bluuebunny/crossref_metadata_2025_split huggingface dataset:
Selective versus non‐selective laser photocoagulation of placental vessels in twin‐to‐twin transfusion syndrome
Authors: Quintero R. A. , Comas C. , Bornick P. W. , Allen M. H. , Kruger M. 
Published: March 2003

AbstractObjectiveWe have recently described a surgical technique for the treatment of twin‐to‐twin transfusion syndrome (TTTS) that allows precise identification of vascular anastomoses (selective laser photocoagulation of communicating vessels, or S‐LPCV). The purpose of this study was to compare S‐LPCV with the previous non‐selective technique (NS‐LPCV) that targeted all vessels crossing the dividing membrane.Materials and MethodsPatients with TTTS were treated with NS‐LPCV from May 1994 to June 1997 and with S‐LPCV from July 1997 to December 1999. TTTS was defined as polyhydramnios of ≥8 cm maximum vertical pocket (MVP) in the recipient twin and oligohydramnios of ≤2 cm MVP in the donor twin. Outcome was measured as survival per number of pregnancies and per number of fetuses together with limited morbidity data.ResultsNS‐LPCV was used in 18 patients and 74 were treated with S‐LPCV. Three patients interrupted their pregnancies electively after surgery (S‐LPCV) and were removed from further analysis. Survival of at least one fetus was higher in S‐LPCV (83.1%) than in NS‐LPCV (61.1%) (P = 0.04), mostly due to a lower rate of dual intra‐uterine fetal demise in S‐LPCV (5.6%) than in NS‐LPCV (22%) (P = 0.05). There were more hydropic fetuses in the NS‐LPCV group (27%) than in the S‐LPCV group (5.4%), but this difference did not account for the results. There was no difference in the survival per number of fetuses between the two groups.ConclusionsS‐LPCV represents an important evolution in the surgical treatment of TTTS. The use of this technique by all centers should allow better comparison of fetal survival and morbidity rates. S‐LPCV should be the standard technique in trials comparing amniocentesis versus laser for the treatment of severe TTTS. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic markers of exencephaly at 9 + 3 weeks of gestation
Authors: Becker R. , Mende B. , Stiemer B. , Entezami M. 
Published: March 2003

AbstractFollowing the introduction of transvaginal sonography, several first trimester diagnoses of the exencephaly anencephaly sequence have been reported, with the earliest being described at 10 weeks of gestation. We report a case with a high index of suspicion for exencephaly at 9 weeks and 3 days because of three sonographic features: the cranial pole of the embryo was smaller than the chest, the cranial pole bulged dorsally and the surface of the cranium was irregular. The diagnosis was confirmed by a repeat ultrasound examination at 11 + 4 weeks and by autopsy after termination of pregnancy. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic assessment of amniotic fluid volume between 11 and 24 weeks of gestation: construction of reference intervals related to gestational age
Authors: Gramellini D. , Delle Chiaie L. , Piantelli G. , Sansebastiano L. , Fieni S. , Vadora E. 
Published: March 2003

AbstractObjectiveAt present, most of the methods for sonographic assessment of amniotic fluid volume are unreliable in the second trimester of pregnancy, or else they do not present nomograms related to gestational age.DesignThe aim of this prospective cross‐sectional study was to construct normal reference ranges of four ultrasound parameters for the evaluation of amniotic fluid volume which could be applied in the second trimester. For these parameters we calculated normal curve limits suitable for use in clinical practice.SubjectsFrom a population of normal pregnant women between the 12th and the 24th weeks of gestation undergoing a routine ultrasound examination during 1997 at our institute, 273 were found to be suitable for the study, after the exclusion of all cases which presented any feto‐maternal pathology or complications up to the 24th week.MethodsThe largest ‘amniotic pocket’ in a vertical direction, free of small fetal parts and umbilical cord, was measured: the maximum vertical and transverse diameters were measured on the same scan; the mean diameter and the product of the two diameters were calculated. The ‘mean amniotic fluid diameter’, the ‘two‐diameter pocket’, the ‘largest vertical pocket’ and the ‘largest transverse pocket’ were the four sonographic parameters considered.ResultsThe four parameters correlated well with gestational week and with the biparietal diameter; the normal reference intervals and normal curve were then calculated. All these parameters were found to have good intra‐ and interoperative reproducibility.ConclusionsWe conclude that the use of an ultrasound semiquantitative method based on the measurement of a single amniotic fluid pocket and involving normal reference intervals according to gestational age could improve the early diagnosis of amniotic fluid variations during the second trimester, although this has yet to be confirmed by extensive clinical trials. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
The characterization of common ovarian cysts in premenopausal women
Authors: Jermy K. , Luise C. , Bourne T. 
Published: March 2003

AbstractObjectivesThe evaluation of the predictive value of transvaginal ultrasound in the assessment of benign adnexal pathology in premenopausal women, based on the recognition of characteristic morphologic patterns particular to endometriotic and dermoid ovarian cysts.MethodsThis was a prospective study. All premenopausal women undergoing surgery for a suspected ovarian cyst underwent a transvaginal ultrasound examination in the week prior to surgery. Between June 1997 and January 2000, 132 women underwent surgery for a suspected ovarian endometrioma or dermoid cyst. The endpoints were either the direct visualization of the cyst wall and contents at surgery, or the histologic evaluation of removed tissues.ResultsOf 83 suspected endometriomas (11 bilateral), 80 were confirmed at surgery and of 68 suspected benign cystic teratomas (eight bilateral), 66 were confirmed by histology. The positive predictive value of transvaginal ultrasonography for the diagnosis of endometrioma and dermoid cysts was 96.4% and 97.1%, respectively. The false positive rates were 3.8% and 3.0%, respectively. There were no malignancies in either group.ConclusionsBased on the recognition of characteristic ultrasound patterns alone, the positive predictive value of transvaginal ultrasonography for the diagnosis of these common, benign cysts in premenopausal women is very high and can be used reliably to select women for appropriate surgery. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Reproducibility of ductus venosus Doppler flow measurements at 11–14 weeks of gestation
Authors: Prefumo F. , De Biasio P. , Venturini P. L. 
Published: March 2003

AbstractObjectivesTo assess the intra‐ and interobserver repeatabilities of fetal ductus venosus Doppler measurements at 11–14 weeks of gestation.DesignFlow velocity waveforms were recorded transabdominally. Intraobserver repeatability was studied in 22 fetuses in whom four repeated measurements were performed by the same observer. Interobserver repeatability was assessed in 54 fetuses in each of whom two observers performed two repeated measurements. The pulsatility index for veins (PIV), peak velocity during ventricular systole (S wave), peak velocity during atrial contraction (A wave) and time‐averaged maximum velocity (TAMV) were recorded. Reproducibility of the Doppler measurements was analyzed by calculating repeatability coefficient, coefficient of variation (CV), intraclass correlation coefficient (ICC), mean differences and their limits of agreement. Cohen's k‐coefficient was used for categorical data.ResultsIntraobserver repeatability was good with a CV of 10%, 13%, 22% and 13% and an ICC of 0.85, 0.94, 0.94 and 0.95, respectively, for PIV, S wave, A wave and TAMV. Interobserver repeatability was also good, and no bias between the observers was detected. A CV of 8.8%, 14%, 27% and 15% and an ICC of 0.86, 0.84, 0.87 and 0.84, respectively, for PIV, S wave, A wave and TAMV were obtained. There was 100% agreement for the detection of normal/abnormal blood flow.ConclusionsIntra‐ and interobserver repeatability of all parameters was acceptable, allowing for the detection of moderate to large changes in Doppler measurements. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of fetal ovarian hyperstimulation
Authors: Berezowski A. T. , Machado J. C. , Mendes M. C. , Moura M. D. , Duarte G. , Cunha S. P. 
Published: March 2003

AbstractA case of prenatal diagnosis of fetal ovarian hyperstimulation in a pregnancy of 35 weeks is reported. Two large cystic septate ovaries with no internal vegetations were observed in the fetal abdomen. The fetus was macrosomic and the remaining morphology was normal. Polyhydramnios and placental thickening were present, with no other macro‐ or microscopic alterations. The only significant maternal change detected was elevation of blood β‐human chorionic gonadotropin (β‐hCG) levels. Evaluation of the newborn confirmed the prenatal diagnosis, with progressive and spontaneous regression of fetal ovarian volume and of maternal serum β‐hCG occurring after delivery. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasound: a novel technique for investigating the urethral sphincter in the third trimester of pregnancy
Authors: Toozs‐Hobson P. , Khullar V. , Cardozo L. 
Published: March 2003

AbstractObjectivesTo measure urethral sphincter volume by three‐dimensional (3D) ultrasound. To assess the reproducibility of this measurement technique and to compare volumes obtained using 3D ultrasound with volumes calculated from a formula based on 2D ultrasound measurements.MethodsWomen were recruited as part of an ongoing study of changes to the pelvis resulting from pregnancy and childbirth. One hundred and eleven women in the third trimester of pregnancy (between 32 and 41 completed weeks' gestation) underwent a 3D transvaginal ultrasound scan of the urethra. In 10 cases the scan was analyzed twice by different observers to assess the reproducibility of the measurements from the scans and the results were analyzed using limits of agreement.ResultsThe interobserver error was consistent between all the linear, 2D and 3D measurements obtained from the area scanned. There was a significant difference between volumes calculated directly by 3D ultrasound and the approximated volumes from conventional 2D measurements.ConclusionsThree‐dimensional ultrasound appears to be a useful tool in measuring urethral sphincter volume. The error is consistent with that of linear and 2D imaging. However, the increase in normal range generated by biological variation in all three planes makes 3D ultrasound a more sensitive method of evaluating change to the urethral sphincter. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Power spectrum analysis of heart rate and blood flow velocity variability measured in the umbilical and uterine arteries in early pregnancy: a comparative study
Authors: Struijk P. C. , Ursem N. T. C. , Mathews J. , Clark E. B. , Keller B. B. , Wladimiroff J. W. 
Published: March 2003

AbstractObjectiveTo compare power spectral derived variability parameters from the fetal side of the placental circulation with those from the maternal side of the placental circulation, during early pregnancy.MethodsDoppler velocity waveforms were obtained from both the umbilical and the uterine arteries in a study group of 40 pregnant women between 10 and 14 (n = 25) and 15 and 20 (n = 15) weeks of gestation. The coefficient of variation of both the beat‐to‐beat heart rate variability and the blood flow velocity variability was determined. The ratio of the integrated low‐frequency components (< 0.2 Hz) and the integrated high‐ frequency components (> 0.2 Hz) from normalized power spectrum analysis (LH‐ratio) was established, to reflect sympathovagal balance.ResultsThe coefficient of variation and LH‐ratio of fetal heart rate variability constitute only a fraction of the same maternal heart rate variability parameters. Nevertheless a highly significant increase (P < 0.001) in LH‐ratio was demonstrated with advancing gestational age. The coefficient of variation and LH‐ratio of blood flow velocity variability were significantly lower in the fetal umbilical artery only in the 10–14‐weeks' gestation group. Due to a decrease of the maternal uterine blood flow velocity variability parameters with advancing gestational age, statistically equal fetal and maternal values for coefficient of variation and LH‐ratio were found in the 15–20 weeks' gestation group.ConclusionsThe increase in LH‐ratio of fetal heart rate variability indicates functional development of the fetal autonomic nervous system at 15–20 weeks' gestation. The umbilical blood flow velocity variability may be secondary to maternal uterine arterial flow variability rather than due to primary changes in fetal cardiovascular function. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
A critical appraisal of the use of umbilical artery Doppler ultrasound in high‐risk pregnancies: use of meta‐analyses in evidence‐based obstetrics
Authors: Westergaard H. B. , Langhoff‐Roos J. , Lingman G. , Marsál K. , Kreiner S. 
Published: March 2003

AbstractObjectivesTo reanalyze randomized controlled trials on the use of umbilical artery Doppler velocimetry in high‐risk pregnancies and determine which high‐risk pregnancies benefit from the use of Doppler velocimetry.MethodsSearching Medline, the Cochrane Library and Embase we found 13 randomized controlled trials on the use of Doppler velocimetry in high‐risk pregnancies. Of these, six included pregnancies with strictly defined suspected intrauterine growth restriction and/or hypertensive disease of pregnancy (‘well‐defined studies’); the rest included a great variety of high‐risk pregnancies (‘general risk studies’). The studies were analyzed with particular regard to the heterogeneity and to outcome. Audits of the perinatal deaths reported in the randomized controlled trials were performed by a panel of 32 international experts.ResultsThe ‘well‐defined studies’ had a more uniform study design as compared to the ‘general risk studies’ and they showed a significant reduction in antenatal admissions (odds ratio, 0.56; 95% confidence interval, 0.43–0.72), inductions of labor (0.78; 0.63–0.96), elective deliveries (inductions of labor and elective Cesarean sections) (0.73; 0.61–0.88) and Cesarean sections (0.78; 0.65–0.94). By perinatal audit it was found that more perinatal deaths in the ‘well‐defined studies’ were potentially avoidable by use of Doppler velocimetry (P < 0.0005) and the rate of avoidable perinatal deaths was higher among controls (50%) than cases (20%) in this group.ConclusionThe randomized controlled trials on umbilical artery Doppler velocimetry show major differences regarding study design and technical and clinical issues and, therefore, they should not be pooled in a simple meta‐analysis. By stratification it was found that only in pregnancies with suspected intrauterine growth restriction and/or hypertensive disease of pregnancy will the use of umbilical artery Doppler velocimetry reduce the number of perinatal deaths and unnecessary obstetric interventions. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonography combined with saline contrast sonohysterography in evaluating the uterine cavity in premenopausal patients with abnormal uterine bleeding
Authors: Dueholm M. , Forman A. , Jensen M. L. , Laursen H. , Kracht P. 
Published: March 2003

AbstractObjectivesTo evaluate whether saline contrast sonohysterography (SCSH) adds additional information to that obtained by transvaginal sonography (TVS) for predicting endometrial abnormality in premenopausal patients with abnormal uterine bleeding.Patients and methodsThis was a two‐center prospective study at a university clinic and a central hospital in Denmark. The uterine cavity was evaluated with TVS and SCSH in 470 premenopausal patients with abnormal uterine bleeding. One hundred and eighty‐nine of the patients had operative hysteroscopy or hysterectomy within 4 months which provided a detailed description of the uterine cavity and was used as the true value for exclusion of polyps and submucous myomas.ResultsBased on normal endometrial morphology alone, the results for detection of an abnormal uterine cavity were as follows: sensitivities of TVS 0.92, SCSH 0.99; specificities of TVS 0.62, SCSH 0.72; positive predictive values of TVS 0.80, SCSH 0.85; negative predictive values of TVS 0.82, SCSH 0.98. Transvaginal sonography combined with SCSH was superior to TVS for detection of intracavitary abnormalities (McNemar test, P = 0.008). The post‐test probability of there being an abnormal cavity after normal findings on TVS alone was 0.18 (0.10–0.32) and after TVS and SCSH it was 0.02 (0.01–0.11). When normal endometrial morphology was combined with an endometrial thickness of < 12 mm for evaluation of all abnormalities including hyperplasia, the diagnostic potential of TVS or SCSH was almost unchanged except for specificities, which were markedly lower (TVS 0.54; SCSH 0.57). In all the patients referred, TVS had a negative predictive value of 0.94 for identification of polyps and myomas when findings at subsequent SCSH were accepted as the true value. Transvaginal sonography reduced the pretest probability of polyps or submucous myomas from 0.35 to a post‐test probability of 0.06, but missed 21% of the polyps.ConclusionsSonohysterography was a sensitive tool and was superior to TVS used alone for evaluation of the uterine cavity in patients who underwent operative surgery for abnormal uterine bleeding. All abnormalities except one were found at SCSH, while TVS alone missed polyps and had almost one in four equivocal findings. The use of TVS, without saline contrast, left one in five of the polyps undiagnosed in referred patients with abnormal bleeding. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Doppler ultrasound examination of uterine arteries on the day of oocyte retrieval in patients with uterine fibroids undergoing in vitro fertilization treatment
Authors: Ernest N. H. , Ho P. 
Published: March 2003

Introduction:  There is no consensus whether uterine fibroids have any adverse effects on the outcomes of assisted reproduction treatment. This prospective study compared the implantation/pregnancy rates of women with and without fibroids undergoing in vitro fertilization/embryo transfer (IVF/ET) and measured uterine blood flow indices of the fibroid group.Methods:  Patients who had fibroids not distorting the endometrial lining during transvaginal scanning were in the fibroid group, while patients with normal uteri served as controls. Those with previous myomectomy or pedunculated subserosal fibroids only were excluded. All received a standard protocol of ovarian stimulation. Doppler ultrasound examinations of uterine arteries were carried out in the fibroid group prior to oocyte retrieval.Results:  Between February 2000 and April 2001, 389 consecutive patients were recruited, 77 (19.8%) in the fibroid group and 312 (80.2%) in the control group. The median diameter of the largest fibroid was 2.1 cm (mean 2.4 cm, 2.5th−97.5th centiles 1.0–6.1 cm). Similar implantation/pregnancy rates, multiple pregnancy rates and pregnancy outcomes were noted between both groups. In the fibroid group, significantly lower pulsatility (PI) and resistance (RI) indices of the right uterine artery and the average of right and left uterine arteries were found in non‐pregnant patients than pregnant patients.Conclusion:  The presence of fibroids not distorting the endometrial lining would not adversely affect implantation and pregnancy rates during IVF/ET treatment. Significantly lower uterine PI and RI were found in non‐pregnant women with fibroids than their pregnant counterparts.
The value of routine ultrasound screening for adnexal masses at the 11–14 weeks early anomaly scan
Authors: Salim R. , Woelfer B. , Aslam N. , Elson J. , Jurkovic D. 
Published: March 2003

Purpose:  To investigate the feasibility and possible advantages of routine screening for ovarian pathology in asymptomatic pregnant women at 11–14 weeks' gestation.Methods:  Pregnant women attending for a routine early anomaly scan at 11–14 weeks' gestation were invited to participate in this prospective study. In all cases, an attempt was made to visualize the ovaries on transabdominal ultrasound scan. The presence of all visible cysts was recorded. Small simple cysts <5 cm in diameter were all managed expectantly with no follow up. All women with a simple cyst >5 cm in diameter or a complex ovarian cyst had a detailed gynecological scan including color Doppler blood flow studies and serum tumor markers. Surgical intervention was offered only to women with clinical symptoms suggestive of cyst complications or those with ultrasound findings suggestive of malignancy. All other women were management expectantly until six weeks after delivery, when they were either discharged from follow up or were offered a definitive surgical intervention.Results:  A total of 2925 women were included into the study. Both ovaries were seen in 1755 (60%) of women, only one ovary was seen in 614 (21%) and neither ovary was seen in 556 (19%). The presence of an ovarian cyst was recorded in 728 (25%) women. A total of 400 (55%) of these were small simple cysts which did not warrant further follow up, whilst 328 (45%) had further scans. Two hundred and seventy‐eight of these cysts resolved spontaneously during pregnancy, two required surgical intervention in pregnancy, four were removed at cesarean section and 40 were still present on the postpartum scan. At postpartum scan, 11 women opted for further expectant management. The ultrasound diagnosis in these cases was dermoid cyst (8), endometrioma (2) and peritoneal pseudocyst (1). Histological diagnoses in 33 women who had surgery were: dermoid cyst (12) and endometrioma (8) benign ovarian cystadenoma (5), luteoma of pregnancy (1), corpus luteum cyst (1), hydrosalpinx (3) and fimbrial cyst (3). Six women were lost to follow up.Conclusions:  Asymptomatic ovarian cysts detected at routine ultrasound screening in the first trimester are unlikely to be malignant or cause clinical symptoms later in pregnancy. The policy of routine examination of the ovaries in pregnancy should therefore be discouraged.