bluuebunny/crossref_metadata_2025_split huggingface dataset:
P64The newly calculated equations of nuchal skinfold thickness measurement in mid‐trimester
Authors: Won H. S. , Kim M. K. , Lee P. R. , Lee I. S. , Kim A. , Nam J. H. 
Published: March 2003

BackgroundUse of nuchal skinfold thickness (NT) measurement as an ultrasound marker for Down syndrome has been limited due to a high false positive rate. We suggested that some variables, which influence on NT have been presented. The purpose of our study was to identify the variables that have effects on measured values of NT, and to make a regression equation based on those variables.MethodThe data on gestational age (GA), cephalic index (CI), presentation (Pr; vertex or breech) and the presence or absence of nuchal cord (NC) were collected prospectively on 548 normal singleton fetuses between 16 and 24 weeks' gestation. We calculated independent correlation of those variables with NT by multiple regression analysis and made a regression equation based on GA, CI, Pr, and NC.ResultsGA has positive correlation and CI has negative correlation with NT significantly. The nuchal skinfold was thicker among fetuses with breech presentation rather than those of vertex presentation and increased in the presence of nuchal cord. The all four variables (GA, CI, Pr, and NC) were independent factors to NT by multiple regression analysis.We calculated the expected NT through these observations; for fetuses presenting vertex, NT = 5.608 + 0.243GA − 0.066CI + NC* and for breech, NT = 2.803 + 0.392GA − 0.066CI + NC* (*if no NC, NC* equals −0.785 and zero for the other).ConclusionThis is the first report, which takes GA, CI, Pr and NC for correlation factors with NT as a whole. These equations may be considered as a screening method for the detection of aneuploidies.
P68Chorionic villus sampling for prenatal diagnosis in Zagreb: experience with 3000 cases
Authors: Podgajski M. , Podobnik M. , Duic Z. , Cigiar S. , Gebauer B. 
Published: March 2003

ObjectivesThis study comprises data from 3000 women allocated to transcervical CVS (TC‐CVS), transabdominal CVS (TA‐CVS) and transvaginal CVS (TV‐CVS). We have assessed the efficacy of transabdominal CVS compared with transcervical CVS and transvaginal CVS, and examined factors that have been implicated in causing spontaneous abortion.MethodOver a 10‐year period, 3000 women underwent chorionic villus sampling at 9–12 weeks of gestation, by transcervical (500 patients), transabdominal (2400 patients) and transvaginal technique (100 patients). Transvaginal color Doppler was used to investigate the uteroplacental and fetal vessels in 500 pregnancies between 11 and 12 weeks of gestation (400 TA‐CVS and 100 TC‐CVS) before and after CVS procedures.ResultsFive hundred (16.7%) patients underwent transcervical CVS (TC‐CVS) and spontaneous abortion after TC‐CVS occurred in five cases (1.0%). Some 2400 (80.0%) patients underwent transabdominal CVS (TA‐CVS) using a 20 gauge spinal needle and abortion after TA‐CVS occurred in 10 cases (0.4%). One hundred (3.7%) patients underwent transvaginal CVS (TV‐CVS) using a 20‐gauge needle and abortion after TV‐CVS occurred in three cases (3.0%). The spontaneous abortion rate after CVS procedures was 0.6%. Some 120 (4.0%) cases showed chromosomal aberration. The spontaneous abortion rate was lower among cases allocated to TA‐CVS after 11 weeks of gestation. There were no significant differences in mean pulsatility indices (PI) between maternal, fetal and intraplacental circulation, before and after CVS procedures.ConclusionsTransabdominal CVS has lower fetal loss rate than transcervical and transvaginal CVS.
P73The value of sequential screening in avoiding invasive procedures when maternal age is considered advanced
Authors: Pedreira D. A. L. , Cha S. C. , Czeresnia C. 
Published: March 2003

AimTo evaluate the importance of sequential screening in the diagnosis of aneuploidies when maternal age is advanced, but invasive procedure is wanted only if screening tests are altered.Material and methodsWe retrospectively analysed all pregnant patients aged 35 years or more at estimated data of delivery, from July 1996 to June 2000. For those in doubt about having an invasive procedure, we offered an alternative strategy of screening. Starting with nucal translucency (NT) (11–14 weeks), if altered we offer CVS, if normal, we offer an anomaly scan at 16–18 weeks targeted to soft markers of chromosomal abnormalities and major malformations. If altered, we then offer amniocentesis, if normal we repeat the anomaly scan at 22–24 weeks, targeting for other malformations (especially in the heart), uterine artery screening and cervical screening.ResultsWe evaluated 296 fetuses (280 pregnancies) patients mean maternal age 37.4 years‐old (range 35–45). 39.9% patients (118) had invasive procedures (IP) with 3 abnormal karyotipe result (1 case T21, 2 cases 47XXY). One missed abortion detected at NT revealed T21. 122 fetuses (114 patients) had NT performed with Likelyhood Ratio increased in 11 cases (9.1%): 2 fetal malformation (skeletal dysplasia and acrania), 5 normal karyotipe after IP and 4 normal live‐born babies. Among this 114 patients, 52 had one or two reassuring anomaly scans after NT and did not had an IP done. 17 pregnancies are still ongoing and all live‐born babies so far were normal (94.8% follow‐up).ConclusionNew studies about the psychological impact of later gestational age termination vs. early ones, showed no significant difference. We believe that sequential screening is a valid alternative for older pregnant patients, especially after IVF. The choice of having a later termination vs. the possible loss of a normal pregnancy after an IP must be given to patients.
P81Predicting delivery before 30 weeks in pregnancies with absent or reversed end‐diastolic velocity (ARED) flow in the umbilical artery
Authors: Francisco R. P. V. , Yamamoto R. M. , Chuba C. C. , Miyadahira S. , Zugaib M. 
Published: March 2003

BackgroundA study of the relation between methods for assessment of fetal well‐being and the occurrence of delivery before 30 weeks of gestational age in fetuses with ARED.MethodsA prospective study was conducted to assess the fetal well‐being in 30 singleton pregnancies with ARED. The results of these methods were compared with the occurrence of delivery before 30 weeks of gestational age (GA). All data were analyzed and compared using logistic regression.ConclusionThe probability of delivery before 30 weeks in AREDV fetuses was predicted by the ti between AREDV diagnosis and delivery and by the gravity of placental lesion estimated by the PI in the umbilical artery.
P86Assessment of fetal well‐being in patients with poor obstetric history: comparison between cases of absent or reversed end‐diastolic velocity in the umbilical artery
Authors: Francisco R. P. V. , Yamamoto R. M. , Leite C. C. , Miyadahira S. , Zugaib M. 
Published: March 2003

BackgroundA study of the assessment of fetal well‐being and perinatal results in patients with poor obstetric history and absent or reversed end‐diastolic velocity flow (AREDV).MethodsBetween 1997 and 2000, 36 high risk pregnant women with poor obstetric history and AREDV were followed by the Fetal Surveillance Unit. Ten cases presented reversed end‐diastolic velocity waveforms.ResultsThe results are shown in the table:

AEDV n = 26
REDV n = 10
P

fhr with deceleration
13/19(68.4%)
5/7(71.4%)
NS

BPS below 6
1/26(3.8%)
5/7(71.4%)
0.004

Amniotic fluid index ≤ 5
6/26(23.1%)
7/10(70.0%)
0.025

MCA PI < 5th p
23/24(95.8%)
8/10(80.0%)
NS

Perinatal death
6/26(23.1%)
6/10(60.0%)
0.04

Birth weight < 1000g
10/26(36.5%)
6/10(60.0%)
NS

ConclusionsThe results show a higher incidence of abnormal BPS and AFI in red cases, with a high rate of perinatal death.
P09Flow velocity waveforms in the spiral artery versus AFP and BHCG maternal serum concentration in pregnancy complicated by threatened abortion
Authors: Persona‐Sliwiñska A. , Brazert J. , Biczysko R. 
Published: March 2003

ObjectivesThe aim of the study was to determine the values of resistance index (RI) and pulsatility index (PI) in the spiral arteries and to evaluate the maternal serum concentration of AFP and β‐hCG trying to find correlation between these parameters in the patients in early pregnancy complicated by threatened abortion.Study methodsWe have analysed 32 pregnant women between 5th and 12th weeks of pregnancy diagnosed as threatened abortion. In all patients TV ultrasound with pulsed color doppler was performed. The RI and PI were calculated for blood flow obtained from the spiral arteries. The concentration of AFP and β‐hCG in maternal serum was evaluated by immunoassays.Results32 velocity waveforms from spiral arteries were analysed and blood flow indices were calculated. We have found statistically significant negative correlation between the values of both blood flow parameters (RI & PI) and successive weeks of pregnancy. In the tested group in 37.5% of patients the level of β‐hCG was low. There was statistically significant correlation between serum β‐hCG, AFP concentrations and blood flow parameters.ConclusionsOnly the combination of Doppler blood flow analysis in spiral arteries and evaluation of AFP and β‐hCG in the maternal serum performed in first trimester may be useful for the intensive fetal monitoring of high risk pregnancies.
Blood flow velocity waveforms from fetal peripheral pulmonary arteries in pregnancies with preterm premature rupture of the membranes: relationship with pulmonary hypoplasia
Authors: Rizzo G. , Capponi A. , Angelini E. , Mazzoleni A. , Romanini C. 
Published: March 2003

Objectives To measure fetal peripheral pulmonary artery velocity waveforms by Doppler ultrasonography in pregnancies complicated by premature rupture of membranes under 24 weeks’ gestation and to relate the Doppler indices to the development of fetal pulmonary hypoplasia.
Design A prospective longitudinal study of fetal peripheral pulmonary artery velocity waveforms from premature rupture of membranes to delivery.
Subjects Twenty pregnancies complicated by premature rupture of membranes before 24 weeks of gestation and delivering after 26 weeks.
Methods Peripheral pulmonary artery velocity waveforms were recorded by Doppler technique at weekly intervals until delivery and Pulsatility Index (PI) calculated. Pregnancies were managed conservatively according to an institutional management protocol. Pulmonary hypoplasia was defined at autopsy by lung/body weight ratios and radial alveolar counts. Pulsatility Indices of fetuses developing pulmonary hypoplasia were compared with those with a normal lung development.
Results After premature rupture of membranes PI values were higher than normal reference limits for gestation, but no differences were found between the six fetuses which developed pulmonary hypoplasia and the remaining 14 fetuses with normal lung development. In this latter group PI values progressively decreased with advancing gestation (ANOVA for repeated measurements F = 11.61; P ≤ 0.001), while they increased in fetuses developing pulmonary hypoplasia (F = 8.44; P ≤ 0.001). As a consequence of these opposite trends significant differences in PI values were present between the two groups of fetuses from 2 weeks after the premature rupture of membranes. Two weeks after the premature rupture of membranes a PI value from the peripheral pulmonary arteries above the 95th centile had a sensitivity of 62.5%, specificity of 94.6%, positive predictive value of 83.3%, negative predictive value of 78.5% and relative risk of 3.88 (95th confidence interval 1.34–11.28) for the prediction of pulmonary hypoplasia.
Conclusion The measurement of peripheral pulmonary velocity waveforms may help to establish the risk of developing pulmonary hypoplasia in pregnancies complicated by premature rupture of membranes.
WS16: Early pregnancy WS16‐01The value of first trimester sonography for the diagnosis of structural and chromosomal abnormalities
Authors: Economides D. L. 
Published: March 2003

ObjectivesTo assess the value of first trimester scanning for the diagnosis of structural and chromosomal abnormalities.Population/methodsAn unselected group of 7447 pregnant women who had a first trimester scan in our unit. In all the cases an anatomical survey was performed and the nuchal translucency was measured. Four thousand and 84 women also had second trimester biochemical screening. We assessed the performance of first trimester scanning in the detection of structural and chromosomal abnormalities.ResultsThe incidence of anomalous fetuses was 1.4%, including 43 chromosomal abnormalities. The detection rate for structural abnormalities was 59% (37/63). Seventy‐eight percent of chromosomal abnormalities were diagnosed at 11–14 weeks either because of a nuchal translucency measurement above the 99th centile or due to the presence of structural abnormalities. Second trimester biochemical screening detected half of the fetuses with trisomy 21 which were missed by first trimester screening, increasing the sensitivity to 90.5% (19/21; 95%C.I. 69.6% to 98.8%). However, the positive predictive value of the biochemical test was very low (0.5%).ConclusionFirst trimester NT measurement is an effective screening test for the prenatal detection of fetuses with structural and chromosomal abnormalities. Although the measurement of biochemical markers in the second trimester can detect additional affected fetuses this may be out‐weighted by the delay in diagnosis, the extra visits and cost so that the right time for biochemical screening still needs to be determined. Second trimester anomaly scanning should continue to be an essential part of a prenatal screening programme.
WS02‐05Serial in‐utero ultrasonographic measurements of the fetal thyroid: a new complementary tool in the management of maternal hyperthyroidism in pregnancy
Authors: Achiron R. , Sivan E. , Dolizki M. , Lipitz S. , Cohen O. 
Published: March 2003

ObjectiveTreatment of hyperthyroidism during pregnancy is complicated by the lack of readily available measures of the fetal thyroid status. Both hyper‐ and hypo‐thyroidism of the fetus may have short and long‐term detrimental effects and thus should be avoided. We therefore followed the fetal thyroidal size during treatment of maternal thyroid disorders and correlated the data with treatment and thyroidal status in the mother.MethodsDuring 24‐month period 20 patients with thyroid disorders were referred for serial fetal thyroid measurements. Thyroid size was measured by transvaginal ultrasonography between 14 and 17 weeks' of gestation and by abdominal ultrasonography between 18 and 38 weeks' gestation.ResultsIn five women with Grave's diseases correlation between thionamide dosage and fetal thyroid size were noted. Two fetuses had an increase in the size of thyroid gland above the upper 95% confidence interval, one of them developed neonatal Grave's of which it was the only prenatal sign of fetal thyroid abnormalities. In all other three fetuses changes inthyroidal size aided in determining the dosage of the antithyroidal drugs.ConclusionsInutero ultrasonographic measurements of the fetal thyroid size can be used as a noninvasive tool for the proper management of maternal hyperthyroidism.
WS05‐03Ultrasound in the diagnosis of endometrial abnormalities
Authors: Valentin L. 
Published: March 2003

There is a potential role of ultrasound examination in the management of women with postmenopausal (PMP) bleeding. Because women with an endometrium = 4 mm at transvaginal ultrasound examination rarely have endometrial pathology, it may be justified not to sample their endometrium. However, endometrial pathology is common among women with endometrium = 5 mm. In our prospective study, 105 consecutive women with PMP bleeding and endometrium = 5 mm underwent hydrosonography, hysteroscopy, D & C, and hysteroscopic resection. 80% of these women had endometrial pathology, including 24% with endometrial malignancy. 94% of the pathological lesions manifested a focal growth pattern. 87% of the focal lesions were only partly removed or remained in situ after D & C, D & C missing 25% of malignancies and 53% of benign pathology. Hydrosonography was as good as hysteroscopy at detecting focally growing lesions in the uterine cavity (agreement between hydrosnography and hysteroscopy being 96%; Kappa 0.77), but neither hysteroscopy nor hydrosnography could reliably discriminate between benign and malignant lesions. In a randomized trial, 49 women with PMP bleeding and endometrium = 4 mm were randomized to D & C and 48 to ultrasound follow up. 14 (29%) women in the D & C group and 22 (46%) in the ultrasound group had either rebleeding or manifested endometrial growth during a 12‐month follow‐up period. Endometrial pathology was not found in women with rebleeding unless the endometrium was = 5 mm.ConclusionWomen with PMP bleeding and endometrium = 5 mm should undergo hydrosnography. If focal lesions are detected hysteroscopic resection should be carried out. In women with PMP bleeding, rebleeding during the first 12 months is an indication to sample the endometrium only if the endometrium measures = 5 mm at ultrasound examination.
WS06: Fetal echocardiography WS06‐01Human fetal cardiac function during the first trimester of pregnancy
Authors: Jouppila P. , Mäkikallio K. , Räsänen J. 
Published: March 2003

IntroductionThe hypothesis was tested whether the improvement in the human fetal cardiac diastolic and systolic functions are associated with changes in the cardiac volume blood flow, inflow blood velocity waveform characteristics, systemic venous blood flow parameters, umbilical artery velocimetry and fetal nuchal translucency. By a longitudinal study protocol the inflow and outflow blood velocity waveforms were obtained in 16 uncomplicated pregnancies at 6, 7, 8, 9 and 10 weeks.ResultsThe proportion of isovolumetric relaxation time decreased and the proportions of filling and ejection times of the cardiac cycle increased significantly from 6 to 7 weeks. The proportion of isovolumetric contraction decreased between 8 and 9 weeks. Every inflow waveform was monophasic before 9 weeks but it was biphasic in all cases at 10 weeks. Mean velocity of inflow and outflow increased between 6 and 7 weeks and Vmean of inflow increased further after 8 weeks. At 9 and 10 weeks, atrioventriculu valve recurgitation (AVVR) was present in 4 and 7 fetuses, respectively. Nuchal translucency was greater in fetuses with AVVR present at 10 weeks compared with non‐AVVR cases.ConclusionImprovement in the diastolic function of fetal heart between 6 and 7 weeks is accompanied by simultaneous increase in the mean velocities across inflow and outflow tracts. Appearance of biphasic inflow pattern is associated with significant change in systolic function between 8 and 9 weeks. AVVR is a common finding at 10 weeks of gestation.
WS06‐02Cardiac anomalies in early pregnancy
Authors: Gembruch U. , Germer U. , Smrcek J. 
Published: March 2003

Fetal echocardiography including colour and spectral Doppler facilitates the diagnosis of the great majority of major structural and functional cardiac abnormalities in the late first and early second trimester of gestation.Based on more than 4000 echocardographic examinations between 10 and 16 weeks of gestation (4/1993–3/2000) following data are demonstrated:1. The four‐chamber view and cross‐over of the pulmonary trunk and aorta were visualised in 44% of the fetuses at 10 weeks and in 100% at 13 weeks of gestation.2. Normative biometric data of the fetal heart has been established. The ratio of the right and left ventricle and of the pulmonary trunk and ascending aorta were constant during this period of pregnancy (approximately 1.00 and 1.10, respectively).3. The detection rate for cardiac malformations was greater than 60%. Colour Doppler increased the detection rate by easier demonstration of the great arteries and of abnormal cardiac blood flow pattern (valvular incompetence and stenosis).4. In fetuses with increased nuchal translucency (= 3 mm) (30% of those with general hydrops) the rate of aneuploidy was twice as high in fetuses with abnormal echocardiographic findings compared to fetuses with normal echocardiogram. In some aneuploid fetuses with normal cardiac structures transient tricuspid regurgitation was observed.5. Some complex cardiac malformations were diagnosed which are very rare in later gestation, e.g. absent pulmonary valve syndrome with patent ductus arteriosus, polyvalvular stenoses of the semilunar valves.
WS06‐03Ultrasound‐detected heart defects associated with aneuploidy
Authors: DeVore G. R. 
Published: March 2003

In North America second trimester genetic ultrasound is offered to patients at risk for trisomy 21 and other chromosomal abnormalities who decline invasive testing. In most major studies in which the prevalence of ultrasound markers used for genetic ultrasound are reported, congenital heart defects are identified in less than 10% of fetuses. When one considers that over 50% of fetuses with trisomy 21 and 90% of fetuses with trisomies 13 and 18 have structural malformations of the heart, the question should be raised as to why the wide discrepancy in prevalence and detection rate of heart defects in these fetuses. The purpose of this presentation is to review the prevalence of CHD in fetuses with trisomy 21, trisomies 13 and 18, and all fetuses with chromosomal defects that were identified following second trimester amniocentesis. To ascertain the presence or absence of CHD, each fetus underwent a fetal echocardiographic study using real‐time and color Doppler ultrasound at the time of genetic amniocentesis.The results of the study demonstrated the following: The detection rate for trisomy 21 (n = 80) increased from 62% to 91% when examination of the fetal heart was performed. The detection rate for trisomy 18 (n = 30) increased from 84%% to 97% when the cardiovascular system was evaluated. For fetuses with any chromosomal abnormality (n = 103) advanced maternal age were examined, the examination of the heart increased the detection rate from 61% to 85%.Given the above findings, the inclusion of the fetal echocardiographic evaluation of the fetus significantly increased the detection rate for the above three groups of fetuses. If physicians and/or sonographers desire to increase the ultrasound detection rate for chromosomal abnormalities, examination of the fetal cardiovascular system must occur.
WS01‐04Fetal lung abnormalities a spectrum of disease: reclassification system based on embryology, 2‐D and Doppler ultrasound
Authors: Achiron R. , Yuval Y. , Lipitz S. , Yagel S. 
Published: March 2003

ObjectiveFetal lung anomalies are traditionally classified into Congenital Cystic Adenomatoid Malformation (CCAM), and Pulmonary Sequestration (PS). During last years we have detected several cases who presented with bizarre and overlapping findings which could not be fitted into this usual classification. We therefore suggest a new approach for classification based on embryology, 2‐D and Doppler ultrasound.MethodDuring 5‐year period, patients with fetal lung lesions who were referred for detailed ultrasound evaluation at the Sheba Medical Center from the data base of this study. All cases were analyzed by 2‐D ultrasound and high resolution Power Doppler technology and were classified into three major categories: I Agenesis of lung; II Lung lesion with normal vascular supply: IIa solid, IIb cystic, IIc mixed; III Lung Lesion with abnormal vascular supply: IIIa chest, IIIb abdomen, IIIc thoracoabdomial. Medical files, natural history and neonatal follow‐up were recorded.ResultsTwenty‐one fetuses were recruited, two fetuses were detected in group one, 14 in group II of normal vascular supply, and five in group III abnormal lung with abnormal vascular involvement.ConclusionsBased on embryology and ultrasound a new classification system is introduced.