bluuebunny/crossref_metadata_2025_split huggingface dataset:
The diagnostic value of fetal heart biometry in early pregnancy
Authors: Smrcek Jan , Germer U. , Berg C. , Gembruch U. 
Published: March 2003

Purpose:  To evaluate the value of early cardiac biometry for the detection of congenital heart defects (CHD) using our normative data.Methods:  Cases were selected from all cases with CHD diagnosed between 10 and 17 weeks of gestation between 1999 and 2000. Detailed fetal two‐dimensional and color‐coded Doppler echocardiography was performed. The transversal heart diameter, both ventricular dimensions, heart area and circumference, thoracic diameter, thoracic circumference and area and the diameters of the pulmonary trunk and ascending aorta were measured.Results:  A total of 31 cases of CHD between 10 and 17 weeks of gestation were diagnosed. Eight fetuses presented with insufficient biometric measurements. In the remaining 23 fetuses different complex abnormalities were present. In three fetuses with an atrioventricular septal defect and two with a ventricular septal defect fetal heart biometry showed normal values. In 18/23 fetuses with CHD fetal heart biometry was partly abnormal. Nuchal translucency (NT) thickness measurements were performed before 14 weeks of gestation and 10/12 fetuses presented with an increased NT. Both fetuses with normal NT showed an abnormal fetal heart biometry. Venous Doppler evaluation was performed in 22 cases, 12 fetuses demonstrated an increased pulsatility in the ductus venosus and 7 with a pulsatile flow in the umbilical vein in addition. In 7/10 fetuses with normal venous Doppler fetal heart biometry was partly abnormal.Conclusion:  Early fetal heart biometry may be helpful in the prenatal diagnosis of some major CHD by demonstration of discordant diameters of the fetal heart and great arteries. At 10–14 weeks of gestation, nuchal translucency thickness measurements and biometric measurements of the fetal heart seem to be complementary methods for the detection of cardiac defects.
The three‐dimensional ultrasound diagnosis of acrania in early pregnancy
Authors: Hsu T.‐Y. 
Published: March 2003

Objective:  To compare the application of two‐ and three‐dimensional (2D and 3D) ultrasound for the antenatal diagnosis of acrania in the early pregnancy.Materials and methods:  Two‐ and three‐diminsional (2D and 3D) ultrasound in early pregnancy were studies prospectively between April 1999 and March 2001. A volume scan (Voluson 530D Kretz Technik, Austria) were performed after the conventional 2D (Acuson 128 XP, mt. view, CA) ultrasound examination were complete. The ability to visualize acrania and weeks gestation of diagnosis were compared between the two techniques. All relevant English‐language clinical research articles retrieved were reviewed and compared.Results:  Five fetuses with acrania in early pregnancy was detected, our cases were diagnosed earlier than previous reports (13.4 ± 1.67 weeks vs. 17 ± 1.83 weeks). The serum level of a fetoprotein were elevated in four cases. Only two fetuses had chromosome study and all were normal.Conclusion:  Our experience of the use of 3D transvaginal ultrasound, a more accurate version of the fetal brain and face can be obtained. We believe that with technical improvements 3D, sonography permits more detailed evaluation than is possible with current 2D sonography.
The role of magnetic resonance imaging (MRI) in the prenatal diagnosis and evaluation of fetal tumors
Authors: Yagel S. , Nadjari S. , Gomori M. 
Published: March 2003

Objective:  Fetal tumors are rare abnormalities, problematic to diagnose accurately by ultrasonography alone. In many cases precise diagnosis depends on advanced tissue characterization, difficult to accomplish with ultrasound. The recent advent of rapid MRI has made this modality more amenable to prenatal diagnosis. Our aim was to investigate the role of this modality in the diagnosis fetal tumors.Patients and methods:  Thirteen cases with suspected fetal tumors underwent thorough early and/or late ultrasound examination, followed by rapid MRI. Postnatal MRI examination or postmortem (PM) pathology was performed as indicated.Results:  Ultrasound examination follow by MRI revealed the following cases: brain tumor, 2; tuberous sclerosis, 1; intracerebral hemorrhage, 1; brain cyst, 1; cystic adenomatoid malformation CCAM, 2; pericardial teratoma, 1; intra thoracic hygroma, 1; sub diaphragmatic lung sequestration, 2; hemorrhagic ovarian cyst, 1; liver hemangioma, 1. Postnatal or PM examination confirmed prenatal rapid MRI diagnosis in 12/13 cases, while ultrasound diagnosis was confirmed in 7/13 cases. In 10/13 cases MRI examination was more accurate than ultrasound examination and significantly improved our prenatal evaluation of the findings, patient counseling and treatment.Conclusion:  Rapid MRI plays an important role in the precise diagnosis of fetal tumors especially when tissue characterization is essential for the diagnosis.
Antenatal diagnosis of the absent inferior cerebellar vermis – is there any clinical significance?
Authors: Wong J. S. M. , Woo B. H. , Yeo G. S. H. 
Published: March 2003

Objective:  The clinical significance of antenatal ultrasound diagnosis of the absent inferior cerebellar vermis (AICV), whether isolated or associated with other ultrasound findings, has not been well‐understood with limited research previously. Because of its association with some syndromes, e.g. Dandy–Walker or Walker–Warburg syndromes, we aim to study the outcome for the purpose of counseling of parents when this is diagnosed antenatally.Methods:  A single‐center, prospective observational study of screening scans of a low risk population was conducted from 1 October 1996 to 30 September 2000. Cases of AICV diagnosed were followed up postnatally for up to 4 years with cranial ultrasound and developmental assessments.Results:  There were 56 746 screening scans on 64 225 babies delivered during this period. Twenty‐eight cases of AICV were diagnosed between 19 and 34 weeks. Six had isolated AICV and all occurred in women less than 35 years old. All had normal outcome and developmental assessment on follow up. The other 22 were associated with other ultrasound findings like echogenic bowel, structural heart defects or Dandy–Walker malformation. Four of them occurred in mothers 35 years and older with three (75%) having abnormal karyotype. Five occurred in mothers aged 30–34 years with two (40%) having abnormal karyotype. Of the remaining 13 in those less than 30 years, five (38%) had abnormal karyotype. These include trisomy 13 and 18, Turner and Goldenhar syndrome.Conclusion:  The antenatal diagnosis of the isolated AICV is associated with low risk of chromosomal abnormalities and thus, does not require further karyotypic analysis. However, if other ultrasound findings are also seen, an abnormal karyotype can be expected in up to 38% of the patients (in our series), and even more (75%) if the maternal age is 35 years and above. Karyotyping should be offered in these cases.
Gender‐adjusted multiples of the median in amniotic fluid alpha‐fetoprotein‐screening for neural‐tube defects halve false‐positive rate without affecting detection rate
Authors: Kozlowski P. , Knippel A. J. , Stressig R. 
Published: March 2003

Introduction:  Previous studies have shown that fetal gender had influence on various pregnancy complications and prenatal diagnostic biochemical markers. We have evaluated, whether elevation of amniotic fluid alpha‐fetoprotein (AF‐AFP) is associated with fetal sex and whether a sex‐related difference can help to identify pregnancies with AFP‐associated malformations or poor pregnancy outcome.Material and methods:  From our database, we obtained 6461 singleton gestations with absolute values and corresponding multiples of the median (MoM) for AF‐AFP for the period database April 1997–March 1999. In all instances high‐resolution ultrasonography was performed before amniocentesis to measure biparietal diameter. Patients with AF‐AFP ≥2 MoM were identified, details of pregnancy outcome were obtained and compared to matched‐pair‐controls having AF‐AFP <2 MoM.Results:  A total of 262 patients showed AF‐AFP levels ≥2 MoM. Outcome information was available in 232 cases (88.6%) including all cases with fetal anomalies recorded at ultrasonographic examination. Of these fetuses significantly more had male gender (147 male fetuses vs. 85 female, P < 0005). Having a positive screen result in the risk of AFP‐associated malformations was significantly higher for female fetuses (25 female fetuses (29.4%) vs. 22 male fetuses (15%) with AFP‐associated malformations, P < 0025). Pregnancies with false positive AF‐AFP had a significantly higher risk for poor pregnancy outcome compared with pregnancies having normal AF‐AFP (11 fetal losses (59%) from 185 vs. two fetal losses (0.9%) from 232, P < 0025) but fetal gender had no significant influence.Conclusions:  Measuring AF‐AFP routinely in amniotic fluid obtained for cytogenetic evaluation is a cheap method to identify fetuses, on which high‐resolution ultrasonography in a level 3 center should be focused. Adjusting the cut‐off MoM to 2.5 for male and to 2.0 for female fetuses halves the false‐positive rate from 3.4 to 1.7 without affecting the detection rate of 95% in our population. Larger studies are required to determine suitable sex‐adjusted cut‐off values.
Increased risk for prenatal asphyxia and death in fetuses with duodenal obstruction
Authors: Brantberg A. , Blaas H.‐G. K. , Salvesen K. Å. , Eik‐Nes S. H. 
Published: March 2003

Purpose:  The aim of this study was to describe the outcome of a cohort of fetuses with duodenal obstruction diagnosed prenatally. Most previous studies are based on results from newborns and have shown a good outcome with a survival rate up to 95–100%.Methods:  Fetuses with prenatally diagnosed duodenal obstruction were registered and prospectively evaluated at the NCFM from January 1985–December 2000.Results:  Duodenal obstruction was found in 29 fetuses at mean 29 weeks and 2 days. Polyhydramnios was found in 24 (83%). Six (21%) had trisomy 21. Associated anomalies, including trisomy 21, were found in 18 cases (62%). Four pregnancies with normal karyotype ended with intrauterine fetal death at 31–35 gestational weeks. One of these had associated anomalies. In all cases, death occurred unexpectedly. Mean gestational age at delivery was 35 weeks and 5 days. Eighteen (64%) delivered prematurely. The mean birth weight was 2562 g. Four infants (14%) were small for gestational age. Three infants died postnatally; all three had associated anomalies. Two infants suffered from severe neurological impairment with cerebral palsy and epilepsy, and two suffered from psycho‐motoric impairment suggesting that these four might have had intrauterine asphyxia. Another fetus had sustained intrauterine bradycardia with subsequent emergency CS.Conclusions:  The present study of 29 prenatally diagnosed duodenal obstructions showed a relatively poor outcome with four intrauterine deaths, three postnatal deaths and four infants with neurological sequele. The neurological sequele indicate possible intrauterine asphyxia. We suggest that there may also be a common reason for the cases of intrauterine fetal death as well as the case with bradycardia. We consider the possibility that it could be caused by bradycardia/asystolia following a vagal overactivity due to distension of the upper gastrointestinal tract.
Vascularity index of the testis: a guiding technique for testicular sperm extraction (TESE)
Authors: Har‐Toov J. , Eitan O. , Hauser R. , Butchan A. , Gull I. , Wolman I. , Yavez H. , Jaffa A. J. 
Published: March 2003

Aim:  To develop a non‐invasive computerized technique that predicts the presence of spermatogenic sites within the testes of non‐obstructive azoospermic (NOA) patients.Material and methods:  Power Doppler ultrasound images of the testes of seven NOA patients and six fertile men were acquired. Three sagittal, three transverse and one coronal cross‐sections of the testis were scanned by a linear 7.5 MHz transducer. Three‐dimensional (3D) matrix of 32 elements was generated from all images of each testis. Each element carried information (a vascularity index, VI) about the blood vessels that crossed its volume. The matrix (4 × 4 × 2) was divided into regions of 16 elements which were classified as ‘positive’, ‘negative’ and ‘undetermined’ according to the VI values in the anterior and posterior layers of a region. The NOA patients underwent testicular biopsies at three locations along the midline of the testis. The results of the biopsies were correlated to the appropriate regions in the 3D matrix.Results:  Of the seven NOA patients, 12 testes were scanned, however, only 27 biopsies were performed. Accordingly, only 27 regions were considered. Thirteen regions were ‘positive’, 12 regions were ‘negative’, and two were ‘undetermined’. Motile spermatozoa were found in nine out of 12 ‘positive’ regions (69.2%). No sperm was found in 10 of the 12 ‘negative’ region (83.3%). In the control group of six patients, there were 12 testes, which divided into 36 regions. Twenty‐four regions were ‘negative’ (66.7%), one was ‘positive’ (2.7%) and 11 were ‘undetermined’ (30.6%).Conclusion:  The results yielded that positive/negative region predict the presence or absence of spermatozoa, and thus, this method appears to be a promising non‐invasive guiding tool for TESE in NOA patients. TESE will be more effective, less biopsies will be needed, and testicular damage will significantly be lowered. However, this method is not suitable to identify spermatozoa in fertile men.
Factors associated with endometrial thickness and uterine size in a random sample of postmenopausal women
Authors: Gull B. E. , Karlsson B. , Milsom I. , Granberg S. 
Published: March 2003

Objective:  To investigate factors possibly associated with endometrial thickness and uterine size in a random sample of postmenopausal women.Study design:  A random sample (n = 1000) of the total population of women aged 45–80 years resident in the city of Göteborg was invited to attend for a transvaginal sonography examination. Eight hundred and twenty‐seven women accepted the invitation and underwent a gynecological and a transvaginal sonographic examination with measurement of endometrial thickness and uterine size. The women's height and weight were measured and a blood sample for analysis of serum estradiol and follicle stimulating hormone was taken. The women also provided information regarding previous medical and gynecological history, possible medication and smoking habits.Results:  Five‐hundred and fifty‐nine women were postmenopausal and 183 of them were taking some form of hormonal substitution (33%). Factors associated with endometrial thickness and uterine size were analyzed using univariate and stepwise multiple regression analyses. The current use of hormone replacement treatment was the most important factor associated with both endometrial thickness and all the uterine size parameters studied. The presence of fibroids was also associated with endometrial thickness. Other factors shown to be associated with uterine size were age, parity, smoking, hypertension and diabetes mellitus.Conclusions:  Several of the known risk factors for endometrial cancer were shown to be associated with endometrial thickness and uterine size parameters.
Uterine artery Doppler ultrasonography and pregnancy outcome in women with a history of early onset pre‐eclampsia and thrombophilia
Authors: Van Eyck J. , Arabin B. , Wibbens B. 
Published: March 2003

Purpose:  To assess the relationship between persistence after 22 weeks' gestation of the notch in the uterine artery and pregnancy outcome in pregnant women with a history of early onset (<32 weeks) pre‐eclampsia, were tested for thrombophilia and subsequently received medication according to the disorder.Methods:  Between 1995 and 2000, Doppler ultrasonography of both uterine arteries was performed between 18 and 24 weeks, in 80 pregnant women with a history of early onset pre‐eclampsia, were tested for thrombophilia. A total of 34 women had no thrombophilia and had received only low‐dose aspirin as from 12 weeks' gestation. Forty‐six women had thrombophilic disorders like: protein S deficiency (N = 10), APC‐resistance (N = 11), anticardiolipin antibodies (N = 15) and had received low‐dose aspirin as from 12 weeks gestation in combination with low‐molecular heparin as from 7 weeks' gestation. Seventeen women from this group of 46 women also suffered from hyperhomocysteinemia. Next to their treatment with folic acid and pyridoxin, they had received low‐dose aspirin as from 12 week gestation. Five women had a combination of two disorders and one woman had three disorders.Results:  In 29 women with single hit thrombophilia (protein S deficiency, APC‐resistance or anticardiolipin antibodies), notches persisted in only one woman, who subsequently developed pre‐eclampsia (PE) at 31 weeks. Of the remaining 28 women, four developed PE at 31, 31, 35 and 39 weeks despite disappearance of notches. In 12 women with single hit hyperhomocysteinemia, notches persisted in three women, one of them developing PE at 33 weeks. From the remaining nine women, two developed PE at 31 and 35 weeks. In 34 women without thrombophilia, notches persisted in four, one of them developing PE at 36 weeks. From the remaining 30 women, 3 developed PE at 29, 29 and 38 weeks.Conclusions:  The percentage of persistence of uterine notch in women with ‘treated’ thrombophilia is comparable to women without thrombophilia (11 vs. 12%), whereas recurrence rate of PE is, respectively, 19 and 12%. In both groups averaged gestational age at which PE developed was 3 weeks later than in the index pregnancy. Whether these observations can be contributed to the described medication is currently evaluated in a large prospective, randomized, multicenter study in The Netherlands (FRUIT study).
Accuracy of ultrasonographic determination of fetal weight at term among Filipinos
Authors: Vitug M. R. S. , Rivera R. P. , Clemente L. R. 
Published: March 2003

Background:  The birth weight of an infant is one of the most important factors affecting its survival. Four computer‐generated formulas, Hadlock, Merz, Osaka and Shepard for weight estimation are in common use in our institution, but none of them has been devised specifically for Filipinos. It is the objective of the study to determine which among these formulas is accurate in diagnosing the fetus weighing 4000 g or more among Filipinos.Methods:  The accuracy of in utero fetal weight estimations were evaluated prospectively in 74 Filipino patients during the study period. Sonographic estimate was performed by a single sonologist within 24–48 h of delivery. Estimates of fetal weight were calculated using the Hadlock, Merz, Osaka and Shepard. The newborn birth weight were measured within 30 min of delivery. The results were then compared with the actual birth weight.Results:  Of the 74 patients seen, 62 patients were included. Eighteen (29%) had a birth weight less than 3000 g, 40 (65%) weighed between 3000 and 3999 g and six (10%) had a birth weight of 4000 g or more. When birth weight is less than 3000 g, Osaka and Merz conferred the same diagnostic accuracy but the former had a significantly higher negative predictive (88%). For birth weight ranging from 3000 to 3999 g, Hadlock had the highest diagnostic accuracy (100%). This report confirms that the best in utero weight estimations among fetuses weighing 4000 g or more result from the use of Shepard formula which has sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of 100%.Conclusion:  Since the accuracy of Shepard formula in estimating fetal weight 4000 g or more is significantly better than those based on Hadlock, Merz and Osaka, we recommend the use of such formula in intrapartum fetal weight estimations among Filipinos. This estimated weights can offer guidance in predicting fetal macrosomia, and therefore, aid in obstetric management.
Does amniocentesis (AC) influence fetal growth?
Authors: Nguyen T. huu , Larsen T. 
Published: March 2003

Purpose:  To examine the relationship between AC and birth weight.Methods:  A cohort of singleton pregnancies with AC carried out in Denmark (n = 96893) was compared to the total population of singleton pregnancies without AC or CVS (chorionic villus sampling) (n = 873254) for infants born in years between 1980 and 1996. Exclusion criteria were multiple pregnancies, infants with malformations, chromosomal abnormalities, stillbirths, and death within the first living year. The pregnancies with AC were grouped according to gestational age (14–19th week of gestation) at the time of AC, and mean birth weight was calculated for each group. Maternal age, parity and previous abortions were taken into account when comparing mean birth weights. To exclude social status as a confounder, the overall mean birth weight (pregnancies without CVS or AC) was also compared to the mean birth weight of a subgroup of infants (also without CVS or AC) born to women who undergo AC in some other pregnancy.Results:  The mean birth weight of the AC cohort was found to be significantly higher than that of the total population and inversely related to the gestational age at AC.Conclusion:  The invasive procedure seems to stimulate growth. No known potential cofounders can explain the higher birth weight after pregnancies with AC.
Thromboelastography in the second trimester of pregnancy in the prediction of adverse pregnancy outcome
Authors: Karidas C. , Anastassopoulos P. , Perry D. , Economides D. L. 
Published: March 2003

Thromboelastography (TEG) is a method of monitoring global homeostatic function as a dynamic process, involving the interaction between the protein coagulation cascade and platelets, as opposed to the isolated end points measured by conventional coagulation screens. The purpose of this study is to determine whether TEG variables can be used in the second trimester to predict the development of adverse pregnancy outcomes such as pre‐eclampsia and intrauterine growth restriction (IUGR defined as birth weight below the 5th centile for gestational age).Methods:  A prospective study of a cohort of 273 pregnant women who underwent TEG assessment at 18–24 weeks gestation. Standard parameters were measured from each TEG tracing (R is the reaction time, K the clot formation time, A the angle, and MA the maximum amplitude). Pregnancy outcomes were obtained from the case notes of 251 participants. Twenty‐two patients were lost at follow up. The Mann–Whitney test was employed for analysis, as the above parameters did not follow normal distribution.Results:  Twenty‐three pregnancies (9.2%) were complicated by IUGR and 10 (4%) by pre‐eclampsia. In the IUGR group, no significant difference was observed in any of the TEG parameters in comparison to the normal pregnancies (for R time: Mann–Whitney U = 2296, for K time: U = 2556, for MA: U = 2514.5, for A‐angle: U = 2433, 95% CI (1972, 3273)). Similarly, TEG parameters did not differ significantly in the pregnancies complicated by pre‐eclampsia (for R time: Mann–Whitney U = 971.5, for K time: U = 1063.5, for MA: U = 1199.5 and for A‐angle: U = 1183, 95% CI (765, 1646)). Comparisons after logarithmic transformation, did not reveal any significant differences between the two groups.Conclusion:  Thromboelastography parameters in the second trimester of pregnancy did not differ in normally developed and complicated pregnancies. Therefore, they cannot be used as a single predictor of adverse pregnancy outcome. This is a pilot study, therefore, further studies are required to evaluate their use in conjunction with established predictive tests.