bluuebunny/crossref_metadata_2025_split huggingface dataset:
High‐intensity focused ultrasound in the treatment of postpartum hemorrhage: an animal model
Authors: Nizard J. , Pessel M. , De Keersmaecker B. , Barbet J. P. , Ville Y. 
Published: March 2004

AbstractObjectiveTo investigate the use of high‐intensity focused ultrasound (HIFUS) to reduce uterine artery blood flow in ewes in the postpartum period.MethodsHIFUS was applied to the uterine arteries of seven ewes in the postpartum period. Arterial flow velocities were measured before and after the procedure at the site of HIFUS application (target), as well as 3 cm upstream and 3 cm downstream from the target. The uterine arteries were then removed for macroscopic and histological examination.ResultsMaximum flow velocities in the target area increased after the procedure by 350% and those upstream from the target decreased by 65%. Macroscopically, the vessel diameter was shown to have reduced at the site of HIFUS application. Microscopically, both the endothelium and media showed thermal lesions. Tissues surrounding the arteries were macroscopically and microscopically normal.ConclusionExposure of uterine arteries to HIFUS reduces the vessel diameter and thus induces a dramatic increase in the maximum flow velocities within the target area. HIFUS may have a role in the treatment of postpartum hemorrhage. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Assessment of the fetal nasal bone at 11–14 weeks of gestation by three‐dimensional ultrasound
Authors: Rembouskos G. , Cicero S. , Longo D. , Vandecruys H. , Nicolaides K. H. 
Published: March 2004

AbstractObjectiveTo evaluate the benefit of three‐dimensional (3D) ultrasound in the examination of the fetal nasal bone at 11–14 weeks of gestation.MethodWe examined the fetal nasal bone in 120 stored volumes acquired transabdominally with a 3D scanner from singleton pregnancies at 11–14 weeks of gestation. The volume acquisition had been performed following conventional ultrasound examination that had demonstrated presence of the fetal nasal bone. The volumes were obtained with two‐dimensional (2D) start images in transverse, coronal mid‐sagittal, parasagittal and oblique longitudinal sections of the fetal head.ResultsIn the transverse and coronal sections, a satisfactory image demonstrating presence of the nasal bone was achieved in only three and one, respectively, of the 20 volumes that we obtained. In mid‐sagittal sections, the nasal bone was always visible when the angle was within a range of 30–60°, without the need for sectional image analysis. None of the images with an angle >60° or <30° was satisfactory. In the parasagittal sections with the fetal profile at 45°, a good‐quality image of the nasal bone was possible in all cases that were examined, irrespective of the distance from the mid‐sagittal plane. In the oblique longitudinal sections with the fetal profile at 45°, there were 10 volumes where the 2D start section was at 0–25° from the midline and in all these cases the nasal bone was successfully visualized. In contrast, only 5/20 cases where the 2D start section was at 25–90° from the midline provided a satisfactory image demonstrating the nasal bone. In 5/10 volumes obtained with the fetus facing downwards the nasal bone was visible in both the 2D and 3D images.ConclusionIn a 3D volume the extent to which the nasal bone can be demonstrated to be present in a given reconstructed section is entirely dependent on obtaining a good initial 2D view. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Do maternal cerebral vascular changes assessed by transcranial Doppler antedate pre‐eclampsia?
Authors: Williams K. P. , Moutquin J. M. 
Published: March 2004

AbstractObjectiveTo determine whether maternal transcranial Doppler (TCD) evaluation of the middle cerebral artery identifies changes in the cerebral circulation prior to the development of pre‐eclampsia.MethodsIn a nested, case‐controlled study developed from a previous prospective cohort study, 20 pre‐eclamptic and 40 normotensive pregnancies, matched for maternal age, were assessed with the traditional middle cerebrovascular Doppler parameters (pulsatility index, mean cerebral blood flow velocity), together with non‐traditional Doppler parameters including time taken to achieve end systole (EST) and percentage time to achieve end systole (% EST). Assessments done at 20–24 and 28–32 weeks' gestational age were compared using Student's t‐tests. Significance was set at the P < 0.05 level.ResultsIn the second trimester (20–24 weeks) there were no significant differences in any of the Doppler waveform characteristics in either group. In the third trimester (28–32 weeks) there was a significant increase in the % EST in the group who subsequently developed pre‐eclampsia (45.2 ± 4.2 vs. 42.3 ± 4.1; P < 0.01).ConclusionsPatients who subsequently develop pre‐eclampsia show a significant lengthening in the EST in the third trimester as a late finding, which indicates an increase in the cerebrovascular resistance. Earlier prediction of pre‐eclampsia using TCD waveform analysis will require more provocative testing (i.e. hand grip and CO2 reactivity). Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Umbilical cord diameter at 11–14 weeks of gestation: relation to chromosomal defects
Authors: Rembouskos G. , Cicero S. , Papadopoulos V. , Tripsanas C. , Nicolaides K. H. 
Published: March 2004

AbstractObjectiveTo determine the potential value of measuring umbilical cord diameter (UCD) at 11–14 weeks of gestation in screening for chromosomal defects.MethodsThe UCD was measured in 1323 fetuses immediately before chorionic villus sampling for karyotyping at 11–14 weeks of gestation. In the group of chromosomally normal fetuses, regression analysis was used to determine the association between UCD and crown–rump length (CRL). UCD was compared in normal fetuses and those with chromosomal abnormalities.ResultsThe median gestation was 12 (range, 11–14) weeks. The UCD was successfully measured in all cases. The fetal karyotype was normal in 1150 pregnancies and abnormal in 173, including 97 cases of trisomy 21. In the chromosomally normal group the UCD increased significantly with CRL from a mean of 2.9 mm at a CRL of 45 mm to 4.4 mm at a CRL of 84 mm. The UCD in the group of fetuses with trisomy 21 was significantly smaller than normal. Conversely, there were no significant differences from normal in the UCD of fetuses with other chromosomal abnormalities.ConclusionAt 11–14 weeks of gestation the UCD of fetuses with trisomy 21 is significantly smaller than normal but the magnitude of the difference is too small for useful inclusion of this measurement in screening. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Cesarean scar pregnancy: issues in management
Authors: Seow K.‐M. , Huang L.‐W. , Lin Y.‐H. , Yan‐Sheng Lin M. , Tsai Y.‐L. , Hwang J.‐L. 
Published: March 2004

AbstractObjectiveTo evaluate our experience with the diagnosis and treatment of Cesarean scar pregnancy.MethodsDuring a 6‐year period, 12 cases of Cesarean scar pregnancy were diagnosed using transvaginal color Doppler sonography and treated conservatively to preserve fertility. Incidence, gestational age, sonographic findings, β‐human chorionic gonadotropin ( β‐hCG) levels, flow profiles of transvaginal color Doppler ultrasound, and methods of treatment were recorded.ResultsThe incidence of Cesarean scar pregnancy was 1:2216 and its rate was 6.1% in women with an ectopic pregnancy and at least one previous Cesarean section. Gestational age at diagnosis ranged from 5 + 0 to 12 + 4 weeks. The time interval from the last Cesarean section to the diagnosis of Cesarean scar pregnancy ranged from 6 months to 12 years. High‐velocity and low‐impedance subtrophoblastic flow (resistance index, 0.38) persisted until β‐hCG declined to normal. Patients were treated as follows: transvaginal ultrasound‐guided injection of methotrexate into the embryo or gestational sac (n = 3), transabdominal ultrasound‐guided injection of methotrexate (n = 2), transabdominal ultrasound‐guided injection of methotrexate followed by systemic methotrexate administration (n = 2), systemic methotrexate administration alone (n = 2), dilatation and curettage (n = 2), or local resection of the gestation mass (n = 1). Eleven of the 12 patients preserved their reproductive capacity; the remaining patient, treated by dilatation and curettage, underwent a hysterectomy because of profuse vaginal bleeding. The Cesarean scar mass regressed from 2 months to as long as 1 year after treatment. Uterine rupture occurred in one patient during the following pregnancy at 38 + 3 weeks' gestational age.ConclusionUltrasound‐guided methotrexate injection emerges as the treatment of choice to terminate Cesarean scar pregnancy. Surgical or invasive techniques, including dilatation and curettage are not recommended for Cesarean scar pregnancy due to high morbidity and poor prognosis. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Affective state of women following a prenatal diagnosis: predictors of a negative psychological outcome
Authors: Leithner K. , Maar A. , Fischer‐Kern M. , Hilger E. , Löffler‐Stastka H. , Ponocny‐Seliger E. 
Published: March 2004

AbstractObjectiveThe benefits of prenatal diagnostic procedures are well documented. However, the investigation of psychological consequences related to these procedures has remained a surprisingly neglected area of research. The main aim of the present study was to investigate the potential relationship between psychological outcome and associated (socio‐demographic, psychological and obstetric) variables in women attending a tertiary referral center for prenatal diagnosis and therapy for ultrasound scanning (due to the suspicion of a fetal malformation raised by the gynecologist in private practice), amniocentesis or chorionic villus sampling.MethodsAffective state was assessed by means of standardized measures of anxiety and depression (State‐Trait Anxiety Inventory; Mood Scale) in 77 consecutive, unselected women. A follow‐up investigation, including an additional assessment of coping mechanisms, took place 6 months after the first contact. Given the considerable number of intervening and correlating factors, a path analysis was undertaken.ResultsWe found that all women in our sample experienced acute distress, not only those with proven fetal malformations, genetic disorders or intrauterine fetal death, but also those with the diagnosis of a sonographic sign. At baseline (i.e. immediately after the diagnostic procedure), mood and anxiety scores in our sample were found to be comparable to those of patients with a major depressive episode. A high trait anxiety level, implementation of negative coping strategies and loss of the child during pregnancy were found to be predictive of a negative psychological outcome at follow‐up. Socio‐demographic variables did not have a significant predictive function for the psychological outcome.ConclusionsWe assume that a considerable number of women undergoing prenatal diagnostic procedures experience psychological distress, which may be underestimated by workers in prenatal care. Establishment of interdisciplinary treatment settings, in which access to psychological support is facilitated, may be extremely beneficial for women following a prenatal diagnosis. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Introital ultrasound of the lower genital tract before and after colposuspension: a 4‐year objective follow‐up
Authors: Viereck V. , Pauer H.‐U. , Bader W. , Oppermann M. , Hilgers R. , Gauruder‐Burmester A. , Lange R. , Emons G. , Hackenberg R. , Krauß T. 
Published: March 2004

AbstractObjectiveTo assess the topography of the bladder neck by introital ultrasound before and after open colposuspension.MethodsThree hundred and ten women with urodynamically proven stress urinary incontinence were included in this long‐term study to investigate the position and function of the bladder neck at rest and during straining. Height (H), distance (D), and urethrovesical angle of the bladder neck (β) were measured by means of preoperative and postoperative introital ultrasound. Women were followed up; 152 of them (49%) completed 48 months of follow‐up.ResultsAt the 6‐month follow‐up examination, 90.0% of the women were continent (279/310), 3.5% (11/310) showed voiding difficulties, 3.5% (11/310) had urgency, and 1.6% (5/310) had developed de novo urge incontinence. At the 48‐month follow‐up, 76.8% of the patients were still continent. All postoperative measurements yielded significantly lower values for angle β at rest and during straining compared with the preoperative results (P < 0.0001). The median linear movement of the bladder neck during straining decreased from 18.0 mm before surgery to 6.4 mm at the 48‐month follow‐up (P < 0.0001). The median level of ventrocranial elevation of the vesicourethral junction was 14.3 mm immediately after surgery, 9.9 mm after 6 months and 6.6 mm after 48 months. The degree of surgical bladder‐neck elevation was associated with postoperative urgency/de novo urge incontinence (P < 0.0001) and voiding difficulty (P < 0.0001).ConclusionsThe colposuspension procedure reduces angle β at rest and during straining, restricts linear movement with straining, and elevates the bladder neck. Perioperative introital ultrasound improves understanding of this surgical procedure and might help to prevent postoperative complications. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Two‐ and three‐dimensional sonographic assessment of the fetal face. 1. A systematic analysis of the normal face
Authors: Rotten D. , Levaillant J. M. 
Published: March 2004

AbstractObjectivesTo detail fetal facial examination in utero using ultrasound, to distinguish between requirements for routine screening and those for precise analysis of fetal facial features, and to assess the use of three‐dimensional (3D) ultrasound imaging in fetal facial examination.MethodsThis was a retrospective study, based on the examination of approximately 10 500 fetuses. The usual age at screening ultrasound examination was 22 ± 1 gestational weeks.ResultsThe sonographic anatomy of the normal fetal face was depicted, and the relevance of the three reference scanning planes, sagittal, coronal and axial, was specified.ConclusionsAt routine screening using two‐dimensional sonography, at least two selected views must be imaged: the mid‐sagittal plane (search for facial dysmorphology) and the anterior ‘nose–mouth’ coronal plane (search for disruption in lip continuity or deformation of the narinal bend). Precise analysis of fetal facial anomalies requires visualization and thorough step‐by‐step analysis in the three planes. The difference between routine screening and precise facial features' analysis has been greatly decreased since 3D and 4D sonography have become readily available. Using this modality, after surface analysis of the fetal face, the three reference planes are simultaneously imaged, using the multiplanar modality, and detailed. 3D/4D ultrasound imaging allows easier, more rapid screening and more precise evaluation of the different facial features. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
The ‘iris effect’: how two‐dimensional and three‐dimensional ultrasound can help us understand anti‐incontinence procedures
Authors: Dietz H. P. , Wilson P. D. 
Published: March 2004

AbstractObjectiveThe objective of this prospective, observational study in patients after tension‐free vaginal tape (TVT™) implantation was to describe the spatial relationship between suburethral sling implants, urethra and bony pelvis with the help of translabial two‐dimensional and three‐dimensional (3D) ultrasound.MethodsA total of 141 women were examined by translabial ultrasound, supine and after voiding. The TVT sling is highly echogenic and easily identified posterior to the urethra. Tape location was described in the mid‐sagittal plane relative to bladder neck and inferoposterior symphyseal margin, at rest and on Valsalva maneuver. In a subset of 83 women, 3D volume ultrasound was performed.ResultsThe cranial tape margin was situated on average 9.3 mm above and 16.5 mm posterior to the symphyseal margin (Valsalva: 3.9 mm below and 9.6 mm behind the symphysis); the average tape movement on Valsalva was 16 (range, 2–34.2) mm. The distance between tape and inferoposterior symphyseal margin narrowed highly significantly from 20.4 ± 4.3 mm at rest to 12.9 ± 3.9 mm on Valsalva (P < 0.001). When a fitted line plot was placed through tape coordinates on an x–y coordinate system, it became evident that tape movement occurs in an arc around the fulcrum of the posterior symphysis pubis. The result is an increasing reduction in the gap between tape and symphysis pubis (termed the ‘iris effect’), implying mechanical compression of the urethra.ConclusionsThe curative effect of the TVT on stress incontinence is likely to be due to mechanical compression of the urethra between implant and symphysis pubis. A large variation in tape location and movement explains its wide margin of clinical safety and efficacy. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Transvaginal sonographic appearance of peritoneal pseudocysts
Authors: Savelli L. , De Iaco P. , Ghi T. , Bovicelli L. , Rosati F. , Cacciatore B. 
Published: March 2004

AbstractObjectiveTo describe the sonographic features of peritoneal pseudocysts (PPCs) in order to determine the particular aspects that distinguish them from true ovarian cysts.MethodsThirty‐one women with PPCs were investigated using transvaginal sonography immediately before surgery. The diameters of the cysts were measured, and the shape, margins, content, location, presence of septa and echogenic portions were analyzed.ResultsThe PPCs were monolateral in 20 (65%) and bilateral in 11 (35%) women. A well‐defined cystic structure was found in only six (19%) women, while in the other 25 (81%) women the PPCs showed blurred, undefined margins and a bizarre morphology, giving them a star‐like tubular or lumpy shape. The ipsilateral ovary was identified in 26 (84%) cases either external to the cyst or entrapped within it like a ‘spider in a web’. Septa were present in 25 (81%) cases and were often mobile, resembling a ‘flapping sail’ when touched by the endovaginal probe.ConclusionDespite having a gross morphology resembling that of a true ovarian cyst, PPCs present some characteristic sonographic findings that allow a correct differential diagnosis in the vast majority of cases. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Correlating structure and function: three‐dimensional ultrasound of the urethral sphincter
Authors: Robinson D. , Toozs‐Hobson P. , Cardozo L. , Digesu A. 
Published: March 2004

AbstractObjectiveThree‐dimensional (3D) ultrasound facilitates assessment of the anatomy of the urethral sphincter, a decrease in sphincter volume being associated with stress incontinence. Urethral pressure profilometry (UPP) is used to assess urethral sphincter function although it is not diagnostic of stress incontinence. The aim of this pilot study was to determine whether 3D sphincter volume can be correlated with the area under the UPP curve.MethodsPrimigravid women were recruited antenatally between 32 and 42 weeks' gestation. 3D transvaginal ultrasound scans of the urethra were performed in modified lithotomy position with a comfortably full bladder. Length and cross‐sectional area were measured allowing the sphincter volume to be calculated. UPP measurements were performed with a Gaeltec solid‐state pressure transducer and the area under the curve mapped out and calculated. All scans and measurements were repeated between 3 and 6 months postpartum.ResultsNineteen women participated in the study. Antenatal and postnatal data were available in all cases. There was a statistically significant correlation between antenatal sphincter volumes and area under the UPP curve although this relationship was lost following delivery.ConclusionsThere appears to be a correlation between structural anatomy and functional anatomy in the antenatal period although following delivery this is lost. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Likelihood ratio for trisomy 21 in fetuses with absent nasal bone at the 11–14‐week scan
Authors: Cicero S. , Rembouskos G. , Vandecruys H. , Hogg M. , Nicolaides K. H. 
Published: March 2004

AbstractObjectiveTo update the likelihood ratio for trisomy 21 in fetuses with absent nasal bone at the 11–14‐week scan.MethodsUltrasound examination of the fetal profile was carried out and the presence or absence of the nasal bone was noted immediately before karyotyping in 5918 fetuses at 11 to 13+6 weeks. Logistic regression analysis was used to examine the effect of maternal ethnic origin and fetal crown–rump length (CRL) and nuchal translucency (NT) on the incidence of absent nasal bone in the chromosomally normal and trisomy 21 fetuses.ResultsThe fetal profile was successfully examined in 5851 (98.9%) cases. In 5223/5851 cases the fetal karyotype was normal and in 628 cases it was abnormal. In the chromosomally normal group the incidence of absent nasal bone was related first to the ethnic origin of the mother, being 2.2% for Caucasians, 9.0% for Afro‐Caribbeans and 5.0% for Asians; second to fetal CRL, being 4.7% for CRL of 45–54 mm, 3.4% for CRL of 55–64 mm, 1.4% for CRL of 65–74 mm and 1% for CRL of 75–84 mm; and third to NT, being 1.6% for NT ≤ 95th centile, 2.7% for NT > 95th centile–3.4 mm, 5.4% for NT 3.5–4.4 mm, 6% for NT 4.5–5.4 mm and 15% for NT ≥ 5.5 mm. In the chromosomally abnormal group there was absent nasal bone in 229/333 (68.8%) cases with trisomy 21 and in 95/295 (32.2%) cases with other chromosomal defects. Logistic regression analysis demonstrated that in the chromosomally normal fetuses significant independent prediction of the likelihood of absent nasal bone was provided by CRL, NT and Afro‐Caribbean ethnic group, and in the trisomy 21 fetuses by CRL and NT. The likelihood ratio for trisomy 21 for absent nasal bone was derived by dividing the likelihood in trisomy 21 by that in normal fetuses.ConclusionAt the 11–14‐week scan the incidence of absent nasal bone is related to the presence or absence of chromosomal defects, CRL, NT and ethnic origin. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
Enlarged adrenal glands as a prenatal marker of congenital adrenal hyperplasia: a report of two cases
Authors: Esser T. , Chaoui R. 
Published: March 2004

AbstractWe report the prenatal findings of congenital adrenal hyperplasia (CAH) in two consecutive fetuses of one family. The first pregnancy was terminated at 23 weeks' gestation due to the presence of a complex heart anomaly. The adrenal glands appeared enlarged on prenatal ultrasound examination and autopsy confirmed CAH. The parents were subsequently examined and were found to be heterozygous for nucleotide 656 of the CYP21B gene. In a subsequent pregnancy, chorionic villus sampling at 11 weeks confirmed CAH in the male fetus. At this gestational age, mild body edema was present and the nuchal translucency measured 2.1 mm. From 14 weeks onwards, enlargement of the adrenal glands was the only sign of CAH. These findings suggest that enlarged adrenal glands may be a prenatal sign for CAH. In fetal medicine, when a pregnancy is terminated due to fetal malformations, autopsy should be performed because it can provide additional information that is helpful in counseling women with regard to subsequent pregnancies. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.