bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of maternal cigarette smoking on maternal weight gain, uterine and umbilical flow velocities and fetal growth
Authors: Albuquerque C. A. , Smith K. , Johnson C. , Harding R. 
Published: March 2003

Objective:  To investigate the effects of cigarette smoking during pregnancy on maternal body mass index, maternal weight gain, uterine and umbilical artery flow velocities and fetal growth.Methods:  We studied 37 pregnant women (17 cigarette smokers [>10/day] and 20 non‐smokers) using an ATL HDI 5000 scanner for fetal anatomic survey and measurement of uterine and umbilical artery flow velocities. Maternal BMI change and weight gain during pregnancy, uterine and umbilical cord flow velocities, and fetal weight at delivery were measured in all patients.Results:  There were no differences between the smoking and non‐smoking groups in gestational age at scanning (23.7 ± 1.5 vs. 26.5 ± 1.3 week), gravid (2.3 ± 0.3 vs. 2.1 ± 0.3) and parity (0.9 ± 0.2 vs. 0.6 ± 0.2). The median maternal BMI was less in smokers than non‐smokers both pre‐pregnancy (19 vs. 24) and at delivery (27.5 ± 1.3 vs. 32.3 ± 1.3). Maternal weight gain was less in smokers than non‐smokers (10.2 ± 1.6 vs. 14.7 ± 1.5 kg, P < 0.05). In the uterine artery, there was no significant difference in the systolic/diastolic ratio between smokers and non‐smokers (1.9 ± 0.1 vs. 1.8 ± 0.1). The umbilical artery systolic/diastolic ratio was greater in smokers than non‐smokers (3.25 ± 0.2 vs. 2.31 ± 0.07, P < 0.05) and fetal weight at delivery was lower in smokers (2.7 ± 0.2 vs. 3.3 ± 0.2 kg, P < 0.05).Conclusions:  Decreased BMI and lower weight gain of women who smoke suggest that their nutritional intake may be lower than in non‐smokers. Decreased maternal weight gain in smokers and increased umbilico–placental resistance may both contribute to fetal growth restriction. Smoking appears not to affect utero‐placental resistance.
Incidental discovery of small adnexal tumors: how well do the conventional diagnostic models work?
Authors: Lawrence A. C. , Aslam N. , Elson J. , Salim R. , Jurkovic D. 
Published: March 2003

Background:  The increasing use of diagnostic ultrasound in gynecology has led to a growing number of small adnexal tumors being diagnosed incidentally in asymptotic women. Although numerous diagnostic models have been designed to estimate the preoperative risk of malignancy in symptomatic adnexal masses, it is not known whether these methods are also applicable to small tumors. The aim of this study was to investigate the accuracy of a number of diagnostic models in the preoperative diagnosis of clinically undetectable adnexal masses.Methods:  All patients undergoing surgery for known adnexal masses were assessed preoperatively using clinical examination, transvaginal ultrasound, color Doppler imaging and serum CA125 measurements. The presenting complaint and demographic details were also recorded. The risk of malignancy was then estimated using a variety of previously published morphological scoring systems, Doppler indices of impedance to flow, tumor markers and logistic regression models. The receiver operating characteristic curves were calculated for each diagnostic approach to examine significant differences in their performance for the detection of ovarian cancer.Results:  A total of 115 patients had surgery for adnexal tumors between August 1997 and June 2000. Of these, 90 had benign masses, 6 borderline and 19 malignant. Of the 115 patients, 69 had a clinically detectable cyst and 46 small tumors were found incidentally. In these 46 cases, the best characterization of ovarian tumors was achieved by the use of a logistic regression model, which combined menopausal status, presence of tumor papillarities, blood supply and serum CA125 levels. This model achieved 100% sensitivity with a specificity of 78% in the diagnosis of ovarian malignancy.Conclusion:  A combination of various diagnostic parameters in the form of a logistic regression model is superior to other methods for non‐invasive diagnosis of ovarian cancer diagnosed incidentally on ultrasound scan.
Is nuchal translucency measurement useful as a screening test for major cardiac abnormalities?
Authors: Lee‐Tannock A. , Cincotta R. B. , Chan F. Y. , Hawthorne F. 
Published: March 2003

Aim:  To determine if measurement of nuchal translucency is a useful predictor of major cardiac abnormality in a low risk population.Methods:  A total of 1888 fetuses (1849 patients) were scanned in our department as part of a nuchal translucency screening programme between 1 January 1999 and 31 December 2000. Those pregnancies with abnormal karyotypes were excluded from this study. Follow up was obtained and cases of major isolated cardiac anomalies were identified.Results:  There were 35 fetuses that had normal chromosomes and a nuchal translucency measurement greater than the 95th centile. Nine of these had a nuchal translucency measurement greater than 3.5 mm, and 12 of these had a nuchal translucency measurement greater than 4.5 mm. In our study population, there were six fetuses diagnosed with an isolated major cardiac defect (3.2/1000 births). All of these fetuses had normal nuchal translucency measurements less than the 95th centile and none came from the group with increased nuchal translucency. In one case, the diagnosis was made at 12 weeks, three were diagnosed at the 18–20 weeks morphology scan and two were diagnosed after birth.Discussion:  Several studies have demonstrated a link between an increased nuchal translucency measurement and cardiac defects in fetuses with normal chromosomes. Hyett suggests that increased nuchal translucency at 10–14 weeks will detect 55% of major cardiac abnormalities. According to the risk estimates from this paper, we estimate that there should have been 1.5 cases of cardiac anomalies in the low risk group whilst there should have been two cardiac anomalies in the fetuses above the 95th centile. We found six major cardiac anomalies in the low risk group and none in the higher risk group. However, the difference between the estimated and observed number of cases was not statistically significant due to the small size of our screening study. We would recommend larger studies to determine the efficacy of nuchal translucency as a screening tool for detection of cardiac anomalies. Detailed cardiac imaging at the 18–20 weeks morphology scan should continue to be performed on all patients regardless of the nuchal translucency measurement in the first trimester.
Functional evaluation of normal kidney by three‐dimensional (3D) ultrasonography – the hourly fetal urine production rate
Authors: Jun J. K. , Jin S. M. , Ko E. M. , Park J. S. , Yoon B. H. , Moon S. Y. , Syn H. C. , Lee H. P. 
Published: March 2003

Background and objective:  Fetal urine is the main source of amniotic fluid, which is very important marker of fetal wellbeing. Single deepest pocket measurement or amniotic fluid index method are widely used to evaluate amniotic fluid volume. They are well correlated with real amniotic fluid volume in cases of normal amniotic fluid volume. However, they are not in extreme cases, which are clinically more important. Direct measurement of fetal urine production may be another option to evaluate amniotic fluid volume and fetal kidney function. Moreover, it is well known that 3D USG is superior to 2D USG especially in volume measurement of irregular shape object. We undertook this study to measure the hourly fetal urine production rate (HFUPR) with 3D US in normal pregnancies and evaluate its clinical implication and feasibility.Material and methods:  From 20 weeks of gestation to term, 157 pregnant women were enrolled. We used Voluson 730 to measure 3D bladder volume. Vocal (virtual organ computer aided analysis) software was used to measure the volume. Initially, we measured the volume of fetal urinary bladder and observed whether the bladder was emptying or not in 5 and 10 min after initial measurement. We excluded 35 cases whose bladder was found empty within 5 min. If distended bladder was still found, we calculate the HFUPR. We constructed a best‐fit graph of the HFUPR according to gestational age (GA) in weeks.Results:  We constructed the following quadratic equation and plotted a graph on the basis of our data. We also showed 10 and 90% values of each gestational week.Conclusion:  We demonstrated that serial 3D USG assessment of fetal bladder volume could be used as an alternative method to evaluate amniotic fluid volume.
Twin cervical ectopic pregnancy
Authors: Bethune M. P. , Sampson A. 
Published: March 2003

A 40‐year‐old woman presented for IVF treatment due to 8 years of secondary infertility. Two embryos were transferred without ultrasound guidance. The patient presented at 6.5 weeks gestation with heavy vaginal bleeding. A transvaginal ultrasound revealed twin cervical ectopic pregnancies, lying side by side in the cervical canal and within 6 mm of the external os. One contained a 9‐mm embryo with a normal fetal heart rate. The other sac was anembryonic. The bHCG level was 129 000 IU/L. The patient was treated with the same regimen of methotrexate as used for persistent trophoblast disease: second daily methotrexate with folinic acid rescue after each dose. Complete resolution of the twin pregnancy occurred, bleeding was however, recurrently heavy over the next 6 weeks.Discussion:  Cervical ectopic pregnancy is a rare event, accounting for less than 1% of ectopic pregnancies. The incidence is increasing due to the increased use of in vitro fertilization. Prior to the advent of conservative treatments most patients required hysterectomy due to severe, uncontrollable bleeding. Conservative measures include dilatation and curettage (usually combined with uterine artery embolization, ligation or cervical balloon tamponade); local injection of methotrexate or potassium chloride (ultrasound guided); or systemic methotrexate. Twin cervical pregnancy is an extremely rare event with only two previous case reports in the literature [1]. Due to the large size of this twin pregnancy mass, the high bHCG level and the large volume of vascular trophoblast; we decided to treat this patient in a similar manner to a patient with gestational trophoblast disease. This mode of treatment should be considered with cervical ectopic pregnancies where the bHCG level is abnormally elevated.
The association between the Doppler hypoxia index and arterial umbilical cord pH in multiple gestation pregnancies complicated by intrauterine growth restriction
Authors: Musser U. , Gaziano E. P. , Arbeille P. H. 
Published: March 2003

Purpose:  To study the relationship between the Doppler hypoxia index and umbilical cord pH in multiple gestation pregnancies complicated by fetal growth restriction.Methods:  Seventeen fetuses were studied from 12 multiple gestation pregnancies (11 twins and 1 triplet). Each pregnancy had at least one growth‐restricted fetus from which middle cerebral artery and umbilical artery Doppler values were collected, the last value of which was within 3 weeks of delivery. For each fetus, we calculated the cerebral umbilical ratio and the hypoxia index, which reflects the duration and degree of Doppler determined fetal blood flow redistribution. Umbilical arterial cord blood was obtained for blood gas analysis immediately after the births. Excluded were fetuses with major congenital anomalies and those with reverse end diastolic flow in the umbilical artery.Results:  There is a significant correlation at the 0.05 level, one‐tailed, between the hypoxia index and arterial umbilical cord pH. A linear regression model suggests that gestational age and birth weights are not cofounders in the relationship between the hypoxia index and arterial pH. While the hypoxia index has the same sensitivity (75%) as the cerebral umbilical ratio for identifying fetuses who will have an arterial cord pH of less than 7.20, the hypoxia index has a better specificity (85 vs. 69%), positive predictive value (50 vs. 38%) and negative predictive value (92 vs. 90%).Conclusions:  There is a significant correlation between the non‐invasive hypoxia index and arterial umbilical cord pH in the growth‐restricted fetus from multiple gestation pregnancies.
The use of umbilical artery Doppler velocimetry in the monitoring of pregestational diabetic pregnancy
Authors: Wong S.‐F. , Chan F.‐Y. , Cincotta R. , Oats J. , McIntyre D. 
Published: March 2003

Purpose:  To assess whether umbilical artery Doppler velocity waveform analysis can predict adverse perinatal outcomes for pregnancies complicated with pre‐existing diabetes mellitus (types 1 and 2 diabetes mellitus).Methods:  All diabetic pregnancies (types 1 and 2) delivered at Mater Mothers' Hospital, Australia, between 1st January 1995 and 31st December 1999, were included. All pregnant diabetic women were monitored with umbilical artery Doppler velocimetry at 28, 32, 36, and 38 weeks gestation. Umbilical artery Doppler study was repeated on weekly basis for pregnancies complicated by macrosomia, polyhydramnios, or fetal growth restriction. Adverse perinatal outcome was defined as pregnancies with one or more of the following: small‐for‐gestational age (birth weight <10th centile), cesarean section for non‐reassuring cardiotocography, fetal acidemia at delivery (cord blood arterial pH < 7.2), 1‐min Apgar of ≤3, 5‐min Apgar of <7, hypoxic ischaemic encephalopathy, stillbirth and perinatal deaths. Abnormal umbilical artery Doppler index was defined as systolic/diastolic ratio of 95th centile or higher for gestation (including absent or reversed end‐diastolic flow). The incidence of adverse perinatal outcomes was compared between those with normal umbilical artery Doppler and those with elevated systolic/diastolic (S/D) ratio.Results:  One hundred and four pregnancies had umbilical arterial Doppler studies performed during the study period. Twenty‐three pregnancies (22.1%) had elevated S/D ratio of the umbilical artery Doppler velocimetry. If the scans were performed within 2 weeks of delivery, 71% of pregnancy with abnormal umbilical Doppler study have adverse outcome. For umbilical artery Doppler studies performed within 1 week of delivery, the sensitivity was 35%; specificity was 94%; positive predictive value was 80%; and negative predictive value was 68%. However, only 30% of women with adverse perinatal outcomes had abnormal umbilical Doppler flow.Conclusion:  Elevated umbilical arterial Doppler S/D ratio is associated with adverse perinatal outcomes. However, the majority of diabetic pregnancies with adverse perinatal outcomes have normal umbilical artery Doppler velocimetry. Thus, this could be a useful test for monitoring, but is not a good predictor of adverse perinatal outcomes.
Third trimester abdominal pregnancy
Authors: Salim A. , Handaya P. , Wiknjosastro G. H. , Karsono B. 
Published: March 2003

Introduction:  Surviving of the fetus of the third trimester abdominal pregnancy is possible although very rare. The high fetal and maternal mortality rates is associated with it. We report four cases which succeed in having two living healthy babies. The subsequent problem is about the placenta which is left in the abdomen.Methods:  Four women suspected of late abdominal pregnancy were referred to our center for further management. All of them underwent abdominal ultrasound and vaginal if necessary. Blood flow of the umbilical artery also studied. They were treated until the fetus is viable according to our pediatrician prior to be delivered abdominally.Results:  From April 1994 until October 2000, we have four cases of third trimester abdominal pregnancy. Two cases of 30 and 32 weeks gestational age with fetal death intra‐abdominally. Another two cases of 33 and 31 weeks with living fetus intra‐abdominally and placenta implanted at the superior and posterior side of the uterus. Umbilical artery RIs were 0.67 and 0.71. The interval between time of admission till the delivery were 19 and 33 days. Female babies 2400 g Apgar score 9/10 and 1680 g Apgar score 6/8 for 1 and 5 min. They are growing and developing well except the first one has a slight club‐feet.Conclusion:  We report four cases of third trimester abdominal pregnancies, two of which succeed in delivering healthy babies.
Three‐dimensional color power angiography of an aneurysm of the vein of Galen
Authors: Ximenes R. , Ximenes D. S. , Ximenes A. , Szejnfeld J. , Ajzen S. , D'Hippolitto G. , Goldman S. M. , Sandoval R. 
Published: March 2003

Description of the case:  A 26‐year‐old, gravida 1, para 0, female. The first scan was at 16 weeks, with normal fetal biometry and development. At 25 weeks' gestation, a cystic area at the level of the biparietal‐diameter, measuring 25 mm of diameter, ventricles has normal sizes, the cystic area was interrogated with color Doppler and showed a typical ‘turbulent flow’. The transvaginal probe was performed for evaluation of the fetal brain. Color Doppler energy was used to evaluate the cystic area and their communications –‘angiography’, followed by tri‐dimensional reconstruction of the brain vessels, especially the venous drainage and the arterial communications. This pathology is referred as a complex arterio‐venous malformation (AVM). Antenatal MRI was performed to evaluate the central nervous system. The parents were counseled about the prognosis. At 34 weeks' gestation, the shunts of the arteriovenous malformation were more prominent, ventriculomegaly, tricuspid regurgitation and polyhydramnios.Proof of diagnosis:  At 35–36 weeks' gestation, she delivered a female baby, weighing 2900 g, with Apgar score 4 and 8. The baby was transferred for the neonatal intensive care, but after 24 h died because of renal failure.Relevance:  This report demonstrated that 3D color Doppler energy mode is useful in prenatal diagnosis and a more detailed angio‐architecture of the aneurysm of the vein of Galen, with a excellent correlation with MRI. We hope, in the near future this technique could guide the identification of the fetus at increased risk for intrauterine and neonatal cardiac failure and therefore poor prognosis.
Prevention of preterm labor by AIWA's score
Authors: Yoshitake H. , Koyama Y. , Fukuda J. , Uehira K. , Amiya S. , Yano S. 
Published: March 2003

Purpose:  To elucidate the availability of ‘AIWA’s scoring' in prevention of preterm labor.Patients:  We retrospectively studied the 6434 deliveries after 22 weeks of gestation, managed at AIWA‐Maternity Hospital from 1986 to 1990, and from 1995 to 2000.

• C‐stage: deliveries from 1986 to 1990: 1786 (control stage without AIWA's scoring);

• P‐stage: deliveries from 1995 to 1997: 2190 (prototype stage without AIWA's scoring);

• A‐stage: deliveries from 1998 to 2000: 2458 (applied stage with AIWA's scoring).

Nine twins and seven cases of pregnant mother transportation (MT) in (C) 1786, 25 twins and 3 MT in (P) 2190, and 17 twins, 2 triplets, 6 MT in (A) 2458, were involved, respectively.Methods:  The ‘AIWA’s score' of risk assessment for premature delivery consists of cervical consistency, insertion resistance to external os of uterus by internal examination, and cervical length and funneling of internal os of uterus measured by transvaginal ultrasonography. The full AIWA's score is 12 point, which means extremely high risk of premature labor. On the other hand, 0 point means no risk of it. Then, P‐score (0–3) consists of the history of early delivery, abortion after 18 weeks of gestation, present multiplicity and so forth. AIWA's score + P‐score = AP‐score. (A) From 1998 to 2000, in case with AP‐score >8, before 26 weeks of gestation, patients had cervical cerclage if they wanted after severely informed consent. We compared some parameters between C‐ and A‐stage.Results:  The rate of premature delivery declined (from 4.5 to 3.2% <37 weeks [P < 0.05]; from 2.5 to 1.3%, <36 weeks [P < 0.01]) in A‐stage using the risk assessment system. In all premature deliveries, those before 32 weeks of gestation declined from 15.2 to 2.6% (P < 0.01) in A‐stage. The rate of preterm PROM <34 weeks in all deliveries declined from 0.56 to 0.12% (P < 0.05), while the rate of preterm PROM in premature labor decreased from 12.7 to 3.9%, and the rate of emergency cervical cerclage also decreased from 13.5 to 1.2% (P < 0.05). In single baby delivery, the rate of cervical cerclage slightly decreased from 1.1 to 0.75% in nulliparous mother, however, it extremely increased from 2.7 to 5.3% in multipara.Conclusions:  Prevention of preterm labor by prophylactic cervical cerclage using ‘AIWA’s score' would be useful to decrease premature deliveries and eventually to relieve the shortage of NICU beds in Japan. Preterm PROM before 34 weeks of gestation has been a problem for long years in perinatal management. Also, the success rate of emergency cervical cerclage has been poor. The rate of those two problems would declined using AIWA's scoring system. The rate of cervical cerclage in multipara was two times higher than that in control stage. The future issues is making of more appropriate indication and contraindication of cervical cerclage with special reference to patients QOL.
Pregnancy outcome following amnioinfusion in oligohydroamnios
Authors: Kim G. J. , Kim S. Y. , Son M. S. 
Published: March 2003

Objective:  We sought to evaluate the fetal outcome following antepartum transabdominal amnioinfusion in oligohydroamanios except membrane rupture.Materials and methods:  Twenty‐six transabdomial amnioinfusion were performed in 17 cases of singleton pregnancy with severe oligohydroamnios. We excluded premature membrane rupture cases. Transabdominal amnioinfusion was done with warmed lactate Ringer solution.Results:  Infusion (mean volume 545 mL) of lactate Ringer's solution significantly increased the amniotic fluid index from 4 dm to 9.3 cm. Mean infusion time was 56.8 min The gestational weeks were prolonged significantly from 29.4 to 36.5 weeks. There was one case of fetal death. The mean birth weight was 2.6 kg and the mean Apgar score at 1, 5 min was 7.6 and 8.9. Uterine contractions after infusion were observed 3 in 21, no needle scratching marks detected at birth. No chorioamnionitis were observed.Conclusions:  Our results show that antepartum transabdominal amnioinfusion is a relatively safe procedure, and it can significantly increase the amniotic fluid index and prolong the gesational age.