bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sonographic based triage – transvaginal sonography (TVS) and sonohysterography (SHG) – for benign uterine lesions and surgical management
Authors: Leone F. P. G. , Tonta A. , Lanzani C. , Di Grandi M. , Mastromatteo C. 
Published: March 2003

Purpose:  To assess the reduction of clinical indications to hysterectomy as a consequence of sonographic based triage – transvaginal sonography (TVS) and sonohysterography (SHG) – in the surgical management of benign uterine lesions.Methods:  All women undergoing surgery for symptomatic (methrorragia) benign uterine lesions were included. Women with prolapse, cervical lesions and malignant lesions were excluded. Data from 180 and 154 patients treated during 1998–99 (group A) and the year 2000 (group B), respectively, were analyzed.Diagnostic triage:  All patients had complete history collected and pelvic examination performed. Group A. Patients were evaluated by TVS – not mandatory – VABRA curettage and/or D&C and/or diagnostic histeroscopy with biopsy. Group B. All patients were evaluated by TVS and in case of endometrial thickness >4 mm, a SHG was performed to distinguish focal lesions (polyps, myomas, focal hyperplasia) and diffuse lesions (hyperplasia). Theraputic protocol (in group A) was decided in each single case by the medical‐equipe; in group B: patients with focal endocavitary lesions underwent operative hysteroscopy. Patients with diffuse lesions underwent hysteroscopy and endometrial guided biopsy. Indications to abdominal miomectomy were: submucous myomas (G0–G1) > 5 cm, G2 or subserous myomas in women asking to preserve the uterus. Indications to hysterectomy (vaginal/abdominal) were large miometrial lesions non‐responding to medical therapy.Results:  Median age of group A and B patients was not significantly different (46 years, interquartile range 40–56). The frequency of abdominal/vaginal hysterectomy was significantly lower in group B (28%) than in group A (54%) (P < 0.01). Laparotomic myomectomy were not significantly different in the two series (24% vs. 22%). The frequency of operative hysteroscopy was significantly higher group B 63%) than in group A (9%) (P < 0.01).Conclusions:  The introduction of sonographic based triage and therapeutic protocols for benign uterine lesions determined a dramatic reduction of demolitive uterine surgery, even in the same medical equipe. This involves a significant reduction of economic cost and an improvement in health care for the same abnormal conditions.
Ultrasonic fetal and placental tissue characterization and the role of Doppler ultrasound in lung maturity
Authors: Podobnik M. , Podgajski M. , Gebauer B. , Breyer B. 
Published: March 2003

Background:  The aim of this study is to confirm the relationship between the gestational age and quantitative assessment of ultrasonic signs of placental tissue, fetal lungs and liver tissue and to correlate Doppler parameters from main stems of the pulmonary arteries for determining fetal lung maturity in normal pregnancy and pregnancy with pre‐eclampsia and diabetes.Methods:  The placenta, fetal lungs and fetal liver in 300 normal pregnancies, 100 pre‐eclamptic pregnancies and 100 diabetic pregnancy were examined by ultrasound at 30–41 weeks of gestation. The coefficients of variation (the standard deviation divided by the mean value) were used to characterize the tissue in different groups during pregnancy. Doppler velocimetry was performed in the main stems of pulmonary arteries in normal pregnancies and pregnancies with pre‐eclampsia and diabetes.Results:  The coefficients of variation in mature fetuses were greater than 29% for placentas in vivo, greater than 34% for placentas in vitro, greater than 28% for liver tissue and greater than 30% for lung tissue. Placental, lung and liver tissue of diabetic pregnancy tended to have lower coefficients of variation throughout their pregnancies. We found in mature fetuses mean peak systolic velocity higher than 40 cm/s and PI lower than 3.00. In mature fetuses with pre‐eclampsia, we found higher mean peak systolic velocity in compared with normotensive patients.Conclusions:  The coefficient of variation values for placentas in vivo and in vitro, and fetal lungs and liver increase during pregnancy in normal and pre‐eclamptic patients with increasing gestational age and decrease in diabetic patients.
Effect of income on fetal biometry by ultrasound
Authors: Taher M. A. 
Published: March 2003

Objective:  To compare gestational age corrected fetal biometry among rich and poor women.Methods:  An ultrasound database from August 2000 to January 2001 was used for the purpose of this study. One hundred and seventy‐five patients with certain menstrual history were included. Patient's income was assigned based on their report during the initial evaluation. There were 137 rich and 38 poor women. All data were enter into Statistix 7.0 statistical package, and analyzed using appropriate statistical tests. Probability values less than 5% were considered significant.Results:  Multiple regression analysis using a second‐order model for gestational age a S function of fetal biometry, income, and fetal biometry–income interaction did not show income to alter the relationship between gestational age and fetal biometry except for femur lengths. Ninety‐five percent prediction intervals for gestational age did not show clinically significant difference between rich and poor.Conclusion:  There does not appear to be a significant difference in ultrasound measured fetal biometry among different income groups.
Comparison of two methods of cervical stress testing
Authors: Okitsu O. , Niki H. , Mimura T. 
Published: March 2003

Purpose:  Cervical ultrasonography provides useful information on the prediction of preterm delivery. However, the cervix in natural state evaluated by sonography does not always show the predicting signs of preterm delivery. Some insist on the usefulness of the cervical stress testing like transfundal pressure or Valsalva maneuver, which provoke cervical shortening or funneling by increasing intrauterine pressure. Our object was to compare the efficiency of the transfundal pressure with that of the Valsalva maneuver as cervical stress testing.Methods:  Normal pregnant women visiting our outpatient department for routine check up underwent transvaginal ultrasonography. Cervical length was measured and the shape of the internal os were evaluated. When the shape of internal os was flat or mildly depressed, these women were regarded as candidates for the stress testing. First, Valsalva maneuver, second, transfundal pressure were applied. Cervical shortening ratio was calculated in comparison with the natural state, and appearance of funneling was evaluated.Results:  Twenty‐five examinations were performed on 20 pregnant women. The shortening ratio in transfundal pressure was 9.8%, which was greater than that in Valsalva maneuver, 6.5%. However, the number in which cervical length became 25 mm or less was same in each test. On the other hand, funneling was induced in two cases only by transfundal pressure.Conclusion:  Although transfundal pressure seemed better testing than Valsalva maneuver, further examinations is required to conclude which test is superior.
Three‐dimensional ultrasound (3DUS) does not enhance maternal bonding during pregnancy
Authors: Hull A. D. , Pretorius D. H. , James G. , Parry B. , Newton R. 
Published: March 2003

Purpose:  To assess the impact of 3DUS on maternal–fetal bonding during pregnancy.Methods:  A total of 36 primi gravidae were randomized to either 3DUS or conventional two‐dimensional ultrasound (2DUS) at 12 or 24 weeks of gestation. Prior to imaging all subjects were given a structured clinical interview at 12 weeks of gestation. The following instruments were also applied: Parent Bonding Instrument, Beck Depression Inventory (BDI), Maternal Social Support Index, State‐Trait Anxiety Inventory (STAI), and the Maternal Fetal Attachment Scales (MFA). After their scan, all subjects received a ‘best picture’ image of their fetus and a short video tape of their study. The BDI STAI and MFA were re‐administered to all subjects during the second and third trimesters.Results:  A total of 20 subjects underwent 3DUS (10 at 12 weeks, and 10 at 24 weeks) and 16 underwent 2DUS (7 at 12 weeks, and 9 at 24 weeks). No serious psychological disorders were identified at the initial interview. Maternal–fetal bonding, as assessed by the various instruments increased steadily throughout pregnancy in all subjects with a marked increase following quickening. No significant differences (P < 0.001) in objective measures of maternal–fetal bonding were identified between the 3D and 2D groups regardless of gestational age at imaging.Conclusion:  The 3DUS does not appear to increase maternal–fetal bonding during the course of normal primi gravid pregnancy when compared to 2DUS.
Evaluation of color Doppler usefulness in diagnostics of pathological changes in endometrium supported by histological verification
Authors: Stachowiak G. , Jedrzejczyk S. , Pertynski T. , Polac I. , Romanowicz H. 
Published: March 2003

Purpose:  To evaluate in Doppler examinations the frequency of vascularization and its character in individual types of pathological changes within endometrium in postmenopausal women without HRT on the basis of histological verification.Methods:  A total of 327 postmenopausal women were under initial uniform diagnostic algorithm ended in dilatation and curretage or hysteroscopy with uterine sampling for histopathological examination. In all the patients, vaginal sonography, and then color Doppler study was performed. The frequency of vascularization, its character and distribution, resistance and pulsatility indices in uterine arteries and in detected vessels inside pathological changes were estimated.Results:  In all cases, in which in histological results did not show any pathological changes, no intraendometrial flows were detected in Doppler examination. Internal vascularization was found in 69% of patients with submucosal fibroids, in 66% of patients with endometrial polyps, in 37% of patients with endometrial hyperplasia, whereas in 78% of patients with endometrial cancers. In 50% of patients with endometrial hyperplasia regular distributed internal vascularization was found, however, in 66.7% of patients with endometrial cancer ample irregular distribution of vascularization was detected. Doppler flows in arteries detected in pathological changes showed mean lowered PI and RI only in the group with endometrial hyperplasia and no statistically significant changes in the above indices in the groups with other pathological changes. In uterine arteries, statistically significant lowering of both RI and PI in the group with hyperplasia was found as well as in the group with endometrial cancers, whereas statistically significant increased PI were measured in the group with endometrial polyps.Conclusions:  (1) Detection of endometrial flows during color Doppler examination in postmenopausal women without HRT may be a substantial sign of pathology requiring histological verification. (2) Lowering of RI and PI in uterine arteries together with irregular distribution of vascularization inside endometrial echo may be auxiliary elements in sonographic differentiation of endometrial cancers from other pathological changes. (3) Lowered RI and PI both in uterine arteries and arteries inside endometrial echo seem to be characteristic features of endometrial hyperplasia.
Should the three vessels view be the part of routine scanning for congenital heart defects?
Authors: Ioudina E. V. , Medvedev M. V. 
Published: March 2003

Objective:  To estimate the effectiveness of the three vessels view in prenatal diagnosis of congenital heart defects (CHD).Methods:  A total of 44 904 pregnant women of low‐ and high risk for CHD were examined from 16 to 39 weeks and followed throughout their gestation between January 1994 and December 2000.Results:  CHD were diagnosed in 249 cases, 169 (67.9%) were classified as major cardiac anomalies. The overall prevalence of CHD was 5.5‰. Out of 169 cases 130 (76.9%) were detected prenatally including 46 isolated CHD. The detection rate of isolated CHD was 63.9% (46/72). From 1994 to 1996 four chamber view was the only one obligatory plan of heart examination. For the next three years, we used four chamber view in combination with identification of outflow tracts. In 1999 the three vessels view became the standard test in screening program for CHD. The detection rate of CHD increased from 54.2% over the first period of time to 80.4% in 1997–98 and to 87.9% at the end of the study. In 2000, this index run up to 89.4%. The part of missed main vessels malformations decreased from 39% in 1994 to 20% in 2000.Conclusion:  The three vessels view is an easily obtained scan of the fetal heart. This plane can simplify prenatal cardiac examination and appreciably increase the detection rate of CHD. The three vessels view should be an obligatory part of routine scanning for CHD.
Early antenatal diagnosis of cardiac failure using Doppler ultrasound of umbilical artery
Authors: Murta C. G. V. , Moron A. F. , Ávila M. A. P. , Vasques F. A. P. 
Published: March 2003

Background:  During the last 2 years, few prenatal ultrasonographic studies have documented a strong association between abnormal fetal venous return and chromosomal abnormalities. Articles in the English language medical literature were identified through MEDLINE. There is only one report of reverse flow pattern in the umbilical vein in severe intrauterine growth restriction at 29 weeks' gestation. The present case is the earliest documentation of this alteration in fetal venous return.A 30‐year‐old primigravida was referred to our ultrasonography clinic at 12 weeks of gestation. The fetal crown‐rump length (57 mm) was not compatible with menstrual dates. The ultrasound examination showed an increased nuchal translucency (9.1 mm), bilateral pyelectasis, hiperechoic bowel, echogenic intracardic focus and ventricular septal cardiac defect. The fetal heart rate was 147 beats/min. The Doppler examination revealed high retrograde flow in the inferior vena cava, reverse flow in the ductus venosus during atrial contraction and reverse flow in the umbilical vein. Cytogenetic analysis by chorionic villus sampling diagnosed trisomy 9. Ten days later, fetal demise was observed. A non‐mosaic trisomy of chromosome 9 was confirmed on fetal cells' analysis. At autopsy, the characteristics findings were of complete trisomy 9 and the multiple abnormalities detected by ultrasonography were confirmed.Conclusion:  Doppler blood evaluation of the venous return to the heart might provide relevant information on cardiac function. The reverse blood flow in umbilical vein may indicate an impending fetal death. We speculate that the association of abnormal nuchal translucency thickness with alterations of the fetus venous return might be a complementary tool to assess the risk for fetal aneuploidy in the first trimester of pregnancy. In addition, these Doppler velocimetry alterations can be an alarm sign for investigating cardiac abnormalities.
Prenatal diagnosis of cardiosplenic syndromes by fetal echocardiography: a 10‐year experience
Authors: Berg C. T. , Geipel A. A. , Baschat A. A. , Kohl T. , Krapp M. , Germer U. , Gembruch U. 
Published: March 2003

Purpose:  To assess the accuracy of fetal echocardiography in the diagnosis of cardiosplenic syndromes.Methods:  Retrospective survey of 27 fetuses with the pre‐ or postnatal diagnosis of cardiosplenic syndromes in our database over a period of 10 years.Results:  In 24 out of 27 fetuses, the diagnosis of cardiosplenic syndrome was confirmed postpartum. In the remainder, two cases of situs inversus totalis with heart block and multiple cardiac malformations, but no evidence of heterotaxy were diagnosed at autopsy or after birth. In one fetus with situs ambiguus, dextrocardia, bradyarrhythmia and transposition of great arteries (TGA) no autopsy was performed after termination of pregnancy. In 18 fetuses, left atrial isomerism were prenatally diagnosed and confirmed at autopsy or postpartum. Main echocardiographic features were azygos continuation of interrupted inferior caval vein (15), complete atrioventricular septal defect (CAVSD) (11), persistent bradyarrhythmia (11), pulmonary stenosis (PS) (9), ventricular septal defect (VSD) (8), fetal hydrops (8) and dextrocardia (5). Other associated cardiac malformations were l‐TGA (2), double outlet right ventricle (DORV) (3), hypoplastic left ventricle (3), and partial/total anomalous venous connection (1/1). Ten pregnancies were terminated, two fetuses demised in utero, six children survived. In six fetuses, right atrial isomerism was prenatally diagnosed and confirmed postpartum. Echocardiographic features were CAVSD (4), dextrocardia (4), PS (2), l‐TGA (1), azygos continuation of interrupted inferior caval vein (1), fetal hydrops (1), DORV (1) and bradyarrhythmia with cardiomegaly (1). One pregnancy was terminated, two fetuses demised within 10 days postpartum, three children survived.Conclusion:  A combination of CAVSD, first and early second trimester persistent bradyarrhythmia and/or azygos continuation of interrupted inferior caval vein, and/or visceral situs ambiguus should suggest specific diagnosis of cardiosplenic syndrome. The correct diagnosis made in utero allows for maternal counseling and transfer to an appropriate facility prior to delivery for corrective surgery.
Sonographers and sonologists hold favorable views of the role of three‐dimensional ultrasound (3DUS) in obstetrics following a formal lecture on the subject
Authors: Hull A. D. , Pretorius D. H. , Newton R. , James G. 
Published: March 2003

Purpose:  To assess awareness and attitudes towards the use of 3DUS in obstetrics in a group of medical professionals attending a national imaging conference.Methods:  Around 200 subjects attended a 45‐min lecture on 3DUS and obstetrics at a major national meeting. The lecture included slides and multimedia content. Eighty‐eight individuals (68 female and 20 male) completed a self‐administered questionnaire regarding their impressions of the subject following the talk.Results:  No subject had personally undergone 3DUS, however, 78% of women said that they would like to have a 3DUS in a future pregnancy. Sixty‐five percent of men said they would encourage their partner to have a 3DUS in a future pregnancy. Of those who favored 3DUS in a future pregnancy, 54% cited better visualization of fetal anatomy as their main reason for this choice, 12% felt that 3DUS afforded advantages over 2DUS in anomaly detection. Only 5% felt that 3DUS would be more reassuring than 2DUS to them personally. Despite this, 80% of all subjects felt that 3DUS would have a major role in reassurance for lay women carrying a normal fetus in the future. Seventy‐two felt that 3DUS should be more widely available for prenatal diagnosis than at present. 3DUS was felt to offer advantages over 2DUS for anomaly detection by 38% of subjects. The multiplanar capability of 3DUS, production of ‘realistic images’ and ready recognition of fetal structures were cited as reasons for this view.Conclusion:  3DUS used in an obstetric setting appears to have already gained significant levels of acceptance amongst this audience of imaging professionals. Most believe that 3DUS should be more widely available for the evaluation of both normal and abnormal fetuses. The value of 3DUS in the production of readily understandable images of a normal fetus in the reassurance of pregnant women was widely endorsed.
Three‐dimensional sonographic assessment of fetal behavior in the early second trimester of pregnancy
Authors: Kuno A. , Yanagihara T. , Hanaoka U. , Tanaka H. , Hata T. 
Published: March 2003

Objective:  The purpose of our study was to evaluate the fetal behavioral pattern in the early second trimester of pregnancy by use of a specially developed abdominal real‐time three‐dimensional sonography.Methods:  Real‐time three‐dimensional sonographic examinations were performed on 11 normal pregnant women from 14 to 18 weeks of gestation. This imaging system provides continuous three‐dimensional sonographic images every 1–2 s. The fetal movement was monitored for 60 min in each patient, and head, mouth, arm, trunk, and leg movements were evaluated. All fetal behavioral patterns were observed during the period studied.Results:  Active phase (time with fetal movements) was 59.4%, and resting phase 40.6%. The most active fetal behavioral pattern was an arm movement, whereas the least was a mouth movement. Moreover, each fetal movement was synchronized and harmonized with other fetal movements.Conclusions:  Real‐time three‐dimensional sonography provides a novel means on the evaluation of fetal behavior in the early second trimester of pregnancy. These results suggest that real‐time three‐dimensional sonography become an important modality in future early fetal behavior research and in evaluation of fetal well‐being in the second trimester of pregnancy.
Chorionic villus sampling after the first trimester
Authors: Podobnik M. , Podgajski M. , Duic Z. , Ciglar S. 
Published: March 2003

Background:  The purpose of this article was to evaluate the association between late CVS (placental biopsy) and complications between sampling and delivery.Methods:  Late chorionic villus sampling under ultrasound guidance was carried out in 3000 (85.7%) cases in the second trimester and 500 (14.3%) cases in the third trimester of pregnancy. Out of 3500 late CVS, 710 (20.3%) were performed because of suspicious ultrasonographic findings. In the 500 patients between 13 and 16 weeks of gestation color, Doppler was used to investigate the uteroplacental and fetal vessels before and after late chorionic villus sampling.Results:  In 30 patients (0.85%), complications between sampling and delivery were found. There were only 11 (0.31%) spontaneous abortions four to six weeks after late chorionic villus sampling. We found 166 (4.74%) chromosomal abnormalities. In the group with suspicious ultrasonic findings (710 cases), we found significant oligohydramnios in 314 (44.2%) and significant polyhydramnios in 155 (21.8%), and 110 (15.5%) had chromosomal abnormalities. Among the 166 patients with chromosomal abnormalities, ultrasonographic findings in 90 (54.2%) were detected after 20th week of pregnancy. There were no significant differences in mean pulsatility indices between uteroplacental and fetal vessels before and after late chorionic villus sampling. Preliminary data for 25 trisomic fetuses indicate an abnormally increased umbilical PI and abnormally decreased middle cerebral artery PI.Conclusions:  Late CVS is a safe method of prenatal diagnosis for high‐risk couples and does not significantly affect the outcome of pregnancy.