20) weeks. In all cases, viability was established by ultrasound scan at the time of chorion villus sampling (CVS) and just before termination of pregnancy. Eight (11.4%) fetuses died in the interval between CVS and termination of pregnancy and this rate of lethality was higher than the 6.9% estimated rate for an unselected population of trisomy 21 fetuses. This 4.5% increase may, in part, be attributed to the effects of CVS and may also be due to patient selection on the basis of increased nuchal translucency. The rate of lethality increased with translucency thickness from 5.3% for those with translucency of 1–3 mm to 23.5% for translucency of > 7 mm. In trisomy 21, the rate of Intrauterine lethality is associated with nuchal translucency thickness. Nevertheless, a policy of screening by maternal age and fetal nuchal translucency followed by selective termination of affected fetuses would still result in a more than 70% reduction in the live birth incidence of trisomy 21. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic endometrial thickness: a useful test to predict atrophy in patients with postmenopausal bleeding. An Italian multicenter study
Authors: Ferrazzi E. , Torri V. , Trio D. , Zannoni E. , Filiberto S. , Dordoni D. 
Published: March 2003

AbstractEighteen centers took part in this prospective study into which 930 eligible patients were recruited. The selection criteria for admission were atypical bleeding after at least 6 months of postmenopausal amenorrhea, and absence of hormonal therapies for at least 6 months. The sonographic measurement of the maximum bi‐endometrial thickness was made in a longitudinal plane. Sonographic measurements were always performed within 3 days prior to histological evaluation.In these patients the mean number of years from menopause (25–75th centile) was 6 (range 2–l6). The prevalence of endometrial carcinoma was 11.5% and the prevalence of atrophy was 49.2%. The area under the receiver operator characteristic curves generated by sonographic thickness measurements reached the level of 85%, both for cancer and atrophy. The likelihood ratio for cancer, yielded by an endometrial thickness of ≤ 4.0 mm, was 0.05, and for atrophy it was 7.1. This cut‐off of > 4.0 mm yielded a sensitivity for the detection of cancer of 98% and a negative predictive value of 99%. The overall sensitivity and positive predictive value for atrophy achieved by this cut‐off were 57.2% and 87.3%, respectively. A multivariate logistic model showed that age and body mass index were independent variables associated with a significantly higher risk of endometrial cancer. The post‐test probabilities for cancer and atrophy were recalculated on the basis of the integration of age, body mass index and endometrial thickness. The estimated reduction of invasive procedures on the basis of this integration was 31%.Transvaginal sonographic measurement of endometrial thickness, integrated with individual risk factors, can help in the management of postmenopausal patients with atypical bleeding, with regard to either the need for histological evaluation in high risk cases, or the choice of possible expectant management. We have shown that an endometrial thickness of ≤ 4.0 mm safely predicts endometrial atrophy and justifies expectant management when the patient understands the need for proper follow up. This could be achieved with a reduction in the use of invasive procedures without unwonted delay in cancer diagnosis. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Venous circulation in the maternal lower limb: a Doppler study with the Valsalva maneuver
Authors: Palmgren J , Kirkinen P. 
Published: March 2003

AbstractIn order to evaluate the normal physiology of the maternal venous circulation, Doppler examinations of the venous system in the right inferior extremity and suprainguinal part of the common femoral vein were carried out in 38 healthy pregnant women, in 12 non‐pregnant controls and in 16 women at early puerperium. Examinations were carried out when the mother was lying in a left semi‐recumbent supine position. Blood flow velocities in the suprainguinal femoral and deep femoral veins decreased significantly in the first trimester and were almost normalized by the third postpartum day. Continuous forward venous flow with respiratory fluctuation was maintained in the femoral veins over the whole gestational period. The response to the Valsalva maneuver was similar in the pregnant and non‐pregnant women. Our findings provide evidence that the venous valvular system and wall distensibility in the femoral area and the inferior extremity are in vivo not greatly changed in pregnancy. A more important reason for decreased velocities is probably the pregnancy‐associated decrease of the arterial input to this area. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Absence of significant hemodynamic changes in the fetus following maternal betamethasone administration
Authors: Cohlen B. J. , Stigter R. H. , Derks J. B. , Mulder E. J. H. , Visser G. H. A. 
Published: March 2003

AbstractMaternal betamethasone administration causes a transient but considerable reduction in fetal body and breathing movements and in fetal heart rate variation. The aim of the present prospective study was to investigate whether there is evidence of circulatory changes in fetal, placental or uterine arteries, consistent with hypoxemia. Eighteen women at risk for preterm delivery received betamethasone to enhance fetal lung maturation. Doppler studies were performed before treatment, and 24 and 72 h after the second dose of betamethasone. Blood flow velocity waveforms were obtained from both uterine arteries, umbilical arteries, fetal descending aorta, fetal renal artery, and fetal cerebral arteries. No significant changes occurred in the pulsatility index of any of these blood vessels, suggesting that the transient reduction in fetal heart rate variation and fetal body and maternal betamethasone through fetal bypoxemia. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Incorporating sonographic cheek‐to‐cheek diameter, biparietal diameter and abdominal circumference improves weight estimation in the macrosomic fetus
Authors: Abramowicz J. S. , Robischon K. , Cox C. 
Published: March 2003

AbstractThe objective of this study was to improve the accuracy of sonographic fetal weight estimation in macrosomic (> 4000 g) fetuses by combining the cheek‐to‐cheek diameter (CCD), an indicator of subcutaneous tissue mass, with the biparietal diameter (BPD) and abdominal circumference (AC) in generating a new weight formula.Three hundred well‐dated, uncomplicated singleton pregnancies > 32 weeks' gestational age (GA) were analyzed. Sonographic fetal measurements obtained in every case included BPD, head circumference, AC, femur length and CCD. Sonographic estimation of fetal weight (EFW) was derived by using BPD and AC. Actual birth weights (BW) of fetuses delivered within 7 days of the last sonographic examination and weighing over 1500 g (n = 123) were compared to EFW. A formula was derived by correlating BPD, AC and CCD with BW in these 123 fetuses using multiple regression analysis. A second formula was derived from the data of 39 macrosomic fetuses. The two formulae were then tested for accuracy of prediction of fetal weight in 157 other fetuses delivered within 7 days and grouped by birth weight, 44 of them weighing > 4000 g.The new formula for macrosomic fetuses was: EFW (g) = 1065 + 84.5 BPD (cm) + 41.29 AC (cm) + 111.0 CCD (cm). In the macrosomic fetuses, a difference of < 10% between EFW and BW was demonstrated in 72.7% by the BPD‐AC formula and 95.5% when incorporating CCD. In this group, the mean percentage error was significantly smaller: 4.14 vs. 7.97% (p = 0.0005). In the regression analysis, the contributions of BPD, AC and CCD to the variance in BW were 5.5%, 16%, and 18.3%, respectively (p = 0.008). In the non‐macrosomic fetuses, CCD improved prediction of BW, but the trend did not reach statistical significance.Our results demonstrate that, in the macrosomic fetus, CCD explains more of the variance in BW than other parameters and incorporating it in the sonographic weight estimation greatly improves its accuracy. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Cerebro—costo—mandibular syndrome: early sonographic prenatal diagnosis
Authors: Ibba R. M. , Corda A. , Zoppi M. A. , Floris M. , Todde P. , Monni G. 
Published: March 2003

AbstractIn this case report the sonographic appearance of cerebro—costo—mandibular syndrome is described. Increased fetal nuchal translucency (at 11 weeks), micrognathia (at 12 weeks) and failure of ultrasound to identify the ribs (at 18 weeks) were revealed with serial scanning. These cardinal findings allowed the prenatal diagnosis of cerebro—costo—mandibular syndrome to be made at 18 weeks' gestation. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Does a prenatal diagnosis of congenital heart disease alter short‐term outcome?
Authors: Copel J. A. , Tan A. S. A. , Kleinman C. S. 
Published: March 2003

AbstractCongenital heart disease (CHD) is the most common fatal congenital anomaly in the first year after birth. Fetal echocardiography has become accepted as a method of diagnosing CHD in utero, but the benefits of prenatal diagnosis have not been evaluated.We performed a cohort analysis of neonates with CHD in the absence of other life‐threatening conditions. One group (I) consisted of neonates who had been diagnosed as fetuses to have CHD and who were delivered at Yale‐New Haven Hospital. The other group (II) consisted of neonates who were not diagnosed to have CHD until after birth, and were either delivered at, or transferred to, the same hospital. Costs of initial hospitalization, length of hospitalization, and survival to discharge home with the parents were primary outcome measures. Our primary hypothesis was that all outcome measures would be improved by prenatal diagnosis. We also examined secondary hypotheses that these same measures would be improved among selected subgroups, including those requiring univentricular management, those amenable to biventricular repair, those with ductal dependent lesions, and those requiring any surgery during the primary admission.From January 1, 1991 to June 30, 1996 we identified 45 antenatal cases and 54 postnatal cases of CHD that met the study entry criteria. The median length (± SE) of initial hospitalization was 16 ± 3.8 days in group I, and 11 ± 3.8 days in group II (p < 0.08). The median cost of initial hospitalization was $57 678 ± 12 340 vs. $53 604 ± 7249 (not significant). Eighty percent of group I survived to hospital discharge compared with 67% of group II (p = 0.14). There was no difference in survival among those requiring univentricular management (64 vs. 44%), but costs and length of hospitalization were greater in group I, regardless of whether or not surgery was performed post‐natally. Surgery was undertaken more often among the prenatal diagnosis group with univentricular hearts (86 vs. 56%, p < 0.05). Among those fetuses amenable to biventricular repair, survival was better (96 vs. 76%, p < 0.05) and the cost of hospitalization was lower ($30 277 ± 16 869 vs. $64 616 ± 9441, p = 0.06) in the prenatal diagnosis group.Prenatal diagnosis of CHD does not result in the expected savings in cost, length of hospitalization or survival in the overall group of patients. The prenatal diagnosis group showed a skew towards single ventricle physiology. Within that group a high rate of pregnancy termination results in a group of parents who are likely to choose postnatal surgery despite high short‐ and long‐term mortality risks. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Successful thoracoamniotic shunting using a double‐flower catheter in a case of fetal cystic adenomatoid malformation associated with hydrops and polyhydramnios
Authors: Ryo E. , Okai T. , Namba S. , Okagaki R. , Kikuchi A. , Kozuma S. , Yoshikawa H. , Taketani Y. 
Published: March 2003

AbstractWe describe a case of congenital cystic adenomatoid mal‐formation treated by thoracoamniotic shunting using a double‐flower catheter. An ultrasound examination at 25 weeks' gestation revealed a cystic mass within the fetal thoracic cavity, hydrops and polyhydramnios. Thoracoamniotic shunting under ultrasound guidance using a double‐flower catheter was performed at 27 weeks. The procedure not only decompressed the lung cyst but also improved the secondary physiological changes, i.e. mediastinal shift, hydrops and polyhydramnios. A 2438‐g male neonate was delivered at 37 weeks with no respiratory problems and resection of the right lower pulmonary lobe was successfully performed 24 h after birth. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis and perinatal management of a lingual lymphangioma
Authors: Paladini D. , Morra T. , Guida F. , Lamberti A. , Martinelli P. 
Published: March 2003

AbstractWe describe the prenatal ultrasonographic features that led to the diagnosis of a lingual lymphangioma. The risk of upper airway obstruction, which is associated with this rare abnormality, prompted us to plan careful perinatal management. We believe that, in cases of suspected lymphangioma of the tongue or other oropharyngeal tumors, elective delivery should be carried out in a tertiary referral center in which emergency ventilation and tracheostomy are possible. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Doppler echocardiography of the main stems of the pulmonary arteries in the normal human fetus
Authors: Chaoui R. , Taddei F. , Rizzo G. , Bast C. , Lenz F. , Bollmann R. 
Published: March 2003

AbstractThe objective of this study was to describe the normal blood flow velocity waveforms in the main branches of the right and left pulmonary arteries in the human fetus and to establish reference ranges for different Doppler parameters during the second half of pregnancy. Cross‐sectional data were collected from 86 healthy human singleton fetuses between 18 and 38 weeks of gestation. With advancing gestation a significant increase (p < 0.001) in the peak systolic velocity, time averaged velocity and time velocity integral was observed. The pulsatility index decreased significantly (p < 0.05) in the same period, suggesting a decrease in the pulmonary arterial vascular resistance. The acceleration time (AT) and the ratio of AT to ejection time (AT/ET), described in postnatal cardiology as having an inverse correlation with mean arterial pressure, increased significantly (p < 0.001). This is possibly the result of decreased pulmonary arterial pressure.The data show that Doppler examination of blood flow in the main stem of both the right and the left pulmonary arteries of the fetus is feasible, and increases insight into the lung perfusion of the human fetus. The observed changes throughout gestation are in accordance with animal experiments showing an increase in perfusion as well as a decrease in the vascular resistance and pressure. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Maternal middle cerebral artery velocity changes in HELLP syndrome versus pre‐eclampsia
Authors: Williams K. P. , Wilson S. 
Published: March 2003

AbstractOur objective was to determine whether there is a difference in middle cerebral artery blood flow velocity in patients with the syndrome of hemolysis, elevated liver enzymes and low platelet counts (HELLP syndrome) compared to a matched controlled group of patients with pre‐eclampsia and without HELLP syndrome.Six pre‐eclamptic patients with HELLP syndrome and 12 pre‐eclamptic women without HELLP syndrome had maternal middle cerebral artery blood flow velocity assessed antepartum and at 24 and 48 h postpartum. We compared the effect of the development of HELLP syndrome on middle cerebral artery blood flow velocity changes using non‐parametric tests.Patients with HELLP syndrome showed no significant differences in diastolic, systolic, mean middle cerebral artery blood flow velocity or pulsatility index in either the antepartum or 24‐h and 48‐h postpartum phases when compared to non‐HELLP pre‐eclamptic patients. Our data suggest that there is no difference in the blood flow velocity waveform of the maternal middle cerebral artery between patients with pre‐eclampsia and those with HELLP syndrome. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Defects and syndromes in chromosomally normal fetuses with increased nuchal translucency thickness at 10–14 weeks of gestation
Authors: Souka A. P. , Snijders R. J. M. , Novakov A. , Soares W. , Nicolaides K. H. 
Published: March 2003

AbstractIncreased fetal nuchal translucency thickness at 10–14 weeks of gestation is a common phenotypic expression of fetal chromosomal defects, structural abnormalities and genetic syndromes. This study reports on the prevalence of structural abnormalities and genetic syndromes in 4116 chromosomally normal pregnancies with increased fetal nuchal translucency thickness and reviews the relevant literature. In fetuses with increased nuchal translucency thickness, the prevalence of major cardiac defects, diaphragmatic hernia, exomphalos, body stalk anomaly and fetal akinesia deformation sequence is substantially higher than expected in the general population. In addition, there may be an association between increased nuchal translucency thickness and a wide range of rare skeletal dysplasias and genetic syndromes that are usually found in less than one in 10 000 pregnancies; however, the number of affected cases, both in the present and in previous series of fetuses with increased nuchal translucency thickness, is too small for definite conclusions to be drawn. The rates of miscarriage and perinatal death increase, whereas the rate of survival and the prevalence of live births with no obvious abnormalities decrease with increasing nuchal translucency thickness. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Fetal hepatosplenomegaly: an isolated sonographic sign of trisomy 21 in a case of myeloproliferative disorder
Authors: Hartung J. , Chaoui R. , Wauer R. , Bollmann R. 
Published: March 2003

AbstractEnlargement of the fetal liver and spleen as well as oligo‐hydramnios were the only pathological sonographic signs detected in a pregnant woman presenting because of decreased fetal movements at 31 weeks' gestation. Doppler examination of fetal vessels revealed pathological values (absent or reversed flow in the umbilical artery, centralization of fetal circulation). No hydrops development or any further malformations were seen. The association of pathological Doppler findings with hepatosplenomegaly roused the suspicion of fetal infection. The infant had to be delivered because of deterioration of fetal heart rate patterns 2 days later. The newborn had Down's syndrome and the confirmed hepatosplenomegaly was found to be due to a transient myeloproliferative disorder with severe leukocytosis and predominance of immature blast forms. Hematological parameters normalized without specific therapy within 3 weeks.Although transient leukemic reactions have been diagnosed prenatally in cases of Down's syndrome associated with non‐immune hydrops, to our knowledge this is the first reported case of isolated hepatosplenomegaly visualized by prenatal ultrasound as a sign of trisomy 21. The presence of fetal hepatosplenomegaly has to be taken into consideration as a possible marker for trisomy 21 and not only for infectious or metabolic diseases. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonographic markers of tubal inflammatory disease
Authors: Timor‐Tritsch I. E. , Lerner J. P. , Monteagudo A. , Murphy K. E. , Heller D. S. 
Published: March 2003

AbstractObjectivesSince the introduction of transvaginal sonography (TVS), clear pictures of the female reproductive tract have been obtained. These images enable the accurate description of Fallopian tube pathology. However, the current literature on the ultrasound diagnosis of pelvic inflammatory disease (PID) is confusing and contradictory. The goal of our study was to identify sonographic markers of inflammatory disease of the pelvis and to place these in a clinical context.Patients and methodsSeventy‐seven patients were scanned by TVS. They were divided into two groups, according to their clinical picture, the first group with acute PID and the second with a history of chronic PID or no history at all. The sonographic markers studied were shape, wall structure and wall thickness of the Fallopian tube. Ovarian involvement and the presence of pelvic fluid were also evaluated.ResultsThe best marker of tubal inflammatory disease, either acute or chronic, was the presence of an incomplete septum of the tubal wall, which was present in 92% of the total cases. A thick wall and the ‘cogwheel’ sign were sensitive markers of acute disease, whereas a thin wall and ‘beads‐on‐a‐string’ sign were indicators of chronic disease. Palpable findings and surgical history were not discriminatory, but were present in three‐quarters and one‐third of the study population, respectively. Three false‐positive cases are presented: an ovarian cystadenoma, an appendiceal mucocele and one case with periovarian fluid accumulation.ConclusionsThe tubo–ovarian complex and the tubo–ovarian abscess should be considered separate entities that differ in their clinical implications. TVS allows one to distinguish between them. Distinguishing characteristics of acute and chronic salpingitis are presented. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology