bluuebunny/crossref_metadata_2025_split huggingface dataset:
P91The influence of maternal exercise on placental blood flow measured by simultaneous multigate spectral Doppler imaging (SM‐SDI)
Authors: Degani S. , Feiner B. , Leibovich Z. , Shapiro I. , Ohel G. 
Published: March 2003

ObjectiveTo evaluate the effect of maternal isometric exercise on the placental blood flow as reflected by the velocimetric indices PI and RI derived from placental arteries.SubjectsThirty‐four healthy women with normal singleton pregnancies between 22 and 35 weeks of gestation.MethodsAll subjects underwent an isometric handgrip exercise test. Maternal blood pressure and heart rate together with placental PI and RI were measured at rest, during the exercise and in the postexercise recovery phase. All Doppler measurements were obtained using the Simultaneous Multigate Spectral Doppler Imaging (SM‐SDI) technique, a new ultrasound modality that enables a Doppler study of multiple locations to take place within a very short time.ResultsThere was a significant increase in the mean values of the maternal blood pressure and heart rate during the exercise, and a significant decline in the recovery phase. There was no significant change in the mean value of the Doppler indices throughout the examination.ConclusionMaternal isometric exercise of a similar degree of effort does not affect the impedance of the placental circulation.
P93Comparison of renal artery blood flow velocity waveform and renal volume in normal and growth‐retarded fetuses
Authors: Lee K. S. , Park M. Y. , Woo B. H. 
Published: March 2003

ObjectiveThe purposes of this study are to evaluate renal artery blood flow velocity waveform and renal volume in growth‐retarded fetuses compared with normal fetuses.MethodDoppler flow velocity waveform of renal artery and renal volume measured by three‐dimensional ultrasonography were obtained in 78 normal fetuses at gestational age from 25 to 39 weeks and 18 cases of IUGR fetuses weighted below the tenth percentile at birth.Results;Fetal renal artery pulsatility index (PI) decreased throughout the gestational period (r = 0.703, p 0.0001). In growth‐retarded fetuses, although all of them had abnormal Doppler velocity waveform of middle cerebral artery, renal pi was not increased significantly. Fetal renal volume increased throughout the gestational period (r = 0.834, p 0.0001). and in growth‐retarded fetuses, renal volume of all was below the fifth percentile of normal fetuses.ConclusionFetal renal volume measured by three‐dimensional ultrasonography may be the helpful parameter in the evaluation of growth‐retarded fetus.
P95Doppler velocimetry in M1 and M2 segments of middle cerebral artery (MCA) in prediction of fetal hypoxia in normal and growth‐restricted fetuses
Authors: Bednarek M. , Dubiel M. , Brêborowicz G. H. 
Published: March 2003

BackgroundThe aim of the study was to evaluate the prognostic value of the examination of PI of two segments of MCA in the prediction of hypoxia in normal and growth‐restricted fetuses.MethodDoppler examination was performed in 98 normal and 64 growth‐restricted fetuses. A combined color coded pulsed Doppler and two‐dimensional real time ultrasound equipment with transabdominal 3.5 MHz transducer was used (Acuson 128XP). A fetal/neonatal hypoxia was defined as: late decelerations during the delivery, Apgar score in 5′ < 7, pH of umbilical artery below 7.15, neonatal respiratory disorders leading to artificial ventilation.ResultsThe prognostic values (sensitivity, specificity, positive and negative predictive values) of PI estimated during 7 days before delivery were as follow: for M1 – 31%, 83%, 67%, 52% and for M2 34%, 88%, 75%, 55%, respectively. Using stronger criteria for the recognition of fetal/neonatal hypoxia (pH and BE of umbilical artery < 7,10 and < − 12 mmol/l, respectively) the prognostic values of PI were as follow: for M1 – 40%, 89%, 70% and 70%; for M2 – 48%, 87%, 69% and 72%, respectively.ConclusionPI of M1 and M2 segments of the MCA seems to be a good predictor of fetal hypoxia during the second half of pregnancy complicated by growth restriction.
P97Elevated maternal midtrimester chorionic gonadotropin is associated with fetal cerebral blood flow redistribution
Authors: Hershkovitz R. , Erez O. , Mankuta D. , Mazor M. 
Published: March 2003

BackgroundElevated midtrimester human chorionic gonadotropin (hCG) is associated with adverse maternal and perinatal outcome. The aims of the study were to evaluate the association between elevated hCG and fetal arterial circulation and to determine the relationship between maternal and perinatal complications and elevated hCG.MethodsPulsatility indices (PI) of middle cerebral artery (MCA) and umbilical artery (UA) were determined prospectively in 72 consecutive patients with abnormal maternal serum hCG (> 2.5 MoM). Each patient had between two to four US scans during pregnancy. Patients with known structural or chromosomal anomalies were excluded from the study.ResultsOut of 72 women with hCG > 2.5 MoM, 48% (35/72) had hCG > 3.5 and 24% (17/72) had. hCG levels > 4.5 MoM. MCA PI was lower in women with hCG > 4.5 MoM between 28 and 36 wks' gestation, but not between 18 and 27 wks' gestation (fig). No differences of MCA PI were found when the cutoff point of hCG was 3.5. PI of the UA was not different between the groups.Women with hCG levels > 4.5 MoM had a higher prevalence of PIH and preeclampsia, preterm deliveries and cesarean sections in comparison to women with hCG < 4.5 MoM. Birthweight was lower and the rate of Apgar score < 7 was higher. No differences were not found with cutoff 3.5MoM.ConclusionsMaternal midtrimester hCG > 4.5 mom is associated with cerebral blood flow redistribution and with higher rates of maternal and perinatal complications in comparison to maternal hCG of 2.5–4.5 MoM.
P98Effects of maternal betamethasone administration on fetal Doppler flow velocity waveforms
Authors: Kaehler C. , Schleußner E. , Möller A. , Möller U. , Seewald H. ‐J. 
Published: March 2003

BackgroundTo investigate the effect of maternal betamethasone administration on fetal arterial, venous and cardiac Doppler flow velocity waveforms.Method Patients: 13 women with singleton pregnancies considered at risk of preterm labour received an intravenous dosis of 2 × 8 mg betamethasone. Study design: Prospective study. Main outcome measures: Doppler studies were performed from the umbilical artery, middle cerebral artery, both uterine arteries, from the ductus venosus, inferior vena cava, right hepatic vein, form the av‐valves, right and left ventricular outflow tract and the ductus arteriosus before and after (30 min, 24, 48 and 72 h) betamethasone administration. Peak systolic velocities and maximum end‐diastolic velocities were recorded. Calculation of the resistance index (RI) for the arterial system, the peak velocity index for veins (PVIV) for the venous system and the E/A ratio for the av‐valves.ResultsNo significant variation was noted in the Doppler measurements before and after betamethasone administration. A slight and reversible increase of the peak systolic velocity of the ductus arteriosus and the right ventricular outflow tract was observed at 30 min after betamethasone administration.ConclusionBetamethasone administration does not cause a significant change of the arterial, venous and intracardiac Doppler flow velocity waveforms in healthy fetuses.
WS16‐03Three‐dimensional‐ultrasound in the assessment of embryonic anatomy
Authors: Blaas H.‐G. K. 
Published: March 2003

Diagnostic ultrasound in the early pregnancy deals with the recognition of normal anatomy and/or the detection of anomalies in very early viable pregnancies. There are clinical situations where the position of the embryo does not allow imaging of the optimal section of a certain organ. This is often the case with the transvaginal approach, where movements of the transducer are limited.Deriving new 2D images by anyplane slicing is an important presentation mode of embryonic 3D ultrasound. Geometric 3D reconstructions can also be helpful for the understanding of the embryonic anatomy. High quality 2D tomograms are the prerequisite of 3D imaging of the tiny embryo and its organs. Such ultrasound tomograms can be achieved by using annular array transducers, which have a thin elevation plane due to symmetric focussing.Examples of multiplane imaging and geometric volume reconstructions in the assessment of the embryonic anatomy will be presented, and the limitations will be discussed.
WS02‐02Management of premature rupture of the membranes by ultrasound
Authors: Rizzo G. , Capponi A. , Angelini E. , Grassi C. , Romanini C. 
Published: March 2003

ObjectiveIn pregnancies complicated by preterm premature rupture of the membranes (pPROM) there are essentially two causes of perinatal death: prematurity and lung hypoplasia. We used ultrasound to try to predict these complications.Design and methodsThe cervical length was measured by transvaginal ultrasound in 167 pregnancies complicated by pPROM < 32 weeks of gestation. Further in 20 pregnancies with pPROM before 24 weeks of gestation peripheral pulmonary artery (PPA) waveforms were recorded by Doppler technique at weekly interval until delivery and the Pulsatility Index (PI) calculated. Pregnancies were managed conservatively according to an Institutional management protocol. The occurrence of preterm delivery and pulmonary hypoplasia was evaluated and related to ultrasound findings.ResultsThe cervical length at admission predicts the time interval elapsing between pPROM and delivery. Significant differences in PI values from PPA were present from 2 weeks onwards the pPROM between the fetuses who developed pulmonary hypoplasia and those with a normal outcome.ConclusionThe measurement of the cervical length and of PPA velocity waveforms may help to establish the risk of developing prematurity and pulmonary hypoplasia in pregnancies complicated by pPROM.
WS18: Breast WS18‐01Ultrasounds of the breast – the role of the gynecologist
Authors: Cosmi E. V. , Cascialli G. L. , Nusiner P. , Meggiorini L. , Patella A. 
Published: March 2003

Early detection of breast cancer is of paramount importance for its management. Therefore, new diagnostic tools are continously searched, including 3D‐US and 3D Power Doppler, and for later management, the study of the sentinel node.3D ultrasonography (3‐D US) may be of value in the differential diagnosis of the following conditions.CystsNot all cysts display a typical US appearance. Small cysts may lack the distal sound enhancement. Inflammatory cysts may exhibit a thickened wall. However, the major problem it the not so rare presence of intracystic echoes, which may be either real or artifactual.FibroadenomasA refraction artifact (edge shadowing) is often noted at each lateral margin of smooth‐marginated fibroadenomas. Contours are irregular in about 25% of cases, and in about 5% shadowing makes it impossible to rule out malignancy.CarcinomasShadowing is associated only with those carcinomas that have a significant amount of fibrosis (< 50% of cases in our experience). Some partial shadowing seen with some carcinomas may also be caused by beam scattering by jagged margins, with 3D scan potentially useful for diagnosis. The sentinel node. Axillary lymph node status is the most important pathological determinant of prognosis in early breast cancer, whereas local axillary lynphadenectomy is the most reliable staging procedure. However, routine axillary dissection does not benefit the majority of patients with early breast cancer who are node‐negative, thereby sustaining the potential morbidity of the procedure. Sentinel node is the first regional node to receive lymph from the breast and accurately represents the metastatic status of the primary cancer. Sentinel node biopsy appears to offer an alternative to routine axillary lymph node dissection for staging patients with breast cancer. (Supported in part my MURST and CNR, Italy)
WS03‐05Ultrasound based simplified infertility investigation
Authors: Granberg S. , Hauge K. , Flo K. , Riedhart M. 
Published: March 2003

ObjectivesTo compare the use a simplified ultrasound based infertility investigation of the infertile couple with the current use of laparoscopy and hysteroscopy.Study designThirty‐three infertile couples underwent transvaginal ultrasound and hystero‐salpingo‐contrast‐sonography. A diagnosis was formulated based on the results of the ultrasound investigations, a semen analysis and endocrine parameters. The following day all subjects underwent a laparoscopic chrompertubation and hysteroscopy by a surgeon unaware of the ultrasound findings. A diagnosis based on the findings at laparoscopy and hysteroscopy, the same semen analysis and endocrine parameters, was then made. The two diagnoses were compared.ResultsA 90.9% agreement was found between the diagnoses made from the two methods used. When considering laparoscopic diagnosis the Gold Standard of tubal patency, the sensitivity to diagnose occluded tubes using hystero‐contrast‐sonography was 92.8%. The corresponding figures for specificity, PPV and NPV were 96.2%, 92.8% and 98.1%, respectively.ConclusionsA simple, ultrasound based approach to investigate the infertile couple, can be used effectively as an initial examination modality during the couple's work‐up. However, there is a need for a larger study to confirm these results.
WS01‐02Color Doppler in the diagnosis of fetal malformations
Authors: Margulies N. D. 
Published: March 2003

The color and Power Doppler gives us the opportunity to investigate the vascular anatomy as an angiography and furthermore lets us ‘see’ hydro jets. This singular ability leads us to make some diagnosis and confirm others.During this lecture we will show our experience in the diagnosis of some fetal anomalies such as renal agenesis, urachal cysts, megacystis microcolon Hypoperistalsis syndrome, renal displasia, Galeno vein aneurysm, anterior wall defects such as omphalocele and gastroschisis, diaphragmatic hernia, duodenal atresia, coartation of the aorta, single umbilical artery Dandy Walker Malformation, and some fetal tumors.
WS06‐06A novel sonographic approach to the fetal echocardiogram
Authors: Bronshtein M. 
Published: March 2003

At present there are four concepts guiding the sonographic examination of the fetal heart: (1) the fetal echocardiogram (FEC) is difficult to perform and time‐consuming, (2) FEC should be performed only in high risk pregnancies, (3) the optimal time to perform FEC is 18–22 weeks gestation, (4) FEC relies on several sonographic still views. In our lecture, we will present a new systemic ‘video’ approach to the great vessels and the four chambers in early pregnancy using transvaginal sonography.Transvaginal ultrasound examination of the cardiovascular system was performed in 36 323 consecutive fetuses using a dynamic ‘video’ multidirectional approach. Cardiovascular anomalies were detected in 173 fetuses giving an overall incidence of 1 in 210 pregnancies and 1 in 238 low‐risk pregnancies. Fifty‐six percent of the fetuses had associated anomalies. The prenatal diagnosis was confirmed in 90 cases. In 10 fetuses a different cardiac anomaly was observed. In four fetuses the cardiovascular anomaly was not detected in early pregnancy. In the remaining cases, postmortem examination was not performed. Early fetal heart examination is suggested in all pregnancies.ConclusionsFetal ECC should be performed: (a) transvaginally, (b) in early pregnancy (14–16 weeks), (c) in every pregnancy , (d) using the video multidirectional approach.
WS06‐09Prenatal detection of congenital heart disease: the need for a cost‐effectiveness analysis
Authors: Paladini D. , Teodoro A. , Lamberti A. , Arienzo M. , Martinelli P. 
Published: March 2003

BackgroundRecent reports have shown a significantly improved survival for complex congenital heart disease (CHD) when detected antenatally. This has further substantiated the need to detect CHD in utero. Since the performance of the 4‐chamber view as a screening tool is rather insufficient, the issue is now to find more effective and not too expensive alternative methods to reach this aim.MethodThe cost‐effectiveness analysis (CEA) is an efficient method to assess health outcomes and resource costs of health interventions. We have applied this tool to prenatal detection of CHD, comparing 3 models: (1) 4‐chamber view at level I; (2) outflow tracts at level I; (3) Outflow tracts at level II. To perform the analysis we have made the following assumptions: (1) the incidence of CHD at 20 weeks is 10/1000; (2) the percentage of severe CHD is 40%; (3) the monthly salary are 2500 USD and 3500 USD for level I and level II operators, respectively; (4) detection rate for CHD detectable on the 4‐chamber view and on outflows only are 35%/20%, 60%/60%, and 90%/90% for the three options (level I 4‐chamber, level I outflows, level II outflows).Results and conclusionsBased on the forementioned assumptions, the costs for (1) a diagnosis of CHD; (2) a diagnosis of severe CHD; (3) TOP of any CHD; TOP of a severe CHD are reported below. These results, which were also submitted to sensitivity analyses, will be discussed.

Costs

Outcome
Level I 4‐ch.
Level I  Outflows
Level II  Outflows

Det. Any CHD
1796 USD
1157 USD
324 USD

Det Severe CHD
6510 USD
2894 USD
810 USD

TOP Any CHD
5314 USD
2893 USD
810 USD

TOP Severe CHD
9300 USD
4133 USD
1157 USD
WS08‐02Three‐level view (TLV) of fetal brain imaging in the prenatal diagnosis of congenital anomalies
Authors: Goldstein I. , Reece E. 
Published: March 2003

The purpose of this study was to determine whether a systematic stream‐lined approach could be routinely used in the evaluation of the fetal intracranal anatomy, and which could be used to effectively and efficiently exclude all major intracranial malformation.Three planes were determined to be independent without overlay. Following the establishment of these three independent oblique planes across the intracranial anatomy, there were applied clinically to determine whether such planes would be sufficient to diagnose the major intracranial abnormalities.After retrospectively examining the various imaging levels taken, it was independently determined that three levels of intracranial imaging provided the greatest anatomic view of the entire fetal brain: the lateral ventricular level (Level I); the medial‐thalamic level (Level II); and the inferior‐posterior fossa view (Level III).We examined 131 cases of intracranial abnormalities that were prenatally diagnosed between 14 and 24 weeks gestation. One investigator was given the three‐level view protocol to determine if the anomalies could be identified using this system. It was determined that, of the 131 abnormal cases, 126 (96.2%) were diagnosed using Levels I, II or III, independently or in combination. There were no false‐positive test results.The present study investigated the efficacy of a three level view (TLV) imaging of the fetal brain representing a complete 2‐D examination. We found this approach to be applicable throughout pregnancy and suitable for visualization of normal intracranial structures as well as the identification of abnormalities.
WS08‐03Prenatal diagnosis of congenital and acquired brain abnormality
Authors: Pooh R. K. 
Published: March 2003

The intrauterine development of the central nervous system (CNS) is one of the most interesting fields in perinatology. The brain has three‐dimensional structure and rapidly changes its appearance during pregnancy. Therefore, the fetal brain should be evaluated three‐dimensionally with consideration of gestational age.Sonoembryology has been established by high‐frequency transvaginal sonography. Premature brain structure and ventricular system of early fetuses can be clearly demonstrated and prenatal diagnosis of congenital anomalies has been done earlier and earlier. Application of transvaginal approach to the fetal brain in the second and third trimesters has enabled brain imaging from fetal parietal direction through fontanelles and cranial sutures, and ‘neurosonography’ has been established. Recent introduction of 3D ultrasound in neurosonography produced skull imaging, serial parallel images of the brain structure, volume extraction of target organ and brain circulatory images. Furthermore, advanced technology of magnetic resonance imaging (MRI) can demonstrate CNS morphology including the brain stem, which is not clearly depicted by sonography. By using all those technologies, prenatal diagnosis of CNS abnormalities has been more objective and accurate. Intracranial changes in cases with CNS anomalies have been objectively demonstrated in vivo. Furthermore, intrauterine acquired brain damage such as periventricular leukomalacia, which is one of the controversial issues in perinatology, has been proven by sonography in a few cases. Further case studies will be required for investigation of CNS pathology in utero.
WS01‐05Genitourinary anomalies – is there anything new?
Authors: Meizner I. 
Published: March 2003

BackgroundUltrasound malformations of the fetal genitourinary tract are well documented in the sonographic literature. However, we would like to report on some specific observations. These will include a survey of fetal pelvic kidneys, an association between single umbilical artery (SUA) and absence of one of the kidneys, and the ‘Tulip sign’– an ultrasonic marker for severe penoscrotal hypospadias.MethodAll records of patients with ectopic kidneys over a 5‐year period (1995–99) have been perused. Sonographic parameters of ectopic kidney have been evaluated.The same was done for cases of SUA and agenesis of one kidney and for cases with severe penoscrotal hypospadias.ResultsPelvic kidney was diagnosed prenatally in 35 cases, of which, bilateral pelvic kidney was detected in 2 cases. There was no predilection for fetal gender, and no tendency to side of appearance. Most cases were diagnosed in late 2nd trimester of pregnancy. The association of SUA and absent kidney was detected in 6 cases. In all cases the diagnosis was made in the 2nd trimester of pregnancy. In 6 cases, the specific ‘Tulip sign’ was detected prenatally and proven postnatally.ConclusionsUnique presentations of renal anomalies can be detected prenatally. Pelvic kidney is easily dealt with, however, the association of SUA and absent kidney requires further evaluation of the fetus to exclude the VATER association. The ‘Tulip sign’ is helpful in diagnosing severe hypospadias.
WS08‐06Fetal hemodynamics, hypoxia index and brain damage
Authors: Salihagić A. , Jugović D. , Tumbri J. , Latin V. , Kos M. , Kurjak A. , Arbeille P. H. 
Published: March 2003

ObjectiveTo estimate the value of a new vascular score, hypoxia index (HI), in prediction of functional and/or structural brain lesions caused by fetal hypoxia and to examine the relationship between this index, Doppler cerebral‐umbilical ratio (C/U) and neonatal neurosonography in growth retarded and hypoxia fetuses.Study designIn the prospective study 41 growth retarded fetuses were included from 29 to 40 weeks of gestation. Flow velocity waveforms the umbilical and middle cerebral arteries were recorded each other day, at least two weeks. The C/U ratio and HI were calculated. After the birth, obstetric parameters and ultrasound of neonatal brain were used as outcome parameters.ResultsDoppler C/U ratio < 1 as well as HI > 150 were associated with poor perinatal outcome. The neonatal brain damage was detected in 16 growth‐retarded and hypoxic fetuses. Hypoxia index had greater statistic significance in the prediction of neonatal brain lesions. Also, specificity and sensitivity of HI was better than the last value of C/U ratio measured before delivery.ConclusionsThe C/U ratio and HI represent the best indicators for early detecting and assessment of fetal hypoxia. Furthermore, they may also be parameters for the prediction of poor neurological outcome in pregnancies with growth retardation. So, the use of HI would represent a significant advance in prevention of hypoxic brain lesions, which are one of the most frequent causes of perinatal morbidity and mortality.