bluuebunny/crossref_metadata_2025_split huggingface dataset:
Longitudinal survey of blood flow at three different locations in the middle cerebral artery in normal fetuses
Authors: Hsieh Y.‐Y. , Chang C.‐C. , Tsai H.‐D. , Tsai C.‐H. 
Published: March 2003

AbstractObjectivesTo assess vascular impedance at three different locations in the middle cerebral artery (MCA) in normal fetuses throughout gestation.Materials and methodsUncomplicated singleton pregnancies at 15–40 weeks' gestation in which Doppler surveys of both MCAs could be obtained were recruited. The pulsatility index (PI) and resistance index (RI) of the proximal, mid and distal sites of both MCAs were measured. The five gestation periods at which the Doppler surveys were performed were (i) 15–19 completed weeks; (ii) 20–24 completed weeks; (iii) 25–29 completed weeks; (iv) 30–34 completed weeks; (v) 35–39 completed weeks.ResultsA total of 42 fetuses were recruited. The average PI/RI values of the proximal, mid and distal MCA were 1.61/0.82, 1.77/0.82, and 1.84/0.84, respectively. The PI value of the proximal MCA was lower than that of the mid and distal MCA. The PI values of the mid and distal MCA showed no difference. The RI value of the MCA from the three locations also showed no difference. The PI/RI values of MCA for each gestational phase were: (i) 1.81/0.87; (ii) 1.79/0.86; (iii) 1.78/0.86; (iv) 1.70/0.81; (v) 1.62/0.77, respectively. Decreased PI/RI values were observed after 30 weeks' gestation.ConclusionsThe PI values of the proximal MCA are lower than those of the mid and distal MCA. A marked decrease in PI/RI values was observed after 30 weeks' gestation. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Fetal cardiac performance in uncomplicated and well‐controlled maternal type I diabetes
Authors: Jaeggi E. T. , Fouron J.‐C. , Proulx F. 
Published: March 2003

AbstractObjectiveTo study the impact of well‐controlled, uncomplicated maternal diabetes on fetal cardiac development and performance.MethodsThe following variables were studied in 45 fetuses of type I diabetic women by means of mid‐ and late‐trimester echocardiography: interventricular septal thickness; aortic and pulmonary valve diameters; peak and time‐to‐peak flow velocity of the great arteries; the ratio between peak velocities during early (E) and late (A) ventricular filling at the level of the atrioventricular valves; ventricular fractional shortenings; and output. The findings were compared to age‐matched control groups of normal fetuses.ResultsA significant augmentation of interventricular septal thickness was demonstrated for mid‐trimester fetuses of diabetic women, which progressed further towards the end of pregnancy. However, the indices of diastolic and systolic function remained comparable between the gestational age‐matched groups.ConclusionProgressive myocardial thickening occurs commonly in mid‐ and late‐trimester fetuses of uncomplicated and well‐controlled diabetic pregnancies. The observed degree of hypertrophy is generally mild and does not affect age‐related changes in fetal cardiac function. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Fetal transcerebellar diameter and chromosomal abnormalities
Authors: Vinkesteijn A. S. M. , Jansen C. L. R. , Los F. J. , Mulder P. G. H. , Wladimiroff J. W. 
Published: March 2003

AbstractObjectiveTo evaluate the association between chromosomal abnormalities and fetal cerebellar size.DesignA retrospective cross‐sectional study.MethodsUltrasound measurements of transcerebellar diameter, head and upper‐abdominal circumference from 88 fetuses with chromosomal abnormalities were analyzed. Abnormalities included trisomy 21 (n = 23), trisomy 18 (n = 17), ‘other numerical chromosomal abnormalities’ (n = 9), sex chromosomal abnormalities (n = 9), mosaicism (n = 12), balanced translocations (n = 9) and unbalanced translocations (n = 9). Multiple regression analysis was performed to compare transcerebellar diameters between the reference group and each of the subsets of chromosomal abnormalities and between trisomies 18 and 21. Also, in the latter two subsets, comparison of the transcerebellar diameter before and after 25 weeks of gestation was carried out.ResultsFetal transcerebellar diameter was reduced in relation to gestational age but was normal when control was made for fetal size in all chromosomal subsets, except for balanced translocations. The transcerebellar diameter in trisomy 18 was significantly smaller than that in trisomy 21. No difference in cerebellar size was found when comparing the gestational age period before and after 25 weeks in each of these two subsets.ConclusionsA reduction in fetal transcerebellar diameter was demonstrated in all chromosomal abnormalities with imbalance of genetic material. Cerebellar hypoplasia was more severe in trisomy 18 than in trisomy 21. The degree of reduction in fetal transcerebellar diameter in these subsets seems to be independent of the time period during which the transcerebellar diameter measurement was performed. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound‐indicated cervical cerclage: operative findings and preoperative cervical length predict outcome
Authors: Groom K. M. , Shennan A. H. , Bennett P. R. 
Published: March 2003

Objectives:  To relate preoperative cervical length, operative findings, postoperative cervical length and pregnancy outcome in high risk women treated with ultrasound indicated cervical cerclage to establish if it was possible to determine the most appropriate criteria to offer cervical cerclage.Study design:  A prospective observational study of 305 high risk women undergoing serial transvaginal ultrasonographic assessment of cervical length during the second trimester. Fifty‐four women met criteria for cerclage (cervical length <15 mm, significant progressive shortening to <25 mm or funneling >50%). Data concerning preoperative cervical length, operative findings, postoperative cervical length and pregnancy outcome was collected, and analyzed data is expressed as median values. Statistical analysis was performed using Fisher's exact and Mann–Whitney U‐tests.Results:  Gestation at delivery was 37 ± 5 weeks, suture insertion to delivery interval was 115 days and overall fetal survival rate was 85.2%. Median preoperative cervical length was 15.0 mm. Median gestation at suture insertion was 19 ± 5 weeks. There was a significant increase in postoperative cervical length 15.0 vs. 25.0 mm (P < 0.0001). Fetal membranes were visible in 19% of cases at the time of surgery, this occurred in 75, 5, and 0% cases with a cervical length <10, 11–15 and >15 mm, respectively. Overall outcome was considerably worse for those cases with visible membranes at the time of surgery than for those with no visible membranes (gestation at delivery 23 ± 0 vs. 38 ± 2 weeks (P = 0.002), suture insertion to delivery interval 17 vs. 122 days (P < 0.0001), fetal survival rates 50 vs. 93% (P = 0.0005)). This finding was regardless of preoperative cervical length (of all women with preoperative cervical length <15 mm (n = 31) gestation at delivery 25 ± 1 vs. 35 ± 5 (P = 0.008), suture insertion to delivery interval 17 vs. 119 days (P = 0.0005), fetal survival rate 50 vs. 90%).Conclusions:  In a high risk population undergoing serial transvaginal ultrasound surveillance of cervical length, regardless of preoperative cervical length, the presence of visible membranes at the time of suture insertion is associated with a poor outcome. Fetal membranes were not visible in any case with a preoperative cervical length >15 mm. These findings support a concept of cervical cerclage at a cervical length of 15 mm.
Regional variation in power Doppler perfusion measurements within normal placenta
Authors: Welsh A. W. , Fisk N. M. 
Published: March 2003

Background:  Power Doppler ultrasound is well suited to the evaluation of placental perfusion, with its sensitivity to low flow, lack of aliasing and relative angle independence. Previously published work from our group has proposed the use of power Doppler evaluation of abnormal placentation to monitor progress after significant placental abruption. Commercially available software (CQ Analysis, Kinetic Imaging Ltd., UK) is able to segment color flow information from compound color/greyscale images and express flow information in relation to vessels (mean color velocity or energy) or tissue (percentage integrated velocity or energy). Care must be taken to either standardize power Doppler values to local regions of 100% blood flow or alternatively to compare regions at the same depth and machine settings sat the same examination.Methods:  Ten patients with uncomplicated pregnancies were recruited for additional power Doppler ultrasound examination. All were in the third trimester with anterior placentas. The placental location was initially mapped, and then separate regions were chosen, approximating to different placental quadrants. With constant machine settings for each case, and depth being constant, multiple clips were stored from each region. After image segmentation, all frames were examined individually to exclude any with movement or flash artefact. The percentage of ICE was measured in each frame: firstly, carefully tracing the fetal placental vessels away from the surface and secondly, using an oval shaped region of interest as defined by CQ Analysis. From these two regions, two different examinations were performed, averaging over the whole clip to remove cardiac cycle effects, and looking manually at systolic frames only.Results:  A total of 8156 frames were analyzed, of these 872 selected as systolic. The variation in regional perfusion assessed with power Doppler from normal placenta ranged from 19 to 132%. There were no statistically significant differences in reproducibility for the techniques for region selection and for region selection.Conclusions:  In this study, an attempt was made to show the high degree of variation in normal perfusion within the human placenta as a function of space. Unlike other organs where power Doppler perfusion evaluation may be linked to specific planes or landmarks, this is not technically possible with the placenta. An exception to this may be within areas of pathological placentation that are followed prospectively. However, caution should be exercised in the use of power Doppler for evaluation of normal human placenta perfusion.Acknowledgements:  Alec Welsh was supported by a Research Training Fellowship from RCOG/WellBeing, the BUPA Research Foundation Clinical Scientist Award 2000 and the 2001 Bernhard Baron/RCOG Travelling Scholarship.
The importance of funneling to the level of a cervical cerclage
Authors: O'Brien J. M. , Hill A. L. , Barton J. R. 
Published: March 2003

Purpose:  Our purpose was to evaluate the utility of ultrasound surveillance after cerclage placement and to propose a rationale for cervical sonography in this setting.Methods:  A retrospective case series was evaluated. Women undergoing cervical cerclage by a maternal–fetal medicine specialist regardless of indication and delivering between January 1999 and April 2001 were included. Transvaginal assessment of cervical length and the degree of cervical funneling after cerclage were compared to preoperative values and to outcomes. Funneling to the cerclage was defined as membranes prolapsing down the endocervical canal until they reached the plane of the cerclage.Results:  A total of 53 cases were available for analysis. Cervical cerclage resulted in a significant increase in cervical length as the mean length increased from 2.1 ± 1.2 cm to 2.9 ± 0.8 cm after the procedure, P < 0.001, but this measure was not correlated with gestational age at delivery. Funneling to the level of the cerclage, however, was associated with an earlier gestational age at delivery 31.3 ± 5.6 weeks vs. 36.8 ± 2.8 weeks for those cases without this finding, P < 0.001. This observation was statistically significant irrespective of the indication for the procedure and was noted by 28 weeks' gestation in all patients followed. The incidence of premature rupture of the membranes was also significantly greater postcerclage in women with descent of the membranes to the cerclage (52%) vs. those without this finding (3%, P = 0.002).Conclusions:  Funneling to the cerclage has predictive value for earlier preterm delivery in patients who have undergone cervical cerclage. Serial sonography up to 28 weeks' gestation may be useful in identifying patients at higher risk for premature rupture of the membranes.
Abnormal ductus venosus blood flow in fetuses with normal nuchal translucency (NT)
Authors: Char Sang Choon , Yamasaki A. A. , Pares D. 
Published: March 2003

Objective:  To assess the incidence of reverse flow during atrial contraction at ductus venosus in fetuses with normal nuchal translucency and correlation with cardiac abnormalities.Methods:  Ductus venosus Doppler ultrasound blood flow velocity waveform were obtained in 932 fetuses with 11–14 weeks' gestation during measurement of nuchal translucency.Results:  Among 932 fetuses, NT was increased in 43 (4.6%). The incidence of reverse flow was observed in 5.4% of fetuses with normal NT (2.5 mm) and 13.9% of fetuses with increased NT (>2.5 mm). Among fetuses with normal NT, there was no cardiac abnormalities observed.Conclusion:  Reversed flow in fetuses with normal NT is not associated with cardiac abnormalities.
Nuchal translucency screening and antenatal maternal serum screening for Down syndrome: results of a project
Authors: Benavides C. E. , Garcia C. C. , Lagos N. C. , Melgarejo X. C. , Ferres M. I. C. 
Published: March 2003

Objectives:  To asses the implementation of antenatal screening for Down syndrome using individual risk estimates based on maternal age, nuchal translucency and three serum markers; alpha fetoprotein, unconjugated estriol and human chorionic gonadotrophin (hCG) in maternal blood. Women with an estimated risk of 1 in 250 or greater were classified as screen positive and offered diagnostic amniocentesis.Subjects:  A total of 1956 women of all ages with singleton pregnancies seen between June 1999 and March 2001.Results:  The screening result of combination of first trimester ultrasonographic and serum screening was 85% Down syndrome detection and the false positive rate was 3%. The median gestational age of nuchal translucency was 11 weeks and the time of serum screening was 16 weeks.Conclusion:  The combination of nuchal translucency and serum screening increases the Down syndrome detection and decreases the false positive rate. Is very important because the amniocentesis is associated with a risk of pregnancy loss from 0.5 to 1%. Besides, it is cost‐effective and performs better than the selection for amniocentesis on the basis of maternal age only, nuchal translucency only or serum screening.
Associated anomalies and perinatal outcome in fetuses with prenatally diagnosed single umbilical artery
Authors: Park M. H. , Oh K. Y. , Park J. S. 
Published: March 2003

Objective:  To evaluate pattern of associated structural anomalies, abnormal karyotypes and perinatal outcomes of fetuses with prenatally diagnosed single umbilical artery and to evaluate the relation of absent side of a single umbilical artery in association with anomalies and abnormal karyotypes.Materials and methods:  Thirty fetuses with a single umbilical artery were detected by prenatal ultrasound examination between March 1998 and June 2001 at Eul‐Ji University Hospital. All medical records were reviewed for maternal demographics, associated anomalies, karyotypic analysis, pregnancy complications, and neonatal outcome.Results:  Of the 30 fetuses, 11 (36.7%) were terminated because of severe anomalies and 1 (3.3%) experienced neonatal death. 17 fetuses (56.7%) had an associated structural anomaly. The structural anomalies found in association with single umbilical artery were multiple malformations (seven cases, 41.2%), cardiovascular anomalies (four cases, 23.5%), urinogenital anomalies (four cases, 23.5%), CNS anomalies (one case, 5.9%) and ectopia cordis (one case, 5.9%). Karyotype analysis was available in 25 cases and 5 of these were chromosomally abnormal. All of the karyotypically abnormal fetuses had a structural defect diagnosed on prenatal ultrasound examination in addition to the single umbilical artery. Of the 13 fetuses without any associated structural or chromosomal anomalies, 3 (23.1%) demonstrated growth restriction. Of the 26 cases identified, the absent side of a single umbilical artery, the right umbilical artery was absent in 13 (50%) and the left in 13 (50%) fetuses. The frequency with associated structural and chromosomal anomalies was equal on right (46.2, 15.4%) and left (69.2, 23.1%) sides.Conclusion:  When single umbilical artery is detected, a detailed ultrasonographic examination and fetal karyotyping should be recommended for search of associated structural and chromosomal abnormalities. In cases, where single umbilical artery is an isolated finding on prenatal ultrasound, careful attention to fetal growth is necessary.
Dystrophic calcification within fetal myocardium: a case report
Authors: Rowlands S. L. , Sampson A. J. , Kahler S. 
Published: March 2003

A woman presented at 19 weeks gestation for a second opinion of an echogenic cardiac focus. The pregnancy had been complicated by 2 episodes of first trimester vaginal bleeding. She had no significant personal or family medical history. The ultrasound reported a viable fetus with biometry equivalent to 19 weeks gestation. Morphological examination revealed an anatomically normal heart, but there were multiple echogenic foci present within the myocardium. These ranged in size from 2 to 6 mm, and were within both ventricular walls and the interventricular septum. There were no abnormalities of cardiac blood flow. The remaining morphology was normal, the amniotic fluid volume was appropriate and the fetus was active. Rhabdomyomata were thought to be the likely diagnosis. Their association with tuberous sclerosis was discussed and the couple elected to terminate the pregnancy. Postmortem examination showed these echogenic foci to be multiple areas of dystrophic calcification. These were isolated findings. There were no features of rhabdomyomata. Dystrophic calcification within the fetal myocardium has rarely been reported at autopsy. It is thought to represent sites of injury to the myocardium. There are few previous reports of its antenatal detection on ultrasound later confirmed at autopsy and, although reported in fetuses which are stillborn or miscarried, it is rarely otherwise seen (Veldtman et al. Heart 1999; 81: 92–93). Although generalized ischemia can lead to myocardial calcification in older individuals, the present case and those reported by Veldtman et al. do not show evidence of this. The extent of the myocardial calcification suggests that there would have been significant cardiac dysfunction if the pregnancy had progressed. However, we are unaware of cases in which the pregnancy has continued. This report will discuss the appearance, etiology and prognosis of dystrophic calcification of the fetal myocardium and the importance of differentiating it from rhabdomyoma on ultrasound.
Transvaginal sonography of myometrial invasion in endometrial cancer: a reappraisal
Authors: Savelli L. , De Iaco P. , Pilu G. , Rosati F. , Ceccarini M. , Bovicelli A. , Zamparelli A. , Bovicelli L. 
Published: March 2003

Purpose:  A number of studies have suggested that transvaginal sonography can be successfully used in estimating the depth of myometrial invasion of endometrial cancers, thus permitting to tailor the surgical treatment to the needs of the patient. We undertook this study with the aim of evaluating, in a large group of patients, the accuracy of a well‐established method for preoperative sonographic staging of endometrial cancer.Patients and methods:  A total of 136 patients with endometrial carcinoma consecutively admitted to the Department of Gynecology and Obstetrics from 1991 to 2000 underwent a transvaginal sonography within 7 days before surgery. The maximum thickness of endometrial echoes (d1) and the antero–posterior diameter of the uterus (d2) were recorded. As regards depth of myometrial invasion, staging was performed by means of calculating the ratio between the thickness of endometrial echoes and the antero–posterior diameter of the uterus (d1/d2).Results:  Mean age of the study population was 63 years (35–88). Invasion of >50% of the myometrium was histologically found in 60 (44%) women. Transvaginal sonography demonstrated a sensitivity of 57% (34/60) and a specificity of 67% (51/76) for deep invasion, with a PPV of 58% (34/59) and a NPV of 66% (51/77). Overall accuracy was 62% (85/136).Conclusions:  Although the technique for sonographic staging of endometrial cancer might be of value in the preoperative assessment of myometrial invasion, its diagnostic performance, when applied to a large group of patients, is not as good as that reported in the original publication.
Role of routine fetal echocardiography in clinical practice: its impact on prenatal diagnosis of congenital heart disease in low risk population
Authors: Chinnaiya A. , Mohammed N. B. 
Published: March 2003

Purpose:  Congenital heart disease occurs in approximately 8 of 1000 live births. Its prenatal diagnosis is important for proper perinatal and neonatal management. Basing referral for fetal echocardiography on presence of risk factors, excludes about 85% of fetuses with severe detectable heart defects from screening. The present study aims to examine the non‐selected low risk population to determine the diagnostic accuracy of fetal echocardiography in detecting cardiac anomalies.Methods:  We included 39 808 low risk pregnant women who received antenatal care at the National University Hospital, Singapore between January 1986 and December 1994 and underwent routine second trimester ultrasound imaging to exclude fetal anomalies at the Antenatal Diagnostic Center. Ultrasonographers trained to do congenital abnormality scan including echocardiography (level IV scanning), performed examinations that was checked by obstetricians specially trained in obstetric ultrasonography. The duration of each scan was approximately 30 min. Equipment used were Hitachi 40,400,565A, Alokha 650 and Acuson 128XP. All subjects were followed to delivery. Postnatally, the neonates were examined by a neonatalogist for the confirmation of presence or absence of congenital anomalies. Patients who elected to terminate their pregnancies had their fetuses sent for postmortem assessment.Results:  A total of 294 cases of congenital heart defects were identified prenatally by fetal echocardiography. Atrial and ventricular septal defects were the commonest anomalies identified (154), followed by left hypoplastic heart (23). In 36 subjects, abnormal cardiac sonographic findings were not confirmed postnatally on examination. On the other hand, there were 44 cases of cardiovascular anomalies that were missed by ultrasound prenatally. We obtained sensitivity of 85.4% for detection of congenital heart disease and a specificity of 99.9% to rule out any such anomalies. Our positive predictive rate was 87.7% and a negative predictive rate was 99.9%.Conclusion:  We recommend routine screening by fetal echocardiography of all pregnancies for prenatal detection of cardiac anomalies, to increase the sensitivity and cost‐effectiveness of antenatal obstetric ultrasound screening and hence, to improve the perinatal management of cardiac anomalies.