bluuebunny/crossref_metadata_2025_split huggingface dataset:
Three‐dimensional sonographic evaluation of fetal soft tissue deposition
Authors: Yanagihara T. , Matsumoto M. , Hanaoka U. , Kuno A. , Hata T. 
Published: March 2003

Objectives:  To evaluate fetal nutritional status in utero and to detect intrauterine growth restriction and macrosomia by use of three‐dimensional ultrasonography.Methods:  Fifty‐two fetuses from 28 to 41 weeks gestation were studied within 1 week before delivery using a transabdominal three‐dimensional transducer. The fetal nutrition score values were determined from a qualitative assessment of the amount of subcutaneous tissue present at three locations (face, ribs, and buttocks) on the antenatal three‐dimensional ultrasonograms. Fetal nutritional status, using fetal nutrition score, was compared with those by modified neonatal nutrition score and ponderal index, respectively.Results:  There was a significant linear correlation between fetal nutrition score and modified neonatal nutrition score. Fetal or neonatal nutrition score correlated well with birth weight and neonatal crown‐heel length, respectively. However, no significant correlation between ponderal index and fetal nutrition score or modified neonatal nutrition score was evident. Ponderal index also did not correlate with birth weight and neonatal crown‐heel length, respectively.Conclusion:  We do cast doubt on the usefulness of the ponderal index for measurement of neonatal soft tissue and muscle mass. Fetal nutrition score using three‐dimensional ultrasonography provides a novel means of evaluating the nutritional status of the fetus in utero, and should be useful for predicting the extreme in fetal growth earlier.
Cervical cerclage after hysteroscopic metroplasty
Authors: Leone F.P.G. , Ragusa G. , Lanzani C. , Digrandi M. , Ferrazzi E. 
Published: March 2003

Purpose:  The objective of the study is to evaluate the role of cervical cerclage after hysteroscopic metroplasty.Methods:  Forty‐six women, previously treated by hysteroscopic metroplasty for subseptate uteri, were prospectively recruited for this observational study. A total of 34 patients conceived 46 pregnancies. Miscarriages, ectopic pregnancies, and live births rate were 34, 7, 59%, respectively. Elective or ultrasound indicated cervical cerclage was proposed to these latter 27 patients. After discussing an informed consent form patients were asked to choose the elective cerclage or the ultrasound indicated cerclage. Cervical length was checked every 3 weeks, from 12 weeks of gestation. Indications for cervical cerclage were: cervical funneling or shortening <25 mm. In symptomatic patients, or when cerclage was indicated, a cervicovaginal swab was performed, and, if necessary, antibiotic therapy was started. The Shirodkar technique was adopted for cerclage.Results:  Eleven of 27 patients underwent cervical cerclage: seven on ultrasound indication, four electively. Mean gestational age at the time of indicated cervical cerclage was 20 ± 2 weeks. Three patients, in the US‐indicated group, had a pathologic cervicovaginal swab. All no cervical cerclage delivered at term (39 ± 2 weeks). Mean gestational age at delivery in patients who underwent indicated cervical cerclage was significantly lower (P < 0.05) than in patients with no sonographic indication (37 ± 2 vs. 39 ± 1 weeks).Conclusions:  Ultrasound cervical assessment is a useful tool to select patients for therapeutical cerclage. According to our data cervical cerclage should be performed only in cases of cervical changes diagnosed by transvaginal sonography.
Adenomyomatosis causing an echogenic fetal gallbladder – a new association
Authors: Bethune M. P. , Pahuja M. 
Published: March 2003

Case report:  A primi gravida presented for a third trimester growth scan due to a history of SLE. Biometry was normal but a linear echogenicity was identified in the region of the fetal gallbladder, the gallbladder was not separately identified. The patient delivered an appropriately grown term baby with normal Apgar scores. Postnatal ultrasound identified a normal‐sized gallbladder with echogenic foci in the wall demonstrating the classical ‘comet tail artifact’ seen with adenomyomatosis.Discussion:  The fetal gallbladder can be visualized from late in the first trimester. Previous case reports of echogenicities within the fetal gallbladder have found a high rate of resolution by the time of delivery [1,2]. The persistent echogenic foci in neonates were shown to be gallstones or sludge in almost all cases. All series failed to show any neonatal consequences of these findings [1]. Adenomyomatosis is a benign condition of the gallbladder where the lining epithelium extends as down‐growth between the muscle bundles to form gland like structures, known as Rokitansky–Aschoff sinuses. Within these foci secondary cholesterol crystal deposition occurs. Sonographically these appear as echogenic foci within the gallbladder wall with the classic description of ‘comet tail artefact’. A detailed medline search failed to reveal any reported cases of neonatal diagnosis of this condition. It has only rarely been reported in children. There have been no previous case reports of echogenic fetal gallbladder confirmed as adenomyomatosis in the neonatal period. Adenomyomatosis needs to be included in differential diagnosis of the antenatal echogenic gallbladder.
Radiofrequency ablation of fetal cervical teratoma
Authors: Chan F.‐Y. , Clouston J. , Cincotta R. , Borzi P. 
Published: March 2003

Background:  Highly vascular fetal tumors can lead to death before viability as a result of vascular steal syndrome. Open fetal surgery is associated with significant risks for prematurity and maternal morbidity. Various local ablative techniques have been tried to reduce tumor vascularity, with variable success. Radiofrequency ablation has been performed for sacrococcygeal teratoma, but cervical teratoma poise further significant challenges with its proximity to vital neck structures.Purpose:  This is the first report in which percutaneous radiofrequency ablation was used to reduce tumor vascularity in a human fetus with a large cervical teratoma.Methods:  A partly solid, partly cystic neck tumor was first detected in a 19‐week fetus. The tumor grew rapidly and caused signs of cardiac decompensation by 26 weeks. After extensive counseling and ethics discussion, operation was performed at 28 weeks under general anesthesia. Radiofrequency ablation to the solid component of the tumor was performed with a nine‐prong retractable needle electrode with thermal couples (RITA), deployed to a maximum diameter of 5 cm. The operation was uneventful and fetal condition was monitored throughout the procedure.Results:  Tumor growth was arrested temporarily with improvement of the cardiac status. Re‐growth of the tumor was noted after 32 weeks, necessitating delivery at 33 weeks. Postnatal investigation showed extensive tumor infiltration into the neck tissues and probable liver metastases. Biopsy showed immature teratoma, and chemotherapy was considered to be futile. Intensive care was withdrawn and the baby died 6 days after delivery.Conclusions:  Radiofrequency ablation of fetal tumor in utero can reduce blood flow sufficiently to reverse high‐output fetal heart failure. Cervical tumors poise extra challenges with its proximity to vital neck structures. With careful and meticulous placement of the probe, ablation can be performed without injury to surrounding tissues. Experience in this area is preliminary and all such experiences should be reported.
Incidental ultrasound diagnosis of pseudomyxoma peritonei in an asymptomatic woman
Authors: Khan S. , Patel A. G. , Jurkovic D. 
Published: March 2003

AbstractAn incidental finding of pseudomyxoma peritonei is reported in a woman with a 6‐month history of postmenopausal bleeding. A transvaginal ultrasound scan revealed a poorly defined echogenic mass in the right iliac fossa above the right ovary and free fluid of mixed echogenicity in the pouch of Douglas. Laparoscopic appendicectomy and aspiration of mucinous fluid was performed without adjuvant chemotherapy. Regular postoperative follow‐up scans, which are needed as the disease may have an indolent course, showed no signs of recurrence. The differential diagnosis and management of pseudomyxoma peritonei are discussed. Copyright © 2002 ISUOG
Prenatal age‐specific reference intervals for measuring all five digits of the fetal hand
Authors: Tovbin J. , Maymon R. , Tovbin L. , Dreazen E. , Bukovsky I. , Herman A. 
Published: March 2003

AbstractObjectiveTo construct prenatal age‐specific reference intervals for measurement of five digits in normal fetuses.Patients and MethodsProspective cross‐sectional study of fetuses assessed at an antenatal ultrasound unit in a university‐affiliated general hospital. The study cohort comprised 302 pregnant women attending our clinic for routine fetal biometry or anomaly scan between December 1997 and June 2000. They all fulfilled the study inclusion criteria: singleton fetuses with normal anatomy, accurate gestational age and no medical complications of pregnancy. Each fetus was scanned once only and the finger measurements of one hand were obtained. Electronic calipers were placed on the outer margin of the proximal phalanx to the outer margin of the distal phalanx level. Those measurements and the relevant gestational age were registered in a computerized database.ResultsThe linear increase of size of each of the five fingers was plotted across the evaluated range of gestation (P < 0.001; r
2 between 0.85 and 0.86 for fingers I to V). Tables showing the 5th, 50th and 95th centiles of finger lengths between 14 and 27 weeks' gestation were created based on the reference interval charts.ConclusionsSecond‐trimester measurement of all five digits of the fetal hand is feasible. This may assist in the evaluation of fetuses that are primarily suspected of having genetic abnormalities that might be expressed by deviation in finger length. Copyright © 2002 ISUOG
Can the degree of retrograde diastolic flow in abnormal umbilical artery flow velocity waveforms predict pregnancy outcome?
Authors: Brodszki J. , Hernandez‐Andrade E. , Gudmundsson S. , Dubiel M. , Mandruzzato G. P. , Laurini R. , Maršál K. 
Published: March 2003

AbstractObjectiveReverse end‐diastolic flow is the most pathological type of the umbilical artery flow velocity waveform. We aimed to investigate whether additional prognostic information can be obtained from umbilical artery waveforms in cases with reverse end‐diastolic flow.Subjects and methodsUmbilical artery Doppler velocity waveforms from 44 fetuses with reverse end‐diastolic flow were analyzed and the following parameters measured: the highest amplitude and the area below the maximum velocity curve of forward and reverse flow (A, B and C, D, respectively) and the duration of forward and reverse flow (Tc and Td, respectively). Ratios A/B, C/D and Tc/Td were calculated. The cut‐off values for A/B, C/D and Tc/Td with the best predictive values for perinatal death were established with the help of receiver operating characteristics curves. The three curves were compared with each other.ResultsOf the three ratios, A/B and C/D had the best capacity to predict perinatal death. Both ratios had acceptable sensitivities, specificities and positive predictive values. In this regard, A/B and C/D were comparable. The cut‐off values for A/B and C/D were 4.3 and 4.52, respectively. Survivors had significantly higher A/B and C/D ratios than non‐survivors (P = 0.0001 and 0.0003, respectively). Significantly more fetuses with A/B or C/D below the established cut‐off values had pulsations in the venous system (P < 0.05). In fetuses with a gestational age ≤210 gestational days the survival rate was significantly higher in those with A/B or C/D above the cut‐off values (P = 0.03 and 0.003, respectively).ConclusionsThe A/B or C/D ratio can be used for quantification of the reverse end‐diastolic flow waveforms in the umbilical artery and may offer additional information to the evaluation of fetal condition. Copyright © 2002 ISUOG
Chorionicity determination in twin pregnancies: how accurate are we?
Authors: Stenhouse E. , Hardwick C. , Maharaj S. , Webb J. , Kelly T. , Mackenzie F. M. 
Published: March 2003

AbstractObjectivesTo determine the accuracy of antenatal prediction of chorionicity in twin pregnancies in our institution.MethodsAntenatal chorionicity was determined using the number of placental masses, the presence or absence of a twin peak sign and the fetal sex. The gestational age at assessment was documented. Postnatal diagnosis of chorionicity was determined by neonatal sex and placental pathology.ResultsChorionicity was correctly determined in 95% of cases (n = 131); 91% of the monochorionic and 96% of the dichorionic pregnancies were correctly determined. If chorionicity was assessed prior to 14 weeks' gestation (n = 96) the correct diagnosis was made in all except one case.ConclusionsUltrasound assessment of chorionicity has a high sensitivity and specificity. This is further improved if the assessment is performed prior to 14 weeks' gestation. Copyright © 2002 ISUOG
Prenatal sonographic findings of thalamic cavernous angioma
Authors: Henrich W. , Stupin J. H. , Bühling K. J. , Bührer C. , Bassir C. , Dudenhausen J. W. 
Published: March 2003

AbstractA cavernous angioma of the thalamus is a rare congenital brain tumor. We report the perinatal management and follow‐up to 2 years in a case diagnosed in utero at 37 weeks of gestation, and review the literature. Copyright © 2002 ISUOG
Fetal cardiac abnormalities identified prior to 14 weeks' gestation
Authors: Huggon I. C. , Ghi T. , Cook A. C. , Zosmer N. , Allan L. D. , Nicolaides K. H. 
Published: March 2003

AbstractObjectiveAn increasing number of patients are presenting at early gestational age as being at high risk for congenital heart disease, as a result of ultrasound screening by nuchal translucency. The feasibility and accuracy of fetal echocardiography was assessed in a series of pregnancies studied before 14 weeks' gestation.MethodsEchocardiography was attempted in 478 fetuses of crown–rump length 40.0–85.0 mm (median, 60.3 mm) with increased nuchal translucency, suspected abnormalities on routine scan or a family history of heart defect. The findings were related to results of autopsy, karyotyping, later scans and postnatal follow‐up.ResultsSatisfactory images were obtained transabdominally in 402/478 (84.1%) and transvaginally in a further 13 patients. Cardiac defects were confidently identified in 60 fetuses and abnormalities of uncertain significance (isolated ventricular or great artery disproportion, or tricuspid regurgitation) were observed in a further 49. Defects were suspected in an additional 20 fetuses, and 286 were passed as normal. The karyotype was subsequently demonstrated to be abnormal in 70/286 (24.5%) fetuses with normal echocardiograms, and in 94/129 (72.9%) with abnormal or suspicious cardiac findings. Validation of the scan findings was possible in 241 fetuses. Normal heart structure was confirmed in 204 fetuses, and previously unsuspected cardiac abnormalities revealed in nine. Heart defects were verified in 28 fetuses, but five of these had important additional findings. There were false positive findings in three fetuses.ConclusionsFetal echocardiography is feasible prior to 14 weeks' gestation. Cardiac defects, when present, may be identified or suspected in the majority of cases. In the risk group studied, heart defects were frequently a manifestation of chromosomal abnormality. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Prediction of fetal weight by ultrasound: the contribution of additional examiners
Authors: Gull I. , Fait G. , Har‐Toov J. , Kupferminc M. J. , Lessing J. B. , Jaffa A. J. , Wolman I. 
Published: March 2003

AbstractObjectivesTo assess the contribution of additional examiners to: the average discrepancy between estimated and actual fetal weights; the correlation between estimated and actual fetal weights; the reduction in major (> 10%) discrepancies between estimated and actual fetal weights.DesignThree experienced sonographers independently measured fetal biparietal diameter, head circumference, abdominal circumference and femur length in 39 fetuses at term. The estimated fetal weights were calculated for each examiner. Fetal biometric measurements were analyzed to obtain the source of differences in estimations among the examiners. Discrepancy, correlation and number of major (> 10%) discrepancies between the estimated and actual fetal weights were calculated for each examiner, and the contribution of additional examiners was analyzed.ResultsThe differences in measurements of the biparietal diameter and femur length were lower than those of the head and abdominal circumferences. For each of the three examiners, the average discrepancy between the estimated and actual fetal weights was 6.1%, 5.9% and 6.3%. When the estimation was based on two examiners, the discrepancy decreased to 4.8–5.6%. The contribution of a third examiner was nil. Major (> 10%) discrepancies between estimated fetal weight and actual birth weight were found in seven, eight and nine estimations of the examiners. Estimation by two examiners decreased the number of major discrepancies, and estimation by all three examiners further decreased by approximately 50% the number of major discrepancies between the estimated and actual fetal weights.ConclusionMeasurements by multiple examiners changes only slightly the average number of discrepancies between estimated and actual fetal weights. However, the reduction in major (> 10%) discrepancies is statistically and clinically significant. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Blood redistribution in the fetal brain during chronic hypoxia
Authors: Dubiel M. , Gunnarsson G. Ö. , Gudmundsson S. 
Published: March 2003

AbstractBackgroundStudies on blood flow velocity in the fetal middle cerebral artery have revealed signs of brain sparing in chronic hypoxia. These signs of brain sparing can disappear in the terminal case, but whether this applies to the whole brain or only parts of it is unknown.MethodsVelocity waveforms of the middle cerebral, anterior cerebral and posterior cerebral arteries were recorded in 221 pregnancies complicated by pregnancy‐induced hypertension. The presence of brain sparing (pulsatility index < 2 standard deviations) was noted and correlated to outcome of pregnancy, including emergency operative intervention and/or neonatal distress.ResultsSigns of brain sparing in the anterior cerebral artery were found in 90 fetuses, and in the middle cerebral and posterior cerebral arteries in 52 and 65, respectively. Signs of brain sparing in the anterior cerebral artery showed the strongest relationship to adverse perinatal outcome. The anterior cerebral artery was the only vessel in which signs of brain sparing were predictive of perinatal mortality.ConclusionsVelocimetry of the anterior cerebral artery appears to be superior to that of the middle cerebral and posterior cerebral arteries as a means to predict adverse perinatal outcome. Anterior cerebral artery brain sparing may therefore be less transitory than sparing in the middle cerebral and posterior cerebral arteries, possibly suggesting that the frontal lobes are spared longer than the lateral and occipital regions of the fetal brain.
Impact of a multiparameter, ultrasound‐based triage on surgical management of adnexal masses
Authors: Berlanda N. , Ferrari M. M. , Mezzopane R. , Boero V. , Grijuela B. , Ferrazzi E. , Pardi G. 
Published: March 2003

AbstractObjectiveTo prospectively evaluate the accuracy of a multiparameter, ultrasound‐based triage and its impact on surgical management of adnexal masses.MethodsMasses evaluated as normal according to Ferrazzi's sonographic morphological score were considered as being at low risk of malignancy and eligible for laparoscopic treatment without further evaluation. Masses evaluated as abnormal, but without additional risk factors such as ascites, diameter ≥ 10 cm, bilaterality, immobility, resistance index ≤ 0.6 and serum CA 125 > 35 IU/mL were considered at moderate risk and eligible for laparoscopic evaluation and treatment. Masses with abnormal morphological score and any of these additional risk factors were considered at high risk and treated by laparotomy. The results of pathological examination were obtained for each mass.ResultsTwo hundred and four (87%) masses were benign and 30 (13%) were malignant. Among 182 low‐risk, 19 moderate‐risk and 33 high‐risk masses, the odds of malignancy were 1 : 90, 1 : 18 and 4.5 : 1, respectively. To calculate the diagnostic accuracy of this algorithm, low‐ and moderate‐risk groups were considered together: the sensitivity was 90%, specificity 97%, positive predictive value 82% and negative predictive value 99%. The new algorithm was significantly more accurate than was morphological score alone (P = 0.0002). Ninety‐six percent of benign masses were treated by laparoscopy. All three patients with malignant masses that were incorrectly assigned to laparoscopy underwent laparoscopic adnexectomy and frozen section.ConclusionsThe accuracy of this new algorithm was higher than that of the sonographic morphological scoring system alone. In the present series, it allowed the treatment by laparoscopy of 96% of benign adnexal masses without mismanagement of any cases of ovarian cancer.