bluuebunny/crossref_metadata_2025_split huggingface dataset:
3D ultrasound study of uterine anomalies in women with history of recurrent miscarriage
Authors: Salim R. , Woelfer B. , Regan L. , Bakos M. , Jurkovic D. 
Published: March 2003

Purpose:  Congenital uterine anomalies are associated with adverse reproductive outcomes. In this study, we have examined the significant differences in the severity of uterine malformation in women with history of recurrent miscarriage and those in whom uterine anomaly was diagnosed incidentally.Methods:  A total of 503 consecutive women with a history of recurrent miscarriage and 3228 low risk women attending for an ultrasound scan for indications other than infertility or recurrent pregnancy loss were screened for the presence of congenital uterine anomaly using 3D ultrasound. The anomalies were classified according to the American Fertility Society classification. The length of uterine septa, depth of fundal indentation (arcuate uterus) and length of uterine cavity were all measured. The degree of distortion was expressed as a ratio of septum length (or fundal indentation) and the length of the uterine cavity (distortion ratio = septum length/septum length + residual cavity length).Results:  Eighty‐one arcuate and 26 subseptate uteri were detected in the group of women with history of recurrent miscarriage, whilst 72 arcuate and 29 subseptate uteri were diagnosed incidentally. There was no significant difference in the septum length (P > 0.01) or fundal indentation (P > 0.01) between the two groups. The uterine distortion ratio in women with a history of recurrent miscarriage was significantly greater compared to women with a normal reproductive history in both arcuate (t = − 3.258, P < 0.01) and subseptate (t = − 1.126, P < 0.01) uteri.Conclusions:  The uterine cavity was more distorted in women with history of recurrent miscarriage compared to low risk women. This finding may partly explain the differences in the past reproductive performance between these two groups of women.
First trimester termination of pregnancy: a comparative trial of intraoperative ultrasound guidance
Authors: Wolman I. , Shefer G. , Pausner D. , Har‐Toov J. , Amster R. , Fait G. , Lessing J. B. , Jaffa A. J. 
Published: March 2003

Purpose:  To evaluate whether the frequency of major complications of surgical abortions could be reduced by the routine use of intraoperative ultrasound guidance.Design:  Prospective, single‐blinded study of 1200 consecutive, 15–44‐year‐old‐healthy women, recruited at a gestational age below 12 weeks, and randomized to two groups of 600 women each. In group I, dilatation and vacuum evacuation were conducted under ultrasonographic guidance prior to sharp curettage. In group II (control group), the same procedure was performed, but without ultrasound guidance.Results:  There was a significant lower rate of repeated evaluation after the procedure in the study group (P > 0.01). Furthermore, although the rate of complications was rare in both groups, when nine major complications were pooled together, they were significantly more frequent in the control group (P < 0.01).Conclusion:  The routine use of intraoperative ultrasound guidance is a useful adjunct to surgical abortion. It allows for a shorter procedure, and a lower rate of complications.
Factors influencing the prenatal detection of structural congenital heart diseases
Authors: Wong S.‐F. , Chan F.‐Y. , Cincotta R. , Lee‐Tannock A. , Ward C. 
Published: March 2003

Background:  Congenital heart disease is the commonest congenital anomaly, but the reported antenatal detection rate varies widely from 4.5 to 36%.Purpose:  To assess the factors influencing the antenatal detection rate of structural congenital heart diseases.Methods:  A retrospective study was conducted at a major obstetric hospital in Australia between 1st January 1996 and 30th June 1999. The medical records of all fetuses and infants born with congenital heart diseases, except isolated patent ductus arteriosus, were reviewed. Only pregnancies that had antenatal ultrasound scan assessments for morphological surveys were included. The antenatal detection rate for structural congenital heart diseases was determined. The following factors that might influence the detection rate, were assessed: complexity of the lesions; experience of the sonologists (performance in tertiary vs. non‐tertiary institutions); identification of other structural or chromosomal anomalies; and maternal body mass index.Results:  The incidence of structural congenital heart disease in this series, excluding cases referred from other hospitals, was 7‰ (179/25529). One‐hundred and fifty‐three fetuses and babies with structural congenital cardiac diseases were included. The overall detection rate for congenital heart diseases in this series was 39.9%. Detection rates for isolated septal defects were poor (13.2%). The detection rates were significantly higher for complex lesions (54%), for lesions with concomitant septal defects (47.6%), and for lesions with abnormal four chamber views (62.9%). The detection rate was also higher if the scan was performed in the tertiary institution (59%), and if there were other chromosomal or structural anomalies. Maternal body mass index did not affect the detection rate in the current series. Stepwise logistic regression analysis showed that three independent variables affecting the detection rate were complexity of the cardiac lesion, experience of the operator (tertiary scan), and the detection of other chromosomal anomalies.Conclusion:  The public needs to be educated on the limitations of antenatal screening for congenital heart anomalies, especially on isolated septal defects. To improve future detection rates, further emphasis on the training and supervision of the sonologists needs to be stressed.
Early diagnosis of fetal cardiac anomalies by transvaginal echocardiography in a high risk population
Authors: Comas C. , Mortera C. , Torrents M. , Carrera J. M. 
Published: March 2003

Objective:  To examine the accuracy of early transvaginal fetal echocardiography (TV‐echo) performed in a high risk population.Methods:  A series of 70 high risk pregnancies were screened by TV‐echo at 12–17 weeks gestation between March 2000 and May 2001. A total of 74 fetal heart examinations were performed, including four twin pregnancies. For each fetus, visualization of the four chamber view, the origin of the great arteries, aortic and arterial ductal arches was attempted in a segmental approach. B‐mode and color/pulsed Doppler flow imaging were used in all cases, while M‐mode was occasionally performed. The average duration of complete heart examination was approximately 30 min. All the examinations were performed by the same experienced operator. Reliability was assessed by conventional transabdominal echocardiography at 20–22 weeks, by postnatal follow up in the first three months of life, and/or by autopsy in cases of termination of pregnancy.Results:  The rate of successful visualization of the fetal heart was 90.5% (67/74). In 12 out of 74 fetuses the final diagnosis was abnormal (16.2%), including 10 structural heart abnormalities and two cases of heart dysfunction. In 8 out of 10 cases with structural heart defects, the diagnosis was suspected at early TV‐echo. In three cases, although the main diagnosis was correct, details of cardiac defects were missed at early TV‐echo. Among the heart defect group, five cases had an abnormal karyotype (41.7%) and nine cases showed extra‐cardiac anomalies (75%). There were two false negative cases at early TV echo (two cases of hypoplastic left ventricle). There were no false positive diagnoses. In our series, the sensitivity to detect congenital heart defects was 83% by early TV‐echo and 80% by conventional transabdominal echocardiography.Conclusions:  Early high‐frequency TV‐echo can provide a comprehensive assessment of the fetal heart. The high rate of successful visualization of the fetal heart provides a reliable diagnosis of major cardiac defects at this early stage of pregnancy. However, at present this examination should be restricted to high risk pregnancies.
Use of fetal umbilical to middle cerebral Doppler velocimetry ratio in the presence of normal umbilical Doppler findings as a predictor for adverse perinatal outcome in term fetuses
Authors: To W. W. K. , Mok C. K. M. 
Published: March 2003

Background:  Doppler velocimetry studies of the fetal umbilical artery (UA) in the antenatal period have been shown to be correlated with significant intrauterine growth restriction, subsequent intrapartum fetal distress requiring intervention, and other major adverse perinatal outcome. The addition of middle cerebral Doppler (MCA) studies and expression of the two parameters as a ratio has been shown to predict intrauterine growth restriction (IUGR) sensitively. However, an abnormal ratio was not shown to be associated with increased risk of major perinatal morbidity or mortality or subsequent neurological damage. This study aims at evaluating the correlation between the UA/MCA Doppler ratio and adverse perinatal outcome in a group of term fetuses with suspected IUGR when the umbilical Doppler findings were still largely within the normal range.Methods:  A retrospective analysis of all pregnancies undergoing ultrasound and Doppler studies for evaluation of suspected IUGR after 34 weeks over a period of 6 months in a general obstetric unit that catered for an annual delivery of around 3500 deliveries per year. The data from the ultrasound and Doppler evaluation within 1 week from delivery were analyzed. Those with absent or reversed end diastolic flow, or a systolic/diastolic (S/D) ratio over 3.5 in UA Doppler studies were excluded from analysis. The S/D ratio of UA and MCA Doppler findings were then expressed as a ratio, and these were correlated with the perinatal events and immediate neonatal outcome parameters.Results:  A total of 123 babies with complete data were included in the analysis, of which 10 were from five twin pregnancies. Seventy‐two (58.5%) were confirmed to be growth restricted with birth weight below the 10th percentile for gestation. Sixteen (13%) had an UA/MCA Doppler ratio under 0.75. The incidence of IUGR was significantly higher in this group with abnormal Doppler ratio (87.5%) as compared to the normal ratio group (55%) (P < 0.05). Similarly, the abnormal Doppler ratio group had higher incidence of significant oligohydramnios (75% vs. 17%, P < 0.001), induction of labor (50% vs. 20%, P < 0.01), total cesarean section (62.5% vs. 15.8%, P < 0.001), and cesarean section for fetal distress (43% vs. 11.2%, P < 0.001) than the normal ratio group. The incidence of admission to NICU, meconium stained liquor or intrapartum cardiotocogram abnormalities did not differ.Conclusion:  In the presence of normal UA Doppler findings, early changes of cerebral vasodilation leading to a relatively low UA/MCA Doppler ratio are associated with a higher incidence of obstetric intervention and perinatal morbidity. The MCA Doppler studies should be valuable in the evaluation of suspected growth restriction even when UA Doppler findings are largely normal.
Ductus venosus Doppler velocimetry for the detection of Down syndrome: new criterion of risk
Authors: Moron A. F. , Ávila M. A. P. 
Published: March 2003

Objective:  To test the hypothesis the application of ductus venosus Doppler velocimetry may serve as a screening tool between 10 and 14 weeks gestation for the detection of fetuses with Down syndrome and estimate new criterion of risk.Patients and methods:  A total of 491 fetuses were studied consecutively. In 132 cases, a cytogenetic study was performed on material obtained from a biopsy of the chorionic villus, and in 359 cases the postnatal pheno‐type was used as a basis for the result. In addition to the routine ultrasonographic examination, all the fetuses were submitted to measurement of the nuchal translucency thickness. For statistical analysis the Student's t‐test and ANOVA were used. The sensibility, specificity, positive and negative predictive values, false‐positive probability and likelihood ratio was calculated.Results:  There were 21 cases of Down syndrome. Of these 21 fetuses, ductus venosus blood flow during atrial contraction was either absent (n = 3) or reversed (n = 17) in 95.2%. In the chromosomally normal fetuses (n = 270), only eight had abnormal Doppler profiles in the ductus venosus (specificity = 98.2%, positive and negative predictive values = 71.4 and 99.8%, respectively, and positive and negative likelihood ratio was 56 and 0.1, respectively).Conclusion:  Our preliminary results suggest that the presence of Down syndrome may be strongly suspected when there is reverse or absent flow in the ductus venosus Doppler velocimetry during atrial contraction. We speculate the possibility of new criterion to calculate the new risk of Down syndrome was calculated from the fetal medicine foundation risk, multiplied by a likelihood rate of Doppler of ductus venosus, using at least the values of 50 for positive likelihood rate and 0.1 for negative likelihood rate.
Quality assessment in prospective nuchal translucency screening for Down syndrome in the Copenhagen first trimester study
Authors: Wojdemann K. , Christiansen M. , Sundberg K. , Shalmi A.‐C. , Tabor A. 
Published: March 2003

Purpose:  To develop and apply a quality control system in a Down syndrome (DS) screening study using nuchal translucency (NT) as interventional marker.Methods:  In a prospective DS screening study, the NT was measured in 9236 pregnancies. For quality assessment two models were introduced: (I) image‐scoring evaluation of the NT measurements and (II) establishment of the distribution of NT multiple of the medians (MoMs) over time and influence of an intervention.Results:  The observer variability in the image‐scoring evaluation was high with a kappa value of 0.48 in the overall validation. A revised model showed better interobserver agreement with a kappa value of 0.58; regarding the single criteria the differences were however, still unsatisfactory, i.e. we found highly significant differences for the criteria ‘position of the fetus’ (P = 0.0026) and ‘magnification of the image’ (P = 0.0001). Regarding the distribution of the NT MoMs, the median NT MoM (in groups of 50 fetuses each) stabilized after a short learning phase (representing the practical part of the sonographer's certification). The intergroup standard deviation decreased from initial 0.100–0.060 after the learning phase, and 0.046 after the intervention.Conclusions:  When well‐trained certified examiners perform NT screening, continuous evaluation of the distribution of the NT MoM seems to be a good method to assess the quality for a center and may also be used to identify individual examiners deviating from the mean performance. Intervention towards the examiners seems to decrease variation, which should theoretically decrease the false positive rate. The image‐scoring methods we introduced cannot be recommended for quality control in an NT screening program.
Tissue characterization with gray level histogram width and assessment of fetal lung immaturity
Authors: Maeda K. , Utsu M. , Kihaile P. E. , Serizawa M. , Yamamoto N. , Ito T. 
Published: March 2003

Purpose:  The aims are to clarify the reproducibility of gray level histogram width (GLHW) in ultrasound machines and to demonstrate tissue character of fetal organs and tissues in B‐mode image.Methods:  The GLHW is calculated manually and automatically with the ROM provided by Aloka, and the values are compared among six Aloka, each one of Toshiba, Yokogawa and Kretz 503D wuth use of RMI phantoms. Clinically, the placenta, fetal brain periventricular echodensity (PVE), fetal lung and liver, those of preterm fetuses with the refernece to stable microbubbles of amniotic fluid, and meconium stained amniotic fluid are studied.Results:  No influence of clinical gain control, image depth, STC, 1 cm2 or more ROI or 1000 or more pixels is confirmed. GLHW is large in high image contrast, but it is easily compensated. Some own values are corrected and standardized. GLHW is reproducible among machines. Clinically, GLHW is large in grade III placenta, the value is large in fetal brain PVE and it is large in meconium stained fluid. Normal fetal lung GLHW is low and lower than fetal liver before 30 weeks of pregnancy, fetal GLHW is 31% or less in the group of five or less stable microbubbles with 90% sensitivity and 80% specificity. In gynecology, GLHW is high and coefficient of variation is low in multiple ROIs of ovarian malignancy. GLHW is large in hyperplastic endometrium. Adult organs and tissues are of interest particularly in hepatic diseases.Conclusion:  GLHW is reproducible in ultrasound machines, and it is useful in tissue characterization. It is possible to assess fetal lung immaturity with GLHW.
Fetal congenital heart block
Authors: Pennell C. , Reid K. P. , Dickson J. E. 
Published: March 2003

Purpose:  To ascertain the incidence and outcome of all cases of prenatally diagnosed congenital heart block (CHB) referred to our institution during the decade 1990–2000.Methods:  Cases were identified from the fetal medicine database permitting review of the clinical presentation, ultrasound findings, maternal immunological status, subsequent management and pregnancy outcome.Results:  Eleven cases of CHB were identified during the period of review (100% ascertained for Western Australia) with a diagnosis at median gestation of 20 weeks (16.8–32). Fetal cardiac anatomy was normal in 64% of cases. Fetal hydrops was present at diagnosis in 27% with a further 33% subsequently developing hydrops. Only 18% of fetuses had major structural cardiac anomalies. The median gestation at delivery was 35 weeks (25–38) and there was a female gender bias (7 : 4). The mortality rate was 64% with three pregnancy terminations, one second trimester intrauterine fetal death, one neonatal death and two infant deaths. Maternal immunological abnormalities were common with 36% of the women having clinical autoimmune conditions. Seventy‐eight percent of women had SSA and/or SSB antibodies. Two of the six infants that survived the neonatal period had persistent abnormal autoantibodies during their first year of life. One infant with SSA and SSB died at one year of age from left ventricular failure believed to be of autoimmune origin. This infant was one of triplets, with only the female triplet being affected. Another fetus with SSA and SSB had thrombocytopenia at delivery. Postmortem assessment of five fetuses confirmed focal calcification at the atrioventricular junction associated with a lymphocytic infiltrate and subendocardial fibrosis. Eight subsequent pregnancies have occurred and none were complicated by CHB. Three women underwent prophylactic immunosuppression.Conclusions:  Fetal congenital heart block is a rare condition with a strong association with autoimmune disease and poor outcome. The recurrence risk in this series is lower than previously reported.
Feasibility of a national Web‐based ultrasound learning portfolio for OB/Gyn residents: the KOALA program
Authors: Fung K. F. K. , Gagliari A. , Walker M. , Lacasse C. , Faught W. , Fung M. F. K. 
Published: March 2003

Purpose:  To establish the feasibility of a national ultrasound learning portfolio in resident education in OB/Gyn in order to create a needs assessment for educational programming, ensure students are meeting educational objectives and promote self‐directed learning.Methods:  The Internet‐based KOALA learning portfolio was introduced into 15 of 16 Canadian medical schools in 1997 to track resident learning encounters in OB/Gyn ultrasound. Data entered over 3‐year period analyzed using SPSS 10.0 to identify: (1) categories of ultrasound cases entered; (2) critical incidents of learning; (3) domain and stimulus of questions posed; and (4) educational resources used for learning.Results:  Between 1 July 1997 and 30 June 2000, 3368 ultrasound encounters were voluntarily recorded by 50 residents at 11 university‐affiliated residency training programs. Twelve residents (25%) were categorized as high‐volume, having entered = 100 cases. Learning encounters were recorded according to the following themes: routine second trimester dating scans; diagnostic procedures; amniocentesis, CVS, cordocentesis; assessment of fetal well‐being; targeted anomaly screen; routine gynecological exam. Critical incidents of learning were identified in 25% of ultrasound cases (837/3368). Overall, the majority of questions asked by residents following their ultrasound learning encounter were of a cognitive nature (53.3%), and were significantly associated with identification of a critical incidence of learning (P < 0.001). Overall, medline was the educational resource most likely to be used case‐based learning when critical incidents were identified (P < 0.001). Questions of high volume users were most often stimulated by reflections and self‐assessment (81.5%) when compared to low‐volume users (61.3%). Textbooks were the educational resource most often used by high‐volume users (73.9%) to answer questions concerning their educational encounters. High‐volume users were more likely to report a change in their practice as a result of learning acquired through the use of KOALA systems (P < 0.001). Barriers identified during implementation included lack of computer Internet access in the clinical environment, suboptimal faculty development initiatives, and failure to integrate the learning portfolio as a component of the resident evaluation process.Conclusions:  (1) Implementation of a Web‐based learning portfolio is feasible, allowing collection of data from geographically dispersed areas and programs; (2) voluntary use of the KOALA system was acceptable when the system was made available to OB/Gyn residents; and (3) use of Internet‐based learning portfolio such as KOALA presents a unique opportunity for ultrasound training programs and special society such as ISUOG to assess the educational needs of training physician learners.