bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prenatal diagnosis of the Cerebro‐Oculo‐Facio‐Skeletal (COFS) syndrome
Authors: Paladini D. , D'Armiento M. , Ardovino I. , Martinelli P. 
Published: March 2003

AbstractBackgroundThe Cerebro‐Ocular‐Facio‐Skeletal (COFS) syndrome is an autosomal recessive condition characterized by neurogenic arthrogryposis, severe facial anomalies and brain maldevelopment. We describe here the first case of prenatal diagnosis of this syndrome in a 21‐week fetus.CaseThe woman was referred to our unit on suspicion of fetal microphthalmia. On trans‐abdominal ultrasound, severe bilateral microphthalmia was confirmed. Micrognathia, multiple joint contractures and rockerbottom feet were also detected. On the basis of these findings, the diagnosis of COFS syndrome was hypothesized. After termination of pregnancy, necropsy confirmed all prenatal findings. Histology showed severe architectural derangement of the eye and brain together with cerebellar anomalies compatible with the diagnosis of COFS syndrome.ConclusionsTo the best of our knowledge, this represents the first case of prenatal diagnosis of COFS syndrome. This case demonstrates the feasibility of such a diagnosis by ultrasound and identifies the malformations already present and detectable at mid‐gestation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Doppler evaluation of the uterine and spiral arteries from different sampling sites and phases of the menstrual cycle during controlled ovarian hyperstimulation
Authors: Hsieh Y.‐Y. , Chang F. C.‐C. , Tsai H.‐D. 
Published: March 2003

AbstractObjectiveTo compare the pulsatility index (PI) and resistance index (RI) at different sampling sites of the uterine and spiral arteries in the early and mid‐menstrual phases.Materials and methodsThe uterine and spiral arteries of 110 women undergoing similar ovarian hyperstimulation and intra‐uterine insemination regimes were examined using transvaginal color Doppler ultrasound. The uterine artery was sampled at five sites: (1) ascending branch; (2) descending branch; (3) proximal, near branch division; (4) mid, 0.5 cm distal to the division; (5) lateral location, 1 cm distal to the division. The spiral artery was sampled at three sites: (a) anterior; (b) fundal; (c) posterior. The uterine and spiral arteries were examined twice, on days 2–3 and 14–16, respectively, of the menstrual cycle. The women were also grouped according to age at examination, ≤ 30 years and > 30 years. The PI and RI values for different sites, menstrual phase, and age were compared.ResultsThe mean PI and RI values of the uterine artery were: (1) 2.86 ± 1.20 and 0.92 ± 0.13; (2) 2.66 ± 1.15 and 0.89 ± 0.12; (3) 2.88 ± 1.26 and 0.90 ± 0.15; (4) 3.03 ± 1.02 and 0.91 ± 0.07; (5) 3.23 ± 1.38 and 0.89 ± 0.12; and of the spiral artery were (a) 1.61 ± 1.01 and 0.69 ± 0.17; (b) 1.69 ± 0.74 and 0.74 ± 0.17; (c) 1.73 ± 0.86 and 0.68 ± 0.17. The PI values for uterine and spiral arteries at two phases of the menstrual cycle were 2.92 ± 1.18 and 1.55 ± 0.72 (days 2–3); 3.11 ± 1.15 and 1.80 ± 1.02 (days 14–16), respectively; for younger women (age ≤ 30 years) these values were 2.83 ± 1.22 and 1.6 ± 0.85 and for older women (age > 30 years) 3.0 ± 1.34 and 1.72 ± 0.96, respectively.ConclusionsThere were no significant differences in PI and RI values of the uterine and spiral arteries at different sampling sites, phase of the menstrual cycle or age. The higher PI values tended to occur in the lateral uterine artery and posterior spiral artery, during the mid‐menstrual phase and in the older age group. The PI and RI values of the mid‐uterine and fundal spiral artery sampling sites are representative of the whole uterine artery and spiral artery, respectively. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
A case of body stalk anomaly at 10 weeks of gestation
Authors: Paul C. , Zosmer N. , Jurkovic D. , Nicolaides K. 
Published: March 2003

AbstractWe describe a case of body stalk anomaly which was diagnosed at 10 weeks of gestation on a dating scan. The fetus was visualized within the exocelomic cavity outside an apparently intact amniotic membrane. The fetus displayed multiple anomalies characteristic of body stalk syndrome including a skull and brain defect, abdominal wall defect, kyphoscoliosis and gross deformities of the lower limbs. These findings do not support early amniotic membrane rupture as the primary event in the pathogenesis of body stalk anomaly and indicate that the exocelomic location of the fetus may actually be one of the features of this complex developmental anomaly. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Umbilical vein blood flow in fetuses with normal and lean umbilical cord
Authors: Di Naro E. , Ghezzi F. , Raio L. , Franchi M. , D'Addario V. , Lanzillotti G. , Schneider H. 
Published: March 2003

AbstractObjectiveTo evaluate whether umbilical vascular coiling is correlated with the umbilical vein blood flow profile and to investigate if this is different between fetuses with a lean and those with a normal umbilical cord.MethodsConsecutive women with a singleton gestation who delivered at term and who underwent an ultrasound examination within 24 h from delivery were studied. Umbilical cord and vessel areas were calculated. Umbilical vein blood flow parameters were obtained by digital color Doppler velocity profile integration. After delivery, the umbilical coiling index was calculated.ResultsOne hundred and sixteen women were studied. Twelve (10.3%) had a lean umbilical cord (area < 10th centile). A significant correlation was found between the umbilical coiling index and the umbilical vein blood flow (r = 0.67, P < 0.001). A significant difference between fetuses with and without a lean cord was found in terms of: umbilical coiling index (0.18 ± 0.08 vs. 0.29 ± 0.09, P < 0.005), cord area (87.6 ± 5.1 mm2 vs. 200.6 ± 34.6 mm2, P < 0.001), Wharton's jelly amount (25.7 ± 10.3 mm2 vs. 122.1 ± 33.4 mm2, P < 0.001), umbilical vein blood flow (93.7 ± 17.8 ml/kg per min vs. 126.0 ± 23.4 ml/kg per min, P < 0.001), and umbilical vein blood flow mean velocity (6.6 ± 2.7 cm/s vs. 9.0 ± 3.6 cm/s, P < 0.05). The proportion of fetuses with an umbilical vein blood flow < 80 ml/kg per min was higher when the cord was lean than when it was normal (25% vs. 1.9%, P < 0.01).ConclusionsLean umbilical cords differ from normal cords not only from a structural point of view but also in the umbilical vein blood flow characteristics. This could explain the increased incidence of intrapartum complications and fetal growth restriction among fetuses with a lean and/or hypocoiled cord. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic prenatal diagnosis of intracranial fetus in fetu
Authors: Ianniruberto A. , Rossi P. , Ianniruberto M. , Rella G. , Ciminelli V. 
Published: March 2003

AbstractA case of sonographic prenatal diagnosis of a complex intracranial mass, with features of a fetus in fetu at 17 weeks' gestation, is reported. This diagnosis is reserved for a highly organized tumor containing a vertebral column and recognizable fetal parts and should be differentiated from a teratoma. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Quantitative digital analysis of regional placental perfusion using power Doppler in placental abruption
Authors: Welsh A. W. , Bennett P. R. , Fisk N. M. 
Published: March 2003

AbstractPurposeTo apply digital imaging techniques to the quantification of placental vascularity using power Doppler.Materials and methodsRegional placental blood flow was measured in a case of large placental abruption, shortly after presentation and 1 week later. Images were stored digitally and analysed using purpose‐designed software (CQ Analysis) to extract and measure vascular energy information. The integrated color energy (ICE) was determined in the main body of placental tissue and in a cotyledon isolated by the retroplacental clot.ResultsInitial assessment at 25 weeks showed only a small difference in integrated energy between normal placenta and the isolated cotyledon (ICE ratio 1.44, P < 0.04). One week later, perfusion in the isolated cotyledon had fallen both on qualitative and quantitative assessment (ICE ratio 3.98, P < 0.0001). This area subsequently became devascularized.ConclusionPlacental perfusion may be quantified using digital power Doppler analysis. Further studies are indicated to evaluate its role in assessing regional and/or global placental perfusion as well as fetal organ perfusion. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
The accuracy and indications of fetal echocardiography in high risk patients: a 4‐year clinical experience in an obstetric unit
Authors: Gómez O. , Puerto B. , Borrell A. , Palacio M. , Cararach V. 
Published: March 2003

Objective:  To evaluate the accuracy and assess the indications of fetal echocardiography to diagnose structural heart disease in our high risk population, by an obstetric team.Methodology:  Over a 4‐year period, a transabdominal echocardiography was performed in 912 high risk pregnancies for congenital heart disease at 18–38 weeks of gestation. In the last 140 cases, an early examination combining either the transvaginal or the transabdominal route at 13–16 weeks was also carried out. Follow up was obtained from neonatal examinations and autopsies. The main indications for referral were: pregestational diabetes mellitus, family risk, increased nuchal translucency, suspected cardiac anomaly at screening ultrasound, women at high risk of chromosomal abnormality reluctant to invasive test, suspected arrhythmia, single umbilical artery, exposure to teratogens, and pregnancies affected by a chromosomal abnormality.Results:  There were 79 (8.6%) major congenital heart defects, and most of them were yielded in the group of screening by ultrasound. Seventy of them (88.6%) were diagnosed correctly as abnormal prenatally. Atrioventricular septal defects (21 cases) and hypoplastic left ventricle syndrome (12 cases) were the most prevalent heart anomalies in the fetus. Isolated septal defects and coarctation of the aorta were the most difficult lesions to detect, being the ones with false positive and negative diagnosis. Another four cases of non‐significant (<3 mm, no surgery nor medical treatment required) ventricular septal defects were overlooked during gestation, but closed by the sixth month of life. Fifteen apparently normal cases were lost to follow up.Conclusion:  Our obstetric team results, in accordance with others previously published, show a good effectiveness to diagnose congenital heart anomalies. Most major detectable cardiac anomalies occur in the group without previously‐known risk.
Transvaginal 2D/3D US and MRI of the fetal CNS
Authors: Pooh R. K. , Pooh K. 
Published: March 2003

Introduction:  Transvaginal sonography of the fetal brain produce a series of oblique sections from the same ultrasound window. Transvaginal 3D automatic volume acquisition requires only 1.84–6.07 s for scanning without a shift and angle‐change of the transducer. Multiplanar image analysis and volumetric system are useful for objective evaluation of the fetal brain. Recent advances in fast MRI technology has remarkably improved the T2‐weighted image resolution without motion artifacts, despite a short acquisition time. We used both technologies for the fetal brain assessment.Patients and methods:  Between May 2000 and April 2001, 11 cases with fetal brain abnormalities at 20–37 weeks of gestation were examined by transvaginal 2D/3D sonography and MRI. Logiq 700/500 (GE MS) and Voluson 530D (Medison), and 1.5 T MR unit VISART (Toshiba) with 2D half‐Fourier fast SE sequence were used in this study. Obtained US images and MRI were compared for brain evaluation.Results:  From our study, TVS is better in depicting the corpus callosum in the sagittal section, while MRI with 2D half‐Fourier fast SE is superior in brainstem detection. In evaluation of the ventricular system, cerebrum and cerebellum, the same information was obtained from both methods. The same prenatal diagnoses were obtained from US and MR data in 10 cases. In one case with partial agenesis of corpus callosum at 20 weeks of gestation, US image was more demonstrative than MRI.Conclusions:  Prenatal neuroimaging has been approaching postnatal imaging. Both transvaginal sonography and MRI are useful for evaluation of the fetal CNS. Transvaginal 2D/3D sonography should be used for routine assessment of fetal CNS, and MRI device should be used for more detailed evaluation including brainstem assessment. Practically, MRI is useful regardless of fetal head position, while US is not influenced by fetal movement.
Fetal hydronephrosis – natural history and predictors of postnatal outcome
Authors: Sohn Y. K. , Han S. Y. , Chun D. W. , Park J. S. , Jun J. K. , Yoon B. H. , Syn H. C. , Lee H. P. 
Published: March 2003

Objectives:  The aim of this study was to evaluate the natural history of antenatally detected hydronephrosis and to assess the relationship between the severity of fetal hydronephrosis and postnatal outcome.Materials and methods:  During the study period (1992 through 2001), we identified 70 cases of fetal hydronephrosis and reviewed their antenatal and postnatal follow up record retrospectively. The inclusion criteria was renal pelvic antero‐posterior (AP) diameter 4 mm or greater before 33 weeks of gestation and 7 mm or greater at or after 33 weeks of gestation. Sonographically diagnosed fetal simple renal cyst, multicystic dysplastic kidney, or polycystic kidney were excluded.Results:  Thirty cases (43.4%) showed hydronephrosis without definite renal pathology after postnatal evaluation. Thirty‐one cases (44.9%) had anatomical abnormalities and the most common renal pathology was ureteropelvic junction obstruction (18 of 31, 58%). Eight cases (11.5%) had regression of hydronephrosis before or at birth. One case was lost in follow up. Twenty cases (28.9%) required surgical intervention, 32 cases (46.3%) needed medical intervention, and 17 cases (24.6%) required neither intervention nor long‐term follow up. All with renal pelvic AP diameter of 15 mm or greater prior to delivery needed either medical or surgical intervention postnatally. With cut off value of 15 mm or greater, the sensitivity and specificity in predicting surgical intervention were 90, and 75%, respectively. The fetus with renal pelvic AP diameter of 15 mm or less prior to delivery had less risk for surgical intervention than 15 mm or greater (Odds ratio 0.046, 95% CI 0.009–0.224). Gestational age at detection of fetal hydronephrosis had no statistical significance in predicting outcome.Conclusion:  We concluded that severity of fetal hydronephrosis could affect a postnatal management strategy, either medical or surgical intervention, which is useful in prospective counseling.
Changes in fetal blood flow in hypoxemia during labor
Authors: Ropacka M. , Dubiel M. , Marsal K. , Gudmundsson S. , Breborowicz G. H. 
Published: March 2003

Objective:  The aim of this study was evaluation of intrapartum Doppler velocimetry changes in fetuses with signs of fetal hypoxemia in fetal pulse oximetry (arterial hemoglobin saturation <30%).Study design:  Examinations were performed on 44 women in labor with singleton pregnancies. The subject of analysis was Doppler blood flow velocimetry in umbilical cord, fetal brain and lung. In all cases the following examinations were performed: blood flow velocimetry in middle cerebral artery (MCA), umbilical artery (UA), and pulmonary vein (PV). Among fetuses with normal Doppler velocimetry at the time of admission, we selected those with cephalic presentation and non‐reassuring fetal heart rate pattern during labor. The fetuses were included to the group of fetal pulse oximetry monitoring. All cases with signs of fetal distress in ctg and intrapartum fetal arterial oxygen saturation <30% for at least 5 min were included to the study group. Fetuses with abnormal ctg and fetal oxygen saturation >30% constituted the control group.Results:  Doppler indices (PI, RI) in MCA were significantly lower in the presence of reduced oxygen saturation. Pulsatility and resistance index in UA in the study group were higher, comparing to the control group. But, there was no statistically significant difference between both groups in analyzing parameters. There were no statistically significant changes in parameters describing blood flow in pulmonary veins in both studied groups.Comments:  The combined intrapartum fetal monitoring, including pulse oximetry and Doppler blood flow velocimetry, proved that the reduction of fetal arterial oxygen saturation (<30%) is associated with changes in hemodynamics of fetal cerebral circulation. It has been not observed any changes in blood flow in umbilical artery and pulmonary vein in the presence of decreased fetal saturation.
Prediction of pregnancy outcome in women with an empty gestational sac on ultrasound scan
Authors: Elson J. , Salim R. , Tailor A. , Zosmer N. , Jurkovic D. 
Published: March 2003

Background:  The ultrasound finding of an empty gestational sac may represent either an early normal pregnancy or a missed miscarriage, and follow up visits are usually required to reach a correct diagnosis. The aim of this study was to examine whether a combination of ultrasound and other clinical data may help to predict the final outcome at the initial visit.Methods:  In all women with a diagnosis of an empty sac on transvaginal ultrasound scan, a detailed clinical history was obtained and a blood sample was taken to measure serum human gonadotrophin and progesterone levels. They were managed expectantly and invited to attend for a follow up scan 1 week later. The presence of a live embryo at follow up scan was used to diagnose normal pregnancy, whilst the diagnosis of miscarriage was made if the embryo remained undetectable, and/or the gestational sac showed regressive changes.Results:  A number of 197 women were included into the final analysis, 115 (58%) of whom had a normal pregnancy and 82 (42%) had a missed miscarriage. Women with normal pregnancies were significantly younger (P < 0.01), less likely to present with vaginal bleeding (P < 0.001), had smaller gestational sacs (P < 0.001) and higher serum progesterone (P < 0.001) than those women who had missed miscarriages. On inspecting the ROC curves, serum progesterone was the best test to discriminate between viable and nonviable pregnancies. Using a cut‐off of 25 nmol/L a viable pregnancy could be diagnosed with 100% sensitivity and 45% specificity.Conclusion:  Serum progesterone can be used to differentiate between normal and abnormal pregnancies in women with the diagnosis of an empty sac on ultrasound scan. This may help to improve patient's counseling and significantly reduce the need for follow up visits in women with nonviable pregnancies.
The prediction of spontaneous preterm birth in women with threatened preterm labor using transvaginal ultrasound of the cervix
Authors: Cook C.‐M. , Ellwood D. A. 
Published: March 2003

Purpose:  This study was to determine if cervical parameters, as assessed by transvaginal ultrasound, were predictive of spontaneous preterm birth in women following an episode of threatened preterm labor (TPL).Methods:  Women with a singleton pregnancy (20–34 weeks gestation) and intact membranes were enrolled following admission for TPL. The transvaginal ultrasound assessment of the cervix was performed when uterine activity had ceased. Only the ultrasound relating to the episode of suspected preterm labor is reported.Results:  Sixty women had a transvaginal scan performed at a gestation of 27.7 ± 3.7 weeks (mean ± SD) (range 20.1–33.7 weeks). Cervical parameters were significantly different in women who delivered preterm (shorter closed endocervical canal length –P < 0.0001; increased internal os dilatation –P < 0.0001) to the women who delivered at term. Twenty‐five women had an abnormal cervix (closed endocervical canal length <30 mm + internal os dilatation >5 mm). Of these, 16 (64%) delivered preterm (<37 weeks). In contrast, only one woman with a normal cervix delivered preterm (P < 0.0001; RR 22.4, 95% CI 3.17–158.1). Five women (20%) delivered within 1 day of their abnormal cervical ultrasound, seven (28%) in <7 days, and 10 (40%) in <14 days whereas no woman with a normal cervical ultrasound delivered within 14 days (sensitivity 100%; negative predictive value 100%). In a linear regression model with gestational age at delivery as the dependent variable, endocervical canal length had an R2 of 59.3% (P < 0.0001) which was not improved by the addition of any of the other parameter variables.Conclusions:  Transvaginal ultrasound of the cervix can identify those women with an abnormal cervix following an episode of TPL who are at increased risk of preterm birth. It also identifies the women with normal cervices and therefore at low‐risk of preterm birth which potentially could reduce unnecessary interventions.
Measuring cervical length with ultrasound: evaluation of the procedures and duration of a learning method
Authors: Vayssière C. , Morinière C. , Camus E. , Le Strat Y. , Poty L. , Fermanian J. , Ville Y. 
Published: March 2003

Purpose:  To evaluate the procedures and learning time required for a novice ultrasound operator to master the technique for measuring cervical length with transvaginal ultrasound.Methods:  Two operators new to cervical ultrasound (one with experience in transvaginal ultrasound in gynecology) were assessed during their training. The subjects are asymptomatic patients with a singleton pregnancy between 21 and 38 weeks, consulting for a routine ultrasound. After an initial lecture session on the technique of cervical measurement, both trainees had one or two supervised practice sessions, separated by interobserver agreement studies with 30 patients at a time; these compared the level of agreement consent between trainer and trainee throughout the course. Five ultrasounds were performed at the first practice session; a second practice session was planned only if the trainee did not perform all five ultrasounds alone and correctly, in accordance with the four quality criteria defined in advance for good cervical measurements. The second practice session, if there was one, lasted until five consecutive ultrasounds meeting the quality criteria were performed without the trainer's aid. Agreement between the two operators was assessed by the intra‐class correlation coefficient (ICC). The ICCs were compared with Fisher's Z‐transformation.Results:  The mean age of the 150 women included in the study was 29.2 ± 4.8. The nullipara rate was 45.8%. The preterm delivery rate was 2.7% for the entire set of interobserver studies. The trainee with no experience with transvaginal ultrasound required two practice sessions (of the five ultrasounds performed in the first session, none was correct). In the second session, 18 consecutive ultrasounds were necessary to obtain five consecutive correct examinations. During this trainee's interobserver studies with the trainer, each involving 30 patients, the ICC progressed from 0.43 in the first to 0.64 in the second and 0.77 in the third study. The ICC in the first study differs significantly from that at the third (P = 0.049). The trainee with experience in transvaginal ultrasound required only one practice session (the first five ultrasounds were correct, without help from the trainer). The ICC moved from 0.74 to 0.86 in the two inter‐observer studies with the trainer, not a significant change.Conclusions:  Theoretical training including supervised practice of 23 ultrasounds seems necessary for a trainee with no knowledge or experience in transvaginal ultrasound to acquire the technique for ultrasound measurement of the cervix.