bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fetal cardiac function in fetuses with intracardiac echogenic foci
Authors: Degani S. , Leibovitz Z. , Shapiro I. , Ohel G. 
Published: March 2003

Objective:  To evaluate cardiac dimensions and function in euploid fetuses with intracardiac echogenic foci.Study design:  Forty‐eight fetuses with a single cardiac echogenic focus situated in the left ventricle, had echocardiography performed at 22–24 weeks of gestation. Fifty normal fetuses at 22–24 weeks gestation served as controls. The 2‐D and M‐mode directed fetal echocardiography were used to exclude cardiac anomalies and measure right and left ventricular free walls and interventricular septal thickness and ventricular systolic and diastolic dimensions. Cardiac size was expressed as a ratio of ventricular wall thickness/biparietal diameter, and function was expressed as ventricular shortening fraction. Doppler fetal echocardiography measurements included pulmonary and aortic maximum systolic velocities and time to peak velocities as indices of ventricular systolic function and the ratio between E‐wave and A‐wave at the level of atrioventricular valves as indices of ventricular diastolic function.Results:  Early ventricular filling/active atrial filling ratios (E/A ratios) were significantly lower in fetuses with intracardiac echogenic foci than in control fetuses. No significant differences were found in cardiac dimensions, ventricular shortening fraction and Doppler systolic indices.Conclusion:  Euploid fetuses with intracardiac echogenic foci show low E/A ratio values in mid‐trimester echocardiography. This finding might indicate cardiac diastolic dysfunction.
Accuracy of antenatal ultrasound diagnosis assessed by Gold Standard – postmortem
Authors: Amaraddio D. M. , Chan F. Y. , Stone M. , Cooper D. , Payton D. 
Published: March 2003

Background:  Antenatal ultrasound is an accepted and widespread method for prenatal diagnosis. It has been shown that the performance of ultrasound in tertiary referral centers is better than in general units. Even so, some anomalies could still be missed in tertiary centers. Audits based on neonatal outcomes may not be completely accurate, as some anomalies may not be apparent yet. Postmortem is considered to be the Gold Standard for all identifiable fetal anomalies.Objective:  To evaluate the accuracy of antenatal ultrasound diagnosis in a tertiary referral center, using postmortem findings as the Gold Standard.Methods:  The departmental ultrasound database was searched from 1993 to 1996. All fetuses who had a fetal or perinatal death were identified. This was matched with the database in the department of pathology. Charts of fetuses who matched the entry criteria (antenatal ultrasound performed in the department, and postmortem available) were reviewed. The postmortem findings were compared to the ultrasound report.Results:  One hundred and ninety‐two fetuses with perinatal death were identified from the ultrasound database. One hundred and four received a postmortem. In 64 cases (70.3%), there was full concordance between postmortem and ultrasound findings. In 23 cases (25.3%), the ultrasound findings were confirmed, but additional anomalies were detected at postmortem. In three cases (3.3%), there were minor variations between the ultrasound and postmortem findings. There was no false positive diagnosis, and the only major anomaly not detected antenatally was one case with placenta accreta. Of all organ systems classified, best performance was in neural tube defects, where full concordance was found in 95.6% of cases. Most of the variations between ultrasound and postmortem were in fetuses with multiple anomalies. None of these variations would have affected obstetric management.Conclusion:  In 96.7% of the fetuses identified to have congenital anomalies in this series, the findings were confirmed in postmortem. Postmortem contributed further information in 28.6% of cases. While antenatal ultrasound in this tertiary setting is shown to be accurate, postmortem is still important for future counseling.
MRI and US imaging in fetal anomalies
Authors: Ximenes R. , Ximenes D. S. , Ximenes A. , Sjzenfeld J. , Ajzen S. , D'Hippolitto G. , Goldman S. M. , Carvalho A. C. S. 
Published: March 2003

Purpose:  The use of MRI in diagnose fetal abnormalities and the correlation with ultrasound.Methods:  Twenty‐five patents in which were diagnosed fetal abnormalities (CNS, thorax and renal) were submitted to MRI. The stage of pregnancy at the time of MR imaging ranged 16–34 weeks gestation. The half‐Fourier single shot rapid acquisition with relaxation enhancement (RARE) technique was used to obtain T2‐weighted images, this sequence has excellent contrast resolution of fetal tissues. It is a single selection acquisition technique limits the artifacts related to maternal and fetal motion.Results:  Fetus with CNS, thorax and renal abnormalities were submitted to MRI study. The CNS anomalies were vein of Galen aneurysm, archnoid cyst, Dandy–Walker complex, megacysterna magna, espina bifida. Thorax anomalies were adenomatoid cystic malformation. The renal anomalies were obstructive urophaty, renal displasia. The images of the ultrasound scans and the MRI images were analyzed individually and after compared each other to understand the limits and benefits of each technique.Conclusion:  Fast MR imaging techniques provide excellent resolution for imaging the fetal anatomies without the need for maternal or fetal sedation, and should be used as a complementary tool in the diagnosis of fetal anomalies.
Value of texture analysis in ultrasonographic examination of exised specimens of breast masses
Authors: Bader W. , Westhof G. , Hackmann J. , Dieterle S. , Hatzmann W. , Boehmer S. 
Published: March 2003

Purpose:  Specimen sonography is necessary for successful surgical excision of non‐palpable breast masses, discovered only in breast ultrasound. But is there any difference in echogenicity and echostructure between native and in vitro sonography?Methods:  The ultrasound images from 46 benign and malignant breast tumors were documented under standardized conditions pre‐ and postoperative, using a linear array machine (Shimadzu, US device SDU‐490) and 7.5 MHz transducer with a water path interposed between the transducer and skin or the plastic bag, containing the fresh specimens after surgical excision. Two images of each tumor were documented on a 3/4 in. Sony high‐band video device (U‐matic BVU‐800‐P), and the recordings were digitized with an 8‐bit resolution in 384 × 288 pixels (frame grabber band, Ing. Büro Fa. Fricke, Berlin). In each sonographic image, the maximum area of the region of interest of the tumor was marked and then subjected to consecutive texture analysis and correlation to the histological findings. For evaluation of tumor status eight parameters of first and second order texture statistics (grey level histogram, Fourier analysis, co‐occurrence matrix) were applied.Results:  In all cases, the mass was clearly identified on sonograms obtained in the operating room. Fibroadenomas (n = 11), fibrocystic diseases (n = 5) and ductal carcinomas (n = 26) showed comparable results in texture analysis. On the other hand, lobular carcinomas (n = 4) were clearly different in all parameters, in especially mean of grey level, homogeneity and contrast (P < 0.001 on the basis of Wilcoxon and Student's t‐test).Conclusions:  In vitro examination is a rapid and efficient method of localizing impalpable breast masses in excised specimens, but differences in echostructure and echogenicity are possible.
Uterine artery Doppler blood flow resistance indices in the second half of pregnancy: measures of central tendency, distribution, inter‐ratio dependency, and explanation of variation
Authors: Thompson M. O. , Vines K. S. , Aqualina J. , Harrington K. F. 
Published: March 2003

Study objectives:  To evaluate the three commonly used indices of Doppler blood flow resistance in clinical practice for the uterine artery. By assessing the measures of central tendency, dispersion, and variation, to determine the most appropriate index for clinical use transabdominally in the second half of pregnancy.Methods:  A prospective study of uterine artery Doppler measurement in singleton pregnancies between 18 and 32 weeks gestation. Using previously described methods, two independent measurements were obtained transabdominally from each side in all subjects. The systolic/diastolic ratio (SD ratio), pulsatility index (PI), and resistance index (RI) were recorded from both the right and left uterine artery in turn. All measurements were obtained by a single operator (MOT) using the same machine (Philips SD 800). The results were analyzed statistically for the measures of dispersion, distribution, and the variation explained.Results:  There were 1796 observations from 449 subjects in total, with the SD ratio showing the widest dispersion. The PI measurements were intermediate with respect to both, while the RI showed the least dispersion. The RI distribution was the closest to a naturally distributed (Gaussian) pattern, followed by the PI. The SD ratio did not appear to conform to a normal distribution. The interquartile ranges (IRQ) for the SD ratio were 0.71, 0.73 (left‐ and right‐uterine artery, respectively); PI: 0.42, 0.41; and RI: 0.15, 0.17. The mean of three derived measurements of the RI was sufficient to account for over 99% of the observed variation.Conclusions:  Differences reported between the different resistance and pulsatility Doppler indices could be due to either random or systematic error, or a combination of both. The observations from this study suggest that when the RI is used, these are kept to a minimum. These findings may be helpful in selecting the appropriate index for uterine artery Doppler screening and clinical applications in the second half of pregnancy.
Ultrasound during breast‐feeding in normal term infants
Authors: Jacobs L. A. 
Published: March 2003

The primary objective of this pilot study of infant feeding mechanisms on ultrasound was to develop local ultrasound techniques to assess the infant oral cavity during breast‐feeding.Study methods:  A convenience sample of 32 volunteers with term babies were invited for ultrasound during a breast‐feed in week 1 and 4 of life. Useable data was obtained in 22 participants but not all attended for both scans yielding 36/44. The whole breast‐feeding scan was videotaped for analysis later. Conventionally, accepted positioning and attachment criteria were used. The infant was weighed before and after feeding to satisfaction from one breast. A submental approach was used to obtain a median sagittal view of the nipple position, hard and soft palate, tongue movements and the relationship between these intraoral structures. Various designs and frequency of transducers were tested. The optimal transducer is an EC‐7 endocavity transducer with a 135° end‐firing 7 MHz small radius curved array on a long, thin handle that does not interfere with feeding positioning.Conclusions:  The relationship of nipple to hard palate/soft palate junction is shown to be variable with distances from 3 to 11 mm. The participants had previous and present history of breast‐feeding success. They were not specifically directed to attach in a particular way since their current infants were recruited as thriving, contented examples of the appearances of ‘normal breast‐feeding’. It is unknown, whether the participants in the landmark study by Woolridge et al. (1986), were instructed in feeding attachment prior to ultrasound imaging thus influencing the nipple position. Further data analysis will detect any infant maturation or learning differences between weeks 1 and 4. This simple ultrasound technique can be applied to the assessment of infant feeding problems and preterm infant feeding behavior.
Comparison of power Doppler and velocimetry in predicting outcome of high‐risk pregnancy
Authors: Dubiel M. A. , Breborowicz G. H. , Marsal K. , Gudmundsson S. 
Published: March 2003

Purpose:  To prospectively evaluate semiquantitative computer analysis of power Doppler (PD) signals in the placenta, fetal brain, lung, liver, kidney and spleen in high‐risk pregnancies in relationship to perinatal outcome and also to compare tissue blood flow in the fetal brain and placenta with Doppler velocimetry.Methods:  PD signals were recorded in 180 high‐risk pregnancies between 27 and 41 weeks of gestation. Images from PD scans angiographics were transmitted for computer analysis of pixel intensity. Mean flow signal intensity was recorded for each organ. The PD brain/lung ratio was calculated. The PD results were plotted on reference values and related to perinatal outcome. Middle cerebral (MCA), umbilical (UA) and uterine artery (Ut. A) velocimetry was also performed.Results:  High‐risk pregnancies displayed lower PD signal intensity from the placenta, fetal lung, liver and kidney as compared to normal. However, the brain and spleen signals showed higher intensities suggesting increased tissue perfusion. PD signals from the fetal brain, lung, placenta and PD brain/lung ratio were correlated with perinatal outcome. The PD signal intensity from the fetal liver, kidney and spleen showed poor correlation with perinatal outcome. Fetal brain tissue blood flow showed better correlation with the outcome than MCA velocimetry. Placental tissue blood flow results were similar in predicting outcome to those obtained by means of UA and Ut. A velocimetry.Conclusions:  In comparison with conventional Doppler velocimetry, computer analysis of PD signals, give similar results in the prediction of adverse perinatal outcome.
The accuracy and indications of fetal echocardiography in high‐risk patients: a 4‐year clinical experience in an obstetric unit
Authors: Martínez J. M. , Gómez O. , Puerto B. , Borrell A. , Palacio M. , Cararach V. 
Published: March 2003

Objective:  To evaluate the accuracy and assess the indications of fetal echocardiography to diagnose structural heart disease in our high‐risk population, by an obstetric team.Methodology:  Over a 4‐year period, a transabdominal echocardiography was performed in 912 high‐risk pregnancies for congenital heart disease at 18–38 weeks of gestation. In the last 140 cases an early examination combining either the transvaginal or the transabdominal route at 13–16 weeks was also carried out. Follow up was obtained from neonatal examinations and autopsies. The main indications for referral were: pregestational diabetes mellitus, family risk, increased nuchal translucency, suspected cardiac anomaly at screening ultrasound, women at high risk of chromosomal abnormality reluctant to invasive test, suspected arrhythmia, single umbilical artery, exposure to teratogens, and pregnancies affected by a chromosomal abnormality.Results:  There were 79 (8.6%) major congenital heart defects, and most of them were yielded in the group of screening by ultrasound. Seventy of them (88.6%) were diagnosed correctly as abnormal prenatally. Atrioventricular septal defects (21 cases) and hypoplastic left ventricle syndrome (12 cases) were the most prevalent heart anomalies in the fetus. Isolated septal defects and coarctation of the aorta were the most difficult lesions to detect, being the ones with false positive and negative diagnosis. Another four cases of insignificant (<3 mm, no surgery nor medical treatment required) ventricular septal defects were overlooked during gestation, but closed by the sixth month of life. Fifteen apparently normal cases were lost to follow up.Conclusion:  Our obstetric team results, in accordance with others previously published, show a good effectiveness to diagnose congenital heart anomalies. Most major detectable cardiac anomalies occur in the group without previously known risk.
Intrapartum fetal head position I: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the active stage of labor
Authors: D. M. Sherer , M. Miodovnik , K. S. Bradley , O. Langer 
Published: March 2003

AbstractObjectiveTo test the null hypothesis that no correlation exists between transvaginal digital and the gold standard technique of transabdominal suprapubic ultrasound assessments of fetal head position during labor. A secondary objective was to compare the performance of attending physicians vs. senior residents in depicting fetal head position by transvaginal digital examination in comparison with ultrasound, respectively.MethodsConsecutive patients in active labor at term with normal singleton cephalic‐presenting fetuses were included. All participants had ruptured membranes, cervical dilation ≥4 cm and fetal head at ischial spine station –2 or lower. Transvaginal sterile digital examinations were performed by either senior residents or attending physicians and followed immediately by transverse suprapubic transabdominal ultrasound assessments. Examiners were blinded to each other's findings. Power‐analyses dictated number of subjects required. Statistical analyses included Chi‐square, Cohen's Kappa test and logistic regression analysis. P < 0.05 was considered statistically significant.ResultsOne hundred and two patients were studied (n = 102). In only 24% of patients (n = 24), transvaginal digital examinations were consistent with ultrasound assessments (P = 0.002, 95% confidence interval, 16–33). Logistic regression revealed that cervical effacement (P = 0.03) and ischial spine station (P = 0.01) significantly affected the accuracy of transvaginal digital examination. Parity, gestational age, combined spinal epidural anesthesia, cervical dilation, birth weight and examiner experience did not significantly affect accuracy of the examination. The accuracy of the transvaginal digital exams was increased to 47% (n = 48) (95% confidence interval, 37–57) when fetal head position at transvaginal digital examination was recorded as correct if reported within ±45° of the ultrasound assessment. The rate of agreement between the two assessment methods for attending physicians vs. residents was 58% vs. 33%, respectively (P = 0.02) with the ±45° analysis.ConclusionsUsing ultrasound assessment as the gold standard, our data demonstrate an overall high rate of error (76%) in transvaginal digital determination of fetal head position during active labor, consistent with the null hypothesis. Attending physicians exhibited an almost two‐fold higher success rate in depicting correct fetal head position by physical examination vs. residents in the ±45° analysis. Intrapartum ultrasound increases the accuracy of fetal head position assessment during active labor and may serve as an educational tool for physicians in training. Copyright © 2002 ISUOG
Teaching ultrasound‐guided invasive procedures in fetal medicine: learning curves with and without an electronic guidance system
Authors: Nizard J. , Duyme M. , Ville Y. 
Published: March 2003

AbstractObjectiveTo compare the learning curves of inexperienced junior obstetrics/gynecology registrars for ultrasound‐guided invasive procedures on a training model, with and without an electronic guidance system.Study designFour junior registrars performed their first 100 procedures on a training model with a new electronic guidance system, and four other junior registrars performed their first 100 procedures on the same training model without using the guidance system. All procedures were performed using a free‐hand technique. We evaluated the quality of the procedure, which we defined as the time spent with the entire needle clearly visualized on the screen over the total duration of the procedure. We constructed learning curves for the eight junior registrars for comparative analysis.ResultsQuality of the procedure increased over time for all trainees. The learning curves were significantly steeper for trainees using the electronic guidance system. Trainees using the electronic guidance system performed better in the middle of their learning curve (procedures 25–75). All trainees reached the same level of quality by the end of their 100 procedures.ConclusionsThe automated electronic guidance system helps faster learning but, after 100 procedures on a training model, both groups reached the same level of quality. Copyright © 2002 ISUOG
Normal values of fetal ductus venosus blood flow waveforms during the first stage of labor
Authors: Krapp M. , Denzel S. , Katalinic A. , Berg C. , Smrcek J. , Geipel A. , Huber G. , Germer U. , Gembruch U. 
Published: March 2003

AbstractObjectiveTo present normal values of fetal ductus venosus blood flow waveforms during the first stage of labor during and between contractions.Materials and methodsSeventy‐eight women between the 37th and 41st weeks of gestation were included in the study. At distinct stages of cervical dilation, blood flow velocity waveforms of the fetal ductus venosus during and between contractions were visualized in fetuses with a normal non‐stress test. The pulsatility index for veins, peak velocity index for veins and fetal heart rate were calculated off‐line. The means ± standard deviations (SD) during and between contractions were compared using the Wilcoxon test.ResultsDuctus venosus blood flow velocity waveforms were visualized during 331 contractions and 375 episodes of uterine quiescence in 74 of 78 fetuses (95%) during normal labor. The mean ± standard deviation values of pulsatility and peak velocity indices for veins during contractions were 1.66 ± 0.85 (median: 1.56, range: 0.29–4.69) and 1.46 ± 0.65 (median: 1.34, range: 0.26–3.13), respectively. Between contractions the values were 0.48 ± 0.19 (median: 0.46, range: 0.14–1.00) for the pulsatility index and 0.44 ± 0.18 (median: 0.42, range: 0.14–1.00) for the peak velocity index for veins. These differences during and between contractions were highly significant (P‐value < 0.0001), whereas the fetal heart rate showed no significant differences.ConclusionThere are significant differences in fetal ductus venosus blood flow waveforms during and between labor contractions. Further studies should evaluate whether these normal values of the fetal ductus venosus are beneficial for risk evaluation in fetuses with an abnormal non‐stress test and/or intrauterine growth restriction. Copyright © 2002 ISUOG