bluuebunny/crossref_metadata_2025_split huggingface dataset:
Routine ultrasound screening in 12169 pregnancies
Authors: Chan F.‐Y. , Wong S. , Cincotta R. , Parry A. , Welsh A. , Stone M. , Cooper D. 
Published: March 2003

Purpose:  To assess the detection rate for congenital malformations in a routine ultrasound screening program in a tertiary Australian institution.Methods:  The findings of routine ultrasound screening performed in the Mater Mother's Hospital, Brisbane over a 6‐year period was prospectively collected. Pregnancy and neonatal outcomes were obtained from the obstetric and neonatal database. The presence of major congenital anomalies, as classified according to the Australian National Perinatal Statistics Unit, was checked against the hospital's perinatal database.Results:  Over the 6‐year period, a total of 26649 obstetric ultrasound scans were performed in the unit, 12169 (45.7%) were routine ultrasound scans. This is the largest Australian cohort study on routine ultrasound screening. A total of 75 major congenital anomalies were detected during the antenatal period. The number of major congenital anomalies in the cohort was 131, giving a sensitivity of 57.3%. The sensitivities according to different organ systems were: central nervous system (78%); urogenital tract (83%); gastro‐intestinal tract (38%); cardiovascular system (27%); skeletal system (50%); respiratory system (67%) and others (63%). These results were significantly better than that from the RADIUS study (P < 0.001), and comparable to those from other tertiary referral centers.Conclusion:  The sensitivity for detection of congenital anomalies by routine ultrasound screening at Mater Mothers' Hospital is comparable to most published series from tertiary institutions, and significantly better than that reported in the RADIUS study.
Gastroschisis – can prenatal ultrasonography predict neonatal outcome?
Authors: Peter J. R. , Chan F. Y. , Hockey R. 
Published: March 2003

Background:  Gastroschisis carries significant neonatal morbidity, and occasionally mortality. Previous studies looking at ways to prognosticate this condition by antenatal ultrasound have shown conflicting results. Small numbers limited the power of most previous studies. The current study is one of the largest so far reported.Purpose:  To evaluate the usefulness of prenatal ultrasonograpic parameters to predict neonatal outcome for gastroschisis.Methods:  The charts, photos, and videotapes of all babies with gastroschisis who were assessed during pregnancy at the Mater Mothers' Hospital, Brisbane over an 8.5‐year period (January 1993–May 2001) were reviewed. Bad neonatal outcome was defined as death, severe bowel complications (atresia, perforation, necrotic segments), need for multiple bowel operations, or a combination of these. Various ultrasonographic parameters assessed included: gestation at first diagnosis, maximum bowel diameter, maximum bowel thickness, presence of other anomalies, evidence of growth restriction, and polyhydramnios.Results:  Forty‐five patients met the entry criteria during the study period. Six neonates died, 12 had severe bowel complications, and 14 had a combination of the bad outcomes. Apart from polyhydramnios, none of the other ultrasound parameters were significantly associated with the bad outcomes. Polyhydramnios was most significantly associated with severe bowel complications (P < 0.001, Fisher’s exact test), with likelihood ratio of 11.7 (P = 0.001).Conclusion:  The current study show that most standard ultrasound parameters assessed antenatally in fetal gastroschisis were not significantly associated with neonatal outcome, except for polyhydramnios, which is strongly predictive of severe bowel complications in the neonatal period. This information is important both for parents and for health professionals managing pregnancies with fetal gastroschisis.
The assessment of placental blood flow by three‐dimensional color power Doppler ultrasound: preliminary result of a three‐dimensional histogram study
Authors: Yu C.‐H. , Chang C.‐H. , Chang F.‐M. , Liao T.‐P. , Ko H.‐C. 
Published: March 2003

Objective:  To assess the placenta blood flow in normal gestation by three‐dimensional color power Doppler ultrasound.Methods:  We collected normal pregnant women with gestational age between 20 and 40 weeks prospectively, consecutively and cross‐sectionally. Three‐dimensional ultrasound scanner, Voluson, 530D MT (Kretz, Zipf, Austria) was used to assess the placental blood flow in each case. First, we used the 3D transabdominal probe to scan the placenta under the 3D power Doppler mode at a fixed condition. Second, we used the VOCAL software (Kretz, Zipf, Austria) to calculate the histogram indices of fetal placental blood flow obtained from the 3D power Doppler scanning. The histogram indices included vascularization index (VI), flow index (FI), and vascularization‐flow index (VFI).Results:  One‐hundred singleton pregnant women were enrolled into the program. The best‐fit equations for VI, FI, and VFI are 0.27107 × GΑ − 4.02743, 0.56115 × GΑ + 34.28945, and 0.15663 × GA − 2.53810, respectively. All the P‐values are less than 0.05. All the indices were positively correlated with the fetal gestational age. Besides, The VI, FI, VFI of fetal placenta in third trimester were all higher than those indices of fetal placenta in the second trimester.Conclusion:  The fetal placental blood flow increases with the advancement of gestational age. Our data may be a useful reference for further studies of fetal placental flow in abnormal gestations.
Quantitative ultrasonic tissue characterization of the cervix – a new predictor for prematurity?
Authors: Tekesin I. , Meyer‐Wittkopf M. , Heller G. , Steinfeldt B. , Sierra F. , Schmidt S. 
Published: March 2003

Background:  Since the incidence of premature delivery has remained constant, despite intensive safeguard methods over the last decade, the texture features of the uterine cervix were evaluated using quantitative sonographic gray level analysis at different gestational ages (GA).Materials and methods:  For this purpose quantitative ultrasonic tissue densitometry of the uterine cervix was obtained from 30 asymptotic female patients (group A, mean: 30.3 GA) and compared with values obtained from 16 symptomatic female patients (group B, mean: 29.5 GA) with uterine contractions and shortening of the cervix at similar gestational ages. Once the two‐dimensional transvaginal sonographic measurement of cervical length was completed a region of interest of constant size was defined in the mid‐section of the posterior wall and the tissue‐specific gray scale distribution was determined.Results:  Quantitative ultrasonic tissue characterization of uterine cervix was feasible in all 46 patients at all gestational ages. In patients with premature contractions and shortening of cervix, the average gray scale values were found to be statistically reduced in comparison with those obtained from asymptotic patients. These results showed good reproducibility and intraobserver variability and were found to be independent from the measured cervical length.Conclusion:  Our results prove that quantitative ultrasonic tissue characterization of the uterine cervix might serve as a new parameter for predicting premature delivery in the future.
A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer
Authors: Gull B. E. , Karlsson B. , Milsom I. , Granberg S. 
Published: March 2003

Objective:  To evaluate postmenopausal bleeding (PMB) and transvaginal sonographic (TVS) measurement of endometrial thickness (ET) as predictors of endometrial cancer (EC) and atypical hyperplasia (AH) in women during a >10‐year period following a PMB.Study design:  Women presented with a PMB from November 1987 to October 1990 were included in this study (n = 394). The women underwent TVS with measurement of ET and a dilation and curettage (D & C). It was possible to assess the medical records of 339 of the 394 women (86%) >10 years after referral for PMB. During the follow up period the recurrence of a PMB, the development of EC and mortality were assessed.Results:  After the primary investigation, 39 of the 339 women were diagnosed as having EC (11.5%) and 5 women had AH (1.5%). The relative risk (RR) of diagnosing an EC in women referred for a PMB was 63.9 (CI 46.0 Ð 88.8) and the corresponding RR for EC and AH together was 72.1 (CI 52.8 Ð 98.5) compared to women of the same age from the same region of Sweden. The reliability of PMB as a diagnostic test for EC was assessed: sensitivity 18%; specificity 100%; positive predictive value 12%; and negative predictive value 100%. None of the women with an ET of 2 × 4 mm were diagnosed as having EC. The reliability of ET (cut‐off 2 × 4 mm) as a diagnostic test for EC was assessed: sensitivity 100%; specificity 60%; positive predictive value 25% and negative predictive value 100%. The incidence of EC or AH in women with an intact uterus followed 3 × 10 years was 5.8%. The corresponding figure for women who had 3 × 1 recurrent bleeding during follow up was 22.7%. No EC was diagnosed in women with a recurrent PMB who had an ET of 2 × 4 mm at the initial scan. No EC was diagnosed in the absence of a recurrent bleeding.Conclusion:  PMB incurs a 64‐fold increase risk for EC. No EC was missed when ET measurement (cut‐off 2 × 4 mm) was used even if the women were followed 3 × 10 years. About 5.8% of the women referred for a PMB later developed EC or atypia during the 10‐year observation period. There was no increased risk of EC or AH in women who did not have recurrent bleedings whereas women with a recurrent bleeding were a high risk group. A thick endometrium, with histopathological diagnosis of atrophy or insufficient for diagnosis, should be taken seriously and a guided biopsy should be taken or saline instillation sonography performed with ultrasound‐guided biopsy.
Fetal ovarian cysts: development and neonatal outcome
Authors: Mittermayer C. , Ulm B. , Dörfler‐Grassauer D. , Horcher E. , Deutinger J. , Bernaschek G. 
Published: March 2003

Introduction:  The aim of the study was to evaluate the outcome of fetal ovarian cysts in relation to their size and ultrasonic appearance.Methods:  We retrospectively analyzed pre‐ and postnatal charts of 61 infants with a prenatal diagnosis of ovarian cysts between 1991 and 2000. When completely anechoic and with a thin wall, the cyst was defined uncomplicated. Cysts, which presented themselves echogenic, with a fluid‐debris level, a retraction clot, or a septation were defined complicated.Results:  In a total of 61 fetuses, 65 ovarian cysts were detected by transabdominal ultrasound: 35 (57%) cysts on the left side; 22 (36%) on the right side and four fetuses (7%) had bilateral cysts. Three patients with uncomplicated cysts were lost to follow up and one fetus with bilateral cysts died in the 27th week of gestation. In 17 cysts, treatment was necessary. Fourteen cysts (all complicated) were operated after delivery because of persistence or enlargement. The histological results were either follicular or theca lutein cysts in 12 cases, one lymphangioma and one teratoma. Two cysts were aspirated in utero and one after delivery. In the remaining 40 fetuses, 43 cysts where only controlled by ultrasound. Eight cysts regressed before delivery and 35 cysts after delivery independent of their sonographic appearance. The mean diameter of cysts that required treatment was significantly different from the mean diameter of cysts that resolved spontaneously (6.8 ± SD 2.4 cm vs. 3.3 ± SD 0.8 cm; P < 0.01).Conclusion:  Complicated cysts which do not regress should be treated either by laparotomy or laparoscopically after delivery. Uncomplicated cysts which exceed 5 cm could be treated by in utero aspiration or aspiration after delivery to avoid further complications. Cysts smaller than 5 cm, presenting the tendency to regress, should be left untouched independent of their sonographic appearance.
Heart activity visualization in embryos with crown‐rump length shorter than 5 mm
Authors: Char Sang Choon , Yamasaki A. A. , Pares D. 
Published: March 2003

Introduction:  In the past, heart activity was only visualized by ultrasound in embryos with a crown‐rump length (CRL) of 5 mm or more. When CRL was shorter than 5 mm, non‐visualization of heart activity was considered normal. However, improvement in ultrasound equipment resolution has made it possible to diagnose viability in embryos with CRL as small as 2 mm.Objective:  The aims of this study were to determine: (a) how often heart activity is visualized in embryos with CRL between 2 and 5 mm; (b) outcome when CRL is shorter than 5 mm and heart activity is not visualized.Methods:  Presence or absence of heart activity was examined in embryos with CRL between 2 and 5 mm by vaginal ultrasound (Medison Model Voluson 530 and Aloka Model 1700), 4–7 MHz; B‐ and M‐mode). Follow up scans were carried out one‐week later when the initial scan did not demonstrate heart activity.Results:  Two hundred and forty‐four embryos were examined and heart activity was demonstrated in 210 (86%) cases. Follow up scans demonstrated heart activity in six (17.5%) of the 34 embryos in which heart activity was not initially visualized.Conclusion:  This study has demonstrated that visualization of heart activity is possible in most embryos with CRL between 2 and 5 mm nowadays. Non‐visualization at this stage is associated with embryonic demise in about 80% of cases.
The combination of uterine artery Doppler and placental volume measurement in the first trimester for the prediction of high risk pregnancies
Authors: Schuchter K. , Metzenbauer M. , Hafner E. , Philipp K. 
Published: March 2003

Purpose:  To evaluate the combination of placental volume measurement and uterine artery Doppler in the first trimester for the prediction of pregnancies complicated by preeclampsia, pregnancy induced hypertension, preterm placental abruption or fetal growth retardation.Methods:  At the booking scan in the first trimester one single operator was performing Doppler examinations of both uterine arteries on 380 women with singleton pregnancies. Both the pulsatility index (PI) and the criteria of notching or not notching were recorded. Another operator was recording and afterwards calculating the placental volume at the same visit. In order to correct the placental volume measurement for the gestational age a placenta quotient was calculated (placental volume/crown‐rump length).Results:  Uterine artery PI above the 90th centile could be recorded in 38 pregnant women. Three of these pregnancies were complicated with placental abruption, two of these were preterm placental abruptions with additional PIH. Six of the 38 pregnancies ended with SGA babies. On 39 women, the calculated placental quotient was below the 10th centile. Two of these women developed PIH in addition to the occurance of placental abruption. Six babies had a birth weight below the 10th centile and one of these had PIH. Only eight pregnancies met the criteria of uterine artery PI above the 90th centile and placenta quotient below the 10th centile. Two of these ended with placental abruption and PIH before 37 weeks of gestation, four of these babies had a birth weight below the 10th centile and none of these had a birth weight above the 50th centile.Conclusion:  Regarding our results we think that the combination of placental volume measurement and uterine artery Doppler might be a possible way for the evaluation of high risk pregnancies.
Which is the role of color Doppler sonography in the diagnoses of malignancy in postmenopause ovaries carcinomas?
Authors: Speca S. , Summaria V. , Costantini A. M. , Marano P. 
Published: March 2003

Aim:  To assess the reliability of B‐mode sonography signs in association with color Doppler (CDS) flow analysis in diagnosing the ovaries cancer in postmenopause women.Material and methods:  We studied by sovrapubic and transvaginal sonography 400 consecutive female patients (age 48–64) from January 1996 to September 2000. All the patients were asymptomatic and under estro‐progestinic therapy (postmenopause). We evaluated the morphological, volumetric and sonography changes of the ovaries, in association with the angioarchitecture (absence or presence of a neovascularization; low impedence arterial flow with PI < 0.8 and RI < 0.4).Results:  In the 710 ovaries studied, we diagnosed 37 benign lesions (25 cystis, eight cystic teratomas, and 14 unilateral hydrosalpinxes), all with no flow signal at CDS and four carcinomas (one bilateral ovaries adenocarcinoma, one endometrial adenocarcinomas, one hidrosalpinx with Walthard's nidus); all these last lesions showed a neovascularization with a RI < 0.4 and a PI < 0.8.Conclusion:  Our study confirmed the validity of the CDS in the diagnoses of ovaries malignant lesions, above all if associated to high flow speed and low impedence flow rate.
Weekly and 2‐week Doppler investigations to avoid misunderstanding compromised fetal conditions? SGA fetuses management in our experience
Authors: Solerte L. , Ragusa A. , Garsia S. 
Published: March 2003

Fetal surveillance in adequate for gestational age (AGA) and small for gestational age (SGA) allows to predict distress conditions and improve neonatal outcome. Doppler velocimetry (DV), fetal heart rate monitoring (CTG), biophysical profile with amniotic fluid index, are the common tools used to have fetal direct–indirect signs of well‐being. Several clinical studies stressed DV and CTG‐like reliable evidences of fetal conditions, despite their known limitations, connected with gestational age and compensatory mechanisms. In order to establish the best follow up time for fetal health, we analyzed two different groups of 20 non‐selected pregnant women with SGA 10–30 percentile. Intrauterine growth retardation were excluded for different role of DV in prediction and screening in placental disorders. From January to July 2001 we observed our two groups divided by maternal history; women were homogeneous for age and weight, with SGA.Diagnosis:  Made at 20–24 weeks scan, according to most common used biometry diagrams. DV was performed on the main arterial districts by pulsatility index, in umbilical and middle cerebral artery, and peak velocity in intracardiac aorta, to estimate changes in blood flow velocity and cardiac out‐put, to compare with Apgar index in neonatal outcome, including cesarean section rate. We closed our assessment with a precise definition of utility and applicability of weekly and 2‐week follow up, in order to improve fetal conditions at delivery time, avoid misunderstanding fetal distress organize better work‐time.
Enhancing cervical sonography with methyl‐cellulose gel
Authors: O'Brien J. M. , Houseman B. A. , Allen A. A. , Barton J. R. 
Published: March 2003

Purpose:  Our purpose was to evaluate the performance of two different contrast agents for cervical sonography in obstetrical patients. In addition, we sought to evaluate this technique in a setting other than with transvaginal sonography, such as utilizing a transperineal or transabdominal approach.Methods:  Women with an indication for cervical sonography without premature rupture of the membranes underwent placement of 10 mL of normal saline or water‐soluble methyl‐cellulose gel. Assessment of cervical dimensions and contour was performed via transperineal sonography prior to and after contrast placement. Two authors independently evaluated, the adequacy of visualization of the cervical canal, external os, and vaginal fornices. When an improvement in visualization after contrast placement was noted by both observers, the attribute was counted.Results:  Twenty‐five patients were enrolled into two groups. The mean gestational age at examination was 26.6 ± 6.2 weeks in the saline group, and 27.5 ± 5.2 weeks in the methyl‐cellulose gel group, P = 0.58. Administration of contrast improved visualization in 18 women in the gel group vs. six in the saline group, P = 0.002. Seventeen patients in the gel group had easier identification of the external os and enhanced visualization of the fornices was noted in 13 patients (12 patients had both). The mean cervical length was similar prior to and after administration of contrast (gel 2.8 ± 0.9 vs. 2.9 ± 1.0 cm, P = 0.18, and saline 2.5 ± 0.9 vs. 2.6 ± 0.6 cm, P = 0.45). Intravaginal contrast did not alter the identification of funneling in either group.Conclusion:  Intravaginal contrast allows for easier identification of cervical/vaginal anatomy in some patients undergoing ultrasonographic examination by transperineal scanning but did not significantly alter assessment of cervical length. Intravaginal soluble methyl‐cellulose gel is the superior cervical contrast agent to normal saline. This methodology may also be useful in other settings, such as with a transabdominal approach.
Prenatal treatment of severe congenital erythropoetic porphyria (CEP) – a case report
Authors: Calda P. , Zizka Z. , Dokoupilova M. , Sebron V. , Haakova L. , Eretova V. L. , Plavka R. 
Published: March 2003

Introduction:  Less than 3% of porhpyhia cases affect children and CEP is the most severe.Case report:  We report a case of a 21‐year‐old second digravida whose first pregnancy terminated with intrauterine death in the 27th week of gestation due to hydrops fetalis, cause unknown. The pathologist found organ infiltration with blastic blood elements. The patient was referred to our unit in the 25th week of the second pregnancy with oligohydramnion, ascites, hepatosplenomegaly, and generalized hydrops. The mother was AB Rh‐positive, with negative results for irregular antibodies, CMV, toxoplasmosis, and parvovirus B19. The initial cordocentesis showed severe anemia (Hct 7.7, Hgb 27, RBC 0.89, WBC 2.3, Plt 72), fetal karyotype: 46XY. Virologic examination, direct Coombs test, and amniotic fluid culture were negative. We treated the anemia with five intrauterine transfusions of O Rh‐negative erythrocyte concentrate. In the 25th week the Hgb was 59, during treatment it reached 91 (week 26), 120 (week 27), 134 (week 28), 114 (week 31), and 119 in the 33rd week, respectively. A male fetus was delivered in the 33rd week, with sanguineous amniotic fluid, birth weight 2370 g, APGAR 6‐7‐8, and arterial blood pH 7.25. The newborn had hepatosplenomegaly, anemia, and skin suffusions. Mild RDS was stabilized with nCPAP. From the fourth day, there was macroscopic hematuria. The treatment of renal failure was successful, the skin changes remained as the dominating sign. Eighteen days postpartum the diagnosis of congenital erythroid porphyria (autosomal recessive) was established based on the skin excoriation and urine examination for porphyrins.Discussion:  This rare case of ascites, anemia and thrombocytopenia was diagnosed postnatally, but symptomatic treatment enabled the delivery of a fetus that could be successfully treated postnatally with umbilical blood transfusion.Conclusion:  In all cases of unexplained ascites or hydrops the possibility of CEP should be considered.