bluuebunny/crossref_metadata_2025_split huggingface dataset:
Isolated oral clefts (OC) detected by routine ultrasonography – is it associated with chromosomal abnormalities?
Authors: Wee H. Y. , Woo B. H. , Yeo G. S. H. 
Published: March 2003

Purpose:  To determine if chromosomal abnormalities are associated with isolated OC (cleft‐lip or palate) detected by sonographers trained to perform level two fetal structural surveys in a low risk obstetric population.Methods:  A prospective observational study was conducted on women undergoing screening ultrasonography between 18 and 34 weeks from 1 October 1996 to 30 September 2000 in a single maternity unit. Obstetric and neonatal charts were reviewed in all cases where OC in isolation were detected by ultrasonography. Antenatally missed cases of isolated OC were also analyzed.Results:  There were 64 225 deliveries in this period. Follow up was complete for 40/42 cases of isolated OC detected by ultrasonography. Unilateral, bilateral and central OC accounted for 30, 12, 0 cases, respectively. Karyotyping was performed in 11 cases; nine cases had normal chromosomes, one had 46XY, 16qh+ (same as mother's) and another had 46XX, t (2; 10) (q33; p12.2) (parental karyotype normal). In both cases with chromosomal aberrations, isolated unilateral cleft‐lip and palate were confirmed at delivery. Termination of pregnancy was performed for the latter; whether the balanced translocation would have contributed to an adverse outcome remains unknown. Six newborns had associated abnormalities at delivery: moderate VSD, mild pulmonary stenosis, bilateral clubfeet, Peter's anomaly and two cases of polydactyly. Except for one case of polydactyly which had no karyotyping, the other five had normal chromosomes. Karyotyping was deemed unnecessary by the neonatologist for 27 newborns with confirmed isolated OC. One newborn had no OC (PPV 39/40 = 97.5%). After excluding all cases where associated structural abnormalities were noted at birth, the sensitivity of detecting isolated OC confirmed at delivery was 33/40 (82%).Conclusions:  Isolated OC detected by routine ultrasonography in a unit with high sensitivity is associated with a 1/40 (2.5%) risk of a significant chromosomal abnormality. However, this abnormality may have no adverse effect. This is useful for counseling couples considering prenatal karyotyping.
Prenatally diagnosed fetal thoracic malformations: a 5‐year experience
Authors: Portmann C. E. , Chan F. Y. 
Published: March 2003

Background:  A 5‐year retrospective audit of cases referred to the Mater Mothers Hospital Fetal Medicine Unit with ultrasonographically identified thoracic anomalies was undertaken with specific reference to the distribution of pathologies, antenatal progress and outcomes of affected fetuses.Results:  Twenty‐one fetuses with non‐cardiac, intrathoracic anomalies were identified and managed over a 5‐year period. Twelve demonstrated cystic mass lesions, seven echogenic lung masses were identified and one each of primary mediastinal shift (later found to be hypoplastic lung) and arterio–venous malformation of the lung. All lesions were unilateral. Antenatal diagnosis of congenital cystic adenomatoid malformations of the lung (CCAML) was made in the 12 cases of macrocystic lung lesions and proved correct in 10–1 was found at resection to be a bronchoplumonary sequestration (BPS) with associated AV malformation and chondromatous hamartoma, and one awaits follow up. Of the seven echogenic lung lesions, the antenatal diagnosis proved correct in only the two cases of BPS. Neonatal diagnoses included congenital diaphragmatic hernia (1), hybrid BPS/CCAM (1), resolving bronchial obstruction (2) and one loss to follow up with normal chest X‐ray. Complete resolution of the lesion occurred in five cases (mostly echogenic lesions). Polyhydramnios was found in only one case and resolved spontaneously – there were no cases of hydrops or fetal death. Neonatal outcomes included respiratory distress at birth (2), respiratory distress within 28 days (another two cases) and small for gestational age at birth (2/21). Thoracic CT scans were performed or awaited in all cases barring one loss to follow up with normal chest X‐ray. Some abnormalities were noted in all cases in which CT scan has been performed to date (15), including those cases with normal neonatal chest X‐ray and apparent antenatal resolution of ultrasound findings.Conclusion:  While correct antenatal diagnosis can be made in many cases of cystic lung lesions, echogenic lung lesions may be difficult to diagnose correctly and adjunctive investigation such as MRI may prove beneficial. Postnatal CT scan should be considered as a routine for all antenatally diagnosed intrathoracic lesions regardless of apparent resolution of the lesion on antenatal ultrasound or apparently normal neonatal chest X‐ray.
Prediction of outcome of twin twin transfusion syndrome at presentation
Authors: Cincotta R. B. , Chan F. Y. , Lee‐Tannock A. , Amaraddio D. 
Published: March 2003

Aim:  The aim of this study was to determine what factors are important in prediction of outcome in twin twin transfusion syndrome (TTTS) at presentation.Methods:  A retrospective review was performed of all cases of TTTS managed at the Mater Mother's Hospital, Brisbane, Australia from 1994 until 2001. TTTS was diagnosed when there was coexisting oligohydramnios (MVP < 2 cm) and polyhydramnios (MVP > 8 cm) in a monochorionic pregnancy.Results:  There were 50 cases of TTTS during this time (100 fetuses). Overall, there was a 61% survival rate, with 14% of the fetuses having an NND, 23% were stillborn and there was one termination of pregnancy. Both babies survived in 55% of pregnancies, one survived in 16% and both twins were lost in 29%. The average gestation at diagnosis was 21.5 weeks (range 16–29) and the average gestation at delivery was 28.5 weeks (range 16–36). Sixty percent of pregnancies had a mean of 2.1 amnioreduction performed, and 2002 ± 976 mL was removed. The poorest prognostic factor was the presence of hydrops in the recipient twin. Hydrops at presentation resulted in only a 36% survival for either twin in the affected pregnancy. Hydrops resolved spontaneously in two out of 11 cases and these were the only hydropic twins to survive. At the time of presentation, abnormal Dopplers in the recipient twin were associated with significantly poorer survival than for normal Dopplers (27% vs. 64% P = 0.02) but in contrast to other studies there was no significant difference seen in outcomes for the presence of abnormal Dopplers in the donor twin. Other individual factors did not prove to be good at predicting outcome.Conclusions:  The poorest prognostic indicators for survival in TTTS were the presence of hydrops and abnormal umbilical artery and venous Dopplers in the recipient. Research into identifying good prognostic markers may identify subgroups of TTTS that may benefit from more aggressive therapies in order that we might further improve outcomes.
In utero release of constricting limb bands: successful timing of operation with Doppler flow assessments
Authors: Chan F.‐Y. , Cincotta R. , Borzi P. 
Published: March 2003

Background:  Constricting limb bands in utero can lead to vascular compromise, resulting in limb amputations and/or significant neural compression sequele. In utero release has been described to improve outcome. When constriction bands were identified early in pregnancy, the question as to when operation should be performed remains controversial.Purpose:  We report two cases, where the vascular status of the limbs was serially assessed and operation performed when Doppler flow assessment showed significant compromise.Methods:  Case 1 had insertion of fetal vesico‐amniotic shunt performed at 17 weeks for bladder outlet obstruction. While the urinary bypass was successful, the free end of the shunt was found to have wrapped round the left fetal thigh. With advancing gestation, the shunt was shown to progressively indent on the thigh, and Doppler flow assessment showed 37% reduction in flow below the constriction by 29 weeks. Case 2 was found to have constricting amniotic bands to the left fetal thigh and right leg at 19 weeks. Serial assessments showed no evidence of worsening until 29 weeks, when Doppler flow showed reduction in flow by 50 and 34%, respectively, on the left and right legs. After extensive counseling, fetoscopic release of the constrictions were performed for the two cases at 30 and 32 weeks, respectively.Results:  Both operations were performed with two port uterine accesses (3 mm) under general anaesthesia. The constrictions were identified and divided under direct vision. In case 1, the cut end of the shunt retracted into the fetal bladder. Recurrence of bladder outlet obstruction with hydronephrosis and anhydramnios necessitated delivery at 32 weeks. Anterior and posterior urethral valves were resected at 6 months. Follow up at 2 years of age showed no renal impairment. Case 2 delivered at 36 weeks. Significant limb indentations could be identified at the constriction sites for both fetuses after birth. Case 1 has no neurological deficit of the limbs while case 2 need further surgery for talipes and has minor functional impairments.Conclusions:  In utero release of constricting limb bands may reduce long‐term sequele. Serial Doppler flow assessments can assist in the appropriate timing of such procedures.
Diagnosis and management of low segment Cesarean section scar pregnancies
Authors: Woelfer B. , Salim R. , Elson J. , Lawrence A. C. , Jurkovic D. 
Published: March 2003

Background:  Rising Cesarean section rates have led to an increasing number of pregnancies implanted into postoperative uterine scars. We report a large series of Cesarean scar pregnancies treated in a single tertiary referral center.Methods:  The diagnosis of Cesarean scar pregnancy was made on ultrasound scan when trophoblast was seen covering the lower segment uterine scar. Pregnancies <14 weeks size were treated either medically (local injection of methotrexate ± KCl) or with conservative surgery (dilatation and curettage ± insertion of Foley catheter). Surgical treatment was used for smaller, non‐viable pregnancies and in cases complicated by heavy bleeding or infection. Clinically stable patients with larger, viable pregnancies were treated medically. A single viable pregnancy >14 weeks required total abdominal hysterectomy.Results:  In a 4‐year period, 14 Cesarean section scar pregnancies were diagnosed. Out of 13 women who were <14 weeks pregnant, seven were treated surgically (54%), five medically (38%) and one expectantly (8%). Surgery was successful in all cases. Three women (43%) required insertion of Foley catheter into the cervix to arrest the bleeding and one (14%) required blood transfusion. Three out of five (60%) women who received medical treatment were cured. Two women required surgery because of prolonged and heavy bleeding, one of them was transfused (20%). A case managed expectantly resolved spontaneously without any intervention. Five women tried to conceive again after treatment. All three women who succeeded (60%) had normal singleton intrauterine pregnancies.Conclusion:  Early Cesarean scar pregnancies can be safely treated both medically and by conservative surgery. Although surgical treatment was more effective, this may be due to the selection criteria, which favored use of surgery in cases of smaller, non‐viable pregnancies.
A comparison of the uterine and intraovarian arterial flows in women having a history of recurrent spontaneous miscarriage associated with antiphospholipid syndrome
Authors: Jirous J. , Diejomaoh M. E. , Al‐Abdulhadi F. , Boland M. H. 
Published: March 2003

Purpose:  To study the relationship between values of Doppler indices characterizing the uterine and intraovarian arterial flows in the presence of antiphospholipid syndrome in women with history of recurrent spontaneous miscarriage (RSM). We are not aware of any previous study undertaken on this specific topic.Methods:  Sixty‐two women attending our recurrent spontaneous miscarriage clinic were recruited for this prospective study and subsequently divided to group A (n = 35) involving RSM women with normal anticardiolipin antibodies values (ACL IgM, ACL IgG) and group B (n = 27) for those with antiphospholipid syndrome (abnormal ACL IgM, ACL IgG values). ACL IgM and ACL IgG antibodies were measured in the blood using the standardized enzyme linked immunosorbent assay (ELISA). Color and power Doppler transvaginal ultrasonography was used to estimate the uterine artery pulsatility index (UTAPI), spiral artery resistance index (SARI) and intraovarian resistance index (IOARI) in the 21st day of a regular 28‐day unstimulated menstrual cycle. The data were analyzed using the statistical software SPSS 9.0 Windows. Statistical significance was defined as P < 0.05.Results:  There was no statistically significant difference in the mean age in group A (33.67 ± 5.52 years) and group B (32.70 ± 5.85 years), the mean UTAPI values (3.14 ± 1.16 for group A and 3.44 ± 0.88 for group B), the mean SARI values (0.73 ± 0.13 for group A and 0.73 ± 0.07 for group B). The incidence of the first trimester miscarriages in women over 30 years was significantly higher in group B compared with group A (P < 0.01).Conclusions:  Our preliminary study has revealed that there was no significant difference in UTAPI, SARI and IOARI values of RSM women with normal and abnormal ACL IgM and ACL IgG values. This fact could be explained by the predominantly mild form of antiphospholipid syndrome in Kuwait confirmed in our previous studies. We could hypothesise that such mild disease will have minimal/mild vascular effects in the non‐pregnant uterus and subsequently in the placental bed.
The evaluation of Doppler indices in renal vessels in normal fetuses and in fetuses with obstructive uropathy
Authors: Wyrwas D. , Szaflik K. , Borowski D. , Kozarzewski M. 
Published: March 2003

Purpose:  The aim of the study was an evaluation of Doppler indices in renal vessels in normal fetuses and in fetuses with diagnosed obstructive uropathy.Methods:  In the study, there were included 106 normal fetuses and 21 fetuses with signs of the obstructive uropathy. In pregnancies complicated by the uropathy, the measurements of Doppler flow in renal arteries were performed twice: in the ahydramnion settings and after the diagnostic amnioinfusion. The analyzed indices included the pulsatility index and the resistance index.Results:  The diagnosis of uropathy was set‐up at the mean gestational age of 20.3 ± 2.0 weeks. The control group consisted of 106 healthy fetuses from normal pregnancies at the mean gestational age (28 weeks). The physiological absence of an end‐diastolic flow in renal arteries was found in normal pregnancies and that parameter was excluded from further analysis. The PI values in normal pregnancies decreased with the gestational age from the mean value of 3.16 at 15 weeks to 2.19 at 40 weeks of gestation. In pregnancies at gestational age below 26 weeks complicated by the uropathy, the PI was significantly lower with the mean value of 1.57. However, there were no statistical difference in PI values for pregnancies above 30 weeks of gestation, the mean values of PI were 2.39 and 2.33 for normal and pathological pregnancies, respectively. There were also no differences for PI values among pregnancies with the uropathy before and after amnioinfusion.Conclusions:  There is a physiological linear decrease in the PI values in fetal renal arteries with the gestational age. The RI cannot be used for the evaluation of renal function due to the physiological absence of an end‐diastolic flow in renal arteries. The PI was significantly lower in pregnancies complicated by obstructive uropathy at the gestational age below 26 weeks.
The sensitivity of Doppler studies vs. biochemical indices in predicting fetal outcome in cases of pregnancy induced hypertension
Authors: Ghoneim M. R. , Nicolaides K. , Moneim M. A. Abd‐El , Megahid H. E. , Hafez M. S. 
Published: March 2003

Location:  The Outpatient Clinic of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt and the High Risk Pregnancy Unit of King's College University Hospital, London, UK.Aim of the work:  To compare the sensitivity and specificity of the Doppler studies vs. the biochemical indices in predicting fetal outcome in cases of pregnancy induced hypertension.Material and methods:  A total of 252 cases were the subject of this study 192 cases from King's College Hospital and 60 from Suez Canal University Hospital. All cases were selected as having pregnancy‐induced hypertension, 226 cases with proteinuric hypertension and 26 cases with non‐proteinuric pregnancy induced hypertension. All cases were monitored weekly from 28th gestational week till delivery whereby all Doppler studies were carried out on a free loop of umbilical artery. Serum uric acid, liver enzyme aspartate‐aminotransferase, and platelet count were estimated weekly.Results:  Out of 252 patients with PIH, 136 patients (54%) had abnormal Doppler flow velocimetry associated with abnormal higher mean AST proteinuria, serum urate >350 mm/L, lower platelet count and higher perinatal mortality. The sensitivity and specificity of abnormal Doppler velocimetry in the prediction of intrauterine growth retardation (IUGR) were 80 and 52.6%. These were raised to 94 and 88%, respectively, with higher mean serum urate and lower platelet counts. However, the specificity of the abnormal Doppler with abnormal all biochemical indices for the prediction of adverse neonatal outcome and IUGR was 100%, but this was a late event in cases of PIH as the sensitivity dropped down. It is not advisable to wait for both to happen before taking a decision for induction of labor.
Fetal responses to invasive procedures
Authors: Petrikovsky B. M. , Schneider E. , Holsten N. 
Published: March 2003

Objective:  To study fetal responses to invasive procedures.Study design:  Seven fetuses underwent invasive procedures between 23 and 38 weeks of pregnancy for accepted clinical indications. Two ultrasound machines were used simultaneously; one to provide guidance, and one to register FHR and respiratory rate (RR). A paired‐test was used for statistical analysis.Results:  Three patients had bladder centesis, two placements of the bladder shunts and two placements of pleuro‐amniotic shunts. FHR changed from 128 ± 6 bpm prior to the procedure to 168 ± 8 after it (P < 0.05). RR also increased from 26 ± 12 to 32 ± 8 (P < 0.1).Conclusion:  Invasive fetal procedures are accompanied by an increased FHR and RR which are likely to represent pain response.
Predicting neonatal outcome after prolonged preterm membrane rupture by ultrasound measurement of fetal lung length
Authors: Stone P. R. , Sadler L. , Battin M. , Grant S. , Mitchell J. , Roberts A. 
Published: March 2003

Purpose of study:  To assess the ability of ultrasound measurements of fetal lung length to predict neonatal respiratory outcome after prolonged membrane rupture and oligohydramnios.Methods:  From the database of all cases of spontaneous membrane rupture <28 weeks gestation, normal singleton pregnancies with membrane rupture for at least 7 days and delivery after 24 weeks gestation, where lung length measurements were available, were studied. At least one lung length measurement 7 days after membrane rupture needed to be available. The last lung length prior to delivery was used to predict the likelihood of pulmonary hypoplasia. Complete neonatal follow up was available on all babies. Neonatal outcome measures included, survival, bronchopulmonary dysplasia defined as an oxygen requirement at 36 weeks gestation and in non‐survivors a neonatal respiratory death. Two groups, good and poor outcomes were defined. A comparison between the last lung length before delivery corrected for gestation between the good and poor outcome groups was made to determine whether lung length could predict neonatal outcome. The trends in serial measures of lung length were also examined and compared with neonatal respiratory outcomes.Results:  There were 43 live births eligible for study from the database of 57 babies. All had received antenatal corticosteroids as part of the management of prematurity. There were no differences in maternal age, ethnicity, parity and the incidence of antepartum hemorrhage between the good and poor outcome groups. Parameters significantly associated with a good outcome included gestation at membrane rupture, largest pool of amniotic fluid and gestation at delivery. The last fetal lung length did not predict adverse neonatal respiratory outcome in the 28 babies, in which membrane rupture was >21 days the findings were the same. Serial lung growth data also did not predict outcomes (figures are presented to illustrate the results).Conclusions:  Fetal lung length determined by antenatal ultrasound does not predict adverse neonatal respiratory outcome and the prediction of pulmonary hypoplasia remains an elusive goal.
Differentiated evaluation of blood flow middle cerebral artery in relation to the fetal well‐being
Authors: Rozpravka P. , Ostro A. 
Published: March 2003

Objective:  To state clinical signification of differentiated evaluation Doppler velocimetry middle cerebral artery (MCA) of ultrasonographically detected intrauterine growth retarded (IUGR) fetuses, during pregnancies complicated hypertension (PIH) and pre‐eclampsia.Methods:  In prospective, comparative clinical studies evaluated Doppler velocimetric curve MCA separately in proximal (basal) segment (PS) and distal (cortical) anatomical segment (DS). Values of pulsatility index (PI) were compared in proximal and distal segment MCA. Corticocerebral index (CCI) was stated as ratio PIPS/PIDS. Results were compared in the group‐A with IUGR detected and in control group‐B with normal growth of the fetuses. Period of measurements complex biometry was l week, fetal flowmetry minimally 24 h, maximally l week.Results:  Values of PI in PS and DS MCA were significantly different. Resistance of MCA in cortical direction decrease. Values of PIPS were higher comparing PIDS. We found statistically significant correlation CCI and >1 and chronical fetal hypoxy resulted in IUGR. Differentiated flow analysis of MCA did not show statistically significant differences of PIPS and PIDS. Calculated CCI = 1. MCA resistance does not show changes in cortical direction. We found significantly higher statistical occurrence of perinatal complications of the fetuses, elective cesarean sections for fetal intrauterine hypoxy, when values of CCI and >1. This is the fact concluded worse prognosis of the fetuses with cortical sparing effect in utero, but also worse postnatal adaptation. Main outcome – corticocerebral index is simple parameter for detection of different saturation of the brain of the fetus under hypoxemia. Fetal prosperity in utero has coming worse during cortical preservation. There is significantly higher occurrence of perinatal complications.