Showing papers in "Ultrasound in Obstetrics & Gynecology in 1996"
TL;DR: The use of Doppler studies of the uterine arteries in the prediction of pre‐eclampsia and intrauterine growth retardation has had mixed success, but the introduction of color Dopplers imaging and the use of the ‘notch’ to define an abnormal waveform have helped to improve the predictive value of uterine artery doppler screening.
Abstract: The use of Doppler studies of the uterine arteries in the prediction of pre-eclampsia and intrauterine growth retardation has had mixed success. The introduction of color Doppler imaging and the use of the "notch' to define an abnormal waveform have helped to improve the predictive value of uterine artery Doppler screening. The aim of this study was to evaluate the use of uterine artery Doppler in a group of women of mixed race and parity. This study was a prospective, cross-sectional analysis of 1326 unselected women who were screened with continuous wave uterine Doppler at 19-21 weeks, as part of a fetal anomaly/dating scan. A total of 214 women with abnormal uterine artery waveforms (notching) were referred for assessment at 24 weeks; 191 attended and had color Doppler imaging/pulsed Doppler studies of both uterine arteries. Data from 185 pregnancies were suitable for analysis. There were abnormal uterine Doppler findings (uni- or bilateral notching) in 110 patients at 24 weeks; 48 had bilateral notching. The sensitivity of notching for the prediction of proteinuric pregnancy-induced hypertension (PPIH) was similar in primiparas (76.9%), multiparas (77.7%), African-Caribbean women (82.6%) and Caucasian women (71.4%). The sensitivity of bilateral notching for the prediction of PPIH requiring delivery before 34 weeks was 81.2%, and 57.6% for babies small for gestational age (SGA), with positive predictive values of 27% (PPIH), 31.2% (SGA) and 37.5% (any complication). Patients with persistent bilateral notching are particularly at risk of developing PPIH or delivering an SGA baby before 34 weeks' gestation; they warrant increased surveillance, and may be a group that could benefit from prophylactic therapies.
349 citations
TL;DR: High reliability of ultrasound examination at 10–14 weeks of gestation in determining chorionicity in twin pregnancies demonstrates the high reliability of ultrasounds in Obstetrics and Gynecology.
Abstract: Chorionicity was prospectively determined in 369 twin pregnancies by ultrasound at 10–14 weeks of gestation. Pregnancies were classified as monochorionic if there was a single placental mass in the absence of the lambda sign at the inter-twin membrane-placental junction, and dichorionic if there was a single placental mass but the lambda sign was present, or the placentas were not adjacent to each other. In 81 (22%) cases, the pregnancies were classified as monochorionic and in 288 (78%) as dichorionic. Pregnancy outcome was available in 279 cases and all 63 of these pregnancies classified as monochorionic resulted in the delivery of same-sex twins. Similarly, all 100 different-sex pairs were correctly classified as dichorionic. These findings demonstrate the high reliability of ultrasound examination at 10–14 weeks of gestation in determining chorionicity in twin pregnancies. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
342 citations
TL;DR: The aim of this study was to evaluate the accuracy of three‐dimensional ultrasound distance and volume measurements using a commercially available three-dimensional ultrasound scanner.
Abstract: The aim of this study was to evaluate the accuracy of three-dimensional ultrasound distance and volume measurements using a commercially available three-dimensional ultrasound scanner. Sixty-two distance measurements were performed twice on an ultrasound tissue-mimicking phantom located in a water bath. Three-dimensional ultrasound distance measurements were compared to the actual distance. Volume measurements were made in a water bath with 21 balloons of various shapes ranging in volume from 20 ml to 490 ml. Three-dimensional ultrasound volume measurements were compared to actual balloon volumes and to conventional two-dimensional ultrasound volume calculations. The mean absolute error in three-dimensional ultrasound distance measurements was 1.0 +/- 0.8% (range, -2.3 to +1.9%) in the plane of acquisition and 1.0 +/- 0.6% (range, -2.0 to -0.2%) for planes with other orientations. Three-dimensional ultrasound volume measurements showed a mean absolute error of 6.4 +/- 4.4% (range, -6.0% to +15.5%), which was considerably better than two-dimensional ultrasound volume estimates having a mean absolute error of 12.6 +/- 8.7% (range, -27.5% to +39.2%). Volume measurements using two-dimensional ultrasound methods were much less accurate than three-dimensional ultrasound methods for irregularly shaped objects. In conclusion, our data show that three-dimensional ultrasound measurements of distance and volume are sufficiently accurate to use clinically.
279 citations
TL;DR: The findings suggest that abnormarlities of the heart and great arteries may be implicated in the pathogenesis of increased nuchal translucency not only in trisomic fetuses but also in chromosomally normal fetuses.
Abstract: Pathological examination of trisomic fetuses with increased nuchal translucency thickness at 1l–13 weeks of gestation demonstrated a high prevalence of cardiac defects and abnormalities of the great arteries. This study reports the pathological findings observed from the examination of the heart and great arteries of 21 chromosomally normal fetuses with increased nuchal translucency. In 19 of the 21 cases there were abnormalities the commonest was narrowing of the aorta at the level of the isthmus and immediately above the aortic valve. This finding is different from that in case of trisomy 21, where narrowing of the isthmus is associated with an increased diameter of the aortic valve. These findings suggest that abnormarlities of the heart and great arteries may be implicated in the pathogenesis of increased nuchal translucency not only in trisomic fetuses but also in chromosomally normal fetuses. It can be implied that increased nuchal translucency thickness at 10–14 weeks of gestation may prove to be a useful marker for the identification of fetal cardiac abnormalities. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
218 citations
TL;DR: Non‐surgical methods should be used for primary treatment of cervical pregnancy, while surgery should be reserved for those patients in whom medical therapy is not successful.
Abstract: We report two cases of cervical pregnancy which were diagnosed by ultrasound at 5 and 8 weeks' gestation. In both cases a gestational sac was visualized below the internal os and color Doppler examination demonstrated peritrophoblastic blood flow characteristic of early implantation. Both patients were successfully treated with systemic methotrexate. Including these two cases, a total of 83 early cervical pregnancies have been reported in the literature over the last 10 years. Of these, 40 patients were primarily treated by conservative surgery, 40 by non-surgical methods using methotrexate or potassium chloride, and the remaining three by other chemotherapeutic agents. The likelihood of being cured was similar in the surgical and non-surgical groups (odds ratio 1.1; 95% confidence interval 0.4-3.2). However, patients who were primarily treated by surgery were more likely to sustain major hemorrhage (odds ratio 8.0; 95% confidence interval 2.4-26.5) and to require hysterectomy (odds ratio 7.4; 95% confidence interval 0.9-63.8) than those treated medically. This indicates that non-surgical methods should be used for primary treatment of cervical pregnancy, while surgery should be reserved for those patients in whom medical therapy is not successful.
206 citations
184 citations
TL;DR: Eighteen centers took part in this prospective study into which 930 eligible patients were recruited, and the selection criteria for admission were atypical bleeding after at least 6 months of postmenopausal amenorrhea, and absence of hormonal therapies for at least6 months.
Abstract: Eighteen centers took part in this prospective study into which 930 eligible patients were recruited. The selection criteria for admission were atypical bleeding after at least 6 months of postmenopausal amenorrhea, and absence of hormonal therapies for at least 6 months. The sonographic measurement of the maximum bi-endometrial thickness was made in a longitudinal plane. Sonographic measurements were always performed within 3 days prior to histological evaluation. In these patients the mean number of years from menopause (25-75th centile) was 6 (range 2-16). The prevalence of endometrial carcinoma was 11.5% and the prevalence of atrophy was 49.2%. The area under the receiver operator characteristic curves generated by sonographic thickness measurements reached the level of 85%, both for cancer and atrophy. The likelihood ratio for cancer, yielded by an endometrial thickness of 4.0 mm yielded a sensitivity for the detection of cancer of 98% and a negative predictive value of 99%. The overall sensitivity and positive predictive value for atrophy achieved by this cut-off were 57.2% and 87.3%, respectively. A multivariate logistic model showed that age and body mass index were independent variables associated with a significantly higher risk of endometrial cancer. The post-test probabilities for cancer and atrophy were recalculated on the basis of the integration of age, body mass index and endometrial thickness. The estimated reduction of invasive procedures on the basis of this integration was 31%. Transvaginal sonographic measurement of endometrial thickness, integrated with individual risk factors, can help in the management of postmenopausal patients with atypical bleeding, with regard to either the need for histological evaluation in high risk cases, or the choice of possible expectant management. We have shown that an endometrial thickness of < or = 4.0 mm safely predicts endometrial atrophy and justifies expectant management when the patient understands the need for proper follow up. This could be achieved with a reduction in the use of invasive procedures without unwanted delay in cancer diagnosis.
179 citations
TL;DR: It is concluded that ultrasonic measurement of the biparietal diameter between 15 and 22 weeks of pregnancy is the best method for the estimation of the day of delivery and should be used as a routine procedure.
Abstract: In a non-selected population comprising 15,241 women, an evaluation was performed of the ultrasonic measurement of the biparietal diameter compared with a reliable last menstrual period as the basis for estimation of the day of delivery. In women with a reliable menstrual history and spontaneous onset of labor, the ultrasound estimate was the significantly better predictor of the day of delivery in 52% of cases, and the last menstrual period estimate was the better predictor in 46% of cases. The percentages of women who delivered within 7 days of the predicted day were 61 and 56% for the ultrasound and the last menstrual period estimations, respectively. There was a significantly narrower distribution of births according to the ultrasound estimate (p < 0.001). The proportion of estimated postterm births was 4% using the ultrasound method and 10% using the last menstrual period method (p < 0.001). Even when the difference between the methods in predicting the day of delivery was less than 7 days, the ultrasound method was better than the last menstrual period method. It is concluded that ultrasonic measurement of the biparietal diameter between 15 and 22 weeks of pregnancy is the best method for the estimation of the day of delivery and should be used as a routine procedure.
172 citations
TL;DR: The data suggest that acidosis in growth‐retarded fetuses may be non‐invasively identified by Doppler measurements of the inferior vena cava and that a higher efficiency can be achieved by the use of the pre‐load index.
Abstract: The objective of this study was to assess the value of Doppler indices calculated from the inferior vena cava and ductus venosus in the identification of acidemia and hypoxemia as determined by pH and gas analysis of fetal blood obtained by cordocentesis in growth-retarded fetuses. Doppler measurements were performed in the inferior vena cava and ductus venosus in 209 normally grown fetuses and in 89 growth-retarded fetuses. All growth-retarded fetuses were free from structural and chromosomal abnormalities, and uteroplacental insufficiency characterized by Doppler changes in the umbilical and middle cerebral arteries was the most likely etiology of the growth defect. In this group of fetuses, Doppler recordings were performed immediately before cordocentesis. Ten different indices were calculated from venous velocity waveforms, and reference limits for gestation were constructed by the cross-sectional analysis of data from normally grown fetuses. Logistic regression and receiver operator characteristic curve analysis were performed to examine the relationship between Doppler indices and acid-base status. The pre-load index (peak velocity during atrial contraction/peak velocity during systole) in the inferior vena cava was the best explanatory variable for acidemia (chi 2 = 48.33; p < or = 0.001). Hypoxemia was predicted less well by venous indices and the best results were achieved by the S/A ratio in the ductus venosus (chi 2 = 9.46; p < or = 0.005). In conclusion, our data suggest that acidosis in growth-retarded fetuses may be non-invasively identified by Doppler measurements of the inferior vena cava and that a higher efficiency can be achieved by the use of the pre-load index.
145 citations
TL;DR: During the study period, 24 492 pregnant women attended the Harris Birthright Research Centre at 10–14 weeks of gestation, at which time, in addition to the measurements of nuchal translucency thickness and crown‐rump length, data on fetal abnormalities were recorded onto a computer database.
Abstract: During the study period, 24,492 pregnant women attended the Harris Birthright Research Centre at 10-14 weeks of gestation, at which time, in addition to the measurements of nuchal translucency thickness and crown-rump length (CRL), data on fetal abnormalities were recorded onto a computer database. Cases of megacystis were identified and the records were reviewed. Additionally, the relationship of the longitudinal bladder diameter with the CRL and the bladder diameter/CRL ratio (expressed as a percentage) were examined with the use of data from 300 normal fetuses at 10-14 weeks. Megacystis was present in 15 of the 24,492 pregnancies (1 in 1,633) and in these cases the minimum longitudinal bladder diameter was 8 mm and the minimum bladder diameter/CRL ratio was 13%. In the 300 control fetuses the bladder was visualized in 278 (92.7%) of the cases and the longitudinal bladder diameter increased with the CRL (bladder diameter = 0.065 x CRL - 0.69; r = 0.47, p < 0.001), none of the measurements was more than 6 mm and the median bladder diameter/CRL ratio was 5.4% (range 0-10.4%) which did not change significantly with gestation (r = 0.1, p = 0.09). The bladder was visible in all cases with a minimum CRL of 67 mm. In three of the 15 cases with megacystis, there were chromosomal abnormalities. In the chromosomally normal group, there were seven cases with spontaneous resolution, whereas in four cases there was progression to severe obstructive uropathy. The bladder diameter was 8-12 mm and the bladder diameter/CRL ratio 13-22% in all cases with resolution and in one case with progressive megacystis; in the other three cases with progressive obstruction, the bladder length was more than 16 mm and the bladder diameter/CRL ratio was more than 28%.
138 citations
TL;DR: The study was designed to report the experience with in utero percutaneous umbilical cord ligation for selective feticide in pre‐viable, abnormal, monochorionic multiple gestations and to select patients for evaluation and possible treatment.
Abstract: The study was designed to report our experience with in utero percutaneous umbilical cord ligation for selective feticide in pre-viable, abnormal, monochorionic multiple gestations. The selection criteria prior to offering percutaneous umbilical cord ligation included normal anatomy in the other fetus(es), normal karyotype and polyhydramnios, or uterine contractions. The procedure was performed under combined endoscopic and sonographic guidance. Fifteen patients were referred for evaluation and possible treatment. Two patients were excluded because of misdiagnosis. The mean gestational age at the time of the procedure was 21 weeks (range 16-25 weeks). There were ten acardiac twins, one discordant twin with acrania, and two cases of twin-twin transfusion syndrome with a hydropic twin. Percutaneous umbilical cord ligation was accomplished in 11/13 (84%) cases. An average of 8.5 weeks (range 0-18.5 weeks) was gained after percutaneous umbilical cord ligation, and five of 11 patients delivered at or after 30 weeks. Seven of 11 patients undergoing ligation procedures had living children. Premature rupture of membranes occurred within 3 weeks in 4/13 (30%) of cases. In utero fetal demise remote from the procedure occurred in three ligated patients undergoing ligation, in two of which intraoperative bleeding occurred. One fetus with cystic fibrosis died in the newborn period. Percutaneous umbilical cord ligation is an evolving alternative technique for the management of abnormal monochorionic multiple gestations. The advantages of percutaneous umbilical cord ligation over other approaches include complete extravascular interruption of the blood flow in all vessels of the cord. This may prevent postmortem feto-fetal hemorrhage or possible embolic phenomena that may result in death of the normal twin, as seen with intravascular techniques. Percutaneous umbilical cord ligation prior to spontaneous death of a co-twin may also avert the neurological and other complications that may occur in the surviving twin. Technological advances should decrease the observed complications and improve the success rate of the procedure.
TL;DR: A patient with a large cborioangioma was referred to the authors' institution, with a fetus that was hydropic and showed sonograpbic signs of overt heart failure, and ablation of the blood supply of placental chorioangiomas as a potential management alternative was performed.
Abstract: Clinically significant chorioangiomas, i.e. those greater than 4 cm in diameter, are associated with an overall fetal loss rate of approximately 40%. Maternal complications may also be present. Most patients diagnosed with chorioangiomas have been managed expectantly. A patient with a large chorioangioma was referred to our institution, with a fetus that was hydropic and showed sonographic signs of over heart failure. Fetal anemia, marked erythropoiesis and hypoalbuminemia were documented on cordocentesis. The blood supply to the mass consisted of an artery and a vein of 9 mm in diameter. The vascular supply to the tumor was ablated via operative fetoscopy by suture ligation of the arterial supply, after subchorionic dissection of the vessel. The remaining blood supply was electrocoagulated with bipolar cautery. Although the procedure was technically successful, the fetus died on the 3rd postoperative day. This case illustrates ablation of the blood supply of placental chorioangiomas as a potential management alternative for those patients with large chorioangiomas. Early identification and treatment may result in a successful outcome.
TL;DR: The transvaginal sonographic images of the fetal brain radiate in a fan‐like fashion from the anterior fontanelle; therefore the new proposed nomenclature more accurately describes the true anatomic sections.
Abstract: Owing to the limited mobility of the transvaginal probe within the vagina and the introitus, it is virtually impossible to obtain coronal and sagittal sections that are anatomically comparable to those obtained in anatomic sections, computed tomography or magnetic resonance scanning. The aim of this paper is to standardize the neurosonographic images of the fetal brain and develop a nomenclature that more closely reflects the true anatomic sections. A retrospective review of 347 fetal neuroscans was performed. With the use of specific landmarks within the fetal brain, new nomenclature was developed. The scans were divided into the frontal, coronal and sagittal groups. Each group was subsequently further divided into three specific sections. The transvaginal sonographic images of the fetal brain radiate in a fan-like fashion from the anterior fontanelle; therefore the new proposed nomenclature more accurately describes the true anatomic sections.
TL;DR: Uterine and ovarian size were measured in 765 pre‐ and postmenopausal women by transvaginal ultrasound and 263 women were found to have neither uterine nor ovarian pathological findings.
Abstract: Uterine and ovarian size were measured in 765 pre- and postmenopausal women by transvaginal ultrasound. Of these, 263 (premenopausal, n = 155; postmenopausal, n = 108) were found to have neither uterine nor ovarian pathological findings. According to parity, premenopausal women were separated into three groups: nullipara, primipara and multipara. Postmenopausal women were separated into two groups according to years since menopause: 5 years since menopause. In the premenopausal group, a parity-related enlargement in uterine size was observed between nulliparous and parous women. After the menopause, a significant reduction in uterine size and in the corpus-cervix ratio was observed. The reduction in uterine size was related to years since menopause. The endometrial thickness measured in the group of premenopausal women did not exceed 4 mm on day 4 and 8 mm on day 8 of the menstrual cycle; in the postmenopausal group, endometrial thickness did not exceed 5 mm (mean 3.6 mm). In the group of premenopausal women, no parity-related change in ovarian volume was observed. After menopause, there was an obvious reduction in ovarian volume. Between the two postmenopausal groups, there was a small but significant difference in ovarian volume.
TL;DR: Both the thickness and volume were higher in patients with advanced and less differentiated cancers, and the measurement of endometrial volume was superior to that ofendometrial thickness as a diagnostic test for the detection of Endometrial cancer in symptomatic postmenopausal women.
Abstract: We compared endometrial thickness and volume in patients with postmenopausal bleeding, and examined the value of each parameter in differentiating between benign and malignant endometrial pathology A total of 103 patients with a history of postmenopausal bleeding were recruited into the study Patients who were taking hormone replacements therapy or other hormonal preparations with a known effect on the endometrium were excluded Each patient underwent three-dimensional ultrasonography for the measurement of endometrial thickness and volume In 97 cases both of these measurements were obtained and the results were compared to the histological diagnosis after endometrial biopsy or dilatation and curettage Endometrial cancer was diagnosed in 11 patients The mean endometrial thickness was 295 mm (SD 1259) and the mean volume was 390 ml (SD 3416) In the remaining 86 patients there were eight cases with endometrial hyperplasia and seven with endometrial polyps The endometrial thickness and volume in patients with benign pathology was 1564 mm (SD 526) and 547 ml (SD 632), respectively In 71 patients with atrophic or normal endometrium the mean thickness and volume was 529 mm (SD 397) and 091 ml (SD 171), respectively Receiver operating characteristic curves showed endometrial volume to be superior to endometrial thickness for the diagnosis of endometrial cancer The optimal cut-off value of endometrial thickness for the diagnosis of cancer was 15 mm, with the test sensitivity of 833% and positive predictive value of 545% With the cut-off level of 13 ml for endometrial volume measurement the sensitivity was 100% and the positive predictive value 917% Both the thickness and volume were higher in patients with advanced and less differentiated cancers The measurements of endometrial volume was superior to that of endometrial thickness as a diagnostic test for the detection of endometrial cancer in symptomatic postmenopausal women
TL;DR: The objective of this study was to investigate the relationship between sonographic findings and the occurrence of abortion in pregnancies complicated by first‐trimester bleeding in which fetal cardiac activity was documented upon admission.
Abstract: The objective of our study was to investigate the relationship between sonographic findings and the occurrence of abortion in pregnancies complicated by first-trimester bleeding in which fetal cardiac activity was documented upon admission. A prospective study of transvaginal sonography was performed in 270 pregnant patients with bleeding between 5 and 12 weeks' gestation. The study group included 149 cases in which a singleton fetus with cardiac activity was initially documented. The outcome variable was pregnancy loss prior to 20 weeks. The influence of sonographic findings on admission was studied by univariate analysis and logistic regression. The prevalence of abortion was 23/149 (15%). A significant relationship (p < 0.05) was found between the occurrence of abortion and the following: fetal bradycardia (heart rate less than -1.2 SD from the mean), a discrepancy between the diameter of the gestational sac and crown-rump length less than -0.5 SD from the mean, and a discrepancy between menstrual and sonographic age of more than 1 week. According to the logistic regression equation that was obtained, the probability of abortion in first-trimester bleeding with documented fetal cardiac activity upon admission varied between a minimum of 6% when none of the above risk factors were present and a maximum of 84% when all were present. The presence of any of the above factors identified 84% of all subsequent abortions.
TL;DR: Logistic regression analysis revealed that abnormal blood flow class, both independently and in combination with other factors, was the most significant predictor of MND‐2.
Abstract: Measurements of fetal aortic blood flow velocity and fetal growth were performed in 178 pregnancies. In 87 cases, the estimated fetal weight was > or = 2 SD below the gestational age-related mean of the population. Three fetuses died in utero. In 149 children (85%), a neurological examination was performed at 7 years of age with special emphasis on minor neurological dysfunction. The frequency of the more severe form of minor neurological dysfunction, MND-2, was higher in the group with blood flow class (BFC) III (absent or reversed end-diastolic flow velocity (8/21) than in the group with BFC 0 (normal velocity waveform) (14/105). Logistic regression analysis revealed that abnormal blood flow class, both independently and in combination with other factors, was the most significant predictor of MND-2. The association found between abnormal fetal aortic velocity waveforms and adverse outcome in terms of minor neurological dysfunction suggests that hemodynamic evaluation of the fetus has a predictive value regarding postnatal neurological development.
TL;DR: Evaluated blood flow velocities recorded with Doppler ultrasound in the umbilical vein, inferior vena cava and middle cerebral artery as predictors of survival in 17 fetuses with absent or reversed end‐diastolic flow in the Umbilical artery.
Abstract: High perinatal mortality has been reported in association with the finding of absent end-diastolic flow velocities in the umbilical artery The fetus is known to centralize its circulation during hypoxemia and abnormal venous blood flow velocities have been reported in cases of heart failure and imminent asphyxia The aim of this study was to evaluate blood flow velocities recorded with Doppler ultrasound in the umbilical vein, inferior vena cava and middle cerebral artery as predictors of survival in 17 fetuses with absent or reversed end-diastolic flow in the umbilical artery There were five perinatal deaths, all having abnormal umbilical cord venous pulsations An increased proportion of diastolic blood flow velocity in the middle cerebral artery as a sign of hypoxia was found in 12 fetuses without a relationship to perinatal mortality An increased proportion of retrograde blood flow in the inferior vena cava was recorded in only one fetus, which died on the same day of congestive heart failure, suggesting fetal heart sparing in the remaining complicated pregnancies The results suggest that abnormal end-diastolic umbilical venous pulsation in the cord is a late and ominous sign of a severely compromised fetus, while abnormal blood flow velocimetry in the middle cerebral artery might be an earlier sign of fetal hypoxia, with a better prognosis
TL;DR: The absence of detectableIntervillous flow during most of the first trimester confirms the concept that, during the first 3 months of gestation, blood flow to the intervillous space is inhibited by trophoblastic plugs.
Abstract: The hemodynamic changes in the uteroplacental circulation and the umbilical artery were evaluated in normal pregnancy from 8 to 14 weeks' gestation. A 6–9-MHZ broad-band transvaginal sonographic transducer combined with pulsed color Doppler was used to scan 37 healthy volunteer pregnant women at weekly intervals. Vascular impedance to blood flow in all examined vessels decreased significantly throughout the first gestational trimester. Resistance to flow was highest in the main uterine artery and decreased towards the spiral artery. When the flow velocity waveform patterns of the arteries under investigation were analyzed, specific changes were observed. The diastolic notch was present in the spiral artery flow velocity waveform in all cases until 10 weeks' gestation. From then, the diastolic notch disappeared progressively and was absent in 100% of cases at 13 weeks. The diastolic notch in the arcuate artery disappeared within 2 weeks of its disappearance in the spiral artery. We could not detect intervillous blood flow during the first 12 weeks. From then on, intervillous flow was observed in most pregnancies, reaching 100% at 14 weeks' gestation. These changes reflect the growth and development of the uteroplacental circulation. The absence of detectable intervillous flow during most of the first trimester confirms the concept that, during the first 3 months of gestation, blood flow to the intervillous space is inhibited by trophoblastic plugs. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
TL;DR: A simplified classification of the pathognomonic echo patterns of ovarian cystic teratomas based on three basic types of echo pattern enabled the correct diagnosis to be made in 11 cases and suggested that sonography can become a quick and accurate tool in the recognition of this condition.
Abstract: The great variability in the sonographic appearance of ovarian cystic teratomas poses difficulties for their diagnosis and classification. To overcome such difficulties, we have proposed a simplified classification of the pathognomonic echo patterns of ovarian cystic teratomas based on three basic types of echo pattern. In a prospective study of 118 echogenic adnexal masses, with postoperative histological confirmation, this classification enabled the correct diagnosis to be made in 11.5 cases (accuracy rate, 97.45%). In the three cases misdiagnosed preoperatively as ovarian cystic teratoma, the tumors proved to be benign and included a serous cyst adenoma, a serous cyst adenofibroma and a Brenner tumor. We suggest that, with our proposed classification of the echo patterns of ovarian cystic teratomas, sonography can become a quick and accurate tool in the recognition of this condition. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
TL;DR: Measurements of fetal aortic blood flow velocity and fetal growth were performed in 178 pregnancies and an assessment of overall intellectual ability was performed in 148 children at 6.5 years of age.
Abstract: Measurements of fetal aortic blood flow velocity and fetal growth were performed in 178 pregnancies. In 87 cases, the estimated fetal weight was > 2 SD below the gestational age-related mean of the population. Three fetuses died in utero. In 148 children (84%) an assessment of overall intellectual ability was performed at 6.5 years of age. Verbal and global IQ was lower in the group with an abnormal fetal aortic blood flow velocity waveform (mean +/- SD 96.0 +/- 17.7 and 95.9 +/- 15.7, respectively; n = 41) compared to the group with a normal waveform (102.1 +/- 12.2 and 102.9 +/- 13.2, respectively; n = 105; p < 0.05). Logistic regression analysis revealed that abnormal fetal aortic velocity waveform, both independently and in combination with other factors, was a significant predictor of impaired intellectual outcome. The association found between abnormal fetal aortic velocity waveform and impaired intellectual outcome suggests that hemodynamic evaluation of the fetus has a predictive value regarding postnatal intellectual development.
TL;DR: HyCoSy and HSG are equally well tolerated outpatient procedures for assessing tubal patency and uterine abnormalities and HyCoSy avoids the risks of ovarian irradiation and allows scanning of the uterine corpus and ovaries at the same time.
Abstract: The aim of this study was to assess patient tolerance of two outpatient tests. Sixty-six infertile women were prospectively randomized to hysterosalpingo-contrast sonography (HyCoSy) (n = 34) or X-ray hysterosalpingography (HSG) (n = 32). The procedures were performed by the same operator. The uterine cavity outline and tubal patency were determined by both procedures. The mean times taken and the volume of contrast medium required for HyCoSy and HSG were similar: 12.1 ± 5.2 and 9.5 ± 4.8 min and 9.4 ± 5.2 and 11.5 ± 8.4 ml, respectively. Side-effects were assessed during the procedure, at 2h, 24 h and 28 days. The most common side-effect was pelvic pain, in 56/66 (84%) women, occurring during the procedures (HyCoSy 19/34 (56%); HSG 23/32 (72/%)) and/or in the following 24 h (HyCoSy l4/34 (41%); HSG 15/32 (47%)). This was described as less severe or equal to their usual period pains (HyCoSy 100%; HSG 8.5%). Only 12/66 (18%) women required simple non-steroidal analgesia (HyCoSy 8/34 (24%); HSG 4/32 (13%)). There were no significant differences between the two methods concerning the frequency or severity of pains at different stages during and after the procedure or analgesia requirements. HyCoSy and HSG are equally well tolerated outpatient procedures for assessing tubal patency and uterine abnormalities. In addition, HyCoSy avoids the risks of ovarian irradiation and allows scanning of the uterine corpus and ovaries at the same time. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
TL;DR: Fetal heart rate was measured routinely as part of a prospective study examining the efficacy of screening for trisomy 21 by fetal nuchal translucency thickness and maternal age and the effectiveness of screening by this method was examined in a self‐selected population with completed pregnancies that had undergone first‐trimester scanning.
Abstract: Fetal heart rate was measured routinely as part of a prospective study examining the efficacy of screening for trisomy 21 by fetal nuchal translucency thickness and maternal age. In 6903 normal singleton pregnancies the fetal heart rate decreased from a mean of 171 bpm at 10 weeks of gestation to 156 bpm at 14 weeks (r = 0.413, p < 0.0001). In 85 trisomy 21 pregnancies, the mean heart rate was significantly higher than in the normal group (mean difference 0.67 SD, 95% confidence interval 0.42-0.92, t = 5.3, p < 0.001). The fetal heart rate in trisomy 18 and triploid fetuses was significantly lower and in trisomy 13 and Turner syndrome was higher than normal. There was no significant association between delta fetal heart rate and delta nuchal translucency thickness in either the normal (r = -0.018) or the trisomy 21 (r = -0.031) pregnancies. Consequently, the risk for chromosomal defects can be derived by combining data from maternal age, fetal nuchal translucency and fetal heart rate. The effectiveness of screening by this method was examined in a self-selected population with completed pregnancies that had undergone first-trimester scanning. This population contained 6903 normal and 29 trisomy 21 fetuses. For a false-positive rate of about 5%, the sensitivity for trisomy 21 was 48% by maternal age, 26% by fetal heart rate, 72% by nuchal translucency thickness, 59% by maternal age and fetal heart rate, 76% by maternal age and nuchal translucency thickness and 83% by a combination of maternal age, nuchal translucency thickness and fetal heart rate.
TL;DR: Data show that in normal fetuses the Doppler‐measured impedance to flow in the peripheral pulmonary circulation decreases with advancing gestation, and this increase is related to the severity of fetal hypoxia.
Abstract: The objective of this study was to describe blood flow velocity waveforms of fetal peripheral pulmonary arteries in normally grown and growth-retarded fetuses Doppler studies were performed in 182 normally grown fetuses (gestational age 18-40 weeks) and in 61 growth-retarded fetuses (gestational age 24-36 weeks) that were free from structural and chromosomal abnormalities and whose umbilical and middle cerebral artery Doppler findings suggested uteroplacental insufficiency as the most likely etiology of the growth defect The pulsatility index was used to quantify the velocity waveforms Successful recordings were obtained in 901% of the normally grown and 934% of the growth-retarded fetuses In normally grown fetuses the pulsatility index values significantly decreased with advancing gestation In growth-retarded fetuses the pulsatility index values were significantly elevated compared to those of normal fetuses A significant relationship was observed between the severity of hypoxia and pulsatility index values from the peripheral pulmonary arteries in 29 fetuses in which Doppler recordings were obtained immediately before cordocentesis In conclusion, these data show that in normal fetuses the Doppler-measured impedance to flow in the peripheral pulmonary circulation decreases with advancing gestation Impedance to flow in the lungs is elevated in the presence of growth retardation and this increase is related to the severity of fetal hypoxia
TL;DR: Recent evidence suggests that the most effective method of screening for chromosomal abnormalities is measurement of fetal nucbal translucency thickness at 10–13 weeks, and therefore ultrasound examination at this gestation is likely to become universally available.
Abstract: In an ultrasound screening study at 10–13 weeks of gestation involving 17 870 women, the prevalence of early pregnancy failure was 2.8% (501 cases), including 313 (62.5%) missed abortions and 188 (37.5%) anembryonic pregnancies. Lower gestation and higher maternal age were associated with a higher prevalence (χ2 = 143.5; p < 0.001 and χ2 = 53.3; p < 0.0001, respectively). The prevalence was higher in women with a history of vaginal bleeding (χ2 = 141.5; p < 0.0001), but there was no significant association with previous pregnancy losses (χ2 = 2.8), parity (χ2 = 0.6) or cigarette smoking (χ2 = 0.0). Recent evidence suggests that the most effective method of screening for chromosomal abnormalities is measurement of fetal nucbal translucency thickness at 10–13 weeks, and therefore ultrasound examination at this gestation is likely to become universally available. As shown in this study, an additional advantage of such a scan is the diagnosis of early pregnancy failure, which will be found in about 3% of patients examined. Elective evacuation of retained products of conception is likely to be more cost effective and potentially safer than emergency surgery in a patient presenting during miscarriage. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
TL;DR: The measurement method described here enabled us to determine the position of the bladder neck, the size of the retrovesical angle β and the occurrence of funnelling, and it was observed that when the patient is standing, the bladder necks is lower than when the patients are supine.
Abstract: This is a report on the fundamentals of perineal ultrasound examination for female incontinence. The measurement method described here enabled us to determine the position of the bladder neck, the size of the retrovesical angle beta and the occurrence of funnelling. In four different investigations, each involving at least 30 patients, we investigated the influence of examination position, bladder filling volume and pressure of the ultrasound probe against the perineum on these measurements and analyzed the difference between coughing and the Valsalva maneuver. The results showed that when the patient is standing, the bladder neck is lower than when the patient is supine. We also observed that excessive pressure on the ultrasound probe displaces the bladder neck cranially and can squeeze the urethra. Increasing the bladder filling volume does not affect the measurement values, but funnelling can be seen better with higher bladder volumes. The best overall image quality was obtained at 300 ml. A comparison between coughing and the Valsalva maneuver showed that during coughing, the bladder neck descends less and remains closer to the symphysis than with the Valsalva maneuver.
TL;DR: The vast majority of fetuses which had echogenic foci were normal, but there was a risk of karyotypic abnormality of 1%.
Abstract: The purpose of this study was to determine the pathological significance of echogenic foci in the heart of fetuses with no other sonographic abnormalities and in the absence of other risk factors for chromosomal abnormality. A total of 228 fetuses were identified with single or multiple echogenic foci. This represents 6.9% of the total number of fetuses scanned. The most frequent finding was a single echogenic focus in the left ventricle (n = 136; 60%) but multiple foci were observed in 33%. An echogenic focus in the right ventricle occurred in 16 cases (7%). Karyotypic abnormalities were diagnosed postnatally in two fetuses. One of these fetuses, with an echogenic focus in each ventricle, had trisomy 21, and the other, with two echogenic foci in the left ventricle, had an unbalanced translocation. The vast majority of fetuses which had echogenic foci were normal, but there was a risk of karyotypic abnormality of 1%. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
TL;DR: The objective was to determine the incidence and rate of persistence of placenta previa diagnosed at 15–20 weeks' gestation by using transvaginal sonography (TVS), and to describe the characteristics of TVS that predict placentA previa at delivery.
Abstract: Our objective was to determine the incidence and rate of persistence of placenta previa diagnosed at 15-20 weeks' gestation by using transvaginal sonography (TVS), and to describe the characteristics of TVS that predict placenta previa at delivery. Patients having placental tissue within 20 mm of the cervical os were prospectively identified by transabdominal ultrasound and underwent TVS. The distance of the placental edge from the cervical os was measured in millimeters. Characteristics of TVS predicting placenta previa at delivery were analyzed by logistic regression. The incidence of placenta previa diagnosed by TVS at 15-20 weeks was 1.1%; 14% persisted until delivery. Gestational age at the time of TVS and the distance of the placental edge to the cervical os helped predict placenta previa at delivery. Between 15 and 24 weeks' gestation, placenta overlapping the internal os by > or = 10 mm identified patients at risk of placenta previa at delivery with 100% sensitivity and 85% specificity. The use of TVS in the second trimester to diagnose placenta previa resulted in a lower incidence than was historically reported with the use of transabdominal ultrasound. The distance of the placental edge from the cervical os helps identify patients at risk of previa at delivery.
TL;DR: This retrospective multicenter study represents an analysis of the intrauterine determinants of the prognosis for conotruncal anomalies from three Italian referral units.
Abstract: This retrospective multicenter study represents an analysis of the intrauterine determinants of the prognosis for conotruncal anomalies. Data regarding reason for referral, presence of chromosomal or extracardiac anomalies, pregnancy and surgical outcome were recorded in 67 cases of conotruncal anomalies from three Italian referral units. Chromosomal aberrations effected 11 of the 60 (18.3%) fetuses in which a karyotype was available. Extra-cardiac malformations were present in 25/67 cases (37.3%). No chromosomal anomalies were present in fetuses with complete or corrected transposition of the great arteries. However, tetralogy of Fallot and double-outlet right ventricle were associated with chromosomal anomalies in 22% and 38% of cases, respectively, and with extracardiac anomalies in 45% and 46% of cases, respectively. Only 20 of the 67 (31%) cardiac malformations were associated with an abnormal four-chamber view. There were 28 (41.7%) terminations of pregnancy, six (8.9%) intrauterine deaths and 16 (23.8%) neonatal deaths. Seventeen neonates (25.3%) are currently alive, and 15 of these have undergone reparative surgery. The prognosis of conotruncal anomalies is poorer when the conditions is diagnosed in utero. This is mainly due to the frequent association with chromosomal and/or extracardiac anomalies, often leading to intrauterine or early neonatal death.