bluuebunny/crossref_metadata_2025_split huggingface dataset:
P90Growth hormone and insulin‐ like growth factor 1, in small‐for‐gestational‐age pregnancies with increased pulsatility index in the umbilical artery
Authors: Larsen T. , Main K. , Andersson A. M. , Juul A. , Greisen G. , Skakkebaek N. E. 
Published: March 2003

BackgroundThe aim of the study was to examine some endokrinological aspects of intrauterine growth retardation and, in particular, test whether low levels of GH and IGF‐1 in maternal serum are associated with direct evidence of placental dysfunction.MethodProspectively 48 singleton pregnancies with a SGA fetus and 28 with an AGA fetus were examined with maternal serum GH, IGF‐1, IGFBP‐1 and 3, and fetal weight and umbilical artery pulsatility index at 33 weeks of gestation.ResultsSerum IGF‐1 was lower in the SGA group, which was accounted for in the subgroup of SGA with increased pulsatility index.ConclusionA decreased maternal level of IGF‐1 seems to be specifically related to placental dysfunction as diagnosed by increased Doppler flow pulsatility
P94Fetal cerebrovascular response to chronic hypoxia
Authors: Jugovic D. , Laurini R. , Judaš M. , Arbeille PH. , Kurjak A. , Salihagić A. 
Published: March 2003

ObjectiveTo study the cerebral and umbilical hemodynamics changes in hypoxic and growth‐retarded fetuses. To determine if at long‐term, fetal brain hyperperfusion with loss of cerebral vascular flow velocity variability is associated with brain damage and poor fetal outcome.MethodsThe fetal blood flow redistribution was assessed by using Doppler cerebral‐umbilical ratio in 8 growth‐retarded fetuses, mainly every day. The evolution of the fetal hemodynamics was interpreted according to the clinical, anatomical and histological data.ResultsAll 8 fetuses had poor fetal outcome including fetal death (n = 5). Fetal blood flow redistribution with brain hyperperfusion was detected in all fetuses during the whole period of observation. The early phase of fetal deterioration was characterized by the development of oligohydramnios and the disappearance of the cerebral flow velocity variability. During the later phase of deterioration, fetal heart rate decelerations and the increase of cerebral vascular resistance with reduction of brain perfusion were detected. Histological study of the brains showed hypoxic lesions.ConclusionThe loss of variability of the cerebral resistance index, in the cases of absent umbilical end diastolic flow, and the loss of variability of the cerebral‐umbilical ratio in the other cases, identifies the beginning of the period of very high risk for the fetus. Such a pattern may be considered as a predictor of brain lesion and poor fetal outcome. These results also indicate the existence of two phases in the fetal cerebrovascular response to chronic hypoxia.
Posters Early pregnancy P01First trimester normograms for a wide variety of ultrasound, hemodynamic and serum parameters
Authors: Serra‐Serra V. , Serrano J. E. , Ballester M. J. , Lara C. , Bellver J. , Bonilla‐Musoles F. 
Published: March 2003

BackgroundThe aim of the study was to assess prospectively the evolution of multiple clinical parameters throughout the first trimester of pregnancy.MethodA transvaginal ultrasound examination and a blood test was weekly performed until the 13th gestational week in a group of healthy volunteers. A total of 25 spontaneously conceived singleton pregnant women with good pregnancy outcome finally completed the study. The evolution of 10 transvaginal ultrasound parameters, 5 Doppler measurements and 6 serum parameters was studied.ResultsAn increasing trend with advancing gestation was evident for the mean gestational sac (MSD) and amniotic sac (AS) diameters, trophoblastic rim, CRL and serum progesterone. The uterine, umbilical and fetal cerebral arteries PI decreased with advancing gestation. The FM yolk sac (YS) diameter and β‐hCG levels showed an initial rise and a final decrease. A great interindividual variation was evident for the β‐hCG titer. The YS/CRL progressively approached to 0, whereas the MSD/CRL and the AS/MSD progressively approached to 1. The corpus luteum diameter, corpus luteum arteries PI, subehorionic arteries PI, complement levels (C3 and C4), platelet count and activated partial thromboplastin time experienced minimal changes.ConclusionFirst trimester normograms for multiple clinical parameters are provided.
WS17‐06Three‐dimensional power Doppler ultrasound as a second line screening tool in ovarian cancer screening – preliminary results
Authors: Zodan T. , Gregov M. , Sparac V. , Kurjak A. , Kupesic S. , Ilijas M. 
Published: March 2003

IntroductionIn this screening program, 2D color Doppler (2D CD) was used as the first, and CA‐125 and 3D power Doppler (3D PD) were used as second‐line screening tools when 2D scoring system indicated possible malignancy. The study was designed to show whether early stages of ovarian cancer can be correctly diagnosed by 3D PD and whether 3D would perform better than CA‐125.MethodsAll patients were either postmenopausal, or premenopausal with positive family history, or they had a persistent ovarian cyst. They were all examined by 2D CD and if values of scoring system were over cut‐off point, 3D PD analysis was performed and CA‐125 was tested.ResultsA total of 108 patients (97 postmenopausal and 11 premenopausal with family history) had a 2D scan. In 5 cases 2D scoring indicated possible malignancy after which 3D analysis was done as well as test for CA‐125. In 2 cases 3D PD scoring was negative, as well as CA‐125 and the lesions were simple cyst surrounded by chronic inflammatory process in the first patient and ovarian fibroma in the second. In 3 cases 3D PD scoring was positive while CA‐125 measurement showed increased values only in 1 case. PHD analysis confirmed the diagnosis of ovarian carcinoma in all three lesions. 3D PD correctly predicted benign or malignant nature of the lesion, while CA‐125 failed to do so in two stage 1 ovarian cancers.ConclusionAlthough now expensive and in most hospitals unavailable, 3D power Doppler is a future screening tool in ovarian cancer screening programs. However, a lot more women should be screened before proper statistical analysis could be done.
WS17‐07Fetal and neonatal echocardiographic features in twin‐to‐twin transfusion syndrome
Authors: Murakoshi T. , Seguchi  , Naruse H. , Torii Y. , Maeda K. 
Published: March 2003

BackgroundTwin‐to‐Twin transfusion syndrome (TTTS) is a severe complication in monochorionic twin pregnancies. Particularly severe fetal and neonatal cardiac dysfunction is complicated in recipient twin and attended with high perinatal morbidity and mortality. The aim of this study was to evaluate the abnormal echocardiographic features and clinical complications of cardiac disease in TTTS.MethodWe studied 20 pregnancies complicated with TTTS. Serial fetal and neonatal echocardiography were carried out and evaluated the following parameters: cardiothoracic area ratio, aortic and pulmonary artery Doppler peak velocities, umbilical arterial resistance index, preload index of inferior vena cava, ventricular valve regurgitation and structural heart abnormalities.ResultIn recipients, all features had cardiomegaly, tricuspid valve regurgitation and high preload condition with increased preload index of inferior vena cava. Aortic and pulmonary artery peak velocities were increased in the recipients than those in the donors. Three cases of recipients had pulmonary valve stenosis and received balloon pulmonary valvuloplasty. Furthermore, three cases of donors had coarctation of aorta and also received surgical repair.ConclusionIn addition to the severity of cardiac dysfunction, pulmonary stenosis and coarctation of aorta would be the important factors to evaluate perinatal prognosis of TTTS.
WS17‐08Fetal biochemical markers in severe placental insufficiency – comparison with fetal Doppler findings
Authors: Räsänen J. , Mäkikallio K. , Vuolteenaho O. , Jouppila P. 
Published: March 2003

BackgroundThe aims of this study were to assess the activity of the human fetal atrial natriuretic peptide system in hypertensive pregnancies with and without signs of increased fetal systemic venous pressure and to investigate the association between severe placental insufficiency and fetal myocardial cell destruction.MethodControl group consisted of 50 newborns with uncomplicated pregnancy and labor. In group 1, 22 newborns after hypertensive pregnancies were included. Doppler ultrasonography revealed abnormal umbilical artery (UA) blood velocity waveform in five cases, and normal nonpulsatile umbilical vein (UV) blood velocity profile in every case. Group 2 consisted of five newborns after pregnancies complicated by maternal hypertensive disorder. Atrial pulsations in the UV and retrograde diastolic blood velocity pattern in the UA were detected in every case. Immediately after birth blood samples were collected from the UA and plasma N‐terminal peptide of proatrial natriuretic peptide (NT‐proANP) and serum cardiac specific troponin‐T concentrations were measured.ResultsIn group 1, nt‐proANP concentrations were higher (P < 0.001) than in the control group. In group 1, newborns with abnormal UA blood velocity pattern had higher (P < 0.006) NT‐proANP concentrations than newborns with normal UA Doppler findings. Troponin‐T concentrations in group 1 did not differ from the control group. In group 2, NT‐proANP (P < 0.002) and troponin‐T (P < 0.0001) concentrations were higher than in the control group and study group 1.ConclusionMaternal hypertensive disorder stimulates fetal atrial natriuretic peptide production, being greatest in fetuses with severe placental insufficiency and a rise in systemic venous pressure. These fetuses also have evidence of myocardial cell destruction.
WS03‐07Which information about follicular development in unstimulated cycles can be obtained by ultrasound?
Authors: Vlaisavljević V. 
Published: March 2003

Unstimulated cycles offer a simpler, quicker and less invasive form of IVF and ICSI than the most conventional stimulated cycles. The objective of the study was to evaluate the effectiveness of different approaches for follicle monitoring in unstimulated cycles. This monitoring includes studies of follicle growth during the follicular and luteal phase of the cycle, measurements of blood flow in perifollicular vessels and studies of perifollicular perfusion in vascular network using power Doppler. These studies include 3D analysis of follicular growth, development and its vascularization.A retrospective chart review of all patients undergoing IVF and ICSI in unstimulated cycles at our institution was performed. The outcome measurements used were oocyte recovery rate, fertilization rate, implantation and delivery rate.Unstimulated cycles monitored by ultrasound only were compared with those monitored with different protocols of ultrasound monitoring combined with serum estradiol level and urinary LH.IVF and ICSI were performed in 708 unstimulated cycles. A higher pregnancy rate and lower cancellation rate was obtained when hCG was applied in lower values of serum E2 and smaller follicle diameter.The actual pregnancy rate per embryo transfer in IVF cycles was 23.8% and 26.4% in ICSI cycles when embryo transfer was performed on day + 2 or day + 3. When blastocyst stage embryo transfer was performed the implantation rate per embryo transfer was 37.5%.
WS07‐02Treatment for TTS should be done within a trial
Authors: Ville Y. 
Published: March 2003

Over a year I invited you here to participate to the rct for treating twin‐to‐twin transfusion syndrome (TTS). Are there any data available to reconsider this? The answer is clearly no, on the contrary. Indeed large series on amniodrainage or laser therapy have become available.With serial amniodrainage overall survival for both twins is 49% or 71% where at least one baby survive. In cases where one fetus dies in utero, 20% of the survivors die, and in another 20% they have severe neurological morbidity. Laser treatment has now a survival rate of 54% for both twins and 81% for at least one survivor. Neurological morbidity seems to be less than 10%.Has this larger experience contributed to solve the question whether one or the other therapy is better? No, it only underscores that our estimate of the number of patients needed in a rct was right: 10% difference in survival rate and 15% for severe neonatal morbidity.All new data, all new studies are an urgent call for randomisation. If not, both patients and their obstetricians will continue to argue based on unsubstantiated views. Further case series will not bring any critically new element.ResultsOver 45 patients have now been included, all but a few in France. If we would extrapolate the number of patients randomised at our centre, only three other groups would have to recruit at the same pace to reach the 142 patients needed by the end of next year.DiscussionThere are many arguments to try to finish the study within a few years. It avoids the obvious bias due to improvements of perinatal resuscitation. It would keep high motivation amongst referring clinicians.I would dare to say more: at this point it has become unethical not to randomise cases with TTTS. Not laser, neither amniodrainage have become established yet as the best treatment and there is no room for empirical new techniques until the trial is completed.
WS13‐04Doppler velocimetry determined brain sparing effect: correlations with neonatal outcome in diamniotic monochorionic and diamniotic dichorionic twins
Authors: Gaziano E. P. , Gaziano C. , Hoesktra R. , Terrell C. 
Published: March 2003

ObjectiveNeonatal outcome was studied in 169 infants from diamniotic monochorionic (DAMC) and diamniotic dichorionic (DADC) twin pregnancies in relation to a measure of blood flow redistribution, the cerebroplacental ratio (CPR).Study designTwo groups were assessed, 50 infants from DAMC, and 119 infants from DADC twin pregnancies. Targeted ultrasound and Doppler recordings of umbilical artery (UA) and middle cerebral artery (MCA) were obtained. The resistance index (RI) and CPR were calculated for each fetus.ResultsDAMC twins had lower birth weight (1979 vs. 2223 g for DADC, p≤.01) and prolonged lengths of nicu stay (8.5 days vs. 3.5 days for DADC, p≤.05). For total group, DAMC compared with DADC twins spent greater numbers of days on a ventilator. SGA infants were significantly more frequent in DAMC twins compared to DADC twins. Among antenatal Doppler variables only the CPR demonstrated a significant difference between twin types. For DAMC twins CPR was 1.15 vs. 1.21 for DADC twins, p≤.05.ConclusionsMonochorionic twins from the lower birth weight groups demonstrate a greater number of growth restricted infants and prolonged hospitalizations compared to DADC twins. Among Doppler measures, the CPR is superior to UA‐RI, and/or MCA‐RI for the prediction of adverse events.
WS13‐05Selective photocoagulation of communicating vessels in the treatment of selective growth retardation in monochorionic twins: a functional dichorionization procedure
Authors: Quintero R. A. , Bornick P. W. , Morales W. J. , Allen M. H. , Johnson P. K. 
Published: March 2003

BackgroundIntrauterine fetal demise (IUFD) of a selectively growth‐retarded (IUGR) monochorionic (MC) twin is associated with high morbidity/mortality in the appropriately grown (AGA) twin. Selective laser photocoagulation (SLPCV) allows precise separation of the circulations of both twins. The aim of this study was to assess SLPCV in the treatment of MC‐IUGR.MethodsPatients with previable MC‐IUGR were offered SLPCV. Absent or reverse end‐diastolic velocity in the umbilical artery of the IUGR twin was also required for entry.Communicating vessels were identified endoscopically as deep artery‐to‐vein or superficial artery‐to‐artery or vein‐to‐vein as previously described. The communications were photocoagulated with Nd:YAG laser.ResultsSLPCV was performed in 11 patients (GA mean = 20.9 weeks). Survival of both fetuses was n = 5 (45%), IUFD of the IUGR twin alone was n = 4 (36%) and IUFD of the AGA twin alone was n = 2 (18%). There were no dual losses, or adverse effects of an IUFD on the surviving twin. Previously undescribed superficial artery‐to‐vein anastomosis occurred in three patients.ConclusionsSLPCV can effectively create a ‘functionally dichorionic’ placenta. SLPCV allows the AGA twin to avoid the adverse effects associated with IUFD of the IUGR twin.Unexpected IUFD of the AGA twin may reflect more complex placentation. A new type of vascular communication, superficial artery‐to‐vein, may have important pathophysiologic implications.
WS01‐09Diagnostically critical fetal imaging artifacts: identification and management
Authors: Pretorius D. H. , Nelson T. R. 
Published: March 2003

The purpose of this project was to identify sources and clinical significance of 3DUS artifacts on patient diagnosis and to increase clinician and sonographer awareness to reduce misdiagnosis in 3DUS studies. To accomplish this 3DUS data were acquired and reviewed interactively. Artifacts were cataloged according to origin: B‐mode, color/power Doppler or unique to 3DUS (acquisition, rendering or volume editing). Original scan planes, re‐sliced planes and rendered images were evaluated. Overall our results showed a variety of artifacts. B‐mode artifacts included drop‐out, shadowing, etc. and depending on relationships between slice and imaging plane orientation. Color/power Doppler artifacts were related to gain, aliasing, and flash and could add apparent structure or confusion to the volume images. Rendering artifacts were due to parameter adjustment, shadowing and motion.Important structures could be removed by improper editing. In conclusion 3DUS and 2DUS are prone to similar artifacts plus others unique to 3DUS. Diagnostically significant artifacts can mimick abnormal development, masses, or missing structures thus requiring careful study before reaching a diagnosis.
WS14‐07Volume sonography of the female pelvic floor after childbirth
Authors: Wisser J. 
Published: March 2003

ObjectiveTo evaluate the sonomorphologic changes of the female pelvic floor after childbirth. Furthermore the timing of the appearance of these defects labor are examined.MethodsWe examined three groups of patients. 104 primiparae after vaginal delivery, 26 primiparae after elective cesarean section and 77 primiparae after secondary cesarean section within 3–7 days after delivery. To assess the morphology of the pelvic floor we used to examine the anal morphology, whereas the transrectal route was used to assess the paraurethral fixation of the lateral vaginal edges. Paravaginal defect was defined as descent of the lateral vaginal edges below the suburethral portion of the vagina and defects of the internal anal sphincter is defined by anterior vs. posterior thickness‐ratio below 0.5. Clinical symptoms were documented using a standardized questionnaire.ResultsPrimiparae after elective cesarean section served as control group. After vaginal delivery 7.3% of women showed urinary and 17.7% anal incontinence. Mode of delivery is significantly associated with anal and urinary incontinence. Paraurethral defect is predictive for urinary incontinence. Morphological defects of the pelvic floor could be documented after dilatation of the cervix to more than 7 cm.ConclusionsVolume sonography after childbirth allows to document trauma to the pelvic floor due to vaginal delivery. Defects of the anterior compartment are predictive for the development of urinary incontinence. To study the timing of the appearance of pelvic floor defects during the course of vaginal delivery may be helpful for obstetrical decision making.
Effects of low‐dose aspirin on uterine and fetal blood flow during pregnancy: results of a randomized, placebo‐controlled, double‐blind trial
Authors: Grab D. , Paulus W.E. , Erdmann M. , Terinde R. , Oberhoffer R. , Lang D. , Muche R. , Kreienberg R. 
Published: March 2003

Objective
This study was conducted to evaluate uteroplacental and fetal hemodynamics in fetuses exposed to low‐dose aspirin (100 mg/d).
Design
Randomized, placebo‐controlled, double‐blind trial.
Subjects
The study protocol included singleton pregnancies of less than 20 gestational weeks at risk for pre‐eclampsia or fetal growth restriction. Exclusion criteria were diabetes mellitus, pre‐existing proteinuric hypertension or fetal malformations. Forty‐three pregnant women were randomly allocated to daily treatment with 100 mg aspirin (n = 22) or placebo (n = 21). Methods Pulsed Doppler measurements of the uterine artery, fetal middle cerebral artery, fetal aorta, ductus arteriosus and atrioventricular valves were performed longitudinally at 14 day intervals starting from 18 gestational weeks until delivery. Results were expressed as group medians (aspirin vs. placebo) and were analyzed by Mann–Whitney U‐test. Results There was no difference in uterine, umbilical, aortic, middle cerebral and ductus arteriosus blood flow between the aspirin group and controls. Median ductal peak flow velocities increased with gestational age in both groups, but differences between groups did not reach significance. In the third trimester of pregnancy, ductal peak velocities > 140 cm/s were occasionally observed in both groups. However, end diastolic velocities > 35 cm/s or atrioventricular valve regurgitation never occurred. Conclusions Daily administration of low‐dose aspirin during the second and third trimesters of pregnancy does not alter uteroplacental or fetoplacental hemodynamics and does not cause moderate or severe constriction of the ductus arteriosus.
F107Ultrasonographic diagnosis of spina bifida at 12 weeks: heading towards new indirect signs
Authors: De Keersmaecker B. , Buisson O. , Bernard J. P. , Ville Y. 
Published: March 2003

BackgroundThe diagnosis of spina bifida before 14 weeks' remains difficult to achieve.We believe that the cephalic markers are accessible to an oriented sonogram at 12 weeks' if these signs are specially looked for. Improvements are necessary since prenatal diagnosis is moving towards the first trimester.MethodRetrospective analysis of ultrasound pictures taken at around 12 weeks in 2 cases of spina bifida diagnosed at 12 and 22 weeks, respectively, and 10 controls.ResultsCerebral peduncles appear to be parallel and some degree of retraction of the frontal bones give the head an acorn shape. This parallelism might be the first and only sign amenable for prenatal diagnosis. A sagittal plane of the brain and spine can also visualise a large part of the myelencephale on the same plane as the metencephale, which cannot be seen in normal controls.ConclusionVery subtle signs as peduncular parallelism and alignment of metencephale and myelencephale could be the earliest signs of spina bifida in first trimester. No special skill is necessary to obtain the diagnosis because the plane of the peduncles is part of the routine examination.