bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measurement of the pregnant cervix by transvaginal sonography: an interobserver study and new standards to improve the interobserver variability
Authors: Burger M. , Weber‐Rössler T. , Willmann M. 
Published: March 2003

AbstractTransvaginal sonography has become an important tool for assessing the gravid cervix uteri, especially in patients at risk for cervical incompetence and preterm delivery. The purpose of our prospective study was to evaluate interobserver variability in measurements of the cervical length and, as a second step, improve the reproducibility and interobserver discrepancy by the introduction of quality control standards when producing and measuring the image of the cervix. Before the introduction of these standards we obtained 46 measurements and observed a mean cervical length (internal to external os) of 33.7 mm (range 26–52 mm) and an interobserver average discrepancy of 3.04 mm (range 0–6 mm). Later, measurements were obtained only when the following conditions were assured and visualized on the screen: (1) the internal os is either flat or is an isosceles triangle; (2) the whole length of the cervical canal can be observed; (3) a symmetric image of the external os can be obtained; and (4) the distance from the surface of the posterior lip to the cervical canal is equal to the distance from the anterior lip to the cervical canal. After the implementation of these quality control standards, 70 measurements were performed obtaining a mean length of 35.3 mm (range 27–51) and an average interobserver discrepancy of 1.24 mm (range 0–4). Thus the measurement error was significantly lower following introduction of quality control standards. Furthermore, the coefficient of variation dropped from 7.1% to 3.3% after the introduction of the guidelines. We believe that these guidelines could be helpful by making the measurements of the cervical length more accurate, reducing the interobserver variability, improving the reproducibility and promoting the role of transvaginal sonography in monitoring the incompetent cervix. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Interfetal heart rate and size variation in first‐trimester multifetal pregnancies and heart rate of surviving fetuses after fetal reduction
Authors: Zimmer E. Z. , Chao C. R. , Sharma S. , Timor‐Tritsch I. E. 
Published: March 2003

AbstractThe objective of this study was to determine the variation in first‐trimester fetal size and fetal heart rates in multifetal pregnancies, and to study the effect of fetal reduction on the surviving fetal heart rate. Fetal crown‐rump length and fetal heart rates were measured in 44 patients with multifetal pregnancies who underwent fetal reduction. The heart rates of the surviving fetuses were also measured immediately after, and 1 h following the procedure. A total of 143 fetuses were evaluated prior to reduction and 75 fetuses following the procedure. There was no significant difference in crown‐rump length between fetuses of the same gestation. The interfetal fetal heart rate variation between fetuses of the same gestation, expressed as a standard deviation, was 4.78 ± 0.51 beats/min (mean standard deviation ± standard error of the mean) before reduction; this was a significantly greater variation than could be attributed to error in the measurement of heart rate. In the surviving fetuses, the mean heart rate did not change. However, immediately after the reduction, interfetal heart rate variation was abolished, but was observed again 1 h after the reduction. We conclude that in first‐trimester multifetal pregnancies (1) there is no significant difference in fetal crown‐rump length; (2) there is interfetal variation in heart rates; and (3) fetal reduction has only a limited effect on the heart rates of surviving fetuses. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Hemodynamic changes across the human ductus venosus: a comparison between clinical findings and mathematical calculations
Authors: Pennati G. , Bellotti M. , Ferrazzi E. , Rigano S. , Garberi A. 
Published: March 2003

AbstractWe investigated the hemodynamics of the ductus venosus in the human fetus by means of a combined approach based on Doppler and computational techniques. The aim of our study was to assess the blood velocity changes across the ductus venosus. Color Doppler equipment was used to investigate 29 normal fetuses between 20 and 39 weeks of gestation.Velocities at the systolic peak (S), diastolic peak (D) and atrial contraction (A) were measured at the isthmus and at the outlet of the ductus venosus, and the corresponding angle‐independent indices (S/A, (S ‐ A)/S, (S ‐ A)/D) were calculated. A parametric computational model was developed in order to investigate the influence of anatomical features of the ductus venosus on the hemodynamics of the vessel. In all the fetuses the S, D and A velocities at the outlet portion were significantly lower than those at the isthmic part of the ductus venosus (p < 0.0001). The mean percentages of velocity reduction were 2:3.1%, 26.5% and 33.6%, respectively.Computational simulations also showed a relevant decrease of the velocity along the ductus venosus during the whole cardiac cycle. Velocity reduction along the ductus was mainly due to its conicity and this reduction generally caused velocity values at the outlet to be below the normal range. Conversely, angle‐independent indices measured both at the isthmus and at the outlet lay within the same range of the reported reference values and therefore were not influenced by sampling site. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Venous blood flow pattern suggesting tachycardia‐induced ‘cardiomyopathy’ in the fetus
Authors: Krapp M. , Gembruch U. , Baumann P. 
Published: March 2003

AbstractStudies in the fetal lamb and human fetus demonstrated that, in the late stage of supraventricular tachycardia, myocardial dysfunction (tachycardia‐induced ‘cardiomyopathy’) may appear and even persist after drug‐induced conversion to sinus rhythm. The objective of this study was to verify whether these changes in cardiac function are reflected in the venous system.In seven fetuses with supraventricular tachycardia (five with hydrops and four of these with atrioventricular valve incompetence during tachycardia) between 24 and 33 weeks of gestation, spectral Doppler analysis of flow velocity waveforms in the inferior vena cava and the ductus venosus was performed before and after drug‐induced cardioversion, and was compared with reference values known from the literature and our own indices obtained in 129 normal pregnancies.After drug‐induced conversion from supraventricular tachycardia to sinus rhythm associated with a change from a pulsatile to a normal biphasic forward venous blood flow pattern, abnormal venous indices resulting from increased reverse blood flow during atrial contraction persisted for 2–42 days (median 12 days).Severe functional tricuspid insufficiency can lead to a significant decrease in the systolic peak velocity with deterioration of the venous blood flow indices. In the first days after supraventricular tachycardia, rapid changes in these indices seem to depend predominantly on the decrease of tricuspid insufficiency and the increase of the systolic peak velocity.In addition to the persistence of atrioventricular valve regurgitation, abnormal indices of venous blood flow during sinus rhythm indicate the existence of altered myocardial function, suggesting reversible tachycardia‐induced ‘cardiomyopathy’. Blood flow indices in the venous system seem to reflect changing myocardial function very sensitively and rapidly and, therefore, appear very useful in the surveillance of the fetus with tachyarrhythmia under drug therapy, especially with regard to the assessment of cardiac function at the time of cardioversion and in the period after supraventricular tachycardia. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Umbilical cord coagulation by operative microendoscopy at 16 weeks' gestation in an acardiac twin
Authors: Hecher K. , Hackeloer B. J. , Ville Y. 
Published: March 2003

AbstractTwin reversed arterial perfusion (TRAP) sequence carries high mortality and morbidity in the normal twin due to a hemodynamic imbalance through the feto–fetal vascular anastomosis. This report describes the ultrasound features of TRAP in the first trimester and a new technique for selective fetocide in the early second trimester in monochorionic twin pregnancies complicated by the TRAP sequence. Laser coagulation of the umbilical cord of the acardiac twin was performed under sonoendoscopic control. The blood flow in the umbilical cord of the acardiac twin was successfully arrested and the survivor developed normally. TRAP sequence can be recognized in the first trimester and successfully arrested by microendoscopic surgery. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Isolated choroid plexus cysts and association with fetal aneuploidy in an unselected population
Authors: Geary M. , Patel S. , Lamont R. 
Published: March 2003

AbstractWe sought to determine the relationship between an isolated choroid plexus cyst diagnosed antenatally and fetal aneuploidy in an unselected population at a district general hospital. Over a 5‐year period all women attending for a detailed anomaly scan at 18–20 weeks' gestation were screened for evidence of a fetal choroid plexus cyst. All cases of choroid plexus cyst were recorded prospectively. The size, position and number of the cysts were noted and associated abnormalities seen on ultrasound were also recorded. Cases of choroid plexus cyst associated with fetal aneuploidy were noted. A total of 13 690 women were screened, and 84 cases of choroid plexus cyst were identified (0.6%). Of these, 41% underwent prenatal karyotyping by amniocentesis; 78 of 84 cases (93%) were isolated. Six had other markers for aneuploidy, and three of these fetuses had trisomy 18. All cases of isolated choroid plexus cyst resulted in chromosomally normal neonates. This was confirmed by either normal antenatal karyotype or postnatal examination by the pediatricians. The size, position and number of cysts did not appear to influence the risk of aneuploidy. We conclude that the risk of aneuploidy for a case of isolated choroid plexus cyst in an unselected population appears to be very low, and in this series was 0%. In this setting, we suggest detailed ultrasound examination is essential, rather than routine karyotyping. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Color Doppler sonographic features of uterine arteriovenous malformations: report of two cases
Authors: Müngen E. , Yergök Y. Z. , Ertekin A. A. , Ergür A. R. , Uçmakli E. , Aytaçlar S. 
Published: March 2003

AbstractWe describe the color Doppler sonographic features of uterine arteriovenous malformatiom in two cases. In both cases color Doppler imaging demonstrated hypervascularity throughout the arteriovenous malformation. The dominance of pale shades during both systole and diastole represented low‐impedance, high‐velocity flow within the lesion and a colored mosaic pattern representing turbulent flow was noted. Spectral analysis of the vessels within the lesion confirmed high‐velocity flow during both systole and diastole, and a low resistance index. The spectral waveform trace also showed spectral broadening consistent with turbulence and the spectral envelope was irregular. These findings indicated the presence of numerous arteriovenous shunts and marked turbulence within the arteriovenous malformation. Spectral analysis of the venous flow revealed high flow velocities and systolic velocity peaks similar to an arterial pattern. The uterine artery velocity waveforms were characterized by high flow velocity and a low resistance index. The diagnosis of uterine arteriovenous malformation was confirmed by histological examination in both cases.The findings of these two cases suggest that color Doppler sonography may play an important role in the diagnosis of uterine arteriovenous malformations. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Doppler waveforms from the pulmonary arterial system in normal fetuses and those with pulmonary hypoplasia
Authors: Mitchell J. M. , Roberts A. B. , Lee A. 
Published: March 2003

AbstractColor, pulsed and power Doppler were used to image the fetal pulmonary vasculature in 150 normal pregnancies and ten pregnancies in which the fetus had bilateral multi‐cystic dysplastic kidney disease (MCDK) and associated pulmonary hypoplasia.The normal fetuses had a high resistance pattern in the main pulmonary artery vasculature. There were no significant changes in the resistance of the main pulmonary artery, right pulmonary artery and left pulmonary artery, with increasing gestational age. In the peripheral pulmonary arteries the resistance was less with an increase in diastolic flow, with advancing gestation.All fetuses with MCDK died. This group did not have significantly different Doppler waveforms in the main pulmonary arteries, but Doppler signals from the peripheral pulmonary arteries showed a high resistance pattern quite different from that of normal fetuses.Doppler measurements of the peripheral pulmonary artery may give additional information useful in diagnosing pulmonary hypoplasia. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Nuchal thickening in Jacobsen syndrome
Authors: McClelland S. M. , Smith A. P. M. , Smith N. C. , Gray E. S. , Diack J. S. W. , Dean J. C. S. 
Published: March 2003

AbstractA routine detailed ultrasound examination performed at 20 weeks' gestation demonstrated the presence of nuchal thickening as an apparently isolated finding. The concentration of maternal α‐fetoprotein was normal and the risk of Down's syndrome was 1 in 6800. Amniocentesis was performed and chromosome analysis showed the karyotype 46,XY, del(11)(q23) found in Jacobsen syndrome. Fetal autopsy performed following medical termination at 23 weeks confirmed the phenotype and internal abnormalities found in Jacobsen syndrome. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Abnormal prenatal sonographic findings in the posterior cranial fossa: a case of Joubert's syndrome
Authors: Ní Scanaill S. , Crowley P. , Hogan M. , Stuart B. 
Published: March 2003

AbstractJoubert's syndrome is a well‐documented but rare disorder characterized by a variable combination of central nervous system, respiratory, renal and eye anomalies. The most significant and constant neuropathological finding is partial or complete agenesis of the cerebellar vermis. The syndrome was first described by Joubert and colleagues as a familial agenesis of the cerebellar vermis and appears to be inherited as an autosomal recessive trait. A case of Joubert's syndrome is described in which second‐trimester ultrasonography demonstrated abnormal findings in the fetal posterior fossa with associated renal abnormalities. However, postnatal sonography of the posterior fossa could not confirm the prenatal findings, and the diagnosis of Joubert's syndrome was only later established by computed tomography of the neonatal brain in the knowledge of the characteristic clinical picture. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Intrauterine management of fetal parvovirus B19 infection
Authors: Schild R. L. , Bald R. , Plath H. , Eis‐Hübinger A. M. , Enders G. , Hansmann M. 
Published: March 2003

AbstractObjectivesThe aim of our study was to determine the outcome of pregnancies after intrauterine management of fetal parvovirus B19 infection.DesignRetrospective study.SubjectsA total of 37 cases of maternofetal parvovirus B19 infection, 35 of which were associated with hydrops fetalis, were referred to our tertiary level center between 1989 and 1996. With regard to fetal hydrops, no apparent cause other than parvovirus B19 infection was found in any patient.MethodsIn all patients, cordocentesis was performed to assess the degree of fetal anemia. When anemia was pre‐sent, cordocentesis was followed by intrauterine transfusion with packed red cells into the umbilical vein. Further management depended on the degree of fetal anemia and gestational age and included follow‐up fetal blood sampling/transfusion as well as ultrasound examinations as deemed appropriate.ResultsPacked red cell transfusion was performed in 30 patients with significant fetal anemia (Z‐score 1.6–7.8 below the mean for gestational age). The fetal hemoglobin values ranged from 2.1 to 9.6 g/dl. Serum levels of platelets in the transfusion group were 9–228 × 109/l with Z‐scores in the range of < 1 to 3.8 below the mean. During treatment and follow‐up, there were five intrauterine deaths (13.5%), one neonatal death (2.7%) and 31 live births (83.8%).ConclusionsFetal parvovirus infection can lead to marked anemia and hydrops formation. Cordocentesis allows precise assessment of fetal anemia which can then be corrected by intravenous transfusion. Under this regimen, the outcome proved favorable in the majority of fetuses, even those that were severely anemic. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Fetal pulmonary venous flow into the left atrium relative to diastolic and systolic cardiac time intervals
Authors: Brezinka C. , Laudy J. A. M. , Ursem N. T. C. , Hop W. C. J. , Wladimiroff J. W. 
Published: March 2003

AbstractObjectiveTo establish the nature and gestational age dependency of the pulmonary venous flow velocity pattern into the left atrium relative to systolic and diastolic phases of the cardiac cycle.DesignThis was a cross‐sectional study of Doppler measurements of fetal pulmonary venous inflow velocities, which were correlated with simultaneous recordings of transmitral and aortic flow velocity waveforms based on an equal cardiac cycle length (±5%).ResultsSuccessful recordings were obtained in 28 out of 60 (47%) normal singleton pregnancies at 20–36 weeks of gestation. Reproducibility of waveform analysis of the various phases of the cardiac cycle was satisfactory, within‐patient variance ranging between 1.7% and 6.5%. A statistically significant increase (p < 0.05) in pulmonary venous time average velocity and velocity integral with advancing gestational age was established. A statistically significant increase (p < 0.05) of the pulmonary flow velocity integral was also found when related to each of the systolic and diastolic segments of the cardiac cycle, with the exception of isovolemic relaxation time. The duration of each of the diastolic and systolic segments of the cardiac cycle, as well as the pulmonary venous velocity integral expressed as a percentage of the cardiac cycle, remained constant with advancing gestational age.ConclusionsThe second half of pregnancy is characterized by pulmonary venous inflow into the left atrium throughout the cardiac cycle. Pulmonary venous inflow into the left atrium occurs predominantly during the filling and ejection phases of the cardiac cycle. Absolute cardiac diastolic and systolic time intervals as well as the percentage distribution of pulmonary venous flow velocity integrals between these cardiac time intervals remain unchanged with advancing gestational age. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Nuchal translucency in fetuses affected by homozygous α‐thalassemia‐1 at 12–13 weeks of gestation
Authors: Lam Y. H. , Tang M. H. Y. , Lee C. P. , Tse H. Y. 
Published: March 2003

AbstractObjectiveFetuses affected by homozygous α‐thalassemia‐1 are anemic in the first trimester. We studied their nuchal translucency (NT) measurements at 12–13 weeks of gestation.MethodsNuchal translucency was measured prospectively in fetuses at risk of homozygous α‐thalassemia‐1. Measurements of those fetuses subsequently confirmed to be affected by homozygous α‐thalassemia‐1 but with a normal karyotype were compared to those of 440 controls. The controls were from the general obstetric population who had NT measurements at 12 or 13 weeks with known normal outcome. All the NT measurements were expressed as multiples of the median (MoM) for the gestational day.ResultsBetween 1996 and 1998, 94 at‐risk pregnancies were studied. Of these, 32 were subsequently confirmed to be affected by homozygous α‐thalassemia‐1. Chromosome study was not carried out in three cases and these were excluded from the analysis. Nuchal translucency MoMs for cases and controls were found to fit a log Gaussian distribution. The log means (standard deviation) for case and control NT MoM were 0.075 (0.156) and 0.0019 (0.091), respectively. The median NT MoM (95% CI) for cases was 1.19 (1.08–1.62) and was significantly higher than that of the controls (p < 0.001). However, there was extensive overlap of NT between cases and controls.ConclusionOverall, there was a 19% increase in NT MoM in fetuses affected by homozygous α‐thalassemia‐1. This represents a difference of only 0.3–0.4 mm, which is clinically insignificant. This finding indirectly suggests that the increased NT in trisomic fetuses cannot be explained by fetal anemia. Conversely, the presence of increased NT in a fetus at risk of homozygous α‐thalassemia‐1 should alert one to the possibility of chromosomal abnormality rather than being attributed to fetal anemia. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Fetal craniofacial structure and intracranial morphology in a case of Apert syndrome
Authors: Pooh R. K. , Nakagawa Y. , Pooh K. H. , Nakagawa Y. , Nagamachi N. 
Published: March 2003

AbstractApert syndrome is characterized by craniosynostosis, mid‐facial hypoplasia and bilateral syndactyly. We document in detail the intrauterine natural history of Apert syndrome by serial sonographic examination.Ultrasound examination of a 19‐week fetus revealed an abnormal appearance of the skull. The subsequent examination including transvaginal brain scanning demonstrated a deformed occipital part of the cerebrum and lateral ventricles, frontal bossing, a low nasal bridge and an abnormal appearance of the fetal hands and feet. The distortion of the fetal profile became progressively worse with advancing gestation. Towards the end of pregnancy, anterior prominence of the cerebrum, ventricles and corpus callosum was demonstrated and mild non‐progressive ventriculomegaly was seen. The female 3152‐g newborn with the typical facial appearance of Apert syndrome, bilateral syndactyly of the fingers and toes and isolated cleft palate was delivered at 37 weeks. Postnatal three‐dimensional computed tomography scan demonstrated the fusion of the coronal suture and a wide midline calvarial defect, and cranial magnetic resonance imaging confirmed the prenatal sonographic findings. Although the karyotype was normal, genomic DNA analysis of the fibroblast growth factor receptor 2 revealed Ser252Trp, which is specified in the mutational basis of Apert syndrome.The time course of the prenatal findings in this case may help increase understanding of the intrauterine natural history of Apert syndrome. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology