bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wide iliac angle and short limbs. The best marker for Trisomy 21?
Authors: Pritchard G. 
Published: March 2003

Aim:

• To create a standard protocol for measuring the posterior angle of the iliac crests.

• To construct a score based upon the iliac angle and fetal proximal long bone lengths.

• To compare results between fetuses affected by Trisomy 21 and those unaffected.

Methods:  Fetal morphology and biometry including biparietal diameter, humeral length and femur length were assessed between 15 and 23 weeks gestation according to standard protocol. A symmetrical image of the transverse plane of the iliac wings demonstrating the widest angle and the longest length of the iliac bones was recorded. This view was best obtained with the ultrasound beam perpendicular to the long axis of the fetal spine and perpendicular to the skin line, imaged from posteriorly. It can also be obtained from an anterior aspect. The iliac angle was measured from the internal angle at the intersection of tangential lines drawn along the posterior iliac crests.Results:  A total of 2998 fetuses, 30 with Trisomy 21 and 2968 unaffected fetuses (902 had amniocentesis) were assessed. There was a significant difference (16.78° (95% CI 16.694; 16.846)) between the mean iliac angle for Trisomy 21 fetuses (94.33 ± 7.2°) and unaffected fetuses (77.55 ± 8.86°). The total of 90° was selected as cut‐off. The 22 of 30 (83%) Trisomy 21 fetuses and 228 of 2968 (7.7%) unaffected had iliac angle greater than or equal to 90° (sensitivity 83%, specificity 92.3%). A previous study in our unit had shown that short proximal long bones occurred in 41 of 71 (58%) Trisomy 21 fetuses and 609 of 9022 (6.7%) of a low risk unaffected group (unpublished data). Iliac angle greater than or equal to 90° scored one. Short proximal long bones also scored one. A positive index was a score of 2. The 14 of 30 (46.7%) Trisomy 21 fetuses and 29 of 902 (3.2%) known unaffected fetuses had a score of 2. The likelihood ratio for positive limb–iliac index is 14 (46.7/3.2).Conclusions:  In screening for Trisomy 21, the prevalence and likelihood ratio of fetal anomaly (29%, 96), nuchal skin fold (39%, 11), echogenic bowel (20%, 2), renal pelvic dilatation (20%, 4.2), echogenic intracardiac focus (35%, 2.6) and short long bones (58%, 1.9) are known for our population. A positive iliac angle/limb length score has a prevalence of 47% and likelihood ratio of 14. In our population, this combination surpasses the performance of other markers.
The role of thromboelastography in conjunction with second trimester uterine artery Doppler velocimetry in the prediction of adverse pregnancy outcome
Authors: Karidas C. , Anastassopoulos P. , Perry D. , Economides D. L. 
Published: March 2003

Purpose:  A pilot, prospective study to evaluate the use of thromboelastography in conjunction with uterine artery Doppler in the second trimester as predictors of pre‐eclampsia and IUGR (intrauterine growth restriction defined as birth weight below the 5th centile for gestational age).Methods:  Two‐hundred and forty‐nine (249) unselected pregnant women were recruited at their booking appointment in the Royal Free Hospital. They underwent thromboelastography assessment and color flow/pulsed Doppler imaging of both uterine arteries at 20–24 weeks gestation. Standard parameters were measured from each thromboelastography tracing (R, reaction time; K, clot formation time; A, angle; MA, maximum amplitude). The presence or absence of notches in the flow velocity waveform was noted and the resistance index measured. The main outcome measures were pre‐eclampsia and IUGR.Results:  Twenty‐three pregnancies (9.2%) were complicated by IUGR and 10 (4%) by pre‐eclampsia. Assessment using abnormal Doppler velocimetry, defined as bilateral notches/mean RI ≥ 0.55 (27 cases) or unilateral notch/mean RI ≥ 0.65 (5 cases), demonstrated 52% (95% CI 33–71%) sensitivity for IUGR and 40% (CI 17–69%) for pre‐eclampsia with positive predictive values 37.5% (23–55%) and 12.5% (5–28%), respectively. Furthermore, in the pregnancies complicated by an adverse outcome, the groups with normal (14 cases) and abnormal (15 cases) Doppler velocimetry did not differ significantly in any of the thromboelastography parameters (Mann–Whitney test for comparisons).Conclusion:  Pulsed Doppler velocimetry of the uterine arteries in the second trimester is an established predictor of adverse pregnancy outcome. The additional use of thromboelastography assessment does not appear to contribute significantly in providing further information. As this is a pilot study, larger trials are required to delineate its role.
Sonographic examination of puerperal uterus after repeat cesarean section with traditional and Misgav Ladach methods
Authors: Malvasi A. , Totaro P. , Liaci L. , D'Ambrosio M. , Traina V. 
Published: March 2003

Purpose:  In our Department of Obstetrics, where 1600 deliveries are carried out on average every year, cesarean section (c.s.) with Misgav Ladach methods has been practiced since November 1995, for 2078 cases in all. In our study, we have examined sonographically 309 repeat c.s. with Misgav Ladach methods compared to 318 traditional repeat c.s. The aim of our investigation is the sonographic examination of patients with open peritoneum and those with closed peritoneum to discriminate the frequency of bladder flap hematomas and other complications in the two techniques.Methods:  The patients were examined by transvaginal and transabdominal sonography, on the third and 10th postoperative day, to demonstrate the presence of a fluid or mixed mass on the lower‐uterine‐segment (LUS) of 3 cm or more, clean wall, with reinforcement of distal echoes.Results:  It has been observed that, in the group open peritoneum c.s., there were masses of mixed echostructure referring to hematomas on the 12th day in nine cases, while in the group closed visceral peritoneum in 51 cases (P < 0.05). In 39 cases, they were collection on the LUS from 3 to 4.2 cm in six from 4.2 to 5 cm and only in one case it was a lateral collection of 6 cm which did not require surgical treatment anyway. Besides in 22 patients, the bladder‐flap hematoma was associated with puerperal fever (values >38.5 °C). In Misgav Ladach method, only seven women had adhesion of light‐medium importance so that uterine exteriorization was not necessary, and not significant (NS) in comparison with the reference of nine women.Conclusion:  Peritoneum closure in repeat c.s. lengthens operative time and in some cases favors bladder‐flap hematomas which increase postoperative morbidity (P < 0.05), antibiotics use 2.6 and 4.8% (P < 0.01), length of hospital 3 ± 1 vs. 7 ± 2 days staying (P < 0.01) and costs (P < 0.05). In conclusion, follow up has shown no intraperitoneal compare to repeat c.s. with closed and open peritoneum.
Does chorionic villus sampling (CVS) influence fetal growth?
Authors: Larsen T. , Nguyen T. H. 
Published: March 2003

Purpose:  To examine the relationship between CVS and birth weight.Methods:  A cohort of singleton pregnancies with CVS carried out in Denmark (n = 19737) was compared to the total population of singleton pregnancies without AC (amniocentesis) or CVS (n = 873254) for infants born in the years between 1980 and 1996. Exclusion criteria were multiple pregnancies, infants with malformations, chromosomal abnormalities, stillbirths, and death within the first living year. The pregnancies with CVS were grouped according to gestational age (8–12th week of gestation) at the time of CVS, and mean birth weight was calculated for each group. Maternal age, parity and previous abortions were taken into account when comparing mean birth weights. To exclude social status as a confounder, the overall mean birth weight (pregnancies without CVS or AC) was also compared to the mean birth weight of a subgroup of infants (also without CVS or AC) born to women who undergo CVS in some other pregnancy.Results:  The mean birth weight of the CVS cohort was found to be significantly higher than that of the total population and inversely related to the gestational age at CVS.Conclusion:  The invasive procedure seems to stimulate growth. No known potential cofounders can explain the higher birth weight after pregnancies with CVS.
Fetus with osteogenesis imperfecta presenting as increased nuchal translucency thickness in the first trimester: a case report
Authors: Hsieh T.‐C. , Yeh G.‐P. 
Published: March 2003

Background:  Nuchal translucency (NT) has been used successfully in screening for chromosomal abnormalities at 11–14 weeks of gestation. Increased NT thickness is also associated with lots of fetal anomalies in chromosomally normal fetuses. We report a case of osteogenesis imperfecta (OI), type II, presenting with increased NT thickness. A 26‐year‐old Taiwanese woman, gravida 2, para 1, without medical or family history was scanned for confirmation of menstrual gestational age at 13 weeks of gestation. Crown‐rump length was compatible with menstrual age. Increased NT thickness was noted (3.6 mm). Follow up scan 2 weeks later revealed hypomineralization of skull, multiple fractures of long bones and ribs and severe micromelia. A presumptive diagnosis of OI type II was made based on sonographic findings. After counseling, the parents decided to terminate the pregnancy. A stillborn weighing 70 g was delivered after intravaginal misoprostol application. Postmortem radiograph and autopsy confirmed the diagnosis of OI.Discussion:  NT screening for chromosomal and structural abnormalities at 11–14 weeks of gestation was proposed by Nicolaides in the 1990s. It has gained worldwide popularity due to early screening and high detection rate. Distorted and narrow thoracic cage due to rib fractures or altered composition of the extracelluar matrix has been thought to be the possible mechanisms of increased NT thickness in fetuses with OI. In our opinion, the characteristic of hypomineralization in OI enables clear visualization of intracranial structures which may resemble the sonographic features of increased NT thickness in some cases. This finding should prompt the sonographer to measure NT thickness and scan for possible anomalies.
Reduction of complications during first trimester abortion with the use of sonography
Authors: Malvasi A. , Losito A. , Baldini D. , Mudoni A. , Traina V. 
Published: March 2003

Background:  In our reproductive medicine service, more than 3000 abortions have been practised every year, since 1978. The standard operation for legal abortion is executed, according to law 194/78 within 90 days. The technique in voluntary or spontaneous abortion provides D&C as well as hysterosuction with the patients in general anesthesia. In order to reduce the possible complications for this operation and the increasing legal cases, routine perioperative sonography has been used to evaluate sudden abortion complications.Methods:  Besides ordinary preoperative sonography assessing gestational age, evolution of pregnancy, pelvic disease, etc. the use of intraoperative sonography has been shown to be necessary. A permanent team of four operators performs the operation under sonographic guide by using an R–T 36600 General Electric apparatus owned by our medicine service. In a lapse of time of five years, 16804 abortions under sonographic guide were practised and in a retrospective way there was a statistically significant reduction of complications according to literature. The 16118 cases in the previous 5 years and within the two homogeneous groups.Results:  We registered 11 complete and 13 incomplete uterine perforations vs. 4 and 7 (P < 0.01), 18 cases of retention of ovule remainders vs. 6 (P < 0.05), which required hospital readmission for a further examination of uterine cavity. In addition, the group under sonographic guide has shown a lower rate of failures in operations, antibiotics administrations (P < 0.001), endovaginal prostaglandin use (P < 0.005), anesthetics use (P < 0.05) and hospital stay (P < 0.01). If for the 24 previous uterine perforations in 19 cases the operation was delayed (11 ± days later) 13, when intraoperative sonography was used, it occurred only in three cases, for the other patients under sonographic guide, the uterine cavity was completely cleared with no complications at all (P < 0.001).Conclusions:  In our service, as well as according to literature, intraoperative sonography during abortions, led to a great reduction of complications with a better compliance for the patient and a significant reduction of costs. In particular, thanks to the use of sonography, complete and incomplete uterine perforations descreased, in 91% cases under sonographic guide the uterine cavity was emptied with no complications for the patients. Because of the favorable relationship between costs and benefits, the intervention can be performed under sonographic guide.
Transvaginal ultrasound and induced abortion
Authors: Balic A. N. , Balic D. B. , Balic B. , Zukic I. 
Published: March 2003

Background:  The aim of this study was to audit prospectively the value of preabortion ultrasonography.Methods:  All women who came to our center because of doubt unplanned pregnancy in first trimester from March 1994 to July 2001 underwent an exam by vaginal ultrasound before abortion. We analyzed these data and compared them with complications after legal induced abortion.Results:  During 2 years a total of 334 women were surveyed. Fifty‐three women (8.04%) were not pregnant. In 65 cases (9.86%), the pregnancy was greater by 2 weeks than we expected on the basis of last menstrual period. Also we found: 41 (6.22%) myoma uteri, 10 (1.51%) ovarian cysts, 15 (2.27%) multiple pregnancy, 8 (1.21%) anomaly of the uterus, 4 (0.61%) missed abortions and 5 (0.76%) embrionic abnormality (anencephalus, abdominal cyst, nuchal translucency).Conclusion:  Preabortion ultrasonography increases security of this intervention by eliminating some problems linked induced abortion. Since the examination is simple, fast and cheap, we recommended it for routine use. We hope that it is one way for decreasing late complications after abortion, like infertility.
A large pedunculated leiomyoma with unusual features – a case report
Authors: Lee S.‐L. , Tay S.‐K. 
Published: March 2003

Introduction:  Leiomyoma, a benign tumour arising from smooth muscle, is a common finding on gynecological ultrasound examination. It usually presents as a heterogeneous, hypoechoic mass with ill‐defined borders. According to its location, it may be described as submucous, subserosal, and intraligamentous. With the new generation ultrasound units, its perfusion may be mapped with accuracy.Case report:  The patient is a 39‐year‐old lady who was first seen in our department in October 1998. She just had a delivery by cesarean section in August 1998. Her pregnancy was looked after by a different hospital, where she was told to have a fibroid. No follow up was arranged for her after her delivery. When she came to our department, she was complaining of occasional lower abdominal pain. An ultrasound scan that was performed revealed some small intramural and subserous leiomyomata of 1–2.6 cm. A predominantly cystic, loculated mass with an irregular contour was seen in the POD. It had some echogenic components and its measurements were 10.7 cm × 7.5 cm × 11 cm. Power Doppler detected some intratumoral venous flow. Impression was that it was not of ovarian origin. The patient was scheduled for a myomectomy/frozen section for fibroid on 9 November 1998.Histopathology report:  Leiomyomas with edema, hyalinization and infarction.Discussion:  The ultrasonic features in this case are not typical of a leiomyoma. Although cystic degeneration are sometimes seen in myomata, it is usually not so predominant. Although the state‐of‐the‐art ultrasound units, with color and power Doppler facilities, are supposed to be capable of producing very accurate assessment of pelvic masses, it was found to be inadequate in this instance. Firstly, the classification according to its location was not possible as the stalk was not seen, probably as a result of tumor size. Secondly, the blood flow results were not helpful as this is a predominantly cystic mass. Hence, not much useful information could be derived for the planning of the surgery.
Correlation between the umbilical cord cross‐sectional area and fetal anthropometric parameters
Authors: Vasques F. A. P. , Moron A. F. , Murta C. G. V. , Cattini H. , Barbosa M. M. , Gonçalves T. R. , Hisaba W. J. , Carvalho F. H. C. 
Published: March 2003

A prospective cross‐sectional study was developed to determine the correlation between the umbilical cord cross‐sectional (UCCSA) and fetal anthropometric parameters 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 umbilical cord cross‐sectional area were obtained in a plane adjacent to the insertion of the cord in the abdomen, as proposed by Raio et al., 1999, and compared to the biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) by the non‐parametric correlation of Spearman. The inclusion criteria were: (1) singleton pregnancy; (2) gestational week >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 agent the time the ultrasound examination was performed, i.e. the weight below the 10th or above the 90th percentile; (4) abnormal AFI. The patients were examined and included only once. The statistical analysis was performed by the program called Statistical Package for Social Sciences (SPSS) and we used a Toshiba 140 with a transabdominal transducer of 3.5 MHz. Our results showed a strong correlation (Spearman rank = 0.610, significant at the level of P < 0.01) between the UCCSA and the estimated fetal weight by ultrasound examination and also with the fetal anthropometric parameters (UCCSA × BPD = 0.622; UCCSA × HC = 0.617; UCCSA × AC = 0.625; UCCSA × FL = 0.604, all of them significant at the level of P < 0.01). We concluded that the UCCSA is a parameter that can be included at the routine of obstetrical ultrasound examinations.
Does cigarette smoking causes periodic decreases in blood flow to the fetus of mothers with hypertensive disorders and/or impaired fetal growth?
Authors: Lawrie T. A. , Rosier‐van Dünne F. , Norman K. , Odendaal H. J. 
Published: March 2003

Aim:  To evaluate the acute effect of maternal cigarette smoking on umbilical and middle cerebral artery blood flow in the fetus of women with and without pre‐eclampsia and/or intrauterine growth restriction.Methods:  Pregnant women and ≥24 weeks gestation were recruited from the antenatal ward at Tygerberg Hospital, South Africa. Doppler studies of the umbilical and middle cerebral arteries were performed before and at 10, 20 and 30 min after the mother had smoked a cigarette. The same studies were performed in the non‐smoking controls.Results:  There were 13 smoking mothers with hypertension and/or a fetus with growth restriction (group A), 15 non‐smoking mothers with hypertension and/or a growth restricted fetus (group C) and 24 normotensive smoking mothers and an appropriately grown fetus (group B). There was a significant difference in the mean umbilical artery RI and PI values in group A vs. group C (P = 0.03 and 0.004, respectively). There was a significant difference in the mean middle cerebral artery PI between group B and group C (P = 0.004).Conclusions:  Smoking significantly reduces the feto‐placental perfusion in pregnancies compromised by hypertension and/or intrauterine growth restriction and should be actively discouraged in these patients.
Case report: bradycardia in a fetus with trisomy 21
Authors: Cha S. C. , Porto R. 
Published: March 2003

Introduction:  Trisomy 21 is the most common chromosomal abnormality and the risk of delivering a child with this defect increases with maternal age. Diagnosis can only be done by invasive procedures for fetal karyotyping. For parents who choose to avoid such tests, ultrasound scans can help identify markers of aneuploidy such as increased nuchal translucency thickness. However, these screening methods cannot identify all abnormal cases.Case report:  V.L.F.R., 38 years‐old, first pregnancy, had a 1.6‐mm nuchal translucency thickness measurement at 11 weeks and normal anomaly scan at 20 ± 4 weeks. On the basis of these findings, she decided to avoid fetal karyotyping. Scan at 28 weeks showed normal fetal biometry apart from short femur. Fetal sinusal bradycardia (heart rate = 116 bpm) was diagnosed at 33 weeks and repeat computerized fetal heart monitoring from 34 weeks onwards was always normal apart from previously noted fetal bradycardia. Estimated fetal weight was 2.080 g at 35 weeks (below the 10th centile for gestation) but amniotic fluid volume and fetal Doppler studies were normal. Elective cesarean section was carried out at 38 weeks and a male newborn weighing 2.700 g, Apgar score 7‐9‐10 was delivered. Down syndrome was clinically suspected and confirmed by cytogenetic analysis.Discussion:  Some studies have demonstrated that a silent pattern during fetal heart monitoring, with fewer accelerations and more decelerations, is more often found in trisomic fetuses than in normal ones. In this case report, fetal bradycardia was the only abnormal finding. It raises the possibility of considering this as a marker for aneuploidy when fetal biophysical profile and Doppler studies are normal in the third trimester.
Prenatal diagnosis of congenital cardiac tumors: two cases reports
Authors: Rodrigues G. , Castela E. 
Published: March 2003

Introduction:  Congenital cardiac tumors are rare. Among the pediatric population, more than 90% of cardiac neoplasms are histologically benign. However, they have the potential for serious consequences, if not detected in a timely manner, usually because of their conspicuous location. Rhabdomyomas are the most common tumors of both infancy and childhood, occurring in 62% of cases.Case report:  Cardiac rhabdomyomas were diagnosed in two patients at 33 and 34 weeks with support of pediatric cardiology through tele‐medicine. The first patient had multiple tumors, in right atrium, atrial septum, ventricular septum and mitral valve, with variable size and without cardiac arrythmia or stigmata of the tuberous sclerosis. This patient had unilateral ventriculomegaly due to cerebral ischemy probably linked to tumor embolization. The second patient had a single tumor, localized in ventricular septum without other ultrasounds findings. The two patients had not obstructed valvular inflow or outflow.Conclusion:  Prenatal diagnosis of congenital cardiac tumors is possible in the hands of an expert, although it is impossible to make a histological diagnosis in utero, several ultrasonographic criteria, including tumor number, size, location and echogenicity, may help narrow the differential diagnosis. Thrombosis of cerebral venous circulation can occur antenatally. Accurate diagnosis can be made using fetal real time and color Doppler ultrasound. At the date of preparation of this abstract, the pregnancies are in course and delivery is expected in short‐term in a center of pediatric cardiology.